@Article{info:doi/10.2196/76373, author="Hassard, Juliet and Blake, Holly and Dulal-Arthur, Mishael Teixiera and Frost, Alexandra and Bartle, Craig and Yarker, Joanna and Munir, Fehmidah and Vaughan, Ben and Daly, Guy and Meyer, Caroline and Russell, Sean and Thomson, Louise", title="Web-Based Interactive Training for Managers (Managing Minds at Work) to Promote Mental Health at Work: Pilot Feasibility Cluster Randomized Controlled Trial", journal="JMIR Ment Health", year="2025", month="Sep", day="2", volume="12", pages="e76373", keywords="line managers", keywords="web-based training intervention", keywords="mental health at work", keywords="feasibility pilot study", abstract="Background: Line managers play a key role in preventing poor mental health but often lack necessary skills and knowledge. Existing interventions typically focus on mental health awareness rather than practical skills. The evidence-based Managing Minds at Work (MMW) web-based training program was developed to address this gap by enhancing line managers' confidence and competence in prevention. Objective: This study piloted the MMW intervention to assess its feasibility. Objectives included evaluating (1) uptake potential across small, medium, and large companies; (2) perceived suitability and effectiveness of the intervention; and (3) feasibility of outcome data collection methods. Methods: We conducted a 2-arm pilot cluster randomized controlled trial of a self-guided, web-based training intervention for line managers. Twenty-four organizations were randomly assigned to the MMW intervention or a 3-month waitlist. A total of 224 line managers completed baseline measures (intervention: n=141, 62.9\%; control: n=83, 37.1\%), along with 112 of their direct reports (intervention: n=74, 66.1\%; control: n=38, 33.9\%). Follow-up data were collected at 3 and 6 months. Semistructured interviews with line managers and stakeholders (n=20) explored experiences with the study and intervention, and qualitative data were analyzed thematically. Line managers also completed feedback forms after each of the 5 MMW modules. Results: The recruitment of organizations and line managers exceeded targets, and retention rates of line managers were good at 3 months (161/224, 71.9\%) but not at the 6-month follow-up (55/224, 24.6\%). Feedback on the intervention was very positive, indicating that line managers and organizational stakeholders found the intervention acceptable, usable, and useful. We observed significant improvements with moderate to large effect sizes for all trial outcomes for line managers in the intervention arm from baseline to the 3-month follow-up. Line managers completed a variety of questionnaires, which showed increased scores for confidence in creating a mentally healthy workplace (intervention group: mean change 3.8, SD 3.2; control group: mean change 0.6, SD 3.2), mental health knowledge (intervention group: mean change 1.9, SD 3.0; control group: mean change 0.2, SD 2.9), psychological well-being (intervention group: mean change 3.6, SD 8.3; control group: mean change ?0.7, SD 7.7), and mental health literacy at work (intervention group: mean change 11.8, SD 8.9; control group: mean change 0.8, SD 6.2). Collecting data from direct reports in both study arms was challenging, with results inconclusive regarding observed changes in trial outcomes. Time constraints and workload were commonly cited barriers to completion of the intervention. Conclusions: This pilot feasibility trial provides strong evidence for the usability and acceptability of the MMW digital training and the research design. MMW shows potential to improve line managers' confidence and competencies in promoting mental health. The study also identified key considerations for future large-scale implementation and evaluation. Trial Registration: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019 ", doi="10.2196/76373", url="https://mental.jmir.org/2025/1/e76373", url="http://www.ncbi.nlm.nih.gov/pubmed/40896820" } @Article{info:doi/10.2196/75044, author="Mills, Jodie and Duffy, Orla and Pedlow, Katy and Kernohan, George", title="Exploring Speech and Language Therapists' Perspectives of Voice-Assisted Technology as a Tool for Dysarthria: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Sep", day="2", volume="12", pages="e75044", keywords="smart speakers", keywords="speech and language therapy", keywords="Parkinson disease", keywords="dysarthria", keywords="voice disorder", abstract="Background: People living with Parkinson disease (PD) often experience low speech volume and reduced intelligibility. Research suggests that common voice-assisted technology (VAT) devices, like Amazon Alexa and Google Home, can encourage individuals to modify their speech, speaking more clearly, slowly, and loudly. This highlights the potential of VAT as a therapeutic clinical tool in speech and language therapy (SLT). However, while VAT is emerging as a novel health care technology, gaps exist regarding understanding speech and language therapists' (SaLTs) experiences using these devices in clinical practice for PD-related speech and voice difficulties. Objective: This research set out to explore various experiences of using VAT to address hypokinetic dysarthria, secondary to PD, from a range of stakeholder perspectives. This paper specifically focuses on clinical insights from SaLTs. Methods: SaLTs with prior experience of using smart speakers in clinical practice with people with speech or voice difficulties were invited to participate in focus groups or interviews. Between September and December 2024, seven SaLTs participated in semistructured focus groups or interviews using a topic guide. Discussions were informed by published evidence. Results were transcribed and analyzed using a framework analysis approach and were managed through NVivo software (Lumivero). Results: Four main themes were identified across the groups: (1) potential for VAT in SLT, (2) managing therapeutic beige flags, (3) empowering SaLTs to become digitally enabled practitioners, and (4) envisioning the future of VAT in SLT. Conclusions: This study recognizes VAT's potential as a therapeutic tool that may improve volume, clarity, intelligibility of speech, and facilitate at-home practice for people with PD. However, before VAT can be widely implemented, considerations around data privacy, device limitations, and practical integration into clinical care must be addressed. Future research is proposed to design solutions to address usability challenges for both clients and clinicians. Finally, this paper offers key clinical recommendations for the development of a therapeutic VAT tool for speech and voice difficulties in SLT. ", doi="10.2196/75044", url="https://rehab.jmir.org/2025/1/e75044", url="http://www.ncbi.nlm.nih.gov/pubmed/40896823" } @Article{info:doi/10.2196/75658, author="Bassi, Giulia and Orso, Valeria and Salcuni, Silvia and Gamberini, Luciano", title="Understanding Workers' Well-Being and Cognitive Load in Human-Cobot Collaboration: Systematic Review", journal="J Med Internet Res", year="2025", month="Aug", day="27", volume="27", pages="e75658", keywords="affective well-being", keywords="cognitive workload", keywords="operators", keywords="collaborative robots", keywords="cobots", keywords="manufacturing", keywords="Industry 5.0", keywords="systematic review", abstract="Background: Industry 5.0 emphasizes human centricity by prioritizing human well-being alongside technological advancements. Collaborative robots (cobots) in industrial settings represent one such advancement, and their integration, particularly in manufacturing, is reshaping production processes. Although previous studies have addressed these issues, no systematic review has yet synthesized findings on how cobots impact operators' affective well-being and cognitive workload. Objective: This study focused on psychological dimensions, which are often overlooked, particularly affective states, addressing a gap in the existing literature that has mainly emphasized the impact of cobots on the physical and cognitive workload. Specifically, we aimed to systematically review empirical studies investigating affective well-being (ie, anxiety, stress, and depression symptoms) and cognitive workload in human-cobot collaboration (HCC) within industrial settings. Methods: We conducted a comprehensive systematic search of the literature using several databases (Web of Science, Scopus, ACM Digital Library, and IEEE Xplore). Eligibility criteria included peer-reviewed empirical studies reporting quantitative or qualitative data on cognitive workload or affective well-being in HCC. Two reviewers independently conducted study selection and data extraction. Results: This review included a total of 46 studies. Findings indicated a significant increase in publications from 2020 onward, reflecting the growing interest in HCC. Most studies (28/46, 61\%) were conducted in controlled laboratory settings with university students or researchers, highlighting a gap in real-world industrial research. Results indicated that, while cobots have been shown to alleviate physical fatigue and enhance job satisfaction, they also introduce new psychological challenges, including stress and anxiety symptoms due to concerns about job security and the pressures of high-paced operations. The speed at which cobots operate represents a factor affecting operators' affective well-being and cognitive workload alongside the proximity of cobots, the system usability, and the complexity of the tasks assigned. With regard to cognitive workload, studies using physiological and self-report measures (38/46, 83\%) consistently found that higher task complexity significantly raised both cognitive workload and stress levels. Conclusions: This review identified key factors that influence operators' affective well-being and cognitive workload when working with cobots. These insights can guide the development of longitudinal research and intervention strategies, ensuring that the integration of cobots supports both productivity and operators' well-being in manufacturing environments. To support effective implementation, future studies should be conducted in real-world settings using standardized assessment instruments, physiological measures, and qualitative interviews. ", doi="10.2196/75658", url="https://www.jmir.org/2025/1/e75658" } @Article{info:doi/10.2196/65852, author="Fritz, Q. Cristin and Xu, Meng and Stassun, Justine and Martinez, Susana and Gottlieb, M. Laura and Heerman, J. William and Williams, J. Derek and Mayberry, S. Lindsay", title="Development and Feasibility of a Novel mHealth Resource for Food Insecurity: Mixed Methods Cohort Study", journal="J Med Internet Res", year="2025", month="Aug", day="26", volume="27", pages="e65852", keywords="food insecurity", keywords="mobile health", keywords="mHealth", keywords="pediatric hospitalization", keywords="food resources", keywords="health related social needs", abstract="Background: Pediatric clinical practice guidelines recommend identifying and addressing food insecurity (FI) as part of routine care. However, methods for health systems to connect families experiencing FI to community food resources are lacking. Confidential SMS text messaging can increase equity in resource delivery, is user-friendly, is aligned with caregiver preferences, and is feasible for health systems to implement. Despite the promise of this approach, SMS text messaging has not been widely tested in pediatric settings. Objective: This paper details (1) the process of developing a novel, mobile health intervention to help families access local food resources and (2) results on reach, engagement, usability, and acceptability of the intervention following a 1-year pilot. Methods: We designed and evaluated an automated SMS text messaging system that delivers geographically tailored food resource information to families with FI after hospital discharge at a single US children's hospital. English- and Spanish-speaking caregivers of hospitalized children with a positive FI screen documented during clinical care were included. Caregivers received a food resource text message 1 and 4 days postdischarge. In addition, 2 subsequent text messages asked about reach and engagement. We used system-reported (primary) and caregiver-reported (secondary) measures of reach and engagement and caregiver-reported resource connection as a preliminary measure of effectiveness. We assessed usability (Simplified System Usability Scale [SUS]; >75 indicates good usability), acceptability, and caregiver preferences for resource provision through semistructured interviews among a subset of caregivers (20 English-speaking and 11 Spanish-speaking caregivers). Results: Of 194 patients with a positive FI screen during the study period, 187 (96\%) spoke English or Spanish and were included in the cohort. Primary, system-reported measures indicated that the food resource message successfully reached 175 (94\%) participants; of these, 102 (58\%) engaged with the text messages in some way, with 65 (37\%) clicking the link and 92 (53\%) responding to a text message. Among the subset of text message respondents (n=92), 88 (96\%) reported receiving the resource message, 83 (90\%) read the message, and 42 (46\%) used the information to search for food resources. Among the subset of interviewed caregivers (n=31), the median SUS score was 86.1 (IQR 66.7?91.7); 97\% (30/31) of caregivers felt the intervention was acceptable. Caregivers preferred receiving food resource information via text message rather than paper handouts because it felt more accessible. Conclusions: Providing automated, geographically tailored food resource information via text message to families with FI after hospital discharge was feasible, the information was usable, and the delivery mode was acceptable to families, with SMS text messaging preferred over paper handouts. SMS text messaging offers a promising low-intensity approach to social resource provision for health systems. Future research should assess effectiveness and strategies to increase uptake in clinical care contexts. ", doi="10.2196/65852", url="https://www.jmir.org/2025/1/e65852" } @Article{info:doi/10.2196/71032, author="Kowalski, Leo and Finnes, Anna and Koch, Sabine and Bujacz, Aleksandra", title="Optimizing Intervention Components of a Preventive Stress Management mHealth Intervention for Health Care Workers: Experimental Factorial Study", journal="JMIR Form Res", year="2025", month="Aug", day="25", volume="9", pages="e71032", keywords="digital behavior change intervention", keywords="mHealth", keywords="work stress", keywords="factorial experimental design", keywords="stress management", keywords="mental health", keywords="formative assessment", keywords="multiphase optimization strategy", abstract="Background: Work stress is a prevalent risk factor for mental health problems, such as burnout and depression. Health care workers, especially during the COVID-19 pandemic, face high levels of work stress that make them a vulnerable population in need of support. Digital interventions are a promising way to combat this issue, offering the possibility of scalable programs that are easily accessible. While a wide range of stress management techniques can be incorporated into digital interventions, applying the multiphase optimization strategy enables systematic evaluation of what specific content most contributes to preventing the negative effects of work stress. Objective: The primary aim of this research was to identify which digital intervention components and combinations of components are most effective at preventing symptoms of stress-related health problems. These insights are valuable to inform future intervention development for optimizing intervention design. Methods: This study tested 5 digital intervention components aimed at improving stress management among workers. Engagement and Demands components allow participants to self-reflect on their work engagement and work challenges, while the Control component aids a more action-oriented process considering job crafting and detachment strategies. The Journaling component encourages a deeper reflection, and the Psychoeducation component provides evidence-based strategies for managing stress. In an experimental factorial study, Swedish health care workers (n=297) tested different versions of the intervention containing all possible combinations of these 5 components. Stress-related health outcomes, such as burnout, anxiety, and depression, were measured using questionnaires immediately before, immediately after, and 1 month after the end of the intervention. Results: The most promising intervention effects were observed when the Demands and Control components were present together in the intervention. Including these components led to an increase in social support ($\beta$=0.68; P<.001) and job crafting ($\beta$=0.41; P=.06) during the intervention, as well as a decrease in symptoms of emotional exhaustion ($\beta$=?0.50; P=.005), burnout ($\beta$=?0.54; P=.004), and anxiety ($\beta$=?0.44; P=.04) after the intervention. Notably, including one of the components without the other made outcomes worse than including neither of these 2 components. Furthermore, mindfulness after the intervention increased when both the Engagement and Demands components ($\beta$=0.72; P=.001) were included as well as when the Journaling and Psychoeducation components were included ($\beta$=0.46; P=.04). Conclusions: Results indicate that components aiding self-insight should be integrated with components providing actionable advice to achieve optimal intervention effects. Results from this optimization study may inform the development of preventive digital stress management interventions to be tested in future randomized controlled trials. Trial Registration: ClinicalTrials.gov NCT04719351; https://clinicaltrials.gov/study/NCT04719351 ", doi="10.2196/71032", url="https://formative.jmir.org/2025/1/e71032" } @Article{info:doi/10.2196/49254, author="Thissen, Alica and Salgado-Baez, Eduardo and F{\"u}rstenau, Daniel and Delucchi Danhier, Renate and Meske, Christian and Kuss, Pauline and Angermair, Stefan and Spies, Claudia and Balzer, Felix", title="Barriers and Facilitators of the Use of Computerized Critical Care Information Systems in the Intensive Care Unit: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Aug", day="22", volume="27", pages="e49254", keywords="computerized critical care information system", keywords="intensive care unit", keywords="ICU", keywords="usability", keywords="user-centered design", keywords="co-determination", abstract="Background: Computerized critical care information systems (CCIS) can have a range of positive to negative impacts on clinical care in ICUs and the job satisfaction of ICU staff. Key factors influencing these effects include the usability of the IT system and the level of training provided. Resistance to using the system may arise from users due to increased control imposed by the system and from insufficient participation in its development and configuration. The usability of CCIS, along with other important barriers such as co-determination, has not been thoroughly examined. Objective: The study investigates barriers to using CCIS and aims to provide actionable recommendations for manufacturing companies and hospitals to ensure the successful implementation and use of CCIS. It focuses on known usability factors while incorporating open feedback from current users to uncover new insights and identify additional usability factors not previously documented in the literature. Methods: We conducted 10 semistructured qualitative interviews with ICU staff (4 nurses and 6 doctors) from 3 ICUs at a large German university hospital. Each interview lasted 1 hour and focused on providing a collective assessment of the CCIS. The interviews were recorded, transcribed, and coded using MAXQDA and then analyzed through both deductive and inductive content structure methods. Results: A total of 86 distinct usability issues were identified and categorized into 7 main groups and 23 subgroups. The most common usability issues were (1) unclear information presentation, especially for medication; (2) overly lengthy or small interaction steps in documentation; (3) missing or scattered information across sections; (4) redundant data entry requirements; and (5) slow system speed. Additionally, other challenges associated with system usage included training, co-determination, the perception of feeling constrained, adherence to standard operating procedures, and changes in processes. Participants in the study highlighted that the level of contentment with the system has a direct influence on their job satisfaction. Conclusions: CCIS usability greatly influences satisfaction with the information technology system. Enhancing CCIS usability requires ongoing user testing and transparent employee involvement. Adequate training and standard operating procedure implementation are crucial. Investing time and financial resources in organizational frameworks and feedback mechanisms is an imperative for the successful implementation of CCIS. ", doi="10.2196/49254", url="https://www.jmir.org/2025/1/e49254", url="http://www.ncbi.nlm.nih.gov/pubmed/40192735" } @Article{info:doi/10.2196/65210, author="Ditmore, Melissa and El Karouaoui, Amal and Florez-Arango, Fernando Jose", title="Designing and Evaluating a Prototype of a Trilingual Data Collection Tool for the Middle East and North Africa (MENA) Region to Collect Data About Violence Against Sex Workers: Multiple Methods Approach in User-Centered Design", journal="JMIR Form Res", year="2025", month="Aug", day="22", volume="9", pages="e65210", keywords="mobile health", keywords="sex work", keywords="user-centered design methods", keywords="usability", keywords="heuristic analysis", keywords="cognitive walkthrough", keywords="mHealth", keywords="data collection tool", keywords="violence", keywords="sex worker", keywords="stigmatization", keywords="health care workers", keywords="help-seeking behavior", keywords="human-centered design methods", keywords="heuristic evaluation", keywords="System Usability Scale", keywords="abusive", keywords="sexual violence", keywords="Middle East and North Africa", keywords="MENA", abstract="Background: Sex workers face an epidemic of violence around the world. However, violence against sex workers (VASW) is underreported, and sex workers hesitate to report to the police because they are frequently punished; therefore, an alternative for reporting is needed. Sex workers also face stigmatization from health care workers, further discouraging help-seeking behavior or reporting in health care facilities. Sex workers have been recipients of services from nongovernmental organizations, typically related to HIV and sexual transmission of infections, but violence remains underaddressed. Objective: This study aims to apply human-centered design methods to adapt ReportVASW for use in the Middle East and North Africa and to evaluate the usability of the prototype interface and identify opportunities for improvement. Methods: Evaluation methods included cognitive walkthrough and System Usability Scale by 9 potential end users, and heuristic evaluation by 2 informatics professionals and 2 service providers. Results: This study explores ways to improve the trilingual prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Multiple methods identified multiple issues to address. Heuristic analysis revealed 2 serious issues to address, with scores over 2.5 out of 4 in the tool used. The most serious problems identified in heuristic analysis were related to language, particularly the Arabic version. Translation issues were addressed before end user testing. End users were enthusiastic about the idea of a mobile tool to document VASW, provided it led to change. They gave ReportVASW a System Usability Scale of 91.4, above the 68 considered good. Even as end users were enthusiastic, they offered suggestions for improvement. Conclusions: Many opportunities to improve the interface were identified. Most changes are not overly complex, and the majority involve adapting the language used and improving the translation. Development of the trilingual ReportVASW data collection tool for the Middle East and North Africa region is worth pursuing. ", doi="10.2196/65210", url="https://formative.jmir.org/2025/1/e65210" } @Article{info:doi/10.2196/70620, author="Dutta, Anirban and Das, Abhijit", title="Platform Technology for Extended Reality Biofeedback Training Under Operant Conditioning for Functional Limb Weakness: Protocol for the Coproduction of an at-Home Solution (React2Home)", journal="JMIR Res Protoc", year="2025", month="Aug", day="22", volume="14", pages="e70620", keywords="functional neurological disorder", keywords="functional movement disorder", keywords="extended reality", keywords="biofeedback training", keywords="experience-based co-design", keywords="EBCD", keywords="quality function deployment", keywords="QFD", keywords="rehabilitation", keywords="coproduction", keywords="artificial intelligence", keywords="AI", abstract="Background: Functional neurological disorder (FND), including functional movement disorders (FMDs), arises from disruptions in the perception-action cycle, where maladaptive cognitive learning processes reduce the sense of agency and motor control. FND significantly impacts quality of life, with patients often experiencing physical disability and psychological distress. Extended reality (XR) technologies present a novel therapeutic opportunity by leveraging biofeedback training to target sensory attenuation and amplification mechanisms, aiming to restore motor function and the sense of agency. Objective: This study aims to coproduce and evaluate the usability of an XR technology platform for FND rehabilitation, focusing on functional limb weakness. The platform integrates biofeedback training with haptic and visual feedback to support motor relearning and control. Methods: We propose to use an experience-based co-design framework to engage patients with FND, caregivers, and health care professionals in collaboratively designing the XR platform. Stakeholders can share their experiences through narrative interviews and co-design workshops, which can identify emotional touchpoints and prioritized patient-centered needs. Insights will be synthesized through qualitative analysis and used to guide the development of system requirements via quality function deployment, ensuring that the platform aligns with user needs. XR training tasks---virtual reality relaxation, XR position feedback, and XR force feedback---will be integrated as needed into a unified therapeutic game experience through 4-week Agile sprints. Usability will be assessed using the System Usability Scale and qualitative feedback, with themes analyzed in NVivo to identify key areas for subsequent improvement. Results: High usability scores (>85) were recorded for the XR position feedback tasks in the predesign study, reflecting excellent usability and participant satisfaction. However, the virtual reality relaxation and XR force feedback tasks exhibited interindividual variability, underscoring the need for personalization. Key themes included customization, comfort, accessibility, and XR technological quality, ensuring that the XR platform effectively addressed diverse patient needs. The predesign study highlighted the potential of XR technology for FMD rehabilitation by integrating biofeedback training into a patient-centered game design framework. Approaches such as experience-based co-design and quality function deployment can support coproduction by systematically addressing usability and accessibility challenges. Brain-based metrics may further strengthen this evaluation. Accordingly, this study will use portable brain imaging to capture dynamic functional connectivity in key brain regions, enabling personalized interventions. Conclusions: Through coproduction and iterative refinement, this study aims to demonstrate the promise of personalized XR gaming technology as a scalable, at-home solution for FMD rehabilitation. In this context, personalization and accessibility are critical for optimizing usability and long-term clinical outcomes, paving the way for at-home implementation within the FND stepped care model. International Registered Report Identifier (IRRID): PRR1-10.2196/70620 ", doi="10.2196/70620", url="https://www.researchprotocols.org/2025/1/e70620", url="http://www.ncbi.nlm.nih.gov/pubmed/40844828" } @Article{info:doi/10.2196/73457, author="Borghouts, Judith and Eikey, V. Elizabeth and De Leon, Cinthia and Schueller, M. Stephen and Schneider, Margaret and Stadnick, A. Nicole and Zheng, Kai and Mukamel, B. Dana and Sorkin, H. Dara", title="Characteristics Associated With the Use of the Mindfulness Meditation App Headspace in a Large Public Health Deployment: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2025", month="Aug", day="22", volume="9", pages="e73457", keywords="Headspace", keywords="mental health", keywords="mindfulness", keywords="mobile health", keywords="mHealth", keywords="real-world use", abstract="Background: Mindfulness-based apps can be an effective and accessible resource for mental health support. However, little is known about their use outside of research settings and what user characteristics relate to app use. Objective: This study aimed to examine the characteristics of people who decided to use, not use, or stop using Headspace within the context of a large-scale public deployment, which offered the mindfulness meditation app Headspace as a free mental health resource to community members. Methods: Nearly 100,000 community members received Headspace. All members (N=92,311) received an email inviting them to complete a voluntary and uncompensated survey. In total, 2725 participants completed the survey. The 20-minute survey asked about the use of Headspace, user experience, mental health problems, mental health stigma, and mental health use. Logistic regression models were used to examine relationships between predictors and nonuse, past use, or current use of Headspace. Results: Participants who were still using Headspace at the time of completing the survey (2076/2725, 76.18\%) were more likely to experience mental health challenges and distress and make more use of other digital mental health resources (ie, online tools and connecting with people online) than people who were not using Headspace. In addition, current users of Headspace rated the app higher on user experience compared with past users. The most common reasons for abandoning Headspace were that people were already using other strategies to support their mental health (198/570, 34.7\%), no longer needed Headspace (73/570, 12.8\%), or did not think Headspace was useful (46/570, 8.1\%). Conclusions: Results indicate that a person's mental health challenges, a perceived need for support, and familiarity with digital resources were associated with continued use of Headspace. While the most common reason for not using Headspace was that people were already using other resources, it is important to consider the continuity of mental health support beyond these free programs for those who may not have easy access to other resources. We discuss potential implications of our findings for offering and using apps such as Headspace as a mental health resource, along with factors that influence engagement with this app. ", doi="10.2196/73457", url="https://formative.jmir.org/2025/1/e73457", url="http://www.ncbi.nlm.nih.gov/pubmed/40844821" } @Article{info:doi/10.2196/69756, author="Morse, Brad and Reale, Carrie and Nguyen, T. An and Latella, Erin and Bauguess, Hannah and Anders, Shilo and Roberts, Pamela and SooHoo, L. Spencer and El-Kareh, Robert and Soares, Andrey and Schilling, Lisa", title="Clinician Needs and Requirements for a Decision Aid Navigator: Qualitative Study", journal="JMIR Hum Factors", year="2025", month="Aug", day="21", volume="12", pages="e69756", keywords="qualitative research", keywords="focus groups", keywords="user-centered design", keywords="shared decision-making", keywords="decision aid", abstract="Background: Decision aids (DAs) are important tools that support shared decision-making (SDM) between clinicians and patients, enabling patients to be more informed and engaged in decisions regarding their care. The use of DAs can increase patient knowledge, reduce decisional regret, and engage the clinician and patient in meaningful dialog. Despite proven effectiveness in enhancing patient-centered care, a gap remains in clinician use of DAs. Known clinician barriers to using DAs include (1) time constraints, (2) concerns about the match between patient need and available DAs, (3) forcing users to leave the electronic health record (EHR) to access DAs, and (4) the burden of manually entering data into the DA. Objective: This qualitative study identified the needs and requirements of clinicians to inform the design of a clinician-facing, EHR-integrated, Substitutable Medical Applications, Reusable Technologies (SMART; SMART Health IT) on Fast Healthcare Interoperability Resources (FHIR) (HL7) app, the Decision Aid Navigator (DEAN; University of Colorado Anschutz Medical Campus). The Navigator identifies and surfaces DAs that are relevant to a patient's health care conditions (eg, atrial fibrillation), current care (eg, not on anticoagulation), and demographics (eg, check the youngest age for the stroke prevention), and facilitates documentation of SDM discussions and decisions. Methods: We conducted 13 semistructured interviews with clinicians who were recruited from 4 academic medical centers. Interviews included a demonstration of an initial, mid-fidelity, DEAN app prototype that was designed to address DA use and barriers described in the literature. The interviews focused on clinician context and use of the prototype, affordances and barriers to using the system, and clinician needs and requirements of the system. We used qualitative content analysis to code and reduce the data, using a consensus-making approach, and identify emerging themes. Results: We identified 3 overarching themes: (1) streamlined functionality may simplify workflow and decrease the burden of DA use and SDM; (2) clinicians need appropriate competencies to effectively use the Navigator and relevant DAs; and (3) trust that the Navigator suggests prevetted DAs. Unanimously, clinicians shared that the DEAN Navigator should be integrated into the EHR. To accomplish this clear priority, clinicians stated that they needed the requisite competencies to successfully use the tool within their workflow and build trust with the tool itself. Conclusions: Better tools to support and harness the benefits of SDM are needed. Overcoming the barriers of using DAs is paramount. Tools designed and developed to support DA use must be integrated into the EHR efficiently to create an opportunity for uptake of the technology by busy clinicians. If tools like DEAN can streamline the cumbersome process of documenting the use of DAs, more clinicians may potentially use DAs with their patients, given the right context and appropriate DA. ", doi="10.2196/69756", url="https://humanfactors.jmir.org/2025/1/e69756" } @Article{info:doi/10.2196/73378, author="Campioni, Dafne and Ehrler, Frederic and Berger, Antoine and Clavien, Christine", title="A Digital Serious Game (Anticip'action) to Support Advance Care Planning Discussions in the General Population: Usability Study", journal="JMIR Aging", year="2025", month="Aug", day="21", volume="8", pages="e73378", keywords="advance care planning", keywords="mobile health", keywords="mHealth", keywords="mobile apps", keywords="mobile phone", keywords="palliative care", keywords="usability", keywords="serious game", keywords="conversation tool", keywords="end of life", abstract="Background: In the context of an aging population and increasingly medicalized end-of-life practices, it is crucial to promote early discussions to help patients express their view on what is essential in their life as well as articulate their preferences regarding future medical treatments and end-of-life issues. An interprofessional research team at Geneva University and the Geneva University Hospitals has developed Anticip'action, a card game designed to help initiate and conduct advance care planning and end-of-life discussions. It is available for free in paper format in diverse languages and in a digital version in French. Objective: This study aims to assess the ergonomic quality of the digital version of the game with primary users. Methods: Overall, 10 users (women: n=5, 50\%; men: n=5, 50\%; mean age 41, SD 13.4 years; range 25-65 years; education: upper level; comfortable with smartphones) completed an online usability test. The test began with a rapid desirability test to capture initial impressions of the game's main screen without knowing what it is about. This was followed by a think-aloud procedure, including 26 tasks to perform all steps of the game. Posttest questionnaires were administered to collect participants' subjective perceptions of the usability (System Usability Scale), attractiveness (AttrakDiff), and relevance as well as overall endorsement of the game (Mobile Application Rating Scale). Open-ended questions were used to further explore usability issues. Usability problems were categorized and evaluated using standard evaluation grids. Content readability was assessed with Scolarius. Results: The rapid desirability test revealed an overall good or average impression. In 83.2\% (208/250) of the cases, participants successfully completed the think-aloud tasks without assistance. Some of the tasks (4/25, 16\%) revealed multiple usability issues requiring assistance. Analysis of the 23 failures and difficulties encountered revealed that 3 (13\%) issues were due to suboptimal wording of the task instructions and that there were 9 (39\%) major usability problems. All could be addressed through minor modifications. The Scolarius test indicated that the card titles were understandable at an elementary school level, while the explanations on the back of the cards required a high school reading level. Participants rated Anticip'action as good or excellent in usability (79 out of 100 on the System Usability Scale), attractiveness (1.57 on the ?3 to +3 AttrakDiff scale), and relevance (4.1 out of 5 on section F of the Mobile Application Rating Scale). Participants provided overall positive qualitative feedback. Conclusions: The usability testing of the digital French version of Anticip'action produced positive results, with some areas for improvement identified. It can be recommended as a valuable resource for patients, families, and caregivers to prompt reflection, raise awareness, and support advance care planning conversations. Further tests should be conducted on wider population groups, including older patients and individuals less comfortable with digital solutions. ", doi="10.2196/73378", url="https://aging.jmir.org/2025/1/e73378" } @Article{info:doi/10.2196/57602, author="Dayal, R. Rohan and Yang, Lani Pua and Sisson, Nicole Laura and Bajaj, Mira and Archuleta, Shannon and Yao, Sophie and Park, H. Daniel and Fujii-Rios, Hanae and Haroz, E. Emily", title="Exploring the Perspectives of Pediatric Health Care Providers, Youth Patients, and Caregivers on Machine Learning Suicide Risk Classification: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Aug", day="19", volume="27", pages="e57602", keywords="suicide", keywords="electronic health records", keywords="adolescent", keywords="youth", keywords="clinician", keywords="machine learning", keywords="mixed methods", keywords="risk", keywords="human-centered", keywords="clinical practice", keywords="quantitative", keywords="joint display", keywords="EHR", keywords="clinical decision support", keywords="mental health", keywords="artificial intelligence", abstract="Background: Suicide was the second leading cause of death for youth aged between 10 and 24 years in 2023, necessitating improved risk identification to better identify those in need of support. While machine learning (ML) applied to electronic health records shows promise in improving risk identification, further research on the perspectives of these tools is needed to better inform implementation strategies. Objective: These findings incorporate 2 studies aimed to explore patient, caregiver, and pediatric health care provider perspectives on suicide risk models and associated clinical practices. We sought to use these findings to inform the design and implementation of a suicide risk model and associated clinical workflow to improve the quality of care provided to at-risk youth. Methods: We conducted a convergent mixed methods study to evaluate pediatric provider perspectives by quantitatively surveying and qualitatively interviewing provider participants. The provider study was guided by the Consolidated Framework for Implementation Research, and data were analyzed descriptively and using a template analysis for quantitative and qualitative data, respectively. Qualitative interviews conducted among youth patients and caregivers as part of a sequential mixed methods study, guided by the Theoretical Framework of Acceptability, were analyzed using template analysis as well. The integration of quantitative and qualitative data was achieved through a joint display, and results were interpreted through a narrative review. Results: Forty-five providers completed the first section of the survey (risk model clinical preferences), while 44 completed the second section (risk model usability perspectives) and 38 completed the third section (Consolidated Framework for Implementation Research barriers and facilitators). Eight pediatric providers were interviewed. Ten semistructured qualitative interviews were conducted among 9 patient participants aged between 8 and 25 years and 1 caregiver. Overall, providers, patients, and caregivers expressed interest in applying ML methods to improve suicide risk identification. Providers felt that these tools could address current challenges in suicide-related care, such as inadequacies in manual suicide screeners or communication across care teams. Patients and caregivers saw potential for these tools to facilitate discussions regarding suicide and promote early intervention for patients who might otherwise be missed by current care practices. However, providers also expressed concerns about increased demand for mental health services, implications for patient confidentiality, coercive care, inaccurate diagnosis and response, and medical-legal liability. Ethical concerns shared by patients and caregivers spanned data safety practices and privacy regulations, respect for patient autonomy and informed consent, and decreased future health care engagement due to poor implementation. Conclusions: There is conditional acceptability and enthusiasm among providers, patients, and caregivers for ML-based suicide risk models. Successful implementation requires the incorporation of provider perspectives in a user-led fashion to build trust and empower clinicians to respond appropriately to risk flags, while upholding youth and caregiver perspectives to adequately accommodate patient needs. ", doi="10.2196/57602", url="https://www.jmir.org/2025/1/e57602" } @Article{info:doi/10.2196/69031, author="Nos{\`e}, Michela and Muriago, Giulia and Turrini, Giulia and Tedeschi, Federico and Forlani, Olga and Sartori, Riccardo and Badino, Massimiliano and Barbui, Corrado", title="Effectiveness of a Self-Guided Digital Intervention for Mental Health and Psychological Well-Being in University Students: Pre- and Postintervention Study", journal="J Med Internet Res", year="2025", month="Aug", day="19", volume="27", pages="e69031", keywords="college students", keywords="digital mental health", keywords="psychological well-being", keywords="mental health", keywords="university students", keywords="web-based intervention", keywords="implementation study", abstract="Background: University students frequently face mental health challenges due to academic pressures, lifestyle changes, and developmental factors. Digital interventions, such as Doing What Matters in Times of Stress (DWM), a psychosocial e-mental health intervention developed by the World Health Organization (WHO), offer scalable approaches to address these issues. These data emerging from the literature provide the framework for the CAMPUS (Characterize and Address Mental health Problems in University Students) study aimed at supporting the mental health of students attending the University of Verona. Objective: This study aimed to assess the effectiveness and implementability of DWM as a psychological strategy for effective mental health prevention and promotion, as well as for reducing psychological symptoms and distress and improving well-being in university students. Methods: During the study period (October 2023-June 2024), we conducted a prospective hybrid type-1 nonrandomized follow-up study, with a pretest-posttest design. The study population consisted of students attending the University of Verona, who were recruited through university communication channels and participated via web-based platforms. Data were collected at baseline (T1) and after the intervention (T2) using an ad hoc sociodemographic information page and self-reported tools assessing psychological distress with the Kessler-10 (K-10), depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9) depression scale, anxiety symptoms with the Generalized Anxiety Disorder-7 (GAD-7) scale, and psychological well-being with the WHO-5 Well-Being Index (WHO-5). In addition, at postintervention, the implementability was assessed. Statistical analyses included Wilcoxon matched pairs signed rank tests and logistic regression models to identify associated factors. Results: Out of 2296 interested students, 1498 (65.24\%) completed all DWM sessions and assessments. At T1, students exhibited mild psychological distress, anxiety, and depressive symptoms with moderate well-being. Significant improvements were observed postintervention: the K-10 scores decreased from 22.41 (SD 6.54) to 19.86 (SD 5.96), the GAD-7 scale scores decreased from 8.27 (SD 4.31) to 6.57 (SD 3.76), and the PHQ-9 scores decreased from 8.28 (SD 7.73) to 6.75 (SD 4.37; all P<.001). The WHO-5 well-being scores increased from 11.73 (SD 4.65) to 13.26 (SD 4.68; P<.001). Satisfaction was high, with 90.72\% (1359/1498) of participants agreeing or strongly agreeing on satisfaction, 77.37\% (1159/1498) agreeing or strongly agreeing on appropriateness, and 94.99\% (1423/1498) finding the program easy to use. No significant differences in clinical outcomes were associated with sociodemographic or baseline mental health variables. Conclusions: The DWM intervention demonstrated positive effects on students' mental health, showing reductions in distress, anxiety, and depressive symptoms, alongside improved well-being. The program's high levels of acceptability, appropriateness, and feasibility highlight its potential for broader application as a digital mental health strategy for university students. Trial Registration: Open Science Framework kyv9f; https://osf.io/kyv9f ", doi="10.2196/69031", url="https://www.jmir.org/2025/1/e69031" } @Article{info:doi/10.2196/70694, author="Chavarria, Andres Mario and Ortiz-Escobar, Mar{\'i}a Luisa and Bacca-Cortes, Bladimir and Romero-Cano, Victor and Villota, Isabella and Mu{\~n}oz Pe{\~n}a, Kevin Jhon and Londo{\~n}o S{\'a}nchez, Roberto Jos{\'e} and Campo, Oscar and Suter, Silvan and Cabrera-L{\'o}pez, Jairo Jhon and Sanchez Pati{\~n}o, Fernanda Maria and Caicedo-Bravo, Francisco Eduardo and Stein, Michael and Hurst, Samia and Sch{\"o}nenberger, Klaus and Rivas Velarde, Minerva", title="Challenges and Opportunities of the Human-Centered Design Approach: Case Study Development of an Assistive Device for the Navigation of Persons With Visual Impairment", journal="JMIR Rehabil Assist Technol", year="2025", month="Aug", day="18", volume="12", pages="e70694", keywords="artificial intelligence", keywords="assistive technology", keywords="blindness", keywords="context", keywords="disability", keywords="electronic travel aid", keywords="human-centered design", keywords="navigation", keywords="low and middle-income countries", keywords="LMICs", keywords="user-centered design", keywords="visual impairment", abstract="Background: Visual impairment (VI) significantly impacts quality of life, particularly in autonomous pedestrian navigation. Limitations in independent navigation lead to frustration, diminished confidence, and risks to bodily integrity for individuals with VI. In Colombia, the pilot country of this study, approximately 2 million people live with some form of visual disability. Globally, only 1 in 10 people requiring assistive devices have access to them, with factors such as deficient product design stemming from limited knowledge of user expectations, local needs, and environmental constraints, posing significant challenges, particularly in low- and middle-income countries. Objective: We aimed to evaluate the feasibility and limitations of applying the human-centered design (HCD) principles outlined by the International Organization for Standardization (ISO) 9241-210:2019 standard in assistive technology (AT) development for individuals with VI in Colombia. Methods: We developed a prototype navigation device using the HCD principles, emphasizing a thorough analysis of user needs and environmental contexts. The project leveraged multidisciplinary collaboration to address challenges associated with user engagement and design adaptability while managing legal and bureaucratic constraints. The navigation system integrates artificial intelligence algorithms, specifically developed by the research team as part of this work, to enhance its adaptability and responsiveness to diverse environments. The development process featured iterative prototyping cycles, incorporating user feedback at each stage, all within the boundaries of applicable regulatory frameworks. Results: The development and evaluation of the initial prototype highlighted both the feasibility and key limitations of applying the ISO 9241-210:2019 HCD principles in AT for individuals with VI in the Colombian context. The prototype met several user-defined expectations by prioritizing affordability; extended battery life; autonomy in internet-constrained environments; and improved ergonomics, concealability, aesthetics, and obstacle detection. These achievements demonstrated the potential of HCD to guide context-sensitive innovation. However, the process also revealed significant barriers: limited legal and procedural clarity for engaging users in design phases, difficulties navigating ethics committees, and a lack of practical guidance within the ISO standard itself. These constraints, compounded by challenges in interdisciplinary collaboration, limited the depth and adaptability of user involvement across development stages. Conclusions: Implementing HCD principles in AT development shows promise for creating effective and affordable solutions tailored to user needs and contexts. However, legislative and methodological barriers must be addressed to fully realize HCD's potential. Future efforts should focus on aligning research methodologies with hardware and software development practices while integrating legislative frameworks to enhance the accessibility and effectiveness of AT innovations. ", doi="10.2196/70694", url="https://rehab.jmir.org/2025/1/e70694", url="http://www.ncbi.nlm.nih.gov/pubmed/40825539" } @Article{info:doi/10.2196/72574, author="Wanten, C. Joukje and Bauer, C. No{\"e}l J. and Chowdhury, Mohita and Higham, Aisling and de Pennington, Nick and van den Biggelaar, M. Frank J. H. and Nuijts, A. Rudy M. M.", title="Optimizing the Postcataract Patient Journey Using AI-Driven Teleconsultation: Prospective Case Study", journal="JMIR Form Res", year="2025", month="Aug", day="18", volume="9", pages="e72574", keywords="algorithm-based screening", keywords="remote patient monitoring", keywords="postoperative follow-up", keywords="telemedicine", keywords="digital health", keywords="eHealth intervention", keywords="prospective clinical study", abstract="Background: Given the increasing global demand for ophthalmologic care and the anticipated shortage of ophthalmology professionals, innovative solutions are essential for optimizing health care delivery. Digital health technologies offer promising opportunities to efficiently manage high patient volumes. Cataract surgery, with its established safety profile and routine postoperative care, provides an ideal setting for implementing such innovations. Structured clinical questions have proven effective in identifying patients requiring further assessment, supporting the feasibility of follow-up through telephone consultations. To further extend this approach, artificial intelligence--based follow-up systems may offer an opportunity to automate these interactions, reduce clinician workload, and streamline care pathways. Objective: The aim of the study is to assess the clinical safety and effectiveness of an artificial intelligence--based follow-up call system (Dora-NL1) in identifying patients who require further assessment after cataract surgery in the Netherlands. Methods: This prospective single-center study was conducted at the University Eye Clinic Maastricht, the Netherlands. Adult patients who underwent uncomplicated cataract surgery were eligible to participate. All patients received a Dora-NL1 follow-up telephone call at 1 and 4 weeks postoperatively in addition to standard care (a clinician-led telephone consultation at week 1 and an in-person hospital visit at week 4). The Dora-NL1 calls used a standard conversational flow to evaluate symptoms and recommend a clinical outcome. The recommended outcomes of Dora-NL1 were based on the symptoms reported by the patient. Clinical safety and accuracy were assessed by comparing Dora-NL1 outcomes to blinded clinician assessments of recorded calls and to standard postoperative care. Patient-reported usability was measured using the Telehealth Usability Questionnaire and Net Promoter Score. Results: A total of 105 patients with a mean age of 72 (SD 7) years were included in the analysis. Dora-NL1 demonstrated high agreement with clinician-supervised calls, with symptom evaluation accuracy ranging from 89\% to 99\% ($\kappa$=0.390?0.947) and care management decision accuracy between 83\% and 88\% ($\kappa$=0.640?0.753). At week 1, Dora-NL1 showed a sensitivity of 100\% and a specificity of 42\% compared to standard clinician-led telephone consultations with no missed clinical concerns. At week 4, compared to the in-person follow-up, Dora-NL1 failed to identify 4 (4.1\%) patients who required unexpected management changes, including 3 with asymptomatic complications detected only via slit lamp examination and 1 with complaints in the nonoperated eye. Patients rated Dora-NL1 positively, with Net Promoter Scores of +13.5 and +12.6 at week 1 and 4, respectively. The Telehealth Usability Questionnaire was completed by 98 patients, yielding a mean score of 3.19 (SD 1.13) on a 5-point scale, highlighting its simplicity, ease of use, and audibility. Conclusions: Dora-NL1 is a safe and effective tool for automated postoperative screening following cataract surgery. It offers a safe alternative to clinician-led telephone consultations in routine cases but cannot fully replace in-person examinations. ", doi="10.2196/72574", url="https://formative.jmir.org/2025/1/e72574" } @Article{info:doi/10.2196/73574, author="Javaheri, Hamraz and Fortes Rey, Vitor and Lukowicz, Paul and Stavrou, A. Gregor and Karolus, Jakob and Ghamarnejad, Omid", title="Assessing the Feasibility of Using Apple Vision Pro While Performing Medical Precision Tasks: Controlled User Study", journal="JMIR XR Spatial Comput", year="2025", month="Aug", day="15", volume="2", pages="e73574", keywords="Apple Vision Pro", keywords="HoloLens", keywords="extended reality", keywords="precision task", keywords="head-mounted display", abstract="Background: The emergence of next-generation video-see-through head-mounted displays, such as the Apple Vision Pro (AVP), has generated considerable interest in the medical field. While preliminary studies highlight AVP's potential, no controlled study has rigorously assessed its usability for precision-based medical tasks requiring fine motor control and real-world perception. Objective: This study aims to evaluate the feasibility of using AVP while performing real-world medical precision tasks. Methods: To assess AVP's feasibility, we conducted a controlled user study with 20 health care professionals, who performed 3 different suturing techniques across 3 intervention conditions. Participants completed the same tasks using AVP, the Microsoft HoloLens 2 (MHL2), and a baseline (without a head-mounted display). A within-subject design was used, ensuring that each participant experienced all intervention groups. We used a mixed methods research approach, incorporating both quantitative metrics, including task completion time, suturing performance, system usability score, cognitive load, virtual reality sickness, and presence score, as well as qualitative insights gathered through interviews. Results: Participants took significantly longer to complete the entire task using AVP (570.0, SD 192.0 s) compared with MHL2 (456.0, SD 120.0 s; P<.001) and baseline (472.0, SD 143.0 s; P<.001). The analysis on participants' average suture performance revealed no significant differences across interventions (P=.76). The total raw NASA Task Load Index score among participants was significantly higher for AVP (43.9, SD 15.9) compared with MHL2 (21.5, SD 13.8; P<.001) and baseline (19.1, SD 15.1; P<.001). The analysis of the presence questionnaire demonstrated a significantly higher presence score for MHL2 (115.0, SD 11.4) compared with AVP (93.7, SD 12.7; P<.001). The overall virtual reality sickness questionnaire score was significantly higher for AVP (66.9, SD 19.8) compared with MHL2 (41.1, SD 9.32; P<.001). Moreover, the calculated system usability score for MHL2 (72.7, SD 8.54) was significantly higher compared with AVP (50.3, SD 14.4; P<.001). Conclusions: In conclusion, AVP has potential for non--time-sensitive medical applications or those that emphasize digital elements over real-world interaction. Its current usability limitations, particularly increased cognitive load and prolonged task execution times, suggest that further optimizations are necessary before widespread clinical adoption is feasible. ", doi="10.2196/73574", url="https://xr.jmir.org/2025/1/e73574" } @Article{info:doi/10.2196/66185, author="Rajan, Maya and Furgal, Allison and Kadri, Reema and Arman, Omar and Panzer, Kate and Wicker, Donna and McKee, M. Michael and Plegue, Melissa and Degner, Alexandria and Buis, R. Lorraine", title="Exploring the Utility of Digital Voice Assistants for Primary Care Patients, Including Those With Physical and Visual Disabilities: Cross-Sectional Study", journal="JMIR Mhealth Uhealth", year="2025", month="Aug", day="14", volume="13", pages="e66185", keywords="smartphone", keywords="mobile applications", keywords="disabled persons", keywords="visually impaired persons", keywords="primary health care", keywords="digital voice assistant", abstract="Background: Today, most smartphones provide a digital voice assistant (DVA) for their user, and it is estimated that about 91\% of adults report owning and operating a smartphone. A DVA is an automated system preinstalled on technological devices, such as smartphones, computers, tablets, and speakers, which serves to aid users in performing tasks like answering questions, managing smart devices at home, playing music, managing schedules, sending messages, and more. Research with DVA is emerging, and its applicability to health and health care needs to be elucidated. Objective: The objective of this study was to describe the use of DVAs among primary care patients, as well as purposely sampled clinics including patients with visual and physical disabilities. Methods: A convenience sample of adult participants was recruited to complete a needs assessment survey to ascertain the interest and possible utility of DVAs to promote and enhance health from among three populations at an academic medical center: (1) general primary care patients recruited from a primary care clinic, (2) patients with visual disabilities recruited from a low vision clinic, and (3) patients with physical disabilities recruited from a physical medicine and rehabilitation clinic. The survey used in this study was a 46-item investigator-developed instrument administered to participants assessing knowledge, use, and perceptions of DVAs, participant interest to participate in related future studies, and demographics. Results: The results of the survey showed that the majority of participants have used a DVA before (69.7\%, 152/218) and were or might be willing to use them in the future (84.0\%, 178/212). Participants reported moderate to high concern about the privacy (47.8\%, 97/203), security (54.5\%, 110/202), and confidentiality (51.7\%, 105/203) of DVAs. A greater proportion of those with visual disabilities reported having never used DVA than those without visual disabilities (39.0\% vs 24.6\%, P=.03). There was no significant difference in reliance on DVAs for participants with and those without physical disabilities (45.0\% vs 34.9\%, P=.31), indicating that they do not require it for everyday needs. Conclusions: DVA use remains low among the surveyed participants with physical and visual disabilities. For those with visual disabilities, DVA use was seen to be advantageous in everyday life for tasks such as answering questions and seeking information, but not for those with physical disabilities. However, further research should be conducted that focuses on the use of DVAs by accessing data that represent an individual's DVA use without being biased by knowledge of a research study. In addition, research is needed on DVA use that includes diverse samples of participants with physical and visual disabilities, which address the barriers to using DVAs for these adult populations. ", doi="10.2196/66185", url="https://mhealth.jmir.org/2025/1/e66185" } @Article{info:doi/10.2196/68810, author="Hobbs, Jacob and Bull, Christopher and Claisse, Caroline and Elameer, Mat and Davison, Richard", title="Role of Augmented Reality in Tertiary Care: Qualitative Investigation Using Thematic Analysis", journal="JMIR XR Spatial Comput", year="2025", month="Aug", day="14", volume="2", pages="e68810", keywords="augmented reality", keywords="clinical practice", keywords="radiology", keywords="surgery", keywords="thematic analysis", abstract="Background: While augmented reality (AR) as a concept is not new, it is still an emerging technology with a wide range of applications that it could provide value for. In the medical field, AR is becoming ever more prevalent, but while it has been applied to various medical tasks, it is far from commonplace. Radiological imaging has been suggested as one of these applications, and the radiology workflow capacity crisis the United Kingdom's National Health Service is experiencing is a potential opportunity for technology to alleviate pressure. Understanding clinical stakeholders and current systems is important for identifying design opportunities for developing AR to enhance interactions and gain more from radiological images. Objective: This study had 3 key aims. First, to build an understanding of the field in the context of AR; second, to understand the stakeholders and workflows surrounding radiological images; and finally, to suggest how AR could integrate within these workflows and current practices in order to provide value. Methods: We conducted 14 interviews with hospital-based consultants in a range of specialties and then completed a thematic analysis on the transcripts in order to find trends that suggest what value AR could add to radiological imaging, where that value could be added, and who would benefit. We implemented reflexive thematic analysis to develop themes from across the interviews, which were then built on to suggest design implications. Results: We find that the need for efficiency in image evaluation is present across many roles, regardless of the clinical question, but consultants can be resistant to new technology. Additionally, we find that the current capability of AR technology could be of greater benefit to radiologists as opposed to surgeons or other practitioners. We discuss these findings for the development of AR applications and present 3 design implications that stand as our core contribution. Conclusions: We conclude with 3 design implications for the application of AR within radiological imaging based on the results of our thematic analysis and frame them within the Human-Computer Interaction and medical fields. The first design implication highlights efficiency and how AR has the potential to allow for quicker comprehension and measurements. Second, we suggest that the capability of AR tools should complement existing techniques and not simply replicate current ability in 3 dimensions. Finally, the integration of AR tools with existing workflows is crucial in the uptake of the technology in order not to negatively disrupt practice. ", doi="10.2196/68810", url="https://xr.jmir.org/2025/1/e68810" } @Article{info:doi/10.2196/74275, author="Bamgboje-Ayodele, Adeola and Raubenheimer, Jacques and Paonne, Anna and Yi, Jessica and Jayawardena, Tamasha and Ajwani, Shilpi and Szuba, Eugenia and Chowdhury, Tanmay and Dao, Phu and Ahmed, Mostafa and Von Huben, Amy and Howell, Martin and Nixon, Nicole and Dunn, Adam and Jones, Aaron and Baysari, Melissa", title="Toward Normalizing Inclusive Design by Uncovering Patient Experiences of a Web Portal in a Dental Hospital: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Aug", day="14", volume="27", pages="e74275", keywords="patient portal", keywords="inclusive design", keywords="usability", keywords="patient experience", abstract="Background: Patient portals can improve care delivery and the efficient use of health care resources. Barriers to uptake can hinder the realization of expected benefits for health services and patients, particularly for older adults (?65 y) and those who are culturally and linguistically diverse (CALD). Objective: This study aimed to evaluate the usability and overall patient experience of a patient portal, particularly for CALD and older adults. Methods: A mixed methods study at a dental hospital was performed including a patient experience survey that was administered before (2111 patients) and after (2445 patients) portal implementation to all patients, semistructured interviews (18 patients), and a usability survey (235 patients) that was administered to all patients who had registered to use the portal and had an appointment at the clinic. Also, we conducted a scenario-based usability evaluation (17 patients) with CALD and people. Results: The patient experience survey revealed that the portal had no impact on the ease of changing appointments when the clinic with the portal (Wilcoxon z=?1.62; P=.05) was compared with clinics without the portal in the same hospital (z=?1.54; P=.06). For the usability survey, >82\% were completed by patients and 18\% by carers, and 47.3\% of respondents were older adults (?65 years old). The majority spoke English (n=191, 81.3\%), while others preferred to speak other languages (n=44, 18.7\%) and were identified as CALD. Adult participants (18?64 years old) reported that the portal was easy to use and simple. However, design problems, including inadequate incorporation of inclusivity, were found to more often limit usability for older (?65) and CALD people. The overall Simplified System Usability Scale (SUS) mean score was 63.3 (95\% CI 60.9?65.7). Adult participants reflected higher SUS scores than older participants (F=10.4; P=.001). Interview results revealed how the portal was used and barriers to its uptake. Barriers related to poor usability and gaps in the implementation approach (eg, limited awareness of the purpose of the portal). Usability evaluations indicated that all participants could log in with the one-time password (OTP), but most were assisted. Only 3 of 17 participants were able to send a message to the clinic. Other usability problems identified were focused on display, content, layout, functionality, and navigation categories. Conclusions: The use of inclusive design principles when designing patient portals is necessary for successfully engaging all patients. Our study highlights the importance of normalizing inclusive designs in patient portals to ensure that priority populations, such as older and CALD people, are not marginalized by design. We provide recommendations to guide future design and implementation of patient portals. ", doi="10.2196/74275", url="https://www.jmir.org/2025/1/e74275" } @Article{info:doi/10.2196/73642, author="Alharbi, Yousef Layan and Alrashoud, Rashed Rema and Alotaibi, Shabib Bader and Al Dera, Meshal Abdulaziz and Alajlan, Saleh Raghad and AlHuthail, Rashed Reem and Alessa, Ibrahim Dalal", title="Using Artificial Intelligence ChatGPT to Access Medical Information About Chemical Eye Injuries: Comparative Study", journal="JMIR Form Res", year="2025", month="Aug", day="13", volume="9", pages="e73642", keywords="artificial intelligence", keywords="ChatGPT", keywords="chemical eye injuries", keywords="ophthalmology", keywords="medical information", keywords="patient education", keywords="ICD-9", keywords="ICD-10", keywords="readability", abstract="Background: Chemical ocular injuries are a major public health issue. They cause eye damage from harmful chemicals and can lead to severe vision loss or blindness if not treated promptly and effectively. Although medical knowledge has advanced, accessing reliable and understandable information on these injuries remains a challenge. This is due to unverified web-based content and complex terminology. Artificial intelligence tools like ChatGPT provide a promising solution by simplifying medical information and making it more accessible to the general public. Objective: This study aims to assess the use of ChatGPT in providing reliable, accurate, and accessible medical information on chemical ocular injuries. It evaluates the correctness, thematic accuracy, and coherence of ChatGPT's responses compared with established medical guidelines and explores its potential for patient education. Methods: A total of 9 questions were entered into ChatGPT regarding various aspects of chemical ocular injuries. These included the definition, prevalence, etiology, prevention, symptoms, diagnosis, treatment, follow-up, and complications. The responses provided by ChatGPT were compared with the International Classification of Diseases-9 and International Classification of Diseases-10 guidelines for chemical (alkali and acid) injuries of the conjunctiva and cornea. The evaluation focused on criteria such as correctness, thematic accuracy, and coherence to assess the accuracy of ChatGPT's responses. The inputs were categorized into 3 distinct groups, and statistical analyses, including Flesch--Kincaid readability tests, ANOVA, and trend analysis, were conducted to assess their readability, complexity, and trends. Results: The results showed that ChatGPT provided accurate and coherent responses for most questions about chemical ocular injuries, demonstrating thematic relevance. However, the responses sometimes overlooked critical clinical details or guideline-specific elements, such as emphasizing the urgency of care, using precise classification systems, and addressing detailed diagnostic or management protocols. While the answers were generally valid, they occasionally included less relevant or overly generalized information. This reduced their consistency with established medical guidelines. The average Flesch Reading Ease Score was 33.84 (SD 2.97), indicating a fairly challenging reading level, while the Flesch--Kincaid Grade Level averaged 14.21 (SD 0.97), suitable for readers with college-level proficiency. The passive voice was used in 7.22\% (SD 5.60\%) of sentences, indicating moderate reliance. Statistical analysis showed no significant differences in the Flesch Reading Ease Score (P=.38), Flesch--Kincaid Grade Level (P=.55), or passive sentence use (P=.60) across categories, as determined by one-way ANOVA. Readability remained relatively constant across the 3 categories, as determined by trend analysis. Conclusions: ChatGPT shows strong potential in providing accurate and relevant information about chemical ocular injuries. However, its language complexity may prevent accessibility for individuals with lower health literacy and sometimes miss critical aspects. Future improvements should focus on enhancing readability, increasing context-specific accuracy, and tailoring responses to a person's needs and literacy levels. ", doi="10.2196/73642", url="https://formative.jmir.org/2025/1/e73642" } @Article{info:doi/10.2196/71912, author="Wani, Ahmad Tafheem and Mendoza, Antonette and Gray, Kathleen", title="A Sociotechnical Approach to Bring-Your-Own-Device Security in Hospitals: Development and Pilot Testing of a Maturity Model Using Mixed Methods Action Research", journal="JMIR Hum Factors", year="2025", month="Aug", day="13", volume="12", pages="e71912", keywords="bring your own device", keywords="BYOD", keywords="security", keywords="privacy", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="maturity model", keywords="sociotechnical security", keywords="policy and governance", keywords="artificial intelligence", keywords="AI", abstract="Background: Bring your own device (BYOD) adoption in health care improves clinician productivity, but introduces cybersecurity risks due to weak security controls, human error, and policy circumvention. Existing security frameworks and models are technocentric, while overlooking sociotechnical factors such as clinician behavior, workflow integration, and organizational culture. This misalignment reduces their effectiveness in health care settings. In addition, hospitals vary in structure, resources, and BYOD use, necessitating a flexible yet structured approach to assess security maturity and prioritize improvements, which is lacking in existing models. Objective: This study aims to develop and pilot a hospital BYOD security maturity model that integrates technical, policy, and human factors for a structured assessment and improvement of BYOD security in health care. Methods: This study used mixed methods action research to design and pilot a hospital BYOD security maturity model. Surveys and interviews with IT managers and clinicians shaped the model, which was trialed at a public metropolitan hospital in Victoria, Australia. Participants completed a maturity assessment and joined a 90?minute co?design workshop that prioritized 6 key domains and proposed improvements. Descriptive statistics and thematic analysis guided refinements to improve clarity and usability. Results: The model was initially developed with 22 domains across 3 key dimensions: technology, policy, and people, each structured across 5 maturity levels to support systematic progression in hospital BYOD security. On the basis of participant feedback during the refinement process, 2 training-related domains were merged, resulting in a final model with 21 domains. The technology dimension includes domains such as identity, access, and authentication management; device security; and clinical communication, ensuring technical controls align with hospital policies and workflows. The policy dimension focuses on governance, covering areas such as BYOD strategy, regulatory compliance, and incident response, to establish clear security guidelines and enforcement mechanisms. The people dimension addresses human factors, including security awareness training, stakeholder involvement, and security culture, fostering staff engagement and adherence to security protocols. A maturity assessment survey conducted at a public metropolitan hospital in Victoria, Australia, revealed an overall maturity level of 2.04. Key areas for improvement included identity and access management, clinical communication security, and governance transparency. A 90-minute co-design workshop identified challenges and proposed solutions for the top 6 priority domains. Recommendations included implementing single sign-on, defining a formal BYOD strategy, enhancing secure communication tools, and improving stakeholder engagement. Conclusions: The model can serve as a valuable tool for hospitals and policy makers, offering actionable recommendations to strengthen BYOD security. The pilot implementation demonstrated its practical applicability, helping the hospital identify security gaps and develop a road map for structured enhancements. Further validation across diverse health care settings will enhance its adaptability and long-term impact. ", doi="10.2196/71912", url="https://humanfactors.jmir.org/2025/1/e71912", url="http://www.ncbi.nlm.nih.gov/pubmed/40802372" } @Article{info:doi/10.2196/66040, author="Fleming, William and Coutts, Adam and Pochard, Diane and Trivedi, Daksha and Sanderson, Kristy", title="Human-Centered Design and Digital Transformation of Mental Health Services", journal="JMIR Hum Factors", year="2025", month="Aug", day="11", volume="12", pages="e66040", keywords="digital mental health", keywords="digital transformation", keywords="human-centred design", keywords="mental health policy", keywords="mental health services", keywords="patient and public involvement", doi="10.2196/66040", url="https://humanfactors.jmir.org/2025/1/e66040" } @Article{info:doi/10.2196/71597, author="Ehrler, Frederic and Guebey, Julie and Rochat, Jessica and Gosetto, Laetitia and Rehberg, Benno and Lovis, Christian and Molinard-Chenu, Aude", title="Dolodoc, an App to Leverage Self-Management of Chronic Pain: Design, Development, and Implementation Report", journal="JMIR Med Inform", year="2025", month="Aug", day="8", volume="13", pages="e71597", keywords="implementation", keywords="chronic pain", keywords="mHealth", keywords="self-management", keywords="health behavior change", keywords="user-centered design", abstract="Background: Chronic pain affects approximately 19\% of the European population and presents major challenges, both in terms of individual impact and the economic burden on health care systems. While clinical expertise remains essential, patient empowerment through self-management tools has become a key component in the long-term management of chronic pain. Objective: This report describes the development and implementation of Dolodoc, a mobile app designed to support patients with chronic pain in monitoring and managing their condition. Methods: Developed by a research and development team at the University Hospitals of Geneva, Dolodoc enables users to track their pain across 7 dimensions of daily life. A digital coach provides personalized guidance, drawing from a corpus of over 80 evidence-based recommendations elaborated by clinical experts. The project was conducted over 4 years with the early involvement of stakeholders, including pain specialists and end users, to ensure alignment with user needs. Emphasis was placed on both the scientific validity and accessibility of the recommendations. Results: The project was completed on time and within budget. The app was made freely available to patients identified as likely to benefit. However, a notable limitation is the absence of predefined key performance indicators to assess the impact of the intervention quantitatively. Conclusions: This implementation report illustrates how mobile technology can be leveraged in a university hospital context to address the needs of patients with chronic pain and promote self-management. Early and sustained collaboration with stakeholders was instrumental in aligning the solution with both clinical evidence and user expectations. ", doi="10.2196/71597", url="https://medinform.jmir.org/2025/1/e71597" } @Article{info:doi/10.2196/70412, author="Khaldoun, Lydia and Bellemare, Francois and Genest, Christine and Bergeron, Nicolas and Geoffrion, Steve", title="Health Care Workers' Experience With a Psychological Self-Monitoring App During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Mhealth Uhealth", year="2025", month="Aug", day="7", volume="13", pages="e70412", keywords="psychological self-monitoring", keywords="self-monitoring app", keywords="adherence", keywords="user experience", keywords="health care workers", keywords="well-being", abstract="Background: Health care workers (HCWs) are at risk of experiencing psychological distress, particularly during the COVID-19 pandemic. Psychological self-monitoring apps may contribute to reducing symptoms of depression, anxiety, and trauma exposure by enhancing emotional self-awareness. This study focused on how a basic psychological self-monitoring app was experienced by HCWs during the COVID-19 pandemic in Quebec by exploring users' experience and factors contributing to their adherence. Objective: This study aimed to explore HCWs' experiences with a psychological self-monitoring app, including if their satisfaction with the app, their perception of its contribution to self-awareness, and their experience of distress influenced their adherence to the app. Methods: HCWs in Quebec were invited to respond weekly to questions about their well-being via a mobile app. A convergent mixed methods design was used. Sample data (N=424) were collected from the app, a postparticipation questionnaire was administered, and 30 semistructured interviews were conducted. Correlations and hierarchical multiple regression models were conducted to examine possible factors influencing participants' adherence, and a thematic analysis was used to further explore their experience. Results: Over a 12-week-period, mean adherence to the psychological self-monitoring app was 74.5\% (SD 29.4\%) and mean satisfaction was 80\% (SD 20\%). Most participants perceived that the app contributed moderately (165/418, 39.5\%) or a lot (140/418, 33.5\%) to enhancing their self-awareness. The significant regression model (F5,401=6.59; P<.001) suggested that around 7.6\% of adherence variation could be explained by satisfaction ($\beta$=.16; t401=3.14; P=.002) and the app's perceived contribution to self-awareness ($\beta$=.15; t401=2.88; P=.004). Biological sex (369/419, 88.1\% female and 50/419, 11.9\% male), age (mean 40.8, SD 9.9 y), and the experience of psychological distress at least once in 12 weeks (228/420, 54.3\%) were not statistically significant predictors of adherence. Emergent themes from the 30 interviews highlighted participants' experiences. Psychological self-monitoring was seen as an introspective practice, with reports of enhanced self-awareness and self-care practices. Interviewees generally considered the app as practical, but it did not suit everyone's preferences. Potential app enhancements were provided by the participants. Conclusions: A simple psychological self-monitoring app could be an interesting tool for HCWs who wish to improve their self-awareness and prevent psychological distress, particularly in health crises such as pandemics. ", doi="10.2196/70412", url="https://mhealth.jmir.org/2025/1/e70412" } @Article{info:doi/10.2196/70181, author="Eid, Laura and Kenny, Alexandra and Taher, Rayan and Jacobsen, Pamela and Hsu, Wei Che and Yiend, Jenny", title="A Digital Mental Health Intervention for Paranoia (the STOP App): Qualitative Study on User Acceptability", journal="JMIR Hum Factors", year="2025", month="Aug", day="7", volume="12", pages="e70181", keywords="framework analysis", keywords="interpretation bias", keywords="paranoia", keywords="qualitative", keywords="digital health technologies", keywords="cognitive bias modification", abstract="Background: Cognitive bias modification for interpretation (CBM-I) is a technique to modify interpretation and is used to reduce unhelpful negative biases. CBM-I has been extensively studied in anxiety disorders where interpretation bias has been shown to play a causal role in maintaining the condition. Successful Treatment of Paranoia (STOP) is a CBM-I smartphone app targeting interpretation bias in paranoia. It has been developed following research on the feasibility and acceptability of a computerized version. This qualitative study extended that research by investigating the acceptability of STOP in individuals with paranoia. The study design and implementation were informed by the Evidence Standards Framework for Digital Health Technologies (DHTs) published by the UK National Institute for Health and Care Excellence (NICE). Objective: The aim of the study was to involve service users in the design, development, and testing of STOP and understand the degree of satisfaction with the product. We aimed to establish the extent to which STOP met the NICE minimum and best practice standards for DHTs, specifically its acceptability to intended end users. Methods: In total, 12 participants experiencing mild to moderate levels of paranoia were recruited to complete 6 weekly sessions of STOP before being invited to a feedback interview to share their experiences. Interview questions revolved around the acceptability of the app, its perceived usefulness, and barriers to the intervention, as well as practicality and views on the use of a digital intervention in principle. Interviews were coded and analyzed using the framework analysis method, combining both deductive and inductive approaches. Results: Framework analysis yielded 6 themes: independent use and personal fit; digital versus traditional approaches; user reactions and emotional impact; impact on thinking, awareness, and well-being; design, engagement, and usability; and intervention relevance and practical fit. Conclusions: STOP was found to be a broadly acceptable intervention and was positively received by most participants. The study findings are in line with the NICE Evidence Standards Framework for DHTs, as intended end users were involved in the development, design, and testing of STOP and were mostly satisfied with it. These findings will contribute to the further iterative development of this intervention that targets interpretation bias in paranoia. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-024-08570-3 ", doi="10.2196/70181", url="https://humanfactors.jmir.org/2025/1/e70181" } @Article{info:doi/10.2196/70160, author="Bell, H. Imogen and Li, Cassandra and Thompson, Andrew and Ellinghaus, Carli and O'Sullivan, Shaunagh and Reynolds, Alexandra Kate and Wadley, Greg and Liu, Yang and Bendall, Sarah and Gleeson, John and Valmaggia, Lucia and Alvarez-Jimenez, Mario", title="A Virtual Reality--Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study", journal="JMIR Ment Health", year="2025", month="Aug", day="7", volume="12", pages="e70160", keywords="virtual reality", keywords="depression", keywords="anxiety", keywords="third-wave psychological treatment", keywords="mindfulness", keywords="cognitive defusion", keywords="youth mental health", abstract="Background: Third-wave psychological treatments such as acceptance and commitment therapy can be effective for improving depression and anxiety in youth. However, third-wave therapeutic techniques such as cognitive defusion can be abstract, challenging to learn, and difficult to apply in real-world settings. Translating these techniques into virtual reality (VR) may provide interactive, enjoyable, and concrete learning opportunities, potentially enhancing engagement and effectiveness. This study evaluated a novel VR application that translates the technique of cognitive defusion into a brief, gamified VR experience. Objective: The objectives of this study were to evaluate the feasibility, acceptability, usability, and safety of the VR cognitive defusion application; examine whether it could improve negative thinking and mood states; and understand how it compared to a non-VR cognitive defusion exercise. Methods: In a mixed methods experimental study, 20 young people completed both a VR and audio cognitive defusion exercise in a randomized order within a single session. Quantitative state-based measures were taken before and after each exercise, and a qualitative interview at the end focused on how the two experiences compared. Results: It was feasible to recruit participants, and all participants completed both exercises and assessments. Both the VR and audio exercises were acceptable to participants, with qualitative themes highlighting a preference for VR due to the novel and engaging format; however, there was a need for better guidance and more personalized environments. No severe adverse events were reported, although one participant experienced distress during the VR exercise. Pretest-posttest effects showed improvements in thought discomfort, cognitive defusion, and state anger for both the VR and audio conditions (P<.05), with the latter showing broader improvements, including thought negativity, rumination, tension, depression, distress, and confusion (P<.05). Conclusions: The VR cognitive defusion application was feasible, safe, and acceptable for young people, with potential to enhance mental health treatment through an engaging and enjoyable approach to learning third-wave cognitive behavioral therapy techniques. While VR was preferred by participants, further refinements could improve effectiveness. Future research should focus on enhancing the VR application design based on user feedback, incorporating audio guidance, and conducting a larger trial in real-world settings to thoroughly evaluate the effectiveness and implementation of the VR application. ", doi="10.2196/70160", url="https://mental.jmir.org/2025/1/e70160", url="http://www.ncbi.nlm.nih.gov/pubmed/40773283" } @Article{info:doi/10.2196/76496, author="Blavette, Lauriane and Dacunha, S{\'e}bastien and Alameda-Pineda, Xavier and Hern{\'a}ndez Garc{\'i}a, Daniel and Gannot, Sharon and Gras, Florian and Gunson, Nancie and Lemaignan, S{\'e}verin and Polic, Michal and Tandeitnik, Pinchas and Tonini, Francesco and Rigaud, Anne-Sophie and Pino, Maribel", title="Acceptability and Usability of a Socially Assistive Robot Integrated With a Large Language Model for Enhanced Human-Robot Interaction in a Geriatric Care Institution: Mixed Methods Evaluation", journal="JMIR Hum Factors", year="2025", month="Aug", day="1", volume="12", pages="e76496", keywords="socially assistive robot", keywords="hospital environment", keywords="gerontology", keywords="older adults", keywords="informal caregivers", keywords="acceptability", keywords="usability", keywords="large language model", keywords="human-robot interaction", abstract="Background: Socially assistive robots (SARs) hold promise for supporting older adults (OAs) in hospital settings by promoting social engagement, reducing loneliness, and enhancing emotional well-being. They may also assist health care professionals by delivering information, managing routines, and alleviating workload. However, their acceptability and usability remain major challenges, particularly in dynamic real-world care environments. Objective: This study aimed to evaluate the acceptability and usability of a SAR in a geriatric day care hospital (DCH) and to identify key factors influencing its adoption by OAs and their informal caregivers. Methods: Over the course of 1 year, 97 participants (n=65, 67\%, OA patients and n=32, 33\%, informal caregivers) took part in a mixed methods evaluation of ARI, a socially assistive humanoid robot developed by PAL Robotics. ARI was deployed in the waiting area of a geriatric day care robot in Paris (France), where it interacted with users through voice-based dialogue. After each session, participants completed 2 standardized assessments, the Acceptability E-scale (AES) and the System Usability Scale (SUS), administered orally to ensure accessibility. Open-ended qualitative feedback was also collected to capture subjective experiences and contextual perceptions. Results: Acceptability scores significantly increased across waves (wave 1: mean 15.4/30, SD 5.81; wave 2: mean 20.9/30, SD 5.25; wave 3: mean 22.5/30, SD 4.23; P<.001). Usability scores also improved (wave 1: mean 47.9/100, SD 24.18; wave 2: mean 57.4/100, SD 22.46; wave 3: mean 69.3/100, SD 16.03; P<.001). A strong positive correlation was observed between acceptability and usability scores (r=0.664, P<.001). Qualitative findings indicated improved ease of use, clarity, and user satisfaction over time, particularly following the integration of a large language model (LLM) in wave 2, leading to more coherent, natural, and context-aware interactions. Conclusions: Successive system enhancements, most notably the integration of an LLM, led to measurable gains in usability and acceptability among patients and informal caregivers. These findings underscore the importance of iterative, user-centered design in deploying SARs in geriatric care environments. Trial Registration: Approved by the French national ethics committee (CPP Ouest II, IRB: 2021/20) as it did not involve randomization or clinical intervention ", doi="10.2196/76496", url="https://humanfactors.jmir.org/2025/1/e76496" } @Article{info:doi/10.2196/67986, author="P{\'e}rez-Rangel, Daniel and Monje, G. Mariana H. and Grosjean, Sylvie and Srp, Martin and Antunes, Laura and Bou{\c{c}}a-Machado, Raquel and Cacho, Ricardo and Dom{\'i}nguez Rodr{\'i}guez, Sergio and Inocentes, John and Lynch, Timothy and Tsakanika, Argyri and Fotiadis, Dimitrios and Rigas, George and R??i{\v c}ka, Ev?en and Ferreira, J. Joaquim and Antonini, Angelo and Malpica, Norberto and Mestre, Tiago and S{\'a}nchez-Ferro, {\'A}lvaro and ", title="Insights From a Mixed Methods Analysis of 3 Health Technologies Used in Patients With Parkinson Disease: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Aug", day="1", volume="27", pages="e67986", keywords="technology-enabled care", keywords="usability", keywords="acceptability", keywords="Parkinson disease", abstract="Background: The transition to a patient-centered integrated care model in Parkinson disease (PD) highlights the crucial role of technology. ``Technology-enabled care'' (TEC) supports diagnosis, disease tracking, self-care education, and care team communication. However, gaps remain in developing and evaluating patient-centered TEC solutions. Objective: This study aims to evaluate the usability and acceptability of 3 health technologies for PD and discuss the significance of the results. Methods: This multicenter international study was conducted from December 2020 to September 2023 across 5 tertiary PD centers. Participants included individuals diagnosed with PD who were recruited through these centers. Each participant provided informed consent before enrollment. The study assessed the usability and acceptability of 3 different health technologies designed to support PD management. The System Usability Scale (SUS) was used as the primary quantitative measure, with scores ranging from 0 to 100, with higher scores indicating greater usability. Additionally, participants completed a custom usability and acceptability survey, which included Likert-scale questions and open-ended qualitative feedback. To ensure a comprehensive evaluation, structured user testing sessions were conducted. Participants interacted with each technology under guided conditions, followed by independent use in their home environment for a specified period. Data were collected at baseline and after the trial period to assess any changes in user perception. Qualitative thematic analysis of free-text responses was performed to identify key themes related to user experience, perceived benefits, and challenges. Two independent researchers analyzed the qualitative data to ensure reliability and consistency in theme extraction. Results: The study included 43 people with PD, of whom 15 were female. The median age of participants was 67.0 (IQR 59.9?71.5) years, and the median disease duration was 9.6 (IQR 5.0?13.7) years. The 3 health technologies demonstrated acceptable usability, with median SUS scores ranging from 74.0 to 82.5. Participants expressed a generally positive attitude toward TEC, with a strong interest in continued use. Users particularly valued confidence in navigating the technology and its role in facilitating disease management. The qualitative analysis highlighted several challenges. Users frequently mentioned the need for improved technical support, clearer instructional materials, and simplified report formats to enhance interpretability. Some participants experienced difficulties with initial setup and required assistance, emphasizing the importance of user-friendly onboarding processes. Conclusions: Our study underscores the importance of incorporating patient perspectives in the development of health technologies for PD. Positive user experiences demonstrate the potential of TEC to enhance disease management, but addressing usability challenges remains critical. Future efforts should focus on refining user interfaces, providing comprehensive technical support, and ensuring clear, accessible instructions to maximize adoption and long-term engagement. By prioritizing these aspects, TEC can play a pivotal role in advancing patient-centered health care solutions for PD. ", doi="10.2196/67986", url="https://www.jmir.org/2025/1/e67986" } @Article{info:doi/10.2196/70305, author="Leoste, Janika and Lubi, Kadi and Marmor, Kristel and Kangur, Katrin", title="Evaluating Social Assistive Robots in Clinical Nursing Care: Mixed Method Pilot Study on Health Care Workers' Perceptions and Adoption", journal="JMIR Nursing", year="2025", month="Aug", day="1", volume="8", pages="e70305", keywords="aging population", keywords="nursing", keywords="socially assistive robots", keywords="technology acceptance in healthcare", keywords="human-robot interaction", abstract="Background: The growing demand for older adults care due to aging populations and health care workforce shortages requires innovative solutions. Socially assistive robots (SARs) are increasingly explored for their potential to reduce workload by handling routine tasks. Yet, adoption can be hindered by various health care workers' concerns. Objective: This study examined the perceptions of health care workers toward SARs before and after a pilot use in a clinical nursing care setting. The study focused on SAR usability, emotional appropriateness, and readiness for adoption. Methods: A mixed methods pilot study was conducted at the East Tallinn Central Hospital's Nursing Care Clinic in collaboration with Tallinn University of Technology. The TEMI v3 (Robotemi) robot was used for 2 weeks for visitor guidance, goods delivery, and patrolling tasks. Health care workers filled in pre- and postintervention questionnaires with Likert-scale items and a broad open-ended question. Quantitative data were analyzed for changes in perceived safety, trust, and usability. Qualitative data underwent thematic analysis to understand participants' opinions. Results: Out of 45 involved health care workers, 20 completed the pretest questionnaire, and 5 completed the posttest questionnaire (a 75\% attrition). Pretest results show that 17 of 20 (85\%) participants had limited previous exposure to SARs and mixed perceptions of their role, with 9 (45\%) viewing SARs as machines and 6 (30\%) as somewhat human-like. Although 60\% believed SARs could become mainstream within 5?10 years, there were concerns about the robot's emotional adequacy and job displacement. Posttest findings showed increased confidence in SARs, with all respondents perceiving them as safe tools. Qualitative results indicate improved trust and readiness to integrate SARs into daily routines, with 4 out of 5 (80\%) being willing to advocate for SAR use. Still, participants noted limited impact on facilitating their jobs. Conclusions: The study indicates that short-term collaboration with SARs can enhance health care workers' confidence and their readiness for adoption. However, actual use would need proper emotional adequacy from the robot and aligning its functionalities with specific care needs. The future studies need to examine long-term impacts on care quality and job satisfaction, and also strategies to address generational differences and technophobia among health care staff. Transparent communication and proper training are required to ensure acceptance. ", doi="10.2196/70305", url="https://nursing.jmir.org/2025/1/e70305" } @Article{info:doi/10.2196/63273, author="Bahrampoor Givi, Sara and Gagnon-Roy, Mireille and Pigot, H{\'e}l{\`e}ne and Provencher, V{\'e}ronique", title="User Experience of Older Adults With an Age-Friendly Transportation Planning E-Tool: Scoping Review", journal="JMIR Hum Factors", year="2025", month="Jul", day="28", volume="12", pages="e63273", keywords="older adults", keywords="transportation", keywords="user experience", keywords="E-tool", keywords="review", keywords="design", abstract="Background: Aging is associated with various challenges, especially concerning mobility. Transportation planning e-tools are currently available to provide older adults with real-time travel information and help them choose trip options. However, many older adults find them challenging to use, as they are not tailored to their specific needs, such as lack of accessibility to the different means of transportation. It is necessary to identify knowledge gaps about design based on older adults' experience using transportation planning e-tools. Objective: This study aims to identify knowledge gaps regarding the user experience design and its evaluation for older adults using transportation planning e-tools. Methods: A scoping review of the scientific literature was conducted, based on Arksey and O'Malley's guidelines. The search covers sources published in English from January 2002 to October 2022 through 7 scientific databases, including MEDLINE, AgeLine, CINAHL, SCOPUS, ProQuest, IEEE Explore, and TRID (Transportation Research International Documentation), and was updated in October 2023. Data selection and extraction were performed by the first author and were co-validated by 2 co-authors. The identified sources were analyzed based on source characteristics (authors, year of publication, title of the article, source of article, country, and context of the studies), the purpose of the studies (objectives and study orientation), and the mapping of the methodology and evaluation of user experience (design approach, setting, type of data collection and analysis, type of usability evaluation, and sample size). Both descriptive-analytical methods and thematic analysis were used to analyze the categorized data. Results: Overall, 1905 sources were identified through databases, and 40 sources were selected for full-text analysis. Data analysis revealed in recent years that there has been significant growth in e-tools designed for older adults, but only 2 studies were related to the field of transportation. In total, 12 studies aimed to evaluate user experience, and 22 studies focused on a user-centered design approach. Most of these studies (n=31) were carried out in a laboratory setting, using summative usability evaluation (user-based testing). The System Usability Scale (SUS) was the most prevalent tool (15 studies) to measure user efficiency and satisfaction. However, no studies have been found that specifically aim to improve the mobility experience of older adults using an age-friendly transportation planning e-tool in a real-life context. Conclusions: There is a lack of studies assessing older adults' experience when using transportation planning e-tools in real-life situations. To bridge this gap, a participatory approach is necessary to better consider the needs of older adults in a real-life context and create age-friendly design guidelines for the development of transportation planning e-tools. This will not only enhance their user experience in trip planning but also promote their social engagement by improving their mobility. ", doi="10.2196/63273", url="https://humanfactors.jmir.org/2025/1/e63273" } @Article{info:doi/10.2196/72141, author="Mekhuri, Samantha and Dale, Craig and Buchanan, Francine and Hammash, Nouma and Ambreen, Munazzah and Saha, Sian and Rose, Louise and Amin, Reshma", title="Family Caregivers of Individuals With Neuromuscular Disease Participating in a Randomized Controlled Trial of a Digital Peer Support Program: Nested Qualitative Study", journal="J Med Internet Res", year="2025", month="Jul", day="28", volume="27", pages="e72141", keywords="family caregivers", keywords="neuromuscular disease", keywords="peer support", keywords="digital", keywords="qualitative", abstract="Background: Family caregivers have primary responsibility for providing care in the home for people with neuromuscular diseases (NMDs). This may negatively affect caregiver health. Peer support may enhance quality of life and reduce stress among family caregivers, but few trials have been conducted in NMD caregivers. Therefore, we conducted a randomized controlled trial with a nested qualitative evaluation (this report) of a 12-week digital peer support intervention for family caregivers of children and adults with NMD. Objective: The aim of the study is to gain insights into the perspectives of intervention participants and peer mentors regarding their experiences with the trial's digital peer support program. Methods: We conducted a nested exploratory qualitative study (August 2022 to March 2024), recruiting participants who were randomized to the intervention arm of the randomized controlled trial and study mentors. We conducted semistructured interviews via videoconferencing. Homophily theory and the theoretical framework of acceptability informed our analyses. Results: We interviewed 21 participants and 10 mentors, identifying four themes: (1) program participation motivators, (2) program expectations and appreciation, (3) program appropriateness, and (4) the peer mentor-mentee dyad. We found that participants were motivated to join the program due to existing caregiver burden and social isolation. Participants and mentors appreciated the program's sense of community and flexible digital format, with participants valuing emotional and informational support. However, challenges in relating to each other's situations due to participant and mentor heterogeneity in the extent of the care recipient's needs were perceived to limit benefit. Conclusions: Peer support was perceived as potentially beneficial in relieving caregiver burden and social isolation, creating a sense of community that provides emotional and informational support. The digital and flexible format was an important facilitator. An important barrier was participant-mentor heterogeneity resulting in reduced perception of homophily. These findings can inform the development of other digital peer support programs to alleviate caregiver burden and isolation and provide emotional relief and informational guidance. Trial Registration: ClinicalTrials.gov NCT05070624; https://clinicaltrials.gov/study/NCT05070624 ", doi="10.2196/72141", url="https://www.jmir.org/2025/1/e72141" } @Article{info:doi/10.2196/63944, author="Jolliff, Anna and Loganathar, Priya and Holden, J. Richard and Linden, Anna and Patel, Himalaya and Lee, R. Jessica and Ganci, Aaron and Campbell, Noll and Boustani, Malaz and Werner, E. Nicole", title="Creating User Personas to Represent the Needs of Dementia Caregivers Who Support Medication Management at Home: Persona Development and Qualitative Study", journal="JMIR Aging", year="2025", month="Jul", day="25", volume="8", pages="e63944", keywords="medication adherence", keywords="user-centered design", keywords="digital health technology", keywords="informal caregivers", keywords="dementia", keywords="artificial intelligence", keywords="AI", abstract="Background: Caregiver-assisted medication management plays a critical role in promoting medication adherence and quality of life for people living with Alzheimer disease or related dementias (ADRD). The current landscape of digital and nondigital interventions to support medication management does not meet caregivers' needs, contexts, and levels of technological proficiency. Intervention development can be facilitated using personas or data-driven archetypes that represent end users' traits relevant to solution design. Objective: This study aims to understand the strategies and unmet needs of ADRD caregivers who manage medications and use this understanding to create personas that can inform customized caregiver interventions. Methods: Participants were self-identified primary caregivers of people with ADRD living with or near the care recipient. Virtual contextual inquiry was completed in three stages: (1) enrollment interview, (2) virtual observation over a 1-week period, and (3) postobservation interview. Codebook thematic analysis of interview transcripts was used to identify dimensions of caregivers' approaches to medication management. A reflexive, team-based affinity diagramming approach was used to identify attributes within these dimensions and group attributes into personas. Results: Participants (N=25) were aged 62.32 (SD 11.86) years on average, and 17 (68\%) of them were female. Caregivers varied across 6 dimensions relevant to medication management: strategies for medication acquisition, medication storage and organization, medication administration, monitoring the care recipient for symptoms, communication with care network regarding medication, and acquiring information about medication. Three personas were created to represent the observed strategies, unmet needs, and levels of technology use related to medication management: Checklist Cheryl, in Control; Social Sam, Keeps it Simple; and Responsive Rhonda, Stays Relaxed. Conclusions: Caregivers in this study demonstrated a range of characteristics and values that informed their approach to medication management. They used a combination of technology-based strategies and strategies situated in their physical environments to manage medications. The personas created can be used to inform interventions, such as digital tools, that address caregivers' unmet needs. ", doi="10.2196/63944", url="https://aging.jmir.org/2025/1/e63944" } @Article{info:doi/10.2196/75983, author="Hvid, Lars and Coote, Susan and Pau, Massimiliano and Kalron, Alon", title="An AI-Based Telerehabilitation Solution to Improve Mobility in People With Multiple Sclerosis (the PLATINUMS Project): Protocol for an Implementation and Evaluation Study", journal="JMIR Res Protoc", year="2025", month="Jul", day="24", volume="14", pages="e75983", keywords="multiple sclerosis", keywords="telerehabilitation", keywords="mobility", keywords="feasibility study", keywords="randomized controlled trial", keywords="remote exercise", keywords="validation", keywords="cost-effectiveness", abstract="Background: Multiple sclerosis (MS) is a chronic, progressive, and neurodegenerative disease affecting more than 2.8 million people globally. Mobility impairments are among the most significant challenges faced by people with MS, leading to physical inactivity, deconditioning, and disability progression (for some, even irreversible disability). This negatively impacts mental health, social participation, and quality of life while placing a considerable economic burden on society. Exercise can improve mobility and mitigate disability progression, but facility-based options are often inaccessible, especially for those in remote areas. Telerehabilitation offers a promising alternative, but current systems are limited by complexity and hardware requirements. Objective: The PLATINUMS (Implementation of an Advanced Telerehabilitation Solution for People With Multiple Sclerosis) project proposes an AI-driven telerehabilitation system to deliver accessible, cost-effective, and home-based exercise therapy for people with MS. Methods: The PLATINUMS project begins with working package (WP) 1, focusing on obtaining ethical approval and recruiting staff. Following this, WP2 involves a 4-week system feasibility and usability study (n=40) to assess and refine the digital platform. WP3 comprises a validity study (n=60) to evaluate remote mobility tests via the system, such as the Short Physical Performance Battery (SPPB), functional reach, and sit-to-stand tests, to ensure their reliability for use in WP4, the feasibility multicenter randomized controlled trial (RCT). The 10-week multicenter feasibility RCT will be conducted in MS centers across Denmark, Ireland, Israel, and Italy, with 96 participants varying in disability levels. The primary objective is to evaluate the efficacy of the AI-powered telerehabilitation system on mobility outcomes compared to usual care. Finally, WP5 will assess the cost-effectiveness of the telerehabilitation system by analyzing implementation costs, adherence, and use of health care. The PLATINUMS project aims to revolutionize exercise therapy for people with MS by demonstrating the feasibility, validity, and preliminary efficacy of the AI-driven telerehabilitation system. This approach addresses barriers such as accessibility, privacy, and standardization while promoting patient and therapist acceptance. Results: Funding for the PLATINUMS project was obtained in February 2024. WP2 data collection began in April 2025 across 4 European sites. WP3 is scheduled to launch in July 2025, with WP4 (the feasibility RCT) planned for January 2026. Initial WP2 results are expected by October 2025, with first publications anticipated in mid-2026. Conclusions: The PLATINUMS project is expected to generate critical insights into the feasibility, usability, and preliminary efficacy of an AI-based telerehabilitation system for people with MS. By leveraging widely available technology and real-time feedback, the system addresses key barriers to traditional rehabilitation. Findings from this protocol may inform future large-scale trials and support the broader implementation of digital health solutions in neurological rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/75983 ", doi="10.2196/75983", url="https://www.researchprotocols.org/2025/1/e75983", url="http://www.ncbi.nlm.nih.gov/pubmed/40705418" } @Article{info:doi/10.2196/66476, author="Koohi Habibi Dehkordi, Mahshad and Perl, Yehoshua and Deek, P. Fadi and He, Zhe and Keloth, K. Vipina and Liu, Hao and Elhanan, Gai and Einstein, J. Andrew", title="Improving Large Language Models' Summarization Accuracy by Adding Highlights to Discharge Notes: Comparative Evaluation", journal="JMIR Med Inform", year="2025", month="Jul", day="24", volume="13", pages="e66476", keywords="electronic health record", keywords="EHR", keywords="EHR summaries", keywords="clinical notes summarization", keywords="discharge notes summarization", keywords="LLM summaries", keywords="ChatGPT summaries", keywords="highlighted EHR notes", keywords="accuracy of summaries", keywords="discharge notes", keywords="large language model", keywords="LLM", keywords="ChatGPT", keywords="artificial intelligence", keywords="AI", abstract="Background: The American Medical Association recommends that electronic health record (EHR) notes, often dense and written in nuanced language, be made readable for patients and laypeople, a practice we refer to as the simplification of discharge notes. Our approach to achieving the simplification of discharge notes involves a process of incremental simplification steps to achieve the ideal note. In this paper, we present the first step of this process. Large language models (LLMs) have demonstrated considerable success in text summarization. Such LLM summaries represent the content of EHR notes in an easier-to-read language. However, LLM summaries can also introduce inaccuracies. Objective: This study aims to test the hypothesis that summaries generated by LLMs from highlighted discharge notes will achieve increased accuracy compared to those generated from the original notes. For this purpose, we aim to prove a hypothesis that summaries generated by LLMs of discharge notes in which detailed information is highlighted are likely to be more accurate than summaries of the original notes. Methods: To test our hypothesis, we randomly sampled 15 discharge notes from the MIMIC III database and highlighted their detailed information using an interface terminology we previously developed with machine learning. This interface terminology was curated to encompass detailed information from the discharge notes. The highlighted discharge notes distinguished detailed information, specifically the concepts present in the aforementioned interface terminology, by applying a blue background. To calibrate the LLMs' summaries for our simplification goal, we chose GPT-4o and used prompt engineering to ensure high-quality prompts and address issues of output inconsistency and prompt sensitivity. We provided both highlighted and unhighlighted versions of each EHR note along with their corresponding prompts to GPT-4o. Each generated summary was manually evaluated to assess its quality using the following evaluation metrics: completeness, correctness, and structural integrity. Results: We used the study sample of 15 discharge notes. On average, summaries from highlighted notes (H-summaries) achieved 96\% completeness, 8\% higher than the summaries from unhighlighted notes (U-summaries). H-summaries had higher completeness in 13 notes, and U-summaries had higher or equal completeness in 2 notes, resulting in P=.01, which implied statistical significance. Moreover, H-summaries demonstrated better correctness than U-summaries, with fewer instances of erroneous information (2 vs 3 errors, respectively). The number of improper headers was smaller for H-summaries for 11 notes and U-summaries for 4 notes (P=.03; implying statistical significance). Moreover, we identified 8 instances of misplaced information in the U-summaries and only 2 in the H-summaries. We showed that our findings supported the hypothesis that summarizing highlighted discharge notes improves the accuracy of the summaries. Conclusions: Feeding LLMs with highlighted discharge notes, combined with prompt engineering, results in higher-quality summaries in terms of correctness, completeness, and structural integrity compared to unhighlighted discharge notes. ", doi="10.2196/66476", url="https://medinform.jmir.org/2025/1/e66476", url="http://www.ncbi.nlm.nih.gov/pubmed/40705416" } @Article{info:doi/10.2196/70331, author="Silvestrini, Matthew and Lui, Clarissa and Patwardhan, Anil and Chen, Ying and Ali, Tayyeba and Glik, Elie and Wu, Honglei and Levinstein, Brian and Wenz, Adrianna and Shemonski, Nathan and Yang, Lin and Atkinson, Ian and Kavusi, Sam", title="Performance of a Retinal Imaging Camera With On-Device Intelligence for Primary Care: Retrospective Study", journal="JMIR Form Res", year="2025", month="Jul", day="17", volume="9", pages="e70331", keywords="diabetic retinopathy screening", keywords="retinal camera", keywords="retinal imaging", keywords="fundus imaging", keywords="diabetic retinopathy", abstract="Background: Access to screening continues to be a barrier for the early detection of diabetic retinopathy (DR). Primary care--based diabetic retinopathy screening could improve access, but operational challenges, such as cost and workflow management, hamper the widespread adoption of retinal camera systems in primary care clinics in the United States. Objective: This study aimed to develop and evaluate a retinal screening system suitable for integration into a primary care workflow. Methods: We developed a nonmydriatic, 45{\textdegree} field imaging retinal camera system, the Verily Numetric Retinal Camera (VNRC; Verily Life Sciences LLC), able to generate high-fidelity retinal images enabled by on-device intelligent features. The VNRC output flows into cloud-based software that accepts and routes digitized images for grading. We evaluated the performance and usability of the VNRC in 2 studies. A retrospective performance study compared the performance of VNRC against a reference camera (Crystalvue NFC-700 [Crystalvue Medical]) as well as the correlation between VNRC capture status and gradability (as determined by ophthalmologist graders). The usability study simulated a primary care setting for a combined cohort of trained and untrained users (corresponding to patients in the simulation) and operators (corresponding to health care personnel in the simulation), where respondents completed a questionnaire about their user experience after attempting to capture images with the VNRC. Results: In the comparative performance study (N=108, K=206 images), a total of 98.5\% (203/206) of images captured by the VNRC were graded as sufficient for clinical interpretation compared to 97.1\% (200/206) of Crystalvue NFC-700 images (difference in proportion was 0.015, 95\% CI --0.007 to 0.033). In the quality control algorithm evaluation (N=172, K=343 images), we found a positive association ($\phi$=0.58, 95\% CI 0.45?0.69) between gradability status (gradable or nongradable) as determined by ophthalmologists and the capture status (recapture not-needed or needed) as determined by the VNRC quality control algorithm. In the usability study (n=15 users and n=30 operators), all participating users (15/15) indicated that they were able to have both eyes screened easily. Most users and operators indicated agreement (from somewhat agree to strongly agree) with statements describing the imaging process as intuitive (15/15, 100\% and 29/30, 97\%), comfortable (15/15, 100\% and 30/30, 100\%), and allowing for a positive experience (15/15, 100\% and 30/30, 100\%), of users and operators, respectively. Conclusions: Our findings about the performance and usability of this retinal camera system support its deployment as an integrated end-to-end retinal service for primary care. These results warrant additional studies to fully characterize real-world usability across a wider and diverse set of primary care clinics. ", doi="10.2196/70331", url="https://formative.jmir.org/2025/1/e70331" } @Article{info:doi/10.2196/75316, author="Mills, Jodie and Duffy, Orla and Pedlow, Katy and Kernohan, George", title="Exploring the Perceptions of Voice-Assisted Technology as a Tool for Speech and Voice Difficulties: Focus Group Study Among People With Parkinson Disease and Their Carers", journal="JMIR Rehabil Assist Technol", year="2025", month="Jul", day="16", volume="12", pages="e75316", keywords="Parkinson disease", keywords="voice-assisted technology", keywords="smart speakers", keywords="speech and voice", keywords="dysarthria", keywords="speech and language therapy", abstract="Background: People with Parkinson disease (PD) often report low volume and reduced intelligibility of speech. Common household devices that use voice-assisted technology (VAT) require users to speak slowly, clearly, and loudly for the technology to function. For people with PD, this can be challenging, but this also suggests that VAT may have potential as a therapeutic tool. While VAT is an emerging health care technology, it is important to better understand the thoughts and experiences of people with PD who are already using it despite having speech and voice difficulties. Objective: This study aimed to explore experiences of using VAT to address hypokinetic dysarthria secondary to PD, based on the perspectives of people with PD and family carers. Methods: People with PD experiencing mild to moderate speech changes who were smart speaker users, and their carers, were invited to participate in 1 of 4 in-person focus groups. Between September and December 2024, focus groups were audiovisually recorded. A semistructured topic guide informed by published evidence was used to guide discussions. Results were transcribed and analyzed through a framework analysis approach (managed using NVivo software). Results: A total of 15 participants, including 8 (53\%) people with PD and 7 (47\%) carers, participated in 4 in-person focus groups. Findings revealed shared experiences with VAT that were marked by its therapeutic potential and practical challenges. Five main themes were identified: (1) therapeutic potential for speech and voice, with subthemes of changes in volume, intelligibility, and clarity of speech; the role of VAT feedback; and VAT as an everyday device; (2) distrust of technology, with concerns surrounding data privacy, the listening nature of devices, and measures users take to protect themselves; (3) frustrations with devices, including devices not understanding, devices timing out, and the lack of conversation; (4) support needs, including the impact of a lack of knowledge and the need for education and guidance; and (5) design considerations for a future VAT tool in speech and language therapy (SLT). Conclusions: This study extends on previous research findings, demonstrating that VAT may be acceptable to people with PD to create changes in volume, clarity, and intelligibility. However, attention must be given to users' privacy concerns and frustrations with devices before VAT can used as a tool in SLT. Future research should design solutions to address current usability challenges with people with PD and professionals in three ways: (1) co-designing education and guidelines for people with PD, describing the use of VAT for speech and voice difficulties; (2) refining commercial VAT for use in SLT; and (3) establishing the feasibility of a therapeutic VAT intervention for people with PD with speech and voice difficulties. ", doi="10.2196/75316", url="https://rehab.jmir.org/2025/1/e75316" } @Article{info:doi/10.2196/60143, author="Cho, Jinmyoung and Birchfield, Thomas and Thorud, L. Jennifer and Ory, G. Marcia and Stevens, B. Alan", title="GamePlan4Care, a Web-Based Adaptation of the Resources for Enhancing Alzheimer's Caregiver Health II Intervention for Family Caregivers of Persons Living With Dementia: Formative, Qualitative Usability Testing Study", journal="JMIR Form Res", year="2025", month="Jul", day="11", volume="9", pages="e60143", keywords="dementia caregivers", keywords="user interface/user experience (UI/UX)", keywords="technology", keywords="web-based caregiving program", keywords="user experience", keywords="training", keywords="online resource", keywords="peer support", keywords="Alzheimer disease", keywords="dementia", keywords="caregiving", keywords="caregiver", keywords="carer", keywords="informal care", keywords="family care", keywords="spousal care", keywords="usability", keywords="clinical trial", keywords="aging", keywords="elderly", keywords="geriatrics", keywords="gerontology", keywords="mhealth", keywords="mobile health", keywords="digital health", keywords="online platforms", keywords="web health", keywords="online support", keywords="neurodegeneration", keywords="brain degeneration", keywords="memory loss", abstract="Background: The negative consequences of caregiving can be mitigated by providing caregivers with support programs that increase their dementia care skills and provide emotional and tangible support. Web-based technology can increase the availability of evidence-based caregiver interventions. GamePlan4Care (GP4C) is a web-based adaptation of the Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention, redesigned and reformatted for web-based delivery. Objective: The goal of GP4C is to create a web-based family caregiver support platform that facilitates self-directed exposure to evidence-based skills training and support for caregivers of persons living with dementia. This multidimensional approach of using technology enhanced with live support has the potential for improved scalability and sustainability. In preparation for a randomized clinical trial of the new intervention, the GP4C platform underwent user interface/user experience (UI/UX) testing with caregivers as part of an iterative design process. Methods: UI/UX testing of caregivers' reactions to technical and content-related aspects of the platform was conducted with 31 caregivers recruited through partnerships with community-based organizations in central Texas. Usability testing consisted of performing system tasks, answering open-ended questions on the tasks, and providing feedback on their experience with the platform. Two researchers used an inductive thematic approach to data analysis using transcripts of individual audio and screen-recorded sessions with each participant. The analysis consisted of 3 phases: data familiarization, coding, and theme formulation. Results: In total, 18 participants tested technical-related aspects of the GP4C platform, and 13 participants tested content-related aspects. The average age of participants was 62 (SD 12.2, range 31?86). A majority of participants were female (27/31, 87.1\%) and White or Caucasian (26/31, 83.1\%) while almost one-third were Hispanic (10/31, 32.3\%). The thematic analysis revealed 3 themes: supportive resources as a common theme, active engagement for technical aspects of the platform, and a comprehensive approach for content aspects of the platform. Participants also suggested changes in navigation and content. Conclusions: Findings from the usability testing sessions indicate that the platform provided engaging, useful content that the caregiver would continue to use, resonated with their caregiving experience, helped the caregivers think through their choices and emotions, and could be used to help communicate with the person living with dementia. Caregivers appreciated the personalization based on what they had already completed and the concept of having a Dementia Care Navigator when they needed additional help. Caregivers also provided multiple suggestions on how to improve the system, including changes for easier navigation and inclusiveness. This positive feedback indicates that with a few changes, the platform would be beneficial to meet the needs and provide resources for caregivers of persons living with dementia. The process of involving end users in usability testing during the development stage ensures that the finished tool will better meet users' expectations and current needs. ", doi="10.2196/60143", url="https://formative.jmir.org/2025/1/e60143" } @Article{info:doi/10.2196/72425, author="Kershaw, Steph and Deng, Jessica and Keaveny, Madeleine and Speirs, Bronte and Grager, Anna and Sampson, Dara and Ross, Kate and Newton, Nicola and Teeson, Maree and Kay-Lambkin, Frances and Chapman, Cath", title="A Web-Based Well-Being and Resilience Intervention for Family Members and Friends Supporting a Loved One Using Alcohol and Other Drugs: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2025", month="Jul", day="9", volume="9", pages="e72425", keywords="affected friends and family members", keywords="substance use", keywords="help-seeking", keywords="web-based intervention", keywords="pilot trial", keywords="mobile phone", abstract="Background: Despite the known psychosocial challenges associated with supporting a loved one using alcohol and other drugs (AOD), there is a scarcity of mental health and well-being interventions for affected friends and family members (AFFMs). Stigma has also been shown to discourage help-seeking among AFFMs. Web-based interventions may facilitate help-seeking by ensuring privacy and anonymity. Objective: This pilot study examines the usability, acceptability, and feasibility of the Family and Friend Support Program (FFSP), a world-first, evidence-based web-based resilience and well-being program designed with, and for, people caring for someone using AOD. This study also examined AFFM's experiences of caring for a loved one using AOD and their help-seeking behaviors and barriers. Methods: In 2021 (November-December), participants across Australia completed a baseline web-based cross-sectional survey that assessed the impact of caring for a loved one using AOD (adapted Short Questionnaire for Family Members-Affected by Addiction), and distress levels (Kessler Psychological Distress Scale [K-10]). Following baseline, participants were invited to interact with the FFSP over 10 weeks. Postprogram and follow-up surveys (10 and 14 wk postbaseline, respectively) and semistructured interviews assessed the usability and acceptability of the program, as well as help-seeking experiences and barriers. Results: Baseline surveys were completed by 131 AFFMs, with 37\% (n=49) completing the postprogram survey and 24\% (n=32) completing the follow-up survey. A total of 5 participants took part in individual semistructured interviews at postprogram. On average, K-10 scores fell in the moderate to severe range at baseline (mean 28.4, SD 8.6). At postprogram, the majority of participants (n=27, 55.1\%) reported that they did not seek help to cope with or manage their role supporting their loved one and the most common endorsed barrier was cost (n=11, 28.6\%). Overall, participants found the FFSP easy to use and provided them with relevant, helpful, and validating information. The majority (n=35, 71.5\%) of participants said they would be likely to recommend the FFSP to a person supporting a loved one using AOD. Qualitative responses highlighted the need for free, accessible support for AFFMs such as the FFSP. Limitations included low program engagement and high attrition. Conclusions: Overall, the FFSP appears to be a promising mental health intervention for AFFMs. This study builds on existing research finding high levels of distress among AFFMs, while highlighting the ongoing barriers to help-seeking. Limitations and future directions for refinements and future efficacy evaluation of the FFSP are discussed including ways to address attrition and increase engagement. ", doi="10.2196/72425", url="https://formative.jmir.org/2025/1/e72425" } @Article{info:doi/10.2196/50709, author="Anraad, Charlotte and van Empelen, Pepijn and Ruiter, AC Robert and van Keulen, M. Hilde", title="Online Tailored Decision Aid for Maternal Pertussis Vaccination in a Randomized Controlled Trial: Process Evaluation Study", journal="JMIR Form Res", year="2025", month="Jul", day="8", volume="9", pages="e50709", keywords="decision aid", keywords="process evaluation", keywords="informed decision making", keywords="intervention mapping", keywords="vaccine hesitancy", keywords="maternal pertussis vaccination", abstract="Background: To promote informed decision-making and maternal pertussis vaccination (MPV) uptake, we systematically developed an interactive, web-based decision aid for pregnant users. Intervention reach (the percentage of participants in the intervention group who used the intervention), use (how much and how long those participants used the intervention), and acceptability (how positively they evaluated the intervention) are essential for it to be effective and should be reported to assess which intervention components may have been effective. Objective: This is a process evaluation aiming to evaluate (1) the reach and (2) the use, and (3) the acceptability of the intervention. Methods: We analyzed the reach and use of the intervention among participants in the intervention group of a randomized controlled trial (RCT) that assessed the effects of an online tailored decision aid in the form of a web app. Participants were recruited via social media and midwifery clinics and invited via email to use the intervention at 18 weeks of pregnancy. Reach was measured objectively by assessing the number of participants who visited the intervention at least once. Use of the intervention was logged and included time spent on the decision aid, the number of times clicked, pages visited, and answers given in interactive components. Data from the baseline survey (at <18 wk of pregnancy) were used to measure sociodemographics, informed decision-making, MPV uptake, and determinants of uptake. A posttest survey (20-22 weeks of pregnancy) was used to evaluate the acceptability of the decision aid. We report the findings descriptively and assess baseline differences between those who used versus those who did not use the intervention. Results: Of the 586 participants in the intervention group, 463 (79\%) reached the home page of the intervention. Intervention reach appeared higher among those in their first pregnancy (8.35\% difference, P=.11), those recruited via their midwife rather than via social media (10.56\% difference, P=.04), and those who had completed a higher educational level (7.35\% difference, P=.06). On average, participants spent 4.25 (SD 4.39) minutes on the decision aid. Most participants used the decision aid once (56.2\% of those who reached it, n=260) or twice (26.6\%, n=123). The average number of clicks was 27.24 (SD 25.08) and varied widely. Regarding acceptability, participants evaluated the decision aid positively with an overall grade of 8.0 out of 10 (SD 1.01). In total, 38.9\% (180/463) of participants who used the intervention indicated that the decision aid helped them with their MPV decision-making. Conclusions: The reach of the decision aid was successful with 79\%, and participants were very positive about the decision aid. The use of the intervention (eg, time spent on the intervention) leaves room for improvement and should be improved to maximize intervention effects. ", doi="10.2196/50709", url="https://formative.jmir.org/2025/1/e50709" } @Article{info:doi/10.2196/65472, author="Malik, Ishaq and Neufeld, Teagan and Mushquash, Aislin", title="Usability and Quality of the JoyPop App: Prospective Evaluation Study", journal="JMIR Hum Factors", year="2025", month="Jul", day="4", volume="12", pages="e65472", keywords="usability", keywords="quality", keywords="mobile health", keywords="mental health app", keywords="postsecondary students", keywords="uMARS", keywords="MAUQ", keywords="evaluation study", keywords="mental health", keywords="app", keywords="resilience", keywords="Canada", keywords="student", keywords="usefulness", keywords="satisfaction", keywords="regression analyses", keywords="coping", keywords="smartphone app", keywords="mHealth app", keywords="mHealth", keywords="users", keywords="user version of the Mobile Application Rating Scale", keywords="Mobile Application Usability Questionnaire", abstract="Background: Mental health difficulties are increasing among Canadian postsecondary students, and many face barriers to accessing mental health care. Mobile health smartphone apps for mental health reduce common barriers to care and improve student mental health outcomes. However, students' engagement and use of mental health apps is low. Evaluating the usability and quality of mental health apps is essential not only for user engagement but also for safety and overall utility. Few mental health apps have undergone usability and quality evaluations, especially with measures explicitly designed for these apps. The JoyPop app is a resilience-building mental health app with evidence supporting its effectiveness for student mental health. It has yet to be evaluated using standardized measures of mental health app usability and quality, and the influence of usability and quality on use is unknown. Objective: We evaluated the usability and quality of the JoyPop app and the predictive importance of usability and quality, compared to other relevant user characteristics, in predicting intentions to use the app in the future (usage intentions). Methods: Participants (N=183) completed preapp measures assessing demographics and personality traits, then used the app for 1 week, and then completed postapp measures assessing the usability, quality, and use of the JoyPop app. Usability (overall; and subscales: ease of use, interface and satisfaction, and usefulness) and quality (objective, subjective, and perceived impact) were assessed with descriptive statistics. Multiple regression analyses tested the predictive importance of usability and quality on usage intentions after controlling for other user characteristics. Results: Participants rated the JoyPop app's overall usability as ``very good'' (mean 5.63, SD 0.85). Participants rated the JoyPop app's overall objective quality as ``excellent'' (mean 4.06, SD 0.54). Subjective quality ratings were good, with many participants (135/183, 73.8\%) indicating they would recommend the app to others. Participants rated the app as having a moderate and helpful impact on their mental health and coping skills (mean 3.48, SD 0.88). In each regression model, usability ($\beta$=.56, P<.001) and quality ($\beta$=.52, P<.001) were the strongest predictors and predicted usage intentions over and above other user characteristics. Conclusions: Results align with prior research evaluating the JoyPop app and maintain that it is an engaging and high-quality mental health app that can support students. Findings provide important insight into the optimal design of mental health apps for students and inform adaptations to future iterations of the JoyPop app. ", doi="10.2196/65472", url="https://humanfactors.jmir.org/2025/1/e65472" } @Article{info:doi/10.2196/69190, author="Kim, Hana and Kang, Jae-Heon and Kwon, Yeeun and Kim, Eun Che and Yu, han Jung and Nam, Seung Hyo and Lee, Jisan", title="Development of a Smart Health Care Service Using Metaverse and Chatbot Technologies for Adolescents, Parents, and School Health Teachers: User-Centered Design Approach", journal="J Med Internet Res", year="2025", month="Jul", day="3", volume="27", pages="e69190", keywords="adolescent", keywords="exercise", keywords="needs assessment", keywords="mobile health", keywords="IT", abstract="Background: Adolescent health issues, particularly obesity, have become increasingly serious, highlighting the need for health management strategies tailored to the unique life cycle characteristics of adolescents. Objective: This study aimed to develop a smart health care service for adolescents, their parents, and school health teachers to enhance their health. Methods: The service leverages a mobile app, a web platform, wearable devices, the metaverse, and chatbots. The development process included a needs assessment, core user interface (UI) design, and service model creation. The needs assessment involved a literature review of 65 studies, a web survey of 96 participants, and 30 interviews. A usability evaluation of the core UI, shaped by the insights from the needs assessment, was conducted with 76 participants. Results: The service was conceptualized emphasizing school settings to cater to school-aged users, ensuring that the design is closely aligned with user needs. In addition, it incorporates features to deliver personalized services based on individual health information and uses gamification elements to enhance user engagement. The core UI was developed in response to the needs assessment findings, supported by a user flowchart. Furthermore, we created a use case diagram illustrating the interaction between various users and the services, a flowchart outlining the service algorithm, and a lifelog data collection system. The core UI usability evaluation results revealed that both students and parents considered sleep management important, while school health teachers deemed the measurement of physical activity essential. Students and parents prioritized physical activity measurement, and students particularly favored rewards for activities as the most promising solutions for health management challenges. The outcomes of the core UI usability evaluation indicated that school health teachers rated effectiveness (mean 4.26, SD 0.41), usefulness (mean 4.18, SD 0.54), usability (mean 4.29, SD 0.55), and user control (mean 4.08, SD 0.60) highly, reflecting the highest expectations across all categories. Conclusions: This study demonstrated that a school-based smart health care service can effectively support adolescent health management by integrating personalized health data, gamification, and interactive tools. The usability evaluation revealed that students and parents prioritized sleep and physical activity tracking, while school health teachers emphasized the importance of monitoring physical activity. In addition, reward-based engagement strategies were identified as a promising approach to improve adolescent health behaviors. These findings suggest that leveraging digital health solutions tailored to adolescents' needs can contribute to establishing sustainable health habits from an early age. ", doi="10.2196/69190", url="https://www.jmir.org/2025/1/e69190" } @Article{info:doi/10.2196/64967, author="Jung, Gyuwon and Lim, Heejeong and Han, Kyungsik and Kim, Hyungsook and Lee, Uichin", title="Designing a Visual Analytics Tool to Support Data Analysis Tasks of Digital Mental Health Interventions: Case Study", journal="JMIR Hum Factors", year="2025", month="Jul", day="2", volume="12", pages="e64967", keywords="digital health interventions", keywords="visual analytics", keywords="data analysis tasks", keywords="user characteristics", keywords="user engagement", keywords="effectiveness", keywords="mental health", keywords="observational data", keywords="user experience", keywords="human-data interaction", abstract="Background: Digital health interventions (DHIs) are widely used to manage users' health in everyday life through digital devices. The use of DHIs generates various data, such as records of intervention use and the status of target symptoms, providing researchers with data-driven insights for improving these interventions even after deployment. Although DHI researchers have investigated these data, existing analysis practices have been fragmented, limiting a comprehensive understanding of the data. Objective: We proposed an analysis task model to help DHI researchers analyze observational data from a holistic perspective. This model was then used to prototype an interactive visual analytics tool. We aimed to evaluate the suitability of the model for DHI data analysis and explore task support using a visual analytics tool. Methods: We constructed a data analysis task model using 3 key components (ie, user grouping criteria) for DHI data analysis: user characteristics, user engagement with DHIs, and the effectiveness of DHIs on target symptoms based on comparisons before and after the intervention. On the basis of this model, we designed Maum Health Analytics, a medium-fidelity prototype of an interactive visual analytics tool. Each feature of the prototype was mapped one-to-one to the analysis task described in the model. To investigate whether the proposed model adequately reflects real-world DHI analysis needs, we conducted a preliminary user study with 5 groups of researchers (N=15). Participants explored the tool through scenario-based analysis tasks using in-the-wild data collected from a mobile DHI service targeting depressive symptoms. Following the session, we conducted interviews to assess the appropriateness of the defined tasks and the usability and practical utility of the visual analytics tool. Results: DHI researchers responded positively to both the analysis task model and the visual analytics tool. In the interviews, participants noted that the tool supported the identification of users who needed additional care, informed content recommendations, and helped analyze intervention effectiveness in relation to user characteristics and engagement levels. They also appreciated the tool's role in simplifying analytic tasks and supporting communication across multidisciplinary teams. Additional suggestions included improvements for continuity across tasks and more detailed engagement metrics. Conclusions: We proposed an analysis task model and designed an interactive visual analytics tool to support DHI researchers. Our user study showed that the model allows a holistic investigation of DHI data by integrating key analysis components and that the prototype tool simplifies analytic tasks and enhances communication among researchers. As DHIs grow, the proposed model and tool can effectively meet the data analysis requirements of researchers and improve efficiency. ", doi="10.2196/64967", url="https://humanfactors.jmir.org/2025/1/e64967" } @Article{info:doi/10.2196/67886, author="Keyaerts, Stijn and Szymanski, Maxwell and Godderis, Lode and Vanden Abeele, Vero and Daenen, Liesbeth", title="Evaluating the Impact on Pain Perceptions, Pain Intensity, and Physical Activity of a Mobile App to Empower Employees With Musculoskeletal Pain: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2025", month="Jun", day="27", volume="9", pages="e67886", keywords="mobile health", keywords="mHealth", keywords="occupational health", keywords="musculoskeletal disorders", keywords="mixed methods", keywords="pain perceptions", keywords="pain management", keywords="digital health", keywords="human-centered design", abstract="Background: Mobile apps present opportunities to empower employees with musculoskeletal pain and reduce long-term absenteeism. However, adoption remains limited because of a lack of empirical evidence and challenges in user-friendly design. Objective: This pilot study aimed to evaluate the potential effects of a fully automated, app-based pain management intervention tailored for employees. Specifically, the study aimed to (1) assess the effect of the intervention on maladaptive pain perceptions, pain intensity, and physical activity and (2) identify factors influencing its effectiveness. Methods: A total of 66 employees from a Belgian university hospital who had been experiencing musculoskeletal pain for at least 6 weeks participated in a 24-week intervention. The app-based intervention focused on reducing maladaptive pain perceptions, providing work-related guidance, and promoting healthy activity habits through interactive modules, real-time recommendations, and goal-setting features. Every 6 weeks, participants completed a questionnaire measuring maladaptive pain perceptions (pain catastrophizing and fear-avoidance beliefs). Pain intensity was recorded daily using a visual analog scale, and step count was tracked daily using an activity tracker. In addition, semistructured interviews were conducted with 12 participants to explore how they engaged with the intervention and perceived its impact. Results: Quantitative analysis showed a significant reduction in pain catastrophizing (B=?0.83, P<.001, d=?0.27), with greater decreases observed among participants with higher baseline scores ($\sigma$=?0.38; P=.09). No significant overall change was found in fear-avoidance beliefs (B=?0.35; P=.15), although individual trajectories varied ($\sigma${\texttwosuperior}=1.34; P=.04). Pain intensity also showed significant variability across participants ($\sigma${\texttwosuperior}=17.29; P=.03) despite no overall effect (B=?0.37; P=.67). No significant change was observed in the daily step count (B=107.50; P=.23). Qualitative analysis revealed that the effectiveness of the intervention was hindered by content and design choices that did not adequately account for diverse work settings and the busy lives of employees. Cognitive biases and nonsupportive work environments further complicated the successful implementation of the intervention in the workplace. Conclusions: This pilot study demonstrates the potential of an app-based intervention to support employees with musculoskeletal pain by reducing pain-related fear and promoting active coping strategies. While promising for some, digital interventions alone may be insufficient for employees with more complex needs. Blended approaches and integration within supportive workplace environments are likely essential to enhance effectiveness and promote sustainable work participation. ", doi="10.2196/67886", url="https://formative.jmir.org/2025/1/e67886" } @Article{info:doi/10.2196/66854, author="Lee, J. Jonathan and Patel, Devika and Gadgil, Meghana and Langness, Simone and von Hippel, Dagmar Christiana and Sammann, Amanda", title="Understanding Barriers to Home Safety Assessment Adoption in Older Adults: Qualitative Human-Centered Design Study", journal="JMIR Hum Factors", year="2025", month="Jun", day="24", volume="12", pages="e66854", keywords="human-centered design", keywords="fall prevention", keywords="home safety assessments", keywords="occupational therapy", keywords="aging in place", keywords="elderly", keywords="older adult", keywords="design", keywords="fall", keywords="home safety", keywords="safety", keywords="therapist", keywords="aging", keywords="perspectives", keywords="community-dwelling", keywords="development", keywords="qualitative research", keywords="qualitative data", keywords="semi-structured interviews", keywords="interview", keywords="occupational therapists", keywords="geriatricians", keywords="surgeons", abstract="Background: Falls are the leading cause of injury-related death among adults aged 65 and older. The fear of falling can further limit older adults' independence by contributing to activity restriction, social isolation, and physical decline---ironically increasing the risk of mechanical falls. Although home safety assessments have been shown to reduce fall risk by up to 36\% and decrease serious injuries such as hip fractures, their adoption remains low. Understanding the barriers to implementing these assessments is critical to improving their uptake and effectiveness. Objective: This study aimed to (1) identify specific barriers perceived by older adults in implementing home safety assessments and modifications to reduce the risk of mechanical falls, (2) explore the attitudes of health care professionals and other stakeholders toward these assessments, and (3) identify novel design opportunities to guide the development and implementation of more effective home safety assessment techniques and practices to reduce mechanical fall risk. Methods: This explanatory qualitative study drew on the ``inspiration'' phase of the human-centered design (HCD) research process. We conducted 35 interviews (28 initial and 7 follow-up) with 28 purposefully sampled participants in the San Francisco Bay Area between February and June 2021. Participants included community-dwelling older adults (n=3), geriatricians (n=4), therapists (n=6), product developers (n=2), older health researchers (n=8), and community program leaders (n=5). Interview notes were analyzed inductively by the research team to extract themes and generate insight statements and design opportunities. Results: Analysis yielded three key insights: (1) older adults often experience a conflict between maintaining independence and implementing safety modifications. One participant described living with a ``repeating mantra in my head throughout the day saying `above all, don't fall.''' (2) aesthetic and privacy concerns frequently override safety benefits. Participants rejected modifications that made their homes feel ``institutional.'' (3) access to occupational therapy services---already limited in rural areas---was further constrained by the COVID-19 pandemic, with some providers reporting that travel time ``took up the majority of their day just assessing one home.'' These barriers help explain the low adoption of home safety assessments despite strong supporting evidence. The study identified design opportunities to address these challenges, including customizable, user-friendly safety solutions, dignity-preserving approaches to assessment, and technology-enabled remote alternatives. Conclusions: This study identified specific emotional, aesthetic, logistical, and access-related barriers to the adoption of home safety assessments among older adults. The proposed design solutions offer promising directions to increase uptake, improve user experience, and enhance safety. However, further validation through co-design with a larger and more diverse group of older adults is needed. Future research should pilot test these ideas across varied contexts and evaluate their implementation and impact. ", doi="10.2196/66854", url="https://humanfactors.jmir.org/2025/1/e66854" } @Article{info:doi/10.2196/71924, author="C{\^o}t{\'e}, Jos{\'e} and Auger, Patricia and Chicoine, Gabrielle and Cheng, Jinghui and Cossette, Sylvie and Fontaine, Guillaume and Genest, Christine and Lal, Shalini and Lapierre, Judith and Pag{\'e}, Gabrielle M. and Maheu-Cadotte, Marc-Andr{\'e} and Rouleau, Genevi{\`e}ve and Vinette, Billy and Jutras-Aswad, Didier", title="A Mobile App (Joint Effort) to Support Cannabis Use Self-Management and Reinforce the Use of Protective Behavioral Strategies: Development Process and Usability Testing", journal="JMIR Form Res", year="2025", month="Jun", day="23", volume="9", pages="e71924", keywords="cannabis", keywords="intervention", keywords="mobile app", keywords="mHealth", keywords="self-management", keywords="young adults", keywords="students", keywords="development", keywords="usability", keywords="prototype", abstract="Background: Canada's legalization of recreational cannabis use (CU) has further highlighted the need for innovative interventions that promote lower-risk CU. Young adults aged 18-25 years represent the age group with the highest prevalence of CU. Protective behavioral strategies (PBSs) have been shown to help manage CU and reduce its negative consequences. To date, only a few interventions have focused on PBSs. To address this gap, a mobile app prototype using PBSs to influence CU was developed with and for young adults. Objective: This study aims to describe the development process and usability testing of Joint Effort, a CU self-management mobile app prototype centered on promoting the use of PBSs among young adults with any past 30-day CU. Methods: Intervention mapping (IM) and a co-design approach were used. Six steps were followed: (1) focus groups were conducted to identify needs and preferences regarding CU interventions; (2) a matrix of change objectives was used to select target behaviors and determinants; (3) theory-based intervention methods and practical applications were selected; (4) focus groups were held to validate the intervention structure and examples of tailored messages; (5) preliminary intervention content was created; and (6) the intervention content was transposed into a mobile app prototype. Usability was assessed through qualitative semistructured interviews and the User Version of the Mobile Application Rating Scale (uMARS), completed by a sample of 20 university students with a mean age of 21.8 (median 22) years, 14 (70\%) of whom were women and 15 (75\%) were undergraduates. Qualitative data were analyzed using thematic analysis. Results: Four themes were identified from the interviews: Joint Effort was visually pleasing and easy to use; the content was well-adapted to the target audience and nonjudgmental; customization functions were appreciated; and the app was perceived as helpful and relevant for initiating behavior change. The prototype received a mean quality score of 4.43/5.0 (SD 0.53) per item on the uMARS. The mean scores on the 5 subscales were as follows: engagement (4.14, SD 0.53), functionality (4.60, SD 0.47), aesthetics (4.53, SD 0.52), information quality (4.44, SD 0.61), and subjective quality (3.36, SD 0.53). Conclusions: Our findings highlight the added value of IM and a co-design approach, underscoring the importance of incorporating user feedback in the development of mobile apps. Building on the strong usability results, the Joint Effort prototype has since been developed into an iOS mobile app, and larger-scale evaluations are currently underway to assess its acceptability, feasibility, and efficacy. ", doi="10.2196/71924", url="https://formative.jmir.org/2025/1/e71924", url="http://www.ncbi.nlm.nih.gov/pubmed/40550117" } @Article{info:doi/10.2196/68195, author="Karlsson, {\AA}sa and S{\"o}nnerfors, Pernilla and Lundell, Sara and Toots, Annika and Wadell, Karin", title="Evaluation of a Novel eHealth Tool for Pulmonary Rehabilitation in People With Chronic Obstructive Pulmonary Disease: Randomized Controlled Pilot and Feasibility Trial", journal="JMIR Form Res", year="2025", month="Jun", day="23", volume="9", pages="e68195", keywords="chronic obstructive pulmonary disease", keywords="COPD", keywords="telerehabilitation", keywords="eHealth", keywords="usability testing", keywords="user-centered design", keywords="pulmonary rehabilitation", keywords="eHealth tool", keywords="feasibility trial", keywords="randomized controlled trial", keywords="RCT", abstract="Background: There is a growing interest in eHealth solutions to enhance access to and use of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). Objective: This study aims to evaluate the feasibility of a novel eHealth tool (Me\&COPD) to support pulmonary rehabilitation concerning usability, exercise adherence, intensity, progression, and adverse events. Moreover, this study aims to evaluate clinical outcome measures to prepare for a future larger trial. Methods: A multicenter, parallel-group randomized controlled pilot and feasibility trial was conducted in 6 primary health care centers. People with mild to severe COPD were recruited by physiotherapists at the included health care centers and randomized either to the intervention group with access to Me\&COPD for 3 months or to the control group receiving usual care. The Me\&COPD tool comprised audio-visual and written self-management strategies, including an individually tailored home-based exercise program and interaction with a physiotherapist. The exercise program was prescribed in a face-to-face meeting with a physiotherapist, and thereafter it was regularly reviewed and adjusted through the eHealth tool. The primary outcome, usability, was self-assessed at intervention completion in the intervention group and among participating physiotherapists (n=7) using the Swedish version of the Mobile Health App Usability Questionnaire (S-MAUQ). In addition, use data on exercise adherence, intensity, and progression and adverse events were exported from the eHealth tool. Clinical outcomes, assessed by blinded assessors at baseline and 3 months in the intervention and control groups, included exercise capacity, balance, physical activity level, COPD-related symptoms, and health-related quality of life. Descriptive statistics were used for analysis. Results: In total, 22 participants (women: n=12, 55\%), aged 72.3 (SD 8.4) years on average, were included in the intervention (n=15) and control (n=7) groups. The mean overall S-MAUQ scores out of 7 (highest possible usability) were 4.4 (SD 1.5) for participants and 4.5 (SD 1.2) for physiotherapists. Among the subscales, the highest score was assigned to usefulness among participants (S-MAUQ: mean 4.9, SD 1.3) and physiotherapists (S-MAUQ: mean 5.1, SD 1.7). No severe adverse events were registered, although exercise adherence, intensity, and progression evaluation were limited by incomplete exercise session registration. The test procedures and the clinical outcome measures used were found to be feasible for the participants and the assessors. Conclusions: The novel eHealth tool, Me\&COPD, seemed feasible in terms of safety and had acceptable usability among people with COPD and participating physiotherapists. Usability may be improved by better organization of the information and simplification of the exercise diary to enable collection of data on exercise adherence, intensity, and progression through the eHealth tool. The test procedures seemed feasible, although the recruitment process needs further consideration. The effectiveness of the intervention remains to be evaluated in a future larger trial. Trial Registration: ClinicalTrials.gov NCT05086341; https://clinicaltrials.gov/study/NCT05086341 ", doi="10.2196/68195", url="https://formative.jmir.org/2025/1/e68195", url="http://www.ncbi.nlm.nih.gov/pubmed/40550122" } @Article{info:doi/10.2196/68943, author="Sangngam, Jinnaphat and Rungamornrat, Somsiri and Santipipat, Rungnapa and Ponthanee, Kunchira", title="A Companion Robot for Children With Asthma: Descriptive Development and Feasibility Pilot Study", journal="JMIR Pediatr Parent", year="2025", month="Jun", day="23", volume="8", pages="e68943", keywords="companion robot", keywords="app", keywords="asthma", keywords="children", keywords="caregiver", keywords="model", abstract="Background: Consistent medication use and proper inhaler technique are essential in pediatric asthma, and young children require supportive tools to maintain these practices. Objective: This study aimed to investigate the caregivers' ability to use a companion robot--assisted app for children with asthma, their attitudes toward the usage, and the characteristics that hinder or facilitate the implementation. Methods: This study employed a descriptive design. The sample group consisted of 30 children with asthma aged 3?6 years who received treatment at an asthma clinic and their caregivers. The companion robot for children with asthma called ``Pukkabot,'' which is an innovation that is developed to teach inhalation techniques and to raise awareness about consistent medication administration through positive reinforcement, was examined. Data collection included personal information questionnaires, the System Usability Scale (SUS) for evaluating usage and overall satisfaction, and interviews to gather attitudes toward apps and characteristics that hinder or facilitate. Data were analyzed with descriptive statistics and content analysis. Results: The study revealed that the scores for usability and overall satisfaction were 80.6, which is above the standard threshold and rated at grade A or an excellent level. Additionally, caregivers stated that the companion robots were easy to use, not complicated, had appropriately sized screens, and demonstrated clear images and sounds. The detailed steps for inhalation were exhibited, and reminders included those of medication times. The children with asthma enjoyed the app and were very interested, making most caregivers want to continue their use. Conclusions: Caregivers were generally satisfied with the usability, finding it easy to use and engaging, which successfully attracted the interest of the children with asthma. Therefore, the companion robot may be used further, with the following recommendations: improving its physical design, adding content, incorporating tracking and symptom assessment systems, and creating a downloadable mobile app for greater accessibility and convenience. Trial Registration: Thai Clinical Trials Registry TCTR20240912001; https://www.thaiclinicaltrials.org/show/TCTR20240912001 ", doi="10.2196/68943", url="https://pediatrics.jmir.org/2025/1/e68943" } @Article{info:doi/10.2196/63733, author="Bayor, A. Andrew and Li, Jane and Yang, A. Ian and Varnfield, Marlien", title="Designing Clinical Decision Support Systems (CDSS)---A User-Centered Lens of the Design Characteristics, Challenges, and Implications: Systematic Review", journal="J Med Internet Res", year="2025", month="Jun", day="20", volume="27", pages="e63733", keywords="design", keywords="user-centered design", keywords="design challenges", keywords="emerging technologies", keywords="systematic review", keywords="integration", keywords="artificial intelligence", keywords="explainable AI", keywords="usability evaluation", keywords="design implications", keywords="implementation", keywords="clinical decision support system", keywords="CDSS", keywords="clinicians", keywords="health care delivery", keywords="diagnostics", keywords="medical conditions", keywords="patient-clinician", keywords="fast healthcare interoprabiliity resource", keywords="FHIR", keywords="electronic health records", keywords="EHRs", keywords="electronic medical records", keywords="EMRs", abstract="Background: Clinical decision support systems (CDSS) have the potential to play a crucial role in enhancing health care quality by providing evidence-based information to clinicians at the point of care. Despite their increasing popularity, there is a lack of comprehensive research exploring their design characterization and trends. This limits our understanding and ability to optimize their functionality, usability, and adoption in health care settings. Objective: This systematic review examined the design characteristics of CDSS from a user-centered perspective, focusing on user-centered design (UCD), user experience (UX), and usability, to identify related design challenges and provide insights into the implications for future design of CDSS. Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations and used a grounded theory analytical approach to guide the conduct, data analysis, and synthesis. A search of 4 major electronic databases (PubMed, Web of Science, Scopus, and IEEE Xplore) was conducted for papers published between 2013 and 2023, using predefined design-focused keywords (design, UX, implementation, evaluation, usability, and architecture). Papers were included if they focused on a designed CDSS for a health condition and discussed the design and UX aspects (eg, design approach, architecture, or integration). Papers were excluded if they solely covered technical implementation or architecture (eg, machine learning methods) or were editorials, reviews, books, conference abstracts, or study protocols. Results: Out of 1905 initially identified papers, 40 passed screening and eligibility checks for a full review and analysis. Analysis of the studies revealed that UCD is the most widely adopted approach for designing CDSS, with all design processes incorporating functional or usability evaluation mechanisms. The CDSS reported were mainly clinician-facing and mostly stand-alone systems, with their design lacking consideration for integration with existing clinical information systems and workflows. Through a UCD lens, four key categories of challenges relevant to CDSS design were identified: (1) usability and UX, (2) validity and reliability, (3) data quality and assurance, and (4) design and integration complexities. Notably, a subset of studies incorporating Explainable artificial intelligence highlighted its emerging role in addressing key challenges related to validity and reliability by fostering explainability, transparency, and trust in CDSS recommendations, while also supporting collaborative validation with users. Conclusions: While CDSS show promise in enhancing health care delivery, identified challenges have implications for their future design, efficacy, and utilization. Adopting pragmatic UCD design approaches that actively involve users is essential for enhancing usability and addressing identified UX challenges. Integrating with clinical systems is crucial for interoperability and presents opportunities for AI-enabled CDSS that rely on large patient data. Incorporating emerging technologies such as Explainable Artificial Intelligence can boost trust and acceptance. Enabling functionality for CDSS to support both clinicians and patients can create opportunities for effective use in virtual care. ", doi="10.2196/63733", url="https://www.jmir.org/2025/1/e63733" } @Article{info:doi/10.2196/67398, author="Bakula, M. Dana and Zax, Alexandra and Edwards, Sarah and Nash, Kristina and Escobar, April and Graham, Rachel and Ricketts, Amy and Thompson, Ryan and Bullard, Sarah and Brogren, Julianne and Shimmens, Leah and Erickson, A. Lori", title="Applying the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework to Adapt the CHAMP App for Pediatric Feeding Tube Weaning: Application and Case Report", journal="JMIR Form Res", year="2025", month="Jun", day="16", volume="9", pages="e67398", keywords="gastric feeding tubes", keywords="mobile applications", keywords="interdisciplinary communication", keywords="feeding and eating disorders of childhood", keywords="case report", abstract="Background: Evidence-based tube feeding (TF) weaning involves reducing the volume of tube feeds to induce hunger, with interdisciplinary monitoring to allow for proactive medical, nutritional, and behavioral intervention as needed. This can be done outpatient; however, the current standard of care requires a high degree of medical monitoring and care coordination, which can be challenging to implement. The CHAMP App is a mobile app designed for remote patient monitoring of children born with congenital heart conditions who are at high risk for medical morbidity and mortality. The CHAMP App remote patient monitoring program would be ideally suited to improve medical monitoring and care coordination. Objective: This study aims to determine the feasibility of adapting the CHAMP App for children ready to wean from TF. Methods: We used the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as a formative tool and conducted a case study beta test. Results: The level of complexity for the digital innovation's adaptation supported a high likelihood of success for the TF population. Most issues were simple, such as expanding the types of data that could be entered into the app, and some were more complicated, for instance, training all relevant staff to use and maintain the technology. The case study beta test was conducted with ``Greyson'', a 10-month old child weaning from TF (name changed for confidentiality). Once a week, the team reviewed the parent-entered data and communicated with Greyson's parents, recommending a 25\% reduction in tube feeding each week. With the CHAMP App facilitating 2-way communication between the family and the team, Greyson successfully transitioned from receiving 30\% of his feeds orally and 70\% via tube feeding to 100\% oral feedings over the course of 1 month in a home setting. Conclusions: The CHAMP App is likely to be incredibly valuable in TF weaning. The NASSS framework helped identify key considerations for adapting the CHAMP App for TF weaning at a Midwestern children's hospital. Interviews with the health care team highlighted issues like data entry expansion and staff training. The framework confirmed TF weaning as a suitable application with no major barriers. The CHAMP App successfully supported a test patient, Greyson, in weaning from his feeding tube. It may improve access, communication efficiency, and satisfaction among families and health care teams while reducing costs and enhancing safety monitoring. The app could also make TF weaning more accessible to families with lower health literacy. ", doi="10.2196/67398", url="https://formative.jmir.org/2025/1/e67398" } @Article{info:doi/10.2196/68689, author="Stevens, R. Elizabeth and Alfaro Arias, Veronica and Luu, Son and Lawrence, Katharine and Groom, Lisa", title="Technology Integration to Support Nurses in an ``Inpatient Room of the Future'': Qualitative Analysis", journal="J Med Internet Res", year="2025", month="Jun", day="16", volume="27", pages="e68689", keywords="nursing clinical workflows", keywords="patient room design", keywords="user-centered design", keywords="health information technology", keywords="digital health", keywords="built environment", keywords="technology integration", keywords="human-centered design", abstract="Background: The design and integration of technology within inpatient hospital rooms has a critical role in supporting nursing workflows, enhancing provider experience, and improving patient care. As health care technology evolves, there is a need to design ``future-proofed'' physical environments that integrate technology in ways that support workflows and maintain clinical performance. Assessing how current technologies affect nursing workflows can help inform the development of these future environments. Objective: We assessed the current challenges nursing staff face in inpatient rooms, gather insights on technology, and build environment interactions to envision the design of a technology-integrated ``Inpatient Room of the Future.'' Methods: A qualitative study was conducted involving semistructured interviews, shadowing, and focus groups among nursing staff in the inpatient setting. Methods including horizon scanning, scenario analysis, technology assessment, and backcasting facilitated a comprehensive qualitative analysis of current technology use and needs in inpatient nursing workflows to inform exploratory design considerations for technology-integrated envisioned futures solutions. Results: In total, 26 nursing staff across 4 inpatient hospital units participated in this study. Analysis identified four major themes considered central to designing a technology-integrated inpatient room that enhances nursing workflow and experience: (1) the need for seamless integration of technologies advocating for a unified system that minimizes fragmented technology use and enhances efficiency; (2) the potential for technology to reduce cognitive load, alleviate mental strain, and streamline complex workflows; (3) a focus on enhancing interpersonal communication with specific emphasis on tools that facilitate clear and efficient communication among clinicians and with patients; and (4) the importance of improved staff well-being with design considerations aimed at promoting both physical and mental health for health care workers in the inpatient setting. Envisioned future solutions included enhanced patient monitoring with automated measurements and actions through computer vision and data triangulation, a smart electronic health record--integrated supply management system using computer vision to detect supply shortages and auto-delivery of needed supplies, and a personal tech smart assistant capable of real-time patient monitoring and escalation, task prioritization, and hands-free clinical documentation and communication. Conclusions: While current technologies address specific tasks, there are significant opportunities for better technology integration, reducing cognitive load, enhancing communication, and promoting the physical and mental well-being of nursing staff. Future research should focus on seamless technology integration aligned with clinical workflows and implementing supportive technologies that do not interfere with clinician judgment and critical thinking. Policy recommendations include oversight mechanisms for evaluating artificial intelligence--enabled devices, safeguarding patient information, and ensuring nurses are actively involved at every stage of technology development and implementation. Future inpatient unit designs should actively engage input from both nursing professionals and technologists in developing future-proofed clinical spaces to ensure the creation of integrated systems that foster a cohesive and harmonious user experience. ", doi="10.2196/68689", url="https://www.jmir.org/2025/1/e68689", url="http://www.ncbi.nlm.nih.gov/pubmed/40522717" } @Article{info:doi/10.2196/71493, author="Yoshino, Yusuke and Kimura, Yoshitaka and Wakabayashi, Yoshitaka and Kitazawa, Takatoshi", title="Feasibility of an Electronic Patient-Reported Outcome System in People Living With HIV: Retrospective Analysis of a Mobile App-Based Pilot Study", journal="JMIR Form Res", year="2025", month="Jun", day="10", volume="9", pages="e71493", keywords="patient reported outcome", keywords="smartphone app", keywords="quality of life", keywords="feasibility test", keywords="electronic patient reported outcome", abstract="Background: Advances in antiretroviral therapy have transformed HIV into a manageable chronic condition, allowing people living with HIV to live longer. However, with aging, people living with HIV face increased risks of lifestyle-related diseases and unaddressed psychosocial issues, including stigma, discrimination, and mental health concerns. Patient-reported outcomes are essential tools in person-centered care and have demonstrated clinical utility in oncology and rheumatology; yet remains underutilized in infectious disease settings. Recently, the European AIDS Clinical Society has recommended electronic patient-reported outcome (ePRO) systems to support HIV care. Objective: This study aimed to evaluate the feasibility and clinical utility of a smartphone-based ePRO system specifically developed for people living with HIV in Japan. Methods: A retrospective study was conducted among people living with HIV who attended the HIV outpatient clinic at Teikyo University Hospital between July and September 2022. Participants who consented to use the ePRO system installed a smartphone app and completed the HIV symptom index prior to their clinic visit. Physicians reviewed the responses during consultations; following the visits, patients completed a usability survey addressing clarity, response time, satisfaction, communication quality, and intention for future use. Medical records were reviewed to determine any new symptoms, findings, or medical actions that had not been documented in the previous two years. Results: A total of 27 people living with HIV (median age, 46 years; 100\% male) used the ePRO app, and 25 (93\%) completed the postuse questionnaire. Of these, 19/25 (76\%) completed the Symptom Index within 5 minutes, while one participant required more than 15 minutes. Regarding usability, 76\% (n=19) reported being satisfied or very satisfied, and 76\% (n=19) found the system useful in improving communication with their provider. Additionally, 76\% (n=19) expressed willingness to use the system again, while 5 (20\%) participants indicated interest only if improvements were made. Medical record analysis revealed that 17/27 patients (63\%) had new clinical information documented, including mental health symptoms (n=7, 26\%), skin problems (n=7, 26\%), and new diagnoses or treatment changes in 6 (22\%) cases. Over 40\% (n=11) of patients reported issues such as anxiety, insomnia, dermatological symptoms, or concerns related to body image. Conclusions: This pilot study demonstrated that a smartphone-based ePRO system for people living with HIV is feasible and well-accepted in real-world clinical practice. It facilitated early detection of psychosocial and physical issues that may otherwise be overlooked in routine care and improved patient--provider communication. These findings support the integration of ePRO systems into HIV care and underscore the need for further refinement of the app and prospective studies to assess long-term impact on patient outcomes and quality of care. ", doi="10.2196/71493", url="https://formative.jmir.org/2025/1/e71493" } @Article{info:doi/10.2196/67906, author="Cronin, M. Robert and Quaye, Nives and Liu, Xin and Landes, Kristina and Crosby, E. Lori and Kassim, A. Adetola and DeBaun, R. Michael and Schnell, M. Patrick", title="Usage of a Multipurpose mHealth App Among Adults With Sickle Cell Disease: Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Jun", day="5", volume="9", pages="e67906", keywords="sickle cell disease", keywords="mHealth", keywords="patient engagement", keywords="hospitalizations", keywords="consumer health informatics", keywords="guidelines", abstract="Background: While mobile health (mHealth) apps have been made for various diseases, including sickle cell disease (SCD), most focus on a single purpose. SCD is a chronic disease that requires knowledge of the disease, self-management, and adherence to treatment plans. While mHealth apps have been made with single features for SCD, there is limited understanding of using an mHealth app with a more comprehensive set of features that could engage adults with SCD, depending on what features they prefer and need to engage and empower them in living with their disease. Objective: We evaluated the usage of an mHealth app with various features, including pain tracking, quizzes for patient-facing guidelines, pain and asthma action plans, and goal setting. Methods: Adults with SCD were enrolled at 2 sickle cell centers between 2018 and 2022 as part of a 6-month feasibility randomized controlled trial with participants completing surveys at baseline and 6 months. Participants were randomized into receiving either an mHealth app and booklet with patient-facing guidelines or a booklet with the guidelines alone. The mHealth app comprised web pages with patient-facing guideline material and a Research Electronic Data Capture (REDCap) project. The REDCap project included a personal profile, a pain tracker, goal setting, quizzes about the guidelines, and pain or asthma action plans. The REDCap project also included the ability to send daily text messages at a time they chose, which contained a message they could create and a link to their profile. Outcomes included SCD-specific knowledge and acute health care utilization (emergency room visits and hospitalizations). We evaluated the usage of these different features and relationships with baseline variables, each other, and study outcomes. Results: Approximately 75\% (50/67) of the enrolled and randomized participants completed all the study components, and 100\% (26/26) of the participants who were randomized to the mHealth app arm and completed the study used the mHealth app. Further, 15/30 (50\%) participants used multiple features. Baseline sickle cell knowledge and female gender were associated with more usage of pain diary (P=.04) and mission (P=.046) features, respectively. While not significant, mission completion was associated with lower hospitalizations (P=.06). Conclusions: Adults with SCD engaged differently with an mHealth app with multiple features. As this study was not focused on one part of our app, engagement with features in this app was entirely patient-driven, which may demonstrate the expected real-world use of an mHealth app in this population. A multipurpose app can help engage participants in self-management strategies through different features and potentially improve outcomes. Trial Registration: ClinicalTrials.gov NCT03629678; https://tinyurl.com/3wx5en5r ", doi="10.2196/67906", url="https://formative.jmir.org/2025/1/e67906" } @Article{info:doi/10.2196/68580, author="Dutta, Anirban and Hatjipanagioti, Katerina and Newsham, Alexander Matthew and Leyland, Lewis and Rickson, Lindsey and Buchanan, Alastair and Farkhatdinov, Ildar and Twamley, Jacqueline and Das, Abhijit", title="Extended Reality Biofeedback for Functional Upper Limb Weakness: Mixed Methods Usability Evaluation", journal="JMIR XR Spatial Comput", year="2025", month="Jun", day="3", volume="2", pages="e68580", keywords="extended reality", keywords="haptics", keywords="functional neurological disorder", keywords="biofeedback", keywords="usability", keywords="co-design", keywords="System Usability Scale", abstract="Background: The perception--action cycle enables humans to adapt their behaviors by integrating sensory feedback into motor actions. Functional neurological disorder (FND) disrupts this cycle, leading to maladaptive motor responses and a diminished sense of agency. FND includes functional seizures, movement disorders, and cognitive impairments, significantly affecting quality of life. Recent advancements in extended reality (XR) neurotechnologies provide opportunities for novel rehabilitation approaches, leveraging visual and haptic feedback to retrain motor control and restore agency in individuals with functional limb weakness. Objective: This study aimed to co-design and evaluate an XR-based biofeedback platform for upper-limb rehabilitation in FND, incorporating multisensory feedback (visual and haptic) to enhance motor retraining. Methods: A mixed methods design was used. In phase 1, a Delphi survey (N=20, patients with FND) identified key user requirements, emphasizing customizability, real-time feedback, accessibility, and comfort. These insights guided the codevelopment of an XR biofeedback platform. In phase 2, a co-design workshop with 6 participants (3 FND patient representatives and 3 health care professionals) evaluated the usability of 3 XR training tasks: virtual reality (VR) relaxation task, a guided meditation in a VR calming environment; XR position feedback task (``Hoop Hustle''), a VR-based motion task requiring arm movements to interact with virtual objects, providing real-time positional biofeedback; and XR force feedback task, a haptic robot-assisted exercise using the Human Robotix System (HRX-1) haptic device, applying resistive forces to guide upper limb movements. Participants completed system usability scale (SUS) questionnaires and provided qualitative feedback, which was analyzed using NVivo (QSR International) thematic analysis. Results: The XR position feedback task achieved the highest usability ratings, with 4 out of 6 participants scoring it above 85, indicating ``excellent'' usability. The VR relaxation task received polarized scores: 2 participants rated it highly (90 and 87.5), while 3 scored it poorly (mid-40s), citing motion discomfort and disengagement. The XR force feedback task had mixed usability outcomes (SUS range: 27.5?95.0), with 1 participant with functional dystonia struggling significantly (SUS 27.5), while others rated it between 62.5 and 95.0. Qualitative feedback emphasized comfort (lighter headsets and better ergonomic design), immersion and content quality (clearer visuals and reduced distracting audio prompts), personalization (adjustable settings for speed, difficulty, and force resistance), and accessibility (cost concerns and home usability considerations). Overall, participants viewed the XR biofeedback platform as highly promising but in need of fine-tuning. Conclusions: This study demonstrates the feasibility and usability of an XR neurotechnology platform for FND rehabilitation, with strong acceptance of XR position feedback, mixed reactions to VR relaxation, and individual-specific usability outcomes for the force feedback task. Findings underscore the need for personalization features and hardware refinement. Future work will focus on enhancing usability, improving accessibility, and evaluating effectiveness in larger clinical trials. ", doi="10.2196/68580", url="https://xr.jmir.org/2025/1/e68580" } @Article{info:doi/10.2196/60607, author="Hong, Seojin and Choi, Hyun and Kweon, Hyosun", title="Usability Evaluation of an Electrically Powered Orthopedic Exerciser: Focus Group Interview and Satisfaction Survey Study", journal="JMIR Hum Factors", year="2025", month="May", day="30", volume="12", pages="e60607", keywords="usability evaluation", keywords="usability", keywords="electrically powered orthopedic exerciser", keywords="focus group interview", keywords="satisfaction survey", abstract="Background: Musculoskeletal disorders significantly impair physical function and quality of life, necessitating systematic rehabilitation. Electrically powered orthopedic exercisers, such as continuous passive motion devices, are widely used to enhance joint mobility and muscle recovery. However, existing devices often lack advanced functionalities and user-specific adaptability, limiting their effectiveness. To address these shortcomings, the Rebless Pro was developed as a novel device supporting active and passive exercises with personalized treatment programs. Objective: This study aimed to conduct a formative usability evaluation of the Rebless Pro prototype using focus group interviews (FGIs) and satisfaction surveys with health care professionals specializing in rehabilitation medicine. The goal was to identify areas for improvement to enhance the safety, usability, and information clarity of the device. Methods:: Usability evaluation was performed at the National Rehabilitation Center with 10 participants (5 physiatrists and 5 physical therapists) who had prior experience using similar devices. FGIs were conducted to collect qualitative insights into user experiences, while satisfaction surveys provided quantitative data on ease of use of the user interface and identifiability and understanding of information. Data collection focused on identifying risk factors and usability challenges. Results: Three key areas for improvement were identified: (1) product upgrades to ensure patient safety, including adjustments to exercise speed and resistance; (2) hardware and software improvements to improve usability, including adjustments to the location of the emergency button and improvements to the graphical user interface elements; and (3) improvements to the user manual, including detailed contraindications, patient criteria, and clearer operating instructions. Although the mean score of physiatrists (mean 4.463, SD 0.298) was higher than that of physical therapists (mean 4.114, SD 0.829) in terms of the ease of use of the user interface, the difference was not statistically significant (P=.69). Similarly, in the category of identifiability and understanding of information, higher scores were again reported by physiatrists (mean score 4.467, SD 0.506) than by physical therapists (mean 3.733, SD 0.894), but this difference was also not statistically significant (P=.22). Conclusions: Usability evaluation provided actionable insights into improving the Rebless Pro's safety, usability, and information clarity. To further refine the device, iterative usability evaluations involving both health care professionals and patients are recommended. These efforts are expected to contribute to the development of a safe, effective, and user-friendly electrically powered orthopedic exerciser suitable for commercialization. ", doi="10.2196/60607", url="https://humanfactors.jmir.org/2025/1/e60607" } @Article{info:doi/10.2196/62926, author="Turner, Jessica and Stawarz, Katarzyna", title="Understanding Device Integrations Within Diabetes Apps: Mixed Methods Analysis of App Features and User Reviews", journal="JMIR Diabetes", year="2025", month="May", day="27", volume="10", pages="e62926", keywords="diabetes mellitus", keywords="health apps", keywords="mHealth", keywords="mobile health", keywords="mobile apps", keywords="self-management", keywords="user experience", abstract="Background: Diabetes management involves a large degree of data collection and self-care in order to accurately administer insulin. Several mobile apps are available that allow people to track and record various factors that influence their blood sugar levels. Existing diabetes apps offer features that enable integrations with various devices that streamline diabetes management, such as continuous glucose monitors, insulin pumps, or regular activity trackers. While this reduces the tracking burden on the users, the research highlighted several issues with diabetes apps, including issues with reliability and trustworthiness. As pumps and continuous glucose monitors are safety-critical systems---where issues can result in serious harm or fatalities---it is important to understand what issues and vulnerabilities could be introduced by relying on popular diabetes apps as an interface for interacting with such devices. Objective: As there is a lack of research examining in detail the integrations and potential suitability of apps as part of a wider self-management ecosystem, our goal was 2-fold. First, we aimed to understand the current landscape of device integrations within diabetes apps and how well they meet users' needs. Second, we identified the key issues users of the most popular apps face currently and what features are the source of these issues. Methods: Through searches in Android and iPhone app stores, we systematically identified 21 diabetes apps that offer integrations. We conducted a detailed analysis of 602 user reviews. For each review, we recorded its sentiment, features and issues, and additional contextual information provided by the review writers. We used descriptive statistics to analyze the features and issues. We also analyzed the reviews thematically to identify additional trends related to the context of use and the consequences of issues reported by the users. Results: The reviews focused on key features that users found the most important, including device integrations (n=259, 43\%), tracking (n=194, 32.2\%), data logging (n=86, 14.3\%), and notifications (n=70, 11.6\%). We found that 327 (54.3\%) of the reviews were negative versus 187 (31.1\%) positive and 88 (14.6\%) neutral or mixed, and the majority of reviews (n=378, 62.8\%) mentioned issues. The biggest issues related to device integrations included inability to connect with external devices (n=95, 25.1\%), inability to store, manage, or access data (n=49, 22\%), unreliable notifications and alerts (n=35, 9.2\%), issues caused by or related to software updates (n=31, 8.5\%), hardware issues (n=24, 6.4\%), and issues with accessing the app, related services, or associated hardware (n=12, 3.2\%). Conclusions: Apps for diabetes management are a useful part of self-care only if they are reliable and trustworthy, reduce burden, and increase health benefits. Our results provide a useful overview of desired features for diabetes apps alongside key issues for existing integrations and highlight the future challenges for artificial pancreas system development. ", doi="10.2196/62926", url="https://diabetes.jmir.org/2025/1/e62926" } @Article{info:doi/10.2196/53617, author="Harris, Richard and Murray, Deirdre and McSweeney, Angela and Adam, Frederic", title="Clinician-Focused Connected Health Requirements Gathering for Attention-Deficit/Hyperactivity Disorder Through Clinical Journey Mapping: Design Science Study", journal="JMIR Form Res", year="2025", month="May", day="26", volume="9", pages="e53617", keywords="connected health", keywords="ADHD", keywords="Dundee clinical care pathway", keywords="integrated patient journey mapping tool", keywords="neurodevelopmental", keywords="design science", keywords="journey", keywords="map", keywords="mapping", keywords="diagram", keywords="visualization", keywords="attention deficit", keywords="information system", keywords="care pathway", keywords="design", keywords="implementation", keywords="integration", keywords="attention-deficit/hyperactivity disorder", abstract="Background: Many health care systems globally face severe capacity issues, with lengthening waiting lists and stretched resources. Connected health has been proposed as a game changer for health care. However, the development of connected health apps is difficult and requires multidisciplinary development teams. Patient journey mapping presents an opportunity to streamline the requirements-gathering process for such apps by clearly showing the patient journey to team members who are not familiar with relevant clinical practices. This research project focuses on attention-deficit/hyperactivity disorder (ADHD) as a case study for using clinical journey mapping to represent the ``gold standard'' care pathway for ADHD treatment; the Dundee Clinical Care Pathway. This pathway was analyzed in detail and was further explored in discussions with stakeholders to produce a patient journey map. Objective: The objective of this paper is to answer three research questions: (1) visualizing the Dundee ADHD clinical care pathway using integrated patient journey mapping and exploring how its use benefits multidisciplinary development teams; (2) optimizing the integrated patient journey map arising from the Dundee Clinical Care Pathway, in line with the underlying clinical realities of Child and Adolescent Mental Health Service in Ireland; and (3) proposing areas where connected health integration can deliver efficiency and substantial gains for Child and Adolescent Mental Health Services. Methods: This study uses a design science approach where a sample artifact is presented to a relevant audience for review and feedback and is then leveraged to work iteratively toward an improved, final artifact. This paper presents the feedback collected from both information systems and clinical professionals at each iteration of the map. Results: This research delivers a comprehensive clinical patient journey map based on the Dundee clinical care pathway. Using unified modeling language concepts and color coding, multiple patient personas are mapped onto a streamlined diagram, allowing the diagram, at an abstract level, to cover the most typical clinical scenarios. Conclusions: Clinical journey mapping provides a way for team members to get up to speed on clinical practices, while also presenting a way for development teams to identify key gaps where connected health systems can be embedded in clinical pathways to optimize the use of clinical resources and ultimately deliver better patient outcomes. ", doi="10.2196/53617", url="https://formative.jmir.org/2025/1/e53617" } @Article{info:doi/10.2196/65759, author="Fosbrooke, Vera and Riguzzi, Marco and Raab, M. Anja", title="Stakeholders and Contextual Factors in the Implementation of Assistive Robotic Arms for Persons With Tetraplegia: Deductive Content Analysis of Focus Group Interviews", journal="JMIR Rehabil Assist Technol", year="2025", month="May", day="16", volume="12", pages="e65759", keywords="assistive technologies", keywords="robotic arm", keywords="implementation", keywords="barriers", keywords="facilitators", keywords="Consolidated Framework for Implementation Research", abstract="Background: Tetraplegia imposes significant challenges on affected individuals, caregivers, and health care systems. Assistive technologies (ATs) such as assistive robotic arms have been shown to improve the quality of life of persons with tetraplegia, fostering independence in daily activities and reducing caregiver burden. Despite potential benefits, the integration of AT innovations into daily life remains difficult. Implementation science offers a systematic approach to bridge this know-do gap. Objective: This study aimed to (1) identify and involve relevant stakeholders; (2) identify relevant contextual factors (barriers and facilitators); and (3) suggest a general outlook for the implementation of AT, specifically an assistive robotic arm, into the everyday private lives of individuals with tetraplegia in Switzerland. Methods: A qualitative design was used, involving 3 semistructured online focus group interviews with 8 stakeholder groups, including persons with tetraplegia as well as those who could provide perspectives on engineering or technology, legal matters, nursing or care, therapy, social counseling, social insurance, and political considerations. The interviews were analyzed using the Focus Group Illustration Mapping tool, and the data were aligned with the domains of the Consolidated Framework for Implementation Research. Results: 3 focus group interviews comprising 22 participants were conducted, and data were mapped onto 21 constructs across the Consolidated Framework for Implementation Research domains. Identified barriers were customization to users' needs, safety concerns, and financing issues for the high AT costs. The collaboration with different stakeholders, including those who provided perspectives on political engagement, proved crucial. Identified facilitators included the enhancement of autonomy for persons with tetraplegia, improvement of quality of life, reduction of caregiver dependency, and addressing health care labor shortages. The implementation outlook involved the formation of an experienced team and the development of an implementation plan using hybrid type 1 and type 2 designs that incorporate both qualitative and quantitative implementation and innovation outcomes. Conclusions: Robotic arms offer promising benefits in terms of improved participation for users, while high costs and regulatory complexities as to who will assume these costs limit their implementation. These findings highlight the complexities involved in implementing AT innovations and the importance of addressing contextual factors. A specific framework for the implementation of AT is needed to ensure the successful integration in Switzerland and other countries with comparable social and health insurance systems. ", doi="10.2196/65759", url="https://rehab.jmir.org/2025/1/e65759", url="http://www.ncbi.nlm.nih.gov/pubmed/40378404" } @Article{info:doi/10.2196/56282, author="Trieu, Phillip and Fetzer, Dominique and McLeod, Briana and Schweickert, Kathryn and Gutstein, Lauren and Egleston, Brian and Domchek, Susan and Fleisher, Linda and Wagner, Lynne and Wen, Kuang-Yi and Cacioppo, Cara and Ebrahimzadeh, E. Jessica and Falcone, Dana and Langer, Claire and Wood, Elisabeth and Karpink, Kelsey and Posen, Shelby and Selmani, Enida and Bradbury, R. Angela", title="Developing the MyCancerGene Digital Health Portal to Improve Patients' Understanding of Germline Cancer Genetic Test Results: Development, User, and Usability Testing Study", journal="JMIR Form Res", year="2025", month="May", day="14", volume="9", pages="e56282", keywords="genetic health portal", keywords="digital intervention development", keywords="health portal", keywords="usability", keywords="digital health", keywords="germline cancer", keywords="multigene panels", keywords="clinical practice", keywords="likelihood", keywords="effectiveness", keywords="medical history", keywords="genetic medicine", keywords="risk information", keywords="digital tool", keywords="intervention", keywords="longitudinal care", keywords="patient-centered content", keywords="electronic information", abstract="Background: The use of multigene panels has significantly increased the likelihood that genetic testing will leave patients with uncertainties regarding test interpretation, implications, and recommendations, which will change over time. Effective longitudinal care models are needed to provide patients with updated information and to obtain patient and family history updates. Objective: To bridge this gap, we aimed to develop a patient- and genetic provider--informed digital genetic health portal (GHP), MyCancerGene, to improve longitudinal patient understanding of and responses to genetic testing. Methods: We used a 5-step process to develop MyCancerGene. To better understand their interest in and willingness to use a digital GHP, we surveyed 307 patients who completed genetic testing (step 1). We completed qualitative interviews with 10 patients and a focus group with 17 genetic providers to inform the content and function of MyCancerGene (step 2). Next, we developed initial intervention content (step 3) and completed user testing of intervention content with 25 providers and 28 patients (step 4). After developing the prototype intervention, we completed usability testing with 8 patients for their feedback on the final content, functions, and ease of use (step 5). Results: In surveys conducted in step 1, 90\% of patients with positive results reported interest in a digital GHP, and over 75\% of participants with variants of uncertain significance or uninformative negative results reported similar interest. The most frequently reported advantages among patients were increasing accessibility, convenience, and efficiency (103/224, 46\%); keeping genetic information organized (54/224, 24.1\%); and increasing or maintaining patient understanding of the information (38/224, 17\%). In qualitative interviews (step 2), both patients and genetic providers endorsed the benefit of the tool for updating personal and family history and for providers to share new risk information, test interpretation, or other medical changes. Patient and provider input informed eight key components of the tool: (1) Landing Page, (2) Summary of Care page, (3) My Genetic Test Results page, (4) My Family History page, (5) Provide an Update page, (6) Review an Update page, (7) Resources page, and (8) the Screenings Tracker. They also recommended key functions, including the ability to download and print materials and the inclusion of reminders and engagement functions. Potential challenges identified by patients included privacy and security concerns (67/206, 32.5\%) and the potential for electronic information to generate distress (20/206, 9.7\%). While patients were comfortable with updates (ie, even variant reclassification upgrades or clinically significant results), 44\% (11/25) of genetic providers were uncomfortable sharing variant reclassification upgrades through MyCancerGene. Conclusions: MyCancerGene, a patient-centered digital GHP, was developed with extensive patient and genetic provider feedback and designed to enhance longitudinal patient understanding of and affective and behavioral responses to genetic testing, particularly in the era of evolving evidence and risk information. ", doi="10.2196/56282", url="https://formative.jmir.org/2025/1/e56282" } @Article{info:doi/10.2196/70628, author="Zargham, Nima and Reinschluessel, V. Anke and M{\"u}hlenbrock, Andre and Muender, Thomas and Cetin, Timur and Uslar, Nicole Verena and Weyhe, Dirk and Malaka, Rainer and D{\"o}ring, Tanja", title="Using Gesture and Speech to Control Surgical Lighting Systems: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="May", day="12", volume="12", pages="e70628", keywords="speech interaction", keywords="gesture recognition", keywords="operating theater", keywords="surgical lighting systems", keywords="smart lighting", keywords="artificial intelligence", abstract="Background: Surgical lighting systems (SLSs) provide optimal lighting conditions for operating room personnel. Current systems are mainly adjusted by hand; surgeons either accommodate the light themselves or communicate their requirements to an assistant to ensure optimal surgical conditions. This poses challenges to maintaining sterility, proper accessibility, and illumination and can lead to potential collision problems. Furthermore, the personnel operating the light may not have deep medical knowledge or equipment expertise. Objective: This paper introduces a touch-free interaction concept for controlling an SLS using speech and gestures. Methods: We used an iterative, user-centered design approach with participatory design sessions. This process involved conducting a literature review, several observations of actual surgical sites, and engaging stakeholders through interviews and focus groups. In addition, we carried out 2 user studies: one in a virtual reality setup and another in a living laboratory environment. Results: Our findings indicate that our interaction concept is a viable alternative for controlling an SLS. Despite some technical limitations, surgical experts found the system intuitive and useful, recognizing the significant potential for touch-free lighting adjustments in the operating room. The combination of speech and gesture modalities was seen as helpful and even necessary, with some interactions better suited to one modality over the other. Offering both modalities for each interaction provided greater flexibility. Conclusions: Our findings suggest that our proposed touch-free interaction concept can enhance surgical conditions and has the potential to replace traditional adjustment. ", doi="10.2196/70628", url="https://humanfactors.jmir.org/2025/1/e70628" } @Article{info:doi/10.2196/60779, author="Seidl, Fritz and Hinterwimmer, Florian and Vogt, Ferdinand and Edenharter, M. G{\"u}nther and Braun, F. Karl and von Eisenhart-Rothe, R{\"u}diger and and Biberthaler, Peter and Pf{\"o}rringer, Dominik", title="Use and Acceptance of Innovative Digital Health Solutions Among Patients and Professionals: Survey Study", journal="JMIR Hum Factors", year="2025", month="May", day="8", volume="12", pages="e60779", keywords="eHealth", keywords="digital health", keywords="medical data use", keywords="information", keywords="survey", keywords="adoption", abstract="Background: Digital solutions are gaining increasing importance and present a challenge regarding their introduction and acceptance into professional medical environments. Significant advances have been made regarding the availability, safety, and ease of use of data generated by a multitude of devices and wearables. However, data security and data protection are delaying factors. The underlying analysis focuses on the use and acceptance of digital solutions, and their respective differences between health care professionals and patients. Objective: This study examines the current use and acceptance of digital solutions among health care professionals and patients. In addition, it derives an outlook on future developments and expectations in the setting of innovative technologies able to penetrate the health market. Methods: An anonymous web-based survey of 23 multiple-choice and 3 open-text questions was conducted among medical professionals and patients between April and September 2023. In this study, quantitative analysis was performed using Python, with Pandas for data processing and Matplotlib for visualization. Chi-square tests were used to analyze binary categorical data, while Mann-Whitney U tests were used to evaluate ordinal data. Additionally, a qualitative analysis was conducted to summarize the results of the open-ended questions. Results: During 178 days, the survey garnered 2058 clicks, resulting in 1389 participants (67.5\% response rate). A total of 1002 participants completed the entire questionnaire, while 387 (27.9\%) did not finish. Incomplete responses were excluded from the comprehensive analysis. The sample comprised 271 (27\%) physicians and 731 (73\%) patients. The study found significant agreement between both groups in adopting and foreseeing the use of digital health tools and telemedicine. Both groups recognized the future importance of digital health without substantial differences. Conclusions: Overall, attitudes toward digital health and telemedicine were consistent, reflecting a uniform acceptance and expectation of these technologies among health care professionals and patients. The consensus on telemedicine's future role over the next 5 years indicates a unified vision for digital health paradigms. These consistencies between the 2 groups might be future drivers for improvements in accessibility, convenience, and efficiency in health care delivery. ", doi="10.2196/60779", url="https://humanfactors.jmir.org/2025/1/e60779" } @Article{info:doi/10.2196/67685, author="Rubyan, Michael and Gouseinov, Yana and Morgan, Mikayla and Rubyan, Deborah and Jahagirdar, Divya and Choberka, David and Boyd, J. Carol and Shuman, Clayton", title="Evaluating the Usability, Acceptability, User Experience, and Design of an Interactive Responsive Platform to Improve Perinatal Nurses' Stigmatizing Attitudes Toward Substance Use in Pregnancy: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="May", day="8", volume="12", pages="e67685", keywords="digital platform", keywords="nurse training", keywords="usability", keywords="user experience", keywords="user interface", keywords="mixed methods", keywords="theatre testing", keywords="stigma", keywords="perinatal substance use", keywords="art intervention", keywords="acceptability", keywords="perinatal", keywords="substance use", keywords="pregnancy", keywords="perinatal nurse", keywords="feasibility", keywords="interactive responsive platform", abstract="Background: Perinatal nurses are increasingly encountering patients who have engaged in perinatal substance use (PSU). Despite growing evidence demonstrating the need to reduce nurses' stigmatizing attitudes toward PSU, limited interventions are available to target these attitudes and support behavior change, especially those reflecting the overwhelming evidence that education alone is insufficient to change practice behavior. Arts-based interventions are associated with increasing nursing empathy, changing patient attitudes, improving reflective practice, and decreasing stigma. We adapted ArtSpective for PSU---a previously evaluated, in-person, arts-based intervention to reduce stigma toward PSU among perinatal nurses---into an interactive, digital, and responsive platform that facilitates intervention delivery asynchronously. Objective: This study aimed to evaluate the usability, acceptability, and feasibility of the interactive, responsive platform version of ArtSpective for PSU. Our goal was to elicit the strengths and weaknesses of the responsive platform by evaluating the user experience to identify strategies to overcome them. Methods: This study used a mixed methods approach to explore the platform's usability, user experience, and acceptability as an intervention to address stigma and implicit bias related to PSU. Theatre testing was used to qualitatively assess usability and acceptability perspectives with nurses and experts; a modified version of the previously validated 8-item Abbreviated Acceptability Rating Profile was used for quantitative assessment. Quantitative data for acceptability and satisfaction were analyzed using descriptive statistics. All qualitative data were analyzed iteratively using an inductive framework analysis approach. Results: Overall, 21 nurses and 4 experts in stigma, implicit bias, and instructional design completed theatre-testing sessions. The mean duration of interviews was 31.92 (SD 11.32) minutes for nurses and 40.73 (SD 8.57) minutes for experts. All participants indicated that they found the digital adaptation of the intervention to be highly acceptable, with mean acceptability items ranging from 5.0 (SD 1.0) to 5.5 (SD 0.6) on a 1-6 agreement scale. Nurses reported high satisfaction with the platform, with mean satisfaction items ranging from 5.14 (SD 0.56) to 5.29 (SD 0.63) on a 1-6 agreement scale. In total, 1797 interview segments were coded from the theatre-testing sessions with 4 major themes: appearance, navigation, characterization, and overall platform, and 16 subthemes were identified. Consistent with the quantitative findings, the results were positive overall, with participants expressing high satisfaction related to the platform's appearance, the ease with which they could navigate the various modules, engagement, clarity of the presentation, and feasibility of being completed asynchronously. Conclusions: Developing and evaluating the usability of a digital adaptation of ArtSpective for PSU resulted in strong support for the usability, acceptability, and satisfaction of the program. It also provided insight into key aspects related to acceptability and usability that should be considered when designing a digital adaptation of an arts-based intervention for health care providers. ", doi="10.2196/67685", url="https://humanfactors.jmir.org/2025/1/e67685", url="http://www.ncbi.nlm.nih.gov/pubmed/40146964" } @Article{info:doi/10.2196/66432, author="Adnan, Ahmer and Irvine, Eilish Rebecca and Williams, Allison and Harris, Matthew and Antonacci, Grazia", title="Improving Acceptability of mHealth Apps---The Use of the Technology Acceptance Model to Assess the Acceptability of mHealth Apps: Systematic Review", journal="J Med Internet Res", year="2025", month="May", day="7", volume="27", pages="e66432", keywords="technology acceptance model", keywords="mHealth", keywords="mobile health apps", keywords="health information technology acceptance model", abstract="Background: Mobile health apps (MHAs) are increasingly used in modern health care provision. The technology acceptance model (TAM) is the most widely used framework for predicting health care technology acceptance. Since the advent of this model in 1989, technology has made generational advancements, and extensions of this model have been implemented. Objective: This systematic review aimed to re-examine TAM models to establish their validity for predicting the acceptance of modern MHAs, reviewing relevant core and extended constructs, and the relationships between them. Methods: In this systematic review, MEDLINE, Embase, Global Health, APA PsycINFO, CINAHL, and Scopus databases were searched on March 8, 2024, with no time constraints, for studies assessing the use of TAM-based frameworks for MHA acceptance. Studies eligible for data extraction were required to be peer-reviewed, English-language, primary research articles evaluating MHAs with health-related utility, using TAM as the primary technology acceptance evaluation framework, and reporting app use data. Data were extracted and grouped into 5 extended TAM construct themes. Quality assessment was conducted using the Joanna Briggs Institute (JBI) tools. For cross-sectional methodologies (9/14, 64\%), the JBI checklist for analytical cross-sectional studies was used. For non--cross-sectional studies (5/14, 36\%), the JBI checklist most relevant to the specific study design was used. For mixed methods studies (1/14, 7\%), the JBI checklist for qualitative studies was applied, in addition to the JBI checklist most suited to the quantitative design. A subsequent narrative synthesis was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Results: A total of 2790 records were identified, and 14 were included. Furthermore, 10 studies validated the efficacy of TAM and its extensions for the assessment of MHAs. Relationships between core TAM constructs (perceived usefulness, perceived ease of use, and behavioral intention) were validated. Extended TAM constructs were grouped into 5 themes: health risk, application factors, social factors, digital literacy, and trust. Digital literacy, trust, and application factor extended construct themes had significant predictive capacity. Application factors had the strongest MHA acceptance predictive capabilities. Perceived usefulness and extended constructs related to social factors, design aesthetics, and personalization were more influential for those from deprived socioeconomic backgrounds. Conclusions: TAM is an effective framework for evaluating MHA acceptance. While original TAM constructs wield significant predictive capacity, the incorporation of social and clinical context-specific extended TAM constructs can enhance the model's predictive capabilities. This review's findings can be applied to optimize MHAs' user engagement and minimize health care inequalities. Our findings also underscore the necessity of adapting TAM and other acceptability frameworks as the technological and social landscape evolves. Trial Registration: PROSPERO CRD42024532974; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024532974 ", doi="10.2196/66432", url="https://www.jmir.org/2025/1/e66432" } @Article{info:doi/10.2196/67948, author="Guo, Rongrong and Zheng, Ziling and Yang, Fangyu and Wu, Ying", title="Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Health Information Technology Usability Evaluation Scale in China: Instrument Validation Study", journal="J Med Internet Res", year="2025", month="May", day="2", volume="27", pages="e67948", keywords="cross-cultural adaptation", keywords="digital health application", keywords="reliability", keywords="translation", keywords="usability", keywords="validity", abstract="Background: The dramatic growth of digital health apps highlights an urgent need for rigorous usability evaluation tools. While the Health Information Technology Usability Evaluation Scale (Health-ITUES) has gained validation, a Chinese version has not yet been developed and validated. Objective: This study aimed to translate and culturally adapt the Health-ITUES into Chinese, customize it for both service consumers and professional health care providers, and evaluate its reliability and validity in the Chinese context. Methods: Following the Guidelines for the Process of Cross-Cultural Adaptation of Self-report measures, the Health-ITUES was meticulously translated and culturally adapted into Chinese version following 2 rounds of expert consultation. Subsequently, based on the SMART system, an intelligent and integrated older adult care model, the Chinese version of the Health-ITUES was customized into the care receiver version (Health-ITUES-R) and professional health care provider version (Health-ITUES-P). Older individuals and nurses participated in the validation testing conducted between December 2020 and February 2021, facilitated by the improvement of the COVID-19 pandemic and the timing preceding the Spring Festival, which ensured feasible recruitment and a sufficient sample size. In addition, the pandemic-driven increase in digital health app usage allowed us to assess usability in a relevant real-world health care setting. Content validity, internal consistency reliability, construct validity, convergent validity, discriminant validity, and criterion validity were used to evaluate the psychometric attributes of the Health-ITUES-R and Health-ITUES-P. Results: A Chinese version of the Health-ITUES comprising 20 items across 4 dimensions was formulated, informing the customization of the Health-ITUES-R and Health-ITUES-P. In total, 110 and 124 eligible older adults and nurses validated the customized Health-ITUES-R and Health-ITUES-P, respectively. Both versions exhibited satisfactory content validity (content validity index of items=0.83-1.00; content validity index of scale=0.99) and adequate internal consistency reliability (Cronbach $\alpha$ and McDonald $\omega$>0.80 for the overall scale; >0.75 for individual items). Confirmatory factor analysis confirmed a 4D structure with acceptable construct validity, as indicated by model fit indices. Both the Health-ITUES-R and Health-ITUES-P showed satisfactory convergent validity (average variance extracted [AVE] value>0.5, composite reliability value>0.7), except for a slightly lower AVE value (0.478) for the second dimension of the Health-ITUES-R. Discriminant validity was supported, with the square root of AVE values exceeding correlation coefficients and the Hetereotrait-Monotrait ratio below 0.85. Furthermore, Pearson correlation coefficients for the perceived usefulness dimension, perceived ease of use dimension, and overall scale of the Health-ITUES-R and patient acceptance questionnaire for mobile health application were 0.587, 0.647, and 0.743 (all P<.01), demonstrating a significant correlation. Conclusions: The Chinese version of the Health-ITUES can be used as a valid and reliable tool to evaluate the usability of digital health apps for both care receivers and professional health care providers in the Chinese context. ", doi="10.2196/67948", url="https://www.jmir.org/2025/1/e67948" } @Article{info:doi/10.2196/68762, author="Yang, Ting-ting and Zheng, Hong-xia and Cao, Sha and Jing, Mei-ling and Hu, Ju and Zuo, Yan and Chen, Qing-yong and Zhang, Jian-jun", title="Harnessing an Artificial Intelligence--Based Large Language Model With Personal Health Record Capability for Personalized Information Support in Postsurgery Myocardial Infarction: Descriptive Qualitative Study", journal="J Med Internet Res", year="2025", month="Apr", day="30", volume="27", pages="e68762", keywords="myocardial infarction", keywords="post-surgery recovery", keywords="personalized health support", keywords="artificial intelligence", keywords="large language model", keywords="personal health record", keywords="digital health tools", keywords="health information accessibility", keywords="qualitative study", keywords="mobile phone", abstract="Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Although postsurgical cardiac interventions have improved survival rates, effective management during recovery remains challenging. Traditional informational support systems often provide generic guidance that does not account for individualized medical histories or psychosocial factors. Recently, artificial intelligence (AI)--based large language models (LLM) tools have emerged as promising interventions to deliver personalized health information to post-MI patients. Objective: We aim to explore the user experiences and perceptions of an AI-based LLM tool (iflyhealth) with integrated personal health record functionality in post-MI care, assess how patients and their family members engaged with the tool during recovery, identify the perceived benefits and challenges of using the technology, and to understand the factors promoting or hindering continued use. Methods: A purposive sample of 20 participants (12 users and 8 nonusers) who underwent MI surgery within the previous 6 months was recruited between July and August 2024. Data were collected through semistructured, face-to-face interviews conducted in a private setting, using an interview guide to address participants' first impressions, usage patterns, and reasons for adoption or nonadoption of the iflyhealth app. The interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi method. Results: Four key themes revealed included: (1) participants' experiences varied based on digital literacy, prior exposure to health technologies, and individual recovery needs; (2) users appreciated the app's enhanced accessibility to professional health information, personalized advice tailored to their clinical conditions, and the tool's responsiveness to health status changes; (3) challenges such as difficulties with digital literacy, usability concerns, and data privacy issues were significant barriers; and (4) nonusers and those who discontinued use primarily cited complexity of the interface and perceived limited relevance of the advice as major deterrents. Conclusions: iflyhealth, an LLM AI app with a built-in personal health record functionality, shows significant potential in assisting post-MI patients. The main benefits reported by iflyhealth users include improved access to personalized health information and an enhanced ability to respond to changing health conditions. However, challenges such as digital literacy, usability, and privacy and security concerns persist. Overcoming the barriers may further enhance the use of the iflyhealth app, which can play an important role in patient-centered, personalized post-MI management. ", doi="10.2196/68762", url="https://www.jmir.org/2025/1/e68762", url="http://www.ncbi.nlm.nih.gov/pubmed/40305084" } @Article{info:doi/10.2196/60169, author="Mu{\~n}oz Olivar, Carolina and Pineiro, Miguel and G{\'o}mez Quintero, Sebasti{\'a}n Juan and Avenda{\~n}o-V{\'a}squez, Javier Carlos and Orme{\~n}o-Arriagada, Pablo and Palma Rivadeneira, Silvia and Taramasco Toro, Carla", title="Education and Symptom Reporting in an mHealth App for Patients With Cancer: Mixed Methods Development and Validation Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="28", volume="12", pages="e60169", keywords="cancer", keywords="patient-reported outcome measures", keywords="software design", keywords="unpleasant symptom", keywords="toxicity", keywords="mHealth", keywords="mobile health", keywords="surveys and questionnaires", keywords="application", keywords="design", keywords="evaluation", keywords="chemotherapy", keywords="health care communication", keywords="mixed methods", keywords="validation", keywords="efficiency", keywords="security", abstract="Background: The widespread prevalence of cancer across the globe demands cutting-edge solutions for its treatment. Current cancer therapies, notably chemotherapy, pose challenges due to their side effects. The early detection and management of the side effects are vital but complex. This study introduces a mobile health app designed to bridge the communication gaps between patients with cancer and health care providers. Hence, it allows patients to report symptoms immediately and also enables proactive symptom management by health care providers. Objective: This study has 2 objectives: first, to design a cancer-focused mobile health app that integrates educational content and real-time symptom reporting for chemotherapy patients. Second, to validate and evaluate the app quality using the Mobile App Rating Scale (MARS). The app seeks to foster health care communication, reduce hospital readmissions, and optimize symptom management, contributing to a more impactful patient experience. Methods: This mixed-methods study details the development and validation of mobile health applications. The app was designed by a multidisciplinary team, including nurses, medical professionals, pharmaceutical chemists, computer engineers, and software developers, using agile methodologies. For validation, the app was assessed by 13 evaluators, including clinical professionals (nurses and physicians) and engineers. The evaluation included technical performance analysis using Google tools and quality assessment using the MARS, which measures engagement, functionality, aesthetics, and information quality. Results: Performance metrics highlighted areas for improvement, with loading times showing delays in displaying content. Meanwhile, the response time of the app was moderate, and visual stability remained excellent. The app achieved an overall MARS score of 3.75 (SD 0.42), indicating consistent quality, with functionality scoring the highest (4.35; SD 0.52) and engagement the lowest (3.31; SD 0.61). The reliability of the MARS was confirmed (interclass correlation coefficient: 0.84; 95\% CI: 0.72?0.92). Evaluators unanimously praised the app's potential benefits for patients and clinical professionals while identifying areas for improvement such as customization, onboarding guidance, and navigation. Conclusions: The CONTIGO app showed strengths in functionality, usability, and information quality, supported by robust security measures. However, areas such as user interactivity and engagement require improvement. Future refinements will integrate insights from patients with cancer to address user-specific needs and enhance the oncology care experience. ", doi="10.2196/60169", url="https://humanfactors.jmir.org/2025/1/e60169" } @Article{info:doi/10.2196/67114, author="Moylan, Kayley and Doherty, Kevin", title="Expert and Interdisciplinary Analysis of AI-Driven Chatbots for Mental Health Support: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Apr", day="25", volume="27", pages="e67114", keywords="mental health", keywords="therapy", keywords="design", keywords="chatbots", keywords="artificial intelligence", keywords="AI", keywords="ethics", keywords="emotional dependence", keywords="self-reliance", abstract="Background: Recent years have seen an immense surge in the creation and use of chatbots as social and mental health companions. Aiming to provide empathic responses in support of the delivery of personalized support, these tools are often presented as offering immense potential. However, it is also essential that we understand the risks of their deployment, including their potential adverse impacts on the mental health of users, including those most at risk. Objective: The study aims to assess the ethical and pragmatic clinical implications of using chatbots that claim to aid mental health. While several studies within human-computer interaction and related fields have examined users' perceptions of such systems, few studies have engaged mental health professionals in critical analysis of their conduct as mental health support tools. This paper comprises, in turn, an effort to assess the ethical and pragmatic clinical implications of using chatbots that claim to aid mental health. Methods: This study included 8 interdisciplinary mental health professional participants (from psychology and psychotherapy to social care and crisis volunteer workers) in a mixed methods and hands-on analysis of 2 popular mental health--related chatbots' data handling, interface design, and responses. This analysis was carried out through profession-specific tasks with each chatbot, eliciting participants' perceptions through both the Trust in Automation scale and semistructured interviews. Through thematic analysis and a 2-tailed, paired t test, these chatbots' implications for mental health support were thus evaluated. Results: Qualitative analysis revealed emphatic initial impressions among mental health professionals of chatbot responses likely to produce harm, exhibiting a generic mode of care, and risking user dependence and manipulation given the central role of trust in the therapeutic relationship. Trust scores from the Trust in Automation scale, while exhibiting no statistically significant differences between the chatbots (t6=--0.76; P=.48), indicated medium to low trust scores for each chatbot. The findings of this work highlight that the design and development of artificial intelligence (AI)--driven mental health--related solutions must be undertaken with utmost caution. The mental health professionals in this study collectively resist these chatbots and make clear that AI-driven chatbots used for mental health by at-risk users invite several potential and specific harms. Conclusions: Through this work, we contributed insights into the mental health professional perspective on the design of chatbots used for mental health and underscore the necessity of ongoing critical assessment and iterative refinement to maximize the benefits and minimize the risks associated with integrating AI into mental health support. ", doi="10.2196/67114", url="https://www.jmir.org/2025/1/e67114" } @Article{info:doi/10.2196/64212, author="He, Xing and Bian, Jiang and Berlinski, Ariel and Guo, Yi and Simmons, Larry A. and Marshall, Alexandra S. and Greene, J. Carolyn and Brown, Hudson Rita and Turner, Jessica and Perry, T. Tamara", title="Mobile Health App for Adolescent Asthma Self-Management: Development and Usability Study of the Pulmonary Education and Knowledge Mobile Asthma Action Plan", journal="JMIR Form Res", year="2025", month="Apr", day="24", volume="9", pages="e64212", keywords="asthma self-management", keywords="mobile health", keywords="user-centered design", keywords="usability", keywords="adolescents", keywords="mobile phone", abstract="Background: Adolescents with asthma are vulnerable to poor asthma outcomes due to inadequate self-management skills and nonadherence to medications. Mobile health (mHealth) apps have shown promise in improving asthma control, medication adherence, and self-efficacy. However, existing mHealth asthma apps lack personalization and real-time feedback and are not tailored for at-risk adolescents. Objective: This study aimed to design, develop, and test a smartphone-based mHealth Asthma Action Plan for adolescents, called Pulmonary Education and Knowledge Mobile Asthma Action Plan (PEAK-mAAP), in preparation for a large-scale randomized controlled trial. Methods: We employed user-centered design principles to develop our app, leveraging our previous work and following guidelines from the National Heart, Lung, and Blood Institute. The app consists of a patient-facing mobile app and a provider-facing portal. A convenience sample of 13 adolescents (aged 12?20 years) was recruited from the Arkansas Children's Research Institute database or direct health care provider referrals. Participants underwent a task-based usability assessment followed by the System Usability Scale assessment to measure user satisfaction, interface effectiveness, and overall system usability. Results: PEAK-mAAP integrates 7 core modules supporting personalized asthma self-management, symptom monitoring, medication tracking, and real-time feedback. The mean System Usability Scale score was 83/100 (SD 5.54), indicating high user satisfaction and system usability. Notably, older adolescents (>17 years) reported higher usability scores (87.5) than younger users (77.5), suggesting potential age-related differences in app navigation and engagement. Conclusions: The results demonstrate that PEAK-mAAP is a feasible and user-friendly mHealth intervention for adolescent asthma self-management. While the high usability score reflects a positive user experience, some participants encountered initial usability challenges, highlighting the need for minor refinements and user training materials. The integration of personalized self-management tools and real-time feedback distinguishes PEAK-mAAP from existing asthma apps, addressing key barriers to adherence and engagement. Moving forward, an ongoing randomized controlled trial will assess its clinical effectiveness, long-term engagement, and impact on asthma outcomes, providing further insights into its potential as a scalable solution for adolescent asthma care. ", doi="10.2196/64212", url="https://formative.jmir.org/2025/1/e64212" } @Article{info:doi/10.2196/63709, author="Popoff, Benjamin and Cabon, Sandie and Cuggia, Marc and Bouzill{\'e}, Guillaume and Clavier, Thomas", title="Expectations of Intensive Care Physicians Regarding an AI-Based Decision Support System for Weaning From Continuous Renal Replacement Therapy: Predevelopment Survey Study", journal="JMIR Med Inform", year="2025", month="Apr", day="23", volume="13", pages="e63709", keywords="clinical decision support system", keywords="artificial intelligence", keywords="decision support", keywords="decision making", keywords="clinical decision making", keywords="survey study", keywords="intensive care physicians", keywords="renal replacement therapy", keywords="therapeutic", keywords="ICU", keywords="user-centered design", keywords="cross-sectional survey", keywords="survey", keywords="French", keywords="physician", keywords="questionnaire", keywords="AI tools", keywords="user-centered", abstract="Background: Critically ill patients in intensive care units (ICUs) require continuous monitoring, generating vast amounts of data. Clinical decision support systems (CDSS) leveraging artificial intelligence (AI) technologies have shown promise in improving diagnostic, prognostic, and therapeutic decision-making. However, these models are rarely implemented in clinical practice. Objective: The aim of this study was to survey ICU physicians to understand their expectations, opinions, and level of knowledge regarding a proposed AI-based CDSS for continuous renal replacement therapy (CRRT) weaning, a clinical decision-making process that is still complex and lacking in guidelines. This will be used to guide the development of an AI-based CDSS on which our team is working to ensure user-centered design and successful integration into clinical practice. Methods: A prospective cross-sectional survey of French-speaking physicians with clinical activity in intensive care was conducted between December 2023 and April 2024. The questionnaire consisted of 20 questions structured around 4 axes: overview of the problem and current practices concerning weaning from CRRT, opinion on AI-based CDSS, implementation in daily clinical practice, real-life operation and willingness to adopt the CDSS in everyday practice. Statistical analyses included Wilcoxon rank sum tests for quantitative variables and $\chi$2 or Fisher exact tests for qualitative variables, with multivariate analyses performed using ordinal logistic regression. Results: A total of 171 complete responses were received. Physicians expressed an interest in a CDSS for CRRT weaning, with 70.2\% (120/171) viewing AI-based CDSS favorably. Opinions were split regarding the difficulty of the weaning decision itself, with 46.2\% (79/171) disagreeing that it is challenging, while 31.6\% (54/171) agreed. However, 66.1\% (113/171) of respondents supported the value of an AI-based CDSS to assist them in this decision, with younger physicians showing stronger support (81.8\%, 27/33 vs 62.3\%; 86/138; P=.01). Most respondents (163/171, 95.3\%) emphasized the importance of understanding the criteria used by the model to make its predictions. Conclusions: Our findings highlight an optimistic attitude among ICU physicians toward AI-based CDSS for CRRT weaning, emphasizing the need for transparency, integration into existing workflows, and alignment with clinicians' decision-making processes. Actionable recommendations include incorporating key variables such as urine output and biological parameters, defining probability thresholds for recommendations and ensuring model transparency to facilitate the successful adoption and integration into clinical practice. The methodology of this survey may help the development of further predevelopment studies accompanying AI-based CDSS projects. ", doi="10.2196/63709", url="https://medinform.jmir.org/2025/1/e63709" } @Article{info:doi/10.2196/59477, author="Hollman, Heather and Sui, Wuyou and Zhang, Haowei and Rhodes, E. Ryan", title="A Mobile Health App Informed by the Multi-Process Action Control Framework to Promote Physical Activity Among Inactive Adults: Iterative Usability Study", journal="JMIR Form Res", year="2025", month="Apr", day="23", volume="9", pages="e59477", keywords="physical activity", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="usability study", keywords="inactive adults", keywords="smartphone", abstract="Background: Mobile health apps have high potential to address the widespread deficit in physical activity (PA); however, they have demonstrated greater impact on short-term PA compared to long-term PA. The multi-process action control (M-PAC) framework promotes sustained PA behavior by combining reflective (eg, attitudes) and regulatory (eg, planning and emotion regulation) constructs with reflexive (eg, habits and identity) constructs. Usability testing is important to determine the integrity of a mobile health app's intrinsic properties and suggestions for improvement before feasibility and efficacy testing. Objective: This study aimed to gather usability feedback from end users on a first and a second version of an M-PAC app prototype. Methods: First, 3 workshops and focus groups, with 5 adult participants per group, were conducted to obtain first impressions of the M-PAC app interface and the first 3 lessons. The findings informed several modifications to the app program (eg, added cards with reduced content) and its interface (eg, created a link placeholder image and added a forgot password feature). Subsequently, a single-group pilot usability study was conducted with 14 adults who were not meeting 150 minutes per week of moderate-to-vigorous PA. They used the updated M-PAC app for 2 weeks, participated in semistructured interviews, and completed the Mobile App Usability Questionnaire (MAUQ) to provide usability and acceptability feedback. The focus groups and interviews were recorded, transcribed, and analyzed with content analysis informed by usability heuristics. The MAUQ scores were analyzed descriptively. Results: Participants from the workshops and focus groups (mean age 30.40, SD9.49 years) expressed overall satisfaction with the app layout and content. The language was deemed appropriate; however, some terms (eg, self-efficacy) and acronyms (eg, frequency, intensity, time, and type) needed definitions. Participants provided several recommendations for the visual design (eg, more cards with less text). They experienced challenges in accessing and using the help module and viewing some images, and were unsure how to create or reset the password. Findings from the usability pilot study (mean age 41.38, SD12.92 years; mean moderate-to-vigorous PA 66.07, SD57.92 min/week) revealed overall satisfaction with the app layout (13/13, 100\%), content (10/13, 77\%), and language (7/11, 64\%). Suggestions included more enticing titles and additional and variable forms of content (eg, visual aids and videos). The app was easy to navigate (9/13, 69\%); however, some errors were identified, such as PA monitoring connection problems, broken links, and difficulties entering and modifying data. The mean MAUQ total and subscale scores were as follows: total=5.06 (SD1.20), usefulness=4.17 (SD1.31), ease of use=5.36 (SD1.27), and interface and satisfaction=5.52 (SD1.42). Conclusions: Overall, the M-PAC app was deemed usable and acceptable. The findings will inform the development of the minimum viable product, which will undergo subsequent feasibility testing. ", doi="10.2196/59477", url="https://formative.jmir.org/2025/1/e59477" } @Article{info:doi/10.2196/65163, author="Butorac, Isobel and McNaney, Roisin and Seguin, Paolo Joshua and Olivier, Patrick and Northam, C. Jaimie and Tully, A. Lucy and Carl, Talia and Carter, Adrian", title="Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study", journal="JMIR Pediatr Parent", year="2025", month="Apr", day="22", volume="8", pages="e65163", keywords="digital mental health", keywords="young people", keywords="cultural diversity", keywords="web-based and mobile health interventions", keywords="qualitative methods", keywords="user-centered design", keywords="human-computer interaction", abstract="Background: Approximately 39\% of young people (aged 16-24 y) experience mental ill health, but only 23\% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. Objective: The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based ``check-in'' tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. Methods: We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44\%; young people: n=10, 56\%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Results: Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. Conclusions: The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study's findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations. ", doi="10.2196/65163", url="https://pediatrics.jmir.org/2025/1/e65163" } @Article{info:doi/10.2196/53339, author="Buchan, Claire M. and Katapally, Reddy Tarun and Bhawra, Jasmin", title="Application of an Innovative Methodology to Build Infrastructure for Digital Transformation of Health Systems: Developmental Program Evaluation", journal="JMIR Form Res", year="2025", month="Apr", day="17", volume="9", pages="e53339", keywords="digital health platform", keywords="citizen science", keywords="evaluation", keywords="health systems", keywords="digital health", keywords="app", keywords="innovative", keywords="digital transformation", keywords="public health", keywords="crises", keywords="communicable disease", keywords="coronavirus", keywords="chronic diseases", keywords="decision-making", keywords="assessment", keywords="thematic analysis", keywords="self-report survey", keywords="risk", keywords="artificial intelligence", keywords="AI", abstract="Background: The current public health crises we face, including communicable disease pandemics such as COVID-19, require cohesive societal efforts to address decision-making gaps in our health systems. Digital health platforms that leverage big data ethically from citizens can transform health systems by enabling real-time data collection, communication, and rapid responses. However, the lack of standardized and evidence-based methods to develop and implement digital health platforms currently limits their application. Objective: This study aims to apply mixed evaluation methods to assess the development of a rapid response COVID-19 digital health platform before public launch by engaging with the development and research team, which consists of interdisciplinary researchers (ie, key stakeholders). Methods: Using a developmental evaluation approach, this study conducted (1) a qualitative survey assessing digital health platform objectives, modifications, and challenges administered to 5 key members of the software development team and (2) a role-play pilot with 7 key stakeholders who simulated 8 real-world users, followed by a self-report survey, to evaluate the utility of the digital health platform for each of its objectives. Survey data were analyzed using an inductive thematic analysis approach. Postpilot test survey data were aggregated and synthesized by participant role. Results: The digital health platform met original objectives and was expanded to accommodate the evolving needs of potential users and COVID-19 pandemic regulations. Key challenges noted by the development team included navigating changing government policies and supporting the data sovereignty of platform users. Strong team cohesion and problem-solving were essential in the overall success of program development. During the pilot test, participants reported positive experiences interacting with the platform and found its features relatively easy to use. Users in the community member role felt that the platform accurately reflected their risk of contracting COVID-19, but reported some challenges interacting with the interface. Those in the decision maker role found the data visualizations helpful for understanding complex information. Both participant groups highlighted the utility of a tutorial for future users. Conclusions: Evaluation of the digital health platform development process informed our decisions to integrate the research team more cohesively with the development team, a practice that is currently uncommon given the use of external technology vendors in health research. In the short term, the developmental evaluation resulted in shorter sprints, and the role-play exercise enabled improvements to the log-in process and user interface ahead of public deployment. In the long term, this exercise informed the decision to include a data scientist as part of both teams going forward to liaise with researchers throughout the development process. More interdisciplinarity was also integrated into the research process by providing health system training to computer programmers, a key factor in human-centered artificial intelligence development. ", doi="10.2196/53339", url="https://formative.jmir.org/2025/1/e53339" } @Article{info:doi/10.2196/62986, author="?erban, Bianca Irina and Fruytier, Lonneke and Houben, Steven and Colombo, Sara and van de Sande, Danny and Kemps, Hareld and Brombacher, Aarnout", title="Design Requirements for Cardiac Telerehabilitation Technologies Supporting Athlete Values: Qualitative Interview Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="17", volume="12", pages="e62986", keywords="athletes with established coronary artery disease", keywords="cardiac telerehabilitation", keywords="value-sensitive design", keywords="sports monitoring", keywords="card sorting", keywords="qualitative research", keywords="artificial intelligence", keywords="AI", abstract="Background: Cardiac telerehabilitation (CTR) interventions can provide accessible and affordable remote rehabilitation services. However, as cardiac rehabilitation (CR) primarily targets inactive patients, little is known about the experiences with CR of highly active patients (ie, recreational athletes or, simply, athletes) with established coronary artery disease. Consequently, existing CTR interventions do not address the specific needs of the athletic subpopulation. Understanding the needs and values of athletes is crucial for designing meaningful CTR interventions that enhance user acceptance and engagement, thereby facilitating effective rehabilitation for this patient subgroup. Objective: This study aimed to inform the design of technologies that facilitate CTR for athletes. We intended to identify athletes' values related to CR, including health and sports tracking, as well as high-level requirements for technologies that can facilitate the CTR of athletes according to the identified values. Methods: We used value-sensitive design with a human-centric design approach to elicit design requirements for CTR that can serve athletes with established coronary artery disease. To identify athletes' values, we conducted 25 value-oriented semistructured interviews with 15 athletic patients and 10 health care professionals involved in CR programs. In a second phase, we conducted 6 card-sorting focus group sessions with 13 patients and 7 health care professionals to identify desired CTR features. Finally, we derived high-level CTR technology requirements connected to the athletes' needs and values. Results: We defined 12 athlete values divided into 3 categories: body centric, care centric, and data and technology centric. We clustered findings from the card-sorting activity into CTR technology requirements, such as remotely monitored sport-specific training and training data representations next to clinical limitations, and paired them with corresponding values. Conclusions: Athletes have distinct values and health goals in CR compared to general populations targeted by CTR interventions. Designing patient-centric CTR interventions that address these needs is crucial to support optimal recovery, safe return to sports, and adherence to CTR technologies in the home environment. ", doi="10.2196/62986", url="https://rehab.jmir.org/2025/1/e62986", url="http://www.ncbi.nlm.nih.gov/pubmed/40245391" } @Article{info:doi/10.2196/65185, author="Zeitlin, Anya and Mathenjwa, Thulile and Zuma, Thembelihle and Wyke, Sally and Matthews, Philippa and McGrath, Nuala and Seeley, Janet and Shahmanesh, Maryam and Blandford, Ann", title="Creating a Usable and Effective Digital Intervention to Support Men to Test for HIV and Link to Care in A Resource-Constrained Setting: Iterative Design Based on A Person-Based Approach and Human Computer Interaction Methods", journal="JMIR Form Res", year="2025", month="Apr", day="17", volume="9", pages="e65185", keywords="person-based approach", keywords="HIV", keywords="resource-constrained settings", keywords="digital intervention", keywords="user-centered design", keywords="behavior change techniques", keywords="digital health", abstract="Background: It is challenging to design usable and effective digital health interventions (DHIs). The person-based approach (PBA) has been proposed to incorporate users' perspectives for the design of DHIs. However, it does not explicitly describe the iterative stages of design and evaluation that are essential in moving from early planning to deployment. For this, we draw on methods from human computer interaction (HCI) that have been developed for various situations. Objective: This study aimed to reflect on the adaptation and synthesis of PBA and HCI approaches to developing DHIs. We present a case study applying both approaches to develop Empowering People through Informed Choices for HIV (EPIC-HIV1), a DHI designed for men living in rural KwaZulu-Natal, South Africa, intended to support them in making an informed choice about whether to take an HIV test and, if necessary, engage in care. Methods: We conducted a retrospective analysis of the documentation generated during the development of EPIC-HIV1 including findings about requirements, design representations, and the results of iterative rounds of testing. We developed an account of the process, the outcomes, and the strengths and limitations of the design and evaluation techniques applied. We also present the design of EPIC-HIV1 and summarize considerations when designing for hard-to-reach people in such settings. Results: The PBA was applied to deliver a first prototype. This helped identify key messages to convey and how to manage issues such as user privacy, but the resulting prototype was judged by the team not to be engaging for potential users, and it was unclear whether the design was inclusive of people with low digital or health literacy. We therefore introduced methods from HCI to iteratively test and refine the app. Working with local community representatives, we conducted four refinement cycles with 29 participants, adapting and retesting the app until no further changes were needed. Key changes included making it clearer what the consequences of selecting options in the app were and changing wording to minimize misconceptions (eg, that the app would test for HIV) while addressing common concerns about testing and emphasizing long-term benefits of engaging with care, if needed. Conclusions: Techniques for developing DHIs need to be situationally appropriate. The PBA enabled us to establish both empirical data and theory to design the content of EPIC-HIV1, but it did not directly inform interaction design to make the app usable and effective for the intended users; HCI techniques tailored to the setting enabled us to refine the app to be easy for men with little familiarity with digital technologies to use within the constraints of the setting. Iterative testing ensured the app was easy to use and that the intended clinical messages were communicated effectively. ", doi="10.2196/65185", url="https://formative.jmir.org/2025/1/e65185", url="http://www.ncbi.nlm.nih.gov/pubmed/40244652" } @Article{info:doi/10.2196/55430, author="de Fran{\c{c}}a, Galv{\~a}o Caroline Villela and Segalla, Boaro Paola and Reis, Assis Felipe Sebasti{\~a}o de and Pereira, Silveira Jos{\'e} Ricardo and de Mattos, Oliveira Alexandre and Ferron, Moura Roberta de and de Oliveira, Zanardo Cleyton and Borges, Bassani J{\'e}ssica and Hoffmann, Quintal Lilian and Caboclo, Giaimo Edmundo Di", title="Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="16", volume="12", pages="e55430", keywords="telemedicine cabin", keywords="telehealth", keywords="teleservice", keywords="e-health", keywords="connected offices", abstract="Background: Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. Objective: This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Benefic{\^e}ncia Portuguesa de S{\~a}o Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. Methods: A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. Results: The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. Conclusions: The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care. ", doi="10.2196/55430", url="https://humanfactors.jmir.org/2025/1/e55430" } @Article{info:doi/10.2196/65357, author="Keinert, Marie and Schindler-Gmelch, Lena and Rupp, Helene Lydia and Sadeghi, Misha and Richer, Robert and Capito, Klara and Eskofier, M. Bjoern and Berking, Matthias", title="The EmpkinS-EKSpression Reappraisal Training Augmented With Kinesthesia in Depression: One-Armed Feasibility Study", journal="JMIR Form Res", year="2025", month="Apr", day="14", volume="9", pages="e65357", keywords="depression", keywords="cognitive reappraisal", keywords="facial expression", keywords="kinesthesia", keywords="smartphone-based intervention", keywords="mobile phone", abstract="Background: Harboring dysfunctional depressogenic cognitions contributes to the development and maintenance of depression. A central goal of cognitive behavioral therapy (CBT) for depression is to invalidate such cognitions via cognitive reappraisal (CR). However, relatively low remission rates and high dropout rates in CBT demonstrate the need for further improvement. Potentially, the effects of CBT could be enhanced by addressing not only dysfunctional depressogenic cognitions but also body states associated with depression. This may be done, for example, by systematically pairing the invalidation of depressogenic cognitions with the performance of antidepressive kinesthesia. Objective: This study aimed to examine the feasibility and clinical potential of a smartphone-based cognitive restructuring task that required users to deliberately perform antidepressive kinesthesia in conjunction with the rejection of depressogenic statements and the affirmation of antidepressive statements. This feasibility study was conducted as a precursor to a large-scale randomized controlled trial. Methods: In total, 10 healthy participants engaged in a single 90-120-minute session of smartphone-based CR training. During the training, they completed 2 phases in which they were required to reject 20 depressogenic and affirm 20 antidepressive statements, respectively. Diagnostic assessments were conducted 1 week (T1) before and directly prior (T2) to the training, and again directly posttraining (T3) and at a 2-week follow-up posttraining (T4). Feasibility outcomes assessed at T3 included intervention safety recorded by study therapists, compliance, technical feasibility, usability assessed using the Short Version of the User Experience Questionnaire (UEQ-S), and acceptability assessed using the UEQ-S and self-developed items. Preliminary clinical potential was evaluated via single-item ratings of current depressed and positive mood assessed continuously during the training. Feasibility outcomes were analyzed descriptively, and clinical potential was examined using paired-sample t tests of pre and post ratings of mood at each training phase. Results: Overall, the results indicated that the training was safe, feasible, and usable (UEQ-S pragmatic quality scale: mean 1.45, SD 0.71). However, acceptance was limited (UEQ-S hedonic quality scale: mean 1.05, SD 0.79). While 80\% (8/10) of the participants were generally satisfied with the training, 80\% (8/10) would recommend it to a friend, 90\% (9/10) found it interesting, and 80\% (8/10) rated it as ``leading edge,'' 40\% (4/10) to 70\% (7/10) did not consider it particularly helpful and 50\% (5/10) found it repetitive. Preliminary results regarding clinical potential were promising, with significant increases in positive mood (rejection: Hedges g=0.63; affirmation: Hedges g=0.25), whereas changes in depressed mood were not significant. Conclusions: This study evaluated the feasibility and acceptability of a smartphone-based CR training augmented with validating and invalidating kinesthesia. This provided valuable insights for further optimizing the intervention for the subsequent randomized controlled trial, but also potential similar interventions. If future studies confirm their clinical potential, such interventions offer a promising approach to enhancing CBT for depression. Trial Registration: OSF Registries pw6ma; https://osf.io/pw6ma/ ", doi="10.2196/65357", url="https://formative.jmir.org/2025/1/e65357" } @Article{info:doi/10.2196/64350, author="Somerville, Mari and Wozney, Lori and Gallant, Allyson and Curran, A. Janet", title="Designing eHealth Interventions for Pediatric Emergency Departments: Protocol for a Usability Testing Study With Youth, Parent, and Clinician Participants", journal="JMIR Res Protoc", year="2025", month="Apr", day="14", volume="14", pages="e64350", keywords="eHealth intervention", keywords="emergency department", keywords="usability testing", keywords="youth", keywords="health services", keywords="parents", keywords="pediatric", keywords="digital health tools", keywords="mixed methods", keywords="quantitative surveys", abstract="Background: Usability tests provide important insight into user preferences, functional issues, and differences between target groups for health interventions and products. However, there is limited guidance on how to adapt the usability testing approach for a youth audience, especially for digital health interventions. Objective: This protocol paper outlines a novel approach for conducting usability tests with a diverse audience of youth, parents, and clinicians in the development of 2 digital health tools for the pediatric emergency department (ED) setting. Methods: This paper outlines a protocol for usability testing as part of a broader study aimed at co-designing ED discharge communication tools with youth, parents, and clinicians. The broader study involved co-designing 2 digital tools: one for asthma and one for concussions. A multimethods approach to usability testing was used to assess the functionality of these tools through 2 rounds of testing. A mix of youth, parents, and ED clinicians were invited to participate in each round of usability testing. Participants were asked to provide feedback on the tools through quantitative surveys and open-ended qualitative questions. The usability testing approach was adapted to suit each target group, such as including a youth in the data collection process, to enhance the quality of the data. The severity of usability problems was analyzed following the first round of testing, and each tool was refined based on this feedback. The second round of usability tests involved collecting both qualitative and quantitative feedback on the revised tools. Results: All usability data have been collected and are being analyzed. Outcomes will be disseminated through a subsequent publication. Results will include demographic characteristics from each user group from both rounds of testing, severity of usability scores, qualitative and quantitative feedback, and differences in test outcomes between each target group. Conclusions: This paper provides novel guidance for conducting usability tests with youth participants when designing digital health tools. By using a comprehensive co-design and usability testing approach, we anticipate that final tools will be highly relevant to the end users and will lead to better uptake and patient outcomes when pilot-tested in future studies. The outlined approach may be adapted to different health care contexts for other youth participants. Further research should continue to explore ways to design usability tests that are suitable for youth audiences, as there is still a significant gap in the literature around this topic. International Registered Report Identifier (IRRID): DERR1-10.2196/64350 ", doi="10.2196/64350", url="https://www.researchprotocols.org/2025/1/e64350" } @Article{info:doi/10.2196/70852, author="Mackey, Tim and Cuomo, E. Raphael and Xu, Qing and McMann, J. Tiana and Li, Zhuoran and Cai, Mingxiang and Wenzel, Christine and Yang, S. Joshua", title="Approach to Design and Evaluate Digital Tools to Enhance Young Adult Participation in Clinical Trials: Co-Design and Controlled Intercept Study", journal="J Med Internet Res", year="2025", month="Apr", day="11", volume="27", pages="e70852", keywords="health", keywords="clinical trials", keywords="COVID-19", keywords="digital health", keywords="coronavirus disease", abstract="Background: Certain populations are underrepresented in clinical trials, limiting the generalizability of new treatments and their efficacy and uptake in these populations. It is essential to identify and understand effective strategies for enrolling young adults in clinical trials, as they represent a vital and key demographic for future clinical trial participation. Objective: This study aimed to develop, test, and evaluate digital tools designed to encourage the participation of young adults in the clinical trial process. An interdisciplinary approach, incorporating social listening, qualitative focus groups, and co-design workshops, was used to achieve this goal. Methods: Digital tools were designed and evaluated using a 4-phase approach that included: (1) social listening to characterize lived experiences with COVID-19 trials as self-reported by online users, (2) qualitative focus groups with young adults to explore specific lived attitudes and experiences related to COVID-19 clinical research hesitancy and engagement, (3) a series of cocreation and co-design workshops to build digital tools aimed at encouraging clinical trial participation, and (4) a controlled intercept study to assess the usability and specific outcome measures of the co-designed digital tools among young adults. Results: A significantly higher change in the likelihood of participating in a clinical trial post exposure was observed among study participants when exposed to prototypes of a mobile app ($\Delta$=0.74 on a 10-point scale, P<.01) and website ($\Delta$=0.93, P<.01) compared to those exposed to a Facebook ad ($\Delta$=0.21) but not a digital flyer ($\Delta$=0.58). Furthermore, those exposed to the mobile app (x?=5.76, P=.04) and electronic flier (x?=5.72, P=.04), but not the website (x?=5.55), exhibited significantly higher postexposure interest in learning about clinical trials when compared to participants exposed to the Facebook (Meta) ad (x?=5.06). Participants in the intercept study were more likely to consider joining a clinical trial after seeing a mobile app ($\Delta$=0.74, P<.01) or website ($\Delta$=0.93, P<.001) compared to a Facebook ad ($\Delta$=0.21), but the digital flyer ($\Delta$=0.58) did not show a significant difference. In addition, those who saw the mobile app (x?=5.76, P=.04) or the digital flyer (x?=5.72, P=.04) showed more interest in learning about clinical trials than those who saw the Facebook ad (x?=5.06), though the website (x?= 5.55) did not significantly impact interest. Conclusions: Mobile apps and web pages co-designed with young diverse adults may represent effective digital tools to advance shared goals of encouraging inclusive clinical trials. ", doi="10.2196/70852", url="https://www.jmir.org/2025/1/e70852" } @Article{info:doi/10.2196/67137, author="Ibrahim, Hussein Radhwan and Yaas, Hussein Marghoob and Hamarash, Qadir Mariwan and Al-Mukhtar, Hazim Salwa and Abdulghani, Faris Mohammed and Al Mushhadany, Osama", title="Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes", journal="JMIR Pediatr Parent", year="2025", month="Apr", day="11", volume="8", pages="e67137", keywords="cognitive behavioral therapy", keywords="CBT", keywords="psychotherapy", keywords="mHealth", keywords="app", keywords="adolescents", keywords="teenager", keywords="mental health", keywords="usability", keywords="engagement", keywords="anxiety", keywords="depression", keywords="user experience", keywords="UX", keywords="focus group", keywords="interview", keywords="digital health", abstract="Background: Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited. Objective: This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes. Methods: A qualitative study was conducted with 40 adolescents aged 13?19 years (mean age 15.8, SD 1.9 years; 18/40, 45\% male; 22/40, 55\% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50\%), depression (15/40, 38\%), and both (5/40, 13\%). Of these, 10 (25\%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests. Results: The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16?19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13?15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95\% CI 1.6?5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95\% CI 1.7?5.6; P=.001). Usability challenges included complex navigation (20/40, 50\%), interface design issues (12/40, 30\%), and content overload (8/40, 20\%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50\%) and gamification features (10/40, 25\%), while lack of personalization (14/40, 35\%) and external distractions (18/40, 45\%) were significant barriers. Mood improvement (15/40, 38\%) and learning new coping skills (12/40, 30\%) were the most reported outcomes. Conclusions: The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement. ", doi="10.2196/67137", url="https://pediatrics.jmir.org/2025/1/e67137" } @Article{info:doi/10.2196/67275, author="Hutchison, G. Michael and Di Battista, P. Alex and Pyndiura, L. Kyla", title="Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e67275", keywords="mild traumatic brain injury", keywords="recovery", keywords="mHealth", keywords="app", keywords="digital health", keywords="smartphone", keywords="eHealth", keywords="digital", keywords="technology", keywords="usability", keywords="concussion rehabilitation", keywords="brain injury", keywords="rehabilitation protocols", keywords="evidence-based exercise", keywords="single-arm pilot study", keywords="home-based rehabilitation", keywords="user-friendly", keywords="questionnaire", keywords="telehealth", keywords="telemedicine", abstract="Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from ``strongly agree'' to ``strongly disagree''. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82\%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100\% positive responses, with no single question scoring below 83\% positive responses. In the ``ease of use and satisfaction'' category, 100\% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83\%-96\% (19-22) of users responded positively to the remaining four questions. In the ``system information arrangement'' category, 100\% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87\%-96\% of users approving action acknowledgment, error recovery, and expected functions. Under the ``usefulness'' category, 96\% (n=22) of users found the app beneficial for health and well-being, and 91\% (n=21) users felt it effectively managed their health. For the five custom questions, 100\% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app's potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. ", doi="10.2196/67275", url="https://formative.jmir.org/2025/1/e67275" } @Article{info:doi/10.2196/59942, author="Biernetzky, A. Olga and Thyrian, Ren{\'e} Jochen and Boekholt, Melanie and Berndt, Matthias and Hoffmann, Wolfgang and Teipel, J. Stefan and Kilimann, Ingo", title="Identifying Unmet Needs of Informal Dementia Caregivers in Clinical Practice: User-Centered Development of a Digital Assessment Tool", journal="JMIR Aging", year="2025", month="Apr", day="7", volume="8", pages="e59942", keywords="unmet needs", keywords="assessment development", keywords="family caregivers of people with dementia", keywords="dementia", keywords="need", keywords="Alzheimer", keywords="self-guided", keywords="self-reported", keywords="caregiver", keywords="informal care", keywords="spousal care", keywords="interview", keywords="qualitative", keywords="thematic", keywords="usability", keywords="mHealth", keywords="tablet", keywords="self-completed", keywords="aging", keywords="patient care", keywords="health interventions", keywords="care giver", keywords="digital health", keywords="ehealth", keywords="digital assessment", keywords="memory", abstract="Background: Despite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective. Objective: Our study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting. Methods: The development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angeh{\"o}rige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers' biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically. Results: Data from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings. Conclusions: The input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial. Trial Registration: ClinicalTrials.gov NCT04037501; https://clinicaltrials.gov/study/NCT04037501 ", doi="10.2196/59942", url="https://aging.jmir.org/2025/1/e59942" } @Article{info:doi/10.2196/66473, author="Coletta, Giulia and Noguchi, S. Kenneth and Beaudoin, Kayla and McQuarrie, Angelica and Tang, Ada and Ganann, Rebecca and Phillips, M. Stuart and Griffin, Meridith", title="Older Adults' Perspectives on Participating in a Synchronous Online Exercise Program: Qualitative Study", journal="JMIR Aging", year="2025", month="Apr", day="3", volume="8", pages="e66473", keywords="exercise", keywords="older adults", keywords="qualitative study", keywords="qualitative", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="interview", keywords="internet", keywords="kinesiology", keywords="physiotherapy", keywords="synchronous", keywords="online", keywords="home-based", keywords="gerontology", keywords="geriatric", keywords="older", keywords="aging", keywords="physical activity", abstract="Background: Older adults face several barriers to exercise participation, including transportation, lack of access, and poor weather conditions. Such barriers may influence whether older adults meet the Canadian 24-Hour Movement Guidelines. Recently, older adults have adopted technology for health care and are increasingly using digital health technologies to improve their access to care. Therefore, technology may be a valuable tool to reduce barriers to exercise and increase exercise participation rates within this population. Objective: This study aimed to explore older adults' perceptions and experiences of exercise, in general, and specifically related to our synchronous online exercise program for community-dwelling older adults. Methods: A total of 3 registered kinesiologists and 1 physiotherapist with experience working with older adults delivered an 8-week, thrice-weekly synchronous online group-based exercise program for older adults in 3 cohorts. The program focused on strength, balance, and aerobic activity. Following the program, a qualitative study with interpretive descriptive design was conducted to explore participants' perceptions and experiences. Participants were invited to take part in a 30-minute, one-on-one semistructured interview via Zoom with a research team member. Interview data were thematically analyzed to identify common themes. Results: A total of 22 older adults (16 women, 6 men; mean age 70, SD 4 years) participated in interviews. Three themes were identified as follows: (1) health, exercise, and aging beliefs; (2) the pandemic interruption and impacts; and (3) synchronous online exercise programs attenuate barriers to exercise. Participants discussed their exercise beliefs and behaviors and their desire to safely and correctly participate in exercise. Older adults found that their physical activity was curtailed, routines disrupted, and access to in-person exercise programs revoked due to the pandemic. However, many suggested that our synchronous online exercise program was motivational and attenuated commonly reported environmental barriers to participation, such as transportation concerns (eg, time spent traveling, driving, and parking), accessibility and convenience by participating at a location of their choice, and removing travel-related concerns during poor weather conditions. Conclusions: Given these reported experiences, we posit that synchronous online exercise programs may help motivate and maintain adherence to exercise programs for older adults. These findings may be leveraged to improve health outcomes in community-dwelling older adults. Trial Registration: ClinicalTrials.gov NCT04627493; https://clinicaltrials.gov/study/NCT04627493 ", doi="10.2196/66473", url="https://aging.jmir.org/2025/1/e66473" } @Article{info:doi/10.2196/64131, author="Dougherty, Kylie and Tesfaye, Yihenew and Biza, Heran and Belew, Mulusew and Benda, Natalie and Gebremariam Gobezayehu, Abebe and Cranmer, John and Bakken, Suzanne", title="User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="3", volume="12", pages="e64131", keywords="health information technology", keywords="design and evaluation", keywords="Ethiopia", keywords="usability", keywords="nursing informatics", keywords="user-centered design", keywords="basic emergency obstetric care", keywords="obstetric", keywords="nurse", keywords="user-centered", keywords="design", keywords="maternal mortality", keywords="maternal", keywords="develop", keywords="sub-Saharan Africa", keywords="Africa", keywords="dashboard", keywords="tracking", keywords="emergency care", abstract="Background: Maternal mortality remains a persistent public health concern in sub-Saharan African countries such as Ethiopia. Health information technology solutions are a flexible and low-cost method for improving health outcomes with proven benefits in low- to middle-income countries' health systems. Objective: This study aimed to develop and assess the usability of an electronic dashboard to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboard: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain, (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboard, and (3) usability heuristic evaluation with human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboard informed by end-user preferences and perceptions, with recommendations focusing on aesthetic design, filtering and sorting, and matching with the real world. An example of an end-user recommendation included increasing font sizes on the dashboard and using a red, yellow, and green color-coding scheme. Next, domain and visualization SMEs continued the dashboard's iterative refinement, focusing on aesthetic design and navigation, by confirming design choices incorporated from the user-centered design sessions and recommending changes to enhance user experience moving through the dashboard, such as adding more filtering options. HCI SMEs rated the dashboard as highly usable (0.82 on a scale of 0-4, with 0 being no usability concern and 4 being a catastrophic usability concern). The principle with the highest usability severity scores was a match between the system and the real world with a score of 1.4. The HCI SMEs also rated the information visualization aspects of the dashboard favorably with 2 usability principles, spatial organization and information coding, scoring 0. Conclusions: Dashboards are a novel method for promoting and tracking facility capacity to manage BEmOC. By including targeted end users and SMEs in the design process, the team was able to tailor the dashboard to meet user needs, fit it into the existing government health systems, and ensure that the dashboard follows design best practices. Collectively, the novel, customized BEmOC dashboard can be used to track and improve facility-level readiness in Amhara, Ethiopia, and similar global BEmOC facilities. ", doi="10.2196/64131", url="https://humanfactors.jmir.org/2025/1/e64131" } @Article{info:doi/10.2196/68149, author="Hong, Seojin and Choi, Hyun and Kweon, Hyosun", title="Medical Device Based on a Virtual Reality--Based Upper Limb Rehabilitation Software: Usability Evaluation Through Cognitive Walkthrough", journal="JMIR Form Res", year="2025", month="Apr", day="1", volume="9", pages="e68149", keywords="usability", keywords="cognitive walkthrough", keywords="virtual reality-based upper limb rehabilitation software", keywords="upper limb", keywords="limb rehabilitation", keywords="rehabilitation", keywords="therapist", keywords="virtual reality", keywords="VR", keywords="medical device", keywords="formative evaluation", keywords="quantitative", keywords="qualitative", keywords="occupational therapy", keywords="user safety", keywords="usability testing", keywords="software", keywords="risk factor", abstract="Background: The use of virtual reality (VR) technology in rehabilitation therapy has been growing, leading to the development of VR-based upper-limb rehabilitation softwares. To ensure the effective use of such software, usability evaluations are critical to enhance user satisfaction and identify potential usability issues. Objective: This study aims to evaluate the usability of a VR-based upper-limb rehabilitation software from the perspective of occupational therapists. Specifically, the study seeks to identify usability challenges and provide insights to improve user satisfaction. Methods: The VR-based upper-limb rehabilitation software was tailored for therapists to operate while delivering therapy to patients. Usability testing was conducted with occupational therapists from the Korean National Rehabilitation Center using cognitive walkthroughs and surveys. Participants performed tasks that simulated real clinical scenarios, including turning the device on, assisting patients with wearing the device, and shutting it down. Observers recorded user reactions during task performance, and participants completed surveys to assess the ease of use of the user interface. This mixed-methods approach provided qualitative insights into user difficulties and their root causes. Results: Usability evaluations were conducted with 6 participants. Cognitive walkthroughs revealed potential areas for improvement in the software, including (1) enhancements to the graphical user interface for ease of use, (2) refinements in the natural user interface, and (3) better user manuals for clearer product instructions. The ease-of-use score for the user interface averaged 1.58 on a 5-point scale (1=very easy to 5=very difficult). Conclusions: This study provides valuable insights into improving user satisfaction by focusing on the needs of occupational therapists who operate a VR-based rehabilitation software. Future research should explore software refinement and clinical efficacy to maximize the therapeutic potential of such technologies. ", doi="10.2196/68149", url="https://formative.jmir.org/2025/1/e68149" } @Article{info:doi/10.2196/56798, author="Flaucher, Madeleine and Berzins, Sabrina and Jaeger, M. Katharina and Nissen, Michael and Rolny, Jana and Tri{\ss}ler, Patricia and Eckl, Sebastian and Eskofier, M. Bjoern and Leutheuser, Heike", title="Perception and Evaluation of a Knowledge Transfer Concept in a Digital Health Application for Patients With Heart Failure: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="31", volume="12", pages="e56798", keywords="health literacy", keywords="digital Literacy", keywords="user-centered design", keywords="digital health app", keywords="heart failure", keywords="mixed methods study", keywords="user centered deign", keywords="usability", keywords="patient engagement", keywords="mHealth app", keywords="development", abstract="Background: Digital health education can enhance the quality of life of patients with heart failure by providing accessible and tailored information, which is essential for effective self-care and self-management. Objective: This work aims to develop a mobile health knowledge transfer concept for heart failure in a user-centered design process grounded in theoretical frameworks. This approach centers on enhancing the usability, patient engagement, and meaningfulness of mobile health education in the context of heart failure. Methods: A user-centered design process was employed. First, semistructured stakeholder interviews were conducted with patients (n=9) and medical experts (n=5). The results were used to develop a health knowledge transfer concept for a mobile health app for heart failure. This concept was implemented as a digital prototype based on an existing German mobile health app for patients with heart failure. We used this prototype to evaluate our concept with patients with heart failure in a study composed of user testing and semistructured patient interviews (n=7). Results: Stakeholder interviews identified five themes relevant to mobile health education: individualization, content relevance, media diversity, motivation strategies, and trust-building mechanisms. The evaluation of our prototype showed that patients value the adaptation of content to individual interests and prior knowledge. Digital rewards such as badges and push notifications can increase motivation and engagement but should be used with care to avoid overload, irrelevance, and repetition. Conclusions: Our findings emphasize the importance of tailoring mobile health education to the specific needs and preferences of patients with heart failure. At the same time, they also highlight the careful implementation of motivation strategies to promote user engagement effectively. These implications offer guidance for developing more impactful interventions to improve health outcomes for this population. ", doi="10.2196/56798", url="https://humanfactors.jmir.org/2025/1/e56798" } @Article{info:doi/10.2196/64384, author="Wittmar, Silke and Frankenstein, Tom and Timm, Vincent and Frei, Peter and Kurpiers, Nicolas and W{\"o}lwer, Stefan and Sch{\"a}fer, Meender Axel Georg", title="User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study", journal="JMIR Form Res", year="2025", month="Mar", day="28", volume="9", pages="e64384", keywords="usability testing", keywords="health promotion", keywords="exercise", keywords="smartphone app", keywords="mHealth", keywords="physical activity", keywords="user experience", keywords="user", keywords="university student", keywords="undergraduate", keywords="college", keywords="student", keywords="mixed methods", keywords="physical fitness", keywords="digital intervention", keywords="mobile health", keywords="promote", keywords="engagement", keywords="mobile phone", abstract="Background: Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences. Objective: This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA. Methods: A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data. Results: The UX received positive ratings across 4 User Experience Questionnaire scales (range --3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale ($\eta$=0.232, P=.04), and between age and the perspicuity (Kendall $\tau$b=0.132, P=.03) and stimulation subscales (Kendall $\tau$b=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale ($\eta$=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students' appreciation for the personalized, diverse content and social networking features of futur.move. Conclusions: futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features ``your condition'' and ``goal setting.'' While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advanced prototype and conducting a longitudinal study to assess its impact on PA behavior and sustained engagement. ", doi="10.2196/64384", url="https://formative.jmir.org/2025/1/e64384" } @Article{info:doi/10.2196/63704, author="Rookes, Alanna Tasmin and Batla, Amit and Armstrong, Megan and Ambler, Gareth and Walters, Kate and Schrag, Anette", title="Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study", journal="JMIR Form Res", year="2025", month="Mar", day="25", volume="9", pages="e63704", keywords="Parkinson disease", keywords="feasibility", keywords="remote monitoring", keywords="Parkinson", keywords="acceptability", keywords="reliability", keywords="wearable devices", keywords="wearable", keywords="self-management", keywords="quantitative assessments", keywords="quantitative", keywords="qualitative", keywords="monitoring", keywords="patient", abstract="Background: Parkinson disease is a progressive neurodegenerative disorder with complex motor and nonmotor symptoms. To assess these, clinical assessments are completed, providing a snapshot of a person's experience. Monitoring Parkinson disease using wearable devices can provide continuous and objective data and capture information on movement patterns in daily life. Objective: The aim of the study is to assess patient acceptability and technical reliability of 2 wearable devices used in clinical trials (ActivInsights and Axivity AX3). Methods: Participants in a feasibility study testing a self-management toolkit (PD-Care) optionally wore a wearable device for 1 week, providing feedback through an open- and closed-question survey conducted over the telephone about the acceptability of wearing the device. The closed questions used a Likert scale from 1 to 5 (with 1=strongly agree and 5=strongly disagree) asking whether (1) the device was comfortable to wear, (2) the device was easy to put on, (3) the device was easy to wear, (4) the device was embarrassing to wear, and (5) if they were happy to wear the device for longer than 7 days. Differences in acceptability between devices were analyzed using Mann-Whitney U tests and Wilcoxon matched pairs signed rank tests. These were followed by open-ended questions asking (1) How did you find wearing the device? (2) How did you find putting the device on? (3) Did you take it off and why? (4) What was your overall impression? (5) Did you prefer the wrist- or trunk-worn device and why (Axivity AX3 only)? Results: A total of 22 of 32 (69\%) participants offered the device agreed to wear it. There were no significant differences in the demographic characteristics between those monitored and those who chose not to be. Acceptance with both devices was generally good. The ActivInsights device was more acceptable than the wrist- and trunk-worn Axivity AX3 devices, as more participants found it to be comfortable (n=15, 100\% vs n=5, 71\%; P=.02 and n=4, 57\%; P=.004, respectively), easy to wear (n=15, 100\% vs n=6, 86\%; P=.048 and n=3, 43\%; P=.004, respectively) and would wear for more than 7 days (n=13, 87\% vs n=4, 57\%; P=.02 and n=1, 14\%; P<.001, respectively). The trunk-worn Axivity AX3 device had the lowest acceptance rates, but there were no statistical differences in acceptability between the wrist- and trunk-worn Axivity AX3 devices (all P>.05). There were issues with battery life and recording errors in 3 of 14 (21\%) Axivity AX3 devices and upload failures in 3 of 15 (20\%) ActivInsights devices. Conclusions: Acceptability of wearables for monitoring Parkinson was satisfactory, especially when wrist-worn, although a few participants experienced difficulties in correct use, and there were some errors with the data upload. Trial Registration: ISRCTN Registry ISRCTN92831552; https://www.isrctn.com/ISRCTN92831552 ", doi="10.2196/63704", url="https://formative.jmir.org/2025/1/e63704" } @Article{info:doi/10.2196/60582, author="Rivas, Vincent Eric and Lesley, Ulf and Davoody, Nadia", title="Health Care Professionals' Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="24", volume="12", pages="e60582", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="advanced home care", keywords="content analysis", keywords="nurse", keywords="staff-patient relationship", keywords="aging population", keywords="patient engagement", keywords="personalized care", keywords="patient experience", abstract="Background: The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals' (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited. Objective: This study aims to explore HCPs' perspectives on using eHealth tools in advanced home care and these tools' impact on HCP-patient relationships. Methods: In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes. Results: The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction. Conclusions: The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting. ", doi="10.2196/60582", url="https://humanfactors.jmir.org/2025/1/e60582" } @Article{info:doi/10.2196/72032, author="Hooten, Michael W. and Erickson, J. Darin and Chawarski, Marek and Scholz, A. Natalie and Waljee, F. Jennifer and Brummett, M. Chad and Jeffery, M. Molly", title="Unintended Prolonged Opioid Use: Protocol for a Case-Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="24", volume="14", pages="e72032", keywords="opioid use", keywords="case-control", keywords="unintended opioid use", keywords="prolonged opioid use", keywords="prospective", abstract="Background: Misuse of prescription opioids remains a public health problem. Appropriate short-term use of these medications in opioid-naive patients is indicated in selected settings but can result in unintended prolonged opioid use (UPOU), defined as the continuation of opioid therapy beyond the period by which acute pain would have been expected to resolve. Clinical strategies aimed at preventing UPOU are lacking due to the absence of information about how this poorly understood clinical phenomenon actually develops. Objective: In this research project, 3 Clinical and Translational Science Awards (CTSA) programs (Mayo Clinic, University of Michigan, and Yale University) leveraged the conceptual framework for UPOU to investigate how patient characteristics, practice environment characteristics, and opioid prescriber characteristics facilitate or impede UPOU. All data management and analyses were conducted at a fourth CTSA program (University of Minnesota). This work was accomplished by pursuing 3 specific aims. Methods: In aim 1, opioid-naive adults receiving an initial opioid prescription were recruited for study participation. Opioid prescriptions were identified longitudinally, and patterns of use were categorized as short-term, episodic, or long-term use using established criteria. Using a prospective case-control design, patients progressing to UPOU were matched 1:1 with patients who did not develop UPOU, and differences in patient characteristics were assessed. In aim 2, clinicians who prescribed opioids to patients in aim 1 were identified and recruited for prospective assessments. Institutional and individual practice environments were assessed using a validated self-report survey. In aim 3, structural equation modeling was used to evaluate data collected in aims 1 and 2, and identified interactions were further evaluated in a large national administrative claims database. Results: Patient recruitment began on August 1, 2019. However, due to the COVID-19 pandemic, patient recruitment was slowed and intermittently interrupted over the ensuing 3-year period. As a result of regional variations in the impact of the COVID-19 pandemic on research activities, the majority of patient and clinician recruitment occurred at the Mayo Clinic site. Conclusions: Following complete data analyses, it is anticipated that electronic health record systems will be leveraged to help clinicians identify at risk patients and to develop direct-to-patient educational materials to raise awareness of the risk factors for developing UPOU. Trial Registration: ClinicalTrials.gov NCT04024397; https://clinicaltrials.gov/study/NCT04024397 International Registered Report Identifier (IRRID): DERR1-10.2196/72032 ", doi="10.2196/72032", url="https://www.researchprotocols.org/2025/1/e72032", url="http://www.ncbi.nlm.nih.gov/pubmed/39992690" } @Article{info:doi/10.2196/65567, author="Kauttonen, Janne and Rousi, Rebekah and Alam{\"a}ki, Ari", title="Trust and Acceptance Challenges in the Adoption of AI Applications in Health Care: Quantitative Survey Analysis", journal="J Med Internet Res", year="2025", month="Mar", day="21", volume="27", pages="e65567", keywords="artificial intelligence", keywords="AI", keywords="health care technology", keywords="technology adoption", keywords="predictive modeling", keywords="user trust", keywords="user acceptance", abstract="Background: Artificial intelligence (AI) has potential to transform health care, but its successful implementation depends on the trust and acceptance of consumers and patients. Understanding the factors that influence attitudes toward AI is crucial for effective adoption. Despite AI's growing integration into health care, consumer and patient acceptance remains a critical challenge. Research has largely focused on applications or attitudes, lacking a comprehensive analysis of how factors, such as demographics, personality traits, technology attitudes, and AI knowledge, affect and interact across different health care AI contexts. Objective: We aimed to investigate people's trust in and acceptance of AI across health care use cases and determine how context and perceived risk affect individuals' propensity to trust and accept AI in specific health care scenarios. Methods: We collected and analyzed web-based survey data from 1100 Finnish participants, presenting them with 8 AI use cases in health care: 5 (62\%) noninvasive applications (eg, activity monitoring and mental health support) and 3 (38\%) physical interventions (eg, AI-controlled robotic surgery). Respondents evaluated intention to use, trust, and willingness to trade off personal data for these use cases. Gradient boosted tree regression models were trained to predict responses based on 33 demographic-, personality-, and technology-related variables. To interpret the results of our predictive models, we used the Shapley additive explanations method, a game theory--based approach for explaining the output of machine learning models. It quantifies the contribution of each feature to individual predictions, allowing us to determine the relative importance of various demographic-, personality-, and technology-related factors and their interactions in shaping participants' trust in and acceptance of AI in health care. Results: Consumer attitudes toward technology, technology use, and personality traits were the primary drivers of trust and intention to use AI in health care. Use cases were ranked by acceptance, with noninvasive monitors being the most preferred. However, the specific use case had less impact in general than expected. Nonlinear dependencies were observed, including an inverted U-shaped pattern in positivity toward AI based on self-reported AI knowledge. Certain personality traits, such as being more disorganized and careless, were associated with more positive attitudes toward AI in health care. Women seemed more cautious about AI applications in health care than men. Conclusions: The findings highlight the complex interplay of factors influencing trust and acceptance of AI in health care. Consumer trust and intention to use AI in health care are driven by technology attitudes and use rather than specific use cases. AI service providers should consider demographic factors, personality traits, and technology attitudes when designing and implementing AI systems in health care. The study demonstrates the potential of using predictive AI models as decision-making tools for implementing and interacting with clients in health care AI applications. ", doi="10.2196/65567", url="https://www.jmir.org/2025/1/e65567" } @Article{info:doi/10.2196/65025, author="Folch-Sanchez, Daniel and Pellicer-Roca, Maria and Sestelo, Agustina Mar{\'i}a and Zuluaga, Paola and Arias, Francisco and Guzm{\'a}n Cortez, Pablo and Amechat, Salma and Gil-Berrozpe, Gustavo and Lopez Montes, Estefania and Mercad{\'e}, Clara and Fonseca, Francina and Miquel, Laia and Mestre-Pint{\'o}, I. Joan", title="Evaluating Perceptions of the CANreduce 2.0 eHealth Intervention for Cannabis Use: Focus Group Study", journal="J Med Internet Res", year="2025", month="Mar", day="19", volume="27", pages="e65025", keywords="addiction", keywords="cannabis", keywords="drug use disorder", keywords="eHealth", keywords="digital health intervention", keywords="qualitative research", keywords="focus groups", keywords="user-centered design", keywords="user-centered intervention", abstract="Background: Cannabis is the most widely used illicit drug, and admissions for cannabis use disorders (CUDs) are increasing globally, posing a significant public health challenge. Despite its negative consequences, a substantial proportion of individuals with problematic use do not seek treatment. In recent years, digital health interventions (DHIs) have emerged as accessible and cost-effective solutions, empowering users to manage their health care. CANreduce is one such eHealth intervention that has demonstrated effectiveness in reducing cannabis use (CU); however, its suboptimal adherence rates underscore the need for strategies to enhance user engagement and motivation. Objective: This study aims to improve the effectiveness, adherence, and user experience of the Spanish version of CANreduce 2.0 by employing focus groups (FGs) within a user-centered design approach that actively involves both users and professionals. Methods: Separate FGs were conducted for users and professionals, involving a total of 10 participants. Users were recruited from individuals registered on the CANreduce 2.0 platform and active cannabis users, while professionals comprised addiction specialists familiar with the platform. Each session was held remotely and moderated by 2 interviewers following a semistructured script. Qualitative analysis of the transcripts was performed using MAXQDA software and content analysis methodology to identify key themes related to the acceptability, usability, and utility of CANreduce 2.0. Results: The qualitative analysis identified 3 main themes, encompassing 15 subcodes. Within the ``motivation and awareness'' theme, both users (n=6, mean age 31.8 years, SD 4.1 years) and professionals (n=4, mean age 37.25 years, SD 1.71 years) frequently discussed the importance of ``motivation'' and ``problem awareness'' as crucial for the success of CANreduce 2.0. In the ``guidance and use'' theme, the subcode ``complement to face-to-face therapy'' was the most emphasized. Professionals supported CANreduce 2.0 as a valuable adjunct to in-person therapy, serving as both an educational and monitoring tool, with no objections raised by either group. Lastly, within the ``content and design'' theme, ``information,'' ``small achievements,'' and ``personalized content'' emerged as key areas for improvement, highlighting the need to enhance motivation and adherence through gamification and tailored content. Conclusions: Personalization, robust motivational strategies, and an engaging, interactive design are essential for the success of DHIs, particularly in addiction treatment. Collaboration among technology developers, health care professionals, and users should be central to the development process, fostering the cocreation of practical and effective solutions that are responsive to the needs of those seeking treatment. This approach ensures that DHIs are not only functional but also widely accepted and impactful. Insights from this study will inform the ongoing refinement of CANreduce 2.0, enhancing its relevance and effectiveness in addressing CU. ", doi="10.2196/65025", url="https://www.jmir.org/2025/1/e65025" } @Article{info:doi/10.2196/69008, author="Kang, Hyunjin and Yang, Tingting and Banu, Nazira and Ng, Ting Sheryl Wei and Lee, Kyu Jeong", title="Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study", journal="JMIR Aging", year="2025", month="Mar", day="19", volume="8", pages="e69008", keywords="smart health wearables", keywords="self-determination theory", keywords="AI anxiety", keywords="perceived privacy risk", keywords="health consciousness", abstract="Background: Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems. Objective: This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults' psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults' intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults' intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3). Methods: A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60?85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention. Results: Health consciousness positively influenced all intrinsic motivation factors---competence, autonomy, and relatedness---while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults' intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without. Conclusions: This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation---particularly competence---in older adults' adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults' motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management. ", doi="10.2196/69008", url="https://aging.jmir.org/2025/1/e69008" } @Article{info:doi/10.2196/57789, author="Thell, Maria and Edvardsson, Kerstin and Aljeshy, Reem and Ibrahim, Kalid and Warner, Georgina", title="A Trauma Support App for Young People: Co-design and Usability Study", journal="JMIR Form Res", year="2025", month="Mar", day="18", volume="9", pages="e57789", keywords="co-design", keywords="young people", keywords="trauma", keywords="app development", keywords="usability testing", abstract="Background: One of the most common reasons young people with mental health issues, such as posttraumatic stress disorder, do not seek help is stigma, which digital support tools could help address. However, there is a lack of trauma support apps specifically designed for young people. Involving the target group in such projects has been shown to produce more engaging and effective results. Objective: This study aimed to apply a child rights--based participatory approach to develop a trauma support app with young people. Methods: Seven young people (aged 14-19 years; 3 males and 4 females) with experiences of trauma were recruited as coresearchers. A child rights--based framework guided the working process. The app was developed through a series of Design Studio workshops and home assignments, using the manualized intervention Teaching Recovery Techniques as the foundation for its content. The coresearchers were trained in research methodology and conducted usability testing with other young people (n=11) using the think-aloud method, the System Usability Scale (SUS), and qualitative follow-up questions. Results: A functional app prototype was developed using a no-code platform, incorporating various trauma symptom management techniques. These techniques covered psychoeducation, normalization, relaxation, and cognitive shifting, presented in multiple formats, including text, audio, and video. The contributions of the coresearchers to the design can be categorized into 3 areas: mechanics (rules and interactions shaping the app's structure), dynamics (user-visible elements, such as the outcome when pressing a button), and aesthetics (the emotional responses the app aimed to evoke in users during interaction). Beyond influencing basic aesthetics, the coresearchers placed significant emphasis on user experience and the emotional responses the app could evoke. SUS scores ranged from 67.5 to 97.5, with the vast majority exceeding 77.5, indicating good usability. However, usability testing revealed several issues, generally of lower severity. For instance, video content required improvements, such as reducing light flickering in some recordings and adding rewind and subtitle selection options. Notably, the feature for listening to others' stories was removed to minimize emotional burden, shifting the focus to text formats with more context. Conclusions: Young people who have experienced trauma can actively participate in the cocreation of a mental health intervention, offering valuable insights into the needs and preferences of their peers. Applying a child rights--based framework to their involvement in a research project supported the fulfillment of the Convention on the Rights of the Child Article 12. ", doi="10.2196/57789", url="https://formative.jmir.org/2025/1/e57789" } @Article{info:doi/10.2196/64249, author="Ghorbanian Zolbin, Maedeh and Kujala, Sari and Huvila, Isto", title="Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Mar", day="14", volume="27", pages="e64249", keywords="eHealth services", keywords="older adults", keywords="immigrant", keywords="usability", keywords="user experience", keywords="emotion", keywords="self-determination theory", abstract="Background: The emergence of eHealth services could contribute to improving individuals' quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults' use of eHealth services. Objective: This study aimed to understand the perspectives of older adults (aged ?65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups. Methods: This study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32\%), nonimmigrants residing in rural areas (n=9, 36\%), and Iranian immigrants residing in cities (n=8, 32\%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory. Results: Interacting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64\%), had insufficient digital skills (15/25, 60\%), and experienced usability issues (15/25, 60\%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64\%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults' interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults' needs to the design of eHealth services (10/25, 40\%) and by supporting their digital skills (19/25, 76\%). Conclusions: Some older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults' needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults. ", doi="10.2196/64249", url="https://www.jmir.org/2025/1/e64249" } @Article{info:doi/10.2196/57697, author="Haegens, L. Lex and Huiskes, B. Victor J. and van den Bemt, F. Bart J. and Bekker, L. Charlotte", title="Factors Influencing the Intentions of Patients With Inflammatory Rheumatic Diseases to Use a Digital Human for Medication Information: Qualitative Study", journal="J Med Internet Res", year="2025", month="Mar", day="13", volume="27", pages="e57697", keywords="digital human", keywords="information provision", keywords="intention to use", keywords="qualitative study", keywords="focus groups", keywords="drug-related problems", keywords="medication safety", keywords="safety information", keywords="information seeking", keywords="Netherlands", keywords="Pharmacotherapy", keywords="medication", keywords="telehealth", keywords="communication technologies", keywords="medication information", keywords="rheumatic diseases", keywords="rheumatology", abstract="Background: Introduction: Patients with inflammatory rheumatic diseases (IRDs) frequently experience drug-related problems (DRPs). DRPs can have negative health consequences and should be addressed promptly to prevent complications. A digital human, which is an embodied conversational agent, could provide medication-related information in a time- and place-independent manner to support patients in preventing and decreasing DRPs. Objective: This study aims to identify factors that influence the intention of patients with IRDs to use a digital human to retrieve medication-related information. Methods: A qualitative study with 3 in-person focus groups was conducted among adult patients diagnosed with an IRD in the Netherlands. The prototype of a digital human is an innovative tool that provides spoken answers to medication-related questions and provides information linked to the topic, such as (instructional) videos, drug leaflets, and other relevant sources. Before the focus group, participants completed a preparatory exercise at home to become familiar with the digital human. A semistructured interview guide based on the Proctor framework for implementation determinants was used to interview participants about the acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability of the digital human. Focus groups were recorded, transcribed, and analyzed thematically. Results: The participants included 22 patients, with a median age of 68 (IQR 52-75) years, of whom 64\% (n=22) were female. In total, 6 themes describing factors influencing patients' intention to use a digital human were identified: (1) the degree to which individual needs for medication-related information are met; (2) confidence in one's ability to use the digital human; (3) the degree to which using the digital human resembles interacting with a human; (4) technical functioning of the digital human; (5) privacy and security; and (6) expected benefit of using the digital human. Conclusions: The intention of patients with IRDs to use a novel digital human to retrieve medication-related information was influenced by factors related to each patient's information needs and confidence in their ability to use the digital human, features of the digital human, and the expected benefits of using the digital human. These identified themes should be considered during the further development of the digital human and during implementation to increase intention to use and future adoption. Thereafter, the effect of applying a digital human as an instrument to improve patients' self-management regarding DRPs could be researched. ", doi="10.2196/57697", url="https://www.jmir.org/2025/1/e57697" } @Article{info:doi/10.2196/65776, author="Wolfe, H. Brooke and Oh, Jung Yoo and Choung, Hyesun and Cui, Xiaoran and Weinzapfel, Joshua and Cooper, Amanda R. and Lee, Hae-Na and Lehto, Rebecca", title="Caregiving Artificial Intelligence Chatbot for Older Adults and Their Preferences, Well-Being, and Social Connectivity: Mixed-Method Study", journal="J Med Internet Res", year="2025", month="Mar", day="13", volume="27", pages="e65776", keywords="older adults", keywords="technology use", keywords="AI chatbots", keywords="artificial intelligence", keywords="well-being", keywords="social connectedness", keywords="mobile phone", abstract="Background: The increasing number of older adults who are living alone poses challenges for maintaining their well-being, as they often need support with daily tasks, health care services, and social connections. However, advancements in artificial intelligence (AI) technologies have revolutionized health care and caregiving through their capacity to monitor health, provide medication and appointment reminders, and provide companionship to older adults. Nevertheless, the adaptability of these technologies for older adults is stymied by usability issues. This study explores how older adults use and adapt to AI technologies, highlighting both the persistent barriers and opportunities for potential enhancements. Objective: This study aimed to provide deeper insights into older adults' engagement with technology and AI. The technologies currently used, potential technologies desired for daily life integration, personal technology concerns faced, and overall attitudes toward technology and AI are explored. Methods: Using mixed methods, participants (N=28) completed both a semistructured interview and surveys consisting of health and well-being measures. Participants then participated in a research team--facilitated interaction with an AI chatbot, Amazon Alexa. Interview transcripts were analyzed using thematic analysis, and surveys were evaluated using descriptive statistics. Results: Participants' average age was 71 years (ranged from 65 years to 84 years). Most participants were familiar with technology use, especially using smartphones (26/28, 93\%) and desktops and laptops (21/28, 75\%). Participants rated appointment reminders (25/28, 89\%), emergency assistance (22/28, 79\%), and health monitoring (21/28, 75\%). Participants rated appointment reminders (25/28, 89.3\%), emergency assistance (22/28, 78.6\%), and health monitoring (21/28, 75\%) as the most desirable features of AI chatbots for adoption. Digital devices were commonly used for entertainment, health management, professional productivity, and social connectivity. Participants were most interested in integrating technology into their personal lives for scheduling reminders, chore assistance, and providing care to others. Challenges in using new technology included a commitment to learning new technologies, concerns about lack of privacy, and worries about future technology dependence. Overall, older adults' attitudes coalesced into 3 orientations, which we label as technology adapters, technologically wary, and technology resisters. These results illustrate that not all older adults were resistant to technology and AI. Instead, older adults are aligned with categories on a spectrum between willing, hesitant but willing, and unwilling to use technology and AI. Researchers can use these findings by asking older adults about their orientation toward technology to facilitate the integration of new technologies with each person's comfortability and preferences. Conclusions: To ensure that AI technologies effectively support older adults, it is essential to foster an ongoing dialogue among developers, older adults, families, and their caregivers, focusing on inclusive designs to meet older adults' needs. ", doi="10.2196/65776", url="https://www.jmir.org/2025/1/e65776" } @Article{info:doi/10.2196/68906, author="Park, Suhyun and Marquard, L. Jenna and Austin, R. Robin and Martin, L. Christie and Pieczkiewicz, S. David and Delaney, W. Connie", title="Exploratory Co-Design on Electronic Health Record Nursing Summaries: Case Study", journal="JMIR Form Res", year="2025", month="Mar", day="11", volume="9", pages="e68906", keywords="electronic health records", keywords="interview", keywords="nurses", keywords="user-computer interface", keywords="co-design", abstract="Background: Although electronic health record nursing summaries aim to provide a concise overview of patient data, they often fall short of meeting nurses' information needs, leading to underutilization. This gap arises from a lack of involvement of nurses in the design of health information technologies. Objective: The purpose of this exploratory co-design case study was to solicit insights from nurses regarding nursing summary design considerations, including key information types and the preferred design prototype. Methods: We recruited clinical nurses (N=33) from 7 inpatient units at a university hospital in the Midwestern United States using a purposive sampling method. We used images from a simulated nursing summary to generate visual card versions of the 46 information types currently included in an electronic health record vendor--generated nursing summary. Participants selected which cards to include and arranged them in their designs based on their perceived relevance of the information types to the summary and their preferred reading layout. The nurses' perceived relevance of information types to the summary was analyzed by quantifying the frequency of included cards, while the nurses' preferred reading layout was analyzed by quantifying the occurrence of closely paired cards to identify common groupings. After participants evaluated the information type cards, debriefing interviews were conducted and analyzed thematically to explore their rationales for the desired content and its arrangement. Results: The participants demonstrated a high level of engagement in the activities. On average, all 33 participants included 61\% (n=28) of the total information types (n=46). The most frequently included cards were ``unit specimen'' (results of the analysis of body fluid, tissue, or urine), ``activity,'' ``diet,'' and ``hospital problems,'' each included by 33 participants. Participants most frequently preferred adjacency of the following pairs: ``activity'' and ``diet'' (paired by 26 participants; 79\%) and ``notes to physicians'' and ``notes to treatment team'' (paired by 25 participants; 76\%). Participants preferred arranging the cards to improve information accessibility, focusing on key information types. Conclusions: Involving nurses in the co-design process may result in more useful and usable designs, thereby reducing the time required to navigate nursing summaries. Future work should include refining and evaluating prototypes based on the designs created by the nurses. ", doi="10.2196/68906", url="https://formative.jmir.org/2025/1/e68906" } @Article{info:doi/10.2196/64869, author="Groninger, Hunter and Arem, Hannah and Ayangma, Lylian and Gong, Lisa and Zhou, Eric and Greenberg, Daniel", title="Development of a Voice-Activated Virtual Assistant to Improve Insomnia Among Young Adult Cancer Survivors: Mixed Methods Feasibility and Acceptability Study", journal="JMIR Form Res", year="2025", month="Mar", day="10", volume="9", pages="e64869", keywords="cancer", keywords="survivor", keywords="insomnia", keywords="cognitive behavioral therapy", keywords="technology", keywords="app", keywords="oncology", keywords="mobile health", keywords="artificial intelligence", keywords="young adults", keywords="sleep", keywords="mHealth", keywords="CBT", keywords="voice-activated virtual assistant", keywords="virtual assistants", keywords="focus group", keywords="qualitative research", abstract="Background: Up to 75\% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold-standard intervention to address insomnia. To improve CBT-I access and treatment adherence, screen-based digital CBT-I platforms have been developed. However, even with these digital products, widespread uptake of CBT-I remains limited, and new strategies for CBT-I delivery are warranted. Objective: The objective of this study is to understand how YACS experience insomnia and how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel screen-free voice-activated virtual assistant--delivered CBT-I prototype. Methods: Eligible participants---ages 18-39, living with a history of cancer (any type, any stage), self-reporting on average less sleep than National Sleep Foundation recommendations, and English-speaking---were recruited from a major urban cancer center, 2 regional oncology clinics, and 2 cancer survivorship support groups. We conducted 4 focus groups to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. Results: In total, 26 YACS (6-7 participants per group) experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. In total, 12 participants completed device prototype testing, engaging with the prototype 94\% of the assigned times (twice daily for 14 days; meeting predetermined feasibility cutoff of engagement ?70\% of assigned times) and rating the prototype with an overall mean score of 5.43 on the Satisfaction subscale of the Usability, Satisfaction, and Ease of Use scale (range 4.42-7; exceeding the predetermined cutoff score for acceptability of 5.0). All participants completing the study reported they would be interested in using the prototype again and would recommend it to someone else with insomnia. Conclusions: YACS were highly engaged with our voice-activated virtual assistant--delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate the efficacy of this intervention among YACS. Trial Registration: ClinicalTrials.gov NCT05875129; https://clinicaltrials.gov/study/NCT05875129 ", doi="10.2196/64869", url="https://formative.jmir.org/2025/1/e64869" } @Article{info:doi/10.2196/66801, author="Pozzar, A. Rachel and Tulsky, A. James and Berry, L. Donna and Batista, Jeidy and Barwick, Paige and Lindvall, J. Charlotta and Dykes, C. Patricia and Manni, Michael and Matulonis, A. Ursula and McCleary, J. Nadine and Wright, A. Alexi", title="Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study", journal="JMIR Cancer", year="2025", month="Mar", day="10", volume="11", pages="e66801", keywords="ovarian neoplasm", keywords="ovarian cancer", keywords="cancer", keywords="oncology", keywords="oncologist", keywords="metastases", keywords="communication", keywords="physician-patient relations", keywords="electronic health record", keywords="EHR", keywords="electronic medical record", keywords="EMR", keywords="implementation science", keywords="digital", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="mobile phone", abstract="Background: People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients' and caregivers' needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record. Objective: We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation. Methods: We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0?100, scores ?70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance. Results: We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI's integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients' and caregivers' needs. Conclusions: The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial. ", doi="10.2196/66801", url="https://cancer.jmir.org/2025/1/e66801" } @Article{info:doi/10.2196/63607, author="Buawangpong, Nida and Sirikul, Wachiranun and Siviroj, Penprapa", title="Factors Associated With the Intention to Use mHealth Among Thai Middle-Aged Adults and Older Adults: Cross-Sectional Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="7", volume="12", pages="e63607", keywords="mHealth", keywords="mobile healthcare", keywords="older adults", keywords="elderly", keywords="aging", keywords="questionnaire", keywords="smartphone", keywords="mHealth usage", keywords="intention to use", abstract="Background: Mobile health care (mHealth) apps are emerging worldwide as a vital component of internet health care, but there are issues, especially among older adults. Objective: We aim to investigate the factors influencing the intention to use (ITU) mHealth apps, focusing on those with and without prior mHealth experience. Methods: A cross-sectional study conducted from August 2022 to July 2023 included Thai citizens aged 45 years or older. Self-reported questionnaires collected data on sociodemographic information, health conditions, smartphone or tablet ownership, and mHealth usage experience. The Thai mHealth Senior Technology Acceptance Model questionnaires with a 10-point Likert scale evaluated mHealth acceptance. A multivariable logistic regression analysis, adjusted for age, gender, education, income, and living area, was performed for 2 subgroups: those who used ITU mHealth apps and those who did not. Results: Of 1100 participants, 537 (48.8\%) intended to use mHealth apps, while 563 (51.2\%) did not. The ITU group had a younger average age, higher education levels, higher income, and fewer underlying diseases compared to those who did not intend to use mHealth apps. For those who had never used mHealth apps, having a smartphone was strongly associated with higher odds of ITU (adjusted odds ratio 2.81, 95\% CI 1.6 to 4.93; P<.001), while having any underlying disease was associated with lower odds of ITU (adjusted odds ratio 0.63, 95\% CI 0.42 to 0.97; P=.034). Higher acceptance levels, characterized by a positive attitude toward mHealth and lower fear of making mistakes, were also associated with higher ITU. For those with prior mHealth experience, acceptance in areas such as perceived ease of use, gerontechnology anxiety, and facilitating conditions was significantly associated with ITU. Conclusions: Among inexperienced users, a positive attitude toward mHealth significantly enhanced ITU. Conversely, having an underlying disease decreased ITU, indicating a need for tailored mHealth apps. For experienced users, acceptance levels in areas such as ease of use and gerontechnology anxiety were crucial. Future research should explore specific mHealth apps for more targeted insights. ", doi="10.2196/63607", url="https://humanfactors.jmir.org/2025/1/e63607" } @Article{info:doi/10.2196/72477, author="Lee, Yura and Park, Ye-Eun", title="Authors' Reply: Advancing Digital Health Integration in Oncology", journal="J Med Internet Res", year="2025", month="Mar", day="7", volume="27", pages="e72477", keywords="mHealth", keywords="user experience", keywords="cancer", keywords="technology acceptance model", keywords="structural equation modeling", keywords="health care app", keywords="mixed-method study", keywords="medical care", keywords="digital health care", keywords="cancer survivors", keywords="disparities", keywords="health status", keywords="behavioral intervention", keywords="clinician", doi="10.2196/72477", url="https://www.jmir.org/2025/1/e72477", url="http://www.ncbi.nlm.nih.gov/pubmed/40053760" } @Article{info:doi/10.2196/70316, author="Khan, Umar Rai Muhammad and Tariq, Hassan", title="Advancing Digital Health Integration in Oncology", journal="J Med Internet Res", year="2025", month="Mar", day="7", volume="27", pages="e70316", keywords="mHealth", keywords="user experience", keywords="cancer", keywords="technology acceptance model", keywords="structural equation modeling", keywords="health care app", keywords="mixed-method study", keywords="medical care", keywords="digital health care", keywords="cancer survivors", keywords="disparities", keywords="health status", keywords="behavioral intervention", keywords="clinician", doi="10.2196/70316", url="https://www.jmir.org/2025/1/e70316", url="http://www.ncbi.nlm.nih.gov/pubmed/40053796" } @Article{info:doi/10.2196/58867, author="Beerbaum, Julian and Robens, Sibylle and Fehring, Leonard and Mortsiefer, Achim and Meister, Sven", title="Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study", journal="JMIR Form Res", year="2025", month="Mar", day="5", volume="9", pages="e58867", keywords="technology acceptance", keywords="UTAUT", keywords="family doctor", keywords="digital health", keywords="eHealth", keywords="video consultation", keywords="electronic health records", keywords="digital anamnesis", keywords="online appointment scheduling", abstract="Background: Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients' overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine. Objective: To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach. Methods: Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case. Results: Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2\%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; $\beta$=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; $\beta$=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; $\beta$=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; $\beta$=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; $\beta$=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; $\beta$=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; $\beta$=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; $\beta$=.053; P=.10). Conclusions: In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice. ", doi="10.2196/58867", url="https://formative.jmir.org/2025/1/e58867", url="http://www.ncbi.nlm.nih.gov/pubmed/40053731" } @Article{info:doi/10.2196/48370, author="Francis, Karlee and Francis, Julie and Latimer, Margot and Gould, Hayley and Blackmore, Shante and MacLeod, Emily", title="Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="3", volume="12", pages="e48370", keywords="app", keywords="eHealth", keywords="pain", keywords="Indigenous", keywords="First Nations", keywords="children", keywords="youths", keywords="mobile phone", abstract="Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10?19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth's preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. ", doi="10.2196/48370", url="https://humanfactors.jmir.org/2025/1/e48370" } @Article{info:doi/10.2196/60096, author="de Thurah, Lena and Kiekens, Glenn and Weermeijer, Jeroen and Uyttebroek, Lotte and Wampers, Martien and Bonnier, Rafa{\"e}l and Myin-Germeys, Inez", title="Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis", journal="JMIR Hum Factors", year="2025", month="Mar", day="3", volume="12", pages="e60096", keywords="digital self-monitoring", keywords="technology appropriation", keywords="experience sampling method", keywords="mental health care", keywords="mental health", keywords="self-monitoring", keywords="digital health", keywords="adoption", keywords="implementation", keywords="thematic", keywords="usability", keywords="interview", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="acceptance", abstract="Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants' prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients' mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians' and clients' choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. ", doi="10.2196/60096", url="https://humanfactors.jmir.org/2025/1/e60096" } @Article{info:doi/10.2196/64661, author="Connelly, Jenni and Swingler, Kevin and Rodriguez-Sanchez, Nidia and Whittaker, C. Anna", title="Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool", journal="JMIR Aging", year="2025", month="Mar", day="3", volume="8", pages="e64661", keywords="ageing", keywords="digital technology", keywords="dietary measurement", keywords="care homes", keywords="co-design", keywords="dietary intake", keywords="food diary", abstract="Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57\%; and residents: n=6, 43\%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool's needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home--personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. ", doi="10.2196/64661", url="https://aging.jmir.org/2025/1/e64661", url="http://www.ncbi.nlm.nih.gov/pubmed/40053797" } @Article{info:doi/10.2196/67962, author="Midgett, Aida and Doumas, M. Diana and Peralta, Claudia and Peck, Matt and Reilly, Blaine and Buller, K. Mary", title="Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="21", volume="12", pages="e67962", keywords="technology-based bullying intervention", keywords="STAC-T", keywords="usability testing", keywords="middle school", keywords="rural", abstract="Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48\% school personnel; n=11, 52\% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90\% (9/10) rated the program with 4 or 5 stars. Among students, 91\% (10/11) stated they would recommend the program to others, and 100\% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. ", doi="10.2196/67962", url="https://humanfactors.jmir.org/2025/1/e67962" } @Article{info:doi/10.2196/55316, author="Dauber-Decker, L. Katherine and Feldstein, David and Hess, Rachel and Mann, Devin and Kim, Ji Eun and Gautam-Goyal, Pranisha and Solomon, Jeffrey and Khan, Sundas and Malik, Fatima and Xu, Lynn and Huffman, Ainsley and Smith, D. Paul and Halm, Wendy and Yuroff, Alice and Richardson, Safiya", title="Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study", journal="JMIR Form Res", year="2025", month="Feb", day="18", volume="9", pages="e55316", keywords="clinical decision support", keywords="CDS", keywords="decision aid", keywords="clinical aid", keywords="cough", keywords="sore throat", keywords="strep pharyngitis", keywords="snowball group usability testing", keywords="snowball group", keywords="usability testing", abstract="Background: Usability testing is valuable for assessing a new tool or system's usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. Objective: Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. Methods: We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. Results: The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites' sessions prior to conducting their own testing. Conclusions: Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized. Trial Registration: Clinicaltrials.gov NCT04255303; https://clinicaltrials.gov/study/NCT04255303 ", doi="10.2196/55316", url="https://formative.jmir.org/2025/1/e55316" } @Article{info:doi/10.2196/55720, author="Heuvelink, Annerieke and Saini, Privender and Ta?ar, {\"O}zg{\"u}r and Nauts, Sanne", title="Improving Pediatric Patients' Magnetic Resonance Imaging Experience With an In-Bore Solution: Design and Usability Study", journal="JMIR Serious Games", year="2025", month="Feb", day="13", volume="13", pages="e55720", keywords="MRI", keywords="magnetic resonance imaging", keywords="imaging", keywords="radiology", keywords="pediatrics", keywords="children", keywords="patient guidance", keywords="patient experience", keywords="design", keywords="usability", keywords="breath hold", abstract="Background: Annually, millions of children undergo a magnetic resonance imaging (MRI) examination. Hospitals increasingly aim to scan young children awake, as doing so benefits both patients and health care systems. To help hospitals reduce the need for anesthesia, we have developed solutions to prepare pediatric patients at home and in the hospital. Objective: The goal of our project was to design, develop, and test a solution that extends our preparation solutions by guiding and engaging children during their MRI examination. Methods: Pediatric In-bore was designed to deliver a familiar experience by reusing design elements from our preparation solutions. It offers child-friendly movies and auditory and visual guidance about examination progress and breath holding. To evaluate children's liking and understanding of the solution, we conducted a usability study. Ten healthy children participated in a mock MRI examination featuring pediatric In-bore. We observed task compliance (ability to lie still and hold one's breath) and conducted guided interviews to assess their experience and understanding of the guidance offered. Results: Participants (aged 5 to 10 years) were generally positive about pediatric In-bore. They liked the main character (Ollie the elephant) and her movie. Auditory and visual guidance were generally liked and understood. All but one participant successfully managed to lie still during the mock examination, and 6 (60\%) out of 10 participants successfully held their breath. Conclusions: Pediatric In-bore appears promising for engaging and guiding young children during awake MRI. It completes the Pediatric Coaching solution that now offers guidance throughout the MRI journey. Future research can expand on this work by evaluating the clinical impact of the Pediatric Coaching solution in a larger and more diverse sample of pediatric patients. ", doi="10.2196/55720", url="https://games.jmir.org/2025/1/e55720" } @Article{info:doi/10.2196/63610, author="Seo, Woosuk and Jain, Shruti and Le, Vivian and Li, Jiaqi and Zhang, Zhan and Singh, Hardeep and Pasupathy, Kalyan and Mahajan, Prashant and Park, Young Sun", title="Designing Patient-Centered Interventions for Emergency Care: Participatory Design Study", journal="JMIR Form Res", year="2025", month="Feb", day="12", volume="9", pages="e63610", keywords="emergency department", keywords="participatory design", keywords="patient", keywords="technology", keywords="intervention", abstract="Background: Emergency departments (EDs) are high-pressure environments where clinicians diagnose patients under significant constraints, including limited medical histories, severe time pressures, and frequent interruptions. Current ED care practices often inadequately support meaningful patient participation. Most interventions prioritize clinical workflow and health care provider communication, inadvertently overlooking patients' needs. Additionally, patient-facing technologies in EDs are typically developed without meaningful patient input, leading to solutions that may not effectively address patients' specific challenges. To enhance both patient-centered care practices and the diagnosis process in EDs, patient involvement in technology design is essential to ensure their needs during emergency care are understood and addressed. Objective: This study aimed to invite ED patients to participatory design sessions, identify their needs during ED visits, and present potential design guidelines for technological interventions to address these needs. Methods: We conducted 8 design sessions with 36 ED patients and caregivers to validate their needs and identify considerations for designing patient-centered interventions to improve diagnostic safety. We used 10 technological intervention ideas as probes for a needs evaluation of the study participants. Participants discussed the use cases of each intervention idea to assess their needs during the ED care process. We facilitated co-design activities with the participants to improve the technological intervention designs. We audio- and video-recorded the design sessions. We then analyzed session transcripts, field notes, and design sketches. Results: On the basis of ED patients' feedback and evaluation of our intervention designs, we found the 3 most preferred intervention ideas that addressed the common challenges ED patients experience. We also identified 4 themes of ED patients' needs: a feeling of inclusion in the ED care process, access to sources of medical information to enhance patient comprehension, addressing patient anxiety related to information overload and privacy concerns, and ensuring continuity in care and information. We interpreted these as insights for designing technological interventions for ED patients. Therefore, on the basis of the findings, we present five considerations for designing better patient-centered interventions in the ED care process: technology-based interventions should (1) address patients' dynamic needs to promote continuity in care; (2) consider the amount and timing of information that patients receive; (3) empower patients to be more active for better patient safety and care quality; (4) optimize human resources, depending on patients' needs; and (5) be designed with the consideration of patients' perspectives on implementation. Conclusions: This study provides unique insights for designing technological interventions to support ED diagnostic processes. By inviting ED patients into the design process, we present unique insights into the diagnostic process and design considerations for designing novel technological interventions to enhance patient safety. International Registered Report Identifier (IRRID): RR2-10.2196/55357 ", doi="10.2196/63610", url="https://formative.jmir.org/2025/1/e63610" } @Article{info:doi/10.2196/67043, author="Jacob, Christine and M{\"u}ller, Roman and Sch{\"u}ler, Sonja and Rey, Alix and Rey, Guillaume and Armenian, Berj and Vonlaufen, Alain and Drepper, Michael and Zimmerli, Marius", title="Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="12", volume="12", pages="e67043", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="technology assessment", keywords="technology adoption", keywords="technology implementation", keywords="usability study", keywords="colonoscopy", keywords="app", keywords="application", keywords="examinations", keywords="smartphone", keywords="usability", abstract="Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25\% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100\% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. ", doi="10.2196/67043", url="https://humanfactors.jmir.org/2025/1/e67043" } @Article{info:doi/10.2196/59386, author="Grieve, Natalie and Braaten, Kyra and MacPherson, Megan and Liu, Sam and Jung, E. Mary", title="Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e59386", keywords="usability evaluation", keywords="mHealth", keywords="usability testing", keywords="app", keywords="end-user", keywords="focus group", keywords="participant", keywords="survey", keywords="diabetes", keywords="user-centered", keywords="cognitive walkthrough", keywords="cognitive walkthroughs", keywords="questionnaire", keywords="mobile phone", keywords="digital health", keywords="prediabetes", abstract="Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app's usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8\% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client's preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes' program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. ", doi="10.2196/59386", url="https://formative.jmir.org/2025/1/e59386" } @Article{info:doi/10.2196/49610, author="Zuidhof, Niek and Peters, Oscar and Verbeek, Peter-Paul and Ben Allouch, Somaya", title="Social Acceptance of Smart Glasses in Health Care: Model Evaluation Study of Anticipated Adoption and Social Interaction", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e49610", keywords="smart glasses", keywords="technology adoption", keywords="social interaction", keywords="instrument development", keywords="structural equation modeling", abstract="Background: Despite the growing interest in smart glasses, it is striking that they are not widespread among health care professionals. Previous research has identified issues related to social interactions involving the use of smart glasses in public settings, which may differ from those associated with their application in health care contexts. Objective: Assuming that smart glasses mediate contact between the health care provider and patient, the objectives of this research are two-fold: (1) to develop an instrument that combines the adoption and mediation perspectives, and (2) to gain insights into how the intention to use is influenced through aspects of adoption and social interaction. Methods: A questionnaire was administered to a target audience of health care professionals (N=450), with recruitment via MTurk. The sample primarily included male participants from the United States, with the majority aged 42 years or younger. Although a large portion of respondents were medical doctors, the sample also included nurses and other health care professionals. Data were analyzed by structural equation modeling. Results: Regarding the aim of developing an instrument combining adoption and social interaction, the internal consistency was above the aspirational level ($\alpha$>.70) for the instrument. Furthermore, regarding the second objective involving gaining insights into the influential constructs of the anticipated intention to use, the following results were highlighted: in testing the conceptual model, the measurement model generated a good fit and the respecified structural model also generated a good fit. The tested hypotheses confirmed that social interaction constructs could explain a higher variance of users' anticipated intention to use. Perceived social isolation and decreased attentional allocation did not have a significant effect on attitude. Furthermore, the intention to use smart glasses despite nonacceptance of smart glasses by the patient significantly influenced the anticipated intention to use. In summary, constructs that focus on social interaction could contribute to better explanation and prediction of the expected adoption of smart glasses in health care. Conclusions: The empirical findings of this study provide new insights into how the mediation perspective can increase the explained variance compared to existing knowledge about adoption. Against expectations based on previous literature and despite the social issues raised earlier, these social aspects do play important roles for health care professionals but are ultimately not decisive for the intention to use. As a result, there are fewer threats to the adoption of smart glasses from the perspective of health care professionals than might be expected based on the previous literature. Therefore, the use of smart glasses can still be considered as an innovative way of working in health care. ", doi="10.2196/49610", url="https://formative.jmir.org/2025/1/e49610" } @Article{info:doi/10.2196/60495, author="Perez Ramirez, Alejandra and Ortega, Adrian and Stephenson, Natalie and Mu{\~n}oz Osorio, Angel and Kazak, Anne and Phan, Thao-Ly", title="mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e60495", keywords="obesity", keywords="user testing", keywords="mHealth", keywords="mobile health", keywords="Spanish", keywords="child", keywords="rural population", abstract="Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform---the Healthy Lifestyle (Nemours Children's Health) dashboard---was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100\% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100\%) selected the same dashboard icon and 71\% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. ", doi="10.2196/60495", url="https://formative.jmir.org/2025/1/e60495", url="http://www.ncbi.nlm.nih.gov/pubmed/39932772" } @Article{info:doi/10.2196/67289, author="Elkourdi, Farah and Asan, Onur", title="Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="10", volume="8", pages="e67289", keywords="pediatric care", keywords="children with medical complexity", keywords="family-centered care", keywords="health information technology", keywords="health care software solutions", keywords="mobile phone", keywords="artificial intelligence", abstract="Background: Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non--English-speaking immigrant populations. Objective: This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources. Methods: We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity. Results: We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies. Conclusions: The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity. ", doi="10.2196/67289", url="https://pediatrics.jmir.org/2025/1/e67289" } @Article{info:doi/10.2196/63819, author="Serck-Hanssen, Ingrid and Solheim-Witt, Marit and Anker, J. Justin and Sugarman, E. Dawn", title="A Web-Based Resource Informed by Cognitive Behavioral Therapy and Positive Psychology to Address Stress, Negative Affect, and Problematic Alcohol Use: A Usability and Descriptive Study", journal="JMIR Form Res", year="2025", month="Feb", day="10", volume="9", pages="e63819", keywords="alcohol misuse", keywords="stress", keywords="drinking to cope", keywords="DTC", keywords="negative affect", keywords="positive psychology intervention", keywords="PPI", keywords="cognitive behavior therapy", keywords="CBT", keywords="alcohol use", keywords="drinking", keywords="usability", keywords="descriptive study", keywords="behavior", keywords="emotion", keywords="coping skill", keywords="positive psychology", keywords="psychology", keywords="online resource", keywords="mobile phone", abstract="Background: Research documents that drinking to cope behavior can be disrupted by enhancing emotion regulation and coping skills related to the experience of stress and negative affect. The Alpha Element Self-Coaching Plan incorporates principles of positive psychology and cognitive behavioral therapy to redirect negative thinking and emotions and, therefore, has the potential to benefit individuals who use alcohol to cope with stress. Objective: This study aimed to evaluate satisfaction and usability of the web-based Alpha Element Self-Coaching Plan in order to inform the development of an expanded digital platform based on the Alpha Element framework. Methods: Participants enrolled in the web-based program as part of their clinical care were eligible to participate. A total of 20 individuals (14 women and 6 men) between ages 30 and 79 (mean 54.5, SD 14.14) years completed web-based questionnaires to assess product performance in areas such as ease of technology use, quality of videos and handouts, and the value of the activities. Participants also completed the System Usability Scale (SUS) and provided background and demographic information, including alcohol use. Results: Only 1 participant reported no alcohol use in the past year; 55\% (11/20) of participants drank alcohol 2?4 times per month or less and 45\% (9/20) reported drinking alcohol 2?3 times per week or more. The average SUS score of 76.38 (SD 17.85) was well above the commonly accepted threshold of 68, indicating high system usability. A majority of the sample (16/19, 84\%) agreed or strongly agreed that the activities in the program inspired behavioral changes; and most agreed or strongly agreed that the program was engaging (16/20, 80\%), well-organized (18/20, 90\%), and easy to follow (17/20, 85\%). Only 2 participants endorsed experiencing difficulty using the program on a smartphone. Suggestions for program improvements included expanding the platform, updating the web format, adding user interactivity, and enhancing navigation. Conclusions: These data suggest that participants were generally satisfied with the web-based Alpha Element Self-Coaching Plan, and rated usability of the program as favorable. Importantly, a significant portion of participants reported that the program inspired behavioral changes. More research is needed with a larger sample to obtain specific data about alcohol consumption and investigate associations between alcohol use and program components, as well as examine gender differences. Data collected from this study will be used to expand the platform and improve user experience. ", doi="10.2196/63819", url="https://formative.jmir.org/2025/1/e63819" } @Article{info:doi/10.2196/65140, author="Astill Wright, Laurence and Moore, Matthew and Reeves, Stuart and Vallejos, Perez Elvira and Morriss, Richard", title="Improving the Utility, Safety, and Ethical Use of a Passive Mood-Tracking App for People With Bipolar Disorder Using Coproduction: Qualitative Focus Group Study", journal="JMIR Form Res", year="2025", month="Feb", day="7", volume="9", pages="e65140", keywords="mood monitoring", keywords="ecological momentary assessment", keywords="EMA", keywords="passive ecological momentary assessment", keywords="passive EMA", keywords="bipolar disorder", keywords="implementation", keywords="qualitative", keywords="mobile phone", abstract="Background: Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. Objective: This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. Methods: A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. Results: Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. Conclusions: People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired. ", doi="10.2196/65140", url="https://formative.jmir.org/2025/1/e65140", url="http://www.ncbi.nlm.nih.gov/pubmed/39918865" } @Article{info:doi/10.2196/58077, author="Kelly, Charlotte Sofia and Wegener, Kauffeldt Emilie and Kayser, Lars", title="Creation of Text Vignettes Based on Patient-Reported Data to Facilitate a Better Understanding of the Patient Perspective: Design Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="5", volume="12", pages="e58077", keywords="patient-reported outcome", keywords="text vignette", keywords="data representation", keywords="Readiness and Enablement Index for Health Technology", keywords="understanding", keywords="health care system", keywords="data analysis", keywords="clinical training", keywords="clinician", keywords="health professional", abstract="Background: Patient-reported outcome (PRO) data refer to information systematically reported by patients, or on behalf of patients, without the influence of health care professionals. It is a focal point of the health care system's ambition toward becoming more involving and personalized. It is recognized that PROs provide valuable data. However, despite this recognition, there are challenges related to both patients' and clinicians' accurate interpretations of the quantitative data. To overcome these challenges, this study explores text vignettes as a representation of PROs. Objective: This study aimed to develop data-informed text vignettes based on data from the Readiness and Enablement Index for Health Technology (READHY) instrument as another way of representing PRO data and to examine how these are perceived as understandable and relevant for both patients and clinicians. Methods: The text vignettes were created from participant responses to the READHY instrument, which encompasses health literacy, health education, and eHealth literacy. The text vignettes were created from 13 individual text strings, each corresponding to a scale in the READHY instrument. This study consisted of 3 sequential parts. In part 1, individuals with chronic obstructive pulmonary disease completed the READHY instrument, providing data to be used to create vignettes based on cluster profiles from the READHY instrument. Part 2 focused on the development of scale-based strings representing all READHY dimensions, which were evaluated through iterative cognitive interviews. In part 3, clinicians and patients assessed the understanding and relevance of the text vignettes. Results: Clinicians and patients both understood and related to the text vignettes. Patients viewed the text vignettes as an accurate reflection of their PRO responses, and clinicians perceived the text vignettes as aligned with their understanding of patients' experiences. Conclusions: Text vignettes can be developed using PRO instruments, with individual scales as input strings. This provides an opportunity to present numeric values in a text format that is understandable and recognizable to most patients and clinicians. Challenges with the vignette's language and layout require customization and clinician training to ensure meaningful interpretation. Findings also support the need to expand the study and enhance clinical relevance with alternative or contextually relevant text vignettes. ", doi="10.2196/58077", url="https://humanfactors.jmir.org/2025/1/e58077" } @Article{info:doi/10.2196/66666, author="Rudin, S. Robert and Herman, M. Patricia and Vining, Robert", title="Addressing the ``Black Hole'' of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study", journal="JMIR Form Res", year="2025", month="Feb", day="4", volume="9", pages="e66666", keywords="low back pain", keywords="clinical decision support", keywords="user-centered design", keywords="usability", keywords="back pain", keywords="low back pain care", keywords="pain", keywords="clinical decision", keywords="societal burden", keywords="substantial", keywords="burden", keywords="evidence-based", keywords="treatment", keywords="diagnosis", keywords="support tool", keywords="clinicians", keywords="chiropractic", keywords="chiropractor", keywords="reviews", keywords="scenario-based interviews", keywords="interviews", abstract="Background: Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Although there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis that does not facilitate evidence-based and individualized care. Objectives: We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on the available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care. Methods: Our 3-step user-centered design approach consisted of identifying clinical requirements through the analysis of evidence reviews, iteratively identifying task-based user requirements and developing a working web-based prototype, and evaluating usability through scenario-based interviews and the System Usability Scale. Results: The 5 participating users had an average of 18.5 years of practicing chiropractic medicine. Clinical requirements included 44 patient interview and examination items. Of these, 13 interview items were enabled for all patients and 13 were enabled conditional on other input items. One examination item was enabled for all patients and 16 were enabled conditional on other items. One item was a synthesis of interview and examination items. These items provided evidence of 12 possible working diagnoses of which 3 were macrodiagnoses and 9 were microdiagnoses. Each diagnosis had relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. User input led to key refinements in the design, such as organizing the input questions by microdiagnosis, adding a patient summary screen that persists during data input and when reviewing output, adding more information buttons and graphics to input questions, and providing traceability by highlighting the input items used by the clinical logic to suggest a working diagnosis. Users believed that it would be important to have the tool accessible from within an electronic health record for adoption within their workflows. The System Usability Scale score for the prototype was 84.75 (range: 67.5?95), considered as the top 10th percentile. Users believed that the tool was easy to use although it would require training and practice on the clinical content to use it effectively. With such training and practice, users believed that it would improve care and shed light on the ``black hole'' of LBP diagnosis and treatment. Conclusions: Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care. ", doi="10.2196/66666", url="https://formative.jmir.org/2025/1/e66666" } @Article{info:doi/10.2196/50331, author="Nakikj, Drashko and Kreda, David and Luthria, Karan and Gehlenborg, Nils", title="Patient-Generated Collections for Organizing Electronic Health Record Data to Elevate Personal Meaning, Improve Actionability, and Support Patient--Health Care Provider Communication: Think-Aloud Evaluation Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="3", volume="12", pages="e50331", keywords="mobile health", keywords="patients", keywords="electronic health records", keywords="sensemaking", keywords="data organization", keywords="collections", keywords="awareness", keywords="proactivity", keywords="self-advocacy", keywords="patient--health care provider communication", abstract="Background: Through third party applications, patients in the United States have access to their electronic health record (EHR) data from multiple health care providers. However, these applications offer only a predefined organization of these records by type, time stamp, or provider, leaving out meaningful connections between them. This prevents patients from efficiently reviewing, exploring, and making sense of their EHR data based on current or ongoing health issues. The lack of personalized organization and important connections can limit patients' ability to use their data and make informed health decisions. Objective: To address these challenges, we created Discovery, an experimental app that enables patients to organize their medical records into collections, analogous to placing pictures in photo albums. These collections are based on the evolving understanding of the patients' past and ongoing health issues. The app also allows patients to add text notes to collections and their constituent records. By observing how patients used features to select records and assemble them into collections, our goal was to learn about their preferred mechanisms to complete these tasks and the challenges they would face in the wild. We also intended to become more informed about the various ways in which patients could and would like to use collections. Methods: We conducted a think-aloud evaluation study with 14 participants on synthetic data. In session 1, we obtained feedback on the mechanics for creating and assembling collections and adding notes. In session 2, we focused on reviewing collections, finding data patterns within them, and retaining insights, as well as exploring use cases. We conducted reflexive thematic analysis on the transcribed feedback. Results: Collections were useful for personal use (quick access to information, reflection on medical history, tracking health, journaling, and learning from past experiences) and clinical visits (preparation and raising physicians' awareness). Assembling EHR data into reliable collections could be difficult for typical patients due to considerable manual work and lack of medical knowledge. However, automated collection building could alleviate this issue. Furthermore, having EHR data organized in collections may have limited use. However, augmenting them with patient-generated data, which are entered with flexible richness and structure, could add context, elevate meaning, and improve actionability. Finally, collections might produce a misconstrued health picture, but bringing the physician in the loop for verification could increase their clinical validity. Conclusions: Collections can be a powerful tool for advancing patients' proactivity, awareness, and self-advocacy, potentially facilitating patient-centered care. However, patients need better support for incorporating their own everyday data and adding meaningful annotations for future reference. Improvements in the comprehensiveness, efficiency, and reliability of the collection assembly process through automation are also necessary. ", doi="10.2196/50331", url="https://humanfactors.jmir.org/2025/1/e50331" } @Article{info:doi/10.2196/63449, author="Hsu, Wan-Chen", title="eHealth Literacy and Cyberchondria Severity Among Undergraduate Students: Mixed Methods Study", journal="JMIR Form Res", year="2025", month="Feb", day="3", volume="9", pages="e63449", keywords="eHealth literacy", keywords="undergraduate student", keywords="cyberchondria", keywords="compucondria", keywords="web-based health information", keywords="health information seeking", keywords="college students", abstract="Background: With the development of the internet, health care websites have become increasingly important by enabling easy access to health information, thereby influencing the attitudes and behaviors of individuals toward health issues. However, few studies have addressed public access to health information and self-diagnosis. Objective: This study investigated the background factors and status of cyberchondria severity among college students by conducting a nationwide sample survey using the Cyberchondria Severity Scale. Further, we explored the perspective of eHealth literacy of those with scores higher than 1 SD from the mean by analyzing their recent experiences using web-based health information. Methods: A nationally representative sample of college students was surveyed, and 802 valid responses were obtained (male: 435/802, 54.2\%; female: 367/802, 45.8\%; mean age 20.3, SD 1.4 years). The Cyberchondria Severity Scale was used, which consisted of 4 dimensions (increased anxiety, obsessive-compulsive hypochondria, perceived controllability, and web-based physician-patient interaction). Additionally, we recruited 9 volunteers who scored more than 1 SD above the mean for in-depth interviews on their web-based health information--seeking behaviors. Results: Significant differences were found across the 4 dimensions of cyberchondria severity (F3,2403=256.26; P<.001), with perceived controllability scoring the highest (mean 2.75, SD 0.87) and obsessive-compulsive hypochondria scoring the lowest (mean 2.19, SD 0.77). Positive correlations were observed between perceived controllability, web-based physician-patient interactions, increased anxiety, and obsessive-compulsive hypochondria (r=0.46-0.75, P<.001). Regression analysis indicated that health concern significantly predicted perceived controllability ($\beta$ coefficient=0.12; P<.05) and web-based physician-patient interaction ($\beta$ coefficient=0.16; P<.001). Interview data revealed that students often experienced heightened anxiety (8/9, 89\%) and stress (7/9, 78\%) after exposure to web-based health information, highlighting the need for improved health literacy and reliable information sources. Conclusions: The study identified both benefits and risks in college students' use of web-based health information, emphasizing the importance of critical consciousness and eHealth literacy. Future research should examine how college students move from self-awareness to actionable change and the development of critical health literacy, which are essential for effective digital health engagement. ", doi="10.2196/63449", url="https://formative.jmir.org/2025/1/e63449" } @Article{info:doi/10.2196/60667, author="Thigpen, Nina and Patel, Shyamal and Zhang, Xi", title="Oura Ring as a Tool for Ovulation Detection: Validation Analysis", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e60667", keywords="ovulation", keywords="digital medicine", keywords="physiology", keywords="body temperature", keywords="menstrual cycles", keywords="wearable", keywords="fertility", keywords="nonhormonal contraception", keywords="reproductive health", keywords="women's health", keywords="calendar method", keywords="mHealth", keywords="mobile health", keywords="detection", abstract="Background: Oura Ring is a wearable device that estimates ovulation dates using physiology data recorded from the finger. Estimating the ovulation date can aid fertility management for conception or nonhormonal contraception and provides insights into follicular and luteal phase lengths. Across the reproductive lifespan, changes in these phase lengths can serve as a biomarker for reproductive health. Objective: We assessed the strengths, weaknesses, and limitations of using physiology from the Oura Ring to estimate the ovulation date. We compared performance across cycle length, cycle variability, and participant age. In each subgroup, we compared the algorithm's performance with the traditional calendar method, which estimates the ovulation date based on an individual's last period start date and average menstrual cycle length. Methods: The study sample contained 1155 ovulatory menstrual cycles from 964 participants recruited from the Oura Ring commercial database. Ovulation prediction kits served as a benchmark to evaluate the performance. The Fisher test was used to determine an odds ratio to assess if ovulation detection rate significantly differed between methods or subgroups. The Mann-Whitney U test was used to determine if the accuracy of the estimated ovulation date differed between the estimated and reference ovulation dates. Results: The physiology method detected 1113 (96.4\%) of 1155 ovulations with an average error of 1.26 days, which was significantly lower (U=904942.0, P<.001) than the calendar method's average error of 3.44 days. The physiology method had significantly better accuracy across all cycle lengths, cycle variability groups, and age groups compared with the calendar method (P<.001). The physiology method detected fewer ovulations in short cycles (odds ratio 3.56, 95\% CI 1.65-8.06; P=.008) but did not differ between typical and long or abnormally long cycles. Abnormally long cycle lengths were associated with decreased accuracy (U=22,383, P=.03), with a mean absolute error of 1.7 (SEM .09) days compared with 1.18 (SEM .02) days. The physiology method was not associated with differences in accuracy across age or typical cycle variability, while the calendar method performed significantly worse in participants with irregular cycles (U=21,643, P<.001). Conclusions: The physiology method demonstrated superior accuracy over the calendar method, with approximately 3-fold improvement. Calendar-based fertility tracking could be used as a backup in cases of insufficient physiology data but should be used with caution, particularly for individuals with irregular menstrual cycles. Our analyses suggest the physiology method can reliably estimate ovulation dates for adults aged 18-52 years, across a variety of cycle lengths, and in users with regular or irregular cycles. This method may be used as a tool to improve fertile window estimation, which can aid in conceiving or preventing pregnancies. This method also offers a low-effort solution for follicular and luteal phase length tracking, which are key biomarkers for reproductive health. ", doi="10.2196/60667", url="https://www.jmir.org/2025/1/e60667" } @Article{info:doi/10.2196/66132, author="Puttkammer, Nancy and Dunbar, Elizabeth and Germanovych, Myroslava and Rosol, Mariia and Golden, Matthew and Hubashova, Anna and Fedorchenko, Vladyslav and Hetman, Larisa and Legkostup, Liudmyla and Flowers, Jan and Nesterova, Olena", title="Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study", journal="JMIR Form Res", year="2025", month="Jan", day="30", volume="9", pages="e66132", keywords="human-centered design", keywords="mobile health", keywords="mHealth", keywords="Ukraine", keywords="HIV testing", keywords="war and humanitarian settings", abstract="Background: Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)--Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking. Objective: The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability. Methods: This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study's formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients. Results: The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine's wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload. Conclusions: It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing. ", doi="10.2196/66132", url="https://formative.jmir.org/2025/1/e66132" } @Article{info:doi/10.2196/59414, author="Saleem, Maham and Zafar, Shamsa and Klein, Thomas and Koesters, Markus and Bashir, Adnan and Fuhr, C. Daniela and Sikander, Siham and Zeeb, Hajo", title="A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan", journal="JMIR Form Res", year="2025", month="Jan", day="28", volume="9", pages="e59414", keywords="digital mental health", keywords="digital technology", keywords="digital intervention", keywords="Problem Management Plus", keywords="lay health worker programme", keywords="common mental health disorders", keywords="low- and middle-income countries", keywords="co-production", abstract="Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization--endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for ``lady health workers'' (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. ", doi="10.2196/59414", url="https://formative.jmir.org/2025/1/e59414", url="http://www.ncbi.nlm.nih.gov/pubmed/39874072" } @Article{info:doi/10.2196/63818, author="Barbazi, Neda and Shin, Youn Ji and Hiremath, Gurumurthy and Lauff, Anne Carlye", title="Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e63818", keywords="assessment", keywords="congenital heart disease", keywords="children health literacy", keywords="health education", keywords="caregiving", keywords="patient-centered care", keywords="design", keywords="qualitative pilot", keywords="children health", keywords="educational interventions", abstract="Background: Congenital heart disease (CHD) is a birth defect of the heart that requires long-term care and often leads to additional health complications. Effective educational strategies are essential for improving health literacy and care outcomes. Despite affecting around 40,000 children annually in the United States, there is a gap in understanding children's health literacy, parental educational burdens, and the efficiency of health care providers in delivering education. Objective: This qualitative pilot study aims to develop tailored assessment tools to evaluate educational needs and burdens among children with CHD, their parents, and health care providers. These assessments will inform the design of medical education toys to enhance health management and outcomes for pediatric patients with CHD and key stakeholders. Methods: Through stakeholder feedback from pediatric patients with CHD, parents, and health care providers, we developed three tailored assessments in two phases: (1) iterative development of the assessment tools and (2) pilot testing. In the first phase, we defined key concepts, conducted a literature review, and created initial drafts of the assessments. During the pilot-testing phase, 12 participants were recruited at the M Health Fairview Pediatric Specialty Clinic for Cardiology---Explorer in Minneapolis, Minnesota, United States. We gathered feedback using qualitative methods, including cognitive interviews such as think-aloud techniques, verbal probing, and observations of nonverbal cues. The data were analyzed to identify the strengths and weaknesses of each assessment item and areas for improvement. Results: The 12 participants included children with CHD (n=5), parents (n=4), and health care providers (n=3). The results showed the feasibility and effectiveness of the tailored assessments. Participants showed high levels of engagement and found the assessment items relevant to their education needs. Iterative revisions based on participant feedback improved the assessments' clarity, relevance, and engagement for all stakeholders, including children with CHD. Conclusions: This pilot study emphasizes the importance of iterative assessment development, focusing on multistakeholder engagement. The insights gained from the development process will guide the creation of tailored assessments and inform the development of child-led educational interventions for pediatric populations with CHD. ", doi="10.2196/63818", url="https://formative.jmir.org/2025/1/e63818" } @Article{info:doi/10.2196/63348, author="Daniels, Kim and Vonck, Sharona and Robijns, Jolien and Quadflieg, Kirsten and Bergs, Jochen and Spooren, Annemie and Hansen, Dominique and Bonnech{\`e}re, Bruno", title="Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study", journal="JMIR Aging", year="2025", month="Jan", day="27", volume="8", pages="e63348", keywords="mobile health", keywords="mHealth", keywords="feasibility", keywords="physical activity", keywords="older adults", keywords="health promotion", keywords="usability", keywords="mobile phone", abstract="Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app's acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57\% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6\%. Analysis showed general satisfaction with the app's workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 ", doi="10.2196/63348", url="https://aging.jmir.org/2025/1/e63348" } @Article{info:doi/10.2196/57659, author="Glaser, Caterina Savannah Lucia and Fraterman, Itske and van Brummelen, Noah and Tibollo, Valentina and Del Campo, Maria Laura and Mallo, Henk and Wilgenhof, Sofie and Wilk, Szymon and Gisko, Vitali and Khadakou, Vadzim and Cornet, Ronald and Ottaviano, Manuel and Medlock, Stephanie", title="Usability and Usefulness of a Symptom Management Coaching System for Patients With Cancer Treated With Immune Checkpoint Inhibitors: Comparative Mixed Methods Study", journal="JMIR Form Res", year="2025", month="Jan", day="23", volume="9", pages="e57659", keywords="oncology", keywords="usability", keywords="usefulness", keywords="symptom management", keywords="coaching system", keywords="patients with cancer", keywords="immune checkpoint inhibitors", keywords="comparative qualitative study", keywords="medication", keywords="eHealth applications", keywords="caregivers", keywords="cancer treatment", keywords="patient education", keywords="well-being interventions", keywords="acceptability", keywords="melanoma", keywords="renal cell carcinoma", keywords="immunotherapy", abstract="Background: The prognosis for patients with several types of cancer has substantially improved following the introduction of immune checkpoint inhibitors, a novel type of immunotherapy. However, patients may experience symptoms both from the cancer itself and from the medication. A prototype of the eHealth tool Cancer Patients Better Life Experience (CAPABLE) was developed to facilitate symptom management, aimed at patients with melanoma and renal cell carcinoma treated with immunotherapy. Better usability of such eHealth tools can lead to improved user well-being and reduced risk of harm. It is unknown for usability evaluations whether certain usability problems would only be evident to patients whose condition closely resembles the target population, or if a broader group of patients would lead to the identification of a broader range of potential usability issues. Objective: This study aims to evaluate the CAPABLE prototype by conducting tests to assess usability, user experience, and perceived acceptability among end users, and to assess any agreements or differences in the results of our wide range of participants. Methods: This usability study was executed by interviewing participants with a melanoma or renal cell carcinoma diagnosis who have received immunotherapy and participants without direct experience with the targeted cancer types who have not received immunotherapy. Participants were asked to review the concept of the tool, perform think-aloud tasks, and complete the System Usability Scale and a Perceived Usefulness questionnaire. Usability problems were extracted from the interview data by independent coding and mapped to an eHealth Usability Problem Framework. Results: We included 21 participants in the study, aged 29 to 73 years; 13 participants who had received immunotherapy and 8 participants who had not received immunotherapy. In total, 76 usability problems were identified. A total of 22 usability problems were in the task-technology fit category of the usability framework, mostly regarding the coaching and symptom functionality of the prototype. Critical problems regarding the symptom monitoring functionality were mainly found by participants who had received immunotherapy. For 8 out of 10 statements in the Perceived Usefulness questionnaire, more than 75\% of participants agreed or strongly agreed. The overall mean System Usability Scale score was 80 out of 100 (SD 11.3). Conclusions: Despite identified usability issues, participants responded positively to the Perceived Usefulness questionnaire regarding the evaluated tool. Further analysis of the usability problems indicates that it was essential to include participants who matched the target end users. Participants treated with immunotherapy, specifically with previous experience in immune-related adverse events, encountered critical problems with symptom reporting that would not have been identified if these participants were not included. For other tasks and functionalities, it seems likely that loosening the inclusion criteria would have resulted in sufficient feedback without critical missing usability issues. ", doi="10.2196/57659", url="https://formative.jmir.org/2025/1/e57659" } @Article{info:doi/10.2196/58128, author="McMullan, Christel and Turner, Grace and Retzer, Ameeta and Belli, Antonio and Davies, Haf Elin and Nice, Laura and Flavell, Luke and Flavell, Jackie and Calvert, Melanie", title="Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study", journal="JMIR Form Res", year="2025", month="Jan", day="23", volume="9", pages="e58128", keywords="usability study", keywords="usability", keywords="patient reported outcome", keywords="PRO", keywords="electronic patient reported outcome", keywords="ePRO", keywords="traumatic brain injury", keywords="TBI", keywords="think aloud", keywords="cognitive interviews", keywords="early warning", keywords="early detection", keywords="mobile phone", abstract="Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform---Atom5---for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK---an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the ``Think Aloud'' method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury -- Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. ", doi="10.2196/58128", url="https://formative.jmir.org/2025/1/e58128" } @Article{info:doi/10.2196/51495, author="Martikainen, Susanna and Viitanen, Johanna and Salovaara, Samuel and Kinnunen, Ulla-Mari and L{\"a}{\"a}veri, Tinja", title="Comparisons of Physicians', Nurses', and Social Welfare Professionals' Experiences With Participation in Information System Development: Cross-Sectional Survey Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="22", volume="12", pages="e51495", keywords="participation", keywords="development", keywords="usability", keywords="user experience", keywords="physician", keywords="nurse", keywords="social worker", keywords="information system", keywords="national survey", keywords="system development", keywords="users", keywords="user feedback", keywords="cross-sectional survey", keywords="Finland", keywords="Finnish", abstract="Background: The integration of health care and social welfare services together with the consolidation of health care information systems (HISs) and client information systems (CISs) has become a timely topic. Despite this development, there is a scarcity of systematic research on physicians', registered nurses' (RNs) and social welfare professionals' (SWPs) experiences of participating in the development of HISs and CISs. Objective: This study aimed to examine how physicians, RNs and SWPs experience collaboration with HIS or CIS vendors, and what kinds of end users have participated in HIS or CIS development. Methods: National cross-sectional usability surveys were conducted in Finland among RNs and SWPs in 2020 and physicians in 2021. Questions concerning participation experiences were analyzed by professional group, working sector, managerial position, and age. Results: In total, 4683 physicians, 3610 RNs, and 990 SWPs responded to the surveys. In all 3 professional groups, those working in nonmanagerial positions and the youngest respondents participated least in HIS or CIS development, and 76\% (n=3528) of physicians, 78\% (n=2814) of RNs and 67\% (n=664) of SWPs had not participated at all. When comparing the groups, physicians were least aware of feedback processes and least satisfied with vendors' interest in end-user feedback and the manner and speed of HIS development. Those who had dedicated working time for HIS or CIS development were less critical of vendors' interest and responsiveness to development ideas than those who had not participated at all. In all 3 professional groups, the youngest were most dissatisfied with HIS and CIS vendor collaboration. Conclusions: Experiences of participation in HIS and CIS development were relatively negative across all 3 professional groups, with physicians being the most critical. Dialogue and collaboration between developers and end users---also the youngest ones and frontline workers---need improvement; simply increasing allotted working time is unlikely to produce more positive participation experiences. ", doi="10.2196/51495", url="https://humanfactors.jmir.org/2025/1/e51495" } @Article{info:doi/10.2196/63567, author="Hultman, Lisa and Eklund, Caroline and von Heideken W{\aa}gert, Petra and S{\"o}derlund, Anne and Lind{\'e}n, Maria and Elfstr{\"o}m, L. Magnus", title="Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study", journal="JMIR Form Res", year="2025", month="Jan", day="20", volume="9", pages="e63567", keywords="behavior change intervention", keywords="adherence", keywords="integrated behavior change model", keywords="autonomous motivation", keywords="affective determinants", abstract="Background: Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process. Objective: The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention. Methods: The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops. Results: Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed. Conclusions: The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention. ", doi="10.2196/63567", url="https://formative.jmir.org/2025/1/e63567" } @Article{info:doi/10.2196/65142, author="Salwei, Elizabeth Megan and Anders, Shilo and Reale, Carrie and Slagle, M. Jason and Ricketts, Todd and Weinger, B. Matthew", title="Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing", journal="JMIR Hum Factors", year="2025", month="Jan", day="20", volume="12", pages="e65142", keywords="usability", keywords="human factors", keywords="patient safety", keywords="over-the-counter hearing aids", keywords="direct-to-consumer hearing aids", keywords="medical device", keywords="hearing loss", keywords="adult", keywords="hearing impairment", keywords="hearing aid use", keywords="hearing care", keywords="formative usability test", keywords="safety", keywords="mobile phone", abstract="Background: Only 15\% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2?5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. ", doi="10.2196/65142", url="https://humanfactors.jmir.org/2025/1/e65142" } @Article{info:doi/10.2196/53231, author="Ezimora, Ifunanya and Lundberg, Tylia and Miars, Dylan and Trujeque, Jeruel and Papias, Ashley and Del Cid, V. Margareth and Folk, B. Johanna and Tolou-Shams, Marina", title="Reflections of Foster Youth Engaging in the Co-Design of Digital Mental Health Technology: Duoethnography Study", journal="JMIR Form Res", year="2025", month="Jan", day="20", volume="9", pages="e53231", keywords="foster youth", keywords="digital health technology", keywords="co-design", keywords="app development", keywords="mental health", keywords="adolescent", keywords="young adult", keywords="mobile health", keywords="mHealth", keywords="foster care", keywords="duoethnography", abstract="Background: Current research on digital applications to support the mental health and well-being of foster youth is limited to theoretical applications for transition-aged foster youth and support platforms developed without intentional input from foster youth themselves. Centering the lived expertise of foster youth in digital solutions is crucial to dismantling barriers to care, leading to an increase in service access and improving mental health outcomes. Co-design centers the intended end users during the design process, creating a direct relationship between potential users and developers. This methodology holds promise for creating tools centered on foster youth, yet little is known about the co-design experience for foster youth. Understanding foster youth's experience with co-design is crucial to identifying best practices, knowledge of which is currently limited. Objective: The aim of this paper is to reflect on the experiences of 4 foster youth involved in the co-design of FostrSpace, a mobile app designed through a collaboration among foster youth in the San Francisco Bay Area; clinicians and academics from the Juvenile Justice Behavioral Health research team at the University of California, San Francisco; and Chorus Innovations, a rapid technology development platform specializing in participatory design practices. Key recommendations for co-designing with foster youth were generated with reference to these reflections. Methods: A duoethnography study was conducted over a 1-month period with the 4 transition-aged former foster youth co-designers of FostrSpace via written reflections and a single in-person roundtable discussion. Reflections were coded and analyzed via reflexive thematic analysis. Results: In total, 4 main themes were identified from coding of the duoethnography reflections: power and control, resource navigation, building community and safe spaces, and identity. Themes of power and control and resource navigation highlighted the challenges FostrSpace co-designers experienced trying to access basic needs, support from caregivers, and mental health resources as foster youth and former foster youth. Discussions pertaining to building community and safe spaces highlighted the positive effect of foster youth communities on co-designers, and discussions related to identity revealed the complexities associated with understanding and embracing foster youth identity. Conclusions: This duoethnography study highlights the importance of centering the lived expertise of co-designers throughout the app development process. As the digital health field increasingly shifts toward using co-design methods to develop digital mental health technologies for underserved youth populations, we offer recommendations for researchers seeking to ethically and effectively engage youth co-designers. Actively reflecting throughout the co-design process, finding creative ways to engage in power-sharing practices to build community, and ensuring mutual benefit among co-designers are some of the recommended core components to address when co-designing behavioral health technologies for youth. ", doi="10.2196/53231", url="https://formative.jmir.org/2025/1/e53231" } @Article{info:doi/10.2196/59704, author="Ramos, Aur{\'e}lien and Boisvert, Maxence and Traverse, Elodie and Levac, Danielle and Lemay, Martin and Demers, Marika and Bordeleau, Martine and Ruest, Sarah-Maude and P{\'e}rinet-Lacroix, Roxanne and Best, L. Krista and Robert, T. Maxime", title="Bridging Needs and Expectations of Individuals With Physical Disabilities and Community Services Stakeholders for the Cocreation of an Adapted Physical Activity Platform in Virtual Reality: Qualitative Study", journal="JMIR Serious Games", year="2025", month="Jan", day="17", volume="13", pages="e59704", keywords="virtual reality", keywords="physical activity", keywords="community organizations", keywords="accessibility", keywords="physical disability", abstract="Background: Physical activity supports the health and well-being of individuals with physical disabilities. Despite the significance of engaging in physical activity, barriers faced by individuals with disabilities, such as limited access to adapted facilities and lack of transportation, can restrict their participation. Community organizations play a role in addressing these challenges, but virtual reality (VR) also offers a way to diversify adapted activities. In some situations, VR can help overcome the resource limitations of organizations by providing accessible, engaging, and highly personalized options for physical activity. Objective: The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a VR physical activity platform in a community organization. Methods: A descriptive qualitative study was conducted using semistructured interviews with individuals with physical disabilities and their interventionists, all associated with a nonprofit organization promoting physical activity among people with disabilities. Data were analyzed using an inductive thematic approach. Results: In total, 15 participants, including 8 people with physical disabilities and 7 interventionists, were interviewed. Through this discussion, we gained insights into the everyday challenges faced by individuals with disabilities and identified priorities for community organizations. Subsequently, we discussed key considerations for using VR, including adapting activities, the possibility of fostering a more positive perception of physical activity, and harnessing the potential of VR to improve access to physical activity. We also discussed the importance of supporting personal goals and creating inclusive experiences while recognizing challenges such as technical difficulties and connectivity issues. Conclusions: By exploring the needs and expectations regarding VR technology from individuals with physical disabilities and their interventionists, this study provided essential insights for integrating immersive and nonimmersive VR into community organizations, informing next steps for the design of adapted physical activities in VR. ", doi="10.2196/59704", url="https://games.jmir.org/2025/1/e59704" } @Article{info:doi/10.2196/64210, author="{\AA}vik Persson, Helene and Castor, Charlotte and Andersson, Nilla and Hyl{\'e}n, Mia", title="Swedish Version of the System Usability Scale: Translation, Adaption, and Psychometric Evaluation", journal="JMIR Hum Factors", year="2025", month="Jan", day="16", volume="12", pages="e64210", keywords="application", keywords="Swedish", keywords="System Usability Scale", keywords="usability", keywords="validation", abstract="Background: The Swedish health care system is undergoing a transformation. eHealth technologies are increasingly being used. The System Usability Scale is a widely used tool, offering a standardized and reliable measure for assessing the usability of digital health solutions. However, despite the existence of several translations of the System Usability Scale into Swedish, none have undergone psychometric validation. This highlights the urgent need for a validated and standardized Swedish version of the System Usability Scale to ensure accurate and reliable usability evaluations. Objective: The aim of the study was to translate and psychometrically evaluate a Swedish version of the System Usability Scale. Methods: The study utilized a 2-phase design. The first phase translated the System Usability Scale into Swedish and the second phase tested the scale's psychometric properties. A total of 62 participants generated a total of 82 measurements. Descriptive statistics were used to visualize participants' characteristics. The psychometric evaluation consisted of data quality, scaling assumptions, and acceptability. Construct validity was evaluated by convergent validity, and reliability was evaluated by internal consistency. Results: The Swedish version of the System Usability Scale demonstrated high conformity with the original version. The scale showed high internal consistency with a Cronbach $\alpha$ of .852 and corrected item-total correlations ranging from 0.454 to 0.731. The construct validity was supported by a significant positive correlation between the System Usability Scale and domain 5 of the eHealth Literacy Questionnaire (P=.001). Conclusions: The Swedish version of the System Usability Scale demonstrated satisfactory psychometric properties. It can be recommended for use in a Swedish context. The positive correlation with domain 5 of the eHealth Literacy Questionnaire further supports the construct validity of the Swedish version of the System Usability Scale, affirming its suitability for evaluating digital health solutions. Additional tests of the Swedish version of the System Usability Scale, for example, in the evaluation of more complex eHealth technology, would further validate the scale. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/study/NCT04150120 ", doi="10.2196/64210", url="https://humanfactors.jmir.org/2025/1/e64210" } @Article{info:doi/10.2196/63941, author="Simioni, Lisa and Tessitore, Elena and Hagberg, Hamdi and Schneider-Paccot, Aur{\'e}lie and Blondon, Katherine and Gschwind, Liliane and Meyer, Philippe and Ehrler, Frederic", title="Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study", journal="JMIR Form Res", year="2025", month="Jan", day="15", volume="9", pages="e63941", keywords="usability", keywords="medication", keywords="mobile health", keywords="mHealth", keywords="Cardiomeds", keywords="mobile app", keywords="patient empowerment", keywords="eHealth", keywords="smartphone", keywords="heart failure", keywords="HF", keywords="chronic disease", keywords="interactive", keywords="self-monitoring", keywords="usability test", keywords="mobile phone", abstract="Background: Mobile health apps have shown promising results in improving self-management of several chronic diseases in patients. We have developed a mobile health app (Cardiomeds) dedicated to patients with heart failure (HF). This app includes an interactive medication list; daily self-monitoring of symptoms, weight, blood pressure, and heart rate; and educational information on HF delivered through various formats. Objective: This study aimed to perform a mixed methods usability study of Cardiomeds. Methods: Smartphone users with HF were recruited from the HF outpatient clinic at the University Hospital of Geneva. The usability test was conducted in 2 stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication and time of intake, or finding information about HF. Each task was timed, sessions were recorded, and all data were anonymized. After completing the tasks, patients completed the System Usability Scale 10-item questionnaire and answered 5 open questions about their perceptions of Cardiomeds. Results: Twenty patients with HF, 75\% (15/20) of whom were men, with a mean age of 55 years, were included in this study. The average time to complete all 14 tasks was 18 (SD 5.7) minutes. Manual medication entry was the most time-consuming task, taking an average of 154.40 (SD 68.08) seconds in the first stage, 103.10 (SD 42.76) seconds in the second stage, and 128 (SD 63) seconds overall. The mean overall success rate was 77\% (SD 0.23\%) for the first stage and 94\% (SD 0.07\%) for the second stage. A total of 30\% (3/10) of participants in the first stage completed all tasks without any help compared with 50\% (5/10) of participants during the second stage. The average System Usability Scale score was 80\% (SD 17\%), showing a slight increase from 79\% (SD 16\%) in the first stage to 80\% (SD 28\%) in the second stage, which qualifies the app as ``good'' in terms of usability. Between the 2 stages, part of the app interface was redesigned to address the key issues identified in the first stage. Despite these improvements, problems related to guidance were frequent and comprised 36\% (8/22) of the problems in the first stage and 40\% (6/15) in the second stage. In response to open questions, 85\% (17/20) of the participants responded that they would like to use the app when it became available. Conclusions: The usability test indicated that Cardiomeds is a suitable and user-friendly app for patients with HF. The app will be further tested in a randomized clinical trial (2022-00731) after acute HF hospitalization to assess its impact on patients' knowledge about HF, self-care, and quality of life. ", doi="10.2196/63941", url="https://formative.jmir.org/2025/1/e63941", url="http://www.ncbi.nlm.nih.gov/pubmed/39813081" } @Article{info:doi/10.2196/63641, author="S{\o}rensen, Linda and Sagen Johannesen, Tomas Dag and Melkas, Helin{\"a} and Johnsen, Mari Hege", title="User Acceptance of a Home Robotic Assistant for Individuals With Physical Disabilities: Explorative Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="13", volume="12", pages="e63641", keywords="physical artificial intelligence", keywords="physical AI", keywords="health care robotics", keywords="assistive technology", keywords="content analysis", keywords="qualitative", keywords="health care", keywords="robotics", keywords="assistive", keywords="robot interaction", keywords="physical disabilities", keywords="readiness", keywords="amputations", abstract="Background: Health care is shifting toward 5 proactive approaches: personalized, participatory, preventive, predictive, and precision-focused services (P5 medicine). This patient-centered care leverages technologies such as artificial intelligence (AI)--powered robots, which can personalize and enhance services for users with disabilities. These advancements are crucial given the World Health Organization's projection of a global shortage of up to 10 million health care workers by 2030. Objective: This study aimed to investigate the acceptance of a humanoid assistive robot among users with physical disabilities during (1) AI-powered (using a Wizard of Oz methodology) robotic performance of predefined personalized assistance tasks and (2) operator-controlled robotic performance (simulated distant service). Methods: An explorative qualitative design was used, involving user testing in a simulated home environment and individual interviews. Directed content analysis was based on the Almere model and the model of domestic social robot acceptance. Results: Nine participants with physical disabilities aged 27 to 78 years engaged in robot interactions. They shared their perceptions across 7 acceptance concepts: hedonic attitudes, utilitarian attitudes, personal norms, social norms, control beliefs, facilitating conditions, and intention to use. Participants valued the robot's usefulness for practical services but not for personal care. They preferred automation but accepted remote control of the robot for some tasks. Privacy concerns were mixed. Conclusions: This study highlights the complex interplay of functional expectations, technological readiness, and personal and societal norms affecting the acceptance of physically assistive robots. Participants were generally positive about robotic assistance as it increases independence and lessens the need for human caregivers, although they acknowledged some current shortcomings. They were open to trying more home testing if future robots could perform most tasks autonomously. AI-powered robots offer new possibilities for creating more adaptable and personalized assistive technologies, potentially enhancing their effectiveness and viability for individuals with disabilities. ", doi="10.2196/63641", url="https://rehab.jmir.org/2025/1/e63641", url="http://www.ncbi.nlm.nih.gov/pubmed/39805579" } @Article{info:doi/10.2196/63568, author="Kwek, Peng Siong and Leong, Ying Qiao and Lee, Vien V. and Lau, Yin Ni and Vijayakumar, Smrithi and Ng, Ying Wei and Rai, Bina and Raczkowska, Natalia Marlena and Asplund, L. Christopher and Remus, Alexandria and Ho, Dean", title="Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e63568", keywords="older adults", keywords="cognitive training", keywords="digital therapeutic", keywords="DTx", keywords="remote", keywords="usability", keywords="acceptance", keywords="interviews", keywords="gerontology", keywords="geriatric", keywords="elderly", keywords="experiences", keywords="attitudes", keywords="opinions", keywords="perceptions", keywords="perspectives", keywords="interview", keywords="cognition", keywords="digital health", keywords="qualitative", keywords="thematic", abstract="Background: Singapore's large aging population poses significant challenges for the health care system in managing cognitive decline, underscoring the importance of identifying and implementing effective interventions. Cognitive training delivered remotely as a digital therapeutic (DTx) may serve as a scalable and accessible approach to overcoming these challenges. While previous studies indicate the potential of cognitive training as a promising solution for managing cognitive decline, understanding the attitudes and experiences of older adults toward using such DTx platforms remains relatively unexplored. Objective: This study aimed to characterize the general acceptability and user experience of CURATE.DTx, a multitasking-based DTx platform that challenges the cognitive domains of attention, problem-solving, and executive function in the Singaporean older adult population. Methods: A total of 15 older adult participants (mean age 66.1, SD 3.5 years) were recruited for a 90-minute in-person session. This session included a 30-minute playtest of CURATE.DTx, followed by a 60-minute semistructured interview to understand their overall attitudes, experience, motivation, and views of the intervention. Interviews were audio-recorded and transcribed verbatim, then analyzed using an inductive approach. Thematic analysis was used to identify emerging patterns and insights. Results: A total of 3 main themes, and their respective subthemes, emerged from the interviews: comprehension, with subthemes of instruction and task comprehension; acceptability, with subthemes of tablet usability, engagement and enjoyment, and attitude and perceived benefits; and facilitators to adoption, with subthemes of framing and aesthetics, motivation recommendations and the role of medical professionals. Our findings revealed that participants encountered some challenges with understanding certain elements of CURATE.DTx. Nevertheless, they were still highly engaged with it, finding the challenge to be enjoyable. Participants also showed a strong awareness of the importance of cognitive training and expressed a keen interest in using CURATE.DTx for this purpose, especially if recommended by medical professionals. Conclusions: Given the positive engagement and feedback obtained from Singaporean older adults on CURATE.DTx, this study can serve as a basis for future platform iterations and strategies that should be considered during implementation. Future studies should continue implementing an iterative codesign approach to ensure the broader applicability and effectiveness of interventions tailored to this demographic. ", doi="10.2196/63568", url="https://formative.jmir.org/2025/1/e63568" } @Article{info:doi/10.2196/64191, author="Fan, Lok Heidi Sze and Leung, Yan Emily Tsz and Lau, Wing Ka and Wong, Ha Janet Yuen and Choi, Hang Edmond Pui and Lam, Christine and Tarrant, Marie and Ngan, Sheung Hextan Yuen and Ip, Patrick and Lin, Chin Chia and Lok, Wan Kris Yuet", title="A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study", journal="JMIR Form Res", year="2025", month="Jan", day="10", volume="9", pages="e64191", keywords="Baby-Friendly Community Initiative", keywords="Baby-Friendly Hospital Initiative", keywords="breastfeeding", keywords="community", keywords="stakeholders", keywords="mobile app", keywords="friendly communities", keywords="baby-friendly", keywords="well-being", keywords="mother", keywords="infant", keywords="application", keywords="mHealth", keywords="qualitative", keywords="user-friendly", keywords="self-management", abstract="Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ``bfGPS'' (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged---bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant's growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app's potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. ", doi="10.2196/64191", url="https://formative.jmir.org/2025/1/e64191" } @Article{info:doi/10.2196/67272, author="Lee, Heui Yoon and Choi, Hanna and Lee, Soo-Kyoung", title="Development of Personas and Journey Maps for Artificial Intelligence Agents Supporting the Use of Health Big Data: Human-Centered Design Approach", journal="JMIR Form Res", year="2025", month="Jan", day="8", volume="9", pages="e67272", keywords="analysis", keywords="health big data", keywords="human-centered design", keywords="persona", keywords="user journey map", keywords="artificial intelligence", keywords="human-AI", keywords="interviews", keywords="users' experiences", abstract="Background: The rapid proliferation of artificial intelligence (AI) requires new approaches for human-AI interfaces that are different from classic human-computer interfaces. In developing a system that is conducive to the analysis and use of health big data (HBD), reflecting the empirical characteristics of users who have performed HBD analysis is the most crucial aspect to consider. Recently, human-centered design methodology, a field of user-centered design, has been expanded and is used not only to develop types of products but also technologies and services. Objective: This study was conducted to integrate and analyze users' experiences along the HBD analysis journey using the human-centered design methodology and reflect them in the development of AI agents that support future HBD analysis. This research aims to help accelerate the development of novel human-AI interfaces for AI agents that support the analysis and use of HBD, which will be urgently needed in the near future. Methods: Using human-centered design methodology, we collected data through shadowing and in-depth interviews with 16 people with experience in analyzing and using HBD. We identified users' empirical characteristics, emotions, pain points, and needs related to HBD analysis and use and created personas and journey maps. Results: The general characteristics of participants (n=16) were as follows: the majority were in their 40s (n=6, 38\%) and held a PhD degree (n=10, 63\%). Professors (n=7, 44\%) and health care personnel (n=10, 63\%) represented the largest professional groups. Participants' experiences with big data analysis varied, with 25\% (n=4) being beginners and 38\% (n=6) having extensive experience. Common analysis methods included statistical analysis (n=7, 44\%) and data mining (n=6, 38\%). Qualitative findings from shadowing and in-depth interviews revealed key challenges: lack of knowledge on using analytical solutions, crisis management difficulties during errors, and inadequate understanding of health care data and clinical decision-making, especially among non--health care professionals. Three types of personas and journey maps---health care professionals as big data analysis beginners, health care professionals who have experience in big data analytics, and non--health care professionals who are experts in big data analytics---were derived. They showed a need for personalized platforms tailored to the user level, appropriate direction through a navigation function, a crisis management support system, communication and sharing among users, and expert linkage service. Conclusions: The knowledge obtained from this study can be leveraged in designing an AI agent to support future HBD analysis and use. This is expected to further increase the usability of HBD by helping users perform effective use of HBD more easily. ", doi="10.2196/67272", url="https://formative.jmir.org/2025/1/e67272" } @Article{info:doi/10.2196/60566, author="Bosco, Cristina and Otenen, Ege and Osorio Torres, John and Nguyen, Vivian and Chheda, Darshil and Peng, Xinran and Jessup, M. Nenette and Himes, K. Anna and Cureton, Bianca and Lu, Yvonne and Hill, V. Carl and Hendrie, C. Hugh and Barnes, A. Priscilla and Shih, C. Patrick", title="Designing a Multimodal and Culturally Relevant Alzheimer Disease and Related Dementia Generative Artificial Intelligence Tool for Black American Informal Caregivers: Cognitive Walk-Through Usability Study", journal="JMIR Aging", year="2025", month="Jan", day="8", volume="8", pages="e60566", keywords="multimodality", keywords="artificial intelligence", keywords="AI", keywords="generative AI", keywords="usability", keywords="black", keywords="African American", keywords="cultural", keywords="Alzheimer's", keywords="dementia", keywords="caregivers", keywords="mobile app", keywords="interaction", keywords="cognition", keywords="user opinion", keywords="geriatrics", keywords="smartphone", keywords="mHealth", keywords="digital health", keywords="aging", abstract="Background: Many members of Black American communities, faced with the high prevalence of Alzheimer disease and related dementias (ADRD) within their demographic, find themselves taking on the role of informal caregivers. Despite being the primary individuals responsible for the care of individuals with ADRD, these caregivers often lack sufficient knowledge about ADRD-related health literacy and feel ill-prepared for their caregiving responsibilities. Generative AI has become a new promising technological innovation in the health care domain, particularly for improving health literacy; however, some generative AI developments might lead to increased bias and potential harm toward Black American communities. Therefore, rigorous development of generative AI tools to support the Black American community is needed. Objective: The goal of this study is to test Lola, a multimodal mobile app, which, by relying on generative AI, facilitates access to ADRD-related health information by enabling speech and text as inputs and providing auditory, textual, and visual outputs. Methods: To test our mobile app, we used the cognitive walk-through methodology, and we recruited 15 informal ADRD caregivers who were older than 50 years and part of the Black American community living within the region. We asked them to perform 3 tasks on the mobile app (ie, searching for an article on brain health, searching for local events, and finally, searching for opportunities to participate in scientific research in their area), then we recorded their opinions and impressions. The main aspects to be evaluated were the mobile app's usability, accessibility, cultural relevance, and adoption. Results: Our findings highlight the users' need for a system that enables interaction with different modalities, the need for a system that can provide personalized and culturally and contextually relevant information, and the role of community and physical spaces in increasing the use of Lola. Conclusions: Our study shows that, when designing for Black American older adults, a multimodal interaction with the generative AI system can allow individuals to choose their own interaction way and style based upon their interaction preferences and external constraints. This flexibility of interaction modes can guarantee an inclusive and engaging generative AI experience. ", doi="10.2196/60566", url="https://aging.jmir.org/2025/1/e60566" } @Article{info:doi/10.2196/58650, author="Bierbooms, A. Joyce J. P. and Sluis-Thiescheffer, W. Wouter R. J. and Feijt, Anne Milou and Bongers, B. Inge M.", title="Co-Design of an Escape Room for e-Mental Health Training of Mental Health Care Professionals: Research Through Design Study", journal="JMIR Form Res", year="2025", month="Jan", day="7", volume="9", pages="e58650", keywords="serious gaming", keywords="mental health care professionals", keywords="e-mental health", keywords="skill enhancement", keywords="training", abstract="Background: Many efforts to increase the uptake of e-mental health (eMH) have failed due to a lack of knowledge and skills, particularly among professionals. To train health care professionals in technology, serious gaming concepts such as educational escape rooms are increasingly used, which could also possibly be used in mental health care. However, such serious-game concepts are scarcely available for eMH training for mental health care professionals. Objective: This study aims to co-design an escape room for training mental health care professionals' eMH skills and test the escape room's usability by exploring their experiences with this concept as a training method. Methods: This project used a research through design approach with 3 design stages. In the first stage, the purpose, expectations, and storylines for the escape room were formulated in 2 co-design sessions with mental health care professionals, game designers, innovation staff, and researchers. In the second stage, the results were translated into the first escape room, which was tested in 3 sessions, including one web version of the escape room. In the third stage, the escape room was tested with mental health care professionals outside the co-design team. First, 2 test sessions took place, followed by 3 field study sessions. In the field study sessions, a questionnaire was used in combination with focus groups to assess the usability of the escape room for eMH training in practice. Results: An escape room prototype was iteratively developed and tested by the co-design team, which delivered multiple suggestions for adaptations that were assimilated in each next version of the prototype. The field study showed that the escape room creates a positive mindset toward eMH. The suitability of the escape room to explore the possibilities of eMH was rated 4.7 out of 5 by the professionals who participated in the field study. In addition, it was found to be fun and educational at the same time, scoring 4.7 (SD 0.68) on a 5-point scale. Attention should be paid to the game's complexity, credibility, and flexibility. This is important for the usefulness of the escape room in clinical practice, which was rated an average of 3.8 (SD 0.77) on a 5-point scale. Finally, implementation challenges should be addressed, including organizational policy and stimulation of eMH training. Conclusions: We can conclude that the perceived usability of an escape room for training mental health care professionals in eMH skills is promising. However, it requires additional effort to transfer the learnings into mental health care professionals' clinical practice. A straightforward implementation plan and testing the effectiveness of an escape room on skill enhancement in mental health care professionals are essential next steps to reach sustainable goals. ", doi="10.2196/58650", url="https://formative.jmir.org/2025/1/e58650" } @Article{info:doi/10.2196/51101, author="Burrell, Joanna and Baker, Felicity and Bennion, Russell Matthew", title="Resilience Training Web App for National Health Service Keyworkers: Pilot Usability Study", journal="JMIR Med Educ", year="2025", month="Jan", day="6", volume="11", pages="e51101", keywords="resilience", keywords="workplace stress", keywords="National Health Service", keywords="NHS keyworker", keywords="digital learning", keywords="digital health", keywords="usability", keywords="feasibility", keywords="mental health", keywords="pilot study", keywords="learning", keywords="training", keywords="exercise", keywords="primary care provider", keywords="health care professional", keywords="occupational health", keywords="worker", keywords="hospital", keywords="emergency", keywords="survey", keywords="questionnaire", keywords="mobile phone", abstract="Background: It is well established that frontline health care staff are particularly at risk of stress. Resilience is important to help staff to manage daily challenges and to protect against burnout. Objective: This study aimed to assess the usability and user perceptions of a resilience training web app developed to support health care keyworkers in understanding their own stress response and to help them put into place strategies to manage stress and to build resilience. Methods: Nurses (n=7) and other keyworkers (n=1), the target users for the resilience training web app, participated in the usability evaluation. Participants completed a pretraining questionnaire capturing basic demographic information and then used the training before completing a posttraining feedback questionnaire exploring the impact and usability of the web app. Results: From a sample of 8 keyworkers, 6 (75\%) rated their current role as ``sometimes'' stressful. All 8 (100\%) keyworkers found the training easy to understand, and 5 of 7 (71\%) agreed that the training increased their understanding of both stress and resilience. Further, 6 of 8 (75\%) agreed that the resilience model had helped them to understand what resilience is. Many of the keyworkers (6/8, 75\%) agreed that the content was relevant to them. Furthermore, 6 of 8 (75\%) agreed that they were likely to act to develop their resilience following completion of the training. Conclusions: This study tested the usability of a web app for resilience training specifically targeting National Health Service keyworkers. This work preceded a larger scale usability study, and it is hoped this study will help guide other studies to develop similar programs in clinical settings. ", doi="10.2196/51101", url="https://mededu.jmir.org/2025/1/e51101" } @Article{info:doi/10.2196/60117, author="Malhotra, Chetna and Yee, Alethea and Ramakrishnan, Chandrika and Kaurani, Naraindas Sanam and Chua, Ivy and Lakin, R. Joshua and Sim, David and Balakrishnan, Iswaree and Ling, Jin Vera Goh and Weiliang, Huang and Ling, Fong Lee and Pollak, I. Kathryn", title="Development and Usability of an Advance Care Planning Website (My Voice) to Empower Patients With Heart Failure and Their Caregivers: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Dec", day="18", volume="7", pages="e60117", keywords="advance care planning", keywords="decision aid", keywords="heart", keywords="website", keywords="heart failure", keywords="care plan", keywords="caregiver", keywords="usability", keywords="acceptability", abstract="Background: Web-based advance care planning (ACP) interventions offer a promising solution to improve ACP engagement, but none are specifically designed to meet the needs of patients with heart failure and their caregivers. Objective: We aimed to develop and assess the usability and acceptability of a web-based ACP decision aid called ``My Voice,'' which is tailored for patients with heart failure and their caregivers. Methods: This study's team and advisory board codeveloped the content for both patient and caregiver modules in ``My Voice.'' Using a mixed methods approach, we iteratively tested usability and acceptability, incorporating feedback from patients, caregivers, and health care professionals (HCPs). Results: We interviewed 30 participants (11 patients, 9 caregivers, and 10 HCPs). Participants found the website easy to navigate, with simple and clear content facilitating communication of patients' values and goals. They also appreciated that it allowed them to revisit their care goals periodically. The average System Usability Scale score was 74 (SD 14.8; range: 42.5-95), indicating good usability. Over 80\% (8/11) of patients and 87\% (7/8) of caregivers rated the website's acceptability as good or excellent. Additionally, 70\% (7/10) of HCPs strongly agreed or agreed with 11 of the 15 items testing the website's acceptability. Conclusions: ``My Voice'' shows promise as a tool for patients with heart failure to initiate and revisit ACP conversations with HCPs and caregivers. We will evaluate its efficacy in improving patient and caregiver outcomes in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT06090734; https://clinicaltrials.gov/study/NCT06090734 ", doi="10.2196/60117", url="https://aging.jmir.org/2024/1/e60117" } @Article{info:doi/10.2196/55176, author="Park, Ye-Eun and Tak, Won Yae and Kim, Inhye and Lee, Jeong Hui and Lee, Bok Jung and Lee, Won Jong and Lee, Yura", title="User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Dec", day="18", volume="26", pages="e55176", keywords="mHealth", keywords="user experience", keywords="cancer", keywords="technology acceptance model", keywords="structural equation modeling", keywords="health care app", keywords="mixed-method study", keywords="medical care", keywords="digital health care", keywords="cancer survivors", keywords="disparities", keywords="health status", keywords="behavioral intervention", keywords="clinician", abstract="Background: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients' abilities and health status on the adoption of these interventions. Objective: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). Methods: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. Results: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness ($\beta$=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. Conclusions: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care. ", doi="10.2196/55176", url="https://www.jmir.org/2024/1/e55176" } @Article{info:doi/10.2196/57622, author="Probst, Freya and Rees, Jessica and Aslam, Zayna and Mexia, Nikitia and Molteni, Erika and Matcham, Faith and Antonelli, Michela and Tinker, Anthea and Shi, Yu and Ourselin, Sebastien and Liu, Wei", title="Evaluating a Smart Textile Loneliness Monitoring System for Older People: Co-Design and Qualitative Focus Group Study", journal="JMIR Aging", year="2024", month="Dec", day="17", volume="7", pages="e57622", keywords="loneliness", keywords="smart textiles", keywords="wearable technology", keywords="health monitoring", keywords="older people", keywords="co-design", keywords="design requirement", keywords="mobile phone", abstract="Background: Previous studies have explored how sensor technologies can assist in in the detection, recognition, and prevention of subjective loneliness. These studies have shown a correlation between physiological and behavioral sensor data and the experience of loneliness. However, little research has been conducted on the design requirements from the perspective of older people and stakeholders in technology development. The use of these technologies and infrastructural questions have been insufficiently addressed. Systems generally consist of sensors or software installed in smartphones or homes. However, no studies have attempted to use smart textiles, which are fabrics with integrated electronics. Objective: This study aims to understand the design requirements for a smart textile loneliness monitoring system from the perspectives of older people and stakeholders. Methods: We conducted co-design workshops with 5 users and 6 stakeholders to determine the design requirements for smart textile loneliness monitoring systems. We derived a preliminary product concept of the smart wearable and furniture system. Digital and physical models and a use case were evaluated in a focus group study with older people and stakeholders (n=7). Results: The results provided insights for designing systems that use smart textiles to monitor loneliness in older people and widen their use. The findings informed the general system, wearables and furniture, materials, sensor positioning, washing, sensor synchronization devices, charging, intervention, and installation and maintenance requirements. This study provided the first insight from a human-centered perspective into smart textile loneliness monitoring systems for older people. Conclusions: We recommend more research on the intervention that links to the monitored loneliness in a way that addresses different needs to ensure its usefulness and value to people. Future systems must also reflect on questions of identification of system users and the available infrastructure and life circumstances of people. We further found requirements that included user cooperation, compatibility with other worn medical devices, and long-term durability. ", doi="10.2196/57622", url="https://aging.jmir.org/2024/1/e57622", url="http://www.ncbi.nlm.nih.gov/pubmed/39688889" } @Article{info:doi/10.2196/56567, author="Bunnell, E. Brian and Schuler, R. Kaitlyn and Ivanova, Julia and Flynn, Lea and Barrera, F. Janelle and Niazi, Jasmine and Turner, Dylan and Welch, M. Brandon", title="Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="12", volume="11", pages="e56567", keywords="mental health", keywords="mental illness", keywords="mental disease", keywords="mental disorder", keywords="homework", keywords="homework challenge", keywords="therapy", keywords="therapist", keywords="barriers", keywords="adult client", keywords="adult", keywords="technology-based solution", keywords="health technology", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="mobile phone", abstract="Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act--compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. ", doi="10.2196/56567", url="https://humanfactors.jmir.org/2024/1/e56567" } @Article{info:doi/10.2196/59513, author="Schnitzbauer, A. Andreas and Detemble, Charlotte and Faqar-Uz-Zaman, Fatima Sara and Dreilich, Julia and Mohr, Lisa and Sliwinski, Svenja and Zmuc, Dora and Siller, Mark and Fleckenstein, Johannes", title="Usability Testing of a Digitized Interventional Prehabilitation Tool for Health Care Professionals and Patients Before Major Surgeries: Formative and Summative Evaluation", journal="JMIR Form Res", year="2024", month="Dec", day="11", volume="8", pages="e59513", keywords="usability testing", keywords="prehabilitation", keywords="MARS", keywords="Mobile Application Rating Scale", keywords="trustworthiness", keywords="surgical research", keywords="usability", keywords="prerehabilitation tool", keywords="tool", keywords="medical device", keywords="surgery", keywords="device", keywords="application", keywords="design", keywords="engineering", keywords="development", abstract="Background: The development of a medical device requires strict adherence to regulatory processes. Prehabilitation in this context is a new area in surgery that trains, coaches, and advises patients in mental well-being, nutrition, and physical activity. As staff is permanently drained from clinical care, remote and digital solutions with real-time assessments of data, including patient-related outcome reporting, may simplify preparation before major surgeries. Objective: This study aimed to evaluate the usability engineering process for the Prehab App, a newly developed medical device, in order to identify and adapt any design and usability flaws found. Methods: We hypothesized that formative and summative usability testing would achieve 80\% interrater and intrarater reliability and consistency and that the safety-relevant scenarios would uncover undetected risks of the medical device (stand-alone software class IIa). In total, 8 experts and 8 laypersons (patients and potential patients) were asked to evaluate paper-based mockups, followed by an evaluation of the minimal viable product (MVP) of the Prehab App at least more than 8 weeks later after instruction and training. The experts had to face 5 and the laypersons 6 usability scenarios. Their evaluations were measured with the Mobile App Rating Scale (MARS) and trustworthiness checklists (range 0-64, with higher scores indicating trustworthiness), and the usability scenarios were evaluated with the After Scenario Questionnaire (ASQ) and a judgment by an observer. The time taken for the scenarios was also recorded. Results: MARS achieved constant scores of more than 4 out of 5 points for both experts and laypersons. The mean trustworthiness score was 51.3 (SD 2.7) for the experts and 50.8 (SD 2.1) for the laypersons (P=.68) in task I. The interrater correlation, shown by the Fleiss-Kappa value, was 0.87 (range 0.85-0.89) for all raters (N=16), 0.86 (range 0.82-0.91) for the experts (n=8, 50\%), and 0.88 (range 0.84-0.93) for the laypersons (n=8, 50\%), reflecting almost perfect agreement between the raters. This indicated the high quality of the usability. The usability scenarios were performed with ease, except for the onboarding part, when the wearable was required to be connected; this took a considerable amount of time and was recognized as a challenge to good usability. Conclusions: The formative and summative evaluation of the Prehab App design resulted in good-to-acceptable results of the design and usability of the critical and safety-relevant areas of the medical device and stand-alone software. Usability testing improves medical devices early in the design and development process, reduces errors, and mitigates risks, and in this study, it delivered a profound ethical and medical justification for a randomized controlled trial (RCT) of the Prehab App in a remote setting as a next step in the development process. Trial Registration: German Registry for Clinical Trials (DRKS00026985); https://drks.de/search/en/trial/DRKS00026985 ", doi="10.2196/59513", url="https://formative.jmir.org/2024/1/e59513", url="http://www.ncbi.nlm.nih.gov/pubmed/39661439" } @Article{info:doi/10.2196/58166, author="Fobelets, Kristel and Mohanty, Nikita and Thielemans, Mara and Thielemans, Lieze and Lake-Thompson, Gillian and Liu, Meijing and Jopling, Kate and Yang, Kai", title="User Perceptions of Wearability of Knitted Sensor Garments for Long-Term Monitoring of Breathing Health: Thematic Analysis of Focus Groups and a Questionnaire Survey", journal="JMIR Biomed Eng", year="2024", month="Dec", day="10", volume="9", pages="e58166", keywords="health technology", keywords="wearability of knitted sensors", keywords="focus groups", keywords="asthma observation", keywords="medical device", keywords="wearable device", keywords="medical instrument", keywords="medical equipment", keywords="medical tool", keywords="sensor", keywords="physiological sensor", keywords="focus group", keywords="breathing", keywords="respiratory", keywords="respirology", keywords="lung", keywords="monitoring", keywords="monitor", keywords="health monitoring", abstract="Background: Long-term unobtrusive monitoring of breathing patterns can potentially give a more realistic insight into the respiratory health of people with asthma or chronic obstructive pulmonary disease than brief tests performed in medical environments. However, it is uncertain whether users would be willing to wear these sensor garments long term. Objective: Our objective was to explore whether users would wear ordinary looking knitted garments with unobtrusive knitted-in breathing sensors long term to monitor their lung health and under what conditions. Methods: Multiple knitted breathing sensor garments, developed and fabricated by the research team, were presented during a demonstration. Participants were encouraged to touch and feel the garments and ask questions. This was followed by two semistructured, independently led focus groups with a total of 16 adults, of whom 4 had asthma. The focus group conversations were recorded and transcribed. Thematic analysis was carried out by three independent researchers in 3 phases consisting of familiarization with the data, independent coding, and overarching theme definition. Participants also completed a web-based questionnaire to probe opinion about wearability and functionality of the garments. Quantitative analysis of the sensors' performance was mapped to participants' garment preference to support the feasibility of the technology for long-term wear. Results: Key points extracted from the qualitative data were (1) garments are more likely to be worn if medically prescribed, (2) a cotton vest worn as underwear was preferred, and (3) a breathing crisis warning system was seen as a promising application. The qualitative analysis showed a preference for a loose-fitting garment style with short sleeves (13/16 participants), 11 out of 16 would also wear snug fitting garments and none of the participants would wear tight-fitting garments over a long period of time. In total, 10 out of 16 participants would wear the snug fitting knitted garment for the whole day and 13 out of 16 would be happy to wear it only during the night if not too hot. The sensitivity demands on the knitted wearable sensors can be aligned with most users' garment preferences (snug fit). Conclusions: There is an overall positive opinion about wearing a knitted sensor garment over a long period of time for monitoring respiratory health. The knit cannot be tight but a snugly fitted vest as underwear in a breathable material is acceptable for most participants. These requirements can be fulfilled with the proposed garments. Participants with asthma supported using it as a sensor garment connected to an asthma attack alert system. ", doi="10.2196/58166", url="https://biomedeng.jmir.org/2024/1/e58166" } @Article{info:doi/10.2196/59426, author="Nuseibeh, Zenk Betsey and Johns, A. Shelley and Shih, C. Patrick and Lewis, F. Gregory and Gowan, M. Tayler and Jordan, J. Evan", title="Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach", journal="JMIR Form Res", year="2024", month="Dec", day="9", volume="8", pages="e59426", keywords="breast cancer survivors", keywords="acceptance and commitment therapy", keywords="mHealth app", keywords="user-centered design", keywords="depression", keywords="anxiety", keywords="therapy", keywords="app", keywords="breast cancer", keywords="expert", keywords="designer", keywords="psychosocial", keywords="need", keywords="co-design", keywords="MOSAIC", keywords="mobile acceptance and commitment therapy stress intervention", keywords="interviews", abstract="Background: Breast cancer is the world's most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91\%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer--specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. ", doi="10.2196/59426", url="https://formative.jmir.org/2024/1/e59426" } @Article{info:doi/10.2196/56796, author="Bruni, Francesca and Mancuso, Valentina and Panigada, Jonathan and Stramba-Badiale, Marco and Cipresso, Pietro and Pedroli, Elisa", title="Exploring How Older Adults Experience semAPP, a 360{\textdegree} Media--Based Tool for Memory Assessment: Qualitative Study", journal="JMIR Aging", year="2024", month="Dec", day="5", volume="7", pages="e56796", keywords="assessment", keywords="virtual reality", keywords="360-degree videos", keywords="user experience", keywords="memory", keywords="aging", keywords="psycho gerontology", abstract="Background: Technology is already a part of our daily lives, and its influence is growing rapidly. This evolution has not spared the health care field. Nowadays, a crucial challenge is considering aspects such as design, development, and implementation, highlighting their functionality, ease of use, compatibility, performance, and safety when a new technological tool is developed. As noted in many works, the abandonment rate is usually higher when a user has a terrible experience with these instruments. It would be appropriate to incorporate the final users---whether they are patients, health care professionals, or both---in the stages of instrument design to understand their needs and preferences. Since most apps that fail did not include end users and health care professionals in the development phase, their involvement at all stages of app development may increase their commitment and improve integration, self-management, and health outcomes. Objective: This study aims (1) to develop semAPP (spatial and episodic memory assessment application), a 360{\textdegree} media--based tool, to assess memory in aging by simulating a real-life situation and (2) to test the usability of the app and the connected experience in an end-user population. Methods: A total of 34 older adults participated in the study: 16 (47\%) healthy individuals and 18 (53\%) patients with mild cognitive impairment. They used semAPP and completed qualitative and quantitative measures. The app includes 2 parts: object recognition and spatial memory tasks. During the first task, users have to navigate in an apartment freely and visit rooms, and then they must recognize the right map of the house. In the second task, users are immersed in a living room, and they have to encode and then recall some target objects, simulating a relocation. We deployed this app on an 11.2-inch iPad, and we tested its usability and the experience of users interacting with the app. We conducted descriptive analyses for both the entire sample and each subgroup; we also conducted parametric and correlation analyses to compare groups and to examine the relationship between task execution and the virtual experience, as well as the acceptance of technology. Results: Both groups judged the app as an easy-to-use tool, and they were willing to use it. Moreover, the results match the idea that usability might be influenced by different factors depending on instrument and personal features, such as presentation, functionality, system performance, interactive behavior, attitudes, skills, and personality. Conclusions: The findings support the possibility of using semAPP in older patients, as well as the importance of designing and evaluating new technological tools, considering not only the general population but also the specific target ones. ", doi="10.2196/56796", url="https://aging.jmir.org/2024/1/e56796" } @Article{info:doi/10.2196/60461, author="Golsong, Konstanze and Kaufmann, Luisa and Baldofski, Sabrina and Kohls, Elisabeth and Rummel-Kluge, Christine", title="Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e60461", keywords="mental health", keywords="eHealth", keywords="app", keywords="health care", keywords="app-based support", keywords="psychiatric symptoms", keywords="mobile phone", keywords="COVID-19", abstract="Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment--like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67\%) were analyzed; 17 (30\%) dropped out. Satisfaction with the app was high, with 53\% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79\% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47\%) of the completers trying relaxation modules and 71\% (27/38) regularly responding to the ecological momentary assessment--like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58\% (22/38) felt ``definitely'' or ``rather'' encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=--0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. ", doi="10.2196/60461", url="https://formative.jmir.org/2024/1/e60461", url="http://www.ncbi.nlm.nih.gov/pubmed/39630503" } @Article{info:doi/10.2196/53430, author="Richardson, Leanne and Noori, Nihal and Fantham, Jack and Timlin, Gregor and Siddle, James and Godec, Thomas and Taylor, Mike and Baum, Charles", title="Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="3", volume="12", pages="e53430", keywords="digital diary", keywords="hypertension", keywords="blood pressure", keywords="remote monitoring", keywords="smartphone app", keywords="mobile phone", keywords="app", keywords="monitoring", keywords="COVID-19", keywords="SARS-CoV-2", keywords="digital intervention", keywords="management", keywords="observational study", keywords="deployment", keywords="feasibility", keywords="use", keywords="safety", keywords="medication", keywords="symptoms", keywords="community", keywords="systolic", keywords="diastolic", keywords="utilization", abstract="Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Results: Of the 389 participants who enrolled in and completed the study, 380 (98\%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9\%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1\%) of the 239 participants entered full BP routines into the digital app 80\% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as ``excellent'' for domains of perspicuity, efficiency, and dependability and ``above average'' for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension. ", doi="10.2196/53430", url="https://mhealth.jmir.org/2024/1/e53430" } @Article{info:doi/10.2196/60353, author="Jolliff, Anna and Holden, J. Richard and Valdez, Rupa and Coller, J. Ryan and Patel, Himalaya and Zuraw, Matthew and Linden, Anna and Ganci, Aaron and Elliott, Christian and Werner, E. Nicole", title="Investigating the Best Practices for Engagement in Remote Participatory Design: Mixed Methods Analysis of 4 Remote Studies With Family Caregivers", journal="J Med Internet Res", year="2024", month="Dec", day="3", volume="26", pages="e60353", keywords="user-centered design", keywords="family caregivers", keywords="mobile health", keywords="digital health", keywords="web-based intervention", keywords="stakeholder engagement", keywords="patient engagement", keywords="community-based participatory action research", keywords="community participation", keywords="qualitative evaluation", abstract="Background: Digital health interventions are a promising method for delivering timely support to underresourced family caregivers. The uptake of digital health interventions among caregivers may be improved by engaging caregivers in participatory design (PD). In recent years, there has been a shift toward conducting PD remotely, which may enable participation by previously hard-to-reach groups. However, little is known regarding how best to facilitate engagement in remote PD among family caregivers. Objective: This study aims to (1) understand the context, quality, and outcomes of family caregivers' engagement experiences in remote PD and (2) learn which aspects of the observed PD approach facilitated engagement or need to be improved. Methods: We analyzed qualitative and quantitative data from evaluation and reflection surveys and interviews completed by research and community partners (family caregivers) across 4 remote PD studies. Studies focused on building digital health interventions for family caregivers. For each study, community partners met with research partners for 4 to 5 design sessions across 6 months. After each session, partners completed an evaluation survey. In 1 of the 4 studies, research and community partners completed a reflection survey and interview. Descriptive statistics were used to summarize quantitative evaluation and reflection survey data, while reflexive thematic analysis was used to understand qualitative data. Results: In 62.9\% (83/132) of evaluations across projects 1-3, participants described the session as ``very effective.'' In 74\% (28/38) of evaluations for project 4, participants described feeling ``extremely satisfied'' with the session. Qualitative data relating to the engagement context identified that the identities of partners, the technological context of remote PD, and partners' understanding of the project and their role all influenced engagement. Within the domain of engagement quality, relationship-building and co-learning; satisfaction with prework, design activities, time allotted, and the final prototype; and inclusivity and the distribution of influence contributed to partners' experience of engagement. Outcomes of engagement included partners feeling an ongoing interest in the project after its conclusion, gratitude for participation, and a sense of meaning and self-esteem. Conclusions: These results indicate high satisfaction with remote PD processes and few losses specific to remote PD. The results also demonstrate specific ways in which processes can be changed to improve partner engagement and outcomes. Community partners should be involved from study inception in defining the problem to be solved, the approach used, and their roles within the project. Throughout the design process, online tools may be used to check partners' satisfaction with design processes and perceptions of inclusivity and power-sharing. Emphasis should be placed on increasing the psychosocial benefits of engagement (eg, sense of community and purpose) and increasing opportunities to participate in disseminating findings and in future studies. ", doi="10.2196/60353", url="https://www.jmir.org/2024/1/e60353" } @Article{info:doi/10.2196/53834, author="McCann, Lisa and Lewis, Liane and Oduntan, Olubukola and Harris, Jenny and Darley, Andrew and Berg, V. Geir and Lubowitzki, Simone and Cheevers, Katy and Miller, Morven and Armes, Jo and Ream, Emma and Fox, Patricia and Furlong, Patricia Eileen and Gaiger, Alexander and Kotronoulas, Grigorios and Patiraki, Elisabeth and Katsaragakis, Stylianos and McCrone, Paul and Miaskowski, Christine and Cardone, Antonella and Orr, Dawn and Flowerday, Adrian and Skene, Simon and Moore, Margaret and De Souza, Nicosha and Donnan, Peter and Maguire, Roma", title="Patients' and Clinicians' Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study", journal="J Med Internet Res", year="2024", month="Dec", day="3", volume="26", pages="e53834", keywords="cancer", keywords="clinician experiences", keywords="digital interventions", keywords="patient experiences", keywords="remote monitoring", keywords="qualitative methods", abstract="Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention---Advanced Symptom Management System (ASyMS)---after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients' and clinicians' experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients' experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients' and clinicians' experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients' and clinicians' experiences using ASyMS. One central orienting theme---ASyMS as a facilitator of change---was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is ``normal'' and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients' and clinicians' experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients' and clinicians' perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 ", doi="10.2196/53834", url="https://www.jmir.org/2024/1/e53834" } @Article{info:doi/10.2196/53157, author="Zhang, Zhan and Bai, Enze and Xu, Yincao and Stepanian, Aram and Kutzin, M. Jared and Adelgais, Kathleen and Ozkaynak, Mustafa", title="A Smart Glass Telemedicine Application for Prehospital Communication: User-Centered Design Study", journal="J Med Internet Res", year="2024", month="Nov", day="29", volume="26", pages="e53157", keywords="smart glass", keywords="telemedicine", keywords="participatory design", keywords="emergency medical service", keywords="health care", keywords="prehospital care", keywords="mobile health", keywords="mHealth", keywords="augmented reality", abstract="Background: Smart glasses have emerged as a promising solution for enhancing communication and care coordination among distributed medical teams. While prior research has explored the feasibility of using smart glasses to improve prehospital communication between emergency medical service (EMS) providers and remote physicians, a research gap remains in understanding the specific requirements and needs of EMS providers for smart glass implementation. Objective: This study aims to iteratively design and evaluate a smart glass application tailored for prehospital communication by actively involving prospective users in the system design process. Methods: Grounded in participatory design, the study consisted of 2 phases of design requirement gathering, rapid prototyping, usability testing, and prototype refinement. In total, 43 distinct EMS providers with diverse backgrounds participated in this 2-year long iterative design process. All qualitative data (eg, transcribed interviews and discussions) were iteratively coded and analyzed by at least 2 researchers using thematic analysis. Quantitative data, such as System Usability Scale (SUS) scores and feature ratings, were analyzed using statistical methods. Results: Our research identified challenges in 2 essential prehospital communication activities: contacting online medical control (OLMC) physicians for medical guidance and notifying receiving hospital teams of incoming patients. The iterative design process led to the identification of 5 key features that could potentially address the identified challenges: video call functionality with OLMC physicians, call priority indication for expedited OLMC contact, direct communication with receiving hospitals, multimedia patient information sharing, and touchless interaction methods for operating the smart glasses. The SUS score for our system design improved from a mean of 74.3 (SD 11.3) in the first phase (classified as good usability) to 80.3 (SD 13.1) in the second phase (classified as excellent usability). This improvement, along with consistently high ratings for other aspects (eg, willingness to use and feature design), demonstrated continuous enhancement of the system's design across the 2 phases. Additionally, significant differences in SUS scores were observed between EMS providers in urban areas (median 85, IQR 76-94) and rural areas (median 72.5, IQR 66-83; Mann-Whitney U=43; P=.17), as well as between paramedics (median 72.5, IQR 70-80) and emergency medical technicians (median 85, IQR: 74-98; Mann-Whitney U=44.5; P=.13), suggesting that EMS providers in urban settings and those with less training in treating patients in critical conditions perceived the smart glass application as more useful and user-friendly. Finally, the study also identified several concerns regarding the adoption of the smart glass application, including technical limitations, environmental constraints, and potential barriers to workflow integration. Conclusions: Using a participatory design approach, this study provided insights into designing user-friendly smart glasses that address the current challenges EMS providers face in dynamic prehospital settings. ", doi="10.2196/53157", url="https://www.jmir.org/2024/1/e53157" } @Article{info:doi/10.2196/57452, author="Mengistu, Meron and Tom, Kris and Gebremikael, Liben and Massaquoi, Notisha and Ezezika, Obidimma", title="Tracking Implementation Outcomes of an Intensive Case Management Program for HIV: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="29", volume="13", pages="e57452", keywords="implementation science", keywords="intensive case management", keywords="ICM", keywords="human immunodeficiency virus", keywords="HIV", keywords="tracking", keywords="outcome", keywords="fidelity", keywords="reach", keywords="sustainability", keywords="implementation outcomes", keywords="perspective", keywords="perception", keywords="Toronto", keywords="Canada", keywords="descriptive statistics", keywords="evidence-based intervention", keywords="effectiveness", keywords="barriers", keywords="facilitators", keywords="adoption", abstract="Background: Implementation science investigates the processes and factors that influence the successful adoption, implementation, and sustainability of interventions in many settings. Although conventional research places significant emphasis on the advancement and effectiveness of interventions, it is equally imperative to comprehend their performance in practical, real-life situations. Through outcome tracking, implementation science enables researchers to investigate complex implementation dynamics and go beyond efficacy, identifying the various aspects that contribute to the success of interventions. Objective: This study aims to evaluate the implementation outcomes of TAIBU's intensive case management (ICM) model tailored for African, Caribbean, and Black communities living with HIV in the Greater Toronto Area. Specifically, it seeks to assess the fidelity, reach, and sustainability of the ICM program. Fidelity monitoring will ensure adherence to program protocols and consistency in service delivery, essential for achieving desired health outcomes. Reach assessment will examine the program's capacity to reach the target population, including demographic coverage and engagement levels among African, Caribbean, and Black individuals. Sustainability assessment will explore the determinants influencing the longevity and impact of the ICM program. Methods: The study uses a mixed methods approach, where we will use probing questionnaires, interviews, and focus-group discussions to gather program performance and engagement data, in-depth insights, and perspectives from the implementation team responsible for delivering the ICM intervention. The collected fidelity and reach data through questionnaires will be analyzed using appropriate statistical techniques, such as descriptive statistics, to summarize the responses and identify patterns and trends within the data. Sustainability data collected through the interviews and focus groups will be analyzed and organized based on the Consolidated Framework for Implementation Research, which provides an organized way to identify and comprehend the determinants influencing implementation outcomes. Results: The study commenced in January 2024, and initial data collection is expected to be completed by December 2024. As of September 2024, we have enrolled 5 participants. Conclusions: This study will significantly contribute to improving the implementation of the ICM program. By conducting a study in an organizational or institutional setting, researchers can acquire valuable insights into the implementation process from those who are directly involved. The information gathered will inform strategies for improving implementation effectiveness; removing impediments; and enhancing the overall quality of the ICM program for African, Caribbean, and Black individuals living with HIV. International Registered Report Identifier (IRRID): DERR1-10.2196/57452 ", doi="10.2196/57452", url="https://www.researchprotocols.org/2024/1/e57452", url="http://www.ncbi.nlm.nih.gov/pubmed/39612213" } @Article{info:doi/10.2196/65680, author="Lancioni, E. Giulio and Alberti, Gloria and Filippini, Chiara and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Orlando, Isabella and Desideri, Lorenzo", title="A Technology System to Help People With Intellectual Disability and Blindness Find Room Destinations During Indoor Traveling: Case Series Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="27", volume="11", pages="e65680", keywords="barcode reader", keywords="barcode", keywords="blindness", keywords="intellectual disability", keywords="indoor traveling", keywords="indoor travel", keywords="digital health", keywords="travel", keywords="navigation", keywords="wayfinding", keywords="patient care", keywords="patient support", keywords="mobile health", keywords="patient assessment", keywords="health intervention", keywords="user engagement", keywords="technology use", keywords="telerehabilitation", keywords="rehabilitation", keywords="disability", keywords="support tools", keywords="mobility", keywords="orientation", keywords="mobile phone", abstract="Background: People with severe or profound intellectual disability and visual impairment tend to have serious problems in orientation and mobility and need assistance for their indoor traveling. The use of technology solutions may be critically important to help them curb those problems and achieve a level of independence. Objective: This study aimed to assess a new technology system to help people with severe to profound intellectual disability and blindness find room destinations during indoor traveling. Methods: A total of 7 adults were included in the study. The technology system entailed a barcode reader, a series of barcodes marking the room entrances, a smartphone, and a special app that controlled the presentation of different messages (instructions) for the participants. The messages varied depending on whether the participants were (1) in an area between room entrances, (2) in correspondence with a room entrance to bypass, or (3) in correspondence with a room entrance representing the destination to enter. The intervention with the technology system was implemented according to a nonconcurrent multiple baseline design across participants. Sessions included 7 traveling trials, in each of which the participants were to reach and enter a specific room (1 of the 7 or 9 available) to deliver an object they had carried (transported) during their traveling. Results: The participants' mean frequency of traveling trials completed correctly was between zero and 2 per session during the baseline (without the system). Their mean frequency increased to between about 6 and nearly 7 per session during the intervention (with the system). Conclusions: The findings suggest that the new technology system might be a useful support tool for people with severe to profound intellectual disability and blindness. ", doi="10.2196/65680", url="https://rehab.jmir.org/2024/1/e65680", url="http://www.ncbi.nlm.nih.gov/pubmed/39602792" } @Article{info:doi/10.2196/60031, author="Wosny, Marie and Strasser, Maria Livia and Kraehenmann, Simone and Hastings, Janna", title="Practical Recommendations for Navigating Digital Tools in Hospitals: Qualitative Interview Study", journal="JMIR Med Educ", year="2024", month="Nov", day="27", volume="10", pages="e60031", keywords="health care", keywords="hospital", keywords="information system", keywords="information technology", keywords="technology implementation", keywords="training", keywords="medical education", keywords="digital literacy", keywords="curriculum development", keywords="health care workforce development", keywords="mobile phone", abstract="Background: The digitalization of health care organizations is an integral part of a clinician's daily life, making it vital for health care professionals (HCPs) to understand and effectively use digital tools in hospital settings. However, clinicians often express a lack of preparedness for their digital work environments. Particularly, new clinical end users, encompassing medical and nursing students, seasoned professionals transitioning to new health care environments, and experienced practitioners encountering new health care technologies, face critically intense learning periods, often with a lack of adequate time for learning digital tools, resulting in difficulties in integrating and adopting these digital tools into clinical practice. Objective: This study aims to comprehensively collect advice from experienced HCPs in Switzerland to guide new clinical end users on how to initiate their engagement with health ITs within hospital settings. Methods: We conducted qualitative interviews with 52 HCPs across Switzerland, representing 24 medical specialties from 14 hospitals. The interviews were transcribed verbatim and analyzed through inductive thematic analysis. Codes were developed iteratively, and themes and aggregated dimensions were refined through collaborative discussions. Results: Ten themes emerged from the interview data, namely (1) digital tool understanding, (2) peer-based learning strategies, (3) experimental learning approaches, (4) knowledge exchange and support, (5) training approaches, (6) proactive innovation, (7) an adaptive technology mindset, (8) critical thinking approaches, (9) dealing with emotions, and (10) empathy and human factors. Consequently, we devised 10 recommendations with specific advice to new clinical end users on how to approach new health care technologies, encompassing the following: take time to get to know and understand the tools you are working with; proactively ask experienced colleagues; simply try it out and practice; know where to get help and information; take sufficient training; embrace curiosity and pursue innovation; maintain an open and adaptable mindset; keep thinking critically and use your knowledge base; overcome your fears, and never lose the human and patient focus. Conclusions: Our study emphasized the importance of comprehensive training and learning approaches for health care technologies based on the advice and recommendations of experienced HCPs based in Swiss hospitals. Moreover, these recommendations have implications for medical educators and clinical instructors, providing advice on effective methods to instruct and support new end users, enabling them to use novel technologies proficiently. Therefore, we advocate for new clinical end users, health care institutions and clinical instructors, academic institutions and medical educators, and regulatory bodies to prioritize effective training and cultivating technological readiness to optimize IT use in health care. ", doi="10.2196/60031", url="https://mededu.jmir.org/2024/1/e60031" } @Article{info:doi/10.2196/62742, author="Jain, Ekta and Gupta, Srishti and Yadav, Vandana and Kachnowski, Stan", title="Assessing the Usability and Effectiveness of an AI-Powered Telehealth Platform: Mixed Methods Study on the Perspectives of Patients and Providers", journal="JMIR Form Res", year="2024", month="Nov", day="25", volume="8", pages="e62742", keywords="usability study", keywords="telemedicine", keywords="web platform", keywords="patient-provider feedback", keywords="artificial intelligence", keywords="AI triage", abstract="Background: Telemedicine has revolutionized health care by significantly enhancing accessibility and convenience, yet barriers remain, such as providers' challenges with technology use. With advancements in telemedicine technologies, understanding the viewpoints of patients and providers is crucial for an effective and acceptable telemedicine service. This study reports the findings on the usability and effectiveness of the HelixVM artificial intelligence powered platform, analyzing key aspetcs like asynchronous health care, access, time efficiency, productivity, data exchange, security, privacy, and quality of care from patient and provider perspectives. Objective: This study aims to assess the usability and effectiveness of the HelixVM marketplace platform. Methods: We recruited 102 patients and 12 providers in a mixed methods study design involving surveys and in-depth structured interviews with a subset of the providers. The survey questionnaires are a modified version of the Telehealth Usability Questionnaire. We analyzed patient data using descriptive statistics and exploratory factor analysis to identify latent demographic patterns. For provider data, we used a deductive thematic analysis approach to identify key themes from the interviews and interpreted overall sentiments of the providers as negative, neutral, or positive. We also calculated percentages of different provider responses from the survey and interviews, where applicable. Results: Overall, 86.3\% (88/102) of the patients reported satisfaction with HelixVM, and 89.2\% (91/102) indicated that they would use the services again. A total of 91.1\% (93/102) of the patients agreed that HelixVM improves access to health care and is an acceptable way to receive health care, and 98\% (100/102) agreed it saves time. Chi-square tests demonstrated statistical significance for all survey questions (P<.001). The results from factor analysis show a higher propensity of middle-aged women, who had a fast-track encounter type, who self-reported a medium level of technology savviness, and who are residing in the South region of the United States rating the platform more positively. With regard to the providers, the thematic analysis identified themes of asynchronous medicine in terms of the accessibility and quality of care, time and productivity, integration within the workflow, data exchange, and artificial intelligence triage. Certain challenges regarding incomplete data in patient charts and its impact on provider time were cited. Suggestions for improvements included options to ensure the completeness of patient charts and better screening to ensure that only asynchronous, qualified patients are able to reach the provider. Conclusions: Overall, our study findings indicate a positive experience for patients and providers. The use of fast-track prescription was considered favorable compared to traditional telemedicine. Some concerns on data completeness, gaps, and accuracy exist. Suggestions are provided for improvement. This study adds to the knowledge base of existing literature and provides a detailed analysis of the real-world implementation of a telemedicine market-place platform. ", doi="10.2196/62742", url="https://formative.jmir.org/2024/1/e62742", url="http://www.ncbi.nlm.nih.gov/pubmed/39418632" } @Article{info:doi/10.2196/59564, author="Chua, Chien Mei and Hadimaja, Matthew and Wong, Jill and Mukherjee, Subhra Sankha and Foussat, Agathe and Chan, Daniel and Nandal, Umesh and Yap, Fabian", title="Exploring the Use of a Length AI Algorithm to Estimate Children's Length from Smartphone Images in a Real-World Setting: Algorithm Development and Usability Study", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="22", volume="7", pages="e59564", keywords="computer vision", keywords="length estimation", keywords="artificial intelligence", keywords="smartphone images", keywords="children", keywords="AI", keywords="algorithm", keywords="imaging", keywords="height", keywords="length", keywords="measure", keywords="pediatric", keywords="infant", keywords="neonatal", keywords="newborn", keywords="smartphone", keywords="mHealth", keywords="mobile health", keywords="mobile phone", abstract="Background: Length measurement in young children younger than 18 months is important for monitoring growth and development. Accurate length measurement requires proper equipment, standardized methods, and trained personnel. In addition, length measurement requires young children's cooperation, making it particularly challenging during infancy and toddlerhood. Objective: This study aimed to develop a length artificial intelligence (LAI) algorithm to aid users in determining recumbent length conveniently from smartphone images and explore its performance and suitability for personal and clinical use. Methods: This proof-of-concept study in healthy children (aged 0-18 months) was performed at KK Women's and Children's Hospital, Singapore, from November 2021 to March 2022. Smartphone images were taken by parents and investigators. Standardized length-board measurements were taken by trained investigators. Performance was evaluated by comparing the tool's image-based length estimations with length-board measurements (bias [mean error, mean difference between measured and predicted length]; absolute error [magnitude of error]). Prediction performance was evaluated on an individual-image basis and participant-averaged basis. User experience was collected through questionnaires. Results: A total of 215 participants (median age 4.4, IQR 1.9-9.7 months) were included. The tool produced a length prediction for 99.4\% (2211/2224) of photos analyzed. The mean absolute error was 2.47 cm for individual image predictions and 1.77 cm for participant-averaged predictions. Investigators and parents reported no difficulties in capturing the required photos for most participants (182/215, 84.7\% participants and 144/200, 72\% participants, respectively). Conclusions: The LAI algorithm is an accessible and novel way of estimating children's length from smartphone images without the need for specialized equipment or trained personnel. The LAI algorithm's current performance and ease of use suggest its potential for use by parents or caregivers with an accuracy approaching what is typically achieved in general clinics or community health settings. The results show that the algorithm is acceptable for use in a personal setting, serving as a proof of concept for use in clinical settings. Trial Registration: ClinicalTrials.gov NCT05079776; https://clinicaltrials.gov/ct2/show/NCT05079776 ", doi="10.2196/59564", url="https://pediatrics.jmir.org/2024/1/e59564" } @Article{info:doi/10.2196/58441, author="Wettstein, Reto and Sedaghat-Hamedani, Farbod and Heinze, Oliver and Amr, Ali and Reich, Christoph and Betz, Theresa and Kayvanpour, Elham and Merzweiler, Angela and B{\"u}sch, Christopher and Mohr, Isabell and Friedmann-Bette, Birgit and Frey, Norbert and Dugas, Martin and Meder, Benjamin", title="A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="22", volume="12", pages="e58441", keywords="wearable", keywords="consumer device", keywords="mobile phone", keywords="mobile health", keywords="telemedicine", keywords="remote patient monitoring", keywords="usability", keywords="Health Level 7 Fast Healthcare Interoperability Resources", keywords="HL7 FHIR", keywords="cardiology", keywords="heart failure", keywords="dilated cardiomyopathy", abstract="Background: Technological advances allow for recording and sharing health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable close management of individual health trajectories, monitoring of risk factors, and asynchronous feedback. However, most remote patient monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack a patient-centric design. Objective: The objective of this study was to conceptualize and implement a user-friendly, reusable, interoperable, and secure RPM system incorporating asynchronous feedback mechanisms using a broadly available consumer wearable (Apple Watch). In addition, this study sought to evaluate factors influencing patient acceptance of such systems. Methods: The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was used as part of the activeDCM prospective randomized interventional study focusing on dilated cardiomyopathy. Each patient used the system for at least 12 months. The System Usability Scale was used to measure usability from a subjective patient perspective. In addition, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data classified into sensor-based health data (SHD) and patient-reported outcome measures (PROMs). Descriptive statistics using box plots and bootstrapped multiple linear regression with 95\% CIs were used for evaluation analyzing the influence of age, sex, device experience, and intervention group membership. Results: The RPM system comprised 4 interoperable components: patient devices, a data server, a data viewer, and a notification service. The system was evaluated with 95 consecutive patients with dilated cardiomyopathy (28/95, 29\% female; mean age 50, SD 12 y) who completed the activeDCM study protocol. The system's app achieved a mean System Usability Scale score of 78 (SD 17), which was most influenced by device experience. In total, 87\% (83/95) of the patients could integrate the use of the app well or very well into their daily routine, and 71\% (67/95) saw a benefit of the RPM system for management of their health condition. On average, patients interacted with the wearable on 61\% (SD 26\%) of days enrolled in the study. SHD were available on average for 78\% (SD 23\%) of days, and PROM data were available on 64\% (SD 27\%) of weeks enrolled in the study. Wearable interaction frequency, SHD, and PROM completeness were most influenced by intervention group membership. Conclusions: Our results mark a first step toward integrating RPM systems based on a consumer wearable device for primary patient input into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable, and secure RPM system that can be integrated into patients' daily routines. ", doi="10.2196/58441", url="https://mhealth.jmir.org/2024/1/e58441" } @Article{info:doi/10.2196/50710, author="Ahumada-Newhart, Veronica and Wood, Taffeta and Satake, Noriko and Marcin, P. James", title="Health Perceptions and Practices of a Telewellness Fitness Program: Exploratory Case Study", journal="JMIR Form Res", year="2024", month="Nov", day="21", volume="8", pages="e50710", keywords="telehealth", keywords="telewellness", keywords="online fitness", keywords="health equity", keywords="community health", keywords="group exercise", keywords="mobile phone", keywords="mobile device", abstract="Background: During the COVID-19 pandemic, many people lacked access to group fitness opportunities due to elevated risk of infection, lockdown, and closure of exercise facilities. Additionally, many people experienced higher than average rates of mental health burden (eg, anxiety and stress). To help address these needs, an existing in-person community exercise class, taught by a faculty member from an academic medical center, transitioned to an online synchronous (OS) physical fitness class via the Zoom (Zoom Video Communications) videoconferencing platform. As such, the instructor advertised the OS fitness classes through an existing email list of community members and university faculty, staff, students, or alumni email listservs. This telewellness intervention sought to create a sense of community, build social support, and promote physical and mental wellness during the COVID-19 pandemic. Objective: Our aim was to determine the perceived mental and physical health benefits of attending an OS fitness class for community members, including health care workers. We also assessed the use and functionality of related technologies necessary for delivering and attending the fitness classes. Methods: An online survey questionnaire was created and tested to collect quantitative and qualitative data for an exploratory study. Data were collected to evaluate the fitness class, motivation, perceived health benefits, and related technologies. A convenience sample of people who had participated in the OS fitness classes was recruited for this study via an emailed recruitment flyer. Results: A total of 51 participants accessed and completed the survey questionnaire. Survey participants consisted of 28 of 51 (55\%) with a university affiliation, 17 of 51 (33\%) with no university affiliation, and 6 of 51 (12\%) who declined to state. The largest group of participants reporting full-time employment (18/51, 35\%) also reported university affiliation with the academic medical center. In this group, 13 of 51 (25\%) participants reported full-time employment, university affiliation, and doctoral degrees. High overall exercise class satisfaction was observed in the survey responses (mean 4.0, SD 1). Data analyses revealed significant perceived value of both mental and physical health benefits as motivating factors for participating in the OS fitness class. Challenges were identified as not being able to receive individual feedback from the instructor and the inability of some participants to see if they were in sync with the rest of the class. Conclusions: Results provide preliminary support for the use of online videoconferencing fitness platforms to promote wellness and facilitate group exercise in the community during times of high infection risk. Future studies should continue to explore perceived benefits, mental and physical wellness, best practices, and the design of related technologies. ", doi="10.2196/50710", url="https://formative.jmir.org/2024/1/e50710" } @Article{info:doi/10.2196/52514, author="Drogt, Jojanneke and Milota, Megan and Veldhuis, Wouter and Vos, Shoko and Jongsma, Karin", title="The Promise of AI for Image-Driven Medicine: Qualitative Interview Study of Radiologists' and Pathologists' Perspectives", journal="JMIR Hum Factors", year="2024", month="Nov", day="21", volume="11", pages="e52514", keywords="digital medicine", keywords="computer vision", keywords="medical AI", keywords="image-driven specialisms", keywords="qualitative interview study", keywords="digital health ethics", keywords="artificial intelligence", keywords="AI", keywords="imaging", keywords="imaging informatics", keywords="radiology", keywords="pathology", abstract="Background: Image-driven specialisms such as radiology and pathology are at the forefront of medical artificial intelligence (AI) innovation. Many believe that AI will lead to significant shifts in professional roles, so it is vital to investigate how professionals view the pending changes that AI innovation will initiate and incorporate their views in ongoing AI developments. Objective: Our study aimed to gain insights into the perspectives and wishes of radiologists and pathologists regarding the promise of AI. Methods: We have conducted the first qualitative interview study investigating the perspectives of both radiologists and pathologists regarding the integration of AI in their fields. The study design is in accordance with the consolidated criteria for reporting qualitative research (COREQ). Results: In total, 21 participants were interviewed for this study (7 pathologists, 10 radiologists, and 4 computer scientists). The interviews revealed a diverse range of perspectives on the impact of AI. Respondents discussed various task-specific benefits of AI; yet, both pathologists and radiologists agreed that AI had yet to live up to its hype. Overall, our study shows that AI could facilitate welcome changes in the workflows of image-driven professionals and eventually lead to better quality of care. At the same time, these professionals also admitted that many hopes and expectations for AI were unlikely to become a reality in the next decade. Conclusions: This study points to the importance of maintaining a ``healthy skepticism'' on the promise of AI in imaging specialisms and argues for more structural and inclusive discussions about whether AI is the right technology to solve current problems encountered in daily clinical practice. ", doi="10.2196/52514", url="https://humanfactors.jmir.org/2024/1/e52514" } @Article{info:doi/10.2196/65728, author="Schmollinger, Martin and Gerstner, Jessica and Stricker, Eric and Muench, Alexander and Breckwoldt, Benjamin and Sigle, Manuel and Rosenberger, Peter and Wunderlich, Robert", title="Evaluation of an App-Based Mobile Triage System for Mass Casualty Incidents: Within-Subjects Experimental Study", journal="J Med Internet Res", year="2024", month="Nov", day="21", volume="26", pages="e65728", keywords="disaster medicine", keywords="mass casualty incidents", keywords="digitalization", keywords="triage", keywords="Germany", keywords="mobile triage app", abstract="Background: Digitalization in disaster medicine holds significant potential to accelerate rescue operations and ultimately save lives. Mass casualty incidents demand rapid and accurate information management to coordinate effective responses. Currently, first responders manually record triage results on patient cards, and brief information is communicated to the command post via radio communication. Although this process is widely used in practice, it involves several time-consuming and error-prone tasks. To address these issues, we designed, implemented, and evaluated an app-based mobile triage system. This system allows users to document responder details, triage categories, injury patterns, GPS locations, and other important information, which can then be transmitted automatically to the incident commanders. Objective: This study aims to design and evaluate an app-based mobile system as a triage and coordination tool for emergency and disaster medicine, comparing its effectiveness with the conventional paper-based system. Methods: A total of 38 emergency medicine personnel participated in a within-subject experimental study, completing 2 triage sessions with 30 patient cards each: one session using the app-based mobile system and the other using the paper-based tool. The accuracy of the triages and the time taken for each session were measured. Additionally, we implemented the User Experience Questionnaire along with other items to assess participants' subjective ratings of the 2 triage tools. Results: Our 2 (triage tool) {\texttimes} 2 (tool order) mixed multivariate analysis of variance revealed a significant main effect for the triage tool (P<.001). Post hoc analyses indicated that participants were significantly faster (P<.001) and more accurate (P=.005) in assigning patients to the correct triage category when using the app-based mobile system compared with the paper-based tool. Additionally, analyses showed significantly better subjective ratings for the app-based mobile system compared with the paper-based tool, in terms of both school grading (P<.001) and across all 6 scales of the User Experience Questionnaire (all P<.001). Of the 38 participants, 36 (95\%) preferred the app-based mobile system. There was no significant main effect for tool order (P=.24) or session order (P=.06) in our model. Conclusions: Our findings demonstrate that the app-based mobile system not only matches the performance of the conventional paper-based tool but may even surpass it in terms of efficiency and usability. This advancement could further enhance the potential of digitalization to optimize processes in disaster medicine, ultimately leading to the possibility of saving more lives. ", doi="10.2196/65728", url="https://www.jmir.org/2024/1/e65728", url="http://www.ncbi.nlm.nih.gov/pubmed/39474975" } @Article{info:doi/10.2196/60037, author="Alnooh, Ghadah and AlTamimi, Z. Jozaa and Williams, A. Elizabeth and Hawley, S. Mark", title="An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="19", volume="8", pages="e60037", keywords="hypertension", keywords="blood pressure", keywords="Dietary Approaches to Stop Hypertension", keywords="DASH diet", keywords="self-efficacy", keywords="mobile health", keywords="mHealth", keywords="Saudi Arabia", keywords="mobile phone", abstract="Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals' and patients' preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62\%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app's educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also?suggested developing an Arabic version of the app and simplifying the method of food logging.?The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. ", doi="10.2196/60037", url="https://formative.jmir.org/2024/1/e60037" } @Article{info:doi/10.2196/55776, author="Ricci, Sofia Fabiana and Liguori, Lorenzo and Palermo, Eduardo and Rizzo, John-Ross and Porfiri, Maurizio", title="Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="18", volume="11", pages="e55776", keywords="assistive technology", keywords="human-computer interaction", keywords="multisensory feedback", keywords="virtual reality", keywords="visual impairment", keywords="haptic", abstract="Background: Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense. Objective: This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI. Methods: The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants' answers to a questionnaire, assessing their experience and preference for feedback modalities. Results: Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72\%) and found it interesting (42/72, 58\%). However, when it came to feedback preferences, less than half of the participants (29/72, 40\%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones. Conclusions: AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users' spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI. ", doi="10.2196/55776", url="https://rehab.jmir.org/2024/1/e55776" } @Article{info:doi/10.2196/52435, author="Wong, Ching Arkers Kwan and Bayuo, Jonathan and Su, Jing Jing and Wong, Yuet Frances Kam and Chow, Sum Karen Kit and Wong, Po Bonnie and Wong, Man Siu and Hui, Vivian", title="Effectiveness of the Support From Community Health Workers and Health Care Professionals on the Sustained Use of Wearable Monitoring Devices Among Community-Dwelling Older Adults: Feasibility Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e52435", keywords="wearable monitoring device", keywords="lay worker", keywords="smartwatch", keywords="older adult", keywords="nurse", keywords="engagement", keywords="attrition", keywords="wearable", keywords="user experience", abstract="Background: The wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge. Objective: This study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives. Methods: This feasibility trial examined the following: (1) the usability of the WMD from the users' perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months. Results: A total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85\%), and the attrition rate was low (8/76, 11\%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups ($\beta$=3.31, 95\% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points. Conclusions: It is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage. Trial Registration: ClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303 ", doi="10.2196/52435", url="https://www.jmir.org/2024/1/e52435" } @Article{info:doi/10.2196/58608, author="Essop, Hafsa and Kekana, Mable Ramadimetja and Brosens, Jacques and Smuts, Hanlie", title="A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e58608", keywords="mobile app", keywords="design science research", keywords="usefulness", keywords="pregnant radiographers", keywords="fetal dosimetry", keywords="occupational health and safety", keywords="mobile phone", keywords="maternal and child health", keywords="PregiDose", abstract="Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users' perceptions of the app's usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users' perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app's core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53\%) engaged with the app, and 4 (24\%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app's usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and ``pregnancy brain,'' were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. ", doi="10.2196/58608", url="https://formative.jmir.org/2024/1/e58608" } @Article{info:doi/10.2196/56807, author="Rivera Rivera, Nathalie Jessica and AuBuchon, E. Katarina and Smith, Marjanna and Starling, Claire and Ganacias, G. Karen and Danielson, Aimee and Patchen, Loral and Rethy, A. Janine and Blumenthal, Joseph H. and Thomas, D. Angela and Arem, Hannah", title="Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="14", volume="7", pages="e56807", keywords="postpartum care", keywords="newborn care", keywords="health education", keywords="chatbot", keywords="mHealth", keywords="mobile health", keywords="feedback", keywords="health equity", abstract="Background: The 42 days after delivery (``fourth trimester'') are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical ``fourth trimester,'' we developed 2 ruled-based chatbots---one for birthing individuals and one for newborn caregivers---that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63\%) individuals opened the newborn chatbot messaging, and 2244 (64\%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40\% (n=40) identified as Black, 27\% (n=27) identified as Hispanic/Latina, and 18\% (n=18) completed the survey in Spanish. Payer distribution was 55\% (n=55) for individuals with public insurance, 39\% (n=39) for those with commercial insurance, and 2\% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80\%) and found the reminders to schedule the newborn visit (n=59, 59\%) and postpartum visit (n=66, 66\%) useful. Across 23 interviews (n=14, 61\% Black; n=4, 17\% Hispanic/Latina; n=2, 9\% in Spanish; n=11, 48\% public insurance), 78\% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot's impact on health outcomes and reduce disparities. ", doi="10.2196/56807", url="https://pediatrics.jmir.org/2024/1/e56807" } @Article{info:doi/10.2196/57390, author="Shojaei, Fereshtehossadat and Shojaei, Fatemehalsadat and Desai, P. Archita and Long, Emily and Mehta, Jade and Fowler, R. Nicole and Holden, J. Richard and Orman, S. Eric and Boustani, Malaz", title="The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design", journal="JMIR Form Res", year="2024", month="Nov", day="13", volume="8", pages="e57390", keywords="AgileNudge+", keywords="agile", keywords="nudge strategy", keywords="nudging interventions", keywords="agile implementation", keywords="human behavior", keywords="software design", keywords="human-computer interaction", keywords="user experience design", keywords="usability testing", abstract="Background: In today's digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. ``AgileNudge+'' (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of ``AgileNudge+'' for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software's interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science--based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software's ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool's usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project's sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95\% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users' needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. ", doi="10.2196/57390", url="https://formative.jmir.org/2024/1/e57390" } @Article{info:doi/10.2196/58624, author="Reynolds, W. Christopher and Lee, HaEun and Sieka, Joseph and Perosky, Joseph and Lori, R. Jody", title="Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="13", volume="12", pages="e58624", keywords="mHealth", keywords="mobile triage", keywords="referral pathways", keywords="Liberia", keywords="LMIC", keywords="low- income country", keywords="obstetric triage", keywords="third delay", keywords="mobile health", keywords="mobile application", keywords="digital health", keywords="digital intervention", keywords="smartphone", keywords="middle-income country", abstract="Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61\%), nurses (20/62, 32\%), physicians assistants (3/62, 5\%), and physicians (1/62, 2\%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100\%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92\%), increasing health worker attentiveness (39/62, 63\%), and contributing to improved patient care (34/62, 55\%). MORES was perceived as sustainable and scalable (62/62, 100\%), particularly if technological barriers (21/62, 34\%) and staff training (19/62, 31\%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89\%), feedback mechanisms for hospitals and RHFs (48/62, 77\%), interprofessional teamwork (21/62, 34\%), longitudinal follow-up care (20/62, 32\%), creating a record of care delays (17/62, 27\%), and electronic health record infrastructure (13/62, 21\%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. ", doi="10.2196/58624", url="https://mhealth.jmir.org/2024/1/e58624" } @Article{info:doi/10.2196/57873, author="Merry, Kohle and MacPherson, M. Megan and Whittaker, L. Jackie and Napier, Christopher and Holsti, Liisa and Scott, Alex", title="An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="13", volume="11", pages="e57873", keywords="exercise therapy", keywords="physical therapy modalities", keywords="rehabilitation", keywords="tendons", keywords="tendinopathy", keywords="mobile health", keywords="mHealth", keywords="mobile phone", abstract="Background: People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective: This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods: The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results: By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions: Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies. ", doi="10.2196/57873", url="https://humanfactors.jmir.org/2024/1/e57873" } @Article{info:doi/10.2196/55137, author="Duran, T. Andrea and Cumella, M. Robin and Mendieta, Miguel and Keener-Denoia, Adrianna and L{\'o}pez Veneros, David and Farris, G. Samantha and Moise, Nathalie and Kronish, M. Ian", title="Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study", journal="JMIR Form Res", year="2024", month="Nov", day="12", volume="8", pages="e55137", keywords="behavioral intervention development", keywords="implementation science", keywords="acute coronary syndrome", keywords="exercise sensitivity", keywords="interoceptive exposure", keywords="digital health", keywords="mobile phone", abstract="Background: To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. Objective: This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. Methods: We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ?4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Results: Of 31 patients approached during recruitment, 3 (10\%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67\% male; 1/3, 33\% Black; and 1/3, 33\% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. Conclusions: The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline. ", doi="10.2196/55137", url="https://formative.jmir.org/2024/1/e55137" } @Article{info:doi/10.2196/60787, author="Wang, Tzu and Huang, Yen-Ming and Chan, Hsun-Yu", title="Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review", journal="J Med Internet Res", year="2024", month="Nov", day="8", volume="26", pages="e60787", keywords="Asia", keywords="adherence", keywords="application", keywords="feature", keywords="medication", keywords="mobile", abstract="Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included ``Asia,'' ``chronic disease,'' ``app,'' ``application,'' ``survey,'' ``experiment,'' ``questionnaire,'' ``group,'' ``medical adherence,'' ``medication adherence,'' ``case-control,'' ``cohort study,'' ``randomized controlled trial,'' ``clinical trial,'' ``observational study,'' ``qualitative research,'' ``mixed methods,'' and ``analysis,'' combined using logical operators ``OR'' and ``AND.'' The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. ", doi="10.2196/60787", url="https://www.jmir.org/2024/1/e60787" } @Article{info:doi/10.2196/59158, author="Straand, J. Ingjerd and F{\o}lstad, Asbj{\o}rn and W{\"u}nsche, C. Burkhard", title="A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e59158", keywords="web-based intervention", keywords="positive psychology", keywords="mental health", keywords="user experience", keywords="persuasive design", abstract="Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named R{\O}ST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. ", doi="10.2196/59158", url="https://formative.jmir.org/2024/1/e59158" } @Article{info:doi/10.2196/51865, author="Lange-Drenth, Lukas and Schulz, Holger and Suck, Isabell and Bleich, Christiane", title="Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e51865", keywords="telerehabilitation", keywords="rehabilitation", keywords="eHealth development", keywords="value specification", keywords="stakeholder participation", keywords="occupational injuries", keywords="vocational rehabilitation", keywords="aftercare", keywords="mobile phone", abstract="Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. ", doi="10.2196/51865", url="https://formative.jmir.org/2024/1/e51865" } @Article{info:doi/10.2196/59897, author="Berger, Mathilde and Deblock-Bellamy, Anne and Ch{\`e}ze, Laurence and Robert, Thomas and Desrosiers, J. Julie and Christe, Guillaume and Bertrand, Martine Anne", title="Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach", journal="JMIR Hum Factors", year="2024", month="Nov", day="7", volume="11", pages="e59897", keywords="chronic low back pain", keywords="needs", keywords="self-management", keywords="physical activity", keywords="mobile health", keywords="mHealth", keywords="user-centered design", abstract="Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. ", doi="10.2196/59897", url="https://humanfactors.jmir.org/2024/1/e59897" } @Article{info:doi/10.2196/54171, author="Larson, Elizabeth and Mattie, L. Rebecca and Riffkin, A. Sophia", title="Assessment of Acceptability, Usage, and Impact on Caregivers of Children With Autism's Stress and Mindfulness: Multiple-Method Feasibility Study of the 5Minutes4Myself App's Mindfulness Module", journal="JMIR Hum Factors", year="2024", month="Oct", day="31", volume="11", pages="e54171", keywords="autism", keywords="caregiver", keywords="activities", keywords="mindfulness", keywords="mobile application", keywords="stress", keywords="wellness", keywords="app", keywords="application", keywords="usage", keywords="children", keywords="developmental disability", keywords="usability", keywords="acceptability", keywords="meditation", keywords="wellness application", abstract="Background: Caregiver wellness programs need to be easily accessible to address caregivers' constraints to participation. Objective: We aimed to assess the feasibility of 5Minutes4Myself app's mindfulness module (usability, usage, and impact on caregivers' levels of mindfulness and perceived stress). Methods: Before and after participation in the 5Minutes4Myself program, 15 participants were asked to complete the Perceived Stress Scale (PSS) and Five Facet Mindfulness Questionnaire (FFMQ). Data on the usage of app-delivered meditations were collected electronically via the app, and app usability was rated on the Modified System Usability Scale. Analyses assessed participants' frequency of use of app-delivered meditations, app usability, and changes in participants' stress and mindfulness post intervention. Results: Overall, participants completed 10.9 minutes of mindfulness meditations per week and rated the app 76.7, indicating above-average usability. Related samples t tests (2-tailed) found that group PSS (t10=1.20, P=.26) and FFMQ (t10=?1.57, P=.15) pre- or postintervention mean scores were not significantly different. However, a visualization of pre- and post-PSS and mindfulness scores suggested there was a group of responders who had decreased stress with increased mindfulness. This was confirmed via an individual change analysis. The effect size of the FFMQ scores (d=0.47) suggests there may be treatment effects with a larger sample. A hierarchical multiple regression analysis examined the degree mindfulness impacted perceived stress; 20\% of the variance in participants' perceived stress could be attributed to increases in self-rated mindfulness (P=.04) when controlling for preintervention stress levels. Conclusions: Caregivers found the app highly usable and on average used low-dose levels of mindfulness meditations (10 min/wk). For responders, increased mindfulness was related to stress reduction to population-based levels. Trial Registration: ClinicalTrials.gov NCT03771001; https://clinicaltrials.gov/study/NCT03771001 ", doi="10.2196/54171", url="https://humanfactors.jmir.org/2024/1/e54171" } @Article{info:doi/10.2196/53443, author="Lopez-Olivo, A. Maria and Suarez-Almazor, E. Maria and Duhon, F. Gabrielle and Cherry, McKenna and Lu, Huifang and Calabrese, Cassandra and Altan, Mehmet and Tawbi, Hussain and Meara, Alexa and Bingham, O. Clifton and Diab, Adi and Leal, B. Viola and Volk, J. Robert", title="Development of an Educational Website for Patients With Cancer and Preexisting Autoimmune Diseases Considering Immune Checkpoint Blockers: Usability and Acceptability Study", journal="JMIR Cancer", year="2024", month="Oct", day="25", volume="10", pages="e53443", keywords="immune checkpoint inhibitors", keywords="patient education", keywords="usability testing", keywords="cancer", keywords="autoimmune diseases", keywords="mobile phones", keywords="user testing", keywords="usability", keywords="user experience", keywords="immunotherapy", keywords="websites", keywords="development", keywords="acceptability", keywords="autoimmune", keywords="immunology", keywords="oncology", keywords="architecture", keywords="iterative", keywords="vasculitis", keywords="Crohn disease", keywords="Sjogren syndrome", keywords="educational", keywords="web-based resource", keywords="health information", keywords="rheumatology", keywords="arthritis", keywords="web design", keywords="eHealth", keywords="adverse events", keywords="patient care", keywords="treatment", abstract="Background: Patients with cancer and an underlying autoimmune disease who are considering immune checkpoint blockers (ICBs) need to know about the benefits and risks of severe immune-related adverse events and flares of the autoimmune condition. Objective: This study aims to develop and alpha test an educational website for patients with cancer. Methods: Learning topics, images, and website architecture (including flow and requirements) were developed and iteratively reviewed by members of a community scientist program, a patient advisory group, and content experts. Alpha testing was performed, measuring the site's usability using the Suitability Assessment of Materials and its acceptability using the Ottawa Acceptability Measure. Results: The website included a home page; general information about ICBs; comprehensive modules on the benefits and risks of ICBs for patients with cancer and preexisting autoimmune diseases; general wellness information; and features such as a quiz, additional resources, and a glossary. For the alpha testing, 9 users assessed the newly developed website. Patient reviewers (n=5) had rheumatoid arthritis, Crohn disease, Sjogren syndrome, or vasculitis. Health care provider reviewers (n=4) were medical oncologists or rheumatologists. The median Suitability Assessment of Materials rating was 75 (IQR 70-79; range 0-100) for patients versus 66 (IQR 57-72; range 0-100) for providers (scores ?70 indicate no substantial changes needed). Recommendations for improvement, mostly involving navigation and accessibility, were addressed. All participants expressed that the website was acceptable and balanced in terms of discussion of benefits and harms. Because half (2/4, 50\%) of the providers suggested we increase the amount of information, we extended the content on the impact of having an autoimmune disease when considering ICB treatment, the probability of flares, and the management of flares in this context. Conclusions: The feedback led to minor revisions to enhance readability, navigation, and accessibility, ensuring the website's suitability as a decision-making aid. The newly developed website could become a supporting tool to facilitate patient-physician discussion regarding ICBs. ", doi="10.2196/53443", url="https://cancer.jmir.org/2024/1/e53443" } @Article{info:doi/10.2196/50457, author="Manning, B. Julia and Blandford, Ann and Edbrooke-Childs, Julian", title="Facilitators of and Barriers to Teachers' Engagement With Consumer Technologies for Stress Management: Qualitative Study", journal="J Med Internet Res", year="2024", month="Oct", day="22", volume="26", pages="e50457", keywords="teachers", keywords="stress", keywords="workplace", keywords="self-management", keywords="digital health", keywords="technology", keywords="qualitative", keywords="context", keywords="high schools", keywords="wearables", keywords="apps", keywords="human-computer interaction", keywords="HCI", keywords="personal informatics", abstract="Background: Consumer technology is increasingly being adopted to support personal stress management, including by teachers. Multidisciplinary research has contributed some knowledge of design and features that can help detect and manage workplace stress. However, there is less understanding of what facilitates engagement with ubiquitous ``off the shelf'' technologies, particularly in a specific occupational setting. An understanding of features that facilitate or inhibit technology use, and the influences of contexts on the manner of interaction, could improve teachers' stress-management opportunities. Objective: The aim of the study was to investigate the interaction features that facilitated or inhibited engagement with 4 consumer technologies chosen by teachers for stress management, as well as the influence of the educational contexts on their engagement. We also examined how use of well-being technology could be better supported in the school. Methods: The choice of consumer technologies was categorized in a taxonomy for English secondary school teachers according to stress-management strategies and digital features. Due to the COVID-19 pandemic, we adapted the study so that working from home in the summer could be contrasted with being back in school. Thus, a longitudinal study intended for 6 weeks in the summer term (in 2020) was extended into the autumn term, lasting up to 27 weeks. Teachers chose to use either a Withings smartwatch or Wysa, Daylio, or Teacher Tapp apps. Two semistructured interviews and web-based surveys were conducted with 8 teachers in England in the summer term, and 6 (75\%) of them took part in a third interview in the autumn term. Interviews were analyzed using reflexive thematic analysis informed by interpretive phenomenological analysis. Results: Technology elements and characteristics such as passive data collation, brevity of interaction, discreet appearance, reminders, and data visualization were described by teachers as facilitators. Lack of instructions and information on features, connectivity, extended interaction requirements, and nondifferentiation of activity and exercise data were described as barriers. Mesocontextual barriers to engagement were also reported, particularly when teachers were back on school premises, including temporal constraints, social stigma, and lack of private space to de-stress. Teachers had ideas for feature improvements and how educational leadership normalizing teachers' stress management with consumer technologies could benefit the school culture. Conclusions: Having preselected their stress-management strategies, teachers were able to harness design features to support themselves over an extended period. There could be an important role for digital interventions as part of teachers' stress management, which the school leadership would need to leverage to maximize their potential. The findings add to the holistic understanding of situated self-care and should inform developers' considerations for occupational digital stress support. ", doi="10.2196/50457", url="https://www.jmir.org/2024/1/e50457" } @Article{info:doi/10.2196/65692, author="Kabukye, K. Johnblack and Nakku, Juliet and Niwemuhwezi, Jackline and Nsereko, James and Namagembe, Rosemary and Groen, Emilie Iris Dorothee and Neumbe, Ritah and Mubiru, Denis and Kisakye, Caroline and Nanyonga, Roseline and Sj{\"o}linder, Marie and Nilsson, Susanne and Wamala-Larsson, Caroline", title="Assessing the Usage and Usability of a Mental Health Advice Telephone Service in Uganda: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Oct", day="21", volume="26", pages="e65692", keywords="mHealth", keywords="mental health", keywords="telephone service", keywords="usability", keywords="satisfaction", keywords="evaluation", keywords="mixed method", keywords="Uganda", keywords="Africa", abstract="Background: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers. Objective: This study aims to assess the usage and usability of this mental health telephone service. Methods: We obtained usage data from the system's call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated. Results: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27\%) stopped at the prerecorded IVR information, while 1710 calls (59.73\%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56\%) were answered, 393 calls (22.98\%) went to voicemail and were returned in the following working days, and 25 calls (1.46\%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0\%) or members of the general public (n=46, 19.2\%), while a few were patients with mental health issues (n=44, 18.3\%). Additionally, the majority were male (n=143, 59.6\%), spoke English (n=180, 75.0\%), had postsecondary education (n=164, 68.3\%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9\%), and were aged 25-44 years (n=160, 66.7\%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02). Conclusions: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings. ", doi="10.2196/65692", url="https://www.jmir.org/2024/1/e65692" } @Article{info:doi/10.2196/64614, author="Fietta, Valentina and Rizzi, Silvia and De Luca, Chiara and Gios, Lorenzo and Pavesi, Chiara Maria and Gabrielli, Silvia and Monaro, Merylin and Forti, Stefano", title="A Chatbot-Based Version of the World Health Organization--Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing", journal="JMIR Hum Factors", year="2024", month="Oct", day="18", volume="11", pages="e64614", keywords="acceptance and commitment therapy", keywords="ACT", keywords="well-being", keywords="pregnancy", keywords="breast cancer", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="development", keywords="usability", keywords="user-centered design", abstract="Background: Advancements in technology offer new opportunities to support vulnerable populations, such as pregnant women and women diagnosed with breast cancer, during physiologically and psychologically stressful periods. Objective: This study aims to adapt and co-design the World Health Organization's Self-Help Plus intervention into a mobile health intervention for these target groups. Methods: On the basis of the Obesity-Related Behavioral Intervention Trials and Center for eHealth Research and Disease Management models, low-fidelity and high-fidelity prototypes were developed. Prototypes were evaluated by 13 domain experts from diverse sectors and 15 participants from the target groups to assess usability, attractiveness, and functionality through semantic differential scales, the User Version of the Mobile Application Rating Scale questionnaire, and semistructured interviews. Results: Feedback from participants indicated positive perceptions of the mobile health intervention, highlighting its ease of use, appropriate language, and attractive multimedia content. Areas identified for improvement included enhancing user engagement through reminders, monitoring features, and increased personalization. The quality of the content and adherence to initial protocols were positively evaluated. Conclusions: This research provides valuable insights for future studies aiming to enhance the usability, efficacy, and effectiveness of the app, suggesting the potential role of a chatbot-delivered Self-Help Plus intervention as a supportive tool for pregnant women and women with a breast cancer diagnosis. ", doi="10.2196/64614", url="https://humanfactors.jmir.org/2024/1/e64614", url="http://www.ncbi.nlm.nih.gov/pubmed/39355954" } @Article{info:doi/10.2196/53557, author="Ditmore, H. Melissa and Florez-Arango, Fernando Jose", title="User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach", journal="JMIR Hum Factors", year="2024", month="Oct", day="9", volume="11", pages="e53557", keywords="mobile health", keywords="sex worker", keywords="user-centered design methods", keywords="usability", keywords="heuristic analysis", keywords="cognitive walkthrough", keywords="aggression", keywords="abuse", keywords="occupational health", keywords="reporting", keywords="prototype", keywords="heuristics", keywords="human-centered design", keywords="implementation", keywords="barriers", keywords="enablers", keywords="data collection", keywords="digital health", keywords="underreporting", abstract="Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing. ", doi="10.2196/53557", url="https://humanfactors.jmir.org/2024/1/e53557" } @Article{info:doi/10.2196/49691, author="Tarver, L. Willi and Savoy, April and Patel, Himalaya and Weiner, Michael and Holden, J. Richard", title="Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis", journal="JMIR Hum Factors", year="2024", month="Sep", day="30", volume="11", pages="e49691", keywords="health information technology", keywords="mobile devices", keywords="nursing and nursing systems", keywords="outpatient care", keywords="SEIPS 2.0", keywords="work-system analysis", abstract="Background: Industrywide, primary care nurses' work is increasing in complexity and team orientation. Mobile health information technologies (HITs) designed to aid nurses with indirect care tasks, including charting, have had mixed success. Failed introductions of HIT may be explained by insufficient integration into nurses' work processes, owing to an incomplete or incorrect understanding of the underlying work systems. Despite this need for context, published evidence has focused more on inpatient settings than on primary care. Objective: This study aims to characterize nurses' and health technicians' perceptions of process inefficiencies in the primary care setting and identify related work system factors. Methods: Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, we conducted an exploratory work system analysis with a convenience sample of primary care nurses and health technicians. Semistructured contextual interviews were conducted in 2 sets of primary care clinics in the Midwestern United States, one in an urban tertiary care center and the other in a rural community-based outpatient facility. Using directed qualitative content analysis of transcripts, we identified tasks participants perceived as frequent, redundant, or difficult, related processes, and recommendations for improvement. In addition, we conducted configuration analyses to identify associations between process inefficiencies and work system factors. Results: We interviewed a convenience sample of 20 primary care nurses and 2 health technicians, averaging approximately 12 years of experience in their current role. Across sites, participants perceived 2 processes, managing patient calls and clinic walk-in visits, as inefficient. Among work system factors, participants described organizational and technological factors associated with inefficiencies. For example, new organization policies to decrease patient waiting invoked frequent, repetitive, and difficult tasks, including chart review and check-in using tablet computers. Participants reported that issues with policy implementation and technology usability contributed to process inefficiencies. Organizational and technological factors were also perceived among participants as the most adaptable. Suggested technology changes included new tools for walk-in triage and patient self-reporting of symptoms. Conclusions: In response to changes to organizational policy and technology, without compensative changes elsewhere in their primary care work system, participants reported process adaptations. These adaptations indicate inefficient work processes. Understanding how the implementation of organizational policies affects other factors in the primary care work system may improve the quality of such implementations and, in turn, increase the effectiveness and efficiency of primary care nurse processes. Furthermore, the design and implementation of HIT interventions should consider influential work system factors and their effects on work processes. ", doi="10.2196/49691", url="https://humanfactors.jmir.org/2024/1/e49691" } @Article{info:doi/10.2196/58578, author="Chen, David and Cao, Christian and Kloosterman, Robert and Parsa, Rod and Raman, Srinivas", title="Trial Factors Associated With Completion of Clinical Trials Evaluating AI: Retrospective Case-Control Study", journal="J Med Internet Res", year="2024", month="Sep", day="23", volume="26", pages="e58578", keywords="artificial intelligence", keywords="clinical trial", keywords="completion", keywords="AI", keywords="cross-sectional study", keywords="application", keywords="intervention", keywords="trial design", keywords="logistic regression", keywords="Europe", keywords="clinical", keywords="trials testing", keywords="health care", keywords="informatics", keywords="health information", abstract="Background: Evaluation of artificial intelligence (AI) tools in clinical trials remains the gold standard for translation into clinical settings. However, design factors associated with successful trial completion and the common reasons for trial failure are unknown. Objective: This study aims to compare trial design factors of complete and incomplete clinical trials testing AI tools. We conducted a case-control study of complete (n=485) and incomplete (n=51) clinical trials that evaluated AI as an intervention of ClinicalTrials.gov. Methods: Trial design factors, including area of clinical application, intended use population, and intended role of AI, were extracted. Trials that did not evaluate AI as an intervention and active trials were excluded. The assessed trial design factors related to AI interventions included the domain of clinical application related to organ systems; intended use population for patients or health care providers; and the role of AI for different applications in patient-facing clinical workflows, such as diagnosis, screening, and treatment. In addition, we also assessed general trial design factors including study type, allocation, intervention model, masking, age, sex, funder, continent, length of time, sample size, number of enrollment sites, and study start year. The main outcome was the completion of the clinical trial. Odds ratio (OR) and 95\% CI values were calculated for all trial design factors using propensity-matched, multivariable logistic regression. Results: We queried ClinicalTrials.gov on December 23, 2023, using AI keywords to identify complete and incomplete trials testing AI technologies as a primary intervention, yielding 485 complete and 51 incomplete trials for inclusion in this study. Our nested propensity-matched, case-control results suggest that trials conducted in Europe were significantly associated with trial completion when compared with North American trials (OR 2.85, 95\% CI 1.14-7.10; P=.03), and the trial sample size was positively associated with trial completion (OR 1.00, 95\% CI 1.00-1.00; P=.02). Conclusions: Our case-control study is one of the first to identify trial design factors associated with completion of AI trials and catalog study-reported reasons for AI trial failure. We observed that trial design factors positively associated with trial completion include trials conducted in Europe and sample size. Given the promising clinical use of AI tools in health care, our results suggest that future translational research should prioritize addressing the design factors of AI clinical trials associated with trial incompletion and common reasons for study failure. ", doi="10.2196/58578", url="https://www.jmir.org/2024/1/e58578", url="http://www.ncbi.nlm.nih.gov/pubmed/39312296" } @Article{info:doi/10.2196/57984, author="Anthony, J. Samantha and Pol, J. Sarah and Selkirk, K. Enid and Matthiesen, Amarens and Klaassen, J. Robert and Manase, Dorin and Silva, Amanda and Barwick, Melanie and Stinson, N. Jennifer and Damer, Alameen and Ayibiowu, Mowa and Dong, X. Selina and Oreskovich, Stephan and Brudno, Michael", title="User-Centered Design and Usability of Voxe as a Pediatric Electronic Patient-Reported Outcome Measure Platform: Mixed Methods Evaluation Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="19", volume="11", pages="e57984", keywords="eHealth", keywords="end user engagement", keywords="mobile phone", keywords="patient-reported outcome", keywords="patient-reported outcome measures", keywords="pediatric", keywords="user-centered design", abstract="Background: Electronic patient-reported outcome measures (ePROMs) are standardized digital instruments integrated into clinical care to collect subjective data regarding patients' health-related quality of life, functional status, and symptoms. In documenting patient-reported progress, ePROMs can guide treatment decisions and encourage measurement-based care practices. Voxe is a pediatric and user-centered ePROM platform for patients with chronic health conditions. Objective: We aimed to describe the user-centered design approach involving feedback from end users and usability testing of Voxe's platform features to support implementation in a pediatric health care setting. Methods: Purposive sampling was used to recruit patients aged 8-17 years from 2 chronic illness populations in 2 pediatric hospitals in Canada. Patients' health care team members were also purposively recruited. One-on-one iterative testing sessions were conducted digitally by research team members with participants to obtain feedback on the appearance and functionalities of the Voxe platform prototype. Patients and health care providers (HCPs) completed Voxe-related task-based activities. International Organization for Standardization key performance indicators were tracked during HCP task-based activities. HCPs also completed the System Usability Scale. To test platform usability, the think-aloud technique was used by participants during the completion of structured tasks. After completing all task-based activities, patient participants selected 5 words from the Microsoft Desirability Toolkit to describe their overall impression and experience with the Voxe platform. Qualitative data about likes, dislikes, and ease of use were collected through semistructured interviews. Feedback testing sessions were conducted with patients and HCPs until Voxe was acceptable to participating end users, with no further refinements identified. Quantitative and qualitative data analysis were completed using descriptive statistics and content analysis. Results: A total of 49 patients and 38 HCPs were recruited. Patients were positive about Voxe's child-centered design characteristics and notification settings. HCPs rated Voxe as user-friendly and efficient, with the time to complete tasks decreasing over time. HCPs were satisfied with the Voxe platform functionalities and identified the value of Voxe's system notifications, summarized display of ePROM results, and its capacity to integrate with electronic medical records. Patients' and HCPs' high satisfaction rates with the Voxe prototype highlight the importance of being responsive to user suggestions from the inception of eHealth platform developments to ensure their efficient and effective design. Conclusions: This paper describes the user-centered creation and usability testing of Voxe as an ePROM platform for implementation into clinical care for pediatric patients with chronic health conditions. As a patient-facing platform that can be integrated into electronic medical records, Voxe aligns with measurement-based care practices to foster quality patient-centered approaches to care. End users' positive feedback and evaluation of the platform's user-friendliness and efficiency suggest that Voxe represents a valuable and promising solution to systematically integrate patient-related outcome (PRO) data into complex and dynamic clinical health care settings. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-053119 ", doi="10.2196/57984", url="https://humanfactors.jmir.org/2024/1/e57984" } @Article{info:doi/10.2196/56559, author="Staras, S. Stephanie A. and Tauscher, Justin and Vinson, Michelle and Thompson, A. Lindsay and Gerend, A. Mary and Shenkman, A. Elizabeth", title="Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e56559", keywords="participatory design", keywords="think-aloud", keywords="implementation science", keywords="adolescent vaccination", keywords="human papillomavirus vaccine", keywords="usability", keywords="eHealth", abstract="Background: In the United States, only 58\% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents' vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app's usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75\%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child's vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75\% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents' children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44\%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. ", doi="10.2196/56559", url="https://formative.jmir.org/2024/1/e56559" } @Article{info:doi/10.2196/48810, author="Johnsen, Mari Hege and Nes, Gon{\c{c}}alves Andr{\'e}a Aparecida and Haddeland, Kristine", title="Experiences of Using a Digital Guidance and Assessment Tool (the Technology-Optimized Practice Process in Nursing Application) During Clinical Practice in a Nursing Home: Focus Group Study Among Nursing Students", journal="JMIR Nursing", year="2024", month="Sep", day="10", volume="7", pages="e48810", keywords="application", keywords="assessment of clinical education", keywords="AssCE", keywords="clinical education assessment tool", keywords="electronic reports", keywords="feedback", keywords="guidance model", keywords="smartphone", keywords="Technology-Optimized Practice Process in Nursing", keywords="TOPP-N", keywords="information system success model", keywords="nurse", keywords="nursing", keywords="allied health", keywords="education", keywords="focus group", keywords="focus groups", keywords="technology enhanced learning", keywords="digital health", keywords="content analysis", keywords="student", keywords="students", keywords="nursing home", keywords="long-term care", keywords="learning management", keywords="mobile phone", abstract="Background: Nursing students' learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students' guidance and assessment and enhance students' learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors. Objective: This study explores first-year nursing students' experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education. Methods: Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean's information system success model. Results: Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application's concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application's perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof). Conclusions: This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators. ", doi="10.2196/48810", url="https://nursing.jmir.org/2024/1/e48810", url="http://www.ncbi.nlm.nih.gov/pubmed/39255477" } @Article{info:doi/10.2196/53907, author="Hodson, Nathan and Woods, Peter and Solano, Luque Juan and Talbot, Charlotte and Giacco, Domenico", title="Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience", journal="JMIR Pediatr Parent", year="2024", month="Sep", day="5", volume="7", pages="e53907", keywords="digital microintervention", keywords="parenting app", keywords="product management", keywords="parent", keywords="parents", keywords="parenting", keywords="app", keywords="apps", keywords="usability", keywords="acceptability", keywords="family", keywords="families", keywords="interview", keywords="interviews", keywords="pediatric", keywords="pediatrics", keywords="child", keywords="children", keywords="youths", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="acceptance", keywords="behavior", keywords="behaviors", keywords="disruptive behavior", keywords="thematic analysis", abstract="Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents' values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family's experience. Conclusions: Parents' use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. ", doi="10.2196/53907", url="https://pediatrics.jmir.org/2024/1/e53907" } @Article{info:doi/10.2196/54193, author="Bressler, Michael and Merk, Joachim and Gohlke, Tanja and Kayali, Fares and Daigeler, Adrien and Kolbenschlag, Jonas and Prahm, Cosima", title="A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study", journal="JMIR Serious Games", year="2024", month="Aug", day="27", volume="12", pages="e54193", keywords="video games", keywords="virtual reality", keywords="exercise therapy", keywords="physical therapy", keywords="hand rehabilitation", keywords="finger rehabilitation", abstract="Background: Restoring hand and finger function after a traumatic hand injury necessitates a regimen of consistent and conscientious exercise. However, motivation frequently wanes due to unchallenging repetitive tasks or discomfort, causing exercises to be performed carelessly or avoided completely. Introducing gamification to these repetitive tasks can make them more appealing to patients, ultimately increasing their motivation to exercise consistently. Objective: This study aims to iteratively develop a serious virtual reality game for hand and finger rehabilitation within an appealing and engaging digital environment, encouraging patient motivation for at least 2 weeks of continuous therapy. Methods: The development process comprised 3 distinct stages, each of which was subject to evaluation. Initially, a prototype was created to encompass the game's core functionalities, which was assessed by 18 healthy participants and 7 patients with impaired hand function. Subsequently, version 1 of the game was developed and evaluated with 20 patients who were divided into an investigation group and a control group. On the basis of these findings, version 2 was developed and evaluated with 20 patients who were divided into an investigation group and a control group. Motivation was assessed using the Intrinsic Motivation Inventory (IMI), while the application's quality was rated using the Mobile Application Rating Scale and the System Usability Scale. User feedback was gathered using semistructured interviews. Results: The prototype evaluation confirmed the acceptance and feasibility of the game design. Version 1 significantly increased motivation in 2 IMI subscales, effort (P<.001) and usefulness (P=.02). In version 2, a significant increase in daily performed exercises was achieved (P=.008) compared to version 1, with significantly higher motivation in the IMI subscale effort (P=.02). High Mobile Application Rating Scale scores were obtained for both versions 1 and 2, with version 2 scoring 86.9 on the System Usability Scale, indicating excellent acceptability. User feedback provided by the semistructured interviews was instrumental in the iterative development regarding improvements and the expansion of the playable content. Conclusions: This study presented a virtual reality serious game designed for hand and finger rehabilitation. The game was well received and provided an environment that effectively motivated the users. The iterative development process incorporated user feedback, confirming the game's ease of use and feasibility even for patients with severely limited hand function. ", doi="10.2196/54193", url="https://games.jmir.org/2024/1/e54193", url="http://www.ncbi.nlm.nih.gov/pubmed/39190432" } @Article{info:doi/10.2196/53939, author="Lyles, Courtney and Berrean, Beth and Buenaventura, Ana and Milter, Svetlana and Hernandez, Daniel Dayana and Sarkar, Urmimala and Gutierrez, Christian and Palmer, Nynikka and Brown III, William", title="Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="16", volume="11", pages="e53939", keywords="mHealth", keywords="mobile health", keywords="eHealth", keywords="electronic health", keywords="application", keywords="digital health", keywords="digital ecosystem", keywords="informatics", keywords="community-based", keywords="community", keywords="co-design", keywords="human-centered design", keywords="community health", keywords="population health", keywords="technology", keywords="innovation", keywords="operations", keywords="social needs", keywords="health resources", keywords="qualitative analysis", abstract="Background: Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective: We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods: Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results: Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled ``Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN),'' was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions: Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, and customization needed in these settings. ", doi="10.2196/53939", url="https://humanfactors.jmir.org/2024/1/e53939" } @Article{info:doi/10.2196/56043, author="Burke, Meghan and Li, Chak and Cheung, Catherine Waifong and Terol, Kaori Adriana and Johnston, Amanda and Schueller, M. Stephen", title="Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study", journal="JMIR Form Res", year="2024", month="Aug", day="14", volume="8", pages="e56043", keywords="human-centered design", keywords="autism", keywords="service access", keywords="families", keywords="digital support", keywords="autistic children", keywords="autistic", keywords="children", keywords="child", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="digital tool", keywords="tool", keywords="tools", abstract="Background: It is difficult for families to navigate and access services for their children with autism. Barriers to service access are compounded among families from low-resourced backgrounds. Objective: The purpose of our study was to explore the development of an app to facilitate access to services among families of children with autism from low-resourced backgrounds. Our specific aims were to explore feedback from an advisory board about the app and to explore feedback from navigators about the app. Methods: Via a multistage codevelopment process, we elicited feedback from 5 key parties: the research team, a community organization, the app development team, the advisory board, and family navigators. Collectively, 36 individuals provided feedback about the development of the app via individual interviews, focus groups, observations, and surveys. The key features of the app included a dashboard showing the service needs of the family and related resources, a messaging feature between the family, the navigator, and the supervisor, and a fidelity checklist and evaluation feature. Results: The advisory board provided feedback about the app to increase its user-friendliness, include the ability to develop an action plan, improve the identification of needed services, and add information about service providers. Navigators suggested that the app should connect navigators to one another, have a clearer purpose for the notes section, and reflect an easier log-in process. Navigators also wanted training to role-play using the app. After participating in a role play using the app, navigators reported significantly more satisfaction with the app and greater usefulness (P<.001). Conclusions: Our work sheds light on the importance of eliciting feedback from end users, especially users who are often overlooked by the research community and app developers. Further, it is important to elicit feedback in multiple ways to improve the app. ", doi="10.2196/56043", url="https://formative.jmir.org/2024/1/e56043", url="http://www.ncbi.nlm.nih.gov/pubmed/39141412" } @Article{info:doi/10.2196/56250, author="Gautam, Kamal and Shrestha, Roman and Dlamini, Sihlelelwe and Razali, Belle and Paudel, Kiran and Azwa, Iskandar and Saifi, Rumana and Toh, YuHang and Justin Lim, Hazriq and Sutherland, Ryan and Restar, Arjee and Phanuphak, Nittaya and Wickersham, A. Jeffrey", title="Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study", journal="JMIR Form Res", year="2024", month="Aug", day="13", volume="8", pages="e56250", keywords="HIV", keywords="AIDS", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="mobile health", keywords="mHealth", keywords="transgender women", keywords="Malaysia", keywords="mobile phone", abstract="Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11\% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women's needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women's uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62\%) and 2 FG sessions with stakeholders (n=11, 38\%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app's features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. ", doi="10.2196/56250", url="https://formative.jmir.org/2024/1/e56250" } @Article{info:doi/10.2196/52676, author="Reicherzer, Leah and Scheermesser, Mandy and Kl{\"a}y, Adrian and Duarte, E. Jaime and Graf, S. Eveline", title="Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists", journal="JMIR Rehabil Assist Technol", year="2024", month="Aug", day="9", volume="11", pages="e52676", keywords="assistive device", keywords="barriers", keywords="facilitators", keywords="mobility", keywords="older adults", keywords="wearable robots", abstract="Background: Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. Objective: The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Methods: Six older adults (aged 72?88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Results: Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. Conclusions: A light wearable robot---the Myosuit---was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need. ", doi="10.2196/52676", url="https://rehab.jmir.org/2024/1/e52676" } @Article{info:doi/10.2196/60771, author="Garc{\'i}a de Alba-Ch{\'a}vez, Alberto Carlos and Espinosa-Curiel, Edrein Ismael and Michel-Nava, Mar{\'i}a Rosa", title="Exploring the Impact of a Persuasive Serious Video Game (Farmily) on Promoting Home Gardening Among Novices: Design and Randomized Controlled Trial", journal="JMIR Serious Games", year="2024", month="Aug", day="8", volume="12", pages="e60771", keywords="serious video game", keywords="persuasive game", keywords="home gardening", keywords="knowledge", keywords="attitude", keywords="self-efficacy", keywords="intention", abstract="Background: Home gardens worldwide provide sustenance, economic support, and access to fresh produce and promote household well-being, health, self-sufficiency, and food security. However, they face significant challenges worldwide and necessitate innovative promotion approaches. Serious video games have proven effective in promoting agricultural knowledge. However, more research is needed on the persuasive potential of agriculture games to influence players' thoughts, attitudes, and behaviors. This provides an opportunity to examine the impact of persuasive games on promoting home gardening among novices. Objective: This study aims to describe the design and development of Farmily, a persuasive video game promoting home gardening among novices. In addition, it evaluated the effectiveness of Farmily and compared its impact with that of a traditional home gardening workshop. Furthermore, the study explored how game enjoyment relates to the game's outcomes. Methods: A randomized controlled trial with 50 novice gardening participants aged 20 to 50 years was carried out. Participants were randomly assigned to a control group (1.5-hour workshop) or an experimental group (1.5-hour Farmily session). Pre- and postintervention assessments were conducted. We evaluated Farmily's impact on knowledge, attitudes, perceived self-efficacy, and intentions regarding initiating home gardens. In addition, we investigated the user enjoyment and its relationship with the game's effect outcomes. Results: The experimental group significantly improved their knowledge (t24=4.26; P<.001), attitude (z24=2.98; P=.003), self-efficacy (t24=2.6; P=.02), and intention to initiate home gardens (z24=4.15; P<.001). The experimental group showed similar effectiveness in knowledge transfer (t24=--1.71; P=.09) and a more significant impact on attitude (z24=2.73; P=.006), self-efficacy (t24=2.21; P=.03), and intention to start a home garden (t24=--5.33; P<.001) than the control group. Farmily was well received by the intervention group, generating high enjoyment. Furthermore, user enjoyment substantially correlated with user attitudes (r23=0.72; P<.001) and self-efficacy (r23=0.67; P<.001), yet no discernible association was observed?among user enjoyment, knowledge (r23=0.26; P=.20), and intention (r23=0.06; P=.77). Conclusions: Evidence indicates that Farmily appears to be a viable tool for promoting home gardening among novices in the short term. Farmily demonstrated similar effects in knowledge improvement to those of a traditional workshop and had a more significant impact on the other variables. In addition, we found that the player's gaming experience positively relates to the player's attitudes and self-efficacy. A well-powered randomized controlled trial with more diverse samples and extended follow-up periods will be conducted to establish the long-term efficacy of Farmily and gain a deeper understanding of the influence of enjoyment on game outcomes. ", doi="10.2196/60771", url="https://games.jmir.org/2024/1/e60771", url="http://www.ncbi.nlm.nih.gov/pubmed/39116437" } @Article{info:doi/10.2196/53811, author="Wiegel, Patrick and Fotteler, Liselotte Marina and Kohn, Brigitte and Mayer, Sarah and Verri, Maria Filippo and Dallmeier, Dhayana and Denkinger, Michael", title="Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="2", volume="11", pages="e53811", keywords="assistive technology", keywords="older adults", keywords="caregiver", keywords="benefits", keywords="usability", keywords="gerontechnology", abstract="Background: Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce. Objective: This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment. Methods: Community-dwelling adults aged ?65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure. Results: A total of 17 older adults (tablet computer: n=8, 47\% and smartwatch: n=9, 53\%) and 16 relatives (tablet computer: n=7, 44\% and smartwatch: n=9, 56\%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05). Conclusions: This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs. ", doi="10.2196/53811", url="https://humanfactors.jmir.org/2024/1/e53811" } @Article{info:doi/10.2196/54999, author="LaVine, Danielle and Greer, Zara and Kim, Jiyun and Kumar, Santosh and Belin, Thomas and Shetty, Vivek", title="A Remote Oral Self-Care Behaviors Assessment System in Vulnerable Populations: Usability and Feasibility Study", journal="JMIR Form Res", year="2024", month="Aug", day="2", volume="8", pages="e54999", keywords="dental disease", keywords="underserved populations", keywords="mHealth", keywords="usability testing", keywords="feasibility testing, mobile phone", abstract="Background: Preventative self-care can reduce dental disease that disproportionately burdens vulnerable populations. Personalized digital oral self-care behavioral interventions offer a promising solution. However, the success of these digital interventions depends on toothbrushing data collection e-platforms attuned to the needs and preferences of vulnerable communities. Objective: The aim of this study is to assess the usability and feasibility of the Remote Oral Behaviors Assessment System (ROBAS), which has been adapted to address the unique requirements of socioeconomically disadvantaged minority individuals. Methods: A cohort of 53 community-clinic participants, including 31 (58\%) Latino and 22 (42\%) Black individuals with no prior experience using electric toothbrushes, were recruited to use ROBAS, with planned assessments at baseline, 2 months, and 4 months. Beyond evaluating ROBAS's technical performance, extensive feedback was gathered to gauge users' experiences, viewpoints, and overall contentment. The System Usability Scale (SUS) served as a primary metric for assessing user satisfaction and acceptability. Results: ROBAS exhibited largely reliable and consistent data-gathering capabilities. SUS scores (mean 75.6, SD 14.5) reflected participant contentment within a range of values for other commonly used digital devices and technologies. Among participants who answered questions about willingness to pay for ROBAS, 97\% (30/31) indicated that they were willing to pay for ROBAS either as a one-time payment or as a subscription-based service. Additionally, 87.5\% of participants expressed that they would endorse it to acquaintances. Most participants expressed no reservations about privacy; among those who expressed privacy concerns (n=20, 50\%), the concerns included exposure of information (n=18, 45\%), monitoring of brushing habits (n=12, 30\%), and collection of information (n=14, 35\%), although these concerns did not significantly correlate with specific participant traits. In qualitative terms, users valued ROBAS's ability to monitor brushing habits but called for refinements, especially in Wi-Fi and application connectivity. Recommendations for system improvements encompassed enhanced app functionality, individualized coaching, more comprehensive brushing data, and the addition of flossing activity tracking. Conclusions: The research highlights ROBAS's promise as a digital platform for unobtrusively tracking daily oral self-care activities in marginalized communities. The system proved to be both feasible, as evidenced by its stable and accurate data capture of brushing behaviors, and user-friendly, as reflected by strong SUS scores and positive user feedback. Influential factors for its uptake included ease of learning and operation, and the feedback provided. ", doi="10.2196/54999", url="https://formative.jmir.org/2024/1/e54999" } @Article{info:doi/10.2196/57953, author="Lee, Audrey and Wyckoff, Elijah and Farcas, Emilia and Godino, Job and Patrick, Kevin and Spiegel, Spencer and Yu, Rose and Kumar, Arun and Loh, J. Kenneth and Gombatto, Sara", title="Preliminary Validity and Acceptability of Motion Tape for Measuring Low Back Movement: Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Aug", day="2", volume="11", pages="e57953", keywords="low back pain", keywords="fabric", keywords="nanocomposite", keywords="sensor acceptability", keywords="sensor validation", keywords="skin", keywords="strain", keywords="wearable", abstract="Background: Low back pain (LBP) is a significant public health problem that can result in physical disability and financial burden for the individual and society. Physical therapy is effective for managing LBP and includes evaluation of posture and movement, interventions directed at modifying posture and movement, and prescription of exercises. However, physical therapists have limited tools for objective evaluation of low back posture and movement and monitoring of exercises, and this evaluation is limited to the time frame of a clinical encounter. There is a need for a valid tool that can be used to evaluate low back posture and movement and monitor exercises outside the clinic. To address this need, a fabric-based, wearable sensor, Motion Tape (MT), was developed and adapted for a low back use case. MT is a low-profile, disposable, self-adhesive, skin-strain sensor developed by spray coating piezoresistive graphene nanocomposites directly onto commercial kinesiology tape. Objective: The objectives of this study were to (1) validate MT for measuring low back posture and movement and (2) assess the acceptability of MT for users. Methods: A total of 10 participants without LBP were tested. A 3D optical motion capture system was used as a reference standard to measure low back kinematics. Retroreflective markers and a matrix of MTs were placed on the low back to measure kinematics (motion capture) and strain (MT) simultaneously during low back movements in the sagittal, frontal, and axial planes. Cross-correlation coefficients were calculated to evaluate the concurrent validity of MT strain in reference motion capture kinematics during each movement. The acceptability of MT was assessed using semistructured interviews conducted with each participant after laboratory testing. Interview data were analyzed using rapid qualitative analysis to identify themes and subthemes of user acceptability. Results: Visual inspection of concurrent MT strain and kinematics of the low back indicated that MT can distinguish between different movement directions. Cross-correlation coefficients between MT strain and motion capture kinematics ranged from --0.915 to 0.983, and the strength of the correlations varied across MT placements and low back movement directions. Regarding user acceptability, participants expressed enthusiasm toward MT and believed that it would be helpful for remote interventions for LBP but provided suggestions for improvement. Conclusions: MT was able to distinguish between different low back movements, and most MTs demonstrated moderate to high correlation with motion capture kinematics. This preliminary laboratory validation of MT provides a basis for future device improvements, which will also involve testing in a free-living environment. Overall, users found MT acceptable for use in physical therapy for managing LBP. ", doi="10.2196/57953", url="https://rehab.jmir.org/2024/1/e57953", url="http://www.ncbi.nlm.nih.gov/pubmed/39093610" } @Article{info:doi/10.2196/54345, author="Aljamaan, Fadi and Temsah, Mohamad-Hani and Altamimi, Ibraheem and Al-Eyadhy, Ayman and Jamal, Amr and Alhasan, Khalid and Mesallam, A. Tamer and Farahat, Mohamed and Malki, H. Khalid", title="Reference Hallucination Score for Medical Artificial Intelligence Chatbots: Development and Usability Study", journal="JMIR Med Inform", year="2024", month="Jul", day="31", volume="12", pages="e54345", keywords="artificial intelligence (AI) chatbots", keywords="reference hallucination", keywords="bibliographic verification", keywords="ChatGPT", keywords="Perplexity", keywords="SciSpace", keywords="Elicit", keywords="Bing", abstract="Background: Artificial intelligence (AI) chatbots have recently gained use in medical practice by health care practitioners. Interestingly, the output of these AI chatbots was found to have varying degrees of hallucination in content and references. Such hallucinations generate doubts about their output and their implementation. Objective: The aim of our study was to propose a reference hallucination score (RHS) to evaluate the authenticity of AI chatbots' citations. Methods: Six AI chatbots were challenged with the same 10 medical prompts, requesting 10 references per prompt. The RHS is composed of 6 bibliographic items and the reference's relevance to prompts' keywords. RHS was calculated for each reference, prompt, and type of prompt (basic vs complex). The average RHS was calculated for each AI chatbot and compared across the different types of prompts and AI chatbots. Results: Bard failed to generate any references. ChatGPT 3.5 and Bing generated the highest RHS (score=11), while Elicit and SciSpace generated the lowest RHS (score=1), and Perplexity generated a middle RHS (score=7). The highest degree of hallucination was observed for reference relevancy to the prompt keywords (308/500, 61.6\%), while the lowest was for reference titles (169/500, 33.8\%). ChatGPT and Bing had comparable RHS ($\beta$ coefficient=--0.069; P=.32), while Perplexity had significantly lower RHS than ChatGPT ($\beta$ coefficient=--0.345; P<.001). AI chatbots generally had significantly higher RHS when prompted with scenarios or complex format prompts ($\beta$ coefficient=0.486; P<.001). Conclusions: The variation in RHS underscores the necessity for a robust reference evaluation tool to improve the authenticity of AI chatbots. Further, the variations highlight the importance of verifying their output and citations. Elicit and SciSpace had negligible hallucination, while ChatGPT and Bing had critical hallucination levels. The proposed AI chatbots' RHS could contribute to ongoing efforts to enhance AI's general reliability in medical research. ", doi="10.2196/54345", url="https://medinform.jmir.org/2024/1/e54345" } @Article{info:doi/10.2196/54032, author="Engelsma, Thomas and Heijmink, Simone and Hendriksen, A. Heleen M. and Visser, C. Leonie N. and Lemstra, W. Afina and Jaspers, M. Monique W. and Peute, P. Linda W.", title="Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Jul", day="31", volume="11", pages="e54032", keywords="dementia", keywords="design principles", keywords="digital health", keywords="memory clinic", keywords="usability evaluation", keywords="mobile phone", abstract="Background: Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. Objective: This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. Methods: First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. Results: The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57\%) with SCD, 1 (14\%) with MCI, and 2 (29\%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6\%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4\%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user's expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. Conclusions: By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6\% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50\% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population. ", doi="10.2196/54032", url="https://humanfactors.jmir.org/2024/1/e54032" } @Article{info:doi/10.2196/56758, author="Ferguson, IreLee and George, Grace and Narine, O. Kevin and Turner, Amari and McGhee, Zelda and Bajwa, Harris and Hart, G. Frances and Carter, Sierra and Beard, Courtney", title="Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial", journal="JMIR Ment Health", year="2024", month="Jul", day="31", volume="11", pages="e56758", keywords="interpretation bias", keywords="anxiety", keywords="depression", keywords="Black", keywords="Latinx", keywords="smartphone", keywords="mobile phone", abstract="Background: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals. Objective: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. Methods: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71\% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. Results: Of the 31 participants that downloaded the app, 27 (87\%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). Conclusions: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention. ", doi="10.2196/56758", url="https://mental.jmir.org/2024/1/e56758", url="http://www.ncbi.nlm.nih.gov/pubmed/39083330" } @Article{info:doi/10.2196/56275, author="Palmeirim, S. Marta and Houngbedji, A. Clarisse and Barth-Jaeggi, Tanja and Kouam{\'e}, Y. Jean-Pierre and Krouman, Aboubakar and Coulibaly, Daouda and Wyss, Kaspar", title="Key Characteristics and Perception of Different Outbreak Surveillance Systems in C{\^o}te d'Ivoire: Cross-Sectional Survey Among Users", journal="JMIR Public Health Surveill", year="2024", month="Jul", day="30", volume="10", pages="e56275", keywords="outbreak surveillance system", keywords="COVID-19", keywords="C{\^o}te d'Ivoire", keywords="SORMAS", keywords="MAGPI", keywords="DHIS2", keywords="outbreak surveillance", keywords="key characteristics", keywords="users' perception", keywords="infectious disease", keywords="infectious diseases", keywords="public health", keywords="disease surveillance", keywords="policy decision", keywords="cross-sectional study", keywords="descriptively analysis", keywords="Policymakers", keywords="health officials", keywords="healthcare system", keywords="Surveillance Outbreak Response Management and Analysis System", keywords="District Health Information Software 2", keywords="policy makers", keywords="health care system", abstract="Background: Accurate and timely infectious disease surveillance is pivotal for effective public health responses. An important component of this is the disease surveillance tools used. Understanding views and experiences of users is crucial for informing policy decisions and ensuring the seamless functioning of surveillance systems. Objective: In this study, we aimed to assess the user perceptions of 3 disease surveillance tools used in C{\^o}te d'Ivoire, namely, MAGPI, District Health Information Software 2 (DHIS2), and Surveillance Outbreak Response Management and Analysis System (SORMAS), the latter was implemented in 2021 within a pilot scheme. Methods: We conducted interviews and a web-based survey distributed to users of the 3 surveillance tools. The survey assessed users' views of the surveillance tools' usefulness, ease of use, feelings toward the tool, conditions that may influence the use, and other characteristics. The descriptive analysis compared responses from SORMAS, MAGPI, and DHIS2 users, providing a comprehensive evaluation of their experiences. Results: Among the 159 respondents who actively use one of the systems, MAGPI was the most widely used surveillance tool among respondents (n=127, 79.9\%), followed by DHIS2 (n=108, 67.9\%), and SORMAS (n=25, 15.7\%). In terms of users' perceptions, SORMAS, despite its limited implementation, emerged as a tool that allows for data analysis and had the most comprehensive set of functionalities. DHIS2 was appreciated for its frequency of report provision, although users reported occasional IT system failures. MAGPI was recognized for its ease of use but was reported to lack certain functionalities offered by the other surveillance systems. Conclusions: This study offers valuable insights into the perceptions of disease surveillance tools users in C{\^o}te d'Ivoire. While all systems were positively regarded, each exhibited strengths and weaknesses addressing different needs and functionalities. Policy makers and health officials can use these findings to enhance existing tools or consider a unified approach for infectious disease surveillance systems. Understanding users' perspectives allows them to optimize the choice of surveillance tools, ultimately strengthening public health responses in C{\^o}te d'Ivoire and potentially serving as a model for other countries facing similar decisions in their health care systems. ", doi="10.2196/56275", url="https://publichealth.jmir.org/2024/1/e56275" } @Article{info:doi/10.2196/51491, author="Shetty, B. Vinutha and Fried, Leanne and Roby, C. Heather and Soon, K. Wayne H. and Nguyen, Rebecca and Ong, Arthur and Jaimangal, Mohinder and Francis, Jacinta and Paramalingam, Nirubasini and Cross, Donna and Davis, Elizabeth", title="Development of a Novel Mobile Health App to Empower Young People With Type 1 Diabetes to Exercise Safely: Co-Design Approach", journal="JMIR Diabetes", year="2024", month="Jul", day="30", volume="9", pages="e51491", keywords="Mobile health application", keywords="Exercise", keywords="fitness", keywords="physical activity", keywords="design", keywords="co-design", keywords="focus group", keywords="focus groups", keywords="acT1ve", keywords="Type 1 diabetes", keywords="Young people", keywords="Blood glucose level", keywords="diabetic", keywords="diabetes", keywords="young", keywords="youth", keywords="type 1", keywords="prototype", keywords="develop", keywords="development", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="user-centered design", keywords="mobile phone", abstract="Background: Blood glucose management around exercise is challenging for youth with type 1 diabetes (T1D). Previous research has indicated interventions including decision-support aids to better support youth to effectively contextualize blood glucose results and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) apps help deliver health behavior interventions to youth with T1D, given the use of technology for glucose monitoring, insulin dosing, and carbohydrate counting. Objective: We aimed to develop a novel prototype mHealth app to support exercise management among youth with T1D, detail the application of a co-design process and design thinking principles to inform app design and development, and identify app content and functionality that youth with T1D need to meet their physical activity goals. Methods: A co-design approach with a user-centered design thinking framework was used to develop a prototype mHealth app ``acT1ve'' during the 18-month design process (March 2018 to September 2019). To better understand and respond to the challenges among youth with diabetes when physically active, 10 focus groups were conducted with youth aged 13-25 years with T1D and parents of youth with T1D. Thereafter, we conducted participatory design workshops with youth to identify key app features that would support individual needs when physically active. These features were incorporated into a wireframe, which was critically reviewed by participants. A beta version of ``acT1ve'' was built in iOS and android operating systems, which underwent critical review by end users, clinicians, researchers, experts in exercise and T1D, and app designers. Results: Sixty youth with T1D, 14 parents, 6 researchers, and 10 clinicians were engaged in the development of ``acT1ve.'' acT1ve included key features identified by youth, which would support their individual needs when physically active. It provided advice on carbohydrates and insulin during exercise, information on hypoglycemia treatment, pre- and postexercise advice, and an educational food guide regarding exercise management. ``acT1ve'' contained an exercise advisor algorithm comprising 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. It also contains other features including an activity log, which displays a complete record of the end users' activities and associated exercise advice provided by the app's algorithm for later reference, and regular reminder notifications for end users to check or monitor their glucose levels. Conclusions: The co-design approach and the practical application of the user-centered design thinking framework were successfully applied in developing ``acT1ve.'' The design thinking processes allowed youth with T1D to identify app features that would support them to be physically active, and particularly enabled the delivery of individualized advice. Furthermore, app development has been described in detail to help guide others embarking on a similar project. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001414101; https://tinyurl.com/mu9jvn2d ", doi="10.2196/51491", url="https://diabetes.jmir.org/2024/1/e51491", url="http://www.ncbi.nlm.nih.gov/pubmed/39078700" } @Article{info:doi/10.2196/57114, author="Sezgin, Emre and Kocaballi, Baki A. and Dolce, Millie and Skeens, Micah and Militello, Lisa and Huang, Yungui and Stevens, Jack and Kemper, R. Alex", title="Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study", journal="JMIR Hum Factors", year="2024", month="Jul", day="19", volume="11", pages="e57114", keywords="social determinants of health", keywords="social needs", keywords="chatbot", keywords="conversational agent", keywords="primary care", keywords="digital health", keywords="iterative design", keywords="implementation", keywords="evaluation", keywords="usability", keywords="feasibility", abstract="Background: Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. Objective: This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. Methods: This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot's design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. Results: Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot's capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. Conclusions: Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs. ", doi="10.2196/57114", url="https://humanfactors.jmir.org/2024/1/e57114" } @Article{info:doi/10.2196/53497, author="Lin, Yulan and Xu, Xiaonan and Liu, Yiyang and Alias, Haridah and Hu, Zhijian and Wong, Ping Li", title="Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey", journal="J Med Internet Res", year="2024", month="Jul", day="16", volume="26", pages="e53497", keywords="telemedicine", keywords="acceptance", keywords="China", keywords="general public", keywords="COVID-19", keywords="pandemic", keywords="health care", keywords="public health", keywords="health care delivery", keywords="health care services", keywords="survey", keywords="cross-sectional survey", keywords="consultation", keywords="teleconsultation", keywords="health care system", abstract="Background: The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services. Objective: This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine. Methods: An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated. Results: In total, 1006 participants completed the survey. A total of 44.3\% (n=446) reported being very likely and 49.3\% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness ($\beta$=0.322; P<.001) and perceived ease of use ($\beta$=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8\%), skin (n=316, 31.4\%), and musculoskeletal issues (n=316, 31.4\%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4\%) and cancer (n=64, 6.4\%). The majority preferred video chat (n=443, 44\%) and text chat (n=317, 31.5\%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2\%) and email (n=53, 5.3\%). Conclusions: Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation. ", doi="10.2196/53497", url="https://www.jmir.org/2024/1/e53497", url="http://www.ncbi.nlm.nih.gov/pubmed/39012687" } @Article{info:doi/10.2196/52496, author="Hasson, E. Rebecca and Xie, Michelle and Tadikamalla, Dhiraj and Beemer, R. Lexie", title="Using a Human-Centered Design Process to Evaluate and Optimize User Experience of a Website (InPACT at Home) to Promote Youth Physical Activity: Case Study", journal="JMIR Hum Factors", year="2024", month="Jul", day="15", volume="11", pages="e52496", keywords="web-based interventions", keywords="children", keywords="adolescents", keywords="child", keywords="adolescent", keywords="youth", keywords="user experience", keywords="website", keywords="websites", keywords="implementation science", keywords="human-centered design", keywords="human-centred design", keywords="HCD", keywords="web based", keywords="home based", keywords="interview", keywords="heuristics", keywords="interviews", keywords="heuristic", keywords="competitive analysis", keywords="video", keywords="videos", keywords="YouTube", keywords="physical activity", keywords="exercise", keywords="fitness", abstract="Background: Web-based physical activity interventions often fail to reach the anticipated public health impact due to insufficient use by the intended audiences. Objective: The purpose of this study was to use a human-centered design process to optimize the user experience of the Interrupting Prolonged sitting with ACTivity (InPACT) at Home website to promote youth physical activity participation. Methods: Qualitative interviews were conducted to assess engagement and pain points with the InPACT at Home website. Interview data were used to create affinity maps to identify themes of user responses, conduct a heuristic evaluation according to Nielsen's usability heuristics framework, and complete a competitive analysis to identify the strengths and weaknesses of competitors who offered similar products. Results: Key themes from end user interviews included liking the website design, finding the website difficult to navigate, and wanting additional features (eg, library of watched videos). The website usability issues identified were lack of labeling and categorization of exercise videos, hidden necessary actions and options hindering users from decision-making, error-prone conditions, and high cognitive load of the website. Competitive analysis results revealed that YouTube received the highest usability ratings followed by the Just Dance and Presidential Youth Fitness Program websites. Conclusions: Human-centered design approaches are useful for bringing end users and developers together to optimize user experience and impact public health. Future research is needed to examine the effectiveness of the InPACT at Home website redesign to attract new users and retain current users, with the end goal of increasing youth physical activity engagement. ", doi="10.2196/52496", url="https://humanfactors.jmir.org/2024/1/e52496" } @Article{info:doi/10.2196/49703, author="Baik, H. Sharon and Clark, Karen and Sanchez, Marisol and Loscalzo, Matthew and Celis, Ashley and Razavi, Marianne and Yang, Dershung and Dale, William and Haas, Niina", title="Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial", journal="JMIR Cancer", year="2024", month="Jul", day="10", volume="10", pages="e49703", keywords="cancer", keywords="distress screening", keywords="eHealth", keywords="supportive care", keywords="mobile phone", abstract="Background: Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient's needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. Objective: This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. Methods: For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. Results: Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, ``help request'' function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference ?2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). Conclusions: Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406 ", doi="10.2196/49703", url="https://cancer.jmir.org/2024/1/e49703" } @Article{info:doi/10.2196/51282, author="Jo, Eunbeen and Song, Sanghoun and Kim, Jong-Ho and Lim, Subin and Kim, Hyeon Ju and Cha, Jung-Joon and Kim, Young-Min and Joo, Joon Hyung", title="Assessing GPT-4's Performance in Delivering Medical Advice: Comparative Analysis With Human Experts", journal="JMIR Med Educ", year="2024", month="Jul", day="8", volume="10", pages="e51282", keywords="GPT-4", keywords="medical advice", keywords="ChatGPT", keywords="cardiology", keywords="cardiologist", keywords="heart", keywords="advice", keywords="recommendation", keywords="recommendations", keywords="linguistic", keywords="linguistics", keywords="artificial intelligence", keywords="NLP", keywords="natural language processing", keywords="chatbot", keywords="chatbots", keywords="conversational agent", keywords="conversational agents", keywords="response", keywords="responses", abstract="Background: Accurate medical advice is paramount in ensuring optimal patient care, and misinformation can lead to misguided decisions with potentially detrimental health outcomes. The emergence of large language models (LLMs) such as OpenAI's GPT-4 has spurred interest in their potential health care applications, particularly in automated medical consultation. Yet, rigorous investigations comparing their performance to human experts remain sparse. Objective: This study aims to compare the medical accuracy of GPT-4 with human experts in providing medical advice using real-world user-generated queries, with a specific focus on cardiology. It also sought to analyze the performance of GPT-4 and human experts in specific question categories, including drug or medication information and preliminary diagnoses. Methods: We collected 251 pairs of cardiology-specific questions from general users and answers from human experts via an internet portal. GPT-4 was tasked with generating responses to the same questions. Three independent cardiologists (SL, JHK, and JJC) evaluated the answers provided by both human experts and GPT-4. Using a computer interface, each evaluator compared the pairs and determined which answer was superior, and they quantitatively measured the clarity and complexity of the questions as well as the accuracy and appropriateness of the responses, applying a 3-tiered grading scale (low, medium, and high). Furthermore, a linguistic analysis was conducted to compare the length and vocabulary diversity of the responses using word count and type-token ratio. Results: GPT-4 and human experts displayed comparable efficacy in medical accuracy (``GPT-4 is better'' at 132/251, 52.6\% vs ``Human expert is better'' at 119/251, 47.4\%). In accuracy level categorization, humans had more high-accuracy responses than GPT-4 (50/237, 21.1\% vs 30/238, 12.6\%) but also a greater proportion of low-accuracy responses (11/237, 4.6\% vs 1/238, 0.4\%; P=.001). GPT-4 responses were generally longer and used a less diverse vocabulary than those of human experts, potentially enhancing their comprehensibility for general users (sentence count: mean 10.9, SD 4.2 vs mean 5.9, SD 3.7; P<.001; type-token ratio: mean 0.69, SD 0.07 vs mean 0.79, SD 0.09; P<.001). Nevertheless, human experts outperformed GPT-4 in specific question categories, notably those related to drug or medication information and preliminary diagnoses. These findings highlight the limitations of GPT-4 in providing advice based on clinical experience. Conclusions: GPT-4 has shown promising potential in automated medical consultation, with comparable medical accuracy to human experts. However, challenges remain particularly in the realm of nuanced clinical judgment. Future improvements in LLMs may require the integration of specific clinical reasoning pathways and regulatory oversight for safe use. Further research is needed to understand the full potential of LLMs across various medical specialties and conditions. ", doi="10.2196/51282", url="https://mededu.jmir.org/2024/1/e51282" } @Article{info:doi/10.2196/47565, author="Ansaldo, In{\'e}s Ana and Masson-Trottier, Mich{\`e}le and Delacourt, Barbara and Dubuc, Jade and Dub{\'e}, Catherine", title="Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study", journal="JMIR Aging", year="2024", month="Jul", day="4", volume="7", pages="e47565", keywords="dementia", keywords="communication", keywords="caregivers", keywords="technology", keywords="burden", keywords="mixed methods design", keywords="quality of life", keywords="mobile phone", keywords="tablet", abstract="Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53\%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65\%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. ", doi="10.2196/47565", url="https://aging.jmir.org/2024/1/e47565", url="http://www.ncbi.nlm.nih.gov/pubmed/38963691" } @Article{info:doi/10.2196/55342, author="Chun, Minki and Yu, Ha-Jin and Jung, Hyunggu", title="A Deep Learning--Based Rotten Food Recognition App for Older Adults: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Jul", day="3", volume="8", pages="e55342", keywords="digital health", keywords="mobile health", keywords="mHealth", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="smartphone", keywords="smartphones", keywords="classification", keywords="digital sensor", keywords="deep learning", keywords="artificial intelligence", keywords="machine learning", keywords="food", keywords="foods", keywords="fruit", keywords="fruits", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="opinions", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="acceptance", keywords="adoption", keywords="usability", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="aged", keywords="camera", keywords="image", keywords="imaging", keywords="photo", keywords="photos", keywords="photograph", keywords="photographs", keywords="recognition", keywords="picture", keywords="pictures", keywords="sensor", keywords="sensors", keywords="develop", keywords="development", keywords="design", abstract="Background: Older adults are at greater risk of eating rotten fruits and of getting food poisoning because cognitive function declines as they age, making it difficult to distinguish rotten fruits. To address this problem, researchers have developed and evaluated various tools to detect rotten food items in various ways. Nevertheless, little is known about how to create an app to detect rotten food items to support older adults at a risk of health problems from eating rotten food items. Objective: This study aimed to (1) create a smartphone app that enables older adults to take a picture of food items with a camera and classifies the fruit as rotten or not rotten for older adults and (2) evaluate the usability of the app and the perceptions of older adults about the app. Methods: We developed a smartphone app that supports older adults in determining whether the 3 fruits selected for this study (apple, banana, and orange) were fresh enough to eat. We used several residual deep networks to check whether the fruit photos collected were of fresh fruit. We recruited healthy older adults aged over 65 years (n=15, 57.7\%, males and n=11, 42.3\%, females) as participants. We evaluated the usability of the app and the participants' perceptions about the app through surveys and interviews. We analyzed the survey responses, including an after-scenario questionnaire, as evaluation indicators of the usability of the app and collected qualitative data from the interviewees for in-depth analysis of the survey responses. Results: The participants were satisfied with using an app to determine whether a fruit is fresh by taking a picture of the fruit but are reluctant to use the paid version of the app. The survey results revealed that the participants tended to use the app efficiently to take pictures of fruits and determine their freshness. The qualitative data analysis on app usability and participants' perceptions about the app revealed that they found the app simple and easy to use, they had no difficulty taking pictures, and they found the app interface visually satisfactory. Conclusions: This study suggests the possibility of developing an app that supports older adults in identifying rotten food items effectively and efficiently. Future work to make the app distinguish the freshness of various food items other than the 3 fruits selected still remains. ", doi="10.2196/55342", url="https://formative.jmir.org/2024/1/e55342" } @Article{info:doi/10.2196/51987, author="Chien, Shao-Yun and Zaslavsky, Oleg and Berridge, Clara", title="Technology Usability for People Living With Dementia: Concept Analysis", journal="JMIR Aging", year="2024", month="Jul", day="3", volume="7", pages="e51987", keywords="usability", keywords="dementia", keywords="older adults", keywords="technology", keywords="concept analysis", keywords="mobile phone", abstract="Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology's role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords ``technology usability'' and ``dementia.'' We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. ", doi="10.2196/51987", url="https://aging.jmir.org/2024/1/e51987" } @Article{info:doi/10.2196/58549, author="Soehnchen, Clarissa and Burmann, Anja and Henningsen, Maike and Meister, Sven", title="A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model", journal="JMIR Form Res", year="2024", month="Jul", day="3", volume="8", pages="e58549", keywords="sexual health education", keywords="Intercultural Research Model", keywords="semistructured interview", keywords="SUS analysis", keywords="user-centered design", abstract="Background: Developing a digital educational application focused on sexual health education necessitates a framework that integrates cultural considerations effectively. Drawing from previous research, we identified the problem and essential requirements to incorporate cultural insights into the development of a solution. Objective: This study aims to explore the Solution Room of the self-established Intercultural Research Model, with a focus on creating a reusable framework for developing and implementing a widely accessible digital educational tool for sexual health. The study centers on advancing from a low-fidelity prototype (She!Masomo) to a high-fidelity prototype (We!Masomo), while evaluating its system usability through differentiation. This research contributes to the pursuit of Sustainable Development Goals 3, 4, and 5. Methods: The research methodology is anchored in the Solution Room of the self-expanded Intercultural Research Model, which integrates cultural considerations. It uses a multimethod, user-centered design thinking approach, focusing on extensive human involvement for the open web-based application. This includes gathering self-assessed textual user feedback, conducting a System Usability Scale (SUS) analysis, and conducting 4 face-to-face semistructured expert interviews, following COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Results: Based on the identified limitations of the low-fidelity prototype, She!Masomo (SUS score 67), which were highlighted through textual user feedback (63/77) and prototype feature comparisons, iterative development and improvement were implemented. This process led to the creation of an enhanced high-fidelity prototype (We!Masomo). The improved effectiveness of the enhanced prototype was evaluated using the qualitative SUS analysis (82/90), resulting in a favorable score of 77.3, compared with the previous SUS score of 67 for the low-fidelity prototype. Highlighting the importance of accessible digital educational tools, this study conducted 4 expert interviews (4/4) and reported e-survey results following the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guideline. The digital educational platform, We!Masomo, is specifically designed to promote universal and inclusive free access to information. Therefore, the developed high-fidelity prototype was implemented in Kenya. Conclusions: The primary outcome of this research provides a comprehensive exploration of utilizing a case study methodology to advance the development of digital educational web tools, particularly focusing on cultural sensitivity and sensitive educational subjects. It offers critical insights for effectively introducing such tools in regions with limited resources. Nonetheless, it is crucial to emphasize that the findings underscore the importance of integrating culture-specific components during the design phase. This highlights the necessity of conducting a thorough requirement engineering analysis and developing a low-fidelity prototype, followed by an SUS analysis. These measures are particularly critical when disseminating sensitive information, such as sexual health, through digital platforms. International Registered Report Identifier (IRRID): RR2-10.1186/s12905-023-02839-6 ", doi="10.2196/58549", url="https://formative.jmir.org/2024/1/e58549" } @Article{info:doi/10.2196/54159, author="Wodu, Obinuchi Chioma and Sweeney, Gillian and Slachetka, Milena and Kerr, Andrew", title="Stroke Survivors' Interaction With Hand Rehabilitation Devices: Observational Study", journal="JMIR Biomed Eng", year="2024", month="Jun", day="26", volume="9", pages="e54159", keywords="stroke", keywords="rehabilitation", keywords="hand rehabilitation devices", keywords="accessibility", keywords="stroke survivors", keywords="rehabilitation technologies", abstract="Background: The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55\% to 75\% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. Objective: In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Methods: Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. Results: A total of 29 participants were included in this study, of whom 10 (34\%) had poor hand function, 17 (59\%) had moderate hand function, and 2 (7\%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20\%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80\%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Conclusions: Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function. ", doi="10.2196/54159", url="https://biomedeng.jmir.org/2024/1/e54159", url="http://www.ncbi.nlm.nih.gov/pubmed/38922668" } @Article{info:doi/10.2196/54029, author="Cho, Aram and Cha, Chiyoung and Baek, Gumhee", title="Development of an Artificial Intelligence--Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial", journal="J Med Internet Res", year="2024", month="Jun", day="21", volume="26", pages="e54029", keywords="artificial intelligence", keywords="burnout", keywords="mobile app", keywords="nurses", keywords="nurse", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="usability", keywords="satisfaction", keywords="effectiveness", keywords="tailored", keywords="mind-body", keywords="meditation", keywords="mindfulness", keywords="ACT", keywords="algorithm", keywords="algorithms", keywords="occupational health", keywords="digital health", keywords="recommender", keywords="optimization", keywords="acceptance and commitment therapy", keywords="job", keywords="worker", keywords="workers", keywords="stress", keywords="employee", keywords="employees", abstract="Background: Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics. Objective: The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction. Methods: In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization. Results: Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=--0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02). Conclusions: This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system. ", doi="10.2196/54029", url="https://www.jmir.org/2024/1/e54029" } @Article{info:doi/10.2196/49309, author="Miller, Morven and McCann, Lisa and Lewis, Liane and Miaskowski, Christine and Ream, Emma and Darley, Andrew and Harris, Jenny and Kotronoulas, Grigorios and V Berg, Geir and Lubowitzki, Simone and Armes, Jo and Patiraki, Elizabeth and Furlong, Eileen and Fox, Patricia and Gaiger, Alexander and Cardone, Antonella and Orr, Dawn and Flowerday, Adrian and Katsaragakis, Stylianos and Skene, Simon and Moore, Margaret and McCrone, Paul and De Souza, Nicosha and Donnan, T. Peter and Maguire, Roma", title="Patients' and Clinicians' Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews", journal="J Med Internet Res", year="2024", month="Jun", day="20", volume="26", pages="e49309", keywords="chemotherapy", keywords="digital health", keywords="education", keywords="predictive risk models", keywords="qualitative research methods", keywords="symptoms", keywords="symptom cluster", keywords="tailored information", abstract="Background: Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported. Objective: We aim to explore patients' and clinicians' perspectives of the utility and real-world application of PRMs to improve the management of CRS. Methods: Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically. Results: Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. Conclusions: Findings from this study provide information on clinicians' and patients' perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 ", doi="10.2196/49309", url="https://www.jmir.org/2024/1/e49309" } @Article{info:doi/10.2196/50795, author="Kunchay, Sahiti and Linden-Carmichael, N. Ashley and Abdullah, Saeed", title="Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="20", volume="11", pages="e50795", keywords="smartwatches", keywords="substance use", keywords="ecological momentary assessment", keywords="mobile health", keywords="mHealth", keywords="human-centered design", keywords="feasibility studies", keywords="mobile phone", abstract="Background: Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused. Objective: This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life. Methods: This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53\%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47\%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period. Results: Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users' experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts. Conclusions: This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden. ", doi="10.2196/50795", url="https://humanfactors.jmir.org/2024/1/e50795" } @Article{info:doi/10.2196/55571, author="Mosch, Lina and S{\"u}mer, Meltem and Flint, Rike Anne and Feufel, Markus and Balzer, Felix and M{\"o}rike, Frauke and Poncette, Akira-Sebastian", title="Alarm Management in Intensive Care: Qualitative Triangulation Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="18", volume="11", pages="e55571", keywords="digital health", keywords="transdisciplinary research", keywords="technological innovation", keywords="patient-centered care", keywords="qualitative", keywords="ethnographic", keywords="ethnography", keywords="intensive care unit", keywords="ICU", keywords="intensive care", keywords="German", keywords="Germany", keywords="Europe", keywords="European", keywords="interview", keywords="interviews", keywords="alarm", keywords="alarms", keywords="intelligent", keywords="artificial intelligence", keywords="grounded theory", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="opinions", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", abstract="Background: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential. Objective: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions. Methods: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach. Results: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease. Conclusions: Staff members' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core. ", doi="10.2196/55571", url="https://humanfactors.jmir.org/2024/1/e55571", url="http://www.ncbi.nlm.nih.gov/pubmed/38888941" } @Article{info:doi/10.2196/55751, author="Porta, X{\`e}nia and Nieto, Rub{\'e}n and Serrat, Mayte and Bourdin Kreitz, Pierre", title="Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Jun", day="18", volume="8", pages="e55751", keywords="fibromyalgia", keywords="chronic pain", keywords="pain management", keywords="information and communication technologies", keywords="use", keywords="satisfaction", abstract="Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75\%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. ", doi="10.2196/55751", url="https://formative.jmir.org/2024/1/e55751" } @Article{info:doi/10.2196/50452, author="Siste, Kristiana and Ophinni, Youdiil and Hanafi, Enjeline and Yamada, Chika and Novalino, Reza and Limawan, P. Albert and Beatrice, Evania and Rafelia, Vania and Alison, Peter and Matsumoto, Toshihiko and Sakamoto, Ryota", title="Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study", journal="JMIR Form Res", year="2024", month="Jun", day="18", volume="8", pages="e50452", keywords="substance use disorder", keywords="cognitive behavioral therapy", keywords="telemedicine", keywords="peer involvement", keywords="Indonesia", keywords="substance use disorders", keywords="digital intervention", keywords="COVID-19", keywords="psychotherapy", keywords="drug", keywords="mobile phone", abstract="Background: Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. Objective: This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Methods: Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. Results: In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88\%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75\%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Conclusions: Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia. ", doi="10.2196/50452", url="https://formative.jmir.org/2024/1/e50452" } @Article{info:doi/10.2196/49581, author="Wekenborg, Katharina Magdalena and F{\"o}rster, Katharina and Schweden, Florian and Weidemann, Robin and Bechtolsheim, von Felix and Kirschbaum, Clemens and Weitz, J{\"u}rgen and Ditzen, Beate", title="Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Jun", day="17", volume="26", pages="e49581", keywords="physicians", keywords="digital transformation", keywords="chronic stress", keywords="hair cortisol concentration", keywords="work stressors", keywords="work resources", abstract="Background: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. Objective: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. Methods: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56\% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55\% women) submitted self-collected hair samples for cortisol analysis. Results: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73\%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. Conclusions: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics. ", doi="10.2196/49581", url="https://www.jmir.org/2024/1/e49581", url="http://www.ncbi.nlm.nih.gov/pubmed/38885014" } @Article{info:doi/10.2196/50086, author="Espinoza Chamorro, Roberto and Santos, O. Luciano H. and Mori, Yukiko and Liu, Chang and Yamamoto, Goshiro and Kuroda, Tomohiro", title="Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="14", volume="11", pages="e50086", keywords="blood donation", keywords="deferral experience", keywords="Theory of Planned Behavior", keywords="Self-Determination Theory", keywords="gamification", keywords="ICT design", keywords="motivation", keywords="patient education", keywords="prototype", keywords="feasibility", abstract="Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. ", doi="10.2196/50086", url="https://humanfactors.jmir.org/2024/1/e50086", url="http://www.ncbi.nlm.nih.gov/pubmed/38875005" } @Article{info:doi/10.2196/59315, author="Lancioni, E. Giulio and Singh, N. Nirbhay and O'Reilly, F. Mark and Sigafoos, Jeff and Alberti, Gloria and Orlando, Isabella and Chiariello, Valeria and Desideri, Lorenzo", title="Enabling People With Intellectual and Sensory Disabilities to Trigger a Tablet's Delivery of Task Instructions by Walking to the Tablet: Proof-of-Concept Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Jun", day="12", volume="11", pages="e59315", keywords="technology", keywords="tablet", keywords="task", keywords="instructions", keywords="intellectual disability, visual impairment, hearing impairment", abstract="Background: People with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people's request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. Objective: This study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). Methods: The system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the ``where'' and ``how'' the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. Results: All participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. Conclusions: The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks. ", doi="10.2196/59315", url="https://rehab.jmir.org/2024/1/e59315", url="http://www.ncbi.nlm.nih.gov/pubmed/38865701" } @Article{info:doi/10.2196/54071, author="Landis-Lewis, Zach and Andrews, A. Chris and Gross, A. Colin and Friedman, P. Charles and Shah, J. Nirav", title="Exploring Anesthesia Provider Preferences for Precision Feedback: Preference Elicitation Study", journal="JMIR Med Educ", year="2024", month="Jun", day="11", volume="10", pages="e54071", keywords="audit and feedback", keywords="dashboard", keywords="motivation", keywords="visualization", keywords="anesthesia care", keywords="anesthesia", keywords="feedback", keywords="engagement", keywords="effectiveness", keywords="precision feedback", keywords="experimental design", keywords="design", keywords="clinical practice", keywords="motivational", keywords="performance", keywords="performance data", abstract="Background: Health care professionals must learn continuously as a core part of their work. As the rate of knowledge production in biomedicine increases, better support for health care professionals' continuous learning is needed. In health systems, feedback is pervasive and is widely considered to be essential for learning that drives improvement. Clinical quality dashboards are one widely deployed approach to delivering feedback, but engagement with these systems is commonly low, reflecting a limited understanding of how to improve the effectiveness of feedback about health care. When coaches and facilitators deliver feedback for improving performance, they aim to be responsive to the recipient's motivations, information needs, and preferences. However, such functionality is largely missing from dashboards and feedback reports. Precision feedback is the delivery of high-value, motivating performance information that is prioritized based on its motivational potential for a specific recipient, including their needs and preferences. Anesthesia care offers a clinical domain with high-quality performance data and an abundance of evidence-based quality metrics. Objective: The objective of this study is to explore anesthesia provider preferences for precision feedback. Methods: We developed a test set of precision feedback messages with balanced characteristics across 4 performance scenarios. We created an experimental design to expose participants to contrasting message versions. We recruited anesthesia providers and elicited their preferences through analysis of the content of preferred messages. Participants additionally rated their perceived benefit of preferred messages to clinical practice on a 5-point Likert scale. Results: We elicited preferences and feedback message benefit ratings from 35 participants. Preferences were diverse across participants but largely consistent within participants. Participants' preferences were consistent for message temporality ($\alpha$=.85) and display format ($\alpha$=.80). Ratings of participants' perceived benefit to clinical practice of preferred messages were high (mean rating 4.27, SD 0.77). Conclusions: Health care professionals exhibited diverse yet internally consistent preferences for precision feedback across a set of performance scenarios, while also giving messages high ratings of perceived benefit. A ``one-size-fits-most approach'' to performance feedback delivery would not appear to satisfy these preferences. Precision feedback systems may hold potential to improve support for health care professionals' continuous learning by accommodating feedback preferences. ", doi="10.2196/54071", url="https://mededu.jmir.org/2024/1/e54071" } @Article{info:doi/10.2196/50107, author="Goerss, Doreen and K{\"o}hler, Stefanie and Rong, Eleonora and Temp, Gesine Anna and Kilimann, Ingo and Bieber, Gerald and Teipel, Stefan", title="Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach", journal="JMIR Aging", year="2024", month="Jun", day="7", volume="7", pages="e50107", keywords="assistive technology", keywords="user-centered design", keywords="usability", keywords="dementia", keywords="smartwatch", keywords="mobile phone", abstract="Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50\% (20/40) of the participants received regular prompts, and 50\% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants' reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76\%). Only a few participants (6/40, 15\%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80\%). In different qualitative analyses, participants' responses were, in most cases, plausible. Only 8\% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. ", doi="10.2196/50107", url="https://aging.jmir.org/2024/1/e50107", url="http://www.ncbi.nlm.nih.gov/pubmed/38848116" } @Article{info:doi/10.2196/52251, author="Narang, Gaurav and Chen, J. Yaozhu and Wedel, Nicole and Wu, Melody and Luo, Michelle and Atreja, Ashish", title="Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study", journal="JMIR Form Res", year="2024", month="Jun", day="6", volume="8", pages="e52251", keywords="cyclic vomiting syndrome", keywords="vomiting", keywords="vomit", keywords="emetic", keywords="emesis", keywords="gut", keywords="GI", keywords="gastrointestinal", keywords="internal medicine", keywords="prototype", keywords="prototypes", keywords="iterative", keywords="self-management", keywords="disease management", keywords="gut-brain interaction", keywords="gut-brain", keywords="artificial intelligence", keywords="digital patient assistant", keywords="assistant", keywords="assistants", keywords="design thinking", keywords="design", keywords="patient-centric", keywords="patient centred", keywords="patient centered", keywords="patient-centric approach", keywords="System Usability Scale", keywords="symptom tracking", keywords="digital health solution", keywords="user experience", keywords="usability", keywords="symptom", keywords="symptoms", keywords="tracking", keywords="monitoring", keywords="participatory", keywords="co-design digital health technology", keywords="patient assistance", keywords="patient experience", keywords="mobile phone", abstract="Background: Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. Objective: We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. Methods: The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. Results: The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. Conclusions: The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios. ", doi="10.2196/52251", url="https://formative.jmir.org/2024/1/e52251", url="http://www.ncbi.nlm.nih.gov/pubmed/38842924" } @Article{info:doi/10.2196/51666, author="Heitkemper, Elizabeth and Hulse, Scott and Bekemeier, Betty and Schultz, Melinda and Whitman, Greg and Turner, M. Anne", title="The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation", journal="JMIR Hum Factors", year="2024", month="Jun", day="5", volume="11", pages="e51666", keywords="data dashboard", keywords="rural health", keywords="health equity", keywords="usability", keywords="nursing informatics", keywords="dashboard", keywords="rural", keywords="informatics", keywords="satisfaction", keywords="think aloud", keywords="content analysis", keywords="user experience", keywords="public health", keywords="visualization", keywords="information systems", abstract="Background: Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. Objective: This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. Methods: Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. Results: Of the 9 participants, all were female and most worked at a local health department (7/9, 78\%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting---89\% (n=8) participants for task 1 and 67\% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be ``extremely useful'' for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. Conclusions: Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities. ", doi="10.2196/51666", url="https://humanfactors.jmir.org/2024/1/e51666", url="http://www.ncbi.nlm.nih.gov/pubmed/38837192" } @Article{info:doi/10.2196/50024, author="Burn, Anne-Marie and Hall, Poppy and Anderson, Joanna", title="A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program", journal="JMIR Form Res", year="2024", month="Jun", day="4", volume="8", pages="e50024", keywords="self-harm", keywords="schools", keywords="young people", keywords="youth", keywords="school staff", keywords="training", keywords="coproduction", keywords="qualitative", abstract="Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person's self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program's effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. ", doi="10.2196/50024", url="https://formative.jmir.org/2024/1/e50024", url="http://www.ncbi.nlm.nih.gov/pubmed/38833286" } @Article{info:doi/10.2196/48099, author="Bunt, Lance and Greeff, Japie and Taylor, Estelle", title="Enhancing Serious Game Design: Expert-Reviewed, Stakeholder-Centered Framework", journal="JMIR Serious Games", year="2024", month="May", day="31", volume="12", pages="e48099", keywords="serious games", keywords="stakeholder theory", keywords="enterprise architecture", keywords="serious game development", keywords="design framework", abstract="Background: Traditional serious game design methods often overlook stakeholder needs. This study integrates stakeholder theory and enterprise architecture (EA), along with the Architecture Development Method, to propose a novel framework for serious game design. Crafted to aid practitioners, researchers, and specialists in leveraging resources more effectively, the framework is validated through a design science research methodology. Expert reviews have further refined its features, making it a robust tool for enhancing serious game design and implementation. Objective: This paper introduces a framework for designing serious games, covering stakeholder analysis, requirements gathering, and design implementation planning. It highlights the importance of expert review in validating and refining the framework, ensuring its effectiveness and reliability for use in serious game design. Through critical assessment by experts, the framework is optimized for practical application by practitioners, researchers, and specialists in the field, ensuring its utility in enhancing serious game development. The next step will be to validate the framework empirically by applying it to a serious game development project. Methods: We developed and validated a conceptual framework for serious game design by synthesizing stakeholder theory and EA through literature review, concept mapping, and theory development by way of a design science research approach. The framework is iteratively refined and validated via expert review, drawing on insights from professionals experienced in serious games, stakeholder theory, and EA. This method ensures the framework's practical relevance and effectiveness in addressing real-world design challenges. Results: An expert review by 29 serious game practitioners validated the framework's success in stakeholder management, confirming its stakeholder-centered effectiveness. Although the experts praised its structured approach, they suggested clearer guidance for game design elements. In addition, the experts, while acknowledging the framework's complexity, saw its depth as valuable for efficient management. The consensus calls for a refined balance between detailed functionality and user-friendly design, with the framework's impact on stakeholder capabilities revealing a spectrum of professional needs. Conclusions: This paper presents a framework for creating effective and organizationally aligned serious games. Evaluated across execution, practical, and EA levels, it is logical but varies in ease of understanding, with experts calling for more accessibility at the EA level. It enhances stakeholder efficiency and management but is criticized for rigidity and a need for flexibility. Recommendations include streamlining the framework, enhancing clarity, reducing administrative tasks, and incorporating clear guidelines on technology use, motivational elements, and operational tools. This aims to help stakeholders produce more targeted and adaptable game designs. The next iteration will be developed after application to a project and team feedback. ", doi="10.2196/48099", url="https://games.jmir.org/2024/1/e48099", url="http://www.ncbi.nlm.nih.gov/pubmed/38820585" } @Article{info:doi/10.2196/56653, author="Murabito, M. Joanne and Faro, M. Jamie and Zhang, Yuankai and DeMalia, Angelo and Hamel, Alexander and Agyapong, Nakesha and Liu, Hongshan and Schramm, Eric and McManus, D. David and Borrelli, Belinda", title="Smartphone App Designed to Collect Health Information in Older Adults: Usability Study", journal="JMIR Hum Factors", year="2024", month="May", day="30", volume="11", pages="e56653", keywords="mobile application surveys", keywords="mixed methods", keywords="electronic data collection", keywords="mHealth", keywords="mobile health", keywords="mobile application", keywords="mobile applications", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="smartphone", keywords="smartphones", keywords="usability", keywords="usable", keywords="usableness", keywords="usefulness", keywords="utility", keywords="health information", abstract="Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40\% women; 15/15, 100\% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47\% women; 3/15, 20\% Hispanic; and 8/15, 53\% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. ", doi="10.2196/56653", url="https://humanfactors.jmir.org/2024/1/e56653", url="http://www.ncbi.nlm.nih.gov/pubmed/38815261" } @Article{info:doi/10.2196/56668, author="Morita, Kentaro and Miura, Kenichiro and Toyomaki, Atsuhito and Makinodan, Manabu and Ohi, Kazutaka and Hashimoto, Naoki and Yasuda, Yuka and Mitsudo, Takako and Higuchi, Fumihiro and Numata, Shusuke and Yamada, Akiko and Aoki, Yohei and Honda, Hiromitsu and Mizui, Ryo and Honda, Masato and Fujikane, Daisuke and Matsumoto, Junya and Hasegawa, Naomi and Ito, Satsuki and Akiyama, Hisashi and Onitsuka, Toshiaki and Satomura, Yoshihiro and Kasai, Kiyoto and Hashimoto, Ryota", title="Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study", journal="JMIR Ment Health", year="2024", month="May", day="30", volume="11", pages="e56668", keywords="schizophrenia", keywords="cognitive function", keywords="eye movement", keywords="diagnostic biomarkers", keywords="digital health tools", abstract="Background: Schizophrenia is a complex mental disorder characterized by significant cognitive and neurobiological alterations. Impairments in cognitive function and eye movement have been known to be promising biomarkers for schizophrenia. However, cognitive assessment methods require specialized expertise. To date, data on simplified measurement tools for assessing both cognitive function and eye movement in patients with schizophrenia are lacking. Objective: This study aims to assess the efficacy of a novel tablet-based platform combining cognitive and eye movement measures for classifying schizophrenia. Methods: Forty-four patients with schizophrenia, 67 healthy controls, and 41 patients with other psychiatric diagnoses participated in this study from 10 sites across Japan. A free-viewing eye movement task and 2 cognitive assessment tools (Codebreaker task from the THINC-integrated tool and the CognitiveFunctionTest app) were used for conducting assessments in a 12.9-inch iPad Pro. We performed comparative group and logistic regression analyses for evaluating the diagnostic efficacy of the 3 measures of interest. Results: Cognitive and eye movement measures differed significantly between patients with schizophrenia and healthy controls (all 3 measures; P<.001). The Codebreaker task showed the highest classification effectiveness in distinguishing schizophrenia with an area under the receiver operating characteristic curve of 0.90. Combining cognitive and eye movement measures further improved accuracy with a maximum area under the receiver operating characteristic curve of 0.94. Cognitive measures were more effective in differentiating patients with schizophrenia from healthy controls, whereas eye movement measures better differentiated schizophrenia from other psychiatric conditions. Conclusions: This multisite study demonstrates the feasibility and effectiveness of a tablet-based app for assessing cognitive functioning and eye movements in patients with schizophrenia. Our results suggest the potential of tablet-based assessments of cognitive function and eye movement as simple and accessible evaluation tools, which may be useful for future clinical implementation. ", doi="10.2196/56668", url="https://mental.jmir.org/2024/1/e56668", url="http://www.ncbi.nlm.nih.gov/pubmed/38815257" } @Article{info:doi/10.2196/53098, author="Greeley, Brian and Chung, Seohyeon Sally and Graves, Lorraine and Song, Xiaowei", title="Combating Barriers to the Development of a Patient-Oriented Frailty Website", journal="JMIR Aging", year="2024", month="May", day="28", volume="7", pages="e53098", keywords="frailty", keywords="frailty website", keywords="patient-oriented assessment", keywords="community-dwelling older adults", keywords="internet security", keywords="privacy", keywords="barrier", keywords="barriers", keywords="development", keywords="implementation", keywords="patient-oriented", keywords="internet", keywords="virtual health resource", keywords="community dwelling", keywords="older adult", keywords="older adults", keywords="health care professional", keywords="caregiver", keywords="caregivers", keywords="technology", keywords="real-time", keywords="monitoring", keywords="aging", keywords="ageing", doi="10.2196/53098", url="https://aging.jmir.org/2024/1/e53098" } @Article{info:doi/10.2196/54699, author="Rony, Jahangir Rahat and Amir, Shajnush and Ahmed, Nova and Atiba, Samuelson and Verdezoto, Nervo and Sparkes, Valerie and Stawarz, Katarzyna", title="Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="May", day="28", volume="11", pages="e54699", keywords="rehabilitation", keywords="wearables", keywords="upper-limb rehabilitation", keywords="user-centered design", keywords="qualitative", keywords="interviews", keywords="experiences", keywords="attitudes", keywords="perceptions", keywords="digital health", keywords="health technology", keywords="wearable", keywords="user centered design", keywords="design", keywords="home", keywords="stroke", keywords="recovery", keywords="affordable", keywords="low income", keywords="low resource", keywords="Bangladesh", keywords="physiotherapy", abstract="Background: People who survive a stroke in many cases require upper-limb rehabilitation (ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible. For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors and patients' everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directed home-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global South countries due to potential costs and limited access to technology. Objective: Our goal was to better understand physiotherapists', patients', and caregivers' experiences of rehabilitation in Bangladesh, existing rehabilitation practices, and how they differ from the rehabilitation approach in the United Kingdom. Understanding these differences and experiences would help to identify opportunities and requirements for developing affordable wearable devices that could support ULR in home settings. Methods: We conducted an exploratory study with 14 participants representing key stakeholder groups. We interviewed physiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, and technology use in this context. We also interviewed UK physiotherapists to explore the similarities and differences between the 2 countries and identify specific contextual and design requirements for low-cost wearables for ULR. Overall, we remotely interviewed 8 physiotherapists (4 in the United Kingdom, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conducted via videoconference, except for 2 interviews, and audio was recorded with consent. A total of 10 hours of discussions were transcribed. The results were analyzed using thematic analysis. Results: We identified several sociocultural factors that affect ULR and should be taken into account when developing technologies for the home: the important role of family, who may influence the treatment based on social and cultural perceptions; the impact of gender norms and their influence on attitudes toward rehabilitation and physiotherapists; and differences in approach to rehabilitation between the United Kingdom and Bangladesh, with Bangladeshi physiotherapists focusing on individual movements that are necessary to build strength in the affected parts and their British counterparts favoring a more holistic approach. We propose practical considerations and design recommendations for developing ULR devices for low-resource settings. Conclusions: Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressing sociotechnical challenges. When developing new health technologies, it is imperative to not only understand how well they could fit into patients', caregivers', and physiotherapists' everyday lives, but also how they may influence any potential tensions concerning culture, religion, and the characteristics of the local health care system. ", doi="10.2196/54699", url="https://rehab.jmir.org/2024/1/e54699" } @Article{info:doi/10.2196/41202, author="Collins-Pisano, Caroline and Leggett, N. Amanda and Gambee, David and Fortuna, L. Karen", title="Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study", journal="JMIR Hum Factors", year="2024", month="May", day="27", volume="11", pages="e41202", keywords="family caregivers", keywords="dementia", keywords="peer support", keywords="technology", keywords="mobile phone", abstract="Background: Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. Objective: The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. Methods: A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. Results: The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non--statistically significant improvements in burden, stress, and strain levels. Conclusions: This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms. ", doi="10.2196/41202", url="https://humanfactors.jmir.org/2024/1/e41202", url="http://www.ncbi.nlm.nih.gov/pubmed/38801660" } @Article{info:doi/10.2196/54145, author="Bridges, Bronwyn and Taylor, Jake and Weber, Thomas John", title="Evaluation of the Parkinson's Remote Interactive Monitoring System in a Clinical Setting: Usability Study", journal="JMIR Hum Factors", year="2024", month="May", day="24", volume="11", pages="e54145", keywords="Parkinson disease", keywords="usability", keywords="remote monitoring", keywords="motor examination", keywords="movement disorders", keywords="thematic analysis", keywords="System Usability Scale", keywords="mobile phone", abstract="Background: The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient's symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient's condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson's Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely. Objective: We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting. Methods: Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society--sponsored revision of the Unified Parkinson's Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics. Results: In total, 11 people with PD participated in the study (female individuals: n=5, 45\%; male individuals: n=6, 55\%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer's notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant's orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants' perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70. Conclusions: Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients' needs. ", doi="10.2196/54145", url="https://humanfactors.jmir.org/2024/1/e54145", url="http://www.ncbi.nlm.nih.gov/pubmed/38787603" } @Article{info:doi/10.2196/54939, author="Prochaska, Eveline and Ammenwerth, Elske", title="Clinical Utility and Usability of the Digital Box and Block Test: Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2024", month="May", day="23", volume="11", pages="e54939", keywords="assessment", keywords="clinical utility", keywords="digital Box and Block Test", keywords="dBBT", keywords="hand dexterity", keywords="dexterity", keywords="usability", abstract="Background: The Box and Block Test (BBT) is a clinical tool used to measure hand dexterity, which is often used for tracking disease progression or the effectiveness of therapy, particularly benefiting older adults and those with neurological conditions. Digitizing the measurement of hand function may enhance the quality of data collection. We have developed and validated a prototype that digitizes this test, known as the digital BBT (dBBT), which automatically measures time and determines and displays the test result. Objective: This study aimed to investigate the clinical utility and usability of the newly developed dBBT and to collect suggestions for future improvements. Methods: A total of 4 occupational therapists participated in our study. To evaluate the clinical utility, we compared the dBBT to the BBT across dimensions such as acceptance, portability, energy and effort, time, and costs. We observed therapists using the dBBT as a dexterity measurement tool and conducted a quantitative usability questionnaire using the System Usability Scale (SUS), along with a focus group. Evaluative, structured, and qualitative content analysis was used for the qualitative data, whereas quantitative analysis was applied to questionnaire data. The qualitative and quantitative data were merged and analyzed using a convergent mixed methods approach. Results: Overall, the results of the evaluative content analysis suggested that the dBBT had a better clinical utility than the original BBT, with ratings of all collected participant statements for the dBBT being 45\% (45/99) equal to, 48\% (48/99) better than, and 6\% (6/99) lesser than the BBT. Particularly in the subcategories ``acceptance,'' ``time required for evaluation,'' and ``purchase costs,'' the dBBT was rated as being better than the original BBT. The dBBT achieved a mean SUS score of 83 (95\% CI 76-96). Additionally, several suggested changes to the system were identified. Conclusions: The study demonstrated an overall positive evaluation of the clinical utility and usability of the dBBT. Valuable insights were gathered for future system iterations. These pioneering results highlight the potential of digitizing hand dexterity assessments. Trial Registration: Open Science Framework qv2d9; https://osf.io/qv2d9 ", doi="10.2196/54939", url="https://rehab.jmir.org/2024/1/e54939" } @Article{info:doi/10.2196/51789, author="Washington, T. Karla and Oliver, Parker Debra and Donehower, K. Allison and White, Patrick and Benson, J. Jacquelyn and Lyons, G. Patrick and Demiris, George", title="Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment", journal="JMIR Hum Factors", year="2024", month="May", day="23", volume="11", pages="e51789", keywords="caregivers", keywords="home care services", keywords="hospice care", keywords="signs and symptoms", keywords="technology", keywords="mobile phone", abstract="Background: Early users found Engagement and Visualization to Improve Symptoms in Oncology Care (ENVISION), a web-based application designed to improve home management of hospice patients' symptoms and support patients' and family caregivers' well-being, to be generally useful and easy to use. However, they also raised concerns about potential challenges users with limited technological proficiency might experience. Objective: We sought to concurrently accomplish two interrelated study aims: (1) to develop a conceptual framework of digital inclusivity for health information systems and (2) to apply the framework in evaluating the digital inclusivity of the ENVISION application. Methods: We engaged ENVISION users (N=34) in a qualitative study in which data were collected via direct observation, think-aloud techniques, and responses to open-ended queries. Data were analyzed via theory elaboration and basic qualitative description. Results: Accessibility, relevance, and impact were identified as 3 essential considerations in evaluating a health system's digital inclusivity. Study findings generally supported ENVISION's digital inclusivity, particularly concerning its perceived relevance to the work of family caregivers and hospice clinicians and its potentially positive impact on symptom management and quality of life. Limitations to ENVISION's digital inclusivity centered around issues of accessibility, particularly operability among individuals with limited technological knowledge and skills. Conclusions: The Accessibility, Relevance, and Impact conceptual framework of digital inclusivity for health information systems can help identify opportunities to strengthen the digital inclusivity of tools, such as ENVISION, intended for use by a broad and diverse range of users. ", doi="10.2196/51789", url="https://humanfactors.jmir.org/2024/1/e51789", url="http://www.ncbi.nlm.nih.gov/pubmed/38781581" } @Article{info:doi/10.2196/54101, author="Teh, Pei-Lee and Kwok, J. Andrei O. and Cheong, Loong Wing and Lee, Shaun", title="Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study", journal="JMIR Form Res", year="2024", month="May", day="21", volume="8", pages="e54101", keywords="digital health", keywords="older adults", keywords="digital divide", keywords="aging", keywords="pilot", keywords="Malaysia", keywords="coach", keywords="digital access", keywords="social barrier", keywords="virtual", keywords="virtual coach", keywords="digital tool", keywords="tool", keywords="engagement", keywords="gamification", keywords="user experience", keywords="app", keywords="technology tool", keywords="digital literacy", keywords="user experience design", keywords="decision support", keywords="support", abstract="Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual's health condition, and improvement in the user-experience design to accommodate older users' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. ", doi="10.2196/54101", url="https://formative.jmir.org/2024/1/e54101", url="http://www.ncbi.nlm.nih.gov/pubmed/38772022" } @Article{info:doi/10.2196/53204, author="Amiot, Odile and Sauvaget, Anne and Alamome, Isabelle and Bulteau, Samuel and Charpeaud, Thomas and Clair, Anne-H{\'e}l{\`e}ne and Courtet, Philippe and Drapier, Dominique and Haffen, Emmanuel and Fakra, Eric and Gaudeau-Bosma, Christian and Gaillard, Adeline and Mouchabac, St{\'e}phane and Pineau, Fanny and Narboni, V{\'e}ronique and Duburcq, Anne and Lecardeur, Laurent", title="Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study", journal="JMIR Form Res", year="2024", month="May", day="20", volume="8", pages="e53204", keywords="prospective acceptability", keywords="digital health", keywords="depression", keywords="e-mental health", keywords="deprexis", keywords="psychotherapy", abstract="Background: Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. Objective: This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. Methods: Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. Results: A total of 245 patients were eligible (n=159, 64.9\% were women and n=138, 56.3\% were single). The mean age was 40.7 (SD 14.1) years. A total of 78\% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9\% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3\% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. Conclusions: DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression. ", doi="10.2196/53204", url="https://formative.jmir.org/2024/1/e53204", url="http://www.ncbi.nlm.nih.gov/pubmed/38568139" } @Article{info:doi/10.2196/53206, author="Bozorgmehr, Arezoo and Thiem, Simon-Konstantin and Wild, Dorothea and Reinsdorff, Melanie and Vollmar, Christian Horst and Kappernagel, Annika and Schloessler, Kathrin and Weissbach, Sabine and Pentzek, Michael and Dehnen, Dorothea and Drexler, Julia and Mueller, Sigrid Beate and Pilic, Larisa and Lehmann, Lion and Loescher, Susanne and Hohmann, Darinka Elena and Frank, Friederike and Ates, G{\"u}lay and Kersten, Susanne and Mortsiefer, Achim and Aretz, Benjamin and Weltermann, Birgitta", title="Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study", journal="JMIR Form Res", year="2024", month="May", day="20", volume="8", pages="e53206", keywords="primary care", keywords="general practice research network", keywords="physicians", keywords="feasibility study", keywords="IT infrastructure", keywords="usability", keywords="FallAkte", keywords="FallAkte Plus system", keywords="mixed methods usability study", keywords="North Rhine-Westphalian general practice research network", keywords="NRW-GPRN", keywords="Germany", keywords="German", keywords="universities", keywords="survey", keywords="questionnaire", keywords="participants", abstract="Background: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. Objective: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany's largest state. Methods: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. Results: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system's emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. Conclusions: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI. ", doi="10.2196/53206", url="https://formative.jmir.org/2024/1/e53206", url="http://www.ncbi.nlm.nih.gov/pubmed/38767942" } @Article{info:doi/10.2196/46151, author="Lemos, Marta and Henriques, Rita Ana and Lopes, Gil David and Mendon{\c{c}}a, Nuno and Victorino, Andr{\'e} and Costa, Andreia and Arriaga, Miguel and Greg{\'o}rio, Jo{\~a}o Maria and de Sousa, Rute and Canh{\~a}o, Helena and Rodrigues, M. Ana", title="Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study", journal="JMIR Form Res", year="2024", month="May", day="17", volume="8", pages="e46151", keywords="DigiAdherence", keywords="mHealth", keywords="mobile app", keywords="technology", keywords="utility", keywords="usability", keywords="ICT", keywords="application", keywords="patient-centered", keywords="tool", keywords="prevention", keywords="falls", keywords="treatment", keywords="nutrition", keywords="physical activity", keywords="pilot study", keywords="older adults", keywords="adherence", keywords="engagement", keywords="compliance", abstract="Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portim{\~a}o, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67\%) and managing therapies and polypharmacy (16/26, 62\%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 ", doi="10.2196/46151", url="https://formative.jmir.org/2024/1/e46151", url="http://www.ncbi.nlm.nih.gov/pubmed/38758585" } @Article{info:doi/10.2196/50398, author="Szkodny, Dominika and Wr{\'o}blewska-Czajka, Ewa and Stryja, Miko?aj and Gara, Filip and Wyl?ga?a, Edward", title="Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study", journal="JMIR Form Res", year="2024", month="May", day="15", volume="8", pages="e50398", keywords="eye donor", keywords="corneal transplant", keywords="donor shortage", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="application", keywords="tissue procurement", keywords="organ", keywords="procurement", keywords="donor", keywords="donors", keywords="donation", keywords="transplant", keywords="transplantation", keywords="transplants", keywords="usability", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="acceptance", keywords="interview", keywords="interviews", keywords="survey", keywords="surveys", keywords="questionnaire", keywords="questionnaires", keywords="reporting", abstract="Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals' attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals' perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application's usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. ", doi="10.2196/50398", url="https://formative.jmir.org/2024/1/e50398", url="http://www.ncbi.nlm.nih.gov/pubmed/38748474" } @Article{info:doi/10.2196/53691, author="Aspelund, Anna and Valkonen, Paula and Viitanen, Johanna and Rauta, Virpi", title="Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions", journal="JMIR Hum Factors", year="2024", month="May", day="14", volume="11", pages="e53691", keywords="usability", keywords="UX", keywords="user experience", keywords="PX", keywords="patient experience", keywords="user-based evaluation", keywords="patients", keywords="eHealth", keywords="digital health solution", keywords="kidney disease", keywords="home dialysis", abstract="Background: Chronic kidney disease affects 10\% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients' quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease. Objective: Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution. Methods: We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores. Results: Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients' own health-related goals and fits with the needs of their everyday lives with the disease. Conclusions: A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions. ", doi="10.2196/53691", url="https://humanfactors.jmir.org/2024/1/e53691", url="http://www.ncbi.nlm.nih.gov/pubmed/38743476" } @Article{info:doi/10.2196/51514, author="Farah, Line and Borget, Isabelle and Martelli, Nicolas and Vallee, Alexandre", title="Suitability of the Current Health Technology Assessment of Innovative Artificial Intelligence-Based Medical Devices: Scoping Literature Review", journal="J Med Internet Res", year="2024", month="May", day="13", volume="26", pages="e51514", keywords="artificial intelligence", keywords="machine learning", keywords="health technology assessment", keywords="medical devices", keywords="evaluation", abstract="Background: Artificial intelligence (AI)--based medical devices have garnered attention due to their ability to revolutionize medicine. Their health technology assessment framework is lacking. Objective: This study aims to analyze the suitability of each health technology assessment (HTA) domain for the assessment of AI-based medical devices. Methods: We conducted a scoping literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched databases (PubMed, Embase, and Cochrane Library), gray literature, and HTA agency websites. Results: A total of 10.1\% (78/775) of the references were included. Data quality and integration are vital aspects to consider when describing and assessing the technical characteristics of AI-based medical devices during an HTA process. When it comes to implementing specialized HTA for AI-based medical devices, several practical challenges and potential barriers could be highlighted and should be taken into account (AI technological evolution timeline, data requirements, complexity and transparency, clinical validation and safety requirements, regulatory and ethical considerations, and economic evaluation). Conclusions: The adaptation of the HTA process through a methodological framework for AI-based medical devices enhances the comparability of results across different evaluations and jurisdictions. By defining the necessary expertise, the framework supports the development of a skilled workforce capable of conducting robust and reliable HTAs of AI-based medical devices. A comprehensive adapted HTA framework for AI-based medical devices can provide valuable insights into the effectiveness, cost-effectiveness, and societal impact of AI-based medical devices, guiding their responsible implementation and maximizing their benefits for patients and health care systems. ", doi="10.2196/51514", url="https://www.jmir.org/2024/1/e51514", url="http://www.ncbi.nlm.nih.gov/pubmed/38739911" } @Article{info:doi/10.2196/53163, author="Sien, Sang-Wha and Kobekyaa, Kyerepagr Francis and Puts, Martine and Currie, Leanne and Tompson, Margaret and Hedges, Penelope and McGrenere, Joanna and Mariano, Caroline and Haase, R. Kristen", title="Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing", journal="JMIR Aging", year="2024", month="May", day="8", volume="7", pages="e53163", keywords="cancer", keywords="aging", keywords="self-management", keywords="usability testing", keywords="design thinking", keywords="design", keywords="oncology", keywords="develop", keywords="development", keywords="usability", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="symptom", keywords="symptoms", keywords="comorbidity", keywords="comorbidities", keywords="comorbid", keywords="multimorbidity", keywords="multimorbidities", keywords="co-design", abstract="Background: Globally, cancer predominates in adults aged older than 60 years, and 70\% of older adults have ?1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a ``home base'' for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. ", doi="10.2196/53163", url="https://aging.jmir.org/2024/1/e53163", url="http://www.ncbi.nlm.nih.gov/pubmed/38717806" } @Article{info:doi/10.2196/53194, author="O'Donnell, A. Elizabeth and Van Citters, D. Aricca and Khayal, S. Inas and Wilson, M. Matthew and Gustafson, David and Barnato, E. Amber and Buccellato, C. Andrea and Young, Colleen and Holthoff, M. Megan and Korsunskiy, Eugene and Tomlin, C. Stephanie and Cullinan, M. Amelia and Steinbaugh, C. Alexandra and Hinson, J. Jennifer and Johnson, R. Kristen and Williams, Andrew and Thomson, M. Ruth and Haines, M. Janet and Holmes, B. Anne and Bradley, D. Ann and Nelson, C. Eugene and Kirkland, B. Kathryn", title="A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study", journal="JMIR Hum Factors", year="2024", month="May", day="8", volume="11", pages="e53194", keywords="human-centered design", keywords="caregivers", keywords="care partners", keywords="serious illness", keywords="peer support", keywords="online support network", keywords="virtual network", keywords="online network", keywords="caregiver", keywords="unmet need", keywords="unmet needs", keywords="active care", keywords="bereaved care", keywords="bereavement", keywords="clinician", keywords="clinicians", keywords="function", keywords="functions", keywords="specification", keywords="information", keywords="emotional support", keywords="technical support", keywords="privacy protection", keywords="rural", keywords="viability", keywords="impact", keywords="engineering design", keywords="care provider", keywords="care providers", keywords="mortality", keywords="quality of life", keywords="tertiary care", keywords="caregiving", abstract="Background: Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available. Objective: This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement. Methods: An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network. Results: The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period. Conclusions: A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network. ", doi="10.2196/53194", url="https://humanfactors.jmir.org/2024/1/e53194", url="http://www.ncbi.nlm.nih.gov/pubmed/38717809" } @Article{info:doi/10.2196/51694, author="Branitsky, Alison and Longden, Eleanor and Bucci, Sandra and Morrison, P. Anthony and Varese, Filippo", title="Group Cohesion and Necessary Adaptations in Online Hearing Voices Peer Support Groups: Qualitative Study With Group Facilitators", journal="JMIR Form Res", year="2024", month="May", day="3", volume="8", pages="e51694", keywords="peer support", keywords="group cohesion", keywords="web-based delivery", keywords="hearing voices", keywords="Hearing Voices Movement", keywords="self-help groups", abstract="Background: Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one's voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion. Objective: This study aims to understand the experience of group cohesion among HVG facilitators in online groups compared with face-to-face groups. Specifically, we examined the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion and how facilitators adapted HVGs to foster group cohesion online. Methods: Semistructured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analyzed using reflexive thematic analysis. Results: The findings are organized into 3 themes and associated subthemes: nonverbal challenges to cohesion (lack of differentiation, transitional space, inability to see the whole picture, and expressions of empathy); discursive challenges to cohesion (topic-based conversation and depth of disclosure); and necessary adaptations for online groups (fostering shared experience and using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online but that it had to be facilitated intentionally. Conclusions: This study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting groups to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the session; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Although these challenges were significant, facilitators nevertheless emphasized that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalizing on moments of humor and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen-sharing features, and using objects from participants' environments to gain deeper insight into their subjective worlds. ", doi="10.2196/51694", url="https://formative.jmir.org/2024/1/e51694", url="http://www.ncbi.nlm.nih.gov/pubmed/38701439" } @Article{info:doi/10.2196/53113, author="Doan, Xengie and Rossi, Arianna and Botes, Marietjie and Selzer, Annika", title="Comparing Attitudes Toward Different Consent Mediums: Semistructured Qualitative Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="30", volume="11", pages="e53113", keywords="consent", keywords="transparency", keywords="data governance", keywords="visualization", keywords="health data sharing", abstract="Background: As consent for data sharing evolves with the digital age, plain-text consent is not the only format in which information can be presented. However, designing a good consent form is highly challenging. The addition of graphics, video, and other mediums to use can vary widely in effectiveness; and improper use can be detrimental to users. Objective: This study aims to explore the expectations and experiences of adults toward consent given in infographic, video, text, newsletter, and comic forms in a health data sharing scenario to better understand the appropriateness of different mediums and identify elements of each medium that most affect engagement with the content. Methods: We designed mock consent forms in infographic, video, text, newsletter, and comic versions. Semistructured interviews were conducted with adults who were interviewed about their expectations for consent and were then shown each consent medium and asked about engaging elements across mediums, preferences for consent mediums, and the value of document quality criteria. We transcribed and qualitatively co-coded to identify themes and perform analyses. Results: We interviewed 24 users and identified different thematic archetypes based on participant goals, such as the Trust Seeker, who considered their own understanding and trust in organizations when making decisions. The infographic was ranked first for enhancing understanding, prioritizing information, and maintaining the proper audience fit for serious consent in health data sharing scenarios. In addition, specific elements such as structure, step-by-step organization, and readability were preferred engaging elements. Conclusions: We identified archetypes to better understand user needs and elements that can be targeted to enhance user engagement with consent forms; this can help inform the design of more effective consent in the future. Overall, preferences for mediums are highly contextual, and more research should be done. ", doi="10.2196/53113", url="https://humanfactors.jmir.org/2024/1/e53113", url="http://www.ncbi.nlm.nih.gov/pubmed/38687983" } @Article{info:doi/10.2196/52191, author="Mitchell, MH Ellen and Adejumo, Adedeji Olusola and Abdur-Razzaq, Hussein and Ogbudebe, Chidubem and Gidado, Mustapha", title="The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="25", volume="10", pages="e52191", keywords="surveillance", keywords="trust", keywords="Integrated Disease Surveillance and Response", keywords="IDSR", keywords="tuberculosis", keywords="notification", keywords="public-private mix", keywords="infectious disease", keywords="disease surveillance", keywords="surveillance behavior", keywords="health care worker", keywords="health professional", keywords="public health", keywords="Nigeria", keywords="survey", keywords="behavior", keywords="self-reported", abstract="Background: Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the ``software'' of surveillance. Objective: We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. Methods: A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. Results: Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed ``always'' notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. Conclusions: Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the ``software'' of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance. ", doi="10.2196/52191", url="https://publichealth.jmir.org/2024/1/e52191", url="http://www.ncbi.nlm.nih.gov/pubmed/38506095" } @Article{info:doi/10.2196/51612, author="Tremoulet, D. Patrice and Lobo, F. Andrea and Simmons, A. Christina and Baliga, Ganesh and Brady, Matthew", title="Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing", journal="JMIR Hum Factors", year="2024", month="Apr", day="25", volume="11", pages="e51612", keywords="technology prototype", keywords="data collection", keywords="documentation", keywords="direct support professionals", keywords="intellectual and developmental disabilities", keywords="pilot test", keywords="mobile phone", abstract="Background: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs' jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. Objective: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. Methods: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. Results: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. Conclusions: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful. ", doi="10.2196/51612", url="https://humanfactors.jmir.org/2024/1/e51612", url="http://www.ncbi.nlm.nih.gov/pubmed/38662420" } @Article{info:doi/10.2196/52292, author="Lu, Yinn Si and Yoon, Sungwon and Yee, Qi Wan and Heng Wen Ngiam, Nerice and Ng, Yi Kennedy Yao and Low, Leng Lian", title="Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study", journal="JMIR Aging", year="2024", month="Apr", day="25", volume="7", pages="e52292", keywords="digital divide", keywords="digital learning", keywords="smartphones", keywords="social gerontology", keywords="older adults", keywords="COVID-19 pandemic", keywords="technology adoption", abstract="Background: Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools. Objective: This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges. Methods: This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ?60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach. Results: Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning. Conclusions: To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults' social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide. ", doi="10.2196/52292", url="https://aging.jmir.org/2024/1/e52292", url="http://www.ncbi.nlm.nih.gov/pubmed/38662423" } @Article{info:doi/10.2196/50234, author="Kwok, Ian and Lattie, Gardiner Emily and Yang, Dershung and Summers, Amanda and Cotten, Paul and Leong, Alina Caroline and Moskowitz, Tedlie Judith", title="Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study", journal="JMIR Form Res", year="2024", month="Apr", day="25", volume="8", pages="e50234", keywords="Alzheimer disease", keywords="dementia", keywords="caregiving", keywords="eHealth", keywords="web-based interventions", keywords="positive emotion", keywords="stress", keywords="coping", abstract="Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection. Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants. Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers. Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished. Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers. ", doi="10.2196/50234", url="https://formative.jmir.org/2024/1/e50234", url="http://www.ncbi.nlm.nih.gov/pubmed/38662432" } @Article{info:doi/10.2196/54645, author="Asano, Masaki and Imai, Shungo and Shimizu, Yuri and Kizaki, Hayato and Ito, Yukiko and Tsuchiya, Makoto and Kuriyama, Ryoko and Yoshida, Nao and Shimada, Masanori and Sando, Takanori and Ishijima, Tomo and Hori, Satoko", title="Factor Analysis of Patients Who Find Tablets or Capsules Difficult to Swallow Due to Their Large Size: Using the Personal Health Record Infrastructure of Electronic Medication Notebooks", journal="J Med Internet Res", year="2024", month="Apr", day="24", volume="26", pages="e54645", keywords="tablet", keywords="tablets", keywords="capsules", keywords="capsule", keywords="size", keywords="personal health record", keywords="electronic medication notebook", keywords="patient preference", keywords="drug", keywords="drugs", keywords="pharmacy", keywords="pharmacies", keywords="pharmacology", keywords="pharmacotherapy", keywords="pharmaceutic", keywords="pharmaceutics", keywords="pharmaceuticals", keywords="pharmaceutical", keywords="medication", keywords="medications", keywords="preference", keywords="preferences", keywords="pill", keywords="pills", keywords="machine learning", keywords="decision tree", keywords="swallow", keywords="swallowing", keywords="throat", keywords="pharynx", keywords="risk", keywords="risks", keywords="dysphagia", keywords="speech", keywords="mobile phone", abstract="Background: Understanding patient preference regarding taking tablet or capsule formulations plays a pivotal role in treatment efficacy and adherence. Therefore, these preferences should be taken into account when designing formulations and prescriptions. Objective: This study investigates the factors affecting patient preference in patients who have difficulties swallowing large tablets or capsules and aims to identify appropriate sizes for tablets and capsules. Methods: A robust data set was developed based on a questionnaire survey conducted from December 1, 2022, to December 7, 2022, using the harmo smartphone app operated by harmo Co, Ltd. The data set included patient input regarding their tablet and capsule preferences, personal health records (including dispensing history), and drug formulation information (available from package inserts). Based on the medication formulation information, 6 indices were set for each of the tablets or capsules that were considered difficult to swallow owing to their large size and concomitant tablets or capsules (used as controls). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of each index. The index demonstrating the highest area under the curve of the ROC was selected as the best index to determine the tablet or capsule size that leads to swallowing difficulties. From the generated ROCs, the point with the highest discriminative performance that maximized the Youden index was identified, and the optimal threshold for each index was calculated. Multivariate logistic regression analysis was performed to identify the risk factors contributing to difficulty in swallowing oversized tablets or capsules. Additionally, decision tree analysis was performed to estimate the combined risk from several factors, using risk factors that were significant in the multivariate logistic regression analysis. Results: This study analyzed 147 large tablets or capsules and 624 control tablets or capsules. The ``long diameter + short diameter + thickness'' index (with a 21.5 mm threshold) was identified as the best indicator for causing swallowing difficulties in patients. The multivariate logistic regression analysis (including 132 patients with swallowing difficulties and 1283 patients without) results identified the following contributory risk factors: aged <50 years (odds ratio [OR] 1.59, 95\% CI 1.03-2.44), female (OR 2.54, 95\% CI 1.70-3.78), dysphagia (OR 3.54, 95\% CI 2.22-5.65), and taking large tablets or capsules (OR 9.74, 95\% CI 5.19-18.29). The decision tree analysis results suggested an elevated risk of swallowing difficulties for patients with taking large tablets or capsules. Conclusions: This study identified the most appropriate index and threshold for indicating that a given tablet or capsule size will cause swallowing difficulties, as well as the contributory risk factors. Although some sampling biases (eg, only including smartphone users) may exist, our results can guide the design of patient-friendly formulations and prescriptions, promoting better medication adherence. ", doi="10.2196/54645", url="https://www.jmir.org/2024/1/e54645", url="http://www.ncbi.nlm.nih.gov/pubmed/38657229" } @Article{info:doi/10.2196/49171, author="Bj{\"o}rling, A. Elin and Sonney, Jennifer and Zade, Himanshu and Rodriguez, Sofia and Pullmann, D. Michael and Moon, Hyun Soo", title="Using Virtual Reality to Reduce Stress in Adolescents: Mixed Methods Usability Study", journal="JMIR XR Spatial Comput", year="2024", month="Apr", day="22", volume="1", pages="e49171", keywords="virtual reality", keywords="adolescents", keywords="perceived stress", keywords="participatory design", keywords="depression", abstract="Background: Adolescent mental health is a national mental health emergency amid surging rates of anxiety and depression. Given the scarcity and lack of scalable mental health services, the use of self-administered, evidence-based technologies to support adolescent mental health is both timely and imperative. Objective: The goal of this study was 2-fold: (1) to determine the feasibility, usability, and engagement of a participatory designed, nature-based virtual reality (VR) environment and (2) to determine the preliminary outcomes of our self-administered VR environment on depression, mindfulness, perceived stress, and momentary stress and mood. Methods: We conducted a within-person, 3-week, in-home study with a community-based sample of 44 adolescents. Participants completed surveys of perceived stress, depression, cognitive fusion, and mindfulness at intake, postintervention, and a 3-week follow-up. Participants were invited to use a nature-based, VR environment that included 6 evidence-based activities 3 to 5 times per week. They completed momentary stress and mood surveys 5 times each day and before and after each VR session. Postintervention, participants completed surveys on system and intervention usability and their experiences with using the VR system. Quantitative data were analyzed using descriptive statistics and mixed effects modeling to explore the effect of the VR environment on stress. Qualitative data were analyzed using collaborative thematic analysis. Results: Participants' use of the VR environment ranged from 1 session to 24 sessions (mean 6.27 sessions) at home over a 3-week period. The 44 participants completed all study protocols, indicating our protocol was feasible and the VR environment was engaging for most. Both the use of the VR system and novel VR intervention received strong usability ratings (mean 74.87 on the System Usability Scale). Most teens indicated that they found the tool to be easily administered, relaxing, and helpful with stress. For some, it offered space to process difficult emotions. The themes calm, regulating, and forget about everything resulted from open-ended exit interview data. Although the Relaxation Environment for Stress in Teens (RESeT) did not significantly affect repeated survey measurements of depression, mindfulness, nor cognitive fusion, it did positively affect momentary mood (pre-intervention: 10.8, post-intervention: 12.0, P=.001) and decrease momentary stress (pre-intervention: 37.9, post-intervention: 20.6, P=.001). We found a significant reduction in within-day momentary stress that strengthened with increased VR use over time during the study period (P=.03). Conclusions: These preliminary data inform our own VR environment design but also provide evidence of the potential for self-administered VR as a promising tool to support adolescent mental health. Self-administered VR for mental health may be an effective intervention for reducing adolescent stress. However, understanding barriers (including disengagement) to using VR, as well as further encouraging participatory design with teens, may be imperative to the success of future mental health interventions. ", doi="10.2196/49171", url="https://xr.jmir.org/2024/1/e49171" } @Article{info:doi/10.2196/53022, author="Foster, Marva and Fix, M. Gemmae and Hyde, Justeen and Dunlap, Shawn and Byrne, H. Thomas and Sugie, F. Naomi and Kuhn, Randall and Gabrielian, Sonya and Roncarati, S. Jill and Zhao, Shibei and McInnes, Keith D.", title="Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology--Supported Intervention", journal="JMIR Res Protoc", year="2024", month="Apr", day="22", volume="13", pages="e53022", keywords="ethnography", keywords="homelessness", keywords="housing transitions", keywords="longitudinal data", keywords="military", keywords="mobile technology", keywords="smartphone", keywords="social support", keywords="veterans", abstract="Background: US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population's health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support. Objective: The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless. Methods: This study's design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3. Results: The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress. Conclusions: This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions. International Registered Report Identifier (IRRID): DERR1-10.2196/53022 ", doi="10.2196/53022", url="https://www.researchprotocols.org/2024/1/e53022", url="http://www.ncbi.nlm.nih.gov/pubmed/38648101" } @Article{info:doi/10.2196/50219, author="Bults, Marloes and van Leersum, Margaretha Catharina and Olthuis, Josef Theodorus Johannes and Siebrand, Egbert and Malik, Zohrah and Liu, Lili and Miguel-Cruz, Antonio and Jukema, Seerp Jan and den Ouden, Maria Marjolein Elisabeth", title="Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study", journal="JMIR Aging", year="2024", month="Apr", day="19", volume="7", pages="e50219", keywords="assistive technology", keywords="technology acceptance", keywords="immigrant", keywords="dementia", keywords="marginalized older adults", abstract="Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one's home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. ", doi="10.2196/50219", url="https://aging.jmir.org/2024/1/e50219", url="http://www.ncbi.nlm.nih.gov/pubmed/38639994" } @Article{info:doi/10.2196/50832, author="Blanchard, Marc and Koller, Nadana Cinja and Azevedo, Ming Pedro and Pr{\'e}tat, Tiffany and H{\"u}gle, Thomas", title="Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach", journal="JMIR Form Res", year="2024", month="Apr", day="19", volume="8", pages="e50832", keywords="digital health", keywords="patient preference", keywords="user experience", keywords="patient-centricity", keywords="platform", keywords="development", keywords="fibromyalgia", keywords="self-management", keywords="quality of life", keywords="patient outcome", keywords="musculoskeletal", keywords="usability testing", keywords="digital health solution", abstract="Background: Persistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30\% of patients with post--COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. Objective: This research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app's design and functionality, the study intends to facilitate better self-management practices and improve adherence. Methods: Using an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients' expectations regarding design features, content, and usability to steer the iterative app development. Results: The study uncovered crucial insights from patient surveys and usability testing, which influenced the app's design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. Conclusions: Incorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID): RR2-10.2196/32193 ", doi="10.2196/50832", url="https://formative.jmir.org/2024/1/e50832", url="http://www.ncbi.nlm.nih.gov/pubmed/38639986" } @Article{info:doi/10.2196/55132, author="Fan, Qiping and Hoang, Minh-Nguyet and DuBose, Logan and Ory, G. Marcia and Vennatt, Jeswin and Salha, Diana and Lee, Shinduk and Falohun, Tokunbo", title="The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study", journal="JMIR Aging", year="2024", month="Apr", day="17", volume="7", pages="e55132", keywords="evaluation", keywords="usability", keywords="family caregiver", keywords="Alzheimer disease", keywords="dementia", keywords="digital health", keywords="mobile phone", abstract="Background: The increasing prevalence of Alzheimer disease and Alzheimer disease--related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ?50 years (25/30, 83\%), women (23/30, 77\%), White (25/30, 83\%), and financially stable (20/30, 67\%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90\% (27/30) rated the app overall positively. Most of the participants (21/30, 70\%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. ", doi="10.2196/55132", url="https://aging.jmir.org/2024/1/e55132", url="http://www.ncbi.nlm.nih.gov/pubmed/38630527" } @Article{info:doi/10.2196/54172, author="McCallum, Claire and Campbell, Miglena and Vines, John and Rapley, Tim and Ellis, Jason and Deary, Vincent and Hackett, Katie", title="A Smartphone App to Support Self-Management for People Living With Sj{\"o}gren's Syndrome: Qualitative Co-Design Workshops", journal="JMIR Hum Factors", year="2024", month="Apr", day="17", volume="11", pages="e54172", keywords="self-management", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="Sj{\"o}gren's syndrome", keywords="patient participation", keywords="patient involvement", keywords="fatigue", keywords="chronic disease", keywords="focus groups", keywords="complex intervention development", keywords="mobile phone", abstract="Background: Sj{\"o}gren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. Objective: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. Methods: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. Results: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. Conclusions: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies.?For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities. ", doi="10.2196/54172", url="https://humanfactors.jmir.org/2024/1/e54172", url="http://www.ncbi.nlm.nih.gov/pubmed/38630530" } @Article{info:doi/10.2196/50118, author="Laidsaar-Powell, Rebekah and Giunta, Sarah and Butow, Phyllis and Keast, Rachael and Koczwara, Bogda and Kay, Judy and Jefford, Michael and Turner, Sandra and Saunders, Christobel and Schofield, Penelope and Boyle, Frances and Yates, Patsy and White, Kate and Miller, Annie and Butt, Zoe and Bonnaudet, Melanie and Juraskova, Ilona", title="Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers", journal="JMIR Med Educ", year="2024", month="Apr", day="17", volume="10", pages="e50118", keywords="family carers", keywords="patient education", keywords="health professional education", keywords="web-based intervention", keywords="mobile phone", abstract="Background: Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill?equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. Objective: To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO?pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. Methods: The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including ``think-aloud'' interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). Results: The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small ``snackable'' sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. Conclusions: The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care. ", doi="10.2196/50118", url="https://mededu.jmir.org/2024/1/e50118", url="http://www.ncbi.nlm.nih.gov/pubmed/38630531" } @Article{info:doi/10.2196/48793, author="Wahl, J. Kate and Brooks, Melissa and Trenaman, Logan and Desjardins-Lorimer, Kirsten and Bell, M. Carolyn and Chokmorova, Nazgul and Segall, Romy and Syring, Janelle and Williams, Aleyah and Li, C. Linda and Norman, V. Wendy and Munro, Sarah", title="User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="16", volume="26", pages="e48793", keywords="family planning", keywords="abortion", keywords="shared decision-making", keywords="patient decision aid", keywords="qualitative", keywords="evaluation", keywords="Canada", keywords="health equity", abstract="Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive---there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (``patient'' participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100\%; health care professionals: n=22, 88\%), was not missing information (patients: n=21, 84\%; health care professionals: n=18, 72\%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92\%; health care professionals: n=23, 92\%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. ", doi="10.2196/48793", url="https://www.jmir.org/2024/1/e48793", url="http://www.ncbi.nlm.nih.gov/pubmed/38625731" } @Article{info:doi/10.2196/51518, author="Opper, A. Claudia and Browne, A. Felicia and Howard, N. Brittni and Zule, A. William and Wechsberg, M. Wendee", title="Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial", journal="JMIR Hum Factors", year="2024", month="Apr", day="16", volume="11", pages="e51518", keywords="HIV", keywords="Black women", keywords="mobile apps", keywords="social determinants of health", keywords="prevention", keywords="substance use", keywords="usability", abstract="Background: In North Carolina, HIV continues to disproportionately affect young African American women. Although mobile health (mHealth) technology appears to be a tool capable of making public health information more accessible for key populations, previous technology use and social determinants may impact users' mHealth experiences. Objective: The objective of this study was to evaluate mHealth usability, assessing differences based on previous technology use and social determinants among a sample of African American women in emerging adulthood. Methods: As part of a National Institute on Drug Abuse--funded randomized controlled trial with African American women (aged 18-25 years), counties were assigned to receive an evidence-based HIV risk reduction intervention through mHealth and participants were asked to complete usability surveys at 6- and 12-month follow-ups. Participants' first survey responses were analyzed through 2-tailed t tests and linear regression models to examine associations with previous technology use and social determinants (P<.05). Results: The mean System Usability Scale (SUS) score was 69.2 (SD 17.9; n=159), which was higher than the threshold of acceptability (68.0). Participants who had previously used a tablet indicated higher usability compared to participants without previous use (mean 72.9, SD 18.1 vs mean 57.6, SD 11.4; P<.001), and participants with previous smartphone use also reported higher usability compared to participants without previous use (mean 71.9, SD 18.3 vs mean 58.0, SD 10.7; P<.001). Differences in SUS scores were observed among those reporting homelessness (mean 58.3, SD 19.0 vs mean 70.8, SD 17.2; P=.01), unemployment (mean 65.9, SD 17.2 vs mean 71.6, SD 18.1; P=.04), or current school enrollment (mean 73.2, SD 18.5 vs mean 65.4, SD 16.5; P=.006). Statistically significant associations were not observed for food insecurity (mean 67.3, SD 18.6 vs mean 69.9, SD 17.7; P=.45). Conclusions: Although above-average usability was observed overall, these findings demonstrate differences in mHealth usability based on past and current life experiences. As mHealth interventions become more prevalent, these findings may have important implications for ensuring that mHealth apps improve the reach of evidence-based interventions. Trial Registration: ClinicalTrials.gov NCT02965014; https://clinicaltrials.gov/study/NCT02965014 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5796-8 ", doi="10.2196/51518", url="https://humanfactors.jmir.org/2024/1/e51518", url="http://www.ncbi.nlm.nih.gov/pubmed/38625721" } @Article{info:doi/10.2196/54214, author="Sobrinho, Silva Andressa Crystine da and Gomes, Oliveira Grace Angelica de and Bueno J{\'u}nior, Roberto Carlos", title="Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach", journal="JMIR Form Res", year="2024", month="Apr", day="15", volume="8", pages="e54214", keywords="information and communications technologies", keywords="ICTs", keywords="health care", keywords="digital inclusion", keywords="focus groups", keywords="health promotion", keywords="user", keywords="usability", keywords="health literacy", keywords="digital competencies", keywords="digital skills", keywords="mobile phone", abstract="Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeir{\~a}o Pr{\^e}to, S{\~a}o Paulo, Brazil, and involved 20 older adults of both genders who were aged ?60 years and enrolled in the Physical Education Program for the Elderly at the University of S{\~a}o Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90\% (18/20) of the participants owned smartphones. However, 20\% (4/20) of the participants faced installation challenges and 30\% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89\% to 70.65\%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. ", doi="10.2196/54214", url="https://formative.jmir.org/2024/1/e54214", url="http://www.ncbi.nlm.nih.gov/pubmed/38619865" } @Article{info:doi/10.2196/53726, author="Louch, Gemma and Berzins, Kathryn and Walker, Lauren and Wormald, Gemma and Blackwell, Kirstin and Stephens, Michael and Brown, Mark and Baker, John", title="Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool", journal="JMIR Form Res", year="2024", month="Apr", day="12", volume="8", pages="e53726", keywords="patient safety", keywords="mental health", keywords="patient involvement", keywords="qualitative", keywords="digital innovation", keywords="real time", keywords="monitoring", keywords="safety", keywords="develop", keywords="development", keywords="design", keywords="perception", keywords="perceptions", keywords="prototype", keywords="evidence scan", keywords="interview", keywords="interviews", keywords="logic model", keywords="programme theory", keywords="dashboard", keywords="dashboards", keywords="interface", abstract="Background: Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. Objective: This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. Methods: The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. Results: We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, ``getting worse'' or ``getting better''; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Conclusions: Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively. ", doi="10.2196/53726", url="https://formative.jmir.org/2024/1/e53726", url="http://www.ncbi.nlm.nih.gov/pubmed/38607663" } @Article{info:doi/10.2196/50968, author="O'Brien, Niki and Fernandez Crespo, Roberto and O'Driscoll, Fiona and Prendergast, Mabel and Chana, Deeph and Darzi, Ara and Ghafur, Saira", title="Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Apr", day="11", volume="8", pages="e50968", keywords="acceptability", keywords="cross sectional", keywords="cybersecurity", keywords="digital health", keywords="digital transformation", keywords="education", keywords="feasibility", keywords="framework", keywords="frameworks", keywords="global health", keywords="health systems", keywords="implementation", keywords="organization", keywords="organizational", keywords="organizations", keywords="patient safety", keywords="SWOT", keywords="TAM", keywords="usability", abstract="Background: Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care--specific resources to help organizations at different levels of maturity develop their cybersecurity practices. Objective: This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. Methods: A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95\% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. Results: A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. Conclusions: The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed. ", doi="10.2196/50968", url="https://formative.jmir.org/2024/1/e50968", url="http://www.ncbi.nlm.nih.gov/pubmed/38603777" } @Article{info:doi/10.2196/46698, author="Hoffmann, Christin and Avery, Kerry and Macefield, Rhiannon and Dvo?{\'a}k, Tade{\'a}{\vs} and Snelgrove, Val and Blazeby, Jane and Hopkins, Della and Hickey, Shireen and Gibbison, Ben and Rooshenas, Leila and Williams, Adam and Aning, Jonathan and Bekker, L. Hilary and McNair, GK Angus and ", title="Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation", journal="JMIR Hum Factors", year="2024", month="Apr", day="10", volume="11", pages="e46698", keywords="surgery", keywords="shared decision-making", keywords="patient participation", keywords="mixed methods", keywords="real-time measurement", keywords="patient-reported measure", keywords="electronic data collection", keywords="usability", keywords="data collection", keywords="patient reported", keywords="satisfaction", keywords="mobile phone", abstract="Background: Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients' experience of SDM in real time is needed to identify the failings of SDM before surgery is performed. We developed a novel approach to automating real-time data collection using an electronic measurement system to address this. Examining usability will facilitate its optimization and wider implementation to inform interventions aimed at improving SDM. Objective: This study examined the usability of an electronic real-time measurement system to monitor surgical patients' experience of SDM. We aimed to evaluate the metrics and indicators relevant to system effectiveness, system efficiency, and user satisfaction. Methods: We performed a mixed methods usability evaluation using multiple participant cohorts. The measurement system was implemented in a large UK hospital to measure patients' experience of SDM electronically before surgery using 2 validated measures (CollaboRATE and SDM-Q-9). Quantitative data (collected between April 1 and December 31, 2021) provided measurement system metrics to assess system effectiveness and efficiency. We included adult patients booked for urgent and elective surgery across 7 specialties and excluded patients without the capacity to consent for medical procedures, those without access to an internet-enabled device, and those undergoing emergency or endoscopic procedures. Additional groups of service users (group 1: public members who had not engaged with the system; group 2: a subset of patients who completed the measurement system) completed user-testing sessions and semistructured interviews to assess system effectiveness and user satisfaction. We conducted quantitative data analysis using descriptive statistics and calculated the task completion rate and survey response rate (system effectiveness) as well as the task completion time, task efficiency, and relative efficiency (system efficiency). Qualitative thematic analysis identified indicators of and barriers to good usability (user satisfaction). Results: A total of 2254 completed surveys were returned to the measurement system. A total of 25 service users (group 1: n=9; group 2: n=16) participated in user-testing sessions and interviews. The task completion rate was high (169/171, 98.8\%) and the survey response rate was good (2254/5794, 38.9\%). The median task completion time was 3 (IQR 2-13) minutes, suggesting good system efficiency and effectiveness. The qualitative findings emphasized good user satisfaction. The identified themes suggested that the measurement system is acceptable, easy to use, and easy to access. Service users identified potential barriers and solutions to acceptability and ease of access. Conclusions: A mixed methods evaluation of an electronic measurement system for automated, real-time monitoring of patients' experience of SDM showed that usability among patients was high. Future pilot work will optimize the system for wider implementation to ultimately inform intervention development to improve SDM. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-079155 ", doi="10.2196/46698", url="https://humanfactors.jmir.org/2024/1/e46698", url="http://www.ncbi.nlm.nih.gov/pubmed/38598276" } @Article{info:doi/10.2196/56143, author="Detsomboonrat, Palinee and Pisarnturakit, Pantuwadee Pagaporn", title="Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study", journal="JMIR Form Res", year="2024", month="Apr", day="10", volume="8", pages="e56143", keywords="capability", keywords="health survey", keywords="oral health", keywords="mobile apps", keywords="personal health information", keywords="PHI", keywords="satisfaction", keywords="tooth", keywords="teeth", keywords="oral", keywords="dental", keywords="dentist", keywords="dentistry", keywords="data entry", keywords="data collection", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="periodontal", keywords="survey", keywords="questionnaire", keywords="questionnaires", abstract="Background: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. Objective: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. Methods: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients' information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. Results: Of the 103 dental records on DMFT and CPI, 5.2\% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). Conclusions: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app. ", doi="10.2196/56143", url="https://formative.jmir.org/2024/1/e56143", url="http://www.ncbi.nlm.nih.gov/pubmed/38598287" } @Article{info:doi/10.2196/53117, author="Krakowczyk, Barbara Julia and Truijens, Femke and Teufel, Martin and Lalgi, Tania and Heinen, Jana and Schug, Caterina and Erim, Yesim and Pantf{\"o}rder, Michael and Graf, Johanna and B{\"a}uerle, Alexander", title="Evaluation of the e--Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial", journal="JMIR Cancer", year="2024", month="Apr", day="9", volume="10", pages="e53117", keywords="psycho-oncology", keywords="eHealth", keywords="digital health", keywords="cancer", keywords="Reduct trial", keywords="oncology", abstract="Background: Make It Training is an e--mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. Objective: This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. Methods: In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Results: Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. Conclusions: e--Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support. ", doi="10.2196/53117", url="https://cancer.jmir.org/2024/1/e53117", url="http://www.ncbi.nlm.nih.gov/pubmed/38592764" } @Article{info:doi/10.2196/45978, author="Haslam-Larmer, Lynn and Grigorovich, Alisa and Shum, Leia and Bianchi, Andria and Newman, Kristine and Iaboni, Andrea and McMurray, Josephine", title="Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Apr", day="8", volume="7", pages="e45978", keywords="remote sensing technologies", keywords="dementia", keywords="real-time location systems", keywords="Fit between Individuals, Tasks, and Technology framework", keywords="FITT framework", keywords="technology implementation", abstract="Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person's movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual's self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80\%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit's HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients' activity levels. ", doi="10.2196/45978", url="https://aging.jmir.org/2024/1/e45978", url="http://www.ncbi.nlm.nih.gov/pubmed/38587884" } @Article{info:doi/10.2196/52179, author="Moorthy, Preetha and Weinert, Lina and Sch{\"u}ttler, Christina and Svensson, Laura and Sedlmayr, Brita and M{\"u}ller, Julia and Nagel, Till", title="Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review", journal="JMIR Mhealth Uhealth", year="2024", month="Apr", day="5", volume="12", pages="e52179", keywords="wearables", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="usability methods", keywords="usability attributes", keywords="evaluation frameworks", keywords="health care", abstract="Background: Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users' acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. Objective: This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. Methods: We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords ``wearable devices,'' ``mobile apps,'' ``mHealth apps,'' ``physiological data,'' ``usability,'' ``user experience,'' and ``user evaluation'' were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Results: A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84\%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66\% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47\%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50\%), ease of use (27/68, 40\%), user experience (16/68, 24\%), perceived usefulness (18/68, 26\%), and effectiveness (15/68, 22\%). Only 10\% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. Conclusions: Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations. ", doi="10.2196/52179", url="https://mhealth.jmir.org/2024/1/e52179", url="http://www.ncbi.nlm.nih.gov/pubmed/38578671" } @Article{info:doi/10.2196/46811, author="Medina-Garc{\'i}a, Rodrigo and L{\'o}pez-Rodr{\'i}guez, A. Juan and Lozano-Hern{\'a}ndez, Mar{\'i}a Cristina and Ruiz Bejerano, Ver{\'o}nica and Criscio, Paride and Del Cura-Gonz{\'a}lez, Isabel and ", title="A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="5", volume="11", pages="e46811", keywords="user-centered design", keywords="multimorbidity", keywords="comorbid", keywords="self-care", keywords="medical informatics", keywords="primary health care", keywords="chronic disease", keywords="chronic condition", keywords="chronic illness", keywords="primary care", keywords="usability", keywords="telemedicne", keywords="telehealth", keywords="information and communication technologies", keywords="ICT", keywords="digital health", keywords="eHealth", keywords="human-computer interaction", abstract="Background: Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between a patient and technology, known as usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure their relevant role in promoting self-care. Objective: The aim of this study was to analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. Methods: A descriptive observational cross-sectional usability study was performed framed in the clinical trial in the primary care health centers of Madrid Health Service of the TeNDER (Affective Based Integrated Care for Better Quality of Life) project. The TeNDER technological tool integrates sensors for monitoring physical and sleep activity along with a mobile app for consulting the data collected and working with self-management tools. This project included patients over 60 years of age who had one or more chronic diseases, at least one of which was mild-moderate cognitive impairment, Parkinson disease, or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate in the usability study. The usability variables investigated were effectiveness, which was determined by the degree of completion and the total number of errors per task; efficiency, evaluated as the average time to perform each task; and satisfaction, quantified by the System Usability Scale. Five tasks were evaluated based on real case scenarios. Usability variables were analyzed according to the sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for task completion. Results: The median age of the 38 participants was 75 (IQR 72.0-79.0) years. There was a slight majority of women (20/38, 52.6\%) and the participants had a median of 8 (IQR 7.0-11.0) chronic diseases. Thirty patients completed the usability study, with a usability effectiveness result of 89.3\% (134/150 tasks completed). Among the 30 patients, 66.7\% (n=20) completed all tasks and 56.7\% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level emerged as a facilitating factor for independent task completion (odds ratio 1.79, 95\% CI 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction score was 55 (IQR 45.0-62.5) out of 100. Conclusions: Although usability effectiveness was high, the poor efficiency and usability satisfaction scores suggest that there are other factors that may interfere with the results. Multimorbidity was not confirmed to be a key factor affecting the usability of the technological tool. Trial Registration: Clinicaltrials.gov NCT05681065; https://clinicaltrials.gov/study/NCT05681065 ", doi="10.2196/46811", url="https://humanfactors.jmir.org/2024/1/e46811", url="http://www.ncbi.nlm.nih.gov/pubmed/38578675" } @Article{info:doi/10.2196/46979, author="Dang, Ha Thu and Wickramasinghe, Nilmini and Forkan, Mohammad Abdur Rahim and Jayaraman, Prakash Prem and Burbury, Kate and O'Callaghan, Clare and Whitechurch, Ashley and Schofield, Penelope", title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach", journal="JMIR Cancer", year="2024", month="Apr", day="3", volume="10", pages="e46979", keywords="cancer", keywords="behavioral science", keywords="design science research", keywords="digital", keywords="medication adherence", keywords="mobile solution", keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology", keywords="SAMSON", keywords="mobile phone", abstract="Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78\%). The app was engaging (18/27, 67\%), informative, increased user interactions, and well organized (19/27, 70\%). Most of the participants (21/27, 78\%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63\%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. ", doi="10.2196/46979", url="https://cancer.jmir.org/2024/1/e46979", url="http://www.ncbi.nlm.nih.gov/pubmed/38569178" } @Article{info:doi/10.2196/56206, author="Correia de Barros, Ana and Bergmans, Mari{\"e}tte and Hasanaj, Kreshnik and Krasniqi, Drian{\"e} and N{\'o}brega, Catarina and Carvalho Carneiro, Bruna and Vasconcelos, A. Priscila and Quinta-Gomes, Lu{\'i}sa Ana and Nobre, J. Pedro and Couto da Silva, Joana and Mendes-Santos, Cristina", title="Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="3", volume="11", pages="e56206", keywords="internet interventions", keywords="mobile health", keywords="mHealth", keywords="older adults", keywords="sexual health", keywords="smartphone", keywords="user experience", keywords="pilot study", keywords="mobile phone", abstract="Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app's usefulness and ease of use. Usability was assessed as ``Ok/Fair.'' The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants' perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. ", doi="10.2196/56206", url="https://humanfactors.jmir.org/2024/1/e56206", url="http://www.ncbi.nlm.nih.gov/pubmed/38568726" } @Article{info:doi/10.2196/51522, author="Adler, F. Rachel and Baez, Kevin and Morales, Paulina and Sotelo, Jocelyn and Victorson, David and Magasi, Susan", title="Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing", journal="JMIR Hum Factors", year="2024", month="Apr", day="2", volume="11", pages="e51522", keywords="mobile health", keywords="mHealth", keywords="apps", keywords="usability", keywords="cancer survivors", keywords="accessibility", keywords="disabilities", keywords="cancer", keywords="oncology", keywords="heuristics", keywords="empowerment", keywords="advocacy", keywords="mindfulness", keywords="problem-solving", abstract="Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen's 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app's design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. ", doi="10.2196/51522", url="https://humanfactors.jmir.org/2024/1/e51522", url="http://www.ncbi.nlm.nih.gov/pubmed/38564261" } @Article{info:doi/10.2196/52365, author="Silva, Rui and Morou{\c{c}}o, Pedro and Lains, Jorge and Amorim, Paula and Alves, Nuno and Veloso, Prieto Ant{\'o}nio", title="Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial", journal="JMIR Res Protoc", year="2024", month="Apr", day="2", volume="13", pages="e52365", keywords="3D printing", keywords="3D scanner", keywords="ankle foot orthosis", keywords="biomechanical analysis", keywords="equinovarus foot", abstract="Background: Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. Objective: This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. Methods: A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications. Results: Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. Conclusions: Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/52365 ", doi="10.2196/52365", url="https://www.researchprotocols.org/2024/1/e52365", url="http://www.ncbi.nlm.nih.gov/pubmed/38564249" } @Article{info:doi/10.2196/54425, author="Choi, Hyeonkyeong and Kim, Seunghee and Jang, Wonseuk", title="User Experience Evaluation of a Spinal Surgery Robot: Workload, Usability, and Satisfaction Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="1", volume="11", pages="e54425", keywords="robot spine surgery", keywords="usability", keywords="satisfaction", keywords="System Usability Scale", keywords="surgical navigation systems", keywords="robotics", keywords="surgery", keywords="neurosurgery", abstract="Background: Robotic spine surgery has continued to evolve since its US Food and Drug Administration approval in 2004, with products now including real-time video guidance and navigation during surgery. As the market for robotic surgical devices evolves, it is important to consider usability factors. Objective: The primary objective of this study was to determine the user experience of a surgical-assistive robotic device. The secondary objective was to evaluate workload, usability, the After-Scenario Questionnaire (ASQ), and the System Usability Scale (SUS). In addition, this study compares the workload, usability, and satisfaction survey of the device among different occupational groups using the device. Methods: Doctors (n=15) and nurses (n=15), the intended users of the surgical assistant robot, participated in the usability evaluation. Participants performed essential scenarios for the surgical assistant robot and provided scenario-specific satisfaction (ASQ), workload (NASA Task Load Index), and usability (SUS) scores. Results: Both doctors and nurses had task success rates of 85\% or higher for each scenario. ASQ results showed that both doctors and nurses were least satisfied with ease of completing the task of registration (group 1: mean 4.73, SD 1.57 and group 2: mean 4.47, SD 1.8), amount of time it took (group 1: mean 4.47, SD 1.63 and group 2: mean 4.40, SD 2.09), and support information satisfaction (group 1: mean 5.13, SD 1.50 and group 2: mean 5.13, SD 1.89). All participants had low workloads, and the overall Task Load Index score had a P value of .77, which is greater than .05. The SUS results showed that the overall usability mean for doctors was 64.17 (SD 16.52) and the mean for nurses was 61.67 (SD 19.18), with a P value of .84, which is greater than .05, indicating no difference between the 2 groups. Conclusions: In this study, doctors and nurses evaluated the interaction of the device in a simulated environment, the operating room. By evaluating the use experience and usability of the device with real intended users, we can develop a more effective and convenient user interface. ", doi="10.2196/54425", url="https://humanfactors.jmir.org/2024/1/e54425", url="http://www.ncbi.nlm.nih.gov/pubmed/38432688" } @Article{info:doi/10.2196/52920, author="Acharya, Harshdeep and Sykes, J. Kevin and Neira, Mir{\'a}s Ton and Scott, Angela and Pacheco, M. Christina and Sanner, Matthew and Ablah, Elizabeth and Oyowe, Kevin and Ellerbeck, F. Edward and Greiner, Allen K. and Corriveau, A. Erin and Finocchario-Kessler, Sarah", title="A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Apr", day="1", volume="8", pages="e52920", keywords="public health", keywords="database", keywords="community health worker", keywords="social determinants of health", keywords="health worker", keywords="health workers", keywords="CHW", keywords="CHWs", keywords="community-based", keywords="data collection", keywords="functionality", keywords="develop", keywords="development", keywords="EHR", keywords="EHRs", keywords="EMR", keywords="EMRs", keywords="dashboard", keywords="dashboards", keywords="health record", keywords="health records", keywords="documentation", keywords="medical record", keywords="medical records", keywords="equity", keywords="inequity", keywords="inequities", abstract="Background: The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. Objective: We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. Methods: The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. Results: At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84\% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44\%) or satisfied (15/32, 48\%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act--compliant record system, improved client engagement, enrollment processes, and identification of resources. Conclusions: Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings. ", doi="10.2196/52920", url="https://formative.jmir.org/2024/1/e52920", url="http://www.ncbi.nlm.nih.gov/pubmed/38557671" } @Article{info:doi/10.2196/51058, author="Thomas, Amy and Asnes, Andrea and Libby, Kyle and Hsiao, Allen and Tiyyagura, Gunjan", title="Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Mar", day="29", volume="26", pages="e51058", keywords="child abuse", keywords="clinical decision support", keywords="CDS", keywords="pediatrics", keywords="child", keywords="children", keywords="natural language processing", keywords="usability", keywords="clinical decision support system", keywords="physical abuse", abstract="Background: Despite the impact of physical abuse on children, it is often underdiagnosed, especially among children evaluated in emergency departments (EDs). Electronic clinical decision support (CDS) can improve the recognition of child physical abuse. Objective: We aimed to develop and test the usability of a natural language processing--based child abuse CDS system, known as the Child Abuse Clinical Decision Support (CA-CDS), to alert ED clinicians about high-risk injuries suggestive of abuse in infants' charts. Methods: Informed by available evidence, a multidisciplinary team, including an expert in user design, developed the CA-CDS prototype that provided evidence-based recommendations for the evaluation and management of suspected child abuse when triggered by documentation of a high-risk injury. Content was customized for medical versus nursing providers and initial versus subsequent exposure to the alert. To assess the usability of and refine the CA-CDS, we interviewed 24 clinicians from 4 EDs about their interactions with the prototype. Interview transcripts were coded and analyzed using conventional content analysis. Results: Overall, 5 main categories of themes emerged from the study. CA-CDS benefits included providing an extra layer of protection, providing evidence-based recommendations, and alerting the entire clinical ED team. The user-centered, workflow-compatible design included soft-stop alert configuration, editable and automatic documentation, and attention-grabbing formatting. Recommendations for improvement included consolidating content, clearer design elements, and adding a hyperlink with additional resources. Barriers to future implementation included alert fatigue, hesitancy to change, and concerns regarding documentation. Facilitators of future implementation included stakeholder buy-in, provider education, and sharing the test characteristics. On the basis of user feedback, iterative modifications were made to the prototype. Conclusions: With its user-centered design and evidence-based content, the CA-CDS can aid providers in the real-time recognition and evaluation of infant physical abuse and has the potential to reduce the number of missed cases. ", doi="10.2196/51058", url="https://www.jmir.org/2024/1/e51058", url="http://www.ncbi.nlm.nih.gov/pubmed/38551639" } @Article{info:doi/10.2196/55199, author="He, Yunfan and Zhu, Wei and Wang, Tong and Chen, Han and Xin, Junyi and Liu, Yongcheng and Lei, Jianbo and Liang, Jun", title="Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study", journal="JMIR Mhealth Uhealth", year="2024", month="Mar", day="28", volume="12", pages="e55199", keywords="hypertension management", keywords="mobile health", keywords="topic modeling", keywords="satisfaction", keywords="2-factor model", keywords="comparative study", abstract="Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22\% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73\%) compared with that for American HMAs (73,907/100,125, 73.81\%). Chinese users primarily focus on reliability (2165/16,561, 13.07\%) and measurement accuracy (2091/16,561, 12.63\%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26\%) and data synchronization (12,837/100,125, 12.82\%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD ($\beta$=.354, P<.001), while cost had the most significant impact on ND ($\beta$=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD ($\beta$=0.312, P<.001), while data synchronization had the most significant impact on ND ($\beta$=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. ", doi="10.2196/55199", url="https://mhealth.jmir.org/2024/1/e55199", url="http://www.ncbi.nlm.nih.gov/pubmed/38547475" } @Article{info:doi/10.2196/54073, author="Liu, Y. Albert and Alleyne, Cat-Dancing and Doblecki-Lewis, Susanne and Koester, A. Kimberly and Gonzalez, Rafael and Vinson, Janie and Scott, Hyman and Buchbinder, Susan and Torres, S. Thiago", title="Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial", journal="JMIR Form Res", year="2024", month="Mar", day="27", volume="8", pages="e54073", keywords="preexposure prophylaxis", keywords="PrEP", keywords="Spanish-speaking", keywords="Latino", keywords="transgender", keywords="men who have sex with men", keywords="mobile health", keywords="mHealth", keywords="HIV prevention", keywords="HIV", keywords="technology", keywords="formative", keywords="development", keywords="mobile technology, mobile app", keywords="text-messaging", keywords="SMS", keywords="app", keywords="application", keywords="USA", keywords="United States", keywords="health equity", keywords="mHealth tool", keywords="tool", keywords="acceptability", keywords="self-management", keywords="pilot", keywords="support", abstract="Background: A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed. Objective: The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools. Methods: PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools. Results: Participants in focus groups liked the ``human touch'' of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the ``good'' to ``excellent'' range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools. Conclusions: Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial. ", doi="10.2196/54073", url="https://formative.jmir.org/2024/1/e54073", url="http://www.ncbi.nlm.nih.gov/pubmed/38536232" } @Article{info:doi/10.2196/56892, author="Irvine, Kathryn Mary and Zimba, Rebecca and Avoundjian, Tigran and Peterson, Meghan and Emmert, Connor and Kulkarni, G. Sarah and Philbin, M. Morgan and Kelvin, A. Elizabeth and Nash, Denis", title="Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York", journal="JMIR Res Protoc", year="2024", month="Mar", day="27", volume="13", pages="e56892", keywords="HIV", keywords="implementation science", keywords="long-acting injectables", keywords="LAI", keywords="patient decision aid", keywords="medical case management", keywords="MCM", keywords="antiretroviral therapy", keywords="ART", abstract="Background: Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. Objective: This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. Methods: In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. Results: The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. Conclusions: This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. Trial Registration: Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542 International Registered Report Identifier (IRRID): DERR1-10.2196/56892 ", doi="10.2196/56892", url="https://www.researchprotocols.org/2024/1/e56892", url="http://www.ncbi.nlm.nih.gov/pubmed/38536227" } @Article{info:doi/10.2196/53593, author="Cyrkot, Samantha and Hartling, Lisa and Scott, D. Shannon and Elliott, A. Sarah", title="Parents' User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study", journal="JMIR Form Res", year="2024", month="Mar", day="20", volume="8", pages="e53593", keywords="awareness", keywords="COVID-19", keywords="credibility", keywords="credible", keywords="descriptive", keywords="guidelines", keywords="health evidence", keywords="information behavior", keywords="information needs", keywords="information seeking", keywords="information-seeking behaviour", keywords="interface", keywords="internet", keywords="interview", keywords="knowledge mobilization", keywords="parent", keywords="parenting", keywords="public health", keywords="qualitative", keywords="recommendation", keywords="recommender", keywords="SARS-CoV-2", keywords="think-aloud activity", keywords="think-aloud", keywords="trust", keywords="trustworthy", keywords="usability", keywords="user experience", keywords="web design", keywords="website", abstract="Background: The eCOVID19 Recommendations Map \& Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents' experiences when accessing and using the RecMap website for COVID-19 health decision-making. Objective: To explore (1) where parents look for COVID-19 health information and why, (2) parents' user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents' awareness, use, and engagement with the RecMap website. Methods: We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to ``think aloud'' as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis. Results: A total of 21 participants (13/21, 62\% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants' information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often. Conclusions: Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public. ", doi="10.2196/53593", url="https://formative.jmir.org/2024/1/e53593", url="http://www.ncbi.nlm.nih.gov/pubmed/38506915" } @Article{info:doi/10.2196/55205, author="Poudyal, Anubhuti and Lewis, Delta-Marie and Taha, Sarah and Martinez, J. Alyssa and Magoun, Lauren and Ho, Xian Y. and Carmio, Natali and Naslund, A. John and Sanchez, Katherine and Lesh, Neal and Patel, Vikram", title="Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study", journal="JMIR Form Res", year="2024", month="Mar", day="11", volume="8", pages="e55205", keywords="digital technology", keywords="mental health", keywords="depression", keywords="task sharing", keywords="nonspecialist providers", keywords="peer supervision", keywords="therapy quality", abstract="Background: The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. Objective: We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. Methods: We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. Results: A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83\%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. Conclusions: We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States. ", doi="10.2196/55205", url="https://formative.jmir.org/2024/1/e55205", url="http://www.ncbi.nlm.nih.gov/pubmed/38466971" } @Article{info:doi/10.2196/45275, author="Savolainen, Kaisa and Kujala, Sari", title="Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services", journal="JMIR Hum Factors", year="2024", month="Mar", day="8", volume="11", pages="e45275", keywords="eHealth", keywords="online symptom checkers", keywords="usability", keywords="cognitive accessibility", keywords="web accessibility", keywords="qualitative research", abstract="Background: The popularity of eHealth services has surged significantly, underscoring the importance of ensuring their usability and accessibility for users with diverse needs, characteristics, and capabilities. These services can pose cognitive demands, especially for individuals who are unwell, fatigued, or experiencing distress. Additionally, numerous potentially vulnerable groups, including older adults, are susceptible to digital exclusion and may encounter cognitive limitations related to perception, attention, memory, and language comprehension. Regrettably, many studies overlook the preferences and needs of user groups likely to encounter challenges associated with these cognitive aspects. Objective: This study primarily aims to gain a deeper understanding of cognitive accessibility in the practical context of eHealth services. Additionally, we aimed to identify the specific challenges that vulnerable groups encounter when using eHealth services and determine key considerations for testing these services with such groups. Methods: As a case study of eHealth services, we conducted qualitative usability testing on 2 online symptom checkers used in Finnish public primary care. A total of 13 participants from 3 distinct groups participated in the study: older adults, individuals with mild intellectual disabilities, and nonnative Finnish speakers. The primary research methods used were the thinking-aloud method, questionnaires, and semistructured interviews. Results: We found that potentially vulnerable groups encountered numerous issues with the tested services, with similar problems observed across all 3 groups. Specifically, clarity and the use of terminology posed significant challenges. The services overwhelmed users with excessive information and choices, while the terminology consisted of numerous complex medical terms that were difficult to understand. When conducting tests with vulnerable groups, it is crucial to carefully plan the sessions to avoid being overly lengthy, as these users often require more time to complete tasks. Additionally, testing with vulnerable groups proved to be quite efficient, with results likely to benefit a wider audience as well. Conclusions: Based on the findings of this study, it is evident that older adults, individuals with mild intellectual disability, and nonnative speakers may encounter cognitive challenges when using eHealth services, which can impede or slow down their use and make the services more difficult to navigate. In the worst-case scenario, these challenges may lead to errors in using the services. We recommend expanding the scope of testing to include a broader range of eHealth services with vulnerable groups, incorporating users with diverse characteristics and capabilities who are likely to encounter difficulties in cognitive accessibility. ", doi="10.2196/45275", url="https://humanfactors.jmir.org/2024/1/e45275", url="http://www.ncbi.nlm.nih.gov/pubmed/38457214" } @Article{info:doi/10.2196/51116, author="Rettinger, Lena and Sch{\"o}nthaler, Erna and Kerschbaumer, Andrea and Hauser, Carina and Klupper, Carissa and Aichinger, Lea and Werner, Franz", title="Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Mar", day="7", volume="11", pages="e51116", keywords="handwriting", keywords="handwriting pressure", keywords="pen", keywords="children", keywords="occupational therapy", keywords="assistive technology", keywords="tablet", keywords="app", abstract="Background: The acquisition of handwriting skills is essential for a child's academic success, self-confidence, and general school performance. Nevertheless, an estimated 5\% to 27\% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. Objective: We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). Methods: A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. Results: The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child's awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs---usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. Conclusions: The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system's impact. ", doi="10.2196/51116", url="https://rehab.jmir.org/2024/1/e51116", url="http://www.ncbi.nlm.nih.gov/pubmed/38451584" } @Article{info:doi/10.2196/50926, author="Anders, Carolin and Moorthy, Preetha and Svensson, Laura and M{\"u}ller, Julia and Heinze, Oliver and Knaup, Petra and Wallwiener, Markus and Deutsch, M. Thomas and Le, Thao-Vy and Weinert, Lina", title="Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking", journal="JMIR Hum Factors", year="2024", month="Mar", day="5", volume="11", pages="e50926", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="breast cancer", keywords="eye tracking", keywords="user interface", keywords="mixed methods", keywords="mobile phone", abstract="Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app's content regularly, and self-administration. In contrast to the app's current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients' feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. ", doi="10.2196/50926", url="https://humanfactors.jmir.org/2024/1/e50926", url="http://www.ncbi.nlm.nih.gov/pubmed/38441959" } @Article{info:doi/10.2196/52442, author="Keogh, Alison and Brennan, Carol and Johnston, William and Dickson, Jane and Leslie, J. Stephen and Burke, David and Megyesi, Peter and Caulfield, Brian", title="Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Mar", day="1", volume="8", pages="e52442", keywords="digital health", keywords="heart failure", keywords="cardiology", keywords="self-care", keywords="behavior change", keywords="eHealth", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="mobile phone", keywords="elderly", keywords="self-management", keywords="digital tools", keywords="digital tool", keywords="human-centered design", keywords="app", keywords="apps", keywords="applications", keywords="wearables", keywords="wearable", keywords="Fitbit", keywords="usability", keywords="adherence", keywords="feasibility", keywords="congestive heart failure", keywords="cardiac failure", keywords="myocardial failure", keywords="heart decompensation", abstract="Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2\% of the days in the 6-month testing period ranging from 40.6\% to 98\%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. ", doi="10.2196/52442", url="https://formative.jmir.org/2024/1/e52442", url="http://www.ncbi.nlm.nih.gov/pubmed/38427410" } @Article{info:doi/10.2196/50528, author="Ni, Chenxu and Wang, Yi-fu and Zhang, Yun-ting and Yuan, Min and Xu, Qing and Shen, Fu-ming and Li, Dong-Jie and Huang, Fang", title="A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study", journal="JMIR Form Res", year="2024", month="Feb", day="29", volume="8", pages="e50528", keywords="WeChat applet", keywords="usability testing", keywords="utility testing", keywords="cancer patients", keywords="patients", keywords="cancer", keywords="qualitative study", abstract="Background: Medication adherence and the management of adverse drug reactions (ADRs) are crucial to the efficacy of antitumor drugs. A WeChat applet, also known as a ``Mini Program,'' is similar to the app but has marked advantages. The development and use of a WeChat applet makes follow-up convenient for patients with cancer. Objective: This study aimed to assess the usability and utility of a newly developed WeChat applet, ``DolphinCare,'' among patients with cancer in Shanghai. Methods: A qualitative methodology was used to obtain an in-depth understanding of the experiences of patients with cancer when using DolphinCare from the usability and utility aspects. The development phase consisted of 2 parts: alpha and beta testing. Alpha testing combined the theory of the Fogg Behavior Model and the usability model. Alpha testing also involved testing the design of DolphinCare using a conceptual framework, which included factors that could affect medication adherence and ADRs. Beta testing was conducted using in-depth interviews. In-depth interviews allowed us to assist the patients in using DolphinCare and understand whether they liked or disliked DolphinCare and found it useful. Results: We included participants who had an eHealth Literacy Scale (eHEALS) score of ?50\%, and a total of 20 participants were interviewed consecutively. The key positive motivators described by interviewers were to be reminded to take their medications and to alleviate their ADRs. The majority of the patients were able to activate and use DolphinCare by themselves. Most patients indicated that their trigger to follow-up DolphinCare was the recommendation of their known and trusted health care professionals. All participants found that labels containing the generic names of their medication and the medication reminders were useful, including timed pop-up push notifications and text alerts. The applet presented the corresponding information collection forms of ADRs to the patient to fill out. The web-based consultation system enables patients to consult pharmacists or physicians in time when they have doubts about medications or have ADRs. The applet had usabilities and utilities that could improve medication adherence and the management of ADRs among patients with cancer. Conclusions: This study provides preliminary evidence regarding the usability and utility of this type of WeChat applet among patients with cancer, which is expected to be promoted for managing follow-up among other patients with other chronic disease. ", doi="10.2196/50528", url="https://formative.jmir.org/2024/1/e50528", url="http://www.ncbi.nlm.nih.gov/pubmed/38421700" } @Article{info:doi/10.2196/55246, author="Lee, Audrey and Dionicio, Patricia and Farcas, Emilia and Godino, Job and Patrick, Kevin and Wyckoff, Elijah and Loh, J. Kenneth and Gombatto, Sara", title="Physical Therapists' Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study", journal="JMIR Hum Factors", year="2024", month="Feb", day="29", volume="11", pages="e55246", keywords="low back pain", keywords="physical therapy", keywords="physical therapist", keywords="wearable sensor", keywords="technology acceptance model", keywords="motion tape", keywords="kinesiology tape", abstract="Background: Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists' acceptance of Motion Tape remains unexplored. Objective: The primary aim of this research study was to evaluate physical therapists' acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists' recommendations for future device development. Methods: Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. Results: Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. Conclusions: Several themes related to Motion Tape's wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape's potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice. ", doi="10.2196/55246", url="https://humanfactors.jmir.org/2024/1/e55246", url="http://www.ncbi.nlm.nih.gov/pubmed/38421708" } @Article{info:doi/10.2196/53991, author="Schmitz, Boris and Wirtz, Svenja and Sestayo-Fern{\'a}ndez, Manuela and Sch{\"a}fer, Hendrik and Douma, R. Emma and Alonso Vazquez, Marta and Gonz{\'a}lez-Salvado, Violeta and Habibovic, Mirela and Gatsios, Dimitris and Kop, Johan Willem and Pe{\~n}a-Gil, Carlos and Mooren, Frank", title="Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis", journal="J Med Internet Res", year="2024", month="Feb", day="22", volume="26", pages="e53991", keywords="eHealth", keywords="coronary artery disease", keywords="rehabilitation", keywords="mHealth", keywords="mobile health", keywords="mobile phone", keywords="app", keywords="apps", keywords="applications", keywords="personalized medicine", keywords="patient empowerment", keywords="living lab", keywords="coronary", keywords="cardiac", keywords="cardiology", keywords="heart", keywords="telehealth", keywords="telemedicine", keywords="monitoring", keywords="survey", keywords="surveys", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="acceptance", keywords="technology use", keywords="usage", abstract="Background: The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients' needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions. Objective: The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance. Methods: A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20\%) and men (63/79, 80\%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients' perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices. Results: All the patients in this study owned a smartphone, while 30\%-40\% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71\% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35\%-50\% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components. Conclusions: The patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful. Trial Registration: ClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729 ", doi="10.2196/53991", url="https://www.jmir.org/2024/1/e53991", url="http://www.ncbi.nlm.nih.gov/pubmed/38386376" } @Article{info:doi/10.2196/49952, author="Pease, Anna and Ingram, Jenny and Lambert, Becky and Patrick, Karen and Pitts, Kieren and Fleming, J. Peter and Blair, S. Peter and ", title="A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner", journal="JMIR Pediatr Parent", year="2024", month="Feb", day="22", volume="7", pages="e49952", keywords="safer sleep", keywords="parent education", keywords="co-design", keywords="process evaluation", keywords="sudden infant death syndrome", keywords="SIDS", keywords="sleep", keywords="baby", keywords="babies", keywords="infant", keywords="infants", keywords="prototype", keywords="interface", keywords="develop", keywords="development", keywords="sleeping", keywords="pattern", keywords="tool", keywords="parent", keywords="infant mortality", keywords="risk", keywords="risks", keywords="assessment", keywords="death", keywords="mortality", keywords="parents", keywords="parenting", keywords="risk assessment", keywords="sudden unexpected death in infancy", keywords="SUDI", keywords="approach", keywords="antenatal", keywords="postnatal", keywords="user testing", keywords="user experience", keywords="web-based", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", abstract="Background: Successful national safer sleep campaigns in the United Kingdom have lowered the death rates from sudden unexpected death in infancy (SUDI) over the past 3 decades, but deaths persist in socioeconomically deprived families. The circumstances of current deaths suggest that improvements in support for some families to follow safer sleep advice more consistently could save lives. Objective: This study aimed to develop and evaluate a risk assessment and planning tool designed to improve the uptake of safer sleep advice in families with infants at increased risk of SUDI. Methods: A co-design approach was used to develop the prototype interface of a web-based tool with 2 parts: an individual SUDI risk assessment at birth and a downloadable plan for safety during times of disruption. The advice contained within the tool is concordant with national guidance from the Lullaby Trust, the United Nations International Children's Emergency Fund (UNICEF), and the National Institute for Health and Care Excellence. User testing of the prototype tool was conducted by inviting health visitors, midwives, and family nurses to use it with families eligible for additional support. Qualitative interviews with health professionals and families allowed for iterative changes to the tool and for insights into its function and influence on parental behavior. Results: A total of 22 health professionals were enrolled in the study, of whom 20 (91\%) were interviewed. They reported appreciating the functionality of the tool, which allowed them to identify at-risk families for further support. They felt that the tool improved how they communicated about risks with families. They suggested expanding its use to include relevance in the antenatal period and having versions available in languages other than English. They reported using the tool with 58 families; 20 parents gave consent to be interviewed by the research team about their experiences with the tool. Families were positive about the tool, appreciated the trustworthy information, and felt that it was useful and appropriate and that the plans for specific infant sleeps would be of benefit to them and other family members. Conclusions: Our tool combines risk assessment and safety planning, both of which have the potential to improve the uptake of lifesaving advice. Refinements to the tool based on these findings have ensured that the tool is ready for further evaluation in a larger study before being rolled out to families with infants at increased risk. ", doi="10.2196/49952", url="https://pediatrics.jmir.org/2024/1/e49952", url="http://www.ncbi.nlm.nih.gov/pubmed/38386377" } @Article{info:doi/10.2196/48445, author="{\O}stervang, Christina and Jensen, Myhre Charlotte and Coyne, Elisabeth and Dieperink, B. Karin and Lassen, Annmarie", title="Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Feb", day="21", volume="11", pages="e48445", keywords="consumer", keywords="eHealth", keywords="elderly", keywords="emergency department", keywords="emergency", keywords="family members", keywords="healthcare professionals", keywords="information system", keywords="mixed methods research: patients", keywords="qualitative interview", keywords="questionnaire", keywords="technology", keywords="usability", keywords="usable", abstract="Background: A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient. Objective: This study aimed to evaluate the usability and experience of a newly developed information system. The system was developed together with patients and their family members to help provide the information needed in the ED. Methods: We conducted a mixed methods study consisting of quantitative data obtained from the System Usability Scale questionnaire and qualitative interview data obtained from purposively selected participants included in the quantitative part of the study. Results: A total of 106 patients and 14 family members (N=120) answered the questionnaire. A total of 10 patients and 3 family members participated in the interviews. Based on the System Usability Scale score, the information system was rated close to excellent, with a mean score of 83.6 (SD 12.8). Most of the participants found the information system easy to use and would like to use it again. The participants reported that the system helped them feel in control, and the information was useful. Simplifications were needed to improve the user experience for the older individuals. Conclusions: This study demonstrates that the usability of the information system is rated close to excellent. It was perceived to be useful as it enabled understanding and predictability of the patient's trajectory in the ED. Areas for improvement include making the system more usable by older individuals. The study provides an example of how a technological solution can be used to diminish the information gap in an ED context. ", doi="10.2196/48445", url="https://humanfactors.jmir.org/2024/1/e48445", url="http://www.ncbi.nlm.nih.gov/pubmed/38381502" } @Article{info:doi/10.2196/49557, author="Hahn, Christine and Tilstra-Ferrell, Emily and Salim, Selime and Goodrum, Nada and Rheingold, Alyssa and Gilmore, K. Amanda and Barber, Sara and Moreland, Angela", title="Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study", journal="JMIR Form Res", year="2024", month="Feb", day="15", volume="8", pages="e49557", keywords="screening, brief intervention, and referral to treatment", keywords="brief intervention", keywords="intimate partner violence", keywords="sexual assault", keywords="substance use", keywords="alcohol use", keywords="mobile phone", abstract="Background: Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. Objective: This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. Methods: Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42\%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25\%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33\%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). Results: Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. Conclusions: Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA. ", doi="10.2196/49557", url="https://formative.jmir.org/2024/1/e49557", url="http://www.ncbi.nlm.nih.gov/pubmed/38358791" } @Article{info:doi/10.2196/54668, author="Ma, Yuanchao and Achiche, Sofiane and Pomey, Marie-Pascale and Paquette, Jesseca and Adjtoutah, Nesrine and Vicente, Serge and Engler, Kim and and Laymouna, Moustafa and Lessard, David and Lemire, Beno{\^i}t and Asselah, Jamil and Therrien, Rachel and Osmanlliu, Esli and Zawati, H. Ma'n and Joly, Yann and Lebouch{\'e}, Bertrand", title="Adapting and Evaluating an AI-Based Chatbot Through Patient and Stakeholder Engagement to Provide Information for Different Health Conditions: Master Protocol for an Adaptive Platform Trial (the MARVIN Chatbots Study)", journal="JMIR Res Protoc", year="2024", month="Feb", day="13", volume="13", pages="e54668", keywords="chatbot", keywords="master protocol", keywords="adaptive platform trial design", keywords="implementation science", keywords="telehealth", keywords="digital health", keywords="Canada", keywords="artificial intelligence", keywords="conversational agent", keywords="self-management", keywords="research ethics", keywords="patient and stakeholder engagement", keywords="co-construction", keywords="mobile phone", abstract="Background: Artificial intelligence (AI)--based chatbots could help address some of the challenges patients face in acquiring information essential to their self-health management, including unreliable sources and overburdened health care professionals. Research to ensure the proper design, implementation, and uptake of chatbots is imperative. Inclusive digital health research and responsible AI integration into health care require active and sustained patient and stakeholder engagement, yet corresponding activities and guidance are limited for this purpose. Objective: In response, this manuscript presents a master protocol for the development, testing, and implementation of a chatbot family in partnership with stakeholders. This protocol aims to help efficiently translate an initial chatbot intervention (MARVIN) to multiple health domains and populations. Methods: The MARVIN chatbots study has an adaptive platform trial design consisting of multiple parallel individual chatbot substudies with four common objectives: (1) co-construct a tailored AI chatbot for a specific health care setting, (2) assess its usability with a small sample of participants, (3) measure implementation outcomes (usability, acceptability, appropriateness, adoption, and fidelity) within a large sample, and (4) evaluate the impact of patient and stakeholder partnerships on chatbot development. For objective 1, a needs assessment will be conducted within the setting, involving four 2-hour focus groups with 5 participants each. Then, a co-construction design committee will be formed with patient partners, health care professionals, and researchers who will participate in 6 workshops for chatbot development, testing, and improvement. For objective 2, a total of 30 participants will interact with the prototype for 3 weeks and assess its usability through a survey and 3 focus groups. Positive usability outcomes will lead to the initiation of objective 3, whereby the public will be able to access the chatbot for a 12-month real-world implementation study using web-based questionnaires to measure usability, acceptability, and appropriateness for 150 participants and meta-use data to inform adoption and fidelity. After each objective, for objective 4, focus groups will be conducted with the design committee to better understand their perspectives on the engagement process. Results: From July 2022 to October 2023, this master protocol led to four substudies conducted at the McGill University Health Centre or the Centre hospitalier de l'Universit{\'e} de Montr{\'e}al (both in Montreal, Quebec, Canada): (1) MARVIN for HIV (large-scale implementation expected in mid-2024), (2) MARVIN-Pharma for community pharmacists providing HIV care (usability study planned for mid-2024), (3) MARVINA for breast cancer, and (4) MARVIN-CHAMP for pediatric infectious conditions (both in preparation, with development to begin in early 2024). Conclusions: This master protocol offers an approach to chatbot development in partnership with patients and health care professionals that includes a comprehensive assessment of implementation outcomes. It also contributes to best practice recommendations for patient and stakeholder engagement in digital health research. Trial Registration: ClinicalTrials.gov NCT05789901; https://classic.clinicaltrials.gov/ct2/show/NCT05789901 International Registered Report Identifier (IRRID): PRR1-10.2196/54668 ", doi="10.2196/54668", url="https://www.researchprotocols.org/2024/1/e54668", url="http://www.ncbi.nlm.nih.gov/pubmed/38349734" } @Article{info:doi/10.2196/50582, author="Lai, Byron and Wadsworth, Danielle and Spring, Katherine and Jones, S. Chloe and Mintz, Madison and Malone, A. Laurie and Kim, Yumi and Wilroy, Jereme and Lee, Holim", title="Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Feb", day="12", volume="11", pages="e50582", keywords="cerebral palsy", keywords="telehealth", keywords="young adults", keywords="telemonitoring", keywords="exercise", keywords="therapy", keywords="therapeutic exercise", keywords="assessment", keywords="teleassessment", keywords="reliability", keywords="usability", keywords="disability", keywords="youth", keywords="physical fitness", keywords="videoconference", abstract="Background: Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities. Objective: The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration. Methods: The study enrolled 19 ambulatory youth: 9 (47\%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53\%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots. Results: The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95\% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05). Conclusions: This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability. ", doi="10.2196/50582", url="https://rehab.jmir.org/2024/1/e50582", url="http://www.ncbi.nlm.nih.gov/pubmed/38345838" } @Article{info:doi/10.2196/49316, author="McElwain, L. Nancy and Fisher, C. Meghan and Nebeker, Camille and Bodway, M. Jordan and Islam, Bashima and Hasegawa-Johnson, Mark", title="Evaluating Users' Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach", journal="JMIR Hum Factors", year="2024", month="Feb", day="8", volume="11", pages="e49316", keywords="wearable devices", keywords="multimodal sensing", keywords="user experience", keywords="usability", keywords="privacy", keywords="children", keywords="mobile phone", abstract="Background: Wearable devices permit the continuous, unobtrusive collection of data from children in their natural environments and can transform our understanding of child development. Although the use of wearable devices has begun to emerge in research involving children, few studies have considered families' experiences and perspectives of participating in research of this kind. Objective: Through a mixed methods approach, we assessed parents' and children's experiences of using a new wearable device in the home environment. The wearable device was designed specifically for use with infants and young children, and it integrates audio, electrocardiogram, and motion sensors. Methods: In study 1, semistructured phone interviews were conducted with 42 parents of children aged 1 month to 9.5 years who completed 2 day-long recordings using the device, which the children wore on a specially designed shirt. In study 2, a total of 110 parents of children aged 2 months to 5.5 years responded to a questionnaire assessing their experience of completing 3 day-long device recordings in the home. Guided by the Digital Health Checklist, we assessed parental responses from both studies in relation to the following three key domains: (1) access and usability, (2) privacy, and (3) risks and benefits. Results: In study 1, most parents viewed the device as easy to use and safe and remote visits as convenient. Parents' views on privacy related to the audio recordings were more varied. The use of machine learning algorithms (vs human annotators) in the analysis of the audio data, the ability to stop recordings at any time, and the view that the recordings reflected ordinary family life were some reasons cited by parents who expressed minimal, if any, privacy concerns. Varied risks and benefits were also reported, including perceived child comfort or discomfort, the need to adjust routines to accommodate the study, the understanding gained from the study procedures, and the parent's and child's enjoyment of study participation. In study 2, parents' ratings on 5 close-ended items yielded a similar pattern of findings. Compared with a ``neutral'' rating, parents were significantly more likely to agree that (1) device instructions were helpful and clear (t109=?45.98; P<.001), (2) they felt comfortable putting the device on their child (t109=?22.22; P<.001), and (3) they felt their child was safe while wearing the device (t109=?34.48; P<.001). They were also less likely to worry about the audio recordings gathered by the device (t108=6.14; P<.001), whereas parents' rating of the burden of the study procedures did not differ significantly from a ``neutral'' rating (t109=?0.16; P=.87). Conclusions: On the basis of parents' feedback, several concrete changes can be implemented to improve this new wearable platform and, ultimately, parents' and children's experiences of using child wearable devices in the home setting. ", doi="10.2196/49316", url="https://humanfactors.jmir.org/2024/1/e49316", url="http://www.ncbi.nlm.nih.gov/pubmed/38329785" } @Article{info:doi/10.2196/47360, author="Bhattacharjee, Ananya and Chen, Pan and Mandal, Abhijoy and Hsu, Anne and O'Leary, Katie and Mariakakis, Alex and Williams, Jay Joseph", title="Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Feb", day="8", volume="8", pages="e47360", keywords="reflection", keywords="mental health", keywords="stress", keywords="reflective questioning activity", keywords="RQA", keywords="brief intervention", keywords="computer-mediated communication", keywords="email", keywords="SMS text messaging", keywords="mobile phone", abstract="Background: Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives. Objective: The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure. Methods: We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA's real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants. Results: In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants' subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations. Conclusions: This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles. ", doi="10.2196/47360", url="https://formative.jmir.org/2024/1/e47360", url="http://www.ncbi.nlm.nih.gov/pubmed/38329800" } @Article{info:doi/10.2196/45492, author="Elavsky, Steriani and Knapova, Lenka and Jani{\vs}, Kamil and Cimler, Richard and Kuhnova, Jitka and Cernicky, Tomas", title="Multiple Perspectives on the Adoption of SMART Technologies for Improving Care of Older People: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Feb", day="7", volume="26", pages="e45492", keywords="adults", keywords="older", keywords="technologies", keywords="technological", keywords="caregivers", keywords="SMART", keywords="mobile phone", abstract="Background: Despite the ever-increasing offering of SMART technologies (ie, computer-controlled devices acting intelligently and capable of monitoring, analyzing or reporting), a wide gap exists between the development of new technological innovations and their adoption in everyday care for older adults. Objective: This study aims to explore the barriers and concerns related to the adoption of SMART technologies among different groups of stakeholders. Methods: Data from 4 sources were used: semistructured in-person or internet-based interviews with professional caregivers (n=12), structured email interviews with experts in the area of aging (n=9), a web-based survey of older adults (>55 years) attending the Virtual University of the Third Age (n=369), and a case study on the adoption of new technology by an older adult care facility. Results: Although all stakeholders noted the potential of SMART technologies to improve older adult care, multiple barriers to their adoption were identified. Caregivers perceived older adults as disinterested or incompetent in using technology, reported preferring known strategies over new technologies, and noted own fears of using technology. Experts viewed technologies as essential but expressed concerns about cost, low digital competency of older adults, and lack of support or willingness to implement technologies in older adult care. Older adults reported few concerns overall, but among the mentioned concerns were lack of ability or interest, misuse of data, and limited usefulness (in specific subgroups or situations). In addition, older adults' ratings of the usefulness of different technologies correlated with their self-rating of digital competency (r=0.258; P<.001). Conclusions: Older adults appeared to have more positive views of various technologies than professional caregivers; however, their concerns varied by the type of technology. Lack of competence and lack of support were among the common themes, suggesting that educationally oriented programs for both older adults and their caregivers should be pursued. ", doi="10.2196/45492", url="https://www.jmir.org/2024/1/e45492", url="http://www.ncbi.nlm.nih.gov/pubmed/38324345" } @Article{info:doi/10.2196/52096, author="Dryden, M. Eileen and Anwar, Chitra and Conti, Jennifer and Boudreau, H. Jacqueline and Kennedy, A. Meaghan and Hung, W. William and Nearing, A. Kathryn and Pimentel, B. Camilla and Moo, Lauren", title="The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults", journal="JMIR Form Res", year="2024", month="Feb", day="1", volume="8", pages="e52096", keywords="qualitative interviews", keywords="visual recall aid", keywords="older adults", keywords="health services research", keywords="web-based methods", keywords="visual tool", keywords="recall", keywords="qualitative interview", keywords="experience", keywords="perspective", keywords="motivation", keywords="patient", keywords="recall capacity", keywords="medical information", keywords="visual appointment", keywords="geriatric", keywords="older people", keywords="telemedicine", keywords="videoconference", keywords="e-consultation", keywords="e-medicine", keywords="internet medicine", keywords="REVISIT", keywords="Remembering Healthcare Encounters Visually and Interactively", keywords="mobile phone", abstract="Background: Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient's recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. Objective: We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. Methods: The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors' experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. Results: REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants.?REVISIT appeared to support older patients' and caregivers' recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. Conclusions: REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences. ", doi="10.2196/52096", url="https://formative.jmir.org/2024/1/e52096", url="http://www.ncbi.nlm.nih.gov/pubmed/38300691" } @Article{info:doi/10.2196/47850, author="van der Heijden, Zo{\"e} and de Gooijer, Femke and Camps, Guido and Lucassen, Desiree and Feskens, Edith and Lasschuijt, Marlou and Brouwer-Brolsma, Elske", title="User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Feb", day="1", volume="8", pages="e47850", keywords="diet", keywords="children", keywords="dietary assessment", keywords="recall", keywords="technological innovation", keywords="mobile health", keywords="mHealth", keywords="mobile phone", abstract="Background: The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. Objective: This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Methods: Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57\% boys and n=6, 43\% girls). Results: Most children were able to complete FoodBear's (11/14, 79\%), myBear's (10/14, 71\%), and FoodCam's (9/14, 64\%) usability tasks, but all children required assistance (14/14, 100\%) and most of the children encountered usability problems (13/14, 93\%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Conclusions: Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children's autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children's dietary assessment and the provision of personalized dietary support. ", doi="10.2196/47850", url="https://formative.jmir.org/2024/1/e47850", url="http://www.ncbi.nlm.nih.gov/pubmed/38300689" } @Article{info:doi/10.2196/51571, author="Moore, Richard and Al-Tamimi, Abdel-Karim and Freeman, Elizabeth", title="Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study", journal="JMIR Form Res", year="2024", month="Jan", day="31", volume="8", pages="e51571", keywords="physical activity", keywords="inactivity", keywords="conversational agent", keywords="CA", keywords="adolescent", keywords="public health", keywords="digital health interventions", keywords="mobile phone", abstract="Background: Conversational agents (CAs) are a promising solution to support people in improving physical activity (PA) behaviors. However, there is a lack of CAs targeted at adolescents that aim to provide support to overcome barriers to PA. This study reports the results of the co-design, development, and evaluation of a prototype CA called ``Phyllis'' to support adolescents in overcoming barriers to PA with the aim of improving PA behaviors. The study presents one of the first theory-driven CAs that use existing research, a theoretical framework, and a behavior change model. Objective: The aim of the study is to use a mixed methods approach to investigate the potential of a CA to support adolescents in overcoming barriers to PA and enhance their confidence and motivation to engage in PA. Methods: The methodology involved co-designing with 8 adolescents to create a relational and persuasive CA with a suitable persona and dialogue. The CA was evaluated to determine its acceptability, usability, and effectiveness, with 46 adolescents participating in the study via a web-based survey. Results: The co-design participants were students aged 11 to 13 years, with a sex distribution of 56\% (5/9) female and 44\% (4/9) male, representing diverse ethnic backgrounds. Participants reported 37 specific barriers to PA, and the most common barriers included a ``lack of confidence,'' ``fear of failure,'' and a ``lack of motivation.'' The CA's persona, named ``Phyllis,'' was co-designed with input from the students, reflecting their preferences for a friendly, understanding, and intelligent personality. Users engaged in 61 conversations with Phyllis and reported a positive user experience, and 73\% of them expressed a definite intention to use the fully functional CA in the future, with a net promoter score indicating a high likelihood of recommendation. Phyllis also performed well, being able to recognize a range of different barriers to PA. The CA's persuasive capacity was evaluated in modules focusing on confidence and motivation, with a significant increase in students' agreement in feeling confident and motivated to engage in PA after interacting with Phyllis. Adolescents also expect to have a personalized experience and be able to personalize all aspects of the CA. Conclusions: The results showed high acceptability and a positive user experience, indicating the CA's potential. Promising outcomes were observed, with increasing confidence and motivation for PA. Further research and development are needed to create further interventions to address other barriers to PA and assess long-term behavior change. Addressing concerns regarding bias and privacy is crucial for achieving acceptability in the future. The CA's potential extends to health care systems and multimodal support, providing valuable insights for designing digital health interventions including tackling global inactivity issues among adolescents. ", doi="10.2196/51571", url="https://formative.jmir.org/2024/1/e51571", url="http://www.ncbi.nlm.nih.gov/pubmed/38294857" } @Article{info:doi/10.2196/49561, author="Al-yaseen, Waraf and Raggio, Procida Daniela and Araujo, Mariana and Innes, Nicola", title="``I Just Wanted a Dentist in My Phone''---Designing Evidence-Based mHealth Prototype to Improve Preschool Children's Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children's Teeth", journal="JMIR Form Res", year="2024", month="Jan", day="30", volume="8", pages="e49561", keywords="oral health promotion", keywords="mobile health", keywords="mHealth", keywords="children", keywords="oral health", keywords="behavior change", keywords="coproduction", keywords="mobile phone", abstract="Background: Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals' health maintenance. However, little is known about caring for their child's teeth and what their preferences would be regarding the content or design of an oral health app. Objective: This study aims to co-design the prototype of an app named App for Children's Teeth with parents, providing a source of information for them about caring for their children's teeth and promoting positive dental habits. Methods: This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ?6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children's oral health, and (3) collect feedback about the app's acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis. Results: The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children's Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child's age, and ``In a Nutshell'' bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas. Conclusions: The coproduction design approach highlighted parents' need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child's age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives. Trial Registration: Open Science Framework; https://osf.io/uj9az ", doi="10.2196/49561", url="https://formative.jmir.org/2024/1/e49561", url="http://www.ncbi.nlm.nih.gov/pubmed/38289667" } @Article{info:doi/10.2196/45494, author="Fiorini, Laura and D'Onofrio, Grazia and Sorrentino, Alessandra and Cornacchia Loizzo, Gabriella Federica and Russo, Sergio and Ciccone, Filomena and Giuliani, Francesco and Sancarlo, Daniele and Cavallo, Filippo", title="The Role of Coherent Robot Behavior and Embodiment in Emotion Perception and Recognition During Human-Robot Interaction: Experimental Study", journal="JMIR Hum Factors", year="2024", month="Jan", day="26", volume="11", pages="e45494", keywords="social robot", keywords="emotion recognition", keywords="human emotion perception", keywords="human-robot interaction", keywords="robot cospeech gestures evaluation", abstract="Background: Social robots are becoming increasingly important as companions in our daily lives. Consequently, humans expect to interact with them using the same mental models applied to human-human interactions, including the use of cospeech gestures. Research efforts have been devoted to understanding users' needs and developing robot's behavioral models that can perceive the user state and properly plan a reaction. Despite the efforts made, some challenges regarding the effect of robot embodiment and behavior in the perception of emotions remain open. Objective: The aim of this study is dual. First, it aims to assess the role of the robot's cospeech gestures and embodiment in the user's perceived emotions in terms of valence (stimulus pleasantness), arousal (intensity of evoked emotion), and dominance (degree of control exerted by the stimulus). Second, it aims to evaluate the robot's accuracy in identifying positive, negative, and neutral emotions displayed by interacting humans using 3 supervised machine learning algorithms: support vector machine, random forest, and K-nearest neighbor. Methods: Pepper robot was used to elicit the 3 emotions in humans using a set of 60 images retrieved from a standardized database. In particular, 2 experimental conditions for emotion elicitation were performed with Pepper robot: with a static behavior or with a robot that expresses coherent (COH) cospeech behavior. Furthermore, to evaluate the role of the robot embodiment, the third elicitation was performed by asking the participant to interact with a PC, where a graphical interface showed the same images. Each participant was requested to undergo only 1 of the 3 experimental conditions. Results: A total of 60 participants were recruited for this study, 20 for each experimental condition for a total of 3600 interactions. The results showed significant differences (P<.05) in valence, arousal, and dominance when stimulated with the Pepper robot behaving COH with respect to the PC condition, thus underlying the importance of the robot's nonverbal communication and embodiment. A higher valence score was obtained for the elicitation of the robot (COH and robot with static behavior) with respect to the PC. For emotion recognition, the K-nearest neighbor classifiers achieved the best accuracy results. In particular, the COH modality achieved the highest level of accuracy (0.97) when compared with the static behavior and PC elicitations (0.88 and 0.94, respectively). Conclusions: The results suggest that the use of multimodal communication channels, such as cospeech and visual channels, as in the COH modality, may improve the recognition accuracy of the user's emotional state and can reinforce the perceived emotion. Future studies should investigate the effect of age, culture, and cognitive profile on the emotion perception and recognition going beyond the limitation of this work. ", doi="10.2196/45494", url="https://humanfactors.jmir.org/2024/1/e45494", url="http://www.ncbi.nlm.nih.gov/pubmed/38277201" } @Article{info:doi/10.2196/50942, author="Cranston, D. Kaela and Grieve, J. Natalie and Dineen, E. Tineke and Jung, E. Mary", title="Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Jan", day="26", volume="8", pages="e50942", keywords="program evaluation", keywords="prediabetic state", keywords="e-learning education", keywords="e-learning", keywords="platform", keywords="usability", keywords="diabetes", keywords="prevention", keywords="knowledge translation", keywords="end user", keywords="type 2 diabetes", keywords="framework", abstract="Background: e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners. Objective: This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training. Methods: An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study. Results: Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved. Conclusions: Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training. ", doi="10.2196/50942", url="https://formative.jmir.org/2024/1/e50942", url="http://www.ncbi.nlm.nih.gov/pubmed/38277214" } @Article{info:doi/10.2196/46941, author="Messina, Anna and Amati, Rebecca and Annoni, Maria Anna and Bano, Beatrice and Albanese, Emiliano and Fiordelli, Maddalena", title="Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach", journal="JMIR Form Res", year="2024", month="Jan", day="24", volume="8", pages="e46941", keywords="informal caregivers", keywords="iSupport", keywords="dementia", keywords="digital interventions", keywords="mHealth", keywords="community-based participatory research", keywords="community", keywords="caregiver", keywords="mental distress", keywords="physical distress", keywords="support", keywords="development", abstract="Background: Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Objective: Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. Methods: We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. Results: The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from ``lesson'' to ``chapter'' and from ``suffering from'' dementia to ``affected by'' dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Conclusions: Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context. ", doi="10.2196/46941", url="https://formative.jmir.org/2024/1/e46941", url="http://www.ncbi.nlm.nih.gov/pubmed/38265857" } @Article{info:doi/10.2196/49415, author="Wang, Xin and Li, Juan and Liang, Tianyi and Hasan, Ul Wordh and Zaman, Tuz Kimia and Du, Yang and Xie, Bo and Tao, Cui", title="Promoting Personalized Reminiscence Among Cognitively Intact Older Adults Through an AI-Driven Interactive Multimodal Photo Album: Development and Usability Study", journal="JMIR Aging", year="2024", month="Jan", day="23", volume="7", pages="e49415", keywords="aging", keywords="knowledge graph", keywords="machine learning", keywords="reminiscence", keywords="voice assistant", abstract="Background: Reminiscence, a therapy that uses stimulating materials such as old photos and videos to stimulate long-term memory, can improve the emotional well-being and life satisfaction of older adults, including those who are cognitively intact. However, providing personalized reminiscence therapy can be challenging for caregivers and family members. Objective: This study aimed to achieve three objectives: (1) design and develop the GoodTimes app, an interactive multimodal photo album that uses artificial intelligence (AI) to engage users in personalized conversations and storytelling about their pictures, encompassing family, friends, and special moments; (2) examine the app's functionalities in various scenarios using use-case studies and assess the app's usability and user experience through the user study; and (3) investigate the app's potential as a supplementary tool for reminiscence therapy among cognitively intact older adults, aiming to enhance their psychological well-being by facilitating the recollection of past experiences. Methods: We used state-of-the-art AI technologies, including image recognition, natural language processing, knowledge graph, logic, and machine learning, to develop GoodTimes. First, we constructed a comprehensive knowledge graph that models the information required for effective communication, including photos, people, locations, time, and stories related to the photos. Next, we developed a voice assistant that interacts with users by leveraging the knowledge graph and machine learning techniques. Then, we created various use cases to examine the functions of the system in different scenarios. Finally, to evaluate GoodTimes' usability, we conducted a study with older adults (N=13; age range 58-84, mean 65.8 years). The study period started from January to March 2023. Results: The use-case tests demonstrated the performance of GoodTimes in handling a variety of scenarios, highlighting its versatility and adaptability. For the user study, the feedback from our participants was highly positive, with 92\% (12/13) reporting a positive experience conversing with GoodTimes. All participants mentioned that the app invoked pleasant memories and aided in recollecting loved ones, resulting in a sense of happiness for the majority (11/13, 85\%). Additionally, a significant majority found GoodTimes to be helpful (11/13, 85\%) and user-friendly (12/13, 92\%). Most participants (9/13, 69\%) expressed a desire to use the app frequently, although some (4/13, 31\%) indicated a need for technical support to navigate the system effectively. Conclusions: Our AI-based interactive photo album, GoodTimes, was able to engage users in browsing their photos and conversing about them. Preliminary evidence supports GoodTimes' usability and benefits cognitively intact older adults. Future work is needed to explore its potential positive effects among older adults with cognitive impairment. ", doi="10.2196/49415", url="https://aging.jmir.org/2024/1/e49415", url="http://www.ncbi.nlm.nih.gov/pubmed/38261365" } @Article{info:doi/10.2196/44423, author="Straand, Jevnaker Ingjerd and F{\o}lstad, Asbj{\o}rn and Bj{\o}rnestad, Ravndal Jone", title="Exploring a Gaming-Based Intervention for Unemployed Young Adults: Thematic Analysis", journal="JMIR Hum Factors", year="2024", month="Jan", day="18", volume="11", pages="e44423", keywords="positive psychology intervention", keywords="digital mental health", keywords="serious gaming", keywords="intervention design", keywords="research through design", keywords="gaming-based intervention", abstract="Background: Promoting positive psychologies that promote resilience such as a growth mindset could be beneficial for young, unemployed adults, as many lack the self-esteem and self-efficacy to cope with job search adversity. These young people may be reached at scale through the web-based delivery of self-administered positive psychology interventions. However, past studies report unsatisfying user experiences and a lack of user engagement. A gaming-based experience could be an approach to overcoming these challenges. Objective: Our research objective was to explore how young, unemployed adults experience a positive psychology intervention designed as a game to extract learning and principles for future intervention research and development. Methods: To respond to the research question, a team of researchers at the University of Stavanger worked with designers and developers to conceptualize and build a gaming-based intervention. Feedback from the users was collected through formative usability testing with 18 young adults in the target group. Retrospectively, recordings and notes were transcribed and subjected to thematic analysis to extract learnings for the purposes of this paper. Results: A total of 3 themes were identified that pinpoint what we consider to be key priorities for future gaming interventions for unemployed young adults: adaptation to user preferences (eg, need for responding to user preferences), empathic player interaction (eg, need for responsiveness to user inputs and a diverse set of interaction modes), and sensemaking of experience and context (eg, need for explicit presentation of game objectives and need for management of user expectations related to genre). Conclusions: Feedback from end users in usability-testing sessions was vital to understanding user preferences and needs, as well as to inform ongoing intervention design and development. Our study also shows that game design could make interventions more entertaining and engaging but may distort the intervention if the game narrative is not properly aligned with the intervention intent and objectives. By contrast, a lack of adaptation to user needs may cause a less motivating user experience. Thus, we propose a structured approach to promote alignment between user preferences and needs, intervention objectives, and gameplay. ", doi="10.2196/44423", url="https://humanfactors.jmir.org/2024/1/e44423", url="http://www.ncbi.nlm.nih.gov/pubmed/38236624" } @Article{info:doi/10.2196/54138, author="Zhu, Di and Al Mahmud, Abdullah and Liu, Wei", title="Digital Storytelling Intervention for Enhancing the Social Participation of People With Mild Cognitive Impairment: Co-Design and Usability Study", journal="JMIR Aging", year="2024", month="Jan", day="17", volume="7", pages="e54138", keywords="co-design", keywords="digital storytelling", keywords="people with mild cognitive impairment", keywords="MCI", keywords="technology-based intervention development", keywords="dementia", keywords="mobile phone", abstract="Background: Community-based social participation has shown promise in delaying cognitive decline in older adults with mild cognitive impairment (MCI) who are at risk of developing dementia. Although group storytelling interventions have proven effective, the need for a skilled workforce to support people with MCI can limit broader community implementation. Technology-based interventions may offer a solution to this limitation by replicating the abilities of therapists. Objective: This study aims to co-design a digital storytelling intervention and evaluate its usability. Methods: This co-design process involved 3 stages, engaging people with MCI (n=12), their caregivers (n=4), and therapists (n=5) in Beijing, China. In the first stage, we used card sorting and voting methods to identify potential incentives for social participation and target the specific abilities that people with MCI wanted to enhance. In the second stage, we conducted brainstorming sessions with people with MCI and their caregivers to identify the potential features of a digital storytelling application named Huiyou (``meeting new friends'' in Chinese). Finally, we assessed Huiyou's usability with people with MCI and therapists, leading to iterative improvements based on the usability findings. Results: We uncovered a crucial link between boosting the self-confidence of people with MCI and their ability to address social participation challenges. Notably, we identified memory improvement and enhanced language expression as key factors for effective communication with grandchildren. Subsequently, participants suggested features and interfaces to address these challenges, leading to the development of Huiyou, a group-based digital storytelling application featuring functions such as generating story materials, conducting memory retrieval activities, and sharing stories. It received an ``excellent'' rating in the User Experience Questionnaire benchmark, displaying high levels of attractiveness, dependability, stimulation, and novelty. People with MCI achieved an average task completion rate of 87\% (n=19; SD 0.13) of the 22 tasks. However, feedback from people with MCI and therapists highlighted usability issues in navigation, activity management, user interface, and feature optimization, indicating a need for improved accessibility and efficiency. Conclusions: The co-design approach contributed to developing the Huiyou prototype, supporting community-based social participation. User feedback highlighted the potential of Huiyou to enhance well-being and facilitate meaningful social interactions while maintaining crucial existing relationships. ", doi="10.2196/54138", url="https://aging.jmir.org/2024/1/e54138", url="http://www.ncbi.nlm.nih.gov/pubmed/38231541" } @Article{info:doi/10.2196/52157, author="Kim, Sung-In and Jang, So-youn and Kim, Taewan and Kim, Bogoan and Jeong, Dayoung and Noh, Taehyung and Jeong, Mingon and Hall, Kaely and Kim, Meelim and Yoo, Jeong Hee and Han, Kyungsik and Hong, Hwajung and Kim, G. Jennifer", title="Promoting Self-Efficacy of Individuals With Autism in Practicing Social Skills in the Workplace Using Virtual Reality and Physiological Sensors: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Jan", day="11", volume="8", pages="e52157", keywords="autism", keywords="virtual reality", keywords="workplace", keywords="self-efficacy", keywords="social skills", keywords="data reflection", abstract="Background: Individuals with autism often experience heightened anxiety in workplace environments because of challenges in communication and sensory overload. As these experiences can result in negative self-image, promoting their self-efficacy in the workplace is crucial. Virtual reality (VR) systems have emerged as promising tools for enhancing the self-efficacy of individuals with autism in navigating social scenarios, aiding in the identification of anxiety-inducing situations, and preparing for real-world interactions. However, there is limited research exploring the potential of VR to enhance self-efficacy by facilitating an understanding of emotional and physiological states during social skills practice. Objective: This study aims to develop and evaluate a VR system that enabled users to experience simulated work-related social scenarios and reflect on their behavioral and physiological data through data visualizations. We intended to investigate how these data, combined with the simulations, can support individuals with autism in building their self-efficacy in social skills. Methods: We developed WorkplaceVR, a comprehensive VR system designed for engagement in simulated work-related social scenarios, supplemented with data-driven reflections of users' behavioral and physiological responses. A within-subject deployment study was subsequently conducted with 14 young adults with autism to examine WorkplaceVR's feasibility. A mixed methods approach was used, compassing pre- and postsystem use assessments of participants' self-efficacy perceptions. Results: The study results revealed WorkplaceVR's effectiveness in enhancing social skills and self-efficacy among individuals with autism. First, participants exhibited a statistically significant increase in perceived self-efficacy following their engagement with the VR system (P=.02). Second, thematic analysis of the interview data confirmed that the VR system and reflections on the data fostered increased self-awareness among participants about social situations that trigger their anxiety, as well as the behaviors they exhibit during anxious moments. This increased self-awareness prompted the participants to recollect their related experiences in the real world and articulate anxiety management strategies. Furthermore, the insights uncovered motivated participants to engage in self-advocacy, as they wanted to share the insights with others. Conclusions: This study highlights the potential of VR simulations enriched with physiological and behavioral sensing as a valuable tool for augmenting self-efficacy in workplace social interactions for individuals with autism. Data reflection facilitated by physiological sensors helped participants with autism become more self-aware of their emotions and behaviors, advocate for their characteristics, and develop positive self-beliefs. ", doi="10.2196/52157", url="https://formative.jmir.org/2024/1/e52157", url="http://www.ncbi.nlm.nih.gov/pubmed/38206652" } @Article{info:doi/10.2196/42823, author="B{\'e}rub{\'e}, Caterina and Lehmann, Franziska Vera and Maritsch, Martin and Kraus, Mathias and Feuerriegel, Stefan and Wortmann, Felix and Z{\"u}ger, Thomas and Stettler, Christoph and Fleisch, Elgar and Kocaballi, Baki A. and Kowatsch, Tobias", title="Effectiveness and User Perception of an In-Vehicle Voice Warning for Hypoglycemia: Development and Feasibility Trial", journal="JMIR Hum Factors", year="2024", month="Jan", day="9", volume="11", pages="e42823", keywords="hypoglycemia", keywords="type-1 diabetes mellitus", keywords="in-vehicle voice assistant", keywords="voice interface", keywords="voice warning", keywords="digital health intervention", keywords="mobile phone", abstract="Background: Hypoglycemia is a frequent and acute complication in type 1 diabetes mellitus (T1DM) and is associated with a higher risk of car mishaps. Currently, hypoglycemia can be detected and signaled through flash glucose monitoring or continuous glucose monitoring devices, which require manual and visual interaction, thereby removing the focus of attention from the driving task. Hypoglycemia causes a decrease in attention, thereby challenging the safety of using such devices behind the wheel. Here, we present an investigation of a hands-free technology---a voice warning that can potentially be delivered via an in-vehicle voice assistant. Objective: This study aims to investigate the feasibility of an in-vehicle voice warning for hypoglycemia, evaluating both its effectiveness and user perception. Methods: We designed a voice warning and evaluated it in 3 studies. In all studies, participants received a voice warning while driving. Study 0 (n=10) assessed the feasibility of using a voice warning with healthy participants driving in a simulator. Study 1 (n=18) assessed the voice warning in participants with T1DM. Study 2 (n=20) assessed the voice warning in participants with T1DM undergoing hypoglycemia while driving in a real car. We measured participants' self-reported perception of the voice warning (with a user experience scale in study 0 and with acceptance, alliance, and trust scales in studies 1 and 2) and compliance behavior (whether they stopped the car and reaction time). In addition, we assessed technology affinity and collected the participants' verbal feedback. Results: Technology affinity was similar across studies and approximately 70\% of the maximal value. Perception measure of the voice warning was approximately 62\% to 78\% in the simulated driving and 34\% to 56\% in real-world driving. Perception correlated with technology affinity on specific constructs (eg, Affinity for Technology Interaction score and intention to use, optimism and performance expectancy, behavioral intention, Session Alliance Inventory score, innovativeness and hedonic motivation, and negative correlations between discomfort and behavioral intention and discomfort and competence trust; all P<.05). Compliance was 100\% in all studies, whereas reaction time was higher in study 1 (mean 23, SD 5.2 seconds) than in study 0 (mean 12.6, SD 5.7 seconds) and study 2 (mean 14.6, SD 4.3 seconds). Finally, verbal feedback showed that the participants preferred the voice warning to be less verbose and interactive. Conclusions: This is the first study to investigate the feasibility of an in-vehicle voice warning for hypoglycemia. Drivers find such an implementation useful and effective in a simulated environment, but improvements are needed in the real-world driving context. This study is a kickoff for the use of in-vehicle voice assistants for digital health interventions. ", doi="10.2196/42823", url="https://humanfactors.jmir.org/2024/1/e42823", url="http://www.ncbi.nlm.nih.gov/pubmed/38194257" } @Article{info:doi/10.2196/44619, author="Luu, Phuoc An and Nguyen, Thanh Truong and Cao, Cam Van Thi and Ha, Diem Trinh Hoang and Chung, Thu Lien Thi and Truong, Ngoc Trung and Nguyen Le Nhu, Tung and Dao, Bach Khoa and Nguyen, Van Hao and Khanh, Quoc Phan Nguyen and Le, Thuy Khanh Thuy and Tran, Bao Luu Hoai and Nhat, Huy Phung Tran and Tran, Minh Duc and Lam, Minh Yen and Thwaites, Louise Catherine and Mcknight, Jacob and Vinh Chau, Van Nguyen and Van Nuil, Ilo Jennifer and ", title="Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19--Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project", journal="JMIR Hum Factors", year="2024", month="Jan", day="5", volume="11", pages="e44619", keywords="vital signs", keywords="wearable devices", keywords="action learning", keywords="technology acceptance model", keywords="TAM", keywords="COVID-19", keywords="user-centered design", keywords="wearables", keywords="remote monitoring", keywords="technology acceptance", keywords="oximeter", abstract="Background: Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. Objective: A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. Methods: We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. Results: In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Conclusions: Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period. ", doi="10.2196/44619", url="https://humanfactors.jmir.org/2024/1/e44619", url="http://www.ncbi.nlm.nih.gov/pubmed/38180799" } @Article{info:doi/10.2196/53679, author="Fubini, Elias Pietro and Savoldelli, Louis Georges and Beckmann, Sara Tal and Samer, Flora Caroline and Suppan, M{\'e}lanie", title="Impact of a Mobile App (LoAD Calc) on the Calculation of Maximum Safe Doses of Local Anesthetics: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jan", day="3", volume="13", pages="e53679", keywords="dose calculation", keywords="drug safety", keywords="information systems research", keywords="local anesthetic systemic toxicity", keywords="local anesthetics", keywords="mobile health app", keywords="study protocol", keywords="toxicity", abstract="Background: Local anesthetics (LAs) are regularly used to alleviate pain during medical or surgical procedures. Their use is generally considered safe, but exceeding the maximum recommended doses can lead to LA systemic toxicity, a rare but potentially lethal complication. Determining maximum safe doses is therefore mandatory before performing local anesthesia, but rules are often unclear and the factors affecting dose calculation are numerous. Mobile health apps have been shown to help clinical decision-making, but most currently available apps present significant limitations. The Local Anesthetics Dose Calculator (LoAD Calc) app was designed to overcome these limitations by taking all relevant parameters into account. Before deploying this app in a clinical setting, it should be tested to determine its effectiveness and whether clinicians would be willing to use it. Objective: The primary objective will be to evaluate the effectiveness of the LoAD Calc app through written simulated cases. The secondary objective will be to determine whether physicians find this app easier, faster, and safer than the methods they generally use. Methods: We describe a parallel-group randomized controlled trial protocol. Anesthesiologists working at the Geneva University Hospitals will be invited to participate. Participants will be asked to compute the maximum dose of LA in 10 simulated clinical cases using 3 different LAs. The maximum safe dose will be determined manually using the same calculation rules that were used to develop LoAD Calc, without using the app itself. An overdose will be considered any dose higher than the correct dose, rounded to the superior integer, while an underdose will be defined as the optimal calculated dose minus 20\%, rounded to the inferior integer. Randomization will be stratified according to current position (resident vs registrar). The participants allocated to the LoAD Calc (experimental) group will use the LoAD Calc app to compute the maximum safe LA doses. Those allocated to the control group will be asked to use the method they generally use. The primary outcome will be the overall overdose rate. Secondary outcomes will include the overdose rate according to ideal and actual body weight and to each specific LA, the overall underdose rate, and the time taken to complete these calculations. The app's usability will also be assessed. Results: A sample size of 46 participants will be needed to detect a difference of 10\% with a power of 90\%. Thus, a target of 50 participants was set to allow for attrition and exclusion criteria. We expect recruitment to begin during the winter of 2023, data analysis in the spring of 2024, and results by the end of 2024. Conclusions: This study should determine whether LoAD Calc, a mobile health app designed to compute maximum safe LA doses, is safer and more efficient than traditional LA calculation methods. International Registered Report Identifier (IRRID): PRR1-10.2196/53679 ", doi="10.2196/53679", url="https://www.researchprotocols.org/2024/1/e53679", url="http://www.ncbi.nlm.nih.gov/pubmed/38170571" } @Article{info:doi/10.2196/52410, author="Choi, Soyoung and Sajib, Zaman Md Refat Uz and Manzano, Jenna and Chlebek, Joseph Christian", title="mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study", journal="JMIR Form Res", year="2023", month="Dec", day="25", volume="7", pages="e52410", keywords="aging", keywords="mobile health", keywords="older adults", keywords="technology", keywords="visual impairment", keywords="wearables", keywords="wearable", keywords="vision", keywords="visual", keywords="qualitative analysis", keywords="health behavior", keywords="mHealth", keywords="mHealth technology", keywords="digital technology", keywords="medical application", keywords="application", keywords="app", keywords="applications", keywords="usage", keywords="well-being", keywords="cross-section interview", keywords="interview", keywords="interviews", keywords="tracking", keywords="health data", keywords="symptom monitoring", keywords="monitor", keywords="monitoring", keywords="symptom", keywords="symptoms", keywords="physical activity", keywords="walking", keywords="routine", keywords="mobile phone", abstract="Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals' disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. ", doi="10.2196/52410", url="https://formative.jmir.org/2023/1/e52410", url="http://www.ncbi.nlm.nih.gov/pubmed/38145472" } @Article{info:doi/10.2196/50550, author="Fridriksdottir, Nanna and Ingadottir, Brynja and Skuladottir, Kristin and Zo{\"e}ga, Sigridur and Gunnarsdottir, Sigridur", title="Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study", journal="JMIR Form Res", year="2023", month="Dec", day="22", volume="7", pages="e50550", keywords="web portal for patients with cancer", keywords="supportive digital health service", keywords="symptom monitoring", keywords="self-management support", keywords="feasibility", keywords="usability", keywords="acceptability", keywords="patient education", keywords="health engagement", keywords="patient-reported outcomes", keywords="digital health service", keywords="patient portal", keywords="electronic health records", keywords="mobile phone", abstract="Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System--Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT\&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT\&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. Results: The portal adoption rate was 72\% (103/143), and the portal use rate was 76.7\% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67\% (69/103). The combined completion rate of the ESASr and DT\&PL was 78.4\% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33\% (26/79) initiated messaging, 73\% (58/79) received messages, and 85\% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age ($\beta$=?.45), ESASr engagement ($\beta$=.5), symptom interference ($\beta$=.4), and received knowledge ($\beta$=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age ($\beta$=?.31), ESASr engagement ($\beta$=.37), symptom interference ($\beta$=.60), self-care self-efficacy ($\beta$=.37), and received knowledge ($\beta$=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P?.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted. ", doi="10.2196/50550", url="https://formative.jmir.org/2023/1/e50550", url="http://www.ncbi.nlm.nih.gov/pubmed/38015268" } @Article{info:doi/10.2196/46306, author="De Sutter, Evelien and Geerts, David and Yskout, Koen and Verreydt, Stef and Borry, Pascal and Barbier, Liese and Huys, Isabelle", title="Testing and Practical Implementation of a User-Friendly Personalized and Long-Term Electronic Informed Consent Prototype in Clinical Research: Mixed Methods Study", journal="J Med Internet Res", year="2023", month="Dec", day="19", volume="25", pages="e46306", keywords="human-centered design", keywords="digital health", keywords="qualitative research", keywords="informed consent", keywords="trial", keywords="stakeholders", keywords="implementation", abstract="Background: Over the years, there has been increasing interest in electronic informed consent (eIC) in clinical research. The user-friendliness of an eIC application and its acceptance by stakeholders plays a central role in achieving successful implementation. Objective: This study aims to identify insights for the design and implementation of a user-friendly, personalized, and long-term eIC application based on a usability study with (potential) research participants and semistructured interviews with stakeholders on the practical integration of such an application into their daily practice. Methods: An eIC prototype was evaluated and refined through usability testing among Belgian citizens and iterative redesign. On the basis of a digital literacy questionnaire, a heterogeneous sample of participants was established. Participants needed to complete a series of usability tasks related to personalization and long-term interaction with the research team while using the ``think aloud'' technique. In addition, usability tests involved completing the System Usability Scale questionnaire and taking part in a semistructured feedback interview. Furthermore, semistructured interviews were conducted with ethics committee members, health care professionals, and pharmaceutical industry representatives active in Belgium and involved in clinical research. Thematic analysis was undertaken using the NVivo software (Lumivero). Results: In total, 3 iterations of usability tests were conducted with 10 participants each. Each cycle involved some participants who reported having low digital skills. The System Usability Scale scores related to the tasks on personalization and long-term interaction increased after each iteration and reached 69.5 (SD 8.35) and 71.3 (SD 16.1) out of 100, respectively, which represents above-average usability. Semistructured interviews conducted with health care professionals (n=4), ethics committee members (n=8), and pharmaceutical industry representatives (n=5) identified the need for an eIC system that can be easily set up. For example, a library could be established enabling stakeholders to easily provide background information about a clinical study, presented in the second layer of the interface. In contrast, some functionalities, such as informing participants about new studies through an eIC system, were not considered useful by stakeholders. Conclusions: This study provides insights for the implementation of a user-friendly personalized and long-term eIC application. The study findings showed that usability testing is key to assessing and increasing the user-friendliness of an eIC application. Although this eIC system has the potential to be usable by a wide audience, participants with low digital literacy may not be able to use it successfully, highlighting the need for additional support for participants or other alternatives to an eIC system. In addition, key lessons emerging from the interviews included ensuring that the application is easy to implement in practice and is interoperable with other established systems. ", doi="10.2196/46306", url="https://www.jmir.org/2023/1/e46306", url="http://www.ncbi.nlm.nih.gov/pubmed/38113088" } @Article{info:doi/10.2196/43309, author="Evans, Eric and Zengul, Ayse and Knight, Amy and Willig, Amanda and Cherrington, Andrea and Mehta, Tapan and Thirumalai, Mohanraj", title="Stakeholders' Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="18", volume="10", pages="e43309", keywords="self-management", keywords="physical disabilities", keywords="physical disability", keywords="chronic condition", keywords="chronic illness", keywords="mental health", keywords="physical activity", keywords="barrier", keywords="disability", keywords="chronic", keywords="technology", keywords="interview", keywords="data", keywords="symptom", keywords="support", keywords="digital", keywords="development", keywords="need", keywords="perspective", keywords="qualitative", keywords="focus group", keywords="assistive technology", keywords="assistive technologies", abstract="Background: While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. Objective: This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. Methods: Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders' experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. Results: A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. Conclusions: The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. Trial Registration: ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593 ", doi="10.2196/43309", url="https://rehab.jmir.org/2023/1/e43309", url="http://www.ncbi.nlm.nih.gov/pubmed/38109170" } @Article{info:doi/10.2196/48055, author="Islam, Riasat and Gooch, Daniel and Karlakki, Sudheer and Price, Blaine", title="A Device for Prehabilitation of Total Knee Replacement Surgery (Slider): Usability Study", journal="JMIR Form Res", year="2023", month="Dec", day="18", volume="7", pages="e48055", keywords="physiotherapy", keywords="rehabilitation", keywords="prehabilitation, knee replacement", keywords="community physiotherapy", keywords="outpatient", keywords="gamification", keywords="motivation", keywords="adherence", keywords="knee", keywords="exercise", keywords="preoperative", keywords="postoperative", keywords="usability", keywords="validation", keywords="software", keywords="exergames", keywords="geriatric rehabilitation", keywords="self-regulated exercise", keywords="assistive technology", keywords="telerehabilitation", keywords="digital health", keywords="healthcare delivery", abstract="Background: Rehabilitation, or ``prehabilitation,'' is essential in preparing for and recovering from knee replacement surgery. The recent demand for these services has surpassed available resources, a situation further strained by the COVID-19 pandemic, which has led to a pivot toward digital solutions such as web- or app-based videos and wearables. These solutions, however, face challenges with user engagement, calibration requirements, and skin contact issues. This study evaluated the practicality of a low-contact, gamified device designed to assist with prehabilitation exercises. Objective: The study aimed to assess the practicality and user-friendliness of a newly designed physiotherapy device (Slider) that enables exercise monitoring without the need for direct contact with the skin. Methods: A total of 17 patients awaiting knee replacement surgery at a UK National Health Service (NHS) hospital participated in this study. They used the device over a 2-week period and subsequently provided feedback through a usability and acceptability questionnaire. Results: The study was completed by all participants, with a majority (13/17, 76\%) finding the device intuitive and easy to use. The majority of patients were satisfied with the device's ability to meet their presurgery physiotherapy requirements (16/17, 94\%) and expressed a willingness to continue using it (17/17, 100\%). No safety issues or adverse effects were reported by the participants. Conclusions: The results indicate that the device was found to be a feasible option for patients to conduct presurgery physiotherapy exercises independently, away from a clinical setting. Further research involving a larger and more diverse group of participants is recommended to validate these findings more robustly. ", doi="10.2196/48055", url="https://formative.jmir.org/2023/1/e48055", url="http://www.ncbi.nlm.nih.gov/pubmed/38109191" } @Article{info:doi/10.2196/49685, author="Mohanraj, Sangeetha and Malone, A. Laurie and Mendonca, J. Christen and Thirumalai, Mohanraj", title="Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Dec", day="15", volume="7", pages="e49685", keywords="web-based exercise", keywords="user experience", keywords="community health", keywords="fitness facility", keywords="tele-exercise", keywords="physical disability", keywords="physical activity", keywords="exercise", keywords="fitness", keywords="virtual", keywords="interface", keywords="disability", keywords="disabilities", keywords="accessibility", keywords="telehealth", keywords="telemedicine", keywords="eHealth", keywords="digital health", keywords="mixed methods study", abstract="Background: People with disabilities experience numerous barriers to being physically active, such as transportation issues, a lack of trained exercise professionals who understand disabilities, and facility access. The use of a virtual exercise platform (VEP) may provide an alternative and limit certain barriers. Objective: The aim of this mixed method study was to evaluate user interaction (effectiveness, efficiency, and satisfaction), the strengths and weaknesses of the user interface, and the user experience with a VEP. Methods: Participants were recruited from a community fitness facility that offers programs for people with disabilities. Inclusion criteria were being older than 18 years, fluent in English, and availability of internet access. Features of the VEP included articles, prerecorded videos, live Zoom classes, web-based class registration, weekly progress tracking, incentives, and surveys. A one-on-one Zoom session was scheduled with each participant, during which they completed certain tasks: (1) create an account or login, (2) register for class, (3) join class, (4) add to calendar, and (5) complete surveys. As participants completed tasks, quantitative observations (time on task, task success, rate of task completion, and number of errors by users, which determined task difficulty), qualitative observations were made and interviews were conducted at the end of the session. The ``concurrent think-aloud'' method was encouraged by the moderator to gauge participants' thoughts as they worked through testing. Participants also completed the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS). Results: A total of 5 people with disabilities (3 male, 2 female), aged 36-78 (mean 54) years, with education levels from high school to PhD, were recruited. Devices used for testing included a laptop (n=3), a Chromebook (n=1), and a desktop (n=1). All participants completed tasks \#1 and \#2 without errors but could not complete task \#4. One participant completed task \#5 with difficulty and another completed task \#3 with difficulty. The average time to complete each task was: (1) 82 seconds (55-110), (2) 11 seconds (4-21), (3) 9 seconds (5-27), and (4) 921.5 seconds (840-958). The mean SUS score was 86.5/100, and the mean user QUIS score was 8.08 out of 10. Qualitative observations indicated that the system was simple, user-friendly, and accessible. Conclusions: People with disabilities reported high usability and user satisfaction with the web-based exercise platform, and the system appears to be an efficient and effective physical activity option. ", doi="10.2196/49685", url="https://formative.jmir.org/2023/1/e49685", url="http://www.ncbi.nlm.nih.gov/pubmed/38100173" } @Article{info:doi/10.2196/49277, author="Beesoon, Sanjay and Drobot, Ashley and Smokeyday, Melissa and Ali, Al-Bakir and Collins, Zoe and Reynolds, Colin and Berzins, Sandra and Gibson, Alison and Nelson, Gregg", title="Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience", journal="JMIR Form Res", year="2023", month="Dec", day="15", volume="7", pages="e49277", keywords="app", keywords="digital health", keywords="patient experience", keywords="provider satisfaction", keywords="application", keywords="recovery", keywords="cost-effective", keywords="evaluation", keywords="implementation", keywords="gynecologic oncology", keywords="colorectal surgery", keywords="surgery", keywords="care", abstract="Background: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. Objective: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. Methods: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. Results: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. Conclusions: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world. ", doi="10.2196/49277", url="https://formative.jmir.org/2023/1/e49277/" } @Article{info:doi/10.2196/48677, author="Huguet, Anna and Rozario, Sharlene and Wozney, Lori and McGrath, J. Patrick", title="An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing", journal="JMIR Hum Factors", year="2023", month="Dec", day="12", volume="10", pages="e48677", keywords="adolescents", keywords="cognitive-behavioral intervention", keywords="design process", keywords="end users", keywords="headaches", keywords="internet", keywords="usability", keywords="young adult", abstract="Background: Headache disorders are common, debilitating health problems. Cognitive-behavioral therapy (CBT) is recommended but rarely easily available. With the use of the internet and communication technologies among youth and young adults, these individuals could be self-trained in CBT skills. There is an increasing number of internet-based interventions for headaches, but there has been little research into the usability of these interventions because evaluating usability across the intervention development life cycle is costly. We developed an internet-based CBT program, the Specialized Program for Headache Reduction (SPHERE). While developing it, we aimed to improve SPHERE through rapid usability testing cycles. Objective: This study aims to presents a rapid and affordable usability testing approach that can be performed throughout the intervention development life cycle. This paper also provides evidence of the usability of SPHERE. Methods: We used the ``think aloud'' usability testing method based on Krug's approach to test user interaction within a lab setting. This was followed by a short posttest interview. We planned to test SPHERE with 3-5 participants testing the same part of the program each cycle. Both the design and development team and the research team actively participated in the usability testing process. Observers independently identified the top 3 usability issues, rated their severity, and conducted debriefing sessions to come to consensus on major issues and generate potential solutions. Results: The testing process allowed major usability issues to be identified and rectified rapidly before piloting SPHERE in a real-world context. A total of 2 cycles of testing were conducted. Of the usability issues encountered in cycles 1 and 2, a total of 68\% (17/25) and 32\% (12/38), respectively, were rated as major, discussed, and fixed. Conclusions: This study shows that rapid usability testing is an essential part of the design process that improves program functionality and can be easy and inexpensive to undertake. ", doi="10.2196/48677", url="https://humanfactors.jmir.org/2023/1/e48677", url="http://www.ncbi.nlm.nih.gov/pubmed/38085567" } @Article{info:doi/10.2196/47426, author="Nitschke, Marlies and Nwosu, Bertrand Obioma and Grube, Lara and Knitza, Johannes and Seifer, Ann-Kristin and Eskofier, M. Bjoern and Schett, Georg and Morf, Harriet", title="Refinement and Usability Analysis of an eHealth App for Ankylosing Spondylitis as a Complementary Treatment to Physical Therapy: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Dec", day="12", volume="7", pages="e47426", keywords="ankylosing spondylitis", keywords="axial spondylarthritis", keywords="DHA", keywords="digital health application", keywords="eHealth", keywords="self-assessment", keywords="Usability", keywords="Yoga", keywords="YogiTherapy", abstract="Background: Mobile eHealth apps have been used as a complementary treatment to increase the quality of life of patients and provide new opportunities for the management of rheumatic diseases. Telemedicine, particularly in the areas of prevention, diagnostics, and therapy, has become an essential cornerstone in the care of patients with rheumatic diseases. Objective: This study aims to improve the design and technology of YogiTherapy and evaluate its usability and quality. Methods: We newly implemented the mobile eHealth app YogiTherapy with a modern design, the option to change language, and easy navigation to improve the app's usability and quality for patients. After refinement, we evaluated the app by conducting a study with 16 patients with AS (4 female and 12 male; mean age 48.1,?SD?16.8 y). We assessed the usability of YogiTherapy with a task performance test (TPT) with a think-aloud protocol and the quality with the German version of the Mobile App Rating Scale (MARS). Results: In the TPT, the participants had to solve 6 tasks that should be performed on the app. The overall task completion rate in the TPT was high (84/96, 88\% completed tasks). Filtering for videos and navigating to perform an assessment test caused the largest issues during the TPT, while registering in the app and watching a yoga video were highly intuitive. Additionally, 12 (75\%) of the 16 participants completed the German version of MARS. The quality of YogiTherapy was rated with an average MARS score of 3.79?(SD?0.51) from a maximum score of 5. Furthermore, results from the MARS questionnaire demonstrated a positive evaluation regarding functionality and aesthetics. Conclusions: The refined and tested YogiTherapy app showed promising results among most participants. In the future, the app could serve its function as a complementary treatment for patients with AS. For this purpose, surveys with a larger number of patients should still be conducted. As a substantial advancement, we made the app free and openly available on the iOS App and Google Play stores. ", doi="10.2196/47426", url="https://formative.jmir.org/2023/1/e47426", url="http://www.ncbi.nlm.nih.gov/pubmed/38085558" } @Article{info:doi/10.2196/44768, author="Jan, Michael and Coppin-Renz, Antonia and West, Robin and Gallo, Le Christophe and Cochran, M. Jeffrey and Heumen, van Emiel and Fahmy, Michael and Reuteman-Fowler, Corey J.", title="Safety Evaluation in Iterative Development of Wearable Patches for Aripiprazole Tablets With Sensor: Pooled Analysis of Clinical Trials", journal="JMIR Form Res", year="2023", month="Dec", day="12", volume="7", pages="e44768", keywords="wearable sensor", keywords="adhesive patch", keywords="adverse events", keywords="skin irritation", keywords="product iteration", keywords="mobile phone", keywords="biocompatibility", keywords="Abilify MyCite", keywords="development", keywords="sensors", keywords="skin", keywords="monitoring", keywords="treatment", keywords="schizophrenia", keywords="bipolar disorder", keywords="depressive disorder", keywords="abrasions", keywords="blisters", keywords="dermatitis", keywords="pain", keywords="rash", abstract="Background: Wearable sensors in digital health may pose a risk for skin irritation through the use of wearable patches. Little is known about how patient- and product-related factors impact the risk of skin irritation. Aripiprazole tablets with sensor (AS, Abilify MyCite; Otsuka America Pharmaceutical, Inc) is a digital medicine system indicated for the treatment of patients with schizophrenia, bipolar I disorder, and major depressive disorder. AS includes aripiprazole tablets with an embedded ingestible event marker, a wearable sensor attached to the skin through a wearable patch, a smartphone app, and a web-based portal. To continuously improve the final product, successive iterations of wearable patches were developed, including raisin patch version 4 (RP4), followed by disposable wearable sensor version 5 (DW5), and then reusable wearable sensor version 2 (RW2). Objective: This analysis pooled safety data from clinical studies in adult participants using the RP4, DW5, and RW2 wearable patches of AS and evaluated adverse events related to the use of wearable patches. Methods: Safety data from 12 studies in adults aged 18-65 years from May 2010 to August 2020 were analyzed. All studies evaluated safety, with studies less than 2 weeks also specifically examining human factors associated with the use of the components of AS. Healthy volunteers or patients with schizophrenia, bipolar I disorder, or major depressive disorder were enrolled; those who were exposed to at least 1 wearable patch were included in the safety analysis. Adverse events related to the use of a wearable patch were evaluated. Abrasions, blisters, dermatitis, discoloration, erythema, irritation, pain, pruritus, rash, and skin reactions were grouped as skin irritation events (SIEs). All statistical analyses were descriptive. Results: The analysis included 763 participants (mean [SD] age 42.6 [12.9] years; White: n=359, 47.1\%; and male: n=420, 55\%). Participants were healthy volunteers (n=269, 35.3\%) or patients with schizophrenia (n=402, 52.7\%), bipolar I disorder (n=57, 7.5\%), or major depressive disorder (n=35, 4.6\%). Overall, 13.6\% (104/763) of the participants reported at least 1 SIE, all of which were localized to the wearable patch site. Incidence of ?1 patch-related SIEs was seen in 18.1\% (28/155), 14.2\% (55/387), and 9.2\% (28/306) of participants who used RP4, DW5, and RW2, respectively. Incidence of SIE-related treatment discontinuation was low, which is reported by 1.9\% (3/155), 3.1\% (12/387), and 1.3\% (4/306) of participants who used RP4, DW5, and RW2, respectively. Conclusions: The incidence rates of SIEs reported as the wearable patch versions evolved from RP4 through RW2 suggest that information derived from reported adverse events may have informed product design and development, which could have improved both tolerability and wearability of successive products. Trial Registration: Clinicaltrials.gov NCT02091882, https://clinicaltrials.gov/study/NCT02091882; Clinicaltrials.gov NCT02404532, https://clinicaltrials.gov/study/NCT02404532; Clinicaltrials.gov NCT02722967, https://clinicaltrials.gov/study/NCT02722967; Clinicaltrials.gov NCT02219009, https://clinicaltrials.gov/study/NCT02219009; Clinicaltrials.gov NCT03568500, https://clinicaltrials.gov/study/NCT03568500; Clinicaltrials.gov NCT03892889, https://clinicaltrials.gov/study/NCT03892889 ", doi="10.2196/44768", url="https://formative.jmir.org/2023/1/e44768", url="http://www.ncbi.nlm.nih.gov/pubmed/38085556" } @Article{info:doi/10.2196/44993, author="Mahmoodi Kahriz, Bahram and Snuggs, Sarah and Sah, Anumeha and Clot, Sophie and Lamport, Daniel and Forrest, Joseph and Helme-Guizon, Agnes and Wilhelm, Marie-Claire and Caldara, Cindy and Anin, Valentine Camille and Vogt, Julia", title="Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries", journal="JMIR Hum Factors", year="2023", month="Dec", day="11", volume="10", pages="e44993", keywords="mobile apps", keywords="healthy eating and physical activity", keywords="attitude", keywords="BMI and self-efficacy", abstract="Background: Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. Objective: In this study, we aimed to identify consumers' most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers' BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. Methods: A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results: ``Home work out suggestions,'' ``exercise tips,'' and ``progress charts'' were the most preferred app features, whereas ``gift vouchers'' and ``shopping discounts'' were the most preferred rewards. ``Connections with other communication apps'' was the least preferred feature, and ``charitable giving'' was the least preferred reward. Importantly, consumers' positive attitude toward the ``social support and connectedness and mindfulness'' app feature predicted willingness to pay for such an app ($\beta$=.229; P=.004). Differences in consumers' health status, motivational factors, and basic demographics moderated these results and consumers' intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. Conclusions: This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers' health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps. ", doi="10.2196/44993", url="https://humanfactors.jmir.org/2023/1/e44993", url="http://www.ncbi.nlm.nih.gov/pubmed/38079197" } @Article{info:doi/10.2196/43096, author="Struik, Laura and Christianson, Kyla and Khan, Shaheer and Sharma, H. Ramona", title="Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study", journal="JMIR Form Res", year="2023", month="Dec", day="8", volume="7", pages="e43096", keywords="qualitative research", keywords="tobacco use", keywords="smoking", keywords="vaping", keywords="cessation", keywords="eHealth", keywords="individuals who smoke", keywords="users", keywords="tobacco", keywords="e-cigarettes", keywords="cigarettes", keywords="web-based", keywords="support", keywords="behavioral", keywords="smartphone app", keywords="social media", keywords="mobile phone", abstract="Background: Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward. Objective: The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape. Methods: Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation). Results: Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke. Conclusions: The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use. ", doi="10.2196/43096", url="https://formative.jmir.org/2023/1/e43096", url="http://www.ncbi.nlm.nih.gov/pubmed/38064266" } @Article{info:doi/10.2196/48461, author="Faber, S. Jasper and Al-Dhahir, Isra and Kraal, J. Jos and Breeman, D. Linda and van den Berg-Emons, G. Rita J. and Reijnders, Thomas and van Dijk, Sandra and Janssen, R. Veronica and Kraaijenhagen, A. Roderik and Visch, T. Valentijn and Chavannes, H. Niels and Evers, M. Andrea W.", title="Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach", journal="J Med Internet Res", year="2023", month="Dec", day="4", volume="25", pages="e48461", keywords="eHealth", keywords="guide", keywords="guidelines professionals", keywords="intervention development", keywords="intervention evaluation", keywords="low socioeconomic position", keywords="low socioeconomic status", keywords="risk groups", keywords="tailored care", abstract="Background: People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. Objective: We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. Methods: This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide's content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide's design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. Results: The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of ``the inclusive eHealth guide.'' Conclusions: The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality. ", doi="10.2196/48461", url="https://www.jmir.org/2023/1/e48461", url="http://www.ncbi.nlm.nih.gov/pubmed/38048148" } @Article{info:doi/10.2196/45177, author="Richardson, X. Matt and Aytar, Osman and Hess-Wiktor, Katarzyna and Wamala-Andersson, Sarah", title="Digital Microlearning for Training and Competency Development of Older Adult Care Personnel: Mixed Methods Intervention Study to Assess Needs, Effectiveness, and Areas of Application", journal="JMIR Med Educ", year="2023", month="Dec", day="4", volume="9", pages="e45177", keywords="digital microlearning", keywords="elderly care", keywords="older adult care", keywords="competency development", keywords="implementation research", keywords="dementia", keywords="COVID-19", abstract="Background: Older adult care organizations face challenges today due to high personnel turnover and pandemic-related obstacles in conducting training and competence development programs in a time-sensitive and fit-for-purpose manner. Digital microlearning is a method that attempts to meet these challenges by more quickly adapting to the educational needs of organizations and individual employees in terms of time, place, urgency, and retention capacity more than the traditional competency development methods. Objective: This study aimed to determine if and how an app-based digital microlearning intervention can meet older adult care organizations' personnel competency development needs in terms of knowledge retention and work performance. Methods: This study assessed the use of a digital microlearning app, which was at the testing stage in the design thinking model among managerial (n=4) and operational (n=22) employees within 3 older adult care organizations. The app was used to conduct predetermined competency development courses for the staff. Baseline measurements included participants' previous training and competency development methods and participation, as well as perceived needs in terms of time, design, and channel. They then were introduced to and used a digital microlearning app to conduct 2 courses on one or more digital devices, schedules, and locations of their own choice during a period of {\textasciitilde}1 month. The digital app and course content, perceived knowledge retention, and work performance and satisfaction were individually assessed via survey upon completion. The survey was complemented with 4 semistructured focus group interviews, which allowed participants (in total 16 individuals: 6 managerial-administrative employees and 10 operational employees) to describe their experiences with the app and its potential usefulness within their organizations. Results: The proposed advantages of the digital microlearning app were largely confirmed by the participants' perceptions, particularly regarding the ease of use and accessibility, and efficiency and timeliness of knowledge delivery. Assessments were more positive among younger or less experienced employees with more diverse backgrounds. Participants expressed a positive inclination toward using the app, and suggestions provided regarding its potential development and broader use suggested a positive view of digitalization in general. Conclusions: Our results show that app-based digital microlearning appears to be an appropriate new method for providing personnel competency development within the older adult care setting. Its implementation in a larger sample can potentially provide more detailed insights regarding its intended effects. ", doi="10.2196/45177", url="https://mededu.jmir.org/2023/1/e45177", url="http://www.ncbi.nlm.nih.gov/pubmed/38048152" } @Article{info:doi/10.2196/51423, author="Pozuelo, R. Julia and Moffett, D. Bianca and Davis, Meghan and Stein, Alan and Cohen, Halley and Craske, G. Michelle and Maritze, Meriam and Makhubela, Princess and Nabulumba, Christine and Sikoti, Doreen and Kahn, Kathleen and Sodi, Tholene and and van Heerden, Alastair and O'Mahen, A. Heather", title="User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study", journal="JMIR Form Res", year="2023", month="Nov", day="30", volume="7", pages="e51423", keywords="depression", keywords="adolescents", keywords="mental health app", keywords="behavioral activation", keywords="user-centered design", keywords="low- and middle-income countries", keywords="mobile phone", abstract="Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (``episodes'') played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention's feasibility, acceptability, and efficacy in reducing depressive symptoms. ", doi="10.2196/51423", url="https://formative.jmir.org/2023/1/e51423", url="http://www.ncbi.nlm.nih.gov/pubmed/38032691" } @Article{info:doi/10.2196/45128, author="Adams, W. Zachary and Marriott, R. Brigid and Karra, Swathi and Linhart-Musikant, Elizabeth and Raymond, L. Jodi and Fischer, J. Lydia and Bixler, A. Kristina and Bell, M. Teresa and Bryan, A. Eric and Hulvershorn, A. Leslie", title="User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study", journal="JMIR Form Res", year="2023", month="Nov", day="30", volume="7", pages="e45128", keywords="access-to-care", keywords="addiction", keywords="adolescent", keywords="behavior", keywords="health disorder", keywords="opioid use disorder", keywords="opioid", keywords="personalized care", keywords="telehealth", keywords="telemedicine", keywords="trauma", keywords="user", keywords="youth", abstract="Background: Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients' behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. Objective: This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. Methods: We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients' postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. Results: Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging--delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients' behavioral health in the months after discharge. Conclusions: Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial. ", doi="10.2196/45128", url="https://formative.jmir.org/2023/1/e45128", url="http://www.ncbi.nlm.nih.gov/pubmed/38032728" } @Article{info:doi/10.2196/50029, author="Ha, Sandeul and Ho, Hee Seung and Bae, Young-Hyeon and Lee, Minyoung and Kim, Hee Ju and Kim, Han Ju and Lee, Jisan", title="Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study", journal="J Med Internet Res", year="2023", month="Nov", day="28", volume="25", pages="e50029", keywords="digital health equity", keywords="digital health care service", keywords="COVID-19", keywords="mobile health", keywords="mHealth", keywords="mobile apps", keywords="needs assessments", keywords="heuristic", keywords="people with disability", keywords="caregivers", keywords="health personnel", keywords="mobile phone", abstract="Background: As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. Objective: This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. Methods: The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Results: Among the participants, ``disability welfare information and related institutional linkage'' was the highest priority. Three of the 14 user interface sketches the participants created were related to ``providing educational content.'' The 11 heuristic evaluation experts identified ``focusing on a single task'' as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. Conclusions: In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity. ", doi="10.2196/50029", url="https://www.jmir.org/2023/1/e50029", url="http://www.ncbi.nlm.nih.gov/pubmed/38015589" } @Article{info:doi/10.2196/45137, author="Ding, Y. Eric and Tran, Khanh-Van and Lessard, Darleen and Wang, Ziyue and Han, Dong and Mohagheghian, Fahimeh and Mensah Otabil, Edith and Noorishirazi, Kamran and Mehawej, Jordy and Filippaios, Andreas and Naeem, Syed and Gottbrecht, F. Matthew and Fitzgibbons, P. Timothy and Saczynski, S. Jane and Barton, Bruce and Chon, Ki and McManus, D. David", title="Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial", journal="JMIR Cardio", year="2023", month="Nov", day="28", volume="7", pages="e45137", keywords="accuracy", keywords="atrial fibrillation", keywords="cardiac arrhythmia", keywords="design", keywords="detection", keywords="diagnosis", keywords="electrocardiography", keywords="monitoring", keywords="older adults", keywords="photoplethysmography", keywords="prevention", keywords="remote monitoring", keywords="smartwatch", keywords="stroke", keywords="usability", abstract="Background: Atrial fibrillation (AF) is a common cause of stroke, and timely diagnosis is critical for secondary prevention. Little is known about smartwatches for AF detection among stroke survivors. We aimed to examine accuracy, usability, and adherence to a smartwatch-based AF monitoring system designed by older stroke survivors and their caregivers. Objective: This study aims to examine the feasibility of smartwatches for AF detection in older stroke survivors. Methods: Pulsewatch is a randomized controlled trial (RCT) in which stroke survivors received either a smartwatch-smartphone dyad for AF detection (Pulsewatch system) plus an electrocardiogram patch or the patch alone for 14 days to assess the accuracy and usability of the system (phase 1). Participants were subsequently rerandomized to potentially 30 additional days of system use to examine adherence to watch wear (phase 2). Participants were aged 50 years or older, had survived an ischemic stroke, and had no major contraindications to oral anticoagulants. The accuracy for AF detection was determined by comparing it to cardiologist-overread electrocardiogram patch, and the usability was assessed with the System Usability Scale (SUS). Adherence was operationalized as daily watch wear time over the 30-day monitoring period. Results: A total of 120 participants were enrolled (mean age 65 years; 50/120, 41\% female; 106/120, 88\% White). The Pulsewatch system demonstrated 92.9\% (95\% CI 85.3\%-97.4\%) accuracy for AF detection. Mean usability score was 65 out of 100, and on average, participants wore the watch for 21.2 (SD 8.3) of the 30 days. Conclusions: Our findings demonstrate that a smartwatch system designed by and for stroke survivors is a viable option for long-term arrhythmia detection among older adults at risk for AF, though it may benefit from strategies to enhance adherence to watch wear. Trial Registration: ClinicalTrials.gov NCT03761394; https://clinicaltrials.gov/study/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 ", doi="10.2196/45137", url="https://cardio.jmir.org/2023/1/e45137", url="http://www.ncbi.nlm.nih.gov/pubmed/38015598" } @Article{info:doi/10.2196/49100, author="Oakley-Girvan, Ingrid and Yunis, Reem and Fonda, J. Stephanie and Longmire, Michelle and Veuthey, L. Tess and Shieh, Jennifer and Aghaee, Sara and Kubo, Ai and Davis, W. Sharon and Liu, Raymond and Neeman, Elad", title="Correlation Between Remote Symptom Reporting by Caregivers and Adverse Clinical Outcomes: Mixed Methods Study", journal="J Med Internet Res", year="2023", month="Nov", day="21", volume="25", pages="e49100", keywords="adverse events", keywords="cancer", keywords="decentralized clinical trials", keywords="electronic patient-reported outcomes", keywords="ePROs", keywords="mobile health app", keywords="observer-reported outcomes", keywords="Patient-Reported Outcomes Measurement Information System Patient-Reported Outcome Common Terminology Criteria for Adverse Events", keywords="patient-reported outcomes", keywords="PRO-CTCAE", keywords="PROMIS", keywords="remote clinical trials", keywords="remote monitoring", keywords="smartphone", abstract="Background: Timely collection of patient-reported outcomes (PROs) decreases emergency department visits and hospitalizations and increases survival. However, little is known about the outcome predictivity of unpaid informal caregivers' reporting using similar clinical outcome assessments. Objective: The aim of this study is to assess whether caregivers and adults with cancer adhered to a planned schedule for electronically collecting patient-reported outcomes (PROs) and if PROs were associated with future clinical events. Methods: We developed 2 iPhone apps to collect PROs, one for patients with cancer and another for caregivers. We enrolled 52 patient-caregiver dyads from Kaiser Permanente Northern California in a nonrandomized study. Participants used the apps independently for 4 weeks. Specific clinical events were obtained from the patients' electronic health records up to 6 months following the study. We used logistic and quasi-Poisson regression analyses to test associations between PROs and clinical events. Results: Participants completed 97\% (251/260) of the planned Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) surveys and 98\% (254/260) of the Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. PRO-CTCAE surveys completed by caregivers were associated with patients' hospitalizations or emergency department visits, grade 3-4 treatment-related adverse events, dose reductions (P<.05), and hospice referrals (P=.03). PROMIS surveys completed by caregivers were associated with hospice referrals (P=.02). PRO-CTCAE surveys completed by patients were not associated with any clinical events, but their baseline PROMIS surveys were associated with mortality (P=.03), while their antecedent or final PROMIS surveys were associated with all clinical events examined except for total days of treatment breaks. Conclusions: In this study, caregivers and patients completed PROs using smartphone apps as requested. The association of caregiver PRO-CTCAE surveys with patient clinical events suggests that this is a feasible approach to reducing patient burden in clinical trial data collection and may help provide early information about increasing symptom severity. ", doi="10.2196/49100", url="https://www.jmir.org/2023/1/e49100", url="http://www.ncbi.nlm.nih.gov/pubmed/37988151" } @Article{info:doi/10.2196/48821, author="Weermeijer, Merlijn Jeroen Dennis and Wampers, Martien and de Thurah, Lena and Bonnier, Rafa{\"e}l and Piot, Maarten and Kuppens, Peter and Myin-Germeys, Inez and Kiekens, Glenn", title="Usability of the Experience Sampling Method in Specialized Mental Health Care: Pilot Evaluation Study", journal="JMIR Form Res", year="2023", month="Nov", day="21", volume="7", pages="e48821", keywords="experience sampling", keywords="ecological momentary assessment", keywords="implementation", keywords="digital mental health", keywords="mobile phone", abstract="Background: Mental health problems occur in interactions in daily life. Yet, it is challenging to bring contextual information into the therapy room. The experience sampling method (ESM) may facilitate this by assessing clients' thoughts, feelings, symptoms, and behaviors as they are experienced in everyday life. However, the ESM is still primarily used in research settings, with little uptake in clinical practice. One aspect that may facilitate clinical implementation concerns the use of ESM protocols, which involves providing practitioners with ready-to-use ESM questionnaires, sampling schemes, visualizations, and training. Objective: This pilot study's objective was to evaluate the usability of an ESM protocol for using the ESM in a specialized mental health care setting. Methods: We created the ESM protocol using the m-Path software platform and tested its usability in clinical practice. The ESM protocol consists of a dashboard for practitioners (ie, including the setup of the template and data visualizations) and an app for clients (ie, for completing the ESM questionnaires). A total of 8 practitioners and 17 clients used the ESM in practice between December 1, 2020, and July 31, 2021. Usability was assessed using questionnaires, ESM compliance rates, and semistructured interviews. Results: The usability was overall rated reasonable to good by practitioners (mean scores of usability items ranging from 5.33, SD 0.91, to 6.06, SD 0.73, on a scale ranging from 1 to 7). However, practitioners expressed difficulty in personalizing the template and reported insufficient guidelines on how to use the ESM in clinical practice. On average, clients completed 55\% (SD 25\%) of the ESM questionnaires. They rated the usability as reasonable to good, but their scores were slightly lower and more variable than those of the practitioners (mean scores of usability items ranging from 4.18, SD 1.70, to 5.94, SD 1.50 on a scale ranging from 1 to 7). Clients also voiced several concerns over the piloted ESM template, with some indicating no interest in the continued use of the ESM. Conclusions: The findings suggest that using an ESM protocol may facilitate the implementation of the ESM as a mobile health assessment tool in psychiatry. However, additional adaptions should be made before further implementation. Adaptions include providing training on personalizing questionnaires, adding additional sampling scheme formats as well as an open-text field, and creating a dynamic data visualization interface. Future studies should also identify factors determining the suitability of the ESM for specific treatment goals among different client populations. ", doi="10.2196/48821", url="https://formative.jmir.org/2023/1/e48821", url="http://www.ncbi.nlm.nih.gov/pubmed/37988137" } @Article{info:doi/10.2196/50438, author="Smayda, Elisabeth Kirsten and Cooper, Hodsdon Sarah and Leyden, Katie and Ulaszek, Jackie and Ferko, Nicole and Dobrin, Annamaria", title="Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Nov", day="20", volume="10", pages="e50438", keywords="chronic stroke", keywords="walking", keywords="InTandem", keywords="MR-001", keywords="neurorehabilitation", keywords="human factors engineering", keywords="usability", keywords="rhythmic auditory stimulation", keywords="validation", keywords="neurotherapeutic", abstract="Background: Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment. Objective: Using design best practices and human factors engineering principles, the research presented here was conducted to validate the safe and effective use of InTandem. Methods: In total, 15 participants in the chronic phase of stroke recovery (?6 months after stroke) participated in this validation study. Participants were scored on 8 simulated use tasks, 4 knowledge assessments, and 7 comprehension assessments in a simulated home environment. The number and types of use errors, close calls, and operational difficulties were evaluated. Analyses of task performances, participant behaviors, and follow-up interviews were conducted to determine the root cause of use errors and difficulties. Results: During this validation study, 93\% (14/15) of participants were able to successfully complete the critical tasks associated with the simulated use of the InTandem system. Following simulated use task assessments, participants' knowledge and comprehension of the instructions for use and key safety information were evaluated. Overall, participants were able to find and correctly interpret information in the materials in order to answer the knowledge assessment questions. During the comprehension assessment, participants understood warning statements associated with critical tasks presented in the instructions for use. Across the entire study, 3 ``use errors'' and 1 ``success with difficulty'' were recorded. No adverse events, including slips, trips, or falls, occurred in this study. Conclusions: In this validation study, people in the chronic phase of stroke recovery were able to safely and effectively use InTandem in the intended use environment. This validation study contributes to the overall understanding of residual use--related risks of InTandem in consideration of the established benefits. ", doi="10.2196/50438", url="https://rehab.jmir.org/2023/1/e50438", url="http://www.ncbi.nlm.nih.gov/pubmed/37983080" } @Article{info:doi/10.2196/46785, author="Wood, D. Michael and West, C. Nicholas and Fokkens, Christina and Chen, Ying and Loftsgard, C. Kent and Cardinal, Krystal and Whyte, D. Simon and Portales-Casamar, Elodie and G{\"o}rges, Matthias", title="An Individualized Postoperative Pain Risk Communication Tool for Use in Pediatric Surgery: Co-Design and Usability Evaluation", journal="JMIR Pediatr Parent", year="2023", month="Nov", day="17", volume="6", pages="e46785", keywords="eHealth", keywords="risk communication", keywords="decision aid", keywords="pain", keywords="individualized risk", keywords="surgery", keywords="anesthesia", keywords="postoperative", keywords="risk", keywords="co-design", keywords="focus group", keywords="requirement definition", keywords="prototyping", keywords="usability", keywords="prototype", keywords="child", keywords="pediatric", keywords="decision support", keywords="iterative", abstract="Background: Risk identification and communication tools have the potential to improve health care by supporting clinician-patient or family discussion of treatment risks and benefits and helping patients make more informed decisions; however, they have yet to be tailored to pediatric surgery. User-centered design principles can help to ensure the successful development and uptake of health care tools. Objective: We aimed to develop and evaluate the usability of an easy-to-use tool to communicate a child's risk of postoperative pain to improve informed and collaborative preoperative decision-making between clinicians and families. Methods: With research ethics board approval, we conducted web-based co-design sessions with clinicians and family participants (people with lived surgical experience and parents of children who had recently undergone a surgical or medical procedure) at a tertiary pediatric hospital. Qualitative data from these sessions were analyzed thematically using NVivo (Lumivero) to identify design requirements to inform the iterative redesign of an existing prototype. We then evaluated the usability of our final prototype in one-to-one sessions with a new group of participants, in which we measured mental workload with the National Aeronautics and Space Administration (NASA) Task Load Index (TLX) and user satisfaction with the Post-Study System Usability Questionnaire (PSSUQ). Results: A total of 12 participants (8 clinicians and 4 family participants) attended 5 co-design sessions. The 5 requirements were identified: (A) present risk severity descriptively and visually; (B) ensure appearance and navigation are user-friendly; (C) frame risk identification and mitigation strategies in positive terms; (D) categorize and describe risks clearly; and (E) emphasize collaboration and effective communication. A total of 12 new participants (7 clinicians and 5 family participants) completed a usability evaluation. Tasks were completed quickly (range 5-17 s) and accurately (range 11/12, 92\% to 12/12, 100\%), needing only 2 requests for assistance. The median (IQR) NASA TLX performance score of 78 (66-89) indicated that participants felt able to perform the required tasks, and an overall PSSUQ score of 2.1 (IQR 1.5-2.7) suggested acceptable user satisfaction with the tool. Conclusions: The key design requirements were identified, and that guided the prototype redesign, which was positively evaluated during usability testing. Implementing a personalized risk communication tool into pediatric surgery can enhance the care process and improve informed and collaborative presurgical preparation and decision-making between clinicians and families of pediatric patients. ", doi="10.2196/46785", url="https://pediatrics.jmir.org/2023/1/e46785", url="http://www.ncbi.nlm.nih.gov/pubmed/37976087" } @Article{info:doi/10.2196/48950, author="Lunde, Pernille and Skoglund, Gyri and Olsen, Fromholt Cecilie and Hilde, Gunvor and Bong, Kiat Way and Nilsson, Blakstad Birgitta", title="Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study", journal="JMIR Hum Factors", year="2023", month="Nov", day="15", volume="10", pages="e48950", keywords="mHealth", keywords="mobile phone app", keywords="smartphone", keywords="lifestyle", keywords="usability", keywords="diabetes", keywords="diabetic", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="think-aloud", keywords="think aloud", keywords="user experience", keywords="mobile phone", abstract="Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. ", doi="10.2196/48950", url="https://humanfactors.jmir.org/2023/1/e48950", url="http://www.ncbi.nlm.nih.gov/pubmed/37966894" } @Article{info:doi/10.2196/41371, author="Tacchino, Andrea and Ponzio, Michela and Confalonieri, Paolo and Leocani, Letizia and Inglese, Matilde and Centonze, Diego and Cocco, Eleonora and Gallo, Paolo and Paolicelli, Damiano and Rovaris, Marco and Sabattini, Loredana and Tedeschi, Gioacchino and Prosperini, Luca and Patti, Francesco and Bramanti, Placido and Pedrazzoli, Elisabetta and Battaglia, Alberto Mario and Brichetto, Giampaolo", title="An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study", journal="JMIR Serious Games", year="2023", month="Nov", day="8", volume="11", pages="e41371", keywords="exergame", keywords="Multiple Sclerosis Fitness Intervention Training", keywords="MS-FIT", keywords="Pilates", keywords="Kinect", keywords="multiple sclerosis", keywords="exercise", keywords="serious games", keywords="balance", keywords="mobile phone", abstract="Background: Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. Objective: In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. Methods: MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44\% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. Results: A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100\%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64\% (9/14) of people with MS and 36\% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. Conclusions: The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status. ", doi="10.2196/41371", url="https://games.jmir.org/2023/1/e41371", url="http://www.ncbi.nlm.nih.gov/pubmed/37938895" } @Article{info:doi/10.2196/49102, author="C{\^a}mara Gradim, Carolina Luma and Santana, Maciel Andr{\'e} Luiz and Archanjo Jos{\'e}, Marcelo and Zuffo, Kn{\"o}rich Marcelo and Lopes, Deus Roseli de", title="An Automated Electronic System in a Motorized Wheelchair for Telemonitoring: Mixed Methods Study Based on Internet of Things", journal="JMIR Form Res", year="2023", month="Nov", day="8", volume="7", pages="e49102", keywords="eHealth systems", keywords="telemonitoring", keywords="inertial measurement unit", keywords="IMU", keywords="sensors", keywords="Internet of Things", keywords="IoT", keywords="pressure injury", keywords="wheelchair", keywords="mobile phone", abstract="Background: Wheelchair positioning systems can prevent postural deficits and pressure injuries. However, a more effective professional follow-up is needed to assess and monitor positioning according to the specificities and clinical conditions of each user. Objective: This study aims to present the concept of an electronic system embedded in a motorized wheelchair, based on the Internet of Things (IoT), for automated positioning as part of a study on wheelchairs and telemonitoring. Methods: We conducted a mixed methods study with a user-centered design approach, interviews with 16 wheelchair users and 66 professionals for the development of system functions, and a formative assessment of 5 participants with descriptive analysis to design system concepts. Results: We presented a new wheelchair system with hardware and software components developed based on coparticipation with singular components in an IoT architecture. In an IoT solution, the incorporation of sensors from the inertial measurement unit was crucial. These sensors were vital for offering alternative methods to monitor and control the tilt and recline functions of a wheelchair. This monitoring and control could be achieved autonomously through a smartphone app. In addition, this capability addressed the requirements of real users. Conclusions: The technologies presented in this system can benefit telemonitoring and favor real feedback, allowing quality provision of health services to wheelchair users. User-centered development favored development with specific functions to meet the real demands of users. We emphasize the importance of future studies on the correlation between diagnoses and the use of the system in a real environment to help professionals in treatment. ", doi="10.2196/49102", url="https://formative.jmir.org/2023/1/e49102", url="http://www.ncbi.nlm.nih.gov/pubmed/37776327" } @Article{info:doi/10.2196/46368, author="Kluge, G. Murielle and Maltby, Steven and Kuhne, Caroline and Walker, Nicole and Bennett, Neanne and Aidman, Eugene and Nalivaiko, Eugene and Walker, Rohan Frederick", title="Evaluation of a Virtual Reality Platform to Train Stress Management Skills for a Defense Workforce: Multisite, Mixed Methods Feasibility Study", journal="J Med Internet Res", year="2023", month="Nov", day="6", volume="25", pages="e46368", keywords="virtual reality", keywords="workplace training", keywords="stress management", keywords="defense", abstract="Background: Psychological stress-related injuries within first-responder organizations have created a need for the implementation of effective stress management training. Most stress management training solutions have limitations associated with scaled adoption within the workforce. For instance, those that are effective in civilian populations often do not align with the human performance culture embedded within first-responder organizations. Programs involving expert-led instructions that are high in quality are often expensive. Objective: This study sought to evaluate a tailored stress management training platform within the existing training schedule of the Australian Defense Force (ADF). The platform, known as Performance Edge (PE), is a novel virtual reality (VR) and biofeedback-enabled stress management skills training platform. Focusing on practical training of well-established skills and strategies, the platform was designed to take advantage of VR technology to generate an immersive and private training environment. This study aimed to assess the feasibility of delivering the VR platform within the existing group-based training context and intended training population. In this setting, the study further aimed to collect data on critical predictors of user acceptance and technology adoption in education, including perceived usability, usefulness, and engagement, while also assessing training impacts. Methods: This study used a mixed methods, multisite approach to collect observational, self-reported, and biometric data from both training staff and trainers within a real-world ``on-base'' training context in the ADF. Validated scales include the Presence Questionnaire and User Engagement Scale for perceived usefulness, usability, and engagement, as well as the State Mindfulness Scale and Relaxation Inventory, to gain insights into immediate training impacts for specific training modules. Additional surveys were specifically developed to assess implementation feedback, intention to use skills, and perceived training impact and value. Results: PE training was delivered to 189 ADF trainees over 372 training sessions. The platform was easy to use at an individual level and was feasible to deliver in a classroom setting. Trainee feedback consistently showed high levels of engagement and a sense of presence with the training content and environment. PE is overall perceived as an effective and useful training tool. Self-report and objective indices confirmed knowledge improvement, increased skill confidence, and increased competency after training. Specific training elements resulted in increased state mindfulness, increased physical relaxation, and reduced breathing rate. The ability to practice cognitive strategies in a diverse, private, and immersive training environment while in a group setting was highlighted as particularly valuable. Conclusions: This study found the VR-based platform (PE) to be a feasible stress management training solution for group-based training delivery in a defense population. Furthermore, the intended end users, both trainers and trainees, perceive the platform to be usable, useful, engaging, and effective for training, suggesting end-user acceptance and potential for technology adoption. ", doi="10.2196/46368", url="https://www.jmir.org/2023/1/e46368", url="http://www.ncbi.nlm.nih.gov/pubmed/37930751" } @Article{info:doi/10.2196/47189, author="Moldestad, Megan and Petrova, V. Valentina and Tirtanadi, Katie and Mishra, R. Sonali and Rajan, Suparna and Sayre, George and Fortney, C. John and Reisinger, Schacht Heather", title="Improving the Usability of Written Exposure Therapy for Therapists in the Department of Veterans Affairs Telemental Health: Formative Study Using Qualitative and User-Centered Design Methods", journal="JMIR Form Res", year="2023", month="Nov", day="6", volume="7", pages="e47189", keywords="evidence-based psychosocial interventions", keywords="telehealth", keywords="qualitative", keywords="user-centered design", keywords="implementation science", keywords="Department of Veterans Affairs health care system", abstract="Background: User modifications are common in evidence-based psychosocial interventions (EBPIs) for mental health disorders. Often, EBPIs fit poorly into clinical workflows, require extensive resources, or pose considerable burden to patients and therapists. Implementation science is increasingly researching ways to improve the usability of EBPIs before implementation. A user-centered design can be used to support implementation methods to prioritize user needs and solutions to improve EBPI usability. Objective: Trauma-focused EBPIs are a first-line treatment for patients with posttraumatic stress disorder (PTSD) in the Department of Veterans Affairs. Written exposure therapy (WET) is a brief, trauma-focused EBPI wherein patients handwrite about trauma associated with their PTSD. Initially developed for in-person delivery, WET is increasingly being delivered remotely, and outcomes appear to be equivalent to in-person delivery. However, there are logistical issues in delivering WET via video. In this evaluation, we explored usability issues related to WET telehealth delivery via videoconferencing software and designed a solution for therapist-facing challenges to systematize WET telehealth delivery. Methods: The Discover, Design and Build, and Test framework guided this formative evaluation and served to inform a larger Virtual Care Quality Enhancement Research Initiative. We used qualitative descriptive methods in the Discover phase to understand the experiences and needs of 2 groups of users providing care within the Department of Veterans Affairs: in-person therapists delivering WET via video because of the COVID-19 pandemic and telehealth therapists who regularly deliver PTSD therapies. We then used user-centered design methods in the Design and Build phase to brainstorm, develop, and iteratively refine potential workflows to address identified usability issues. All procedures were conducted remotely. Results: In the Discover phase, both groups had challenges delivering WET and other PTSD therapies via telehealth because of technology issues with videoconferencing software, environmental distractions, and workflow disruptions. Narrative transfer (ie, patients sending handwritten trauma accounts to therapists) was the first target for design solution development as it was deemed most critical to WET delivery. In the Design and Build phase, we identified design constraints and brainstormed solution ideas. This led to the development of 3 solution workflows that were presented to a subgroup of therapist users through cognitive walkthroughs. Meetings with this subgroup allowed workflow refinement to improve narrative transfers. Finally, to facilitate using these workflows, we developed PDF manuals that are being refined in subsequent phases of the implementation project (not mentioned in this paper). Conclusions: The Discover, Design and Build, and Test framework can be a useful tool for understanding user needs in complex EBPI interventions and designing solutions to user-identified usability issues. Building on this work, an iterative evaluation of the 3 solution workflows and accompanying manuals with therapists and patients is underway as part of a nationwide WET implementation in telehealth settings. ", doi="10.2196/47189", url="https://formative.jmir.org/2023/1/e47189", url="http://www.ncbi.nlm.nih.gov/pubmed/37930747" } @Article{info:doi/10.2196/46968, author="Foley, Gillian and Ricciardelli, Rosemary", title="Views on the Functionality and Use of the PeerConnect App Among Public Safety Personnel: Qualitative Analysis", journal="JMIR Form Res", year="2023", month="Nov", day="6", volume="7", pages="e46968", keywords="peer support", keywords="apps", keywords="mobile health technology", keywords="mobile health", keywords="mHealth", keywords="public safety personnel", keywords="correctional workers", keywords="police officers", keywords="emergency workers", keywords="first responders", keywords="mental health", keywords="Canada", keywords="digital health", keywords="intervention", keywords="peers", keywords="mobile app", keywords="peer support apps", keywords="web-based", keywords="web-based communities", abstract="Background: Research supports that public safety personnel (PSP) are regularly exposed to potentially psychologically traumatic events and occupational stress, which can compromise their well-being. To help address PSP well-being and mental health, peer support is increasingly being adopted (and developed) in PSP organizations. Peer support apps have been developed to connect the peer and peer supporter anonymously and confidentially, but little is known about their effectiveness, utility, and uptake. Objective: We designed this study to evaluate the functionality and use of the PeerConnect app, which is a vehicle for receiving and administering peer support. The app connects peers but also provides information (eg, mental health screening tools, newsfeed) to users; thus, we wanted to understand why PSP adopted or did not adopt the app and the app's perceived utility. Our intention was to determine if the app served the purpose of connectivity for PSP organizations implementing peer support. Methods: A sample of PSP (N=23) participated in an interview about why they used or did not use the app. We first surveyed participants across PSP organizations in Ontario, Canada, and at the end of the survey invited participants to participate in a follow-up interview. Of the 23 PSP interviewed, 16 were PeerConnect users and 7 were nonusers. After transcribing all audio recordings of the interviews, we used an emergent theme approach to analyze themes within and across responses. Results: PSP largely viewed PeerConnect positively, with the Connect feature being most popular (this feature facilitated peer support), followed by the Newsfeed and Resources. App users appreciated the convenience of the app and felt the app helped reduce the stigma around peer support use and pressure on peer supporters while raising awareness of wellness. PSP who did not use the app attributed their nonuse to disinterest or uncertainty about the need for a peer support app and the web-based nature of the app. To increase app adoption, participants recommended increased communication and promotion of the app by the services and continued efforts to combat mental health stigma. Conclusions: We provide contextual information about a peer support app's functionality and use. Our findings demonstrate that PSP are open to the use of mental health and peer support apps, but more education is required to reduce mental health stigma. Future research should continue to evaluate peer support apps for PSP to inform their design and ensure they are fulfilling their purpose. ", doi="10.2196/46968", url="https://formative.jmir.org/2023/1/e46968", url="http://www.ncbi.nlm.nih.gov/pubmed/37930765" } @Article{info:doi/10.2196/47624, author="Longacre, L. Margaret and Chwistek, Marcin and Keleher, Cynthia and Siemon, Mark and Egleston, L. Brian and Collins, Molly and Fang, Y. Carolyn", title="Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit", journal="JMIR Hum Factors", year="2023", month="Nov", day="2", volume="10", pages="e47624", keywords="caregiving", keywords="patient portal, health policy", keywords="palliative oncology", keywords="oncology", keywords="engagement", keywords="family caregiver", keywords="caregiver", keywords="communication", keywords="usage", keywords="usability", keywords="clinical care", keywords="cancer", abstract="Background: The engagement of family caregivers in oncology is not universal or systematic. Objective: We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed. Methods: We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. Results: Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60\% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3\%), financial (n=6, 31.6\%), and physical (n=6, 31.6\%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6\%, 13/15 who completed the user experience interview) and caregivers (94\%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7\% agreed ``quite a bit'' (n=1, 16.7\%) or ``very much'' (n=3, 50\%) that the system allowed them to provide better care. Conclusions: Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses. ", doi="10.2196/47624", url="https://humanfactors.jmir.org/2023/1/e47624", url="http://www.ncbi.nlm.nih.gov/pubmed/37917129" } @Article{info:doi/10.2196/50891, author="Yamada, Kazunosuke and Enokida, Yasuaki and Kato, Ryuji and Imaizumi, Jun and Takada, Takahiro and Ojima, Hitoshi", title="The Feasibility and Reliability of Upper Arm--Worn Apple Watch Heart Rate Monitoring for Surgeons During Surgery: Observational Study", journal="JMIR Hum Factors", year="2023", month="Nov", day="1", volume="10", pages="e50891", keywords="Apple Watch", keywords="heart rate", keywords="surgery", keywords="robot", abstract="Background: Health care professionals, particularly those in surgical settings, face high stress levels, impacting their well-being. Traditional monitoring methods, like using Holter electrocardiogram monitors, are impractical in the operating room, limiting the assessment of physicians' health. Wrist-worn heart rate monitors, like the Apple Watch, offer promise but are restricted in surgeries due to sterility issues. Objective: This study aims to assess the feasibility and accuracy of using an upper arm--worn Apple Watch for heart rate monitoring during robotic-assisted surgeries, comparing its performance with that of a wrist-worn device to establish a reliable alternative monitoring site. Methods: This study used 2 identical Apple Watch Series 8 devices to monitor the heart rate of surgeons during robotic-assisted surgery. Heart rate data were collected from the wrist-worn and the upper arm--worn devices. Statistical analyses included calculating the mean difference and SD of difference between the 2 devices, constructing Bland-Altman plots, assessing accuracy based on mean absolute error and mean absolute percentage error, and calculating the intraclass correlation coefficient. Results: The mean absolute errors for the whole group and for participants A, B, C, and D were 3.63, 3.58, 2.70, 3.93, and 4.28, respectively, and the mean absolute percentage errors were 3.58\%, 3.34\%, 2.42\%, 4.58\%, and 4.00\%, respectively. Bland-Altman plots and scatter plots showed no systematic error when comparing the heart rate measurements obtained from the upper arm--worn and the wrist-worn Apple Watches. The intraclass correlation coefficients for participants A, B, C, and D were 0.559, 0.651, 0.508, and 0.563, respectively, with a significance level of P<.001, indicating moderate reliability. Conclusions: The findings of this study suggest that the upper arm is a viable alternative site for monitoring heart rate during surgery using an Apple Watch. The agreement and reliability between the measurements obtained from the upper arm--worn and the wrist-worn devices were good, with no systematic error and a high level of accuracy. These findings have important implications for improving data collection and management of the physical and mental demands of operating room staff during surgery, where wearing a watch on the wrist may not be feasible. ", doi="10.2196/50891", url="https://humanfactors.jmir.org/2023/1/e50891", url="http://www.ncbi.nlm.nih.gov/pubmed/37910162" } @Article{info:doi/10.2196/36324, author="Moon, Hui-Woun and Park, Me Da Som and Jung, Young Se", title="Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Oct", day="30", volume="7", pages="e36324", keywords="care", keywords="caregiving", keywords="instrument development", keywords="elderly", keywords="quality of life", keywords="ergonomics", keywords="focus groups", keywords="musculoskeletal", keywords="usability", keywords="feasibility", keywords="digital health intervention", keywords="digital health", keywords="health intervention", keywords="nursing", keywords="electronic medical record", abstract="Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses' opinions of smart devices that provide integrated nursing for patients' urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses' work efficiency, reduce their burden, and extend to caregivers and guardians. ", doi="10.2196/36324", url="https://formative.jmir.org/2023/1/e36324", url="http://www.ncbi.nlm.nih.gov/pubmed/37902820" } @Article{info:doi/10.2196/49500, author="Aclan, Roslyn and George, Stacey and Laver, Kate", title="A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study", journal="JMIR Aging", year="2023", month="Oct", day="26", volume="6", pages="e49500", keywords="age-friendliness", keywords="aging", keywords="home environment", keywords="self-assessment", keywords="digital", keywords="tool", abstract="Background: Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial. Objective: This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment. Methods: A cohort of adults aged ?60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen $\kappa$ and Gwet AC1 were used to assess validity. Results: A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77\% agreement, Gwet AC1=0.56), toilets (56\% agreement, $\kappa$=0.10), bathrooms (64\% agreement, $\kappa$=0.46), and backyards (55\% agreement, $\kappa$=0.24). Conclusions: Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment. ", doi="10.2196/49500", url="https://aging.jmir.org/2023/1/e49500", url="http://www.ncbi.nlm.nih.gov/pubmed/37883134" } @Article{info:doi/10.2196/49319, author="Sharma, Nikita and Braakman-Jansen, A. Louise M. and Oinas-Kukkonen, Harri and Croockewit, Hendrik Jan and Gemert-Pijnen, van JEWC", title="Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study", journal="JMIR Aging", year="2023", month="Oct", day="25", volume="6", pages="e49319", keywords="informal caregiving", keywords="cognitive impairment", keywords="unobtrusive sensing solutions", keywords="in-home care", keywords="aging in place", keywords="assistive technologies", abstract="Background: With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. Objective: This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. Methods: A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2\%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Results: Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. Conclusions: From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users. ", doi="10.2196/49319", url="https://aging.jmir.org/2023/1/e49319", url="http://www.ncbi.nlm.nih.gov/pubmed/37878353" } @Article{info:doi/10.2196/47374, author="H{\ae}germark, Aale Emil and Kongshaug, Nina and Raj, Xavier Sunil and Hofsli, Eva and Faxvaag, Arild", title="Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study", journal="JMIR Form Res", year="2023", month="Oct", day="19", volume="7", pages="e47374", keywords="mobile health", keywords="mHealth", keywords="user-centered design", keywords="usability testing", keywords="cancer", keywords="side effects", keywords="cytostatic treatment", keywords="intervention", keywords="mobile app", keywords="usability", keywords="user interface", keywords="user", keywords="smartphone", keywords="mobile phone", abstract="Background: Using mobile health (mHealth) interventions such as smartphone apps to deliver health services is an opportunity to engage patients more actively in their own treatment. Usability tests allow for the evaluation of a service by testing it out on the relevant users before implementation in clinical practice. Objective: The objective of this study was to design, develop, and evaluate the user interface of an app that would aid patients with cancer in reporting a more comprehensive summary of their side effects. Methods: The usability test was conducted by exposing patients with cancer to a prototype of an mHealth app that allowed for reporting of side effects from a chemotherapy regimen. After solving a set of 13 tasks, the test participants completed a system usability scale questionnaire and were interviewed using a semistructured interview guide. The interviews were later transcribed and analyzed. Results: The 10 test participants had a mean age of 56.5 (SD 7.11) years. The mean total task completion time for the task-solving session was 240.15 (SD 166.78) seconds. The calculated system usability scale score was 92.5. Most participants solved most of the tasks without any major issues. A minority reported having difficulties using apps on smartphones in general. One patient never achieved a meaningful interaction with our app prototype. Most of those who engaged with the app approved of features that calmed them down, made them more empowered, and put them in control. They preferred to report on side effects in a detailed and concise manner. App features that provided specific advice could provoke both fear and rational action. Conclusions: The user tests uncovered design flaws that allowed for subsequent refining of an app that has the potential to enhance the safety of patients undergoing home-based chemotherapy. However, a refined version of the app is unlikely to be of value to all patients. Some might not be able to use apps on smartphones in general, or their ability to use apps is impaired because of their disease. This finding should have implications for health care providers' overall design of their follow-up service as the service must allow for all the patients to receive safe treatment whether they can use an mHealth app or not. ", doi="10.2196/47374", url="https://formative.jmir.org/2023/1/e47374", url="http://www.ncbi.nlm.nih.gov/pubmed/37856183" } @Article{info:doi/10.2196/46209, author="Dreesmann, J. Nathan and Buchanan, Diana and Tang, Jean Hsin-Yi and Furness III, Thomas and Thompson, Hilaire", title="Virtual Reality Meditation for Fatigue in Persons With Rheumatoid Arthritis: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2023", month="Oct", day="17", volume="7", pages="e46209", keywords="anxiety", keywords="chronic pain", keywords="depression", keywords="fatigue", keywords="feasibility study", keywords="feasibility", keywords="head-mounted display", keywords="meditation", keywords="mixed method", keywords="mood", keywords="pain", keywords="rheumatoid arthritis", keywords="symptom", keywords="virtual reality", keywords="VR", abstract="Background: Effective symptom management is crucial to enhancing the quality of life for individuals with chronic diseases. Health care has changed markedly over the past decade as immersive, stand-alone, and wearable technologies including virtual reality have become available. One chronic pain population that could benefit from such an intervention is individuals with rheumatoid arthritis (RA). Recent pharmacologic advances in the management of RA have led to a decrease in inflammatory symptoms (eg, chronic pain) or even disease remission, yet up to 70\% of patients with RA still suffer from fatigue. While VR-delivered behavior, meditation, and biofeedback programs show promise for pain and anxiety management, there is little information on the use of virtual reality meditation (VRM) for fatigue management among individuals with RA. Objective: This study aims to (1) examine the feasibility of implementing a study protocol that uses VRM, (2) determine the acceptability of using VRM for fatigue management in an outpatient population, and (3) identify barriers and contextual factors that might impact VRM use for fatigue management in outpatients with RA. Methods: We used a convergent, mixed methods design and enrolled adults aged 18 years or older with a clinical diagnosis of RA. Patient-Reported Outcome Measure Information System (PROMIS) measures of fatigue, depression, anxiety, pain behavior, and physical function were assessed alongside the brief mood introspection scale at baseline and weekly for 4 weeks. VRM use across the 4-week study period was automatically stored on headsets and later extracted for analysis. Semistructured interview questions focused on feedback regarding the participant's experience with RA, previous experience of fatigue, strategies participants use for fatigue management, and the participant's experience using VRM and recommendations for future use. Results: A total of 13 participants completed this study. Most participants completed all study surveys and measures (11/13, 84\% and 13/13, 100\%, respectively) and were active participants in interviews at the beginning and end of the program. Participants used VRM an average of 8.9 (SD 8.5) times over the course of the 4-week program. Most participants enjoyed VRM, found it relaxing, or recommended its use (12/13, 92\%), but 8 (62\%) noted barriers and conceptual factors that impacted VRM use. On average, participants saw decreases in PROMIS fatigue (--6.4, SD 5.1), depression (--5.6, SD 5.7), anxiety (--4.5, SD 6), and pain behavior (--3.9, SD 5.3), and improvements in PROMIS physical function (1.5, SD 2.7) and Brief Mood Introspection Scale mood (5.3, SD 6.7) over the course of this 4-week study. Conclusions: While this study's implementation was feasible, VRM's acceptability as an adjunctive modality for symptom management in RA is contingent on effectively overcoming barriers to use and thoughtfully addressing the contextual factors of those with RA to ensure successful intervention deployment. Trial Registration: ClinicalTrials.gov NCT04804462; https://classic.clinicaltrials.gov/ct2/show/NCT04804462 ", doi="10.2196/46209", url="https://formative.jmir.org/2023/1/e46209", url="http://www.ncbi.nlm.nih.gov/pubmed/37847542" } @Article{info:doi/10.2196/48395, author="Metzler-Baddeley, Claudia and Busse, Monica and Drew, Cheney and Pallmann, Philip and Cantera, Jaime and Ioakeimidis, Vasileios and Rosser, Anne", title="HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study", journal="JMIR Form Res", year="2023", month="Oct", day="6", volume="7", pages="e48395", keywords="Huntington disease", keywords="electronic health", keywords="intervention", keywords="training application", keywords="rhythm", keywords="timing", keywords="drumming", keywords="movement", keywords="cognition", keywords="integrated knowledge translation", keywords="gamification", keywords="Template for Intervention Description and Replication (TIDieR)", keywords="TIDieR", keywords="mobile phone", abstract="Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users' performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. ", doi="10.2196/48395", url="https://formative.jmir.org/2023/1/e48395", url="http://www.ncbi.nlm.nih.gov/pubmed/37801351" } @Article{info:doi/10.2196/46350, author="Hermsen, Sander and Van Abswoude, Femke and Steenbergen, Bert", title="The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study", journal="JMIR Form Res", year="2023", month="Oct", day="5", volume="7", pages="e46350", keywords="active living", keywords="adolescents", keywords="physical activity", keywords="digital health", keywords="mobile phone", abstract="Background: Participation in organized sports and other forms of active living have important health benefits in adolescence and adulthood. Unfortunately, the transition to secondary school has been shown to be a barrier to participation. Social networks can play important roles in activating adolescents, and information and communication technology (ICT) interventions can augment this role. To date, there are few insights into what adolescents themselves think and feel about barriers to and motivators for active living, the role of their social networks in active living, and the potential of ICT for physical activity (PA). Objective: This study aimed to gather insights into the perspectives of adolescents aged 12 to 14 years on active living and sports participation, motivators and demotivators for active living, and the potential roles of their social network and of ICT. Methods: A total of 26 adolescents aged 12 to 14 years from different levels of Dutch secondary schools participated in 1 of 5 semistructured focus group interviews, in which they talked about sports and PA, their social networks, their ICT use, and the role of social networks and ICT in PA. All interviews were transcribed and analyzed using a thematic qualitative approach. Results: The study showed that all participants were physically active, although the transition to secondary school made this difficult, mostly because of time constraints. Participants saw positive physical and mental health effects as important benefits of active living. They regarded social benefits as strong motivators for active living: being together, making friends, and having fun together. However, the social network could also demotivate through negative peer judgment and negative feedback. Participants were willing to share their own positive experiences and hear about those from close peers and friends but would not share their own (and were not interested in others') negative experiences or personal information. Participants were mainly interested in descriptive norms set by others and obtained inspiration from others for PA. With respect to using ICT for active living, participants stated a preference for social challenges among friends, personalized feedback, goals, activities, and rewards. Competition was seen as less important or even unattractive. If mentioned, participants felt that this should be with friends, or peers of a similar level, with fun being more important than the competition itself. Conclusions: This study shows that adolescents feel that their social network is and can be a strong driver of active living. They are willing to use ICT-based solutions that make use of social networks for PA as long as these solutions involve their current (close) network and use an approach based on being together and having fun together. ", doi="10.2196/46350", url="https://formative.jmir.org/2023/1/e46350", url="http://www.ncbi.nlm.nih.gov/pubmed/37796582" } @Article{info:doi/10.2196/45442, author="Randall, Natasha and Kamino, Waki and Joshi, Swapna and Chen, Wei-Chu and Hsu, Long-Jing and Tsui, M. Katherine and {\vS}abanovi{\'c}, Selma", title="Understanding the Connection Among Ikigai, Well-Being, and Home Robot Acceptance in Japanese Older Adults: Mixed Methods Study", journal="JMIR Aging", year="2023", month="Oct", day="4", volume="6", pages="e45442", keywords="ikigai", keywords="meaning in life", keywords="purpose", keywords="well-being", keywords="eudaimonic", keywords="hedonic", keywords="happiness", keywords="home robots", keywords="social robots", keywords="human-robot interaction", keywords="Japan", abstract="Background: Ikigai (meaning or purpose in life) is a concept understood by most older adults in Japan. The term has also garnered international attention, with recent academic attempts to map it to concepts in the Western well-being literature. In addition, efforts to use social and home robots to increase well-being have grown; however, they have mostly focused on hedonic well-being (eg, increasing happiness and decreasing loneliness) rather than eudaimonic well-being (eg, fostering meaning or purpose in life). Objective: First, we explored how Japanese older adults experience ikigai and relate these to concepts in the Western well-being literature. Second, we investigated how a home robot meant to promote ikigai is perceived by older adults. Methods: We used a mixed methods research design---including 20 interviews with older adults, a survey of 50 older adults, and 10 interviews with family caregivers. For interviews, we asked questions about older adults' sources of ikigai, happiness, and social support, along with their perception of the robot (QT). For surveys, a number of well-being scales were used, including 2 ikigai scales---ikigai-9 and K-1---and 6 Patient-Reported Outcomes Measurement Information System scales, measuring meaning and purpose, positive affect, satisfaction with participation in social roles, satisfaction with participation in discretionary social activities, companionship, and emotional support. Questions related to the perception and desired adoption of the robot and older adults' health status were also included. Results: Our results suggest that health is older adults' most common source of ikigai. Additionally, although self-rated health correlated moderately with ikigai and other well-being measures, reported physical limitation did not. As opposed to social roles (work and family), we found that ikigai is more strongly related to satisfaction with discretionary social activities (leisure, hobbies, and friends) for older adults. Moreover, we found that older adults' sources of ikigai included the eudaimonic aspects of vitality, positive relations with others, contribution, accomplishment, purpose, and personal growth, with the first 3 being most common, and the hedonic aspects of positive affect, life satisfaction, and lack of negative affect, with the first 2 being most common. However, the concept of ikigai was most related to eudaimonic well-being, specifically meaning in life, along the dimension of significance. Finally, we found that Japanese older adults have high expectations of a home robot for well-being, mentioning that it should support them in a multitude of ways before they would likely adopt it. However, we report that those with the highest levels of meaning, and satisfaction with their leisure life and friendships, may be most likely to adopt it. Conclusions: We outline several ways to improve the robot to increase its acceptance, such as improving its voice, adding functional features, and designing it to support multiple aspects of well-being. ", doi="10.2196/45442", url="https://aging.jmir.org/2023/1/e45442", url="http://www.ncbi.nlm.nih.gov/pubmed/37792460" } @Article{info:doi/10.2196/44170, author="Goueth, Rose and Darney, Blair and Hoffman, Aubri and Eden, B. Karen", title="Evaluating the Acceptability and Feasibility of a Sexual Health--Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="3", volume="7", pages="e44170", keywords="decision aid", keywords="contraception", keywords="decision-making", keywords="user-centered design", keywords="young adults", keywords="pilot study", keywords="feasibility", keywords="acceptability", keywords="development", keywords="support", keywords="tool", keywords="survey", keywords="sexual health", abstract="Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid---Healthy Sex Choices---designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as ``good.'' Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53\% before vs 45\% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48\% vs 55\%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. ", doi="10.2196/44170", url="https://formative.jmir.org/2023/1/e44170", url="http://www.ncbi.nlm.nih.gov/pubmed/37788070" } @Article{info:doi/10.2196/47228, author="Bui, T. Dung and Barnett, Tony and Hoang, Ha and Chinthammit, Winyu", title="Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study", journal="JMIR Med Educ", year="2023", month="Oct", day="2", volume="9", pages="e47228", keywords="augmented reality", keywords="mentorship", keywords="patient simulation", keywords="patient care management", keywords="quasi-experimental study", keywords="telehealth", abstract="Background: Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. Objective: This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. Methods: This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR's usability, mentorship effectiveness, and mentees' self-confidence and skill performance. Results: A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees' confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees' individual skill performance rates ranged from 98\% in the ACS scenario to 97\% in the AMI, PSRA, and HE scenarios. Conclusions: This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research. ", doi="10.2196/47228", url="https://mededu.jmir.org/2023/1/e47228", url="http://www.ncbi.nlm.nih.gov/pubmed/37782533" } @Article{info:doi/10.2196/48976, author="Fossouo Tagne, Joel and Yakob, Amin Reginald and Mcdonald, Rachael and Wickramasinghe, Nilmini", title="A Web-Based Tool to Report Adverse Drug Reactions by Community Pharmacists in Australia: Usability Testing Study", journal="JMIR Form Res", year="2023", month="Sep", day="29", volume="7", pages="e48976", keywords="ADR", keywords="adverse drug reaction", keywords="pharmacovigilance", keywords="community pharmacy", keywords="digital health evaluation", keywords="usability testing", abstract="Background: Adverse drug reactions (ADRs) are unintended and harmful events associated with medication use. Despite their significance in postmarketing surveillance, quality improvement, and drug safety research, ADRs are vastly underreported. Enhanced digital-based communication of ADR information to regulators and among care providers could significantly improve patient safety. Objective: This paper presents a usability evaluation of the commercially available GuildCare Adverse Event Recording system, a web-based ADR reporting system widely used by community pharmacists (CPs) in Australia. Methods: We developed a structured interview protocol encompassing remote observation, think-aloud moderating techniques, and retrospective questioning to gauge the overall user experience, complemented by the System Usability Scale (SUS) assessment. Thematic analysis was used to analyze field notes from the interviews. Results: A total of 7 CPs participated in the study, who perceived the system to have above-average usability (SUS score of 68.57). Nonetheless, the structured approach to usability testing unveiled specific functional and user interpretation issues, such as unnecessary information, lack of system clarity, and redundant data fields---critical insights not captured by the SUS results. Design elements like drop-down menus, free-text entry, checkboxes, and prefilled or auto-populated data fields were perceived as useful for enhancing system navigation and facilitating ADR reporting. Conclusions: The user-centric design of technology solutions, like the one discussed herein, is crucial to meeting CPs' information needs and ensuring effective ADR reporting. Developers should adopt a structured approach to usability testing during the developmental phase to address identified issues comprehensively. Such a methodological approach may promote the adoption of ADR reporting systems by CPs and ultimately enhance patient safety. ", doi="10.2196/48976", url="https://formative.jmir.org/2023/1/e48976", url="http://www.ncbi.nlm.nih.gov/pubmed/37773620" } @Article{info:doi/10.2196/44562, author="Palm, Klas and Kronlid, Carl and Brantnell, Anders and Elf, Marie and Borg, Johan", title="Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study", journal="JMIR Res Protoc", year="2023", month="Sep", day="28", volume="12", pages="e44562", keywords="barriers", keywords="digital health", keywords="facilitators", keywords="health care", keywords="implementation", keywords="internet of things", keywords="IoT solution", keywords="older people", keywords="person-centered care", keywords="technology", abstract="Background: ?The internet of things (IoT) is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. This study aims to identify the facilitators and barriers associated with implementing IoT solutions in health care within a Scandinavian context. It addresses the pressing need to adapt health care systems to the demographic changes occurring in Scandinavia. The vision of ``Vision eHealth 2025,'' a long-term strategic direction for digitalization in Sweden, serves as the background for this project. The implementation of IoT solutions is a crucial aspect of achieving the vision's goal of making Sweden a global leader in using digitalization and eHealth opportunities by 2025. IoT is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. Previous research has shown that there is a gap in our understanding of social and organizational challenges related to IoT and that the implementation and introduction of new technology in health care is often problematic. Objective: ?In this study, we will identify facilitating and hindering factors for the implementation of IoT solutions in social and health care. Methods: ?We will use an explorative design with a case study approach. The data collection will comprise questionnaires and qualitative interviews. Also, a literature review will be conducted at the start of the project. Thus, quantitative and qualitative data will be collected concurrently and integrated into a convergent mixed methods approach. Results: ?As of June 2023, data for the review and 22 interviews with the stakeholders have been performed. The co-design with stakeholders will be performed in the fall of 2023. Conclusions: ?This study represents a unique and innovative opportunity to gain new knowledge relevant and useful for future implementation of new technology at health care organizations so they can continue to offer high-quality, person-centered care. The outcomes of this research will contribute to a better understanding of the conditions necessary to implement and fully use the potential of IoT solutions. By developing cocreated implementation strategies, the study seeks to bridge the gap between theory and practice. Ultimately, this project aims to facilitate the adoption of IoT solutions in health care for promoting improved patient care and using technology to meet the evolving needs of health care. International Registered Report Identifier (IRRID): DERR1-10.2196/44562 ", doi="10.2196/44562", url="https://www.researchprotocols.org/2023/1/e44562", url="http://www.ncbi.nlm.nih.gov/pubmed/37768725" } @Article{info:doi/10.2196/46738, author="B{\"o}ttinger, J. Melissa and Litz, Elena and Gordt-Oesterwind, Katharina and Jansen, Carl-Philipp and Memmer, Nicole and Mychajliw, Christian and Radeck, Leon and Bauer, M. J{\"u}rgen and Becker, Clemens", title="Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study", journal="JMIR Aging", year="2023", month="Sep", day="26", volume="6", pages="e46738", keywords="aged", keywords="self-assessment", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="community-based participatory research", keywords="co-creation", keywords="comprehensive geriatric assessment", keywords="mobile phone", abstract="Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ?70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. ", doi="10.2196/46738", url="https://aging.jmir.org/2023/1/e46738", url="http://www.ncbi.nlm.nih.gov/pubmed/37751274" } @Article{info:doi/10.2196/44402, author="Oladele, Ayoola David and Iwelunmor, Juliet and Gbajabiamila, Titilola and Obiezu-Umeh, Chisom and Okwuzu, Ogoamaka Jane and Nwaozuru, Ucheoma and Musa, Zaidat Adesola and Tahlil, Kadija and Idigbe, Ifeoma and Ong, Jason and Tang, Weiming and Tucker, Joseph and Ezechi, Oliver", title="An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility", journal="JMIR Form Res", year="2023", month="Sep", day="25", volume="7", pages="e44402", keywords="adolescent", keywords="adolescents and young adults", keywords="Africa", keywords="AYA", keywords="development", keywords="feasibility", keywords="HIV self-testing", keywords="HIV", keywords="HIVST", keywords="information system", keywords="Nigeria", keywords="platform", keywords="testing", keywords="think aloud", keywords="unstructured supplementary service data", keywords="usability", keywords="user-centered", keywords="USSD", keywords="young adult", keywords="youth", abstract="Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6\%). The mean age was 17.5 (SD 3.18) years, and 92.1\% (151/164) of the participants reported that they were heterosexual, while 7.9\% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9\% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach. ", doi="10.2196/44402", url="https://formative.jmir.org/2023/1/e44402", url="http://www.ncbi.nlm.nih.gov/pubmed/37747780" } @Article{info:doi/10.2196/41185, author="Dale, Jeremy and Nanton, Veronica and Day, Theresa and Apenteng, Patricia and Bernstein, Janine Celia and Grason Smith, Gillian and Strong, Peter and Procter, Rob", title="Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study", journal="JMIR Aging", year="2023", month="Sep", day="21", volume="6", pages="e41185", keywords="informal carers", keywords="information technology", keywords="internet", keywords="information needs", keywords="mixed methods evaluation", keywords="Reach, Effectiveness, Adoption, Implementation, and Maintenance", keywords="RE-AIM", keywords="mobile phone", abstract="Background: Informal carers play a major role in supporting relatives and friends who are sick, disabled, or frail. Access to information, guidance, and support that are relevant to the lives and circumstances of carers is critical to carers feeling supported in their role. When unmet, this need is known to adversely affect carer resilience and well-being. To address this problem, Care Companion was co-designed with current and former carers and stakeholders as a free-to-use, web-based resource to provide access to a broad range of tailored information, including links to local and national resources. Objective: This study aimed to investigate the real-world uptake and use of Care Companion in 1 region of England (with known carer population of approximately 100,000), with local health, community, and social care teams being asked to actively promote its use. Methods: The study had a convergent parallel, mixed methods design and drew on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included metrics from carers' use of Care Companion, surveys completed by users recruited through general practice, and interviews with carers and health and social care providers regarding their views about Care Companion and their response to it. Quantitative data were analyzed using descriptive statistics. Interview data were analyzed thematically and synthesized to create overarching themes. The qualitative findings were used for in-depth exploration and interpretation of quantitative results. Results: Despite awareness-raising activities by relevant health, social care, and community organizations, there was limited uptake with only 556 carers (0.87\% of the known carer population of 100,000) registering to use Care Companion in total, with median of 2 (mean 7.2; mode 2) visits per registered user. Interviews with carers (n=29) and stakeholders (n=12) identified 7 key themes that influenced registration, use, and perceived value: stakeholders' signposting of carers to Care Companion, expectations about Care Companion, activity levels and conflicting priorities, experience of using Care Companion, relevance to personal circumstances, social isolation and networks, and experience with digital technology. Although many interviewed carers felt that it was potentially useful, few considered it as being of direct relevance to their own circumstances. For some, concerns about social isolation and lack of hands-on support were more pressing issues than the need for information. Conclusions: The gap between the enthusiastic views expressed by carers during Care Companion's co-design and the subsequent low level of uptake and user experience observed in this evaluation suggests that the co-design process may have lacked a sufficiently diverse set of viewpoints. Numerous factors were identified as contributing to Care Companion's level of use, some of which might have been anticipated during its co-design. More emphasis on the development and implementation, including continuing co-design support after deployment, may have supported increased use. ", doi="10.2196/41185", url="https://aging.jmir.org/2023/1/e41185", url="http://www.ncbi.nlm.nih.gov/pubmed/37733406" } @Article{info:doi/10.2196/45484, author="Chen, Nai-Jung and Huang, Chiu-Mieh and Fan, Ching-Chih and Lu, Li-Ting and Lin, Fen-He and Liao, Jung-Yu and Guo, Jong-Long", title="User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study", journal="JMIR Form Res", year="2023", month="Sep", day="19", volume="7", pages="e45484", keywords="chronic kidney disease", keywords="chatbot", keywords="health education", keywords="push notification", keywords="users' evaluation", abstract="Background: Artificial intelligence--driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. Objective: The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants' user experiences will form the basis for program design improvements. Methods: Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. Results: Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. Conclusions: The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users' evaluation is satisfactory. Trial Registration: ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517 ", doi="10.2196/45484", url="https://formative.jmir.org/2023/1/e45484", url="http://www.ncbi.nlm.nih.gov/pubmed/37725429" } @Article{info:doi/10.2196/45259, author="Verweij, Lynn and Metsemakers, M. Sanne J. J. P. and Ector, G. Genevi{\`e}ve I. C. and Rademaker, Peter and Bekker, L. Charlotte and van Vlijmen, Bas and van der Reijden, A. Bert and Blijlevens, A. Nicole M. and Hermens, G. Rosella P. M.", title="Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach", journal="J Med Internet Res", year="2023", month="Sep", day="15", volume="25", pages="e45259", keywords="eHealth", keywords="digital care platform", keywords="feasibility", keywords="patient experiences", keywords="usability", keywords="chronic myeloid leukemia", keywords="participatory action research", keywords="CMyLife", abstract="Background: The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. Objective: The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. Methods: The study used iterative cycles of planning, action, and reflection, whereby participants' experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. Results: The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67\% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42\% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44\% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. Conclusions: A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users' needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users. ", doi="10.2196/45259", url="https://www.jmir.org/2023/1/e45259", url="http://www.ncbi.nlm.nih.gov/pubmed/37713242" } @Article{info:doi/10.2196/43099, author="Wang, Jitao and Wu, Zhenke and Choi, Won Sung and Sen, Srijan and Yan, Xinghui and Miner, A. Jennifer and Sander, M. Angelle and Lyden, K. Angela and Troost, P. Jonathan and Carlozzi, E. Noelle", title="The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study", journal="JMIR Form Res", year="2023", month="Sep", day="14", volume="7", pages="e43099", keywords="caregiver", keywords="just-in-time adaptive intervention", keywords="JITAI", keywords="mobile health intervention", keywords="health-related quality of life", keywords="HRQOL", keywords="intervention", keywords="self-management", keywords="quality of life", keywords="psychological", keywords="effectiveness", keywords="acceptability", keywords="feasibility", keywords="design", keywords="anxiety", keywords="depression", keywords="QOL", keywords="affect", keywords="medication", keywords="pharma", keywords="rehab", keywords="wearable", keywords="ubiquitous", keywords="accelerometer", keywords="sleep", keywords="polysomnography", keywords="PROMIS Anxiety", keywords="PROMIS Depression", keywords="computer adaptive test", keywords="CAT", keywords="generalized estimating equations", keywords="GEE", keywords="weighted and centered least square", keywords="WCLS", abstract="Background: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood. Objective: The primary objective of this study is to evaluate the dose-response relationship of a fully automated JITAI-based self-management intervention involving personalized mobile app notifications targeted at decreasing the level of caregiver strain, anxiety, and depression. The secondary objective is to investigate whether the effectiveness of this mobile health intervention was moderated by the caregiver group. We also explored whether the effectiveness of this intervention was moderated by (1) previous HRQOL measures, (2) the number of weeks in the study, (3) step count, and (4) minutes of sleep. Methods: We examined 36 caregivers from 3 disease groups (10 from spinal cord injury, 11 from Huntington disease, and 25 from allogeneic hematopoietic cell transplantation) in the intervention arm of a larger randomized controlled trial (subjects in the other arm received no prompts from the mobile app) designed to examine the acceptability and feasibility of this intensive type of trial design. A series of multivariate linear models implementing a weighted and centered least squares estimator were used to assess the JITAI efficacy and effect. Results: We found preliminary support for a positive dose-response relationship between the number of administered JITAI messages and JITAI efficacy in improving caregiver strain, anxiety, and depression; while most of these associations did not meet conventional levels of significance, there was a significant association between high-frequency JITAI and caregiver strain. Specifically, administering 5-6 messages per week as opposed to no messages resulted in a significant decrease in the HRQOL score of caregiver strain with an estimate of --6.31 (95\% CI --11.76 to --0.12; P=.046). In addition, we found that the caregiver groups and the participants' levels of depression in the previous week moderated JITAI efficacy. Conclusions: This study provides preliminary evidence to support the effectiveness of the self-management JITAI and offers practical guidance for designing future personalized JITAI strategies for diverse caregiver groups. Trial Registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591 ", doi="10.2196/43099", url="https://formative.jmir.org/2023/1/e43099", url="http://www.ncbi.nlm.nih.gov/pubmed/37707948" } @Article{info:doi/10.2196/46269, author="Kwok, Ian and Lattie, Gardiner Emily and Yang, Dershung and Summers, Amanda and Grote, Veronika and Cotten, Paul and Moskowitz, Tedlie Judith", title="Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study", journal="JMIR Aging", year="2023", month="Sep", day="6", volume="6", pages="e46269", keywords="dementia", keywords="caregiving", keywords="eHealth", keywords="digital interventions", keywords="positive emotion", keywords="stress", keywords="coping", abstract="Background: The responsibilities of being a primary caregiver for a loved one with dementia can produce significant stress for the caregiver, leading to deleterious outcomes for the caregiver's physical and psychological health. Hence, researchers are developing eHealth interventions to provide support for caregivers. Members of our research team previously developed and tested a positive emotion regulation intervention that we delivered through videoconferencing, in which caregiver participants would meet one-on-one with a trained facilitator. Although proven effective, such delivery methods have limited scalability because they require significant resources in terms of cost and direct contact hours. Objective: This study aimed to conduct a pilot test of a socially enhanced, self-guided version of the positive emotion regulation intervention, Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF). Studies have shown that social presence or the perception of others in a virtual space is associated with enhanced learning and user satisfaction. Hence, the intervention leverages various social features (eg, discussion boards, podcasts, videos, user profiles, and social notifications) to foster a sense of social presence among participants and study team members. Methods: Usability, usefulness, feasibility, and acceptability data were collected from a pilot test in which participants (N=15) were given full access to the SAGE LEAF intervention over 6 weeks and completed preintervention and postintervention assessments (10/15, 67\%). Preliminary outcome measures were also collected, with an understanding that no conclusions about efficacy could be made, because our pilot study did not have a control group and was not sufficiently powered. Results: The results suggest that SAGE LEAF is feasible, with participants viewing an average of 72\% (SD 42\%) of the total available intervention web pages. In addition, acceptability was found to be good, as demonstrated by participants' willingness to recommend the SAGE LEAF program to a friend or other caregiver. Applying Pearson correlational analyses, we found moderate, positive correlation between social presence scores and participants' willingness to recommend the program to others (r9=0.672; P=.03). We also found positive correlation between social presence scores and participants' perceptions about the overall usefulness of the intervention (r9=0.773; P=.009). This suggests that participants' sense of social presence may be important for the feasibility and acceptability of the program. Conclusions: In this pilot study, the SAGE LEAF intervention demonstrates potential for broad dissemination for dementia caregivers. We aim to incorporate participant feedback about how the social features may be improved in future iterations to enhance usability and to further bolster a sense of social connection among participants and study staff members. Next steps include partnering with dementia clinics and other caregiver-serving organizations across the United States to conduct a randomized controlled trial to evaluate the effectiveness of the intervention. ", doi="10.2196/46269", url="https://aging.jmir.org/2023/1/e46269", url="http://www.ncbi.nlm.nih.gov/pubmed/37672311" } @Article{info:doi/10.2196/44540, author="Torres-Robles, Andrea and Allison, Karen and Poon, K. Simon and Shaw, Miranda and Hutchings, Owen and Britton, J. Warwick and Wilson, Andrew and Baysari, Melissa", title="Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study", journal="J Med Internet Res", year="2023", month="Sep", day="5", volume="25", pages="e44540", keywords="remote monitoring", keywords="patient experience", keywords="user experience", keywords="COVID-19", keywords="pulse oximetry", keywords="usability", keywords="acceptability", keywords="oximetry", keywords="wearable device", abstract="Background: As a response to the COVID-19 pandemic, the Sydney Local Health District in New South Wales, Australia, launched the rpavirtual program, the first full-scale virtual hospital in Australia, to remotely monitor and follow up stable patients with COVID-19. As part of the intervention, a pulse oximeter wearable device was delivered to patients to monitor their oxygen saturation levels, a critical indicator of COVID-19 patient deterioration. Understanding users' perceptions toward the device is fundamental to assessing its usability and acceptability and contributing to the effectiveness of the intervention, but no research to date has explored the user experience of the pulse oximeter for remote monitoring in this setting. Objective: This study aimed to explore the use, performance, and acceptability of the pulse oximeter by clinicians and patients in rpavirtual during COVID-19. Methods: Semistructured interviews and usability testing were conducted. Stable adult patients with COVID-19 (aged ?18 years) who used the pulse oximeter and were monitored by rpavirtual, and rpavirtual clinicians monitoring these patients were interviewed. Clinicians could be nurses, doctors, or staff who were part of the team that assisted patients with the use of the pulse oximeter. Usability testing was conducted with patients who had the pulse oximeter when they were contacted. Interviews were coded using the Theoretical Framework of Acceptability. Usability testing was conducted using a think-aloud protocol. Data were collected until saturation was reached. Results: Twenty-one patients (average age 51, SD 13 years) and 15 clinicians (average age 41, SD 11 years) completed the interview. Eight patients (average age 51, SD 13 years) completed the usability testing. All participants liked the device and thought it was easy to use. They also had a good understanding of how to use the device and the device's purpose. Patients' age and device use--related characteristics (eg, the warmth of hands and hand steadiness) were identified by users as factors negatively impacting the accurate use of the pulse oximeter. Conclusions: Patients and clinicians had very positive perceptions of the pulse oximeter for COVID-19 remote monitoring, indicating high acceptability and usability of the device. However, factors that may impact the accuracy of the device should be considered when delivering interventions using the pulse oximeter for remote monitoring. Targeted instructions about the use of the device may be necessary for specific populations (eg, older people and patients unfamiliar with technology). Further research should focus on the integration of the pulse oximeter data into electronic medical records for real-time and secure patient monitoring. ", doi="10.2196/44540", url="https://www.jmir.org/2023/1/e44540", url="http://www.ncbi.nlm.nih.gov/pubmed/37535831" } @Article{info:doi/10.2196/43883, author="Cohen, Edwin and Byrom, Bill and Becher, Anja and J{\"o}rnt{\'e}n-Karlsson, Magnus and Mackenzie, K. Andrew", title="Comparative Effectiveness of eConsent: Systematic Review", journal="J Med Internet Res", year="2023", month="Sep", day="1", volume="25", pages="e43883", keywords="acceptability", keywords="clinical trial", keywords="comprehension", keywords="digital consent", keywords="eConsent", keywords="effectiveness", keywords="electronic consent", keywords="informed consent form", keywords="patient engagement", keywords="usability", abstract="Background: Providing informed consent means agreeing to participate in a clinical trial and having understood what is involved. Flawed informed consent processes, including missing dates and signatures, are common regulatory audit findings. Electronic consent (eConsent) uses digital technologies to enable the consenting process. It aims to improve participant comprehension and engagement with study information and to address data quality concerns. Objective: This systematic literature review aimed to assess the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, and study enrollment and retention rates, as well as the effects of eConsent on the time patients took to perform the consenting process (``cycle time'') and on-site workload in comparison with traditional paper-based consenting. Methods: The systematic review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Ovid Embase and Ovid MEDLINE were systematically searched for publications reporting original, comparative data on the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, enrollment and retention rates, cycle time, and site workload. The methodological validity of the studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as having ``high'' validity if comprehensive assessments were performed using established instruments. Results: Overall, 37 publications describing 35 studies (13,281 participants) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20/35, 57\% of the studies; 10 with ``high'' validity), acceptability (8/35, 23\% of the studies; 1 with ``high'' validity), and usability (5/35, 14\% of the studies; 1 with ``high'' validity) reported significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. None of the studies reported better results with paper than with eConsent. Among the ``high'' validity studies, 6 studies on comprehension reported significantly better understanding of at least some concepts, the study on acceptability reported statistically significant higher satisfaction scores, and the study on usability reported statistically significant higher usability scores with eConsent than with paper (P<.05 for all). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with the content. Data on enrollment and retention were limited. Comparative data from site staff and other study researchers indicated the potential for reduced workload and lower administrative burden with eConsent. Conclusions: This systematic review showed that compared with patients using paper-based consenting, patients using eConsent had a better understanding of the clinical trial information, showed greater engagement with content, and rated the consenting process as more acceptable and usable. eConsent solutions thus have the potential to enhance understanding, acceptability, and usability of the consenting process while inherently being able to address data quality concerns, including those related to flawed consenting processes. ", doi="10.2196/43883", url="https://www.jmir.org/2023/1/e43883", url="http://www.ncbi.nlm.nih.gov/pubmed/37656499" } @Article{info:doi/10.2196/47126, author="Listiyandini, Arruum Ratih and Andriani, Annisa and Kusristanti, Chandradewi and Moulds, Michelle and Mahoney, Alison and Newby, M. Jill", title="Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Aug", day="31", volume="7", pages="e47126", keywords="psychological distress", keywords="mindfulness", keywords="cultural adaptation", keywords="internet-delivered", keywords="students", keywords="Indonesia", keywords="mobile phone", abstract="Background: Psychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress at scale. Unfortunately, evidence-based, internet-delivered mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based, internet-delivered mindfulness interventions is needed. Objective: In this paper, we describe the process of culturally adapting an Australian internet-delivered mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students' psychological distress. Methods: To assist the cultural adaptation process, we used a systematic cultural adaptation framework and a mixed methods approach combining quantitative and qualitative methods. In study 1 (information gathering), we administered an internet-delivered questionnaire to Indonesian university students (n=248) to examine their preferences regarding an internet-delivered mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders (n=25) included local Indonesian mindfulness and mental health professionals (n=6) and university students (n=19), who were selected to maximize sample representativeness regarding personal and professional characteristics. To evaluate the initial design and cultural congruence of the internet-delivered mindfulness program in the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire. Results: In study 1, most Indonesian university students (240/248, 96.8\%) reported openness to an internet-delivered mindfulness program. Most of interested students (127/240, 52.9\%) preferred the length of the program to be 3 to 4 sessions, with 45.8\% (110/240) preferring brief lessons taking only 15 to 30 minutes to complete. They (194/240, 80.8\%) recommended that the program be accessible both through websites and mobile phones. In study 2, Indonesian stakeholders generally found the internet-delivered program to be highly culturally appropriate in terms of language, concepts, context, treatment goals, and depictions of students' emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the program's delivery model (eg, combining visual and audio modalities when delivering psychoeducation), cultural components (eg, including more social and spiritual activities), program practicality (eg, including rewards to promote engagement), and design elements (eg, including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian internet-delivered mindfulness program called Program Intervensi Mindfulness Daring Mahasiswa Indonesia was created. Conclusions: This study highlights the process and importance of cultural adaptation of an evidence-based mindfulness treatment and demonstrates how this may be achieved for internet-delivered psychotherapy programs. We found that a culturally adapted internet-delivered mindfulness program was relevant for Indonesian students with some adjustments to the programs' content and delivery. Future research is now needed to evaluate the clinical benefit of this program. ", doi="10.2196/47126", url="https://formative.jmir.org/2023/1/e47126", url="http://www.ncbi.nlm.nih.gov/pubmed/37651168" } @Article{info:doi/10.2196/45287, author="Vanderhout, Shelley and Goldbloom, B. Ellen and Li, Amy and Newhook, Dennis and Garcia, Meghan and Dulude, Catherine", title="Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study", journal="J Med Internet Res", year="2023", month="Aug", day="30", volume="25", pages="e45287", keywords="environmental scan", keywords="experience", keywords="interviews", keywords="pediatrics", keywords="telemedicine", keywords="virtual care", abstract="Background: Virtual care was rapidly integrated into pediatric health services during the COVID-19 pandemic. While virtual care offers many benefits, it is necessary to better understand the experiences of those who receive, deliver, and coordinate virtual care in order to support sustainable, high-quality, and patient-centered health care. To date, methods implemented to evaluate users' experiences of virtual care have been highly variable, making comparison and data synthesis difficult. Objective: This study aims to describe evaluation strategies currently used to understand personal experiences with pediatric virtual care in Canada. Methods: In this mixed methods environmental scan, we first distributed a web-based questionnaire to clinical, research, and operational leaders delivering and evaluating pediatric virtual care in Canada. The questionnaire collected information about how experiences with virtual care have been or are currently being evaluated and whether these evaluations included the perspectives of children or youth, families, providers, or support staff. Second, respondents were asked to share the questions they used in their evaluations, and a content analysis was performed to identify common question categories. Third, we conducted semistructured interviews to further explore our respondents' evaluation experiences across 4 domains---evaluation approaches, distribution methods, response rates, and lessons learned---and interest in a core set of questions for future evaluations. Results: There were 72 respondents to the web-based questionnaire; among those who had conducted an evaluation, we identified 15 unique evaluations, and 14 of those provided a copy of the tools used to evaluate virtual care. These evaluations measured the virtual care experiences of parents or caregivers (n=15, 100\%), children or youth (n=11, 73\%), health care providers (n=11, 73\%), and support staff (n=4, 27\%). The most common data collection method used was electronic questionnaires distributed by email. Two respondents used validated tools; the remainder modified existing tools or developed new tools. Content analysis of the 14 submitted questionnaires revealed that the most common questions were about overall participant satisfaction, the comparison of virtual care to in-person care, and whether participants would choose virtual care options in the future. Interview findings indicate respondents frequently relied on methods used by peers and that a standardized, core set of questions to evaluate experiences with virtual care would be helpful to improve evaluation practices and support pediatric health care delivery. Conclusions: At our institution and elsewhere in Canada, experiences with pediatric virtual care have been evaluated using a variety of methods. A more consistent evaluation approach using standardized tools may enable more regular comparisons of experiences with virtual care and the synthesis of findings across health care settings. In turn, this may better inform our approach to virtual care, improve its integration into health systems, and facilitate sustainable, high-quality, patient-centered care. ", doi="10.2196/45287", url="https://www.jmir.org/2023/1/e45287", url="http://www.ncbi.nlm.nih.gov/pubmed/37647120" } @Article{info:doi/10.2196/43993, author="Wong, Willis and Ming, David and Pateras, Sara and Fee, Holmes Casey and Coleman, Cara and Docktor, Michael and Shah, Nirmish and Antonelli, Richard", title="Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study", journal="JMIR Form Res", year="2023", month="Aug", day="28", volume="7", pages="e43993", keywords="mobile health", keywords="mHealth", keywords="complex care", keywords="care coordination", keywords="digital health tools", keywords="simulation", keywords="family-centered design", keywords="user-centered design", keywords="participatory design", keywords="co-design", abstract="Background: Care for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record--integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. Objective: This study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. Methods: Caregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non--English-speaking users. Results: A Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. Conclusions: Internet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development. ", doi="10.2196/43993", url="https://formative.jmir.org/2023/1/e43993", url="http://www.ncbi.nlm.nih.gov/pubmed/37639303" } @Article{info:doi/10.2196/45859, author="McCrae, S. Christina and Curtis, F. Ashley and Stearns, A. Melanie and Nair, Neetu and Golzy, Mojgan and Shenker, I. Joel and Beversdorf, Q. David and Cottle, Amelia and Rowe, A. Meredeth", title="Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study", journal="JMIR Aging", year="2023", month="Aug", day="24", volume="6", pages="e45859", keywords="arousal", keywords="caregivers", keywords="cognitive behavioral therapy", keywords="CBT: cognitive behavioral therapy for insomnia", keywords="CBT-I", keywords="dementia", keywords="insomnia", keywords="internet", abstract="Background: Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments. Our team translated an efficacious 4-session standard CBT-I content protocol into digital format to create NiteCAPP. Objective: This study aimed to (1) adapt NiteCAPP for dementia caregivers to create NiteCAPP CARES, a tailored digital format with standard CBT-I content plus caregiver-focused modifications; (2) conduct usability testing and evaluate acceptability of NiteCAPP CARES' content and features; and (3) pilot-test the adapted intervention to evaluate feasibility and preliminary effects on sleep and related health outcomes. Methods: We followed Medical Research Council recommendations for evaluating complex medical interventions to explore user needs and adapt and validate content using a stepwise approach: (1) a rural dementia caregiver (n=5) and primary care provider (n=5) advisory panel gave feedback that was used to adapt NiteCAPP; (2) caregiver (n=5) and primary care provider (n=7) focus groups reviewed the newly adapted NiteCAPP CARES and provided feedback that guided further adaptations; and (3) NiteCAPP CARES was pilot-tested in caregivers (n=5) for feasibility and to establish preliminary effects. Self-report usability measures were collected following intervention. Before and after treatment, 14 daily electronic sleep diaries and questionnaires were collected to evaluate arousal, health, mood, burden, subjective cognition, and interpersonal processes. Results: The stepped approach provided user and expert feedback on satisfaction, usefulness, and content, resulting in a new digital CBT-I tailored for rural dementia caregivers: NiteCAPP CARES. The advisory panel recommended streamlining content, eliminating jargon, and including caregiver-focused content. Focus groups gave NiteCAPP CARES high usefulness ratings (mean score 4.4, SD 0.79, scored from 1=least to 5=most favorable; score range 4.2-4.8). Multiple features were evaluated positively, including the intervention's comprehensive and engaging information, caregiver focus, good layout, easy-to-access intervention material, and easy-to-understand sleep graphs. Suggestions for improvement included the provision of day and night viewing options, collapsible text, font size options, tabbed access to videos, and a glossary of terms. Pilot-test users rated usefulness (mean score 4.3, SD 0.83; range 4.1-4.5) and satisfaction (mean score 8.4, SD 1.41, scored from 1=least to 10=most satisfied; range 7.4-9.0) highly. Preliminary effects on caregiver sleep, arousal, health, mood, burden, cognition, and interpersonal processes (all P<.05) were promising. Conclusions: Adaptations made to standard digital CBT-I created a feasible, tailored digital intervention for rural dementia caregivers. Important next steps include further examination of feasibility and efficacy in a randomized controlled trial with an active control condition, a multisite effectiveness trial, and eventual broad dissemination. Trial Registration: ClinicalTrials.gov NCT04632628; https://clinicaltrials.gov/ct2/show/NCT04632628 ", doi="10.2196/45859", url="https://aging.jmir.org/2023/1/e45859", url="http://www.ncbi.nlm.nih.gov/pubmed/37616032" } @Article{info:doi/10.2196/47335, author="Nair, Monika and Andersson, Jonas and Nygren, M. Jens and Lundgren, E. Lina", title="Barriers and Enablers for Implementation of an Artificial Intelligence--Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews", journal="JMIR Form Res", year="2023", month="Aug", day="23", volume="7", pages="e47335", keywords="implementation", keywords="AI systems", keywords="health care", keywords="interviews", keywords="artificial Intelligence", keywords="AI", keywords="decision support tool", keywords="readmission", keywords="prediction", keywords="heart failure", keywords="digital tool", abstract="Background: Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. Objective: This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Methods: Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Results: Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Conclusions: Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process. ", doi="10.2196/47335", url="https://formative.jmir.org/2023/1/e47335", url="http://www.ncbi.nlm.nih.gov/pubmed/37610799" } @Article{info:doi/10.2196/45955, author="Kouri, Andrew and Gupta, Samir and Straus, E. Sharon and Sale, M. Joanna E.", title="Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study", journal="J Med Internet Res", year="2023", month="Aug", day="22", volume="25", pages="e45955", keywords="older adults", keywords="mHealth", keywords="asthma", keywords="chronic obstructive pulmonary disease", keywords="qualitative research", keywords="digital health", keywords="qualitative study", keywords="airway disease", keywords="barrier", keywords="health technology", keywords="interview", keywords="smartphone", keywords="airway", keywords="implementation", keywords="mobile phone", abstract="Background: The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. Objective: In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Methods: Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults' use of airway mHealth. Results: Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults' use of asthma and COPD mHealth tools. Conclusions: Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts. ", doi="10.2196/45955", url="https://www.jmir.org/2023/1/e45955", url="http://www.ncbi.nlm.nih.gov/pubmed/37606961" } @Article{info:doi/10.2196/46480, author="Krafft, Jelena and Barisch-Fritz, Bettina and Krell-Roesch, Janina and Trautwein, Sandra and Scharpf, Andrea and Woll, Alexander", title="A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study", journal="JMIR Aging", year="2023", month="Aug", day="22", volume="6", pages="e46480", keywords="dementia", keywords="individualized physical exercise", keywords="tailored exercise", keywords="physical activity", keywords="older adults", keywords="app", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="mobile phone", abstract="Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93\% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ``good.'' The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. ", doi="10.2196/46480", url="https://aging.jmir.org/2023/1/e46480", url="http://www.ncbi.nlm.nih.gov/pubmed/37606974" } @Article{info:doi/10.2196/47574, author="Nguyen, Hoang Thinh and Cunha, Pereira Priscila and Rowland, Friedman Annabelle and Orenstein, Evan and Lee, Tricia and Kandaswamy, Swaminathan", title="User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study", journal="JMIR Form Res", year="2023", month="Aug", day="22", volume="7", pages="e47574", keywords="clinical decision support", keywords="peanut", keywords="peanut introduction", keywords="early peanut introduction", keywords="allergy", keywords="electronic health records", keywords="simulation", keywords="user-centered design", abstract="Background: Peanut allergy has recently become more prevalent. Peanut introduction recommendations have evolved from suggesting peanut avoidance until the age of 3 years to more recent guidelines encouraging early peanut introduction after the Learning Early about Peanut Allergy (LEAP) study in 2015. Guideline adherence is poor, leading to missed care opportunities. Objective: In this study, we aimed to develop a user-centered clinical decision support (CDS) tool to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting. Methods: We edited the note template of the well-child check (WCC) visits at ages 4 and 6 months with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing, comparing a test EHR with and without the CDS. Results: Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month and 6-month WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month WCC visit compared to scenarios without the CDS tool (9/15, 60\% with CDS and 0/15, 0\% without CDS). All providers except one at the 4-month WCC scenario gave at least an adequate score for the ease of use of the CDS tool for the history of present illness and assessment and plan sections. During the summative usability testing with the 6-month WCC new build note template, providers more commonly provided comprehensive care once obtaining a patient history concerning for an immunoglobulin E--mediated peanut reaction by placing a referral to allergy/immunology (P=.48), prescribing an epinephrine auto-injector (P=.07), instructing on how to avoid peanut products (P<.001), and providing an emergency treatment plan (P=.003) with CDS guidance. All providers gave at least an adequate score for ease of use of the CDS tool in the after-visit summary. Conclusions: User-centered CDS improved application of early peanut introduction recommendations and comprehensive care for patients who have symptoms concerning for peanut allergy in a simulation. ", doi="10.2196/47574", url="https://formative.jmir.org/2023/1/e47574", url="http://www.ncbi.nlm.nih.gov/pubmed/37606983" } @Article{info:doi/10.2196/47220, author="Vial, St{\'e}phane and Boudhra{\^a}, Sana and Dumont, Mathieu and Tremblay, Melanie and Riendeau, Sophie", title="Developing A Mobile App With a Human-Centered Design Lens to Improve Access to Mental Health Care (Mentallys Project): Protocol for an Initial Co-Design Process", journal="JMIR Res Protoc", year="2023", month="Aug", day="22", volume="12", pages="e47220", keywords="co-design", keywords="human-centered design", keywords="e-mental health", keywords="design expertise", keywords="user engagement", keywords="patient-centered design", keywords="imaginary prototype", abstract="Background: Co-design is one of the human-centered design approaches that allows end users to significantly and positively impact the design of mental health technologies. It is a promising approach to foster user acceptance and engagement in digital mental health solutions. Surprisingly, there is a lack of understanding of what co-design is in this field. In this paper, co-design is approached as a cocreation process involving persons with a lived experience of mental health problems, health professionals, and design experts who lead and facilitate the overall creative process. Objective: This paper describes an initial co-design research protocol for the development of a mobile app that aims to improve access to mental health care. It highlights the characteristics of a co-design approach in e--mental health rooted in human-centered design and led by design experts alongside health experts. The paper focuses on the first steps (phase 1) of the co-design process of the ongoing Mentallys project. Methods: This Mentallys project will be located in Montr{\'e}al (Quebec, Canada). The method approach will be based on the ``method stories,'' depicting the ``making of'' this project and reflecting adjustments needed to the protocol throughout the project in specific situations. Phase 1 of the process will focus on the desirability of the app. Targeted participants will include people with a lived experience of mental health problems, peer support workers and clinicians, and 3 facilitators (all design experts or researchers). Web-based sessions will be organized because of the COVID-19 pandemic, using Miro (RealtimeBoard Inc) and Zoom (Zoom Video Communications, Inc). Data collection will be based on the comments, thoughts, and new ideas of participants around the imaginary prototypes. Thematic analysis will be carried out after each session to inform a new version of the prototype. Results: We conducted 2 stages in phase 1 of the process. During stage 1, we explored ideas through group co-design workshops (divergent thinking). Six co-design workshops were held: 2 with only clinicians (n=7), 2 with peer support workers (n=5) and people with a lived experience of mental health problems (n=2), and 2 with all of them (n=14). A total of 6 facilitators participated in conducting activities in subgroups. During stage 2, ideas were refined through 10 dyad co-design sessions (convergent thinking). Stage 2 involved 3 participants (n=3) and 1 facilitator. Thematic analysis was performed after stage 1, while analytic questioning is being performed for stage 2. Both stages allowed several iterations of the prototypes. Conclusions: The design of the co-design process, the leadership of the design expertise throughout the process, and the different forms of co-design activities are key elements in this project. We highly recommend that health researchers partner with professional designers or design researchers who are familiar with co-design. International Registered Report Identifier (IRRID): DERR1-10.2196/47220 ", doi="10.2196/47220", url="https://www.researchprotocols.org/2023/1/e47220", url="http://www.ncbi.nlm.nih.gov/pubmed/37606978" } @Article{info:doi/10.2196/41552, author="Nakikj, Drashko and Kreda, David and Gehlenborg, Nils", title="Alerts and Collections for Automating Patients' Sensemaking and Organizing of Their Electronic Health Record Data for Reflection, Planning, and Clinical Visits: Qualitative Research-Through-Design Study", journal="JMIR Hum Factors", year="2023", month="Aug", day="21", volume="10", pages="e41552", keywords="patients", keywords="electronic health records", keywords="sensemaking", keywords="pattern detection", keywords="data organization", keywords="alerts", keywords="reports", keywords="collections", abstract="Background: Electronic health record (EHR) data from multiple providers often exhibit important but convoluted and complex patterns that patients find hard and time-consuming to identify and interpret. However, existing patient-facing applications lack the capability to incorporate automatic pattern detection robustly and toward supporting making sense of the patient's EHR data. In addition, there is no means to organize EHR data in an efficient way that suits the patient's needs and makes them more actionable in real-life settings. These shortcomings often result in a skewed and incomplete picture of the patient's health status, which may lead to suboptimal decision-making and actions that put the patient at risk. Objective: Our main goal was to investigate patients' attitudes, needs, and use scenarios with respect to automatic support for surfacing important patterns in their EHR data and providing means for organizing them that best suit patients' needs. Methods: We conducted an inquisitive research-through-design study with 14 participants. Presented in the context of a cutting-edge application with strong emphasis on independent EHR data sensemaking, called Discovery, we used high-level mock-ups for the new features that were supposed to support automatic identification of important data patterns and offer recommendations---Alerts---and means for organizing the medical records based on patients' needs, much like photos in albums---Collections. The combined audio recording transcripts and in-study notes were analyzed using the reflexive thematic analysis approach. Results: The Alerts and Collections can be used for raising awareness, reflection, planning, and especially evidence-based patient-provider communication. Moreover, patients desired carefully designed automatic pattern detection with safe and actionable recommendations, which produced a well-tailored and scoped landscape of alerts for both potential threats and positive progress. Furthermore, patients wanted to contribute their own data (eg, progress notes) and log feelings, daily observations, and measurements to enrich the meaning and enable easier sensemaking of the alerts and collections. On the basis of the findings, we renamed Alerts to Reports for a more neutral tone and offered design implications for contextualizing the reports more deeply for increased actionability; automatically generating the collections for more expedited and exhaustive organization of the EHR data; enabling patient-generated data input in various formats to support coarser organization, richer pattern detection, and learning from experience; and using the reports and collections for efficient, reliable, and common-ground patient-provider communication. Conclusions: Patients need to have a flexible and rich way to organize and annotate their EHR data; be introduced to insights from these data---both positive and negative; and share these artifacts with their physicians in clinical visits or via messaging for establishing shared mental models for clear goals, agreed-upon priorities, and feasible actions. ", doi="10.2196/41552", url="https://humanfactors.jmir.org/2023/1/e41552", url="http://www.ncbi.nlm.nih.gov/pubmed/37603400" } @Article{info:doi/10.2196/45993, author="Broderick, Michelle and O'Shea, Robert and Burridge, Jane and Demain, Sara and Johnson, Louise and Bentley, Paul", title="Examining Usability, Acceptability, and Adoption of a Self-Directed, Technology-Based Intervention for Upper Limb Rehabilitation After Stroke: Cohort Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="21", volume="10", pages="e45993", keywords="stroke rehabilitation", keywords="interactive gaming", keywords="rehabilitation technology", keywords="technology usability", keywords="technology acceptability", keywords="self-management", keywords="usability", keywords="acceptability", keywords="stroke", keywords="rehabilitation", keywords="adoption", keywords="engagement", keywords="acceptance", keywords="limb", keywords="mobility", keywords="mobile phone", abstract="Background: Upper limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose. Rehabilitation technologies present pragmatic solutions to dose enhancement, complementing therapeutic activity within conventional rehabilitation, connecting clinicians with patients remotely, and empowering patients to drive their own recovery. To date, rehabilitation technologies have been poorly adopted. Understanding the barriers to adoption may shape strategies to enhance technology use and therefore increase rehabilitation dose, thus optimizing recovery potential. Objective: We examined the usability, acceptability, and adoption of a self-directed, exercise-gaming technology within a heterogeneous stroke survivor cohort and investigated how stroke survivor characteristics, technology usability, and attitudes toward technology influenced adoption. Methods: A feasibility study of a novel exercise-gaming technology for self-directed UL rehabilitation in early subacute stroke survivors (N=30) was conducted in an inpatient, acute hospital setting. Demographic and clinical characteristics were recorded; participants' performance in using the system (usability) was assessed using a 4-point performance rating scale (adapted from the Barthel index), and adherence with the system was electronically logged throughout the trial. The technology acceptance model was used to formulate a survey examining the acceptability of the system. Spearman rank correlations were used to examine associations between participant characteristics, user performance (usability), end-point technology acceptance, and intervention adherence (adoption). Results: The technology was usable for 87\% (n=26) of participants, and the overall technology acceptance rating was 68\% (95\% CI 56\%-79\%). Participants trained with the device for a median of 26 (IQR 16-31) minutes daily over an enrollment period of 8 (IQR 5-14) days. Technology adoption positively correlated with user performance (usability) ($\rho$=0.55; 95\% CI 0.23-0.75; P=.007) and acceptability as well as domains of perceived usefulness ($\rho$=0.42; 95\% CI 0.09-0.68; P=.03) and perceived ease of use ($\rho$=0.46; 95\% CI 0.10-0.74; P=.02). Technology acceptance decreased with increased global stroke severity ($\rho$=?0.56; 95\% CI ?0.79 to ?0.22; P=.007). Conclusions: This technology was usable and acceptable for the majority of the cohort, who achieved an intervention dose with technology-facilitated, self-directed UL training that exceeded conventional care norms. Technology usability and acceptability were determinants of adoption and appear to be mediated by stroke severity. The results demonstrate the importance of selecting technologies for stroke survivors on the basis of individual needs and abilities, as well as optimizing the accessibility of technologies for the target user group. Facilitating changes in stroke survivors' beliefs and attitudes toward rehabilitation technologies may enhance adoption. Further work is needed to understand how technology can be optimized to benefit those with more severe stroke. ", doi="10.2196/45993", url="https://rehab.jmir.org/2023/1/e45993", url="http://www.ncbi.nlm.nih.gov/pubmed/37603405" } @Article{info:doi/10.2196/41359, author="Alhasani, Rehab and George, Nicole and Radman, Dennis and Auger, Claudine and Ahmed, Sara", title="Methodologies for Evaluating the Usability of Rehabilitation Technologies Aimed at Supporting Shared Decision-Making: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="15", volume="10", pages="e41359", keywords="usability", keywords="technology", keywords="rehabilitation", keywords="shared decision-making", keywords="mobile phone", abstract="Background: The field of rehabilitation has seen a recent rise in technologies to support shared decision-making (SDM). Usability testing during the design process of SDM technologies is needed to optimize adoption and realize potential benefits. There is variability in how usability is defined and measured. Given the complexity of usability, a thorough examination of the methodologies used to measure usability to develop the SDM technologies used in rehabilitation care is needed. Objective: This scoping review aims to answer the following research questions: which methods and measures have been used to produce knowledge about the usability of rehabilitation technologies aimed at supporting SDM at the different phases of development and implementation? Which parameters of usability have been measured and reported? Methods: This review followed the Arksey and O'Malley framework. An electronic search was performed in the Ovid MEDLINE, Embase, CINAHL, and PsycINFO databases from January 2005 up to November 2020. In total, 2 independent reviewers screened all retrieved titles, abstracts, and full texts according to the inclusion criteria and extracted the data. The International Organization for Standardization framework was used to define the scope of usability (effectiveness, efficiency, and satisfaction). The characteristics of the studies were outlined in a descriptive summary. Findings were categorized based on usability parameters, technology interventions, and measures of usability. Results: A total of 38 articles were included. The most common SDM technologies were web-based aids (15/33, 46\%). The usability of SDM technologies was assessed during development, preimplementation, or implementation, using 14 different methods. The most frequent methods were questionnaires (24/38, 63\%) and semistructured interviews (16/38, 42\%). Satisfaction (27/38, 71\%) was the most common usability parameter mapped to types of SDM technologies and usability evaluation methods. User-centered design (9/15, 60\%) was the most frequently used technology design framework. Conclusions: The results from this scoping review highlight the importance and the complexity of usability evaluation. Although various methods and measures were shown to be used to evaluate the usability of technologies to support SDM in rehabilitation, very few evaluations used in the included studies were found to adequately span the selected usability domains. This review identified gaps in usability evaluation, as most studies (24/38, 63\%) relied solely on questionnaires rather than multiple methods, and most questionnaires simply focused on the usability parameter of satisfaction. The consideration of end users (such as patients and clinicians) is of particular importance for the development of technologies to support SDM, as the process of SDM itself aims to improve patient-centered care and integrate both patient and clinician voices into their rehabilitation care. ", doi="10.2196/41359", url="https://rehab.jmir.org/2023/1/e41359", url="http://www.ncbi.nlm.nih.gov/pubmed/37581911" } @Article{info:doi/10.2196/42506, author="Au, Jessica and Falloon, Caitlin and Ravi, Ayngaran and Ha, Phil and Le, Suong", title="A Beta-Prototype Chatbot for Increasing Health Literacy of Patients With Decompensated Cirrhosis: Usability Study", journal="JMIR Hum Factors", year="2023", month="Aug", day="15", volume="10", pages="e42506", keywords="chronic liver disease", keywords="chatbot", keywords="artificial intelligence", keywords="health literacy", keywords="acceptability", abstract="Background: Health literacy is low among patients with chronic liver disease (CLD) and associated with poor health outcomes and increased health care use. Lucy LiverBot, an artificial intelligence chatbot was created by a multidisciplinary team at Monash Health, Australia, to improve health literacy and self-efficacy in patients with decompensated CLD. Objective: The aim of this study was to explore users' experience with Lucy LiverBot using an unmoderated, in-person, qualitative test. Methods: Lucy LiverBot is a simple, low cost, and scalable digital intervention, which was at the beta prototype development phase at the time of usability testing. The concept and prototype development was realized in 2 phases: concept development and usability testing. We conducted a mixed methods study to assess usability of Lucy LiverBot as a tool for health literacy education among ambulatory and hospitalized patients with decompensated CLD at Monash Health. Patients were provided with free reign to interact with Lucy LiverBot on an iPad device under moderator observation. A 3-part survey (preuser, user, and postuser) was developed using the Unified Acceptance Theory Framework to capture the user experience. Results: There were 20 participants with a median age of 55.5 (IQR 46.0-60.5) years, 55\% (n=11) of them were female, and 85\% (n=17) of them were White. In total, 35\% (n=7) of them reported having difficulty reading and understanding written medical information. Alcohol was the predominant etiology in 70\% (n=14) of users. Participants actively engaged with Lucy LiverBot and identified it as a potential educational tool and device that could act as a social companion to improve well-being. In total, 25\% (n=5) of them reported finding it difficult to learn about their health problems and 20\% (n=4) of them found it difficult to find medical information they could trust. Qualitative interviews revealed the conversational nature of Lucy LiverBot was considered highly appealing with improvement in mental health and well-being reported as an unintended benefit of Lucy LiverBot. Patients who had been managing their liver cirrhosis for several years identified that they would be less likely to use Lucy LiverBot, but that it would have been more useful at the time of their diagnosis. Overall, Lucy LiverBot was perceived as a reliable and trustworthy source of information. Conclusions: Lucy LiverBot was well received and may be used to improve health literacy and address barriers to health care provision in patients with decompensated CLD. The study revealed important feedback that has been used to further optimize Lucy LiverBot. Further acceptability and validation studies are being undertaken to investigate whether Lucy LiverBot can improve clinical outcomes and health related quality of life in patients with decompensated CLD. ", doi="10.2196/42506", url="https://humanfactors.jmir.org/2023/1/e42506", url="http://www.ncbi.nlm.nih.gov/pubmed/37581920" } @Article{info:doi/10.2196/39525, author="Madujibeya, Ifeanyi and Lennie, A. Terry and Pelzel, Jamie and Moser, K. Debra", title="Patients' Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis", journal="JMIR Form Res", year="2023", month="Aug", day="15", volume="7", pages="e39525", keywords="heart failure", keywords="patients' experiences", keywords="experience", keywords="satisfaction", keywords="facilitator", keywords="mobile health apps", keywords="mobile app", keywords="health app", keywords="app feature", keywords="mobile health", keywords="cardiology", keywords="cardiovascular", keywords="patient care", keywords="self-management", keywords="patient", keywords="heart", keywords="mHealth", keywords="self-care", keywords="medication", keywords="performance", keywords="feedback", keywords="personalized", abstract="Background: Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)--related self-care. However, there is a dearth of research on patients' experiences using mHealth apps for self-care in real-world settings. Objective: The purpose of this study was to explore patients' experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Methods: Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients' responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Results: Patients (median age 64, IQR 57-71 years; 17/23, 74\% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Conclusions: Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care. ", doi="10.2196/39525", url="https://formative.jmir.org/2023/1/e39525", url="http://www.ncbi.nlm.nih.gov/pubmed/37581912" } @Article{info:doi/10.2196/45240, author="Avramovi{\'c}, Petra and Rietdijk, Rachael and Kenny, Belinda and Power, Emma and Togher, Leanne", title="Developing a Digital Health Intervention for Conversation Skills After Brain Injury (convers-ABI-lity) Using a Collaborative Approach: Mixed Methods Study", journal="J Med Internet Res", year="2023", month="Aug", day="9", volume="25", pages="e45240", keywords="brain injury", keywords="cognitive-communication", keywords="communication partner training", keywords="digital health", keywords="co-design", abstract="Background: People with acquired brain injury (ABI) experience communication breakdown in everyday interactions many years after injury, negatively impacting social and vocational relationships. Communication partner training (CPT) is a recommended intervention approach in communication rehabilitation after ABI. Access to long-term services is essential, both in rural and remote locations. Digital health has potential to overcome the challenges of travel and improve cost efficiencies, processes, and clinical outcomes. Objective: We aimed to collaboratively develop a novel, multimodal web-based CPT intervention (convers-ABI-lity) with key stakeholders and evaluate its feasibility for improving conversation skills after brain injury. Methods: This mixed methods study consisted of 3 key stages guided by the Integrate, Design, Assess, and Share (IDEAS) framework for developing effective digital health interventions. Stage 1 included the integration of current end-user needs and perspectives with key treatment and theoretical components of existing evidence-based interventions, TBI Express and TBIconneCT. Stage 2 included the iterative design of convers-ABI-lity with feedback from end-user interviews (n=22) analyzed using content analysis. Participants were individuals with ABI, family members, health professionals, and paid support workers. Stage 3 included the evaluation of the feasibility through a proof-of-concept study (n=3). A total of 3 dyads (a person with ABI and their communication partner [CP]) completed 7 weeks of convers-ABI-lity, guided by a clinician. The outcome measures included blinded ratings of conversation samples and self-report measures. We analyzed postintervention participant interviews using content analysis to inform further intervention refinement and development. Results: Collaborative and iterative design and development during stages 1 and 2 resulted in the development of convers-ABI-lity. Results in stage 3 indicated positive changes in the blinded ratings of conversation samples for the participants with traumatic brain injury and their CPs. Statistically reliable positive changes were also observed in the self-report measures of social communication skills and quality of life. Intervention participants endorsed aspects of convers-ABI-lity, such as its complementary nature, self-guided web-based modules, clinician sessions, engaging content, and novel features. They reported the intervention to be relevant to their personal experience with cognitive-communication disorders. Conclusions: This study presents the outcome of using the IDEAS framework to guide the development of a web-based multimodal CPT intervention with input from key stakeholders. The results indicate promising outcomes for improving the conversation skills of people with ABI and their CPs. Further evaluation of intervention effectiveness and efficacy using a larger sample size is required. ", doi="10.2196/45240", url="https://www.jmir.org/2023/1/e45240", url="http://www.ncbi.nlm.nih.gov/pubmed/37556179" } @Article{info:doi/10.2196/42912, author="Mehra, Richa and Pulman, Andy and Dogan, Huseyin and Murphy, Jane and Bitters, Fiona", title="A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Aug", day="4", volume="10", pages="e42912", keywords="nutrition", keywords="activity", keywords="behavior change", keywords="telemedicine", keywords="mobile health", keywords="police", keywords="lifestyle management", keywords="management", keywords="usability testing", keywords="design", keywords="build", keywords="prototype", keywords="testing", keywords="survey", keywords="interview", keywords="development", keywords="user center", keywords="officer", keywords="law enforcement", keywords="cop", keywords="detective", keywords="policeman", keywords="policing", keywords="mobile phone", abstract="Background: When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. Objective: The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. Methods: This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19\%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. Results: Data collected during usability testing concerned the 6 domains of the app---food and diet, activity, fluid intake, sleep, good mental health, and financial well-being---and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented---including shift management and catch-up cards---during this cycle of development. Conclusions: This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change. ", doi="10.2196/42912", url="https://humanfactors.jmir.org/2023/1/e42912", url="http://www.ncbi.nlm.nih.gov/pubmed/37540549" } @Article{info:doi/10.2196/45063, author="Ketelhut, Sascha and Bodman, Alex and Ries, Thomas and Nigg, R. Claudio", title="Challenging the Portrait of the Unhealthy Gamer---The Fitness and Health Status of Esports Players and Their Peers: Comparative Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Aug", day="3", volume="25", pages="e45063", keywords="blood pressure", keywords="gamers", keywords="health status", keywords="physical activity behavior", keywords="physical fitness", keywords="esports", keywords="health burden", keywords="sedentary athlete", keywords="health", keywords="fitness", abstract="Background: Esports players are often referred to as sedentary athletes, as gaming requires prolonged sedentary screen exposure. As sedentary behavior and physical inactivity are major causes of noncommunicable diseases and premature death, esports players may be at an increased risk for health implications. Prior research has established esports players as having higher levels of body fat and lower levels of lean body mass versus age-matched controls, suggesting the need to assess further health and fitness outcomes of this demographic. However, while research interest is undoubtedly increasing, the majority of studies has focused on subjective self-report data and has lacked relevant objective health and fitness measurements. Objective: This study aimed to assess the health and fitness status of a group of competitive esports players in relation to an age- and sex-matched comparison group. Methods: In total, 51 competitive esports players (mean 23, SD 3 years, 2 female) and 51 nonesports players (mean 24, SD 3 years, 2 female) were enrolled in this cross-sectional laboratory study. The esports players and the nonesports players completed a questionnaire assessing demographic data and self-reported physical activity levels. Furthermore, physical parameters including BMI, waist-to-height ratio, body fat percentage, systolic blood pressure, diastolic blood pressure, pulse wave velocity, maximal grip strength, and maximal oxygen consumption were assessed. Results: There were no significant differences in BMI (t100=1.54; P=.13; d=0.30), waist-to-height ratio (t100=1.44; P=.16; d=0.28), body fat percentage (t100=?0.48; P=.63; d=?0.09), systolic blood pressure (t100=?0.06; P=.93; d=?0.01), diastolic blood pressure (t100=0.37; P=.71; d=0.07), pulse wave velocity (t93=?2.08; P=.15; d=?0.43), maximal grip strength (t100=?.08; P=.94; d=?0.02), maximal oxygen consumption (t100=?0.11; P=.92; d=?0.02), and physical activity (PA) levels (t86=2.17; P=.08; d=0.46) between the groups. Conclusions: While the health narrative directed toward esports players has been mainly negative, this laboratory-based study indicated that esports players are not less healthy or fit compared to their peers. However, it seems that esports players are very heterogeneous and seem to span across the whole range of the fitness and health spectrum. Thus, the generalized statements of the esports athlete as an obese and unhealthy individual may need to be reconsidered. ", doi="10.2196/45063", url="https://www.jmir.org/2023/1/e45063", url="http://www.ncbi.nlm.nih.gov/pubmed/37535408" } @Article{info:doi/10.2196/41993, author="Mendonca, J. Christen and Malone, A. Laurie and Mohanraj, Sangeetha and Thirumalai, Mohanraj", title="The Usability of a Touchpad Active Video Game Controller for Individuals With Impaired Mobility: Observational Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Aug", day="3", volume="10", pages="e41993", keywords="active video games", keywords="exergames", keywords="usability", keywords="enjoyment", keywords="disability", keywords="mobility limitation", keywords="mobility impairment", abstract="Background: Video games are a popular sedentary activity among people with impaired mobility; however, active video game hardware typically lacks accessibility and customization options for individuals with mobility impairments. A touchpad video game system can elicit moderate physical activity in healthy adults; however, it is unclear if this system is usable by adults with impaired mobility. Objective: The purpose of this study was to assess the usability of a touchpad video game controller system adapted for adults with impaired mobility. Additional outcomes explored were enjoyment, perceived exertion, self-efficacy, participant feedback, and researcher observations of gameplay. Methods: Participants played several video game titles for 20 minutes with a touchpad video game controller as they stood or sat in a chair or their wheelchair. Usability was assessed with the System Usability Scale (SUS) and the Health Information Technology Usability Evaluation Scale (Health-ITUES) surveys after gameplay. After each video game, participants reported enjoyment using a visual analog scale (0 to 100 mm) and a rating of perceived exertion using the OMNI 0 to 10 scale. Self-efficacy was measured before and after gameplay. Participants provided feedback at the end of their session. Results: In total, 21 adults (6 females and 15 males) with a mean age of 48.8 (SD 13.8) years with various mobility impairments participated in this study. The touchpads received mean usability scores on the SUS 80.1 (SD 18.5) and Health-ITUES 4.23 (SD 0.67). Conclusions: The SUS scores reported suggest the touchpad system is ``usable''; however, the Health-ITUES scores were slightly below a suggested benchmark. Participants reported moderate to high enjoyment but perceived the exertion as ``somewhat easy.'' Self-efficacy was moderate to high and did not differ pre- to postgame play. The participants regarded the touchpads as novel, fun, and entertaining. The generalizability of our results is limited due to the heterogenous sample; however, our participants identified several areas of improvement for future iteration. ", doi="10.2196/41993", url="https://rehab.jmir.org/2023/1/e41993", url="http://www.ncbi.nlm.nih.gov/pubmed/37535411" } @Article{info:doi/10.2196/46434, author="Amiri, Maryam and Li, Juan and Hasan, Wordh", title="Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study", journal="JMIR Form Res", year="2023", month="Aug", day="3", volume="7", pages="e46434", keywords="diabetes", keywords="fuzzy logic", keywords="meal planning", keywords="multicriteria decision-making", keywords="optimization", abstract="Background: Chronic diseases such as heart disease, stroke, diabetes, and hypertension are major global health challenges. Healthy eating can help people with chronic diseases manage their condition and prevent complications. However, making healthy meal plans is not easy, as it requires the consideration of various factors such as health concerns, nutritional requirements, tastes, economic status, and time limits. Therefore, there is a need for effective, affordable, and personalized meal planning that can assist people in choosing food that suits their individual needs and preferences. Objective: This study aimed to design an artificial intelligence (AI)--powered meal planner that can generate personalized healthy meal plans based on the user's specific health conditions, personal preferences, and status. Methods: We proposed a system that integrates semantic reasoning, fuzzy logic, heuristic search, and multicriteria analysis to produce flexible, optimized meal plans based on the user's health concerns, nutrition needs, as well as food restrictions or constraints, along with other personal preferences. Specifically, we constructed an ontology-based knowledge base to model knowledge about food and nutrition. We defined semantic rules to represent dietary guidelines for different health concerns and built a fuzzy membership of food nutrition based on the experience of experts to handle vague and uncertain nutritional data. We applied a semantic rule-based filtering mechanism to filter out food that violate mandatory health guidelines and constraints, such as allergies and religion. We designed a novel, heuristic search method that identifies the best meals among several candidates and evaluates them based on their fuzzy nutritional score. To select nutritious meals that also satisfy the user's other preferences, we proposed a multicriteria decision-making approach. Results: We implemented a mobile app prototype system and evaluated its effectiveness through a use case study and user study. The results showed that the system generated healthy and personalized meal plans that considered the user's health concerns, optimized nutrition values, respected dietary restrictions and constraints, and met the user's preferences. The users were generally satisfied with the system and its features. Conclusions: We designed an AI-powered meal planner that helps people create healthy and personalized meal plans based on their health conditions, preferences, and status. Our system uses multiple techniques to create optimized meal plans that consider multiple factors that affect food choice. Our evaluation tests confirmed the usability and feasibility of the proposed system. However, some limitations such as the lack of dynamic and real-time updates should be addressed in future studies. This study contributes to the development of AI-powered personalized meal planning systems that can support people's health and nutrition goals. ", doi="10.2196/46434", url="https://formative.jmir.org/2023/1/e46434", url="http://www.ncbi.nlm.nih.gov/pubmed/37535413" } @Article{info:doi/10.2196/46893, author="Labarta, I. Jos{\'e} and Dimitri, Paul and Keiser, Matthew and Koledova, Ekaterina and Rivera-Romero, Octavio", title="Evaluating the Usefulness and Ease of Use of a Next-Generation--Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals' Perceptions", journal="JMIR Hum Factors", year="2023", month="Aug", day="2", volume="10", pages="e46893", keywords="connected health", keywords="growth hormone deficiency", keywords="participatory health informatics", keywords="recombinant human growth hormone", keywords="technology acceptance", keywords="mobile phone", abstract="Background: Digital solutions targeting children's health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients. Objective: This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use. Methods: A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device. Results: Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100\%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis. Conclusions: This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH. ", doi="10.2196/46893", url="https://humanfactors.jmir.org/2023/1/e46893", url="http://www.ncbi.nlm.nih.gov/pubmed/37531173" } @Article{info:doi/10.2196/45349, author="Patel, S. Khushi and Corbett, F. Cynthia and Combs, M. Elizabeth and Donevant, B. Sara and Selph, J. Margaret and Gibson, M. Lynette and Dawson, M. Robin and Sheth, P. Amit and Hughes, G. Ronda", title="Perceptions of COVID-19 and the Use of Health Information Technology Among People Who Are Uninsured: Multimethod Survey Study", journal="JMIR Form Res", year="2023", month="Jul", day="28", volume="7", pages="e45349", keywords="COVID-19", keywords="medically uninsured", keywords="medical informatics", keywords="telemedicine", keywords="mobile apps", keywords="health literacy", keywords="mobile phone", abstract="Background: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care. Objective: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents' perceptions of and suggestions for adapting a mobile health (mHealth) app to an uninsured population known to have low health literacy. Methods: We conducted a prospective multimethod survey study with a convenience sample of uninsured adults seeking care at 3 free clinics in the United States. Respondents were questioned about their risk for and awareness of COVID-19 symptoms, COVID-19 testing, current technology use, and the use of technology to facilitate their health regarding COVID-19. Data were analyzed using descriptive statistics (eg, frequencies and mean differences). In addition, a small subset of respondents from one of the clinics (n=10) participated in interviews to provide feedback about the design of a COVID-19 web-based smartphone (mHealth) app. Results: The survey respondents (N=240) were 53.8\% (n=129) female, were primarily White (n=113, 47.1\%), and had a mean age of 50.0 (SD 11.67; range 19-72) years. Most respondents (162/222, 73\%) did not think that they were at risk for COVID-19. Although respondents reported only moderate confidence in their knowledge of the short- and long-term symptoms of COVID-19, their knowledge of the symptoms aligned well with reports published by the Centers for Disease Control and Prevention of the most common acute (590/610, 96.7\%) and long-term (217/271, 80.1\%) symptoms. Most respondents (159/224, 71\%) reported an interest in using the mHealth app to gain additional information regarding COVID-19 and available community resources. Respondents who were interviewed provided suggestions to improve the mHealth app but had overall positive perceptions about the potential usefulness and usability of the app. Conclusions: It was encouraging that the knowledge of COVID-19 symptoms aligned well with the reports published by the Centers for Disease Control and Prevention and that respondents were enthusiastic about using an mHealth app to monitor symptoms. However, it was concerning that most respondents did not think they were at a risk of contracting COVID-19. ", doi="10.2196/45349", url="https://formative.jmir.org/2023/1/e45349", url="http://www.ncbi.nlm.nih.gov/pubmed/37505792" } @Article{info:doi/10.2196/42768, author="McCue, Maggie and Khatib, Rasha and Kabir, Christopher and Blair, Chris and Fehnert, Ben and King, James and Spalding, Alexander and Zaki, Lara and Chrones, Lambros and Roy, Anit and Kemp, E. David", title="User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study", journal="JMIR Hum Factors", year="2023", month="Jul", day="26", volume="10", pages="e42768", keywords="depression", keywords="major depressive disorder", keywords="depression management", keywords="patient engagement", keywords="user-centered design", keywords="mobile app", keywords="digital platform", keywords="qualitative research", keywords="shared decision-making", keywords="measurement-based care", keywords="mobile phone", abstract="Background: Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. Objective: This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. Methods: Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. Results: In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. Conclusions: Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team--facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey. ", doi="10.2196/42768", url="https://humanfactors.jmir.org/2023/1/e42768", url="http://www.ncbi.nlm.nih.gov/pubmed/37494099" } @Article{info:doi/10.2196/45164, author="Singleton, C. Anna and Raeside, Rebecca and Hyun, K. Karice and Hayes, Molly and Sherman, A. Kerry and Elder, Elisabeth and Redfern, Julie and Partridge, R. Stephanie", title="A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework", journal="J Med Internet Res", year="2023", month="Jul", day="25", volume="25", pages="e45164", keywords="digital health", keywords="telemedicine", keywords="SMS text messaging", keywords="breast cancer", keywords="implementation science", keywords="cancer survivorship", keywords="supportive care", keywords="public health", keywords="COVID-19", abstract="Background: COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team's lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. Objective: This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods: A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. Results: With regard to the reach/representativeness of the program, 841/1340 (62.8\%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6\%) and White (736/840, 87.6\%) and nearly half (418/841, 49.7\%) finished treatment ?18 months ago. Most resided in major cities (574/838, 68.5\%) and 30\% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8\%) or ``thank you'' (131/852, 15.4\%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4\%), most ``(strongly) agreed'' the SMS text messages were easy to understand (445/448, 99.3\%), useful (373/440, 84.8\%), helped participants feel supported (388/448, 86.6\%), and motivated participants to be physically active (312/445, 70.1\%) and eat healthier (313/457, 68.5\%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50\% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43\% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4\%) and low cost (Aus \$15.40/participant; Aus \$1=US \$0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. Conclusions: EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance. ", doi="10.2196/45164", url="https://www.jmir.org/2023/1/e45164", url="http://www.ncbi.nlm.nih.gov/pubmed/37490319" } @Article{info:doi/10.2196/40219, author="O'Connor, Antonia and Tai, Andrew and Brinn, Malcolm and Hoang, Hien Amy Nguyen Thuc and Cataldi, Daniele and Carson-Chahhoud, Kristin", title="Co-design of an Augmented Reality Asthma Inhaler Educational Intervention for Children: Development and Usability Study", journal="JMIR Pediatr Parent", year="2023", month="Jul", day="25", volume="6", pages="e40219", keywords="asthma", keywords="asthma education", keywords="pediatric", keywords="pediatric asthma", keywords="co-design", keywords="usability", keywords="development", keywords="smartphone", keywords="tablet", keywords="augmented reality", keywords="health education", keywords="mobile app", keywords="mobile phone", abstract="Background: Smartphone and tablet apps that deliver health care education have been identified as effective in improving patient knowledge and treatment adherence in asthma populations. Despite asthma being the most common chronic disease in pediatrics, there are few apps that are targeted specifically for children. Only half of children with asthma have acceptable control of their symptoms, and 40\%-98\% do not use their inhalers correctly. With children being increasingly connected to technology, there is an opportunity to improve asthma inhaler technique education by delivery via smartphone or tablet apps. Augmented reality (AR) technology was used in this study to capitalize on growing technological innovations. Digital health interventions that use a co-design process for development have the highest likelihood of successful uptake and effectiveness on their intended outcomes. Perceived usability also has been shown to improve the effectiveness of education as well as the acceptance of the intervention. Objective: The aims of this study were to describe the co-design process, development, and design outcomes of a smartphone or tablet app that incorporates AR technology to deliver asthma inhaler technique education to children with asthma. This study also aimed to provide a usability evaluation, using the System Usability Scale to inform our work and future research, and recommendations for others performing similar work. Methods: The development of the AR asthma inhaler technique education app was based on an iterative co-design process with likely end users (children with asthma, their caregivers, and health care professionals). This involved multiple stages: recruitment of end users for qualitative interviews and usability testing with a previously designed educational intervention, which used an AR-embedded smartphone or tablet app; ideation of content for a specific asthma inhaler technique education intervention with end users; development of the specific asthma inhaler intervention; and 2 further rounds of interviews and usability testing with the redesign of the initial prototype. Results: We included 16 participants aged 9-45 years. Using the co-design process, the AR asthma inhaler technique education app was designed, incorporating the preferences of end users. After iteration 1, animation was included based on the feedback provided. Iteration 2 feedback resulted in increased AR experiences and the removal of the requirement of a paper-based resource to trigger AR in the third iteration. Throughout all rounds, the ease of use of the app and the novel nature of the intervention were frequently described. The usability of the intervention overall was perceived to be excellent, and the mean System Usability Scale score of the intervention was found to be highest in the final round of evaluation (90.14). Conclusions: The results from this co-design process and usability evaluation will be used to develop a final AR asthma inhaler technique educational intervention, which will be evaluated in the clinical setting. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 ", doi="10.2196/40219", url="https://pediatrics.jmir.org/2023/1/e40219", url="http://www.ncbi.nlm.nih.gov/pubmed/37490325" } @Article{info:doi/10.2196/46849, author="Wrightson-Hester, Aimee-Rose and Anderson, Georgia and Dunstan, Joel and McEvoy, M. Peter and Sutton, J. Christopher and Myers, Bronwyn and Egan, Sarah and Tai, Sara and Johnston-Hollitt, Melanie and Chen, Wai and Gedeon, Tom and Mansell, Warren", title="An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series", journal="JMIR Hum Factors", year="2023", month="Jul", day="21", volume="10", pages="e46849", keywords="mental health", keywords="conversational agents", keywords="chatbots", keywords="young people", keywords="acceptability", keywords="feasibility", keywords="co-design", keywords="artificial therapist", keywords="artificial intelligence", keywords="youth", keywords="child", keywords="adolescent", keywords="chatbot", keywords="Manage Your Life Online", keywords="MYLO", keywords="support", keywords="mobile phone", abstract="Background: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems. Objective: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems. Methods: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements. Results: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants' problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks. Conclusions: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants' symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial. ", doi="10.2196/46849", url="https://humanfactors.jmir.org/2023/1/e46849", url="http://www.ncbi.nlm.nih.gov/pubmed/37477969" } @Article{info:doi/10.2196/44914, author="Howell, Doris and Bryant Lukosius, Denise and Avery, Jonathan and Santaguida, Athina and Powis, Melanie and Papadakos, Tina and Addario, Vincenzo and Lovas, Mike and Kukreti, Vishal and Haase, Kristen and Mayo, J. Samantha and Papadakos, Janet and Moradian, Saeed and Krzyzanowska, K. Monika", title="A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing", journal="JMIR Cancer", year="2023", month="Jul", day="21", volume="9", pages="e44914", keywords="web-based program", keywords="self-management", keywords="cancer treatment", keywords="digital technology", keywords="co-design", keywords="usability", abstract="Background: Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. Objective: We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). Methods: We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). Results: In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed ``chapters''), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. Conclusions: The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial. ", doi="10.2196/44914", url="https://cancer.jmir.org/2023/1/e44914", url="http://www.ncbi.nlm.nih.gov/pubmed/37477968" } @Article{info:doi/10.2196/45501, author="Andersson, Susanne and Scandurra, Isabella and Nystr{\"o}m, Ulrika and Varemo, Marika and Hellstrand Tang, Ulla", title="Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals: Qualitative Study", journal="JMIR Nursing", year="2023", month="Jul", day="18", volume="6", pages="e45501", keywords="diabetes", keywords="foot ulcer", keywords="prevention", keywords="primary health care", keywords="qualitative research", keywords="structured foot examination", keywords="validation", keywords="user experiences", keywords="participatory design", abstract="Background: Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual's quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals. Objective: The study aimed to validate a structured foot examination form by assessing health care professionals' experiences of working with it ``foot side'' when examining patients with diabetes. Methods: Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users' data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled ``Optimised care of persons with diabetes and foot complications,'' with V{\"a}stra G{\"o}taland Region as the responsible health care authority, where the results will be further developed. Results: Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned. Conclusions: The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines. Trial Registration: ClinicalTrials.gov NCT05692778; https://clinicaltrials.gov/ct2/show/NCT05692778 ", doi="10.2196/45501", url="https://nursing.jmir.org/2023/1/e45501", url="http://www.ncbi.nlm.nih.gov/pubmed/37463012" } @Article{info:doi/10.2196/44498, author="Pol, Margriet and Qadeer, Amarzish and van Hartingsveldt, Margo and Choukou, Mohamed-Amine", title="Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jul", day="18", volume="10", pages="e44498", keywords="aging in place", keywords="aging well", keywords="digital technology", keywords="remote monitoring", keywords="activity", keywords="sensor", keywords="mobile phone", abstract="Background: Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identi?ed as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. Objective: The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. Methods: We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. Results: The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Conclusions: Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals. ", doi="10.2196/44498", url="https://rehab.jmir.org/2023/1/e44498", url="http://www.ncbi.nlm.nih.gov/pubmed/37463040" } @Article{info:doi/10.2196/42654, author="Idrisov, Bulat and Hallgren, A. Kevin and Michaels, Alyssa and Soth, Sean and Darnton, James and Grekin, Paul and Woolworth, Steve and Saxon, J. Andrew and Tsui, I. Judith", title="Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study", journal="JMIR Hum Factors", year="2023", month="Jul", day="13", volume="10", pages="e42654", keywords="addiction", keywords="direct observed therapy", keywords="health app", keywords="methadone", keywords="mHealth", keywords="mobile app", keywords="mobile health", keywords="opioid", keywords="smartphone app", keywords="substance use", keywords="usability", keywords="user engagement", keywords="user testing", keywords="workload", abstract="Background: Methadone, a cornerstone of opioid use disorder treatments for many decades, is an essential tool for combatting the opioid epidemic. However, requirements for observing methadone dosing in person through direct observed therapy (DOT) impose significant barriers for many patients. Digital technology can facilitate remote DOT, which could reduce barriers to methadone treatment. Currently, there are limited data on the usability of such technology among patients and counselors in methadone treatment settings. Objective: The primary objective of this study was to assess the workload, usability, and engagement of a video-based DOT mobile app for patients with opioid use disorder receiving methadone treatment. The secondary objective was to assess the workload, usability, and engagement of the provider-facing app portal used by counselors. Methods: Patients (n=12) and counselors (n=3) who previously tried video DOT for methadone through a smartphone app in an opioid treatment program participated in usability testing sessions. Participants completed essential tasks for video DOT, then provided ratings of workload (NASA Task Load Index), usability (modified System Usability Scale), and engagement (modified Engagement Scale) with the core features of the video DOT program Results: Patients and counselors reported low mental, physical, and temporal demands, successful performance, low effort, and low frustration associated with activities. Patients reported high usability (mean 85, SD 9.5) and engagement (mean 3.8, SD 1.1); counselors reported moderate usability (mean 43.3, SD 17.7) and engagement (mean 2.81, SD 0.63). Conclusions: A mobile health app that facilitates video-based DOT for methadone required a low workload for patients and counselors and was highly usable for patients in an opioid treatment program; however, there are opportunities to improve usability and engagement for the counselor-facing portal. ", doi="10.2196/42654", url="https://humanfactors.jmir.org/2023/1/e42654", url="http://www.ncbi.nlm.nih.gov/pubmed/37440298" } @Article{info:doi/10.2196/45974, author="Simola, Saija and H{\"o}rhammer, Iiris and Xu, Yuhui and B{\"a}rk{\aa}s, Annika and Fagerlund, Johansen Asbj{\o}rn and Hagstr{\"o}m, Josefin and Holmroos, Mari and H{\"a}gglund, Maria and Johansen, Alise Monika and Kane, Bridget and Kharko, Anna and Scandurra, Isabella and Kujala, Sari", title="Patients' Experiences of a National Patient Portal and Its Usability: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2023", month="Jun", day="30", volume="25", pages="e45974", keywords="patient portal", keywords="perceived usability", keywords="System Usability Scale", keywords="electronic health record", keywords="patient experiences", keywords="patient-accessible electronic health records", keywords="national survey", abstract="Background: Patient portals not only provide patients with access to electronic health records (EHRs) and other digital health services, such as prescription renewals, but they can also improve patients' self-management, engagement with health care professionals (HCPs), and care processes. However, these benefits depend on patients' willingness to use patient portals and, ultimately, their experiences with the usefulness and ease of use of the portals. Objective: This study aimed to investigate the perceived usability of a national patient portal and the relationship of patients' very positive and very negative experiences with perceived usability. The study was aimed to be the first step in developing an approach for benchmarking the usability of patient portals in different countries. Methods: Data were collected through a web-based survey of the My Kanta patient portal's logged-in patient users in Finland from January 24, 2022, to February 14, 2022. Respondents were asked to rate the usability of the patient portal, and the ratings were used to calculate approximations of the System Usability Scale (SUS) score. Open-ended questions asked the patients about their positive and negative experiences with the patient portal. The statistical analysis included multivariate regression, and the experience narratives were analyzed using inductive content analysis. Results: Of the 1,262,708 logged-in patient users, 4719 responded to the survey, giving a response rate of 0.37\%. The patient portal's usability was rated as good, with a mean SUS score of 74.3 (SD 14.0). Reporting a very positive experience with the portal was positively associated with perceived usability ($\beta$=.51; P<.001), whereas reporting a very negative experience was negatively associated with perceived usability ($\beta$=?1.28; P<.001). These variables explained 23\% of the variation in perceived usability. The information provided and a lack of information were the most common positive and negative experiences. Furthermore, specific functionalities, such as prescription renewal and the ease of using the patient portal, were often mentioned as very positive experiences. The patients also mentioned negative emotions, such as anger and frustration, as part of their very negative experiences. Conclusions: The study offers empirical evidence about the significant role of individual experiences when patients are evaluating the usability of patient portals. The results suggest that positive and negative experiences provide relevant information that can be used for improving the patient portal's usability. Usability should be improved so that patients receive information efficiently, easily, and quickly. Respondents would also appreciate interactive features in the patient portal. ", doi="10.2196/45974", url="https://www.jmir.org/2023/1/e45974", url="http://www.ncbi.nlm.nih.gov/pubmed/37389909" } @Article{info:doi/10.2196/44926, author="Collier, Futterman Ann and Hagemann, Shelby and Trinidad, Brown Susan and Vigil-Hayes, Morgan", title="Human-to-Computer Interactivity Features Incorporated Into Behavioral Health mHealth Apps: Systematic Search", journal="JMIR Form Res", year="2023", month="Jun", day="30", volume="7", pages="e44926", keywords="app", keywords="behavioral app", keywords="behavioral health", keywords="consumers", keywords="engagement", keywords="health application", keywords="interactivity", keywords="mHealth", keywords="stickiness", keywords="support", keywords="therapeutic", keywords="user engagement", keywords="users", abstract="Background: While there are thousands of behavioral health apps available to consumers, users often quickly discontinue their use, which limits their therapeutic value. By varying the types and number of ways that users can interact with behavioral health mobile health apps, developers may be able to support greater therapeutic engagement and increase app stickiness. Objective: The main objective of this analysis was to systematically characterize the types of user interactions that are available in behavioral health apps and then examine if greater interactivity was associated with greater user satisfaction, as measured by app metrics. Methods: Using a modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology, we searched several different app clearinghouse websites and identified 76 behavioral health apps that included some type of interactivity. We then filtered the results to ensure we were examining behavioral health apps and further refined our search to include apps that identified one or more of the following terms: peer or therapist forum, discussion, feedback, professional, licensed, buddy, friend, artificial intelligence, chatbot, counselor, therapist, provider, mentor, bot, coach, message, comment, chat room, community, games, care team, connect, share, and support in the app descriptions. In the final group of 34 apps, we examined the presence of 6 types of human-machine interactivities: human-to-human with peers, human-to-human with providers, human-to--artificial intelligence, human-to-algorithms, human-to-data, and novel interactive smartphone modalities. We also downloaded information on app user ratings and visibility, as well as reviewed other key app features. Results: We found that on average, the 34 apps reviewed included 2.53 (SD 1.05; range 1-5) features of interactivity. The most common types of interactivities were human-to-data (n=34, 100\%), followed by human-to-algorithm (n=15, 44.2\%). The least common type of interactivity was human--artificial intelligence (n=7, 20.5\%). There were no significant associations between the total number of app interactivity features and user ratings or app visibility. We found that a full range of therapeutic interactivity features were not used in behavioral health apps. Conclusions: Ideally, app developers would do well to include more interactivity features in behavioral health apps in order to fully use the capabilities of smartphone technologies and increase app stickiness. Theoretically, increased user engagement would occur by using multiple types of user interactivity, thereby maximizing the benefits that a person would receive when using a mobile health app. ", doi="10.2196/44926", url="https://formative.jmir.org/2023/1/e44926", url="http://www.ncbi.nlm.nih.gov/pubmed/37389916" } @Article{info:doi/10.2196/40579, author="Kekkonen, Markku and Korkiakangas, Eveliina and Laitinen, Jaana and Oinas-Kukkonen, Harri", title="Factors Reducing the Use of a Persuasive mHealth App and How to Mitigate Them: Thematic Analysis", journal="JMIR Hum Factors", year="2023", month="Jun", day="26", volume="10", pages="e40579", keywords="mobile phone", keywords="mobile health", keywords="mHealth", keywords="Persuasive Systems Design", keywords="behavior change", keywords="thematic analysis", keywords="microentrepreneurs", keywords="randomized controlled trial", abstract="Background: Studies on which persuasive features may work for different users in health contexts are rare. The participants in this study were microentrepreneurs. We built a persuasive mobile app to help them to recover from work. Representatives of this target group tend to be very busy due to work, which was reflected in their use of the app during the randomized controlled trial intervention. Microentrepreneurs also often have dual roles; they are professionals in their line of work as well as entrepreneurs managing their own business, which may add to their workload. Objective: This study aimed to present users' views on the factors that hinder their use of the mobile health app that we developed and how these factors could be mitigated. Methods: We interviewed 59 users and conducted both data-driven and theory-driven analyses on the interviews. Results: Factors reducing app use could be divided into 3 categories: use context (problem domain--related issues, eg, the lack of time due to work), user context (user-related issues, eg, concurrent use of other apps), and technology context (technology-related issues, eg, bugs and usability). Due to the nature of the participants' entrepreneurship, which often interferes with personal life, it became clear that designs targeting similar target groups should avoid steep learning curves and should be easy (quick) to use. Conclusions: Personalized tunneling---guiding the user through a system via personalized solutions---could help similar target groups with similar issues better engage with and keep using health apps because of the easy learning curve. When developing health apps for interventions, background theories should not be interpreted too strictly. Applying theory in practice may require rethinking approaches for adaptation as technology has evolved rapidly and continues to evolve. Trial Registration: ClinicalTrials.gov NCT03648593; https://clinicaltrials.gov/ct2/show/NCT03648593 ", doi="10.2196/40579", url="https://humanfactors.jmir.org/2023/1/e40579", url="http://www.ncbi.nlm.nih.gov/pubmed/37358883" } @Article{info:doi/10.2196/47263, author="Forcino, C. Rachel and Rotenberg, Sivan and Morrissette, J. Kali and Godzik, M. Cassandra and Lichtenstein, D. Jonathan and Schiffelbein, E. Jenna and Stevens, J. Courtney and Sundar, Vidya and Brucker, L. Debra and Connolly, Deirdre and Keysor, Julie and Lyons, Doyle Kathleen", title="Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers", journal="JMIR Form Res", year="2023", month="Jun", day="26", volume="7", pages="e47263", keywords="cancer", keywords="employment", keywords="intervention development", keywords="intervention", keywords="people living with cancer", keywords="cancer survivor", keywords="health care provider", abstract="Background: Employment contributes to cancer survivors' quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been developed in other clinical contexts, existing interventions have demonstrated inconsistent effectiveness in supporting cancer survivors at work. We conducted this study as a preliminary step toward program development for employment support among survivors at a rural comprehensive cancer center. Objective: We aimed (1) to identify supports and resources that stakeholders (cancer survivors, health care providers, and employers) suggest may help cancer survivors to maintain employment and (2) to describe stakeholders' views on the advantages and disadvantages of intervention delivery models that incorporate those supports and resources. Methods: We conducted a descriptive study collecting qualitative data from individual interviews and focus groups. Participants included adult cancer survivors, health care providers, and employers living or working in the Vermont--New Hampshire catchment area of the Dartmouth Cancer Center in Lebanon, New Hampshire. We grouped interview participants' recommended supports and resources into 4 intervention delivery models, which ranged on a continuum from less to more intensive to deliver. We then asked focus group participants to discuss the advantages and disadvantages of each of the 4 delivery models. Results: Interview participants (n=45) included 23 cancer survivors, 17 health care providers, and 5 employers. Focus group participants (n=12) included 6 cancer survivors, 4 health care providers, and 2 employers. The four delivery models were (1) provision of educational materials, (2) individual consultation with cancer survivors, (3) joint consultation with both cancer survivors and their employers, and (4) peer support or advisory groups. Each participant type acknowledged the value of providing educational materials, which could be crafted to improve accommodation-related interactions between survivors and employers. Participants saw usefulness in individual consultation but expressed concern about the costs of program delivery and potential mismatches between consultant recommendations and the limits of what employers can provide. For joint consultation, employers liked being part of the solution and the possibility of enhanced communication. Potential drawbacks included additional logistical burden and its perceived generalizability to all types of workers and workplaces. Survivors and health care providers viewed the efficiency and potency of peer support as benefits of a peer advisory group but acknowledged the sensitivity of financial topics as a possible disadvantage of addressing work challenges in a group setting. Conclusions: The 3 participant groups identified both common and unique advantages and disadvantages of the 4 delivery models, reflecting varied barriers and facilitators to their potential implementation in practice. Theory-driven strategies to address implementation barriers should play a central role in further intervention development. ", doi="10.2196/47263", url="https://formative.jmir.org/2023/1/e47263", url="http://www.ncbi.nlm.nih.gov/pubmed/37358907" } @Article{info:doi/10.2196/43527, author="Suzuki, Mai and Yamanaka, Kou and Fukushima, Shinichi and Ogawa, Mayu and Nagaiwa, Yuki and Naito, Toshio", title="A Mobile Medication Support App and Its Impact on People Living With HIV: 12-Week User Experience and Medication Compliance Pilot Study", journal="JMIR Form Res", year="2023", month="Jun", day="22", volume="7", pages="e43527", keywords="human immunodeficiency virus", keywords="HIV", keywords="acquired immunodeficiency syndrome", keywords="mobile health", keywords="mHealth", keywords="medication compliance", keywords="satisfaction survey", abstract="Background: The continuity of care between hospital visits conducted through mobile apps creates new opportunities for people living with HIV in situations where face-to-face interventions are difficult. Objective: This study investigated the user experience of a mobile medication support app and its impact on improving antiretroviral therapy compliance and facilitating teleconsultations between people living with HIV and medical staff. Methods: Two clinics in Japan were invited to participate in a 12-week trial of the medication support app between July 27, 2018, and March 31, 2021. Medication compliance was assessed based on responses to scheduled medication reminders; users, including people living with HIV and medical staff, were asked to complete an in-app satisfaction survey to rate their level of satisfaction with the app and its specific features on a 5-point Likert scale. Results: A total of 10 people living with HIV and 11 medical staff were included in this study. During the trial, the medication compliance rate was 90\%, and the mean response rates to symptom and medication alerts were 73\% and 76\%, respectively. Overall, people living with HIV and medical staff were satisfied with the medication support app (agreement rate: mean 81\% and 65\%, respectively). Over 80\% of medical staff and people living with HIV were satisfied with the ability to record medications taken (9/11 and 8/10 medical staff and people living with HIV, respectively), record symptoms of concern (10/11 and 8/10),and inquire about drug combinations (8/10, 10/10). And further, 90\% of people living with HIV were satisfied with the function for communication with medical staff (9/10). Conclusions: Our preliminary results demonstrate the feasibility of the medication support app in improving medication compliance and enhancing communication between people living with HIV and medical staff. ", doi="10.2196/43527", url="https://formative.jmir.org/2023/1/e43527", url="http://www.ncbi.nlm.nih.gov/pubmed/37021843" } @Article{info:doi/10.2196/41876, author="Diefenbach, A. Michael and Marziliano, Allison and Siembida, J. Elizabeth and Mistretta, Thomas and Pfister, Halie and Yacoub, Andrea and Aibel, Kelli and Patel, Priya and Lapitan, Emmanuel and Tagai, K. Erin and Smaldone, Marc and Miller, M. Suzanne", title="Cancer Resource and Information Support (CRIS) for Bladder Cancer Survivors and Their Caregivers: Development and Usability Testing Study", journal="JMIR Form Res", year="2023", month="Jun", day="22", volume="7", pages="e41876", keywords="muscle invasive bladder cancer", keywords="behavioral intervention development", keywords="ORBIT model", keywords="usability testing", keywords="web-based intervention", abstract="Background: Bladder cancer survivors and their caregivers face profound practical (eg, use of stoma appliances and care for urinary diversion methods) and psychosocial (eg, depression and anxiety) challenges after surgical treatment with cystectomy. Objective: To improve the health-related quality of life and postsurgical outcomes of both bladder cancer survivors and their caregivers, the team, in collaboration with Sourcetop, Inc (software design) and Dappersmith (graphic design), developed the Cancer Resource and Information Support (CRIS) software. The purpose of this manuscript is to report on the development and usability testing of the CRIS software. Methods: The development of the CRIS software was guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for developing behavioral treatments for chronic diseases. The ORBIT model is unique in that it proposes a flexible and progressive process with prespecific clinically significant milestones for forward movement and returns to earlier stages for refinement, and it facilitates communication among diverse groups by using terminology from the drug development model. This paper focuses on 2 phases of the ORBIT model: phase IA: define and IB: refine. During phase IA, the study team developed solutions for the stated clinical problem---adjustment to life post cystectomy---by reviewing the literature and collecting feedback from clinicians, professional organizations, bladder cancer survivors, and their caregivers. During Phase IB, the study team focused on tailoring content in the CRIS software to the user as well as usability testing with 7 participants. Results: The finished product is CRIS, a web-based software for survivors of bladder cancer and their caregivers to serve as a health management and lifestyle resource after surgery. Overarching themes from phase IA (participant feedback) included how to use new medical equipment, tips and tricks for easier living with new medical equipment, questions about health maintenance, and questions about lifestyle modifications. To accommodate our target population, we also incorporated recommendations from the Americans with Disabilities Act for website design, such as large text size, large paragraph spacing, highly contrasting text and background colors, use of headings and labels to describe the purpose of the content, portrait orientation without the need for horizontal scrolling, multiple ways to access a web page within a set of pages, ability to navigate web pages in sequential order, and in-text links that are descriptive. Usability participants evaluated CRIS very positively, indicating that it was easy to use, the functions were well-integrated, and if available, they would use CRIS frequently. Conclusions: CRIS, developed over the course of 18 months by integrating feedback from experts, literature reviews, and usability testing, is the first web-based software developed for bladder cancer survivors and their caregivers to help them adjust to life following cystectomy. The efficacy of CRIS in improving patients' and caregivers' quality of life is currently being evaluated in a randomized controlled trial. ", doi="10.2196/41876", url="https://formative.jmir.org/2023/1/e41876", url="http://www.ncbi.nlm.nih.gov/pubmed/37347533" } @Article{info:doi/10.2196/45400, author="Shah, Harsh and Patel, Jay and Yasobant, Sandul and Saxena, Deepak and Saha, Somen and Sinha, Anish and Bhavsar, Priya and Patel, Yogesh and Modi, Bhavesh and Nimavat, Pankaj and Kapadiya, Dixit and Fancy, Manish", title="Capacity Building, Knowledge Enhancement, and Consultative Processes for Development of a Digital Tool (Ni-kshay SETU) to Support the Management of Patients with Tuberculosis: Exploratory Qualitative Study", journal="J Med Internet Res", year="2023", month="Jun", day="19", volume="25", pages="e45400", keywords="capacity building", keywords="Ni-kshay SETU", keywords="National Tuberculosis Elimination Program", keywords="digital health", keywords="India", keywords="tuberculosis", abstract="Background: Achieving the target for eliminating tuberculosis (TB) in India by 2025, 5 years ahead of the global target, critically depends on strengthening the capacity of human resources as one of the key components of the health system. Due to the rapid updates of standards and protocols, the human resources for TB health care suffer from a lack of understanding of recent updates and acquiring necessary knowledge. Objective: Despite an increasing focus on the digital revolution in health care, there is no such platform available to deliver the key updates in national TB control programs with easy access. Thus, the aim of this study was to explore the development and evolution of a mobile health tool for capacity building of the Indian health system's workforce to better manage patients with TB. Methods: This study involved two phases. The first phase was based on a qualitative investigation, including personal interviews to understand the basic requirements of staff working in the management of patients with TB, followed by participatory consultative meetings with stakeholders to validate and develop the content for the mobile health app. Qualitative information was collected from the Purbi Singhbhum and Ranchi districts of Jharkhand and Gandhinagar, and from the Surat districts of Gujarat State. In the second phase, a participatory design process was undertaken as part of the content creation and validation exercises. Results: The first phase collected information from 126 health care staff, with a mean age of 38.4 (SD 8.9) years and average work experience of 8.9 years. The assessment revealed that more than two-thirds of participants needed further training and lacked knowledge of the most current updates to TB program guidelines. The consultative process determined the need for a digital solution in easily accessible formats and ready reckoner content to deliver practical solutions to address operational issues for implementation of the program. Ultimately, the digital platform named Ni-kshay SETU (Support to End Tuberculosis) was developed to support the knowledge enhancement of health care workers. Conclusions: The development of staff capacity is vital to the success or failure of any program or intervention. Having up-to-date information provides confidence to health care staff when interacting with patients in the community and aids in making quick judgments when handling case scenarios. Ni-kshay SETU represents a novel digital capacity-building platform for enhancing human resource skills in achieving the goal of TB elimination. ", doi="10.2196/45400", url="https://www.jmir.org/2023/1/e45400", url="http://www.ncbi.nlm.nih.gov/pubmed/37335610" } @Article{info:doi/10.2196/44439, author="Ghorayeb, Abir and Comber, Rob and Gooberman-Hill, Rachael", title="Development of a Smart Home Interface With Older Adults: Multi-Method Co-Design Study", journal="JMIR Aging", year="2023", month="Jun", day="16", volume="6", pages="e44439", keywords="data visualization", keywords="digital health", keywords="smart homes", keywords="older people", keywords="technology acceptance", keywords="qualitative research", keywords="mobile phone", abstract="Background: Smart home technologies have the potential to support aging in place; however, older people's perceptions of the value of smart homes may be influenced by their access to the information gathered by the technology. This information is needed to support their informed decision-making. Limited research has been conducted on how best to design visualizations of smart home data in keeping with the needs and wishes of older people. Objective: We aimed to investigate the design options that impact the usefulness of smart home systems, older people's information needs, their perceptions of data visualization, and the ways they would like information displayed to them. Methods: We used a qualitative approach to empower the participants as co-designers. Data collection comprised a sequence of methods such as interviews, observation, focus groups, scenario design, probes, and design workshops. Each phase informed the next. Overall, 13 older adults (n=8, 62\% female and n=5, 38\% male; aged 65-89 years) consented to participate. A thematic approach was used to analyze the data set, and participants were actively involved in designing the in-home interface, which enabled them to better conceptualize their needs. Results: The information collected was clustered into 5 themes: enabling home, health, and self-monitoring; enabling opportunities for social inclusion and engagement; enhancing cognitive abilities; customizability of the display; and promoting inclusion in recreation and leisure activities. These themes informed 5 design sessions in which participants co-designed visual metaphors for the themes based on their own experiences in an age-inclusive manner. Together, the participants produced a user-friendly prototype, which they chose to call My Buddy. They found it useful to receive social and cognitive triggers, as well as recommendations for special diets or activities based on their mood, health, and social status. Conclusions: Smart home data visualization is much more than a nice-to-have option. Visualization is a must-have feature because it deepens the understanding of the information collected and means that technology provides information of value and relevance to older people. This may improve the acceptability and perceived utility of in-home technology. By understanding what older people want to know from smart home technology and considering how to visualize data in ways that work for them, we can provide an appropriate in-home interface. Such an interface would suggest ways or opportunities to connect and socialize; stimulate contact with close friends or family members; maintain awareness of health and well-being; provide support in decision-making, cognitive tasks, and daily life activities; and monitor health status. Older adults are the best co-designers for the development of visual metaphors that resonate with their own experiences. Our findings promote the development of technologies that foreground and reflect the information needs of older people and engage them as designers of the display. ", doi="10.2196/44439", url="https://aging.jmir.org/2023/1/e44439", url="http://www.ncbi.nlm.nih.gov/pubmed/37327037" } @Article{info:doi/10.2196/43903, author="Trivedi, Ranak and Hirayama, Kawena Sierra and Risbud, Rashmi and Suresh, Madhuvanthi and Humber, Blair Marika and Butler, Kevin and Razze, Alex and Timko, Christine and Nelson, Karin and Zulman, M. Donna and Asch, M. Steven and Humphreys, Keith and Piette, D. John", title="Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing", journal="JMIR Form Res", year="2023", month="Jun", day="16", volume="7", pages="e43903", keywords="dyadic", keywords="eHealth", keywords="behavioral interventions", keywords="self-management", keywords="caregiver", keywords="web-based", keywords="interventions", keywords="stress management", keywords="self-care", abstract="Background: The COVID-19 pandemic has amplified the need for web-based behavioral interventions to support individuals who are diagnosed with chronic conditions and their informal caregivers. However, most interventions focus on patient outcomes. Dyadic technology--enabled interventions that simultaneously improve outcomes for patients and caregivers are needed. Objective: This study aimed to describe the methodology used to adapt a telephone-based, facilitated, and dyadic self-management program called Self-care Using Collaborative Coping Enhancement in Diseases (SUCCEED) into a self-guided, web-based version (web-SUCCEED) and to conduct usability testing for web-SUCCEED. Methods: We developed web-SUCCEED in 6 steps: ideation---determine the intervention content areas; prototyping---develop the wireframes, illustrating the look and feel of the website; prototype refinement via feedback from focus groups; finalizing the module content; programming web-SUCCEED; and usability testing. A diverse team of stakeholders including content experts, web designers, patients, and caregivers provided input at various stages of development. Costs, including full-time equivalent employee, were summarized. Results: At the ideation stage, we determined the content of web-SUCCEED based on feedback from the program's original pilot study. At the prototyping stage, the principal investigator and web designers iteratively developed prototypes that included inclusive design elements (eg, large font size). Feedback about these prototypes was elicited through 2 focus groups of veterans with chronic conditions (n=13). Rapid thematic analysis identified two themes: (1) web-based interventions can be useful for many but should include ways to connect with other users and (2) prototypes were sufficient to elicit feedback about the esthetics, but a live website allowing for continual feedback and updating would be better. Focus group feedback was incorporated into building a functional website. In parallel, the content experts worked in small groups to adapt SUCCEED's content, so that it could be delivered in a didactic, self-guided format. Usability testing was completed by veterans (8/16, 50\%) and caregivers (8/16, 50\%). Veterans and caregivers gave web-SUCCEED high usability scores, noting that it was easy to understand, easy to use, and not overly burdensome. Notable negative feedback included ``slightly agreeing'' that the site was confusing and awkward. All veterans (8/8, 100\%) agreed that they would choose this type of program in the future to access an intervention that aims to improve their health. Developing and maintaining the software and hosting together cost approximately US \$100,000, excluding salary and fringe benefits for project personnel (steps 1-3: US \$25,000; steps 4-6: US \$75,000). Conclusions: Adapting an existing, facilitated self-management support program for delivery via the web is feasible, and such programs can remotely deliver content. Input from a multidisciplinary team of experts and stakeholders can ensure the program's success. Those interested in adapting programs should have a realistic estimate of the budget and staffing requirements. ", doi="10.2196/43903", url="https://formative.jmir.org/2023/1/e43903", url="http://www.ncbi.nlm.nih.gov/pubmed/37327057" } @Article{info:doi/10.2196/42649, author="van de Baan, Christian Frank and Lambregts, Stijn and Bergman, Esther and Most, Jasper and Westra, Daan", title="Involving Health Professionals in the Development of Quality and Safety Dashboards: Qualitative Study", journal="J Med Internet Res", year="2023", month="Jun", day="12", volume="25", pages="e42649", keywords="quality improvement", keywords="dashboard", keywords="user involvement", keywords="innovation", keywords="health care provider", keywords="health care professional", keywords="feedback", keywords="opinion", keywords="perspective", keywords="qualitative", keywords="constant comparative method", abstract="Background: Dashboards are an important tool for hospitals to improve quality and safety performance. However, implementing quality and safety dashboards often does not increase performance due to a lack of use by health professionals. Including health professionals in the development process of quality and safety dashboards can improve their use in practice. Yet, it remains unclear how a development process involving health professionals can be executed successfully. Objective: The aim of this study is twofold: (1) to delineate how a process whereby health professionals are included in the development of quality and safety dashboards can be facilitated and (2) to identify the factors that are important to consider in order to make that process successful. Methods: We conducted a qualitative, in-depth exploratory case study in which we analyzed 150 pages of internal documents and interviewed 13 staff members regarding the development of quality and safety dashboards within 2 care pathways of a hospital that has experience in such development. The data were analyzed inductively using the constant comparative method. Results: We found that the development of quality and safety dashboards in collaboration with health professionals was facilitated through a five-stage process: (1) familiarizing participants with dashboards and the development process; (2) brainstorming about potential indicators to be included in the dashboard; (3) prioritizing, defining, and selecting indicators to be included in the dashboard; (4) examining how the indicators can be visualized; and (5) implementing the dashboard and following up on its use. To enhance the success of the process, 3 factors were deemed important. The first is to create and maintain broad involvement, ensuring that various professions are represented and take ownership of the dashboard. Here, potential barriers include gaining engagement from peers not directly involved in the process and maintaining involvement after the initial implementation of the dashboard. Second, unburdening, whereby quality and safety staff facilitate a structured process that has little additional burden for professionals. For this, time management and a lack of collaboration with departments responsible for delivering the data might be an issue. Lastly, focusing on relevance for health professionals, which refers to the inclusion of indicators with value for health professionals. For this factor, a lack of consensus on how indicators should be defined and registered might be a barrier. Conclusions: Health care organizations seeking to develop quality and safety dashboards in collaboration with health professionals can use a 5-stage process. To enhance the success of the process, organizations are advised to focus on 3 key factors. For each of the key factors, potential barriers should be taken into account. Engaging in this process and attaining the key factors could increase the likelihood that the dashboards are used in practice. ", doi="10.2196/42649", url="https://www.jmir.org/2023/1/e42649", url="http://www.ncbi.nlm.nih.gov/pubmed/37307058" } @Article{info:doi/10.2196/42214, author="Fleischer, Jennifer and Ayton, Jeff and Riley, Maree and Binsted, Kim and Cowan, R. Devin and Fellows, M. Abigail and Weiss, A. Jeff and Buckey, C. Jay", title="Web-Based, Interactive, Interest-Based Negotiation Training for Managing Conflict in Isolated Environments: Opportunistic Study With an e-Survey", journal="JMIR Form Res", year="2023", month="Jun", day="9", volume="7", pages="e42214", keywords="conflict management", keywords="bargaining", keywords="confined environments", keywords="COVID-19", keywords="pandemic", keywords="development", keywords="environment", keywords="skill", keywords="training", keywords="users", keywords="essential", keywords="Australia", keywords="management", abstract="Background: Effective negotiation in relationships is critical for successful long-duration space missions; inadequate conflict resolution has shown serious consequences. Less desirable forms of negotiation, including positional bargaining (eg, negotiating prices), can exacerbate conflicts. Traditional positional bargaining may work for simple, low-stakes transactions but does not prioritize ongoing relationships. High-stakes situations warrant interest-based negotiation, where parties with competing interests or goals collaborate in a mutually beneficial agreement. This is learnable but must be practiced. Refresher training during conflicts is important to prevent out-of-practice crew members from using less effective negotiation techniques. Training should be self-directed and not involve others because, on a space mission, the only other people available may be part of the conflict. Objective: We aimed to develop and test an interactive module teaching principles and skills of interest-based negotiation in a way that users find acceptable, valuable for learning, and enjoyable. Methods: Using a web-based, interactive-media approach, we scripted, filmed, and programmed an interest-based negotiation interactive training module. In the module, the program mentor introduces users to ``The Circle of Value'' approach to negotiation and highlights its key concepts through interactive scenarios requiring users to make selections at specific decision points. Each selection prompts feedback designed to reinforce a teaching point or highlight a particular negotiation technique. To evaluate the module, we sought populations experiencing isolation and confinement (an opportunistic design). This included 9 participants in isolated, confined environments in the Australian Antarctic Program and the Hawai'i Space Exploration Analog and Simulation Mars simulation, as well as a subset of people who self-identified as being isolated and confined during the COVID-19 pandemic. Feedback was collected from participants (n=54) through free-response answers and questionnaires with numerical scaling (0=strongly disagree to 4=strongly agree) at the end of the module. Results: In total, 51 of 54 (94\%) participants found the activity valuable for learning about conflict management (identified by those who selected either ``somewhat agree'' or ``strongly agree''), including 100\% of participants in the isolated and confined environment subset (mode=3). In total, 79\% (128/162) of participant responses indicated that the module was realistic (mode=3), including 85\% (23/27) of responses from participants in isolated and confined environments (mode=3). Most participants felt that this would be particularly valuable for new team members in an isolated, confined environment (46/54, 85\% of all participants, mode 4; 7/9, 78\% of the isolated and confined environment subset, mode 3) as well as veterans. Conclusions: This module offers a self-directed, consistent approach to interest-based negotiation training, which is well received by users. Although the data are limited due to the opportunistic study design, the module could be useful for individuals in isolated and confined environments and for anyone involved in high-stakes negotiations where sustaining relationships is essential. ", doi="10.2196/42214", url="https://formative.jmir.org/2023/1/e42214", url="http://www.ncbi.nlm.nih.gov/pubmed/37075233" } @Article{info:doi/10.2196/42740, author="Islam, Ashraful and Chaudhry, Moalla Beenish", title="Design Validation of a Relational Agent by COVID-19 Patients: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Jun", day="8", volume="10", pages="e42740", keywords="COVID-19", keywords="relational agent", keywords="mHealth", keywords="design validation", keywords="health care", keywords="chatbot", keywords="digital health intervention", keywords="health care professional", keywords="heuristic", keywords="health promotion", keywords="mental well-being", keywords="design validation survey", keywords="self-isolation", abstract="Background: Relational agents (RAs) have shown effectiveness in various health interventions with and without doctors and hospital facilities. In situations such as a pandemic like the COVID-19 pandemic when health care professionals (HCPs) and facilities are unable to cope with increased demands, RAs may play a major role in ameliorating the situation. However, they have not been well explored in this domain. Objective: This study aimed to design a prototypical RA in collaboration with COVID-19 patients and HCPs and test it with the potential users, for its ability to deliver services during a pandemic. Methods: The RA was designed and developed in collaboration with people with COVID-19 (n=21) and 2 groups of HCPs (n=19 and n=16, respectively) to aid COVID-19 patients at various stages by performing 4 main tasks: testing guidance, support during self-isolation, handling emergency situations, and promoting postrecovery mental well-being. A design validation survey was conducted with 98 individuals to evaluate the usability of the prototype using the System Usability Scale (SUS), and the participants provided feedback on the design. In addition, the RA's usefulness and acceptability were rated by the participants using Likert scales. Results: In the design validation survey, the prototypical RA received an average SUS score of 58.82. Moreover, 90\% (88/98) of participants perceived it to be helpful, and 69\% (68/98) of participants accepted it as a viable alternative to HCPs. The prototypical RA received favorable feedback from the participants, and they were inclined to accept it as an alternative to HCPs in non-life-threatening scenarios despite the usability rating falling below the acceptable threshold. Conclusions: Based on participants' feedback, we recommend further development of the RA with improved automation and emotional support, ability to provide information, tracking, and specific recommendations. ", doi="10.2196/42740", url="https://humanfactors.jmir.org/2023/1/e42740", url="http://www.ncbi.nlm.nih.gov/pubmed/36350760" } @Article{info:doi/10.2196/44326, author="Martins, Isabel Ana and Santinha, Gon{\c{c}}alo and Almeida, Margarida Ana and Ribeiro, {\'O}scar and Silva, Telmo and Rocha, Nelson and Silva, G. Anabela", title="Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist", journal="J Med Internet Res", year="2023", month="Jun", day="6", volume="25", pages="e44326", keywords="usability evaluation", keywords="Delphi study", keywords="user-centered design", keywords="design", keywords="usability", keywords="evaluation", keywords="process", keywords="development", keywords="user", keywords="digital", keywords="efficient", keywords="reporting", keywords="quality", keywords="applicability", abstract="Background: Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards. Objective: The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies. Methods: A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70\% or more experienced participants scored an item 7 to 9 and less than 15\% of participants scored the same item 1 to 3. Results: A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation--related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82\%) of the procedures related to usability evaluation involving users and for 7 (70\%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies. Conclusions: This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions. ", doi="10.2196/44326", url="https://www.jmir.org/2023/1/e44326", url="http://www.ncbi.nlm.nih.gov/pubmed/37279047" } @Article{info:doi/10.2196/44630, author="Auton, Alice and Zaman, Sameer and Padayachee, Yorissa and Samways, W. Jack and Quaife, M. Nicholas and Sweeney, Mark and Tenorio, Indira and Linton, F. Nick W. and Cole, D. Graham and Peters, S. Nicholas and Mayet, Jamil and Barton, Carys and Plymen, Carla", title="Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives", journal="JMIR Nursing", year="2023", month="Jun", day="6", volume="6", pages="e44630", keywords="heart failure", keywords="health-related quality of life", keywords="mHealth", keywords="nurse specialist", keywords="patient engagement", keywords="self-management", keywords="self-care", abstract="Background: Community-based management by heart failure specialist nurses (HFSNs) is key to improving self-care in heart failure with reduced ejection fraction. Remote monitoring (RM) can aid nurse-led management, but in the literature, user feedback evaluation is skewed in favor of the patient rather than nursing user experience. Furthermore, the ways in which different groups use the same RM platform at the same time are rarely directly compared in the literature. We present a balanced semantic analysis of user feedback from patient and nurse perspectives of Luscii, a smartphone-based RM strategy combining self-measurement of vital signs, instant messaging, and e-learning. Objective: This study aims to (1) evaluate how patients and nurses use this type of RM (usage type), (2) evaluate patients' and nurses' user feedback on this type of RM (user experience), and (3) directly compare the usage type and user experience of patients and nurses using the same type of RM platform at the same time. Methods: We performed a retrospective usage type and user experience evaluation of the RM platform from the perspective of both patients with heart failure with reduced ejection fraction and the HFSNs using the platform to manage them. We conducted semantic analysis of written patient feedback provided via the platform and a focus group of 6 HFSNs. Additionally, as an indirect measure of tablet adherence, self-measured vital signs (blood pressure, heart rate, and body mass) were extracted from the RM platform at onboarding and 3 months later. Paired 2-tailed t tests were used to evaluate differences between mean scores across the 2 timepoints. Results: A total of 79 patients (mean age 62 years; 35\%, 28/79 female) were included. Semantic analysis of usage type revealed extensive, bidirectional information exchange between patients and HFSNs using the platform. Semantic analysis of user experience demonstrates a range of positive and negative perspectives. Positive impacts included increased patient engagement, convenience for both user groups, and continuity of care. Negative impacts included information overload for patients and increased workload for nurses. After the patients used the platform for 3 months, they showed significant reductions in heart rate (P=.004) and blood pressure (P=.008) but not body mass (P=.97) compared with onboarding. Conclusions: Smartphone-based RM with messaging and e-learning facilitates bilateral information sharing between patients and nurses on a range of topics. Patient and nurse user experience is largely positive and symmetrical, but there are possible negative impacts on patient attention and nurse workload. We recommend RM providers involve patient and nurse users in platform development, including recognition of RM usage in nursing job plans. ", doi="10.2196/44630", url="https://nursing.jmir.org/2023/1/e44630", url="http://www.ncbi.nlm.nih.gov/pubmed/37279054" } @Article{info:doi/10.2196/45894, author="Han, Jeong Hee and Mendu, Sanjana and Jaworski, K. Beth and Owen, E. Jason and Abdullah, Saeed", title="Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts", journal="JMIR Form Res", year="2023", month="May", day="29", volume="7", pages="e45894", keywords="conversational agent", keywords="PTSD", keywords="self-management", keywords="clinical experts", keywords="evaluation", keywords="support system", keywords="mental health", keywords="trauma", abstract="Background: Posttraumatic stress disorder (PTSD) is a serious public health concern. However, individuals with PTSD often do not have access to adequate treatment. A conversational agent (CA) can help to bridge the treatment gap by providing interactive and timely interventions at scale. Toward this goal, we have developed PTSDialogue---a CA to support the self-management of individuals living with PTSD. PTSDialogue is designed to be highly interactive (eg, brief questions, ability to specify preferences, and quick turn-taking) and supports social presence to promote user engagement and sustain adherence. It includes a range of support features, including psychoeducation, assessment tools, and several symptom management tools. Objective: This paper focuses on the preliminary evaluation of PTSDialogue from clinical experts. Given that PTSDialogue focuses on a vulnerable population, it is critical to establish its usability and acceptance with clinical experts before deployment. Expert feedback is also important to ensure user safety and effective risk management in CAs aiming to support individuals living with PTSD. Methods: We conducted remote, one-on-one, semistructured interviews with clinical experts (N=10) to gather insight into the use of CAs. All participants have completed their doctoral degrees and have prior experience in PTSD care. The web-based PTSDialogue prototype was then shared with the participant so that they could interact with different functionalities and features. We encouraged them to ``think aloud'' as they interacted with the prototype. Participants also shared their screens throughout the interaction session. A semistructured interview script was also used to gather insights and feedback from the participants. The sample size is consistent with that of prior works. We analyzed interview data using a qualitative interpretivist approach resulting in a bottom-up thematic analysis. Results: Our data establish the feasibility and acceptance of PTSDialogue, a supportive tool for individuals with PTSD. Most participants agreed that PTSDialogue could be useful for supporting self-management of individuals with PTSD. We have also assessed how features, functionalities, and interactions in PTSDialogue can support different self-management needs and strategies for this population. These data were then used to identify design requirements and guidelines for a CA aiming to support individuals with PTSD. Experts specifically noted the importance of empathetic and tailored CA interactions for effective PTSD self-management. They also suggested steps to ensure safe and engaging interactions with PTSDialogue. Conclusions: Based on interviews with experts, we have provided design recommendations for future CAs aiming to support vulnerable populations. The study suggests that well-designed CAs have the potential to reshape effective intervention delivery and help address the treatment gap in mental health. ", doi="10.2196/45894", url="https://formative.jmir.org/2023/1/e45894", url="http://www.ncbi.nlm.nih.gov/pubmed/37247220" } @Article{info:doi/10.2196/43636, author="Geerts, Jody and Pieterse, Marcel and Laverman, Goos and Waanders, Femke and Oosterom, Nicole and Slegten, Jacqueline and Salemink, Elske and Bode, Christina", title="Cognitive Bias Modification Training Targeting Fatigue in Patients With Kidney Disease: Usability Study", journal="JMIR Form Res", year="2023", month="May", day="29", volume="7", pages="e43636", keywords="cognitive bias", keywords="patient perspective", keywords="qualitative study", keywords="nephrology", keywords="fatigue", keywords="vitality", keywords="acceptability", keywords="applicability", keywords="usability", keywords="design", abstract="Background: Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue. Objective: We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training. Methods: This was a longitudinal, qualitative, and multiple stakeholder--perspective usability study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting. Results: Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients' varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data. Conclusions: To the best of our knowledge, this study is the first to introduce a CBM training targeting fatigue. Furthermore, this study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results. Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design. ", doi="10.2196/43636", url="https://formative.jmir.org/2023/1/e43636", url="http://www.ncbi.nlm.nih.gov/pubmed/37247217" } @Article{info:doi/10.2196/43592, author="Blazey, Meghan and Marinac, Catherine and Whiteley, Jessica and Peterson, Sarah and Burns White, Karen and Jacques, Cathyanah and Lam, Helen and Halpenny, Barbara and Patel, Shree and Lamothe, Raymond and Wright, Julie", title="Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study", journal="JMIR Form Res", year="2023", month="May", day="24", volume="7", pages="e43592", keywords="sedentary behavior", keywords="digital health", keywords="dyad-based intervention", keywords="breast cancer risk", keywords="breast cancer survivor", keywords="social support", keywords="mobile phone", abstract="Background: Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12\% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors. Objective: This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling). Methods: This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis. Results: Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60\%), not married (8/10, 80\%), and college graduates (5/10, 50\%). The app was used on average 20.2 (SD 8.9) out of 28 days---SUS score of 72 (range 55-95)---and 70\% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90\% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app. Conclusions: The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community. Trial Registration: ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279 ", doi="10.2196/43592", url="https://formative.jmir.org/2023/1/e43592", url="http://www.ncbi.nlm.nih.gov/pubmed/37223968" } @Article{info:doi/10.2196/46673, author="Olesen, Linnet Mette and Rossen, Sine and J{\o}rgensen, Rikke and Langballe Udbj{\o}rg, Line and Hansson, Helena", title="Usefulness of a Digitally Assisted Person-Centered Care Intervention: Qualitative Study of Patients' and Nurses' Experiences in a Long-term Perspective", journal="JMIR Nursing", year="2023", month="May", day="18", volume="6", pages="e46673", keywords="digital technology", keywords="digital nursing", keywords="digitally assisted guided self-determination", keywords="empowerment", keywords="self-management", keywords="person-centered care", keywords="qualitative", keywords="service design", keywords="patient care", keywords="nurse", keywords="quality of life", keywords="interview", keywords="web-based questionnaire", keywords="functionality", keywords="support", keywords="training", keywords="implementation", keywords="self-determination", keywords="autonomy", keywords="agency", keywords="person centered", keywords="patient centered", keywords="client focus", keywords="gynecology", keywords="oncology", keywords="health knowledge", keywords="health care professional", keywords="health care provider", keywords="HCP", keywords="mobile phone", abstract="Background: Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality health care, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity; however, there is limited information available on barriers, facilitators, and user experiences. A recent review of the effect of digital self-management support tools suggests a beneficial effect on the quality of life in patients with cancer. On the basis of an overall philosophy of empowerment, guided self-determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses. The intervention was adapted into a digital version called digitally assisted guided self-determination (DA-GSD) hosted by the Sundhed DK website that can be delivered face-to-face, via video, or by the combination of the 2 methods. Objective: We aimed to investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in 2 oncology departments and 1 gynecology department over a 5-year implementation period from 2018 to 2022. Methods: This qualitative study was inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in a web questionnaire, 14 qualitative semistructured interviews with nurses and patients who initially completed the web questionnaire, and transcripts of meetings held between the researchers and nurses during the implementation of the intervention. The thematic analysis of all data was done using NVivo (QSR International). Results: The analysis generated 2 main themes and 7 subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time owing to better familiarity with the increasingly mature technology. The first theme was the different experiences and perspectives of nurses and patients concerning barriers to using DA-GSD and comprised 4 subthemes: conflicting perspectives on the ability of patients to engage with DA-GSD and how to provide it, conflicting perspectives on DA-GSD as a threat to the nurse-patient relationship, functionality of DA-GSD and available technical equipment, and data security. The other theme was what influenced the increased acceptability of DA-GSD among the nurses over time and comprised 3 subthemes: a re-evaluation of the nurse-patient relationship; improved functionality of DA-GSD; and supervision, experience, patient feedback, and a global pandemic. Conclusions: The nurses experienced more barriers to DA-GSD than the patients did. Acceptance of the intervention increased over time among the nurses in keeping with the intervention's improved functionality, additional guidance, and positive experiences, combined with patients finding it useful. Our findings emphasize the importance of supporting and training nurses if new technologies are to be implemented successfully. ", doi="10.2196/46673", url="https://nursing.jmir.org/2023/1/e46673", url="http://www.ncbi.nlm.nih.gov/pubmed/37200076" } @Article{info:doi/10.2196/45274, author="Fields, Beth and Still, Catherine and Medlin, Austin and Strayer, Andrea and Arbaje, I. Alicia and Gilmore-Bykovskyi, Andrea and Werner, Nicole", title="Care Partner Inclusion of People Hospitalized With Alzheimer Disease and Related Dementias: Protocol for a Mixed Methods Systems Engineering Approach to Designing a Health Care System Toolkit", journal="JMIR Res Protoc", year="2023", month="May", day="16", volume="12", pages="e45274", keywords="caregiving", keywords="co-design", keywords="dementia", keywords="health care", keywords="systems", keywords="mixed methods", abstract="Background: Research and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners' active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. Objective: This paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. Methods: The A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. Results: The A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. Conclusions: We anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. International Registered Report Identifier (IRRID): DERR1-10.2196/45274 ", doi="10.2196/45274", url="https://www.researchprotocols.org/2023/1/e45274", url="http://www.ncbi.nlm.nih.gov/pubmed/37191978" } @Article{info:doi/10.2196/43129, author="Saly, Lauren and Provvidenza, Christine and Al-Hakeem, Hiba and Hickling, Andrea and Stevens, Sara and Kakonge, Lisa and Hunt, W. Anne and Bennett, Sheila and Martinussen, Rhonda and Scratch, E. Shannon", title="The Teach-ABI Professional Development Module for Educators About Pediatric Acquired Brain Injury: Mixed Method Usability Study", journal="JMIR Hum Factors", year="2023", month="May", day="15", volume="10", pages="e43129", keywords="acquired brain injury", keywords="educators", keywords="professional development", keywords="usability testing", keywords="satisfaction testing", keywords="knowledge translation", keywords="usability", keywords="death", keywords="disability", keywords="children", keywords="development", keywords="Ontario", keywords="research", keywords="online", keywords="school", abstract="Background: Acquired brain injury (ABI) is a leading cause of death and disability in children and can lead to lasting cognitive, physical, and psychosocial outcomes that affect school performance. Students with an ABI experience challenges returning to school due in part to lack of educator support and ABI awareness. A lack of knowledge and training contribute to educators feeling unprepared to support students with ABI. Teach-ABI, an online professional development module, was created to enhance educators' ABI knowledge and awareness to best support students. Using a case-based approach, Teach-ABI explains what an ABI is, identifies challenges for students with ABI in the classroom, discusses the importance of an individualized approach to supporting students with ABI, and describes how to support a student with an ABI in the classroom. Objective: This study aims to assess the usability of and satisfaction with Teach-ABI by elementary school educators. The following questions were explored: (1) Can elementary school teachers use and navigate Teach-ABI?, (2) Are the content and features of Teach-ABI satisfactory?, and (3) What modifications are needed to improve Teach-ABI? Methods: Elementary school educators currently employed or in training to be employed in Ontario elementary schools were recruited. Using Zoom, individual online meetings with a research team member were held, where educators actively reviewed Teach-ABI. Module usability was evaluated through qualitative analysis of think-aloud data and semistructured interviews, direct observation, user success rate during task completion, and the System Usability Scale (SUS) scores. The usability benchmark selected was 70\% of participants performing more than half of module tasks independently. Results: A total of 8 female educators participated in the study. Educators were classroom (n=7) and preservice (n=1) teachers from public (n=7) and private (n=1) school boards. In terms of task performance, more than 85\% of participants (ie, 7/8) independently completed 10 out of 11 tasks and 100\% of participants independently completed 7 out of 11 tasks, demonstrating achievement of the module usability goal. The average overall SUS score was 86.25, suggesting a high satisfaction level with the perceived usability of Teach-ABI. Overall, participants found Teach-ABI content valuable, useful, and aligned with the realities of their profession. Participants appreciated the visual design, organization, and varying use of education strategies within Teach-ABI. Opportunities for enhancement included broadening content case examples of students with ABI and enhancing the accessibility of the content. Conclusions: Validated usability measures combined with qualitative methodology revealed educators' high level of satisfaction with the design, content, and navigation of Teach-ABI. Educators engaged with the module as active participants in knowledge construction, as they reflected, questioned, and connected content to their experiences and knowledge. This study established strong usability and satisfaction with Teach-ABI and demonstrated the importance of usability testing in building online professional development modules. ", doi="10.2196/43129", url="https://humanfactors.jmir.org/2023/1/e43129", url="http://www.ncbi.nlm.nih.gov/pubmed/37184920" } @Article{info:doi/10.2196/38079, author="Alami, Jawad and Hammonds, Clare and Hensien, Erin and Khraibani, Jenan and Borowitz, Stephen and Hellems, Martha and Riggs, Sara", title="Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study", journal="JMIR Med Educ", year="2023", month="May", day="10", volume="9", pages="e38079", keywords="EHR", keywords="pediatric", keywords="usability", keywords="prerounding", keywords="training", keywords="electronic health record", keywords="eHealth", abstract="Background: Electronic health records (EHRs) play a substantial role in modern health care, especially during prerounding, when residents gather patient information to inform daily care decisions of the care team. The effective use of the EHR system is crucial for efficient and frustration-free prerounding. Ideally, the system should be designed to support efficient user interactions by presenting data effectively and providing easy navigation between different pages. Additionally, training on the system should aim to make user interactions more efficient by familiarizing the users with best practices that minimize interaction time while using the full potential of the system's capabilities. However, formal training on EHR systems often falls short of providing residents with all the necessary EHR-related skills, leading to the adoption of inefficient practices and the underuse of the system's full range of capabilities. Objective: This study aims to examine the efficiency of EHR use during prerounding among pediatric residents, assess the effect of experience level on EHR use, and identify areas for improvement in EHR design and training. Methods: A mixed methods approach was used, involving a self-reported survey and video analysis of prerounding practices of the entire population of pediatric residents from a large teaching hospital in the South Atlantic Region. The residents were stratified by experience level by postgraduate year. Data were collected on the number of pages accessed, duration of prerounding, task completion rates, and effective use of data sources. Observational and qualitative data complemented the quantitative analysis. Our study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines, ensuring completeness and transparency of reporting. Results: Of the 30 pediatric residents, 20 were included in the analyses; of these, 16 (80\%) missed at least 1 step during prerounding. Although more experienced residents on average omitted fewer steps, 4 (57\%) of the 7 most experienced residents still omitted at least 1 step. On average, residents took 6.5 minutes to round each patient and accessed 21 pages within the EHR during prerounding; no statistically significant differences were observed between experience levels for prerounding times (P=.48) or number of pages accessed (P=.92). The use of aggregated data pages within the EHR system neither seem to improve prerounding times nor decrease the number of pages accessed. Conclusions: The findings suggest that EHR design should be improved to better support user needs, and hospitals should adopt more effective training programs to familiarize residents with the system's capabilities. We recommend implementing prerounding checklists and providing ongoing EHR training programs for health care practitioners. Despite the generalizability of limitations of our study in terms of sample size and specialization, it offers valuable insights for future research to investigate the impact of EHR use on patient outcomes and satisfaction, as well as identify factors that contribute to efficient and effective EHR usage. ", doi="10.2196/38079", url="https://mededu.jmir.org/2023/1/e38079", url="http://www.ncbi.nlm.nih.gov/pubmed/37163346" } @Article{info:doi/10.2196/44644, author="Jing, Xia and Patel, L. Vimla and Cimino, J. James and Shubrook, H. Jay and Zhou, Yuchun and Draghi, N. Brooke and Ernst, A. Mytchell and Liu, Chang and De Lacalle, Sonsoles", title="A Visual Analytic Tool (VIADS) to Assist the Hypothesis Generation Process in Clinical Research: Mixed Methods Usability Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="27", volume="10", pages="e44644", keywords="usability", keywords="VIADS", keywords="data-driven hypothesis generation", keywords="visualization", keywords="clinical research", keywords="SUS", keywords="mixed methods study", abstract="Background: Visualization can be a powerful tool to comprehend data sets, especially when they can be represented via hierarchical structures. Enhanced comprehension can facilitate the development of scientific hypotheses. However, the inclusion of excessive data can make visualizations overwhelming. Objective: We developed a visual interactive analytic tool for filtering and summarizing large health data sets coded with hierarchical terminologies (VIADS). In this study, we evaluated the usability of VIADS for visualizing data sets of patient diagnoses and procedures coded in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Methods: We used mixed methods in the study. A group of 12 clinical researchers participated in the generation of data-driven hypotheses using the same data sets and time frame (a 1-hour training session and a 2-hour study session) utilizing VIADS via the think-aloud protocol. The audio and screen activities were recorded remotely. A modified version of the System Usability Scale (SUS) survey and a brief survey with open-ended questions were administered after the study to assess the usability of VIADS and verify their intense usage experience with VIADS. Results: The range of SUS scores was 37.5 to 87.5. The mean SUS score for VIADS was 71.88 (out of a possible 100, SD 14.62), and the median SUS was 75. The participants unanimously agreed that VIADS offers new perspectives on data sets (12/12, 100\%), while 75\% (8/12) agreed that VIADS facilitates understanding, presentation, and interpretation of underlying data sets. The comments on the utility of VIADS were positive and aligned well with the design objectives of VIADS. The answers to the open-ended questions in the modified SUS provided specific suggestions regarding potential improvements for VIADS, and the identified problems with usability were used to update the tool. Conclusions: This usability study demonstrates that VIADS is a usable tool for analyzing secondary data sets with good average usability, good SUS score, and favorable utility. Currently, VIADS accepts data sets with hierarchical codes and their corresponding frequencies. Consequently, only specific types of use cases are supported by the analytical results. Participants agreed, however, that VIADS provides new perspectives on data sets and is relatively easy to use. The VIADS functionalities most appreciated by participants were the ability to filter, summarize, compare, and visualize data. International Registered Report Identifier (IRRID): RR2-10.2196/39414 ", doi="10.2196/44644", url="https://humanfactors.jmir.org/2023/1/e44644", url="http://www.ncbi.nlm.nih.gov/pubmed/37011112" } @Article{info:doi/10.2196/37329, author="Sweeney, Megan and Barton, William and Nebeker, Camille", title="Evaluating Mobile Apps Targeting Older Adults: Descriptive Study", journal="JMIR Form Res", year="2023", month="Apr", day="27", volume="7", pages="e37329", keywords="older adults", keywords="mobile apps", keywords="privacy", keywords="data management, research ethics", keywords="app", keywords="aging", keywords="environment", keywords="safety", keywords="smartphone", keywords="personal information", keywords="user knowledge", keywords="user", keywords="data", keywords="data collection", keywords="storage", abstract="Background: Smartphone use has increased dramatically and, in parallel, a market for mobile apps, including health apps, has emerged. The business model of targeted mobile app advertisements allows for the collection of personal and potentially sensitive information, often without user knowledge. Older adults comprise a rapidly growing demographic that is potentially vulnerable to exploitation by those accessing data collected via these apps. Objective: This research examined apps that claimed to be useful to older adults with a goal of (1) classifying the functionality of each app, (2) identifying whether a privacy policy existed and was accessible, and (3) evaluating evidence that could support claims of value to older adults. Methods: An environmental scan was conducted using the Google search engine and typing ``apps for older adults.'' The first 25 sites that this search returned comprised the primary data for this study. Data were organized by descriptive features of purpose (eg, health, finance, and utility), the existence of an electronically accessible privacy policy, price, and evidence supporting each recommended mobile app. Results: A total of 133 mobile apps were identified and promoted as being the best ``apps for older adults.'' Of these 133 mobile apps, 83\% (n=110) included a privacy policy. Fewer apps designated in the ``medical'' category included a privacy policy than those classified otherwise. Conclusions: The results suggest that most mobile apps targeting older adults include a privacy policy. Research is needed to determine whether these privacy policies are readable, succinct, and incorporate accessible data use and sharing practices to mitigate potential risks, particularly when collecting potentially sensitive health information. ", doi="10.2196/37329", url="https://formative.jmir.org/2023/1/e37329", url="http://www.ncbi.nlm.nih.gov/pubmed/37103995" } @Article{info:doi/10.2196/44354, author="Tomas, Vanessa and Hsu, Shaelynn and Kingsnorth, Shauna and Anagnostou, Evdokia and Kirsh, Bonnie and Lindsay, Sally", title="Development and Usability Testing of a Web-Based Workplace Disability Disclosure Decision Aid Tool for Autistic Youth and Young Adults: Qualitative Co-design Study", journal="JMIR Form Res", year="2023", month="Apr", day="27", volume="7", pages="e44354", keywords="autism", keywords="decision aids", keywords="co-design", keywords="disability disclosure", keywords="employment", keywords="knowledge translation", keywords="patient-oriented research", keywords="qualitative", keywords="usability testing", keywords="youth and young adults", abstract="Background: Deciding whether and how to disclose one's autism at work is complex, especially for autistic youth and young adults who are newly entering the labor market and still learning important decision-making and self-determination skills. Autistic youth and young adults may benefit from tools to support disclosure processes at work; however, to our knowledge, no evidence-based, theoretically grounded tool exists specifically for this population. There is also limited guidance on how to pursue the development of such a tool in collaboration with knowledge users. Objective: This study aimed to co-design a prototype of a disclosure decision aid tool with and for Canadian autistic youth and young adults, explore the perceived usability of the prototype (usefulness, satisfaction, and ease of use) and make necessary revisions, and outline the process used to achieve the aforementioned objectives. Methods: Taking a patient-oriented research approach, we engaged 4 autistic youths and young adults as collaborators on this project. Prototype development was guided by co-design principles and strategies, and tool content was informed by a previous needs assessment led by our team, the autistic collaborators' lived experiences, considering intersectionality, research on knowledge translation (KT) tool development, and recommendations from the International Patient Decision Aid Standards. We co-designed a web-based PDF prototype. To assess perceived usability and experiences with the prototype, we conducted 4 participatory design and focus group Zoom (Zoom Video Communications) sessions with 19 Canadian autistic youths and young adults aged 16 to 29 (mean 22.8, SD 4.1) years. We analyzed the data using a combined conventional (inductive) and modified framework method (deductive) analysis to map the data onto usability indicators (usefulness, satisfaction, and ease of use). Grounded in participants' feedback, considering factors of feasibility and availability of resources, and ensuring tool fidelity, we revised the prototype. Results: We developed 4 categories pertaining to the perceived usability of and participant experiences with the prototype: past disclosure experiences, prototype information and activities, prototype design and structure, and overall usability. Participant feedback was favorable and indicative of the tool's potential impact and usability. The usability indicator requiring the most attention was ease of use, which was prioritized when revising the prototype. Our findings highlight the importance of engaging knowledge users throughout the entire prototype co-design and testing processes; incorporating co-design strategies and principles; and having content informed by relevant theories, evidence, and knowledge users' experiences. Conclusions: We outline an innovative co-design process that other researchers, clinicians, and KT practitioners may consider when developing KT tools. We also developed a novel, evidence-based, and theoretically informed web-based disclosure decision aid tool that may help autistic youth and young adults navigate disclosure processes and improve their transitional outcomes as they enter the workforce. ", doi="10.2196/44354", url="https://formative.jmir.org/2023/1/e44354", url="http://www.ncbi.nlm.nih.gov/pubmed/37104002" } @Article{info:doi/10.2196/43782, author="Sch{\"u}ttler, Christina and Zerlik, Maria and Gruendner, Julian and K{\"o}hler, Thomas and Rosenau, Lorenz and Prokosch, Hans-Ulrich and Sedlmayr, Brita", title="Empowering Researchers to Query Medical Data and Biospecimens by Ensuring Appropriate Usability of a Feasibility Tool: Evaluation Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="19", volume="10", pages="e43782", keywords="usability evaluation", keywords="ontology", keywords="feasibility queries", keywords="user-centered design", keywords="clinical research informatics", keywords="user interface", abstract="Background: The Aligning Biobanking and Data Integration Centers Efficiently project aims to harmonize technologies and governance structures of German university hospitals and their biobanks to facilitate searching for patient data and biospecimens. The central element will be a feasibility tool for researchers to query the availability of samples and data to determine the feasibility of their study project. Objective: The objectives of the study were as follows: an evaluation of the overall user interface usability of the feasibility tool, the identification of critical usability issues, comprehensibility of the underlying ontology operability, and analysis of user feedback on additional functionalities. From these, recommendations for quality-of-use optimization, focusing on more intuitive usability, were derived. Methods: To achieve the study goal, an exploratory usability test consisting of 2 main parts was conducted. In the first part, the thinking aloud method (test participants express their thoughts aloud throughout their use of the tool) was complemented by a quantitative questionnaire. In the second part, the interview method was combined with supplementary mock-ups to collect users' opinions on possible additional features. Results: The study cohort rated global usability of the feasibility tool based on the System Usability Scale with a good score of 81.25. The tasks assigned posed certain challenges. No participant was able to solve all tasks correctly. A detailed analysis showed that this was mostly because of minor issues. This impression was confirmed by the recorded statements, which described the tool as intuitive and user friendly. The feedback also provided useful insights regarding which critical usability problems occur and need to be addressed promptly. Conclusions: The findings indicate that the prototype of the Aligning Biobanking and Data Integration Centers Efficiently feasibility tool is headed in the right direction. Nevertheless, we see potential for optimization primarily in the display of the search functions, the unambiguous distinguishability of criteria, and the visibility of their associated classification system. Overall, it can be stated that the combination of different tools used to evaluate the feasibility tool provided a comprehensive picture of its usability. ", doi="10.2196/43782", url="https://humanfactors.jmir.org/2023/1/e43782", url="http://www.ncbi.nlm.nih.gov/pubmed/37074765" } @Article{info:doi/10.2196/41321, author="Hollier, M. John and Strickland, A. Tiant{\'a} and Fordis, Michael C. and van Tilburg, AL Miranda and Shulman, J. Robert and Thompson, Debbe", title="Children's and Caregivers' Review of a Guided Imagery Therapy Mobile App Designed to Treat Children With Functional Abdominal Pain Disorders: Leveraging a Mixed Methods Approach With User-Centered Design", journal="JMIR Form Res", year="2023", month="Apr", day="19", volume="7", pages="e41321", keywords="guided imagery therapy", keywords="guided imagery", keywords="psychotherapy", keywords="disorders of gut-brain interaction", keywords="functional abdominal pain disorders", keywords="pediatric", keywords="pain", keywords="mobile app", keywords="mobile health", keywords="mHealth", keywords="mixed methods research", keywords="usability", keywords="gamification", keywords="user-centered design", keywords="guided image therapy", keywords="app prototype", keywords="prototype", keywords="feedback", keywords="children", keywords="child", keywords="youths", keywords="caregiver", keywords="mobile phone", abstract="Background: Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform. Objective: Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers. Methods: Children aged 7 to 12 years with Rome IV--defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized. Results: We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69\% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75\% (12/16) of children and 69\% (11/16) of caregivers had difficulty setting the reminder notification. The children's interviews confirmed the app's usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app's usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app's ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children's motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation. Conclusions: Children and caregivers rated our GIT app's usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements. ", doi="10.2196/41321", url="https://formative.jmir.org/2023/1/e41321", url="http://www.ncbi.nlm.nih.gov/pubmed/37074773" } @Article{info:doi/10.2196/43960, author="Rui, Angela and Garabedian, M. Pamela and Marceau, Marlika and Syrowatka, Ania and Volk, A. Lynn and Edrees, H. Heba and Seger, L. Diane and Amato, G. Mary and Cambre, Jacob and Dulgarian, Sevan and Newmark, P. Lisa and Nanji, C. Karen and Schultz, Petra and Jackson, Purcell Gretchen and Rozenblum, Ronen and Bates, W. David", title="Performance of a Web-Based Reference Database With Natural Language Searching Capabilities: Usability Evaluation of DynaMed and Micromedex With Watson", journal="JMIR Hum Factors", year="2023", month="Apr", day="17", volume="10", pages="e43960", keywords="medication safety", keywords="patient safety", keywords="usability", keywords="searching behavior", keywords="efficiency", keywords="quality of care", keywords="web-based databases", keywords="point-of-care information", keywords="POCI", keywords="point-of-care tools", keywords="artificial intelligence", keywords="machine learning", keywords="clinical decision support", keywords="natural language processing", abstract="Background: Evidence-based point-of-care information (POCI) tools can facilitate patient safety and care by helping clinicians to answer disease state and drug information questions in less time and with less effort. However, these tools may also be visually challenging to navigate or lack the comprehensiveness needed to sufficiently address a medical issue. Objective: This study aimed to collect clinicians' feedback and directly observe their use of the combined POCI tool DynaMed and Micromedex with Watson, now known as DynaMedex. EBSCO partnered with IBM Watson Health, now known as Merative, to develop the combined tool as a resource for clinicians. We aimed to identify areas for refinement based on participant feedback and examine participant perceptions to inform further development. Methods: Participants (N=43) within varying clinical roles and specialties were recruited from Brigham and Women's Hospital and Massachusetts General Hospital in Boston, Massachusetts, United States, between August 10, 2021, and December 16, 2021, to take part in usability sessions aimed at evaluating the efficiency and effectiveness of, as well as satisfaction with, the DynaMed and Micromedex with Watson tool. Usability testing methods, including think aloud and observations of user behavior, were used to identify challenges regarding the combined tool. Data collection included measurements of time on task; task ease; satisfaction with the answer; posttest feedback on likes, dislikes, and perceived reliability of the tool; and interest in recommending the tool to a colleague. Results: On a 7-point Likert scale, pharmacists rated ease (mean 5.98, SD 1.38) and satisfaction (mean 6.31, SD 1.34) with the combined POCI tool higher than the physicians, nurse practitioner, and physician's assistants (ease: mean 5.57, SD 1.64, and satisfaction: mean 5.82, SD 1.60). Pharmacists spent longer (mean 2 minutes, 26 seconds, SD 1 minute, 41 seconds) on average finding an answer to their question than the physicians, nurse practitioner, and physician's assistants (mean 1 minute, 40 seconds, SD 1 minute, 23 seconds). Conclusions: Overall, the tool performed well, but this usability evaluation identified multiple opportunities for improvement that would help inexperienced users. ", doi="10.2196/43960", url="https://humanfactors.jmir.org/2023/1/e43960", url="http://www.ncbi.nlm.nih.gov/pubmed/37067858" } @Article{info:doi/10.2196/43861, author="Davoody, Nadia and Eghdam, Aboozar and Koch, Sabine and H{\"a}gglund, Maria", title="Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="17", volume="10", pages="e43861", keywords="usability testing", keywords="stroke", keywords="aphasia", keywords="eHealth", keywords="rehabilitation", keywords="co-design", keywords="evaluation", keywords="user-centered design", keywords="effectiveness", keywords="user satisfaction", keywords="mobile phone", abstract="Background: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. Objective: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. Methods: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. Results: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients' disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. Conclusions: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group. ", doi="10.2196/43861", url="https://humanfactors.jmir.org/2023/1/e43861", url="http://www.ncbi.nlm.nih.gov/pubmed/37067848" } @Article{info:doi/10.2196/43512, author="Chen-Sankey, Julia and Elhabashy, Maryam and Gratale, Stefanie and Geller, Jason and Mercincavage, Melissa and Strasser, A. Andrew and Delnevo, D. Cristine and Jeong, Michelle and Wackowski, A. Olivia", title="Examining Visual Attention to Tobacco Marketing Materials Among Young Adult Smokers: Protocol for a Remote Webcam-Based Eye-Tracking Experiment", journal="JMIR Res Protoc", year="2023", month="Apr", day="13", volume="12", pages="e43512", keywords="eye tracking", keywords="remote eye tracking", keywords="e-cigarette marketing", keywords="young adults", keywords="mobile phone", abstract="Background: Eye tracking provides an objective way to measure attention, which can advance researchers' and policy makers' understanding of tobacco marketing influences. The development of remote webcam-based eye-tracking technology, integrated with web-based crowdsourcing studies, may be a cost-effective and time-efficient alternative to laboratory-based eye-tracking methods. However, research is needed to evaluate the utility of remote eye-tracking methods. Objective: This study aimed to detail the process of designing a remote webcam-based eye-tracking experiment and provide data on associations between participant characteristics and the outcomes of experiment completion. Methods: A total of 2023 young adult (aged 18-34 years) cigarette smokers in the United States were recruited to complete a web-based survey that included a 90-second remote eye-tracking experiment that examined attention to e-cigarette marketing materials. Primary outcome measures assessed the completion of the remote eye-tracking experiment---specifically, experiment initiated versus not initiated, experiment completed versus not completed, and usable versus nonusable eye-tracking data generated. Multivariable logistic regressions examined the associations between outcome measures and participants' sociodemographic backgrounds, tobacco use history, and electronic devices (mobile vs desktop) used during the experiment. Results: Study recruitment began on April 14, 2022, and ended on May 3, 2022. Of the 2023 survey participants, 1887 (93.28\%) initiated the experiment, and 777 (38.41\%) completed the experiment. Of the 777 participants who completed the experiment, 381 (49\%) generated usable data. Results from the full regression models show that non-Hispanic Black participants (adjusted odds ratio [AOR] 0.64, 95\% CI 0.45-0.91) were less likely to complete the eye-tracking experiment than non-Hispanic White participants. In addition, female (vs male) participants (AOR 1.46, 95\% CI 1.01-2.11), those currently using (vs not using) e-cigarettes (AOR 2.08, 95\% CI 1.13-3.82), and those who used mobile (vs desktop) devices (AOR 5.10, 95\% CI 3.05-8.52) were more likely to generate usable eye-tracking data. Conclusions: Young adult participants were willing to try remote eye-tracking technology, and nearly half of those who completed the experiment generated usable eye-tracking data (381/777, 49\%). Thus, we believe that the use of remote eye-tracking tools, integrated with crowdsourcing recruitment, can be a useful approach for the tobacco regulatory science research community to collect high-quality, large-scale eye-tracking data in a timely fashion and thereby address research questions related to the ever-evolving tobacco marketing landscape. It would be useful to investigate techniques to enhance completion rates and data usability. International Registered Report Identifier (IRRID): RR1-10.2196/43512 ", doi="10.2196/43512", url="https://www.researchprotocols.org/2023/1/e43512", url="http://www.ncbi.nlm.nih.gov/pubmed/37052989" } @Article{info:doi/10.2196/40932, author="Lundstedt, Rikard and Persson, Johanna and H{\aa}kansson, Carita and Frennert, Susanne and Wallerg{\aa}rd, Mattias", title="Designing Virtual Natural Environments for Older Adults: Think-Aloud Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="7", volume="10", pages="e40932", keywords="virtual natural environments", keywords="user-centered design", keywords="qualitative method", keywords="real-time 3D graphics", keywords="older adults", abstract="Background: Spending time in natural environments is beneficial for human health, but many older adults have limited or no access to natural environments. Virtual reality technology may be a means to facilitate nature experiences, and so, there is a need for knowledge on how to design virtual restorative natural environments for older adults. Objective: The aim of this study was to identify, implement, and test older adults' preferences and ideas regarding virtual natural environments. Methods: A total of 14 older adults (mean age 75, SD 5.9 years) participated in an iterative process to design such an environment. We used think-aloud protocols and qualitative content analysis and established questionnaires that targeted usability, affective aspects, and side effects. These data guided the design decisions for incremental implementations of a prototype. Results: The participants' preferences included trueness to reality in terms of rendition and behavior; traces of human activity and natural processes that trigger the imagination and provide believability; the ability to roam, explore, and interact with the environment; and a familiar, relatable environment that evokes memories. The iterative design process resulted in a prototype featuring many of the participants' ideas and preferences, including a seated locomotion technique, animals, a boat ride, the discovery of a boat wreck, and apple picking. The questionnaire results indicated high perceived usability, interest, and enjoyment; low pressure and tension; moderate value and usefulness; and negligible side effects. Conclusions: We suggested 3 principles for virtual natural environments for older adults: realness, interactivity, and relatedness. Virtual natural environments should also provide a diversity of content and activities to accommodate the heterogeneity in older adults' preferences. These results can contribute to a framework for designing virtual natural environments for older adults. However, these findings need to be tested and potentially revised in future studies. ", doi="10.2196/40932", url="https://humanfactors.jmir.org/2023/1/e40932", url="http://www.ncbi.nlm.nih.gov/pubmed/37027206" } @Article{info:doi/10.2196/43823, author="Willms, Amanda and Rhodes, E. Ryan and Liu, Sam", title="The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a ``No-Code'' Mobile App Builder: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Apr", day="5", volume="7", pages="e43823", keywords="mobile health", keywords="mHealth", keywords="usability study", keywords="financial incentive", keywords="physical activity", keywords="mobile phone", keywords="smartphone", abstract="Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive--driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the ``no-code'' app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. ", doi="10.2196/43823", url="https://formative.jmir.org/2023/1/e43823", url="http://www.ncbi.nlm.nih.gov/pubmed/37018038" } @Article{info:doi/10.2196/42556, author="Bally, S. Esmee L. and Cheng, Demi and van Grieken, Amy and Ferri Sanz, Mireia and Zanutto, Oscar and Carroll, Aine and Darley, Andrew and Roozenbeek, Bob and Dippel, J. Diederik W. and Raat, Hein", title="Patients' Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study", journal="J Med Internet Res", year="2023", month="Apr", day="4", volume="25", pages="e42556", keywords="stroke patients", keywords="digital health technology", keywords="self-management", keywords="co-design", keywords="user-requirements", keywords="user-centered design", keywords="qualitative research", abstract="Background: Digital technologies such as mobile apps and robotics have the potential to involve stroke patients better in the care process and to promote self-management. However, barriers exist that constrain the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for health-related technology. To address these barriers, co-design can be used to enable patients to reflect on their experiences of a service and to tailor digital technologies to the needs and preferences of end users regarding content and usability. Objective: This study aims to explore the perspectives of stroke patients toward how digital health technology could support self-management regarding health and well-being, as well as integrated stroke care. Methods: A qualitative study was conducted to understand patient perspectives. Data were collected in co-design sessions during the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on sociodemographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach. Results: Patients held mixed attitudes toward digital health technologies. Some patients viewed digital technology as a convenient product or service, while others expressed no desire or need to use technology for self-management or care. Digital features suggested by stroke patients included (1) information about the causes of stroke, medication, prognosis, and follow-up care; (2) an online library with information regarding stroke-related health and care issues; (3) a personal health record by which patients can retrieve and manage their own health information; and (4) online rehabilitation support to empower patients to exercise at home. Regarding the user interface of future digital health technology, patients emphasized the need for easy-to-use and simple designs. Conclusions: Stroke patients mentioned credible health information, an online library with stroke-related health and care information, a personal health record, and online rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the ``voice of the stroke patients'' regarding both functionality and the characteristics of the interface. International Registered Report Identifier (IRRID): RR2-10.1186/s12877-022-03333-8 ", doi="10.2196/42556", url="https://www.jmir.org/2023/1/e42556", url="http://www.ncbi.nlm.nih.gov/pubmed/37014677" } @Article{info:doi/10.2196/43135, author="Chagas, Azevedo Bruno and Pagano, Silvina Adriana and Prates, Oliveira Raquel and Praes, Cordeiro Elisa and Ferreguetti, K{\'i}cila and Vaz, Helena and Reis, Nogueira Zilma Silveira and Ribeiro, Bonisson Leonardo and Ribeiro, Pinho Antonio Luiz and Pedroso, Marques Thais and Beleigoli, Alline and Oliveira, Alves Clara Rodrigues and Marcolino, Soriano Milena", title="Evaluating User Experience With a Chatbot Designed as a Public Health Response to the COVID-19 Pandemic in Brazil: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="3", volume="10", pages="e43135", keywords="user experience", keywords="chatbots", keywords="telehealth", keywords="COVID-19", keywords="human-computer interaction", keywords="HCI", keywords="empirical studies in human-computer interaction", keywords="empirical studies in HCI", keywords="health care information systems", abstract="Background: The potential of chatbots for screening and monitoring COVID-19 was envisioned since the outbreak of the disease. Chatbots can help disseminate up-to-date and trustworthy information, promote healthy social behavior, and support the provision of health care services safely and at scale. In this scenario and in view of its far-reaching postpandemic impact, it is important to evaluate user experience with this kind of application. Objective: We aimed to evaluate the quality of user experience with a COVID-19 chatbot designed by a large telehealth service in Brazil, focusing on the usability of real users and the exploration of strengths and shortcomings of the chatbot, as revealed in reports by participants in simulated scenarios. Methods: We examined a chatbot developed by a multidisciplinary team and used it as a component within the workflow of a local public health care service. The chatbot had 2 core functionalities: assisting web-based screening of COVID-19 symptom severity and providing evidence-based information to the population. From October 2020 to January 2021, we conducted a mixed methods approach and performed a 2-fold evaluation of user experience with our chatbot by following 2 methods: a posttask usability Likert-scale survey presented to all users after concluding their interaction with the bot and an interview with volunteer participants who engaged in a simulated interaction with the bot guided by the interviewer. Results: Usability assessment with 63 users revealed very good scores for chatbot usefulness (4.57), likelihood of being recommended (4.48), ease of use (4.44), and user satisfaction (4.38). Interviews with 15 volunteers provided insights into the strengths and shortcomings of our bot. Comments on the positive aspects and problems reported by users were analyzed in terms of recurrent themes. We identified 6 positive aspects and 15 issues organized in 2 categories: usability of the chatbot and health support offered by it, the former referring to usability of the chatbot and how users can interact with it and the latter referring to the chatbot's goal in supporting people during the pandemic through the screening process and education to users through informative content. We found 6 themes accounting for what people liked most about our chatbot and why they found it useful---3 themes pertaining to the usability domain and 3 themes regarding health support. Our findings also identified 15 types of problems producing a negative impact on users---10 of them related to the usability of the chatbot and 5 related to the health support it provides. Conclusions: Our results indicate that users had an overall positive experience with the chatbot and found the health support relevant. Nonetheless, qualitative evaluation of the chatbot indicated challenges and directions to be pursued in improving not only our COVID-19 chatbot but also health chatbots in general. ", doi="10.2196/43135", url="https://humanfactors.jmir.org/2023/1/e43135", url="http://www.ncbi.nlm.nih.gov/pubmed/36634267" } @Article{info:doi/10.2196/43867, author="Mehdizadeh, Hamed and Asadi, Farkhondeh and Nazemi, Eslam and Mehrvar, Azim and Yazdanian, Azade and Emami, Hassan", title="A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study", journal="JMIR Pediatr Parent", year="2023", month="Mar", day="30", volume="6", pages="e43867", keywords="Digital health", keywords="eHealth", keywords="Telehealth", keywords="mHealth", keywords="Mobile app", keywords="self-management", keywords="cancer", keywords="child", keywords="parent", keywords="caregiver", keywords="usability evaluation", abstract="Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children's evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. ", doi="10.2196/43867", url="https://pediatrics.jmir.org/2023/1/e43867", url="http://www.ncbi.nlm.nih.gov/pubmed/36995746" } @Article{info:doi/10.2196/44122, author="Day, Sarah and Ncube, Vuyolwethu and Maja, Lactricia and Wasunna, Beatrice and Pienaar, Jacqueline and Setswe, Geoffrey and Waweru, Evelyn and Feldacker, Caryl", title="Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study", journal="JMIR Form Res", year="2023", month="Mar", day="22", volume="7", pages="e44122", keywords="digital health innovation", keywords="usability", keywords="health care workers perspectives", keywords="low- and middle-income countries", keywords="two-way texting", keywords="postoperative telehealth", keywords="male circumcision", keywords="South Africa", keywords="mobile phone", abstract="Background: Voluntary medical male circumcision (VMMC) is a safe and effective HIV prevention strategy. However, adherence to recommended in-person, postoperative follow-up is inefficient for procedures with few adverse events. Two-way texting (2wT)--based follow-up appears to be a safe and an efficient alternative to scheduled clinic visits for low-risk patients who underwent VMMC. To ensure that 2wT responds to the needs of health care workers (HCWs) and patients, HCWs were closely involved in app design using a human-centered design (HCD) approach. Objective: Embedded within an ongoing randomized controlled trial of 2wT in South Africa and complementary HCD processes of 2wT app optimization, this qualitative study aimed to use key informant interviews (KIIs) to explore the thoughts, suggestions, and opinions on and perceptions of 2wT's usability and acceptability among HCWs involved in 2wT implementation in both urban and rural South Africa. Methods: A total of 7 HCWs using 2wT in Gauteng and the North West province participated in KIIs regarding the usability and acceptability of 2wT. HCWs were asked for their opinions on 2wT as a viable, useful, appropriate, and accessible method of postoperative VMMC care. They were also asked about 2wT-related working, exploring areas where 2wT could add to or reduce their daily tasks. The KII data were explored, coded, and analyzed by 3 qualitative researchers using thematic content analysis and the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software. Results: Most HCWs felt confident, comfortable, satisfied, and well supported using a 2wT-based follow-up as an alternative to in-person clinical reviews. They felt that 2wT was easy to use and required little technical support after initial mentoring on how to use the 2wT system. Few noted safety concerns, as men can receive clinical guidance, reassurance, and referral via 2wT. Although fewer in-person visits reduced the in-person review workload and eased clinical flow, HCWs noted the added burden of having to interact with clients via SMS text messages on evenings or weekends. HCWs reinforced the need for enhanced postoperative counseling to ensure that 2wT patients could recognize and understood how to respond to early signs of complications. HCWs suggested a rotation to spread the evening and weekend workload and ensure swift patient responses. Conclusions: In this formative qualitative study focused on HCWs, 2wT was a highly usable alternative to in-person postoperative reviews for patients who underwent VMMC in South Africa. The HCD processes likely improved the usability and acceptability of 2wT for HCWs. HCWs supported the scale-up of 2wT given the distance from the clinic to the men's homes and the potential for reducing workload. To ensure success, providers urged sensitizing patients to the fact that 2wT augments, but does not replace, the existing after-hours and emergency care services. ", doi="10.2196/44122", url="https://formative.jmir.org/2023/1/e44122", url="http://www.ncbi.nlm.nih.gov/pubmed/36947127" } @Article{info:doi/10.2196/43729, author="Barton, J. Hanna and Salwei, E. Megan and Rutkowski, A. Rachel and Wust, Kathryn and Krause, Sheryl and Hoonakker, LT Peter and Dail, vW Paula and Buckley, M. Denise and Eastman, Alexis and Ehlenfeldt, Brad and Patterson, W. Brian and Shah, N. Manish and King, J. Barbara and Werner, E. Nicole and Carayon, Pascale", title="Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation", journal="JMIR Hum Factors", year="2023", month="Mar", day="9", volume="10", pages="e43729", keywords="patient safety", keywords="heuristic evaluation", keywords="usability", keywords="emergency medicine", keywords="safety", keywords="emergency", keywords="human factors engineering", keywords="discharge summary", keywords="documentation", keywords="heuristic", abstract="Background: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients---with the potential to prevent adverse outcomes---is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how to manage symptoms, medications, and follow-up care. Objective: This study aims to assess a multistage method for integrating diverse expertise (ie, clinical, an older adult care partner, and health IT) with human factors engineering (HFE) expertise in the usability evaluation of the patient-facing ED AVS. Methods: We conducted a three-staged heuristic evaluation of an ED AVS using heuristics developed for use in evaluating patient-facing documentation. In stage 1, HFE experts reviewed the AVS to identify usability issues. In stage 2, 6 experts of varying expertise (ie, emergency medicine physicians, ED nurses, geriatricians, transitional care nurses, and an older adult care partner) rated each previously identified usability issue on its potential impact on patient comprehension and patient safety. Finally, in stage 3, an IT expert reviewed each usability issue to identify the likelihood of successfully addressing the issue. Results: In stage 1, we identified 60 usability issues that violated a total of 108 heuristics. In stage 2, 18 additional usability issues that violated 27 heuristics were identified by the study experts. Impact ratings ranged from all experts rating the issue as ``no impact'' to 5 out of 6 experts rating the issue as having a ``large negative impact.'' On average, the older adult care partner representative rated usability issues as being more significant more of the time. In stage 3, 31 usability issues were rated by an IT professional as ``impossible to address,'' 21 as ``maybe,'' and 24 as ``can be addressed.'' Conclusions: Integrating diverse expertise when evaluating usability is important when patient safety is at stake. The non-HFE experts, included in stage 2 of our evaluation, identified 23\% (18/78) of all the usability issues and, depending on their expertise, rated those issues as having differing impacts on patient comprehension and safety. Our findings suggest that, to conduct a comprehensive heuristic evaluation, expertise from all the contexts in which the AVS is used must be considered. Combining those findings with ratings from an IT expert, usability issues can be strategically addressed through redesign. Thus, a 3-staged heuristic evaluation method offers a framework for integrating context-specific expertise efficiently, while providing practical insights to guide human-centered design. ", doi="10.2196/43729", url="https://humanfactors.jmir.org/2023/1/e43729", url="http://www.ncbi.nlm.nih.gov/pubmed/36892941" } @Article{info:doi/10.2196/42145, author="Kim, Chan Joo and Saguna, Saguna and {\AA}hlund, Christer", title="Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study", journal="JMIR Hum Factors", year="2023", month="Mar", day="8", volume="10", pages="e42145", keywords="Internet of Things", keywords="health monitoring", keywords="older adults", keywords="augmented reality", keywords="user experience", keywords="independent living", keywords="design study", keywords="mobile phone", abstract="Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user's role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult's daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user's role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant's experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of ?3.0 to 3.0. The overall impression of our app was favorable, and we identified that ``simple'' and ``intuitive'' were the main factors affecting older adults' and caregivers' preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91\% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. ", doi="10.2196/42145", url="https://humanfactors.jmir.org/2023/1/e42145", url="http://www.ncbi.nlm.nih.gov/pubmed/36884275" } @Article{info:doi/10.2196/37305, author="Harakeh, Zeena and de Hoogh, M. Iris and van Keulen, Hilde and Kalkman, Gino and van Someren, Eugene and van Empelen, Pepijn and Otten, Wilma", title="360{\textdegree} Diagnostic Tool to Personalize Lifestyle Advice in Primary Care for People With Type 2 Diabetes: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Mar", day="7", volume="7", pages="e37305", keywords="type 2 diabetes", keywords="diagnostic tool", keywords="holistic approach", keywords="personalized advice", keywords="shared decision-making", keywords="health professionals", abstract="Background: Various multifaceted factors need to be addressed to improve the health and quality of life of people with type 2 diabetes (T2D). Therefore, we developed a web-based decision support tool that comprises a more holistic diagnosis (including 4 domains: body, thinking and feeling, behavior, and environment) and personalized advice. This 360{\textdegree} diagnostic tool enables people with T2D and health care professionals at the general practice to obtain an overview of the most important T2D-related issues and, subsequently, determine the most suitable intervention for the person with T2D. Objective: This study aimed to describe the systematic and iterative development and evaluation of the web-based 360{\textdegree} diagnostic tool. Methods: We defined the requirements for the web-based 360{\textdegree} diagnostic tool based on previously developed tools, a literature review, and inputs from a multidisciplinary team of experts. As part of the conceptualization, we defined 3 requirements: diagnostics; feedback; and advice, consultation, and follow-up. Next, we developed and designed the content for each of these requirements. We evaluated the diagnostic part of the tool (ie, measurement instruments and visualization) with a qualitative design, in a usability study with a think-aloud strategy and interview questions, among 8 people with T2D at a Dutch general practice. Results: For each of the 4 domains, specific parameters and underlying elements were selected, and measurement instruments (including clinical data and questionnaires) were chosen. Cutoff values were defined to identify high-, middle-, and low-ranking scores, and decision rules were developed and implemented using R scripts and algorithms. A traffic light color visual design was created (profile wheel) to provide an overview of the scores per domain. We mapped the interventions that could be added to the tool and developed a protocol designed as a card deck with motivational interview steps. Furthermore, the usability study showed that people with T2D perceived the tool as easy to use, useful, easy to understand, and insightful. Conclusions: Preliminary evaluation of the 360{\textdegree} diagnostic tool by experts, health care professionals, and people with T2D showed that the tool was considered relevant, clear, and practical. The iterative process provided insights into the areas of improvement, which were implemented. The strengths, shortcomings, future use, and challenges are also discussed. ", doi="10.2196/37305", url="https://formative.jmir.org/2023/1/e37305", url="http://www.ncbi.nlm.nih.gov/pubmed/36881463" } @Article{info:doi/10.2196/42258, author="Spang, P. Robert and Haeger, Christine and M{\"u}mken, A. Sandra and Brauer, Max and Voigt-Antons, Jan-Niklas and Gellert, Paul", title="Smartphone Global Positioning System--Based System to Assess Mobility in Health Research: Development, Accuracy, and Usability Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="2", volume="10", pages="e42258", keywords="geographic information system", keywords="rehabilitation", keywords="prevention medicine", keywords="geoinformatics", keywords="out-of-home mobility", abstract="Background: As global positioning system (GPS) measurement is getting more precise and affordable, health researchers can now objectively measure mobility using GPS sensors. Available systems, however, often lack data security and means of adaptation and often rely on a permanent internet connection. Objective: To overcome these issues, we aimed to develop and test an easy-to-use, easy-to-adapt, and offline working app using smartphone sensors (GPS and accelerometry) for the quantification of mobility parameters. Methods: An Android app, a server backend, and a specialized analysis pipeline have been developed (development substudy). Parameters of mobility by the study team members were extracted from the recorded GPS data using existing and newly developed algorithms. Test measurements were performed with participants to complete accuracy and reliability tests (accuracy substudy). Usability was examined by interviewing community-dwelling older adults after 1 week of device use, followed by an iterative app design process (usability substudy). Results: The study protocol and the software toolchain worked reliably and accurately, even under suboptimal conditions, such as narrow streets and rural areas. The developed algorithms had high accuracy (97.4\% correctness, F1-score=0.975) in distinguishing dwelling periods from moving intervals. The accuracy of the stop/trip classification is fundamental to second-order analyses such as the time out of home, as they rely on a precise discrimination between the 2 classes. The usability of the app and the study protocol was piloted with older adults, which showed low barriers and easy implementation into daily routines. Conclusions: Based on accuracy analyses and users' experience with the proposed system for GPS assessments, the developed algorithm showed great potential for app-based estimation of mobility in diverse health research contexts, including mobility patterns of community-dwelling older adults living in rural areas. International Registered Report Identifier (IRRID): RR2-10.1186/s12877-021-02739-0 ", doi="10.2196/42258", url="https://rehab.jmir.org/2023/1/e42258", url="http://www.ncbi.nlm.nih.gov/pubmed/36862498" } @Article{info:doi/10.2196/42250, author="Ayyoubzadeh, Mohammad Seyed and Baniasadi, Tayebeh and Shirkhoda, Mohammad and Rostam Niakan Kalhori, Sharareh and Mohammadzadeh, Niloofar and Roudini, Kamran and Ghalehtaki, Reza and Memari, Fereidoon and Jalaeefar, Amirmohsen", title="Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things--Based Device: Development and Usability Study", journal="JMIR Cancer", year="2023", month="Feb", day="15", volume="9", pages="e42250", keywords="eHealth", keywords="telemedicine", keywords="colorectal cancer", keywords="cancer survivor", keywords="IoT", keywords="mHealth", keywords="patient monitoring", keywords="remote monitoring", keywords="postdischarge care", keywords="cancer", keywords="patient care", keywords="cancer care", keywords="postoperative complications", abstract="Background: Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. Objective: This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. Methods: This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen's usability principles. Results: A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. Conclusions: Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system's implementation in clinic settings and hospitals is required to understand the probable barriers and limitations. ", doi="10.2196/42250", url="https://cancer.jmir.org/2023/1/e42250", url="http://www.ncbi.nlm.nih.gov/pubmed/36790851" } @Article{info:doi/10.2196/42572, author="Christensen, R{\o}nn Oliver and Hedegaard, Leonora and Rask, Tr{\o}llund Mette and Clemensen, Jane and Frostholm, Lisbeth and Rosendal, Marianne", title="Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study", journal="JMIR Hum Factors", year="2023", month="Feb", day="8", volume="10", pages="e42572", keywords="eHealth", keywords="digital health", keywords="medically unexplained symptom", keywords="persistent physical symptom", keywords="self-management", keywords="usability", keywords="physical symptom", keywords="persistent symptom", keywords="unexplained symptom", keywords="symptom management", keywords="unguided", keywords="thinking aloud", keywords="think aloud", abstract="Background: Patients with persistent physical symptoms presenting in primary care are often affected by multiple symptoms and reduced functioning. The medical and societal costs of these patients are high, and there is a need for new interventions tailored to both the patients and health care system. Objective: This study aimed to examine the usability of an unguided, self-help treatment program, ``My Symptoms,'' developed to assist patients and general practitioners in symptom management. Methods: In all, 11 users (4 patients with persistent physical symptoms and 7 laypeople) participated in web-based thinking-aloud interviews involving the performance of predefined tasks in the program. Thematic analysis was used to categorize the severity of usability issues. General usability heuristics were cross-referenced with the usability issues. Results: The analysis identified important usability issues related to functionality, navigation, and content. The study shows how therapeutic knowledge in some cases was lost in the translation of face-to-face therapy to a digital format. The user testing helped uncover how the functionality of the digital elements and general navigation of the program played a huge part in locating and accessing the needed treatment. Examples of redesign to mediate the therapeutic value in the digital format involving health care professionals, web developers, and users are provided. The study also highlights the differences of involving patients and laypeople in the interviews. Conclusions: Taking the experience of common symptoms as a point of departure, patients and laypeople contributed to finding usability issues on program functionality, navigation, and content to improve the program and make the treatment more accessible to users. ", doi="10.2196/42572", url="https://humanfactors.jmir.org/2023/1/e42572", url="http://www.ncbi.nlm.nih.gov/pubmed/36753312" } @Article{info:doi/10.2196/38822, author="Triplett, S. Noah and Johnson, Clara and Kiche, Sharon and Dastrup, Kara and Nguyen, Julie and Daniels, Alayna and Mbwayo, Anne and Amanya, Cyrilla and Munson, Sean and Collins, Y. Pamela and Weiner, J. Bryan and Dorsey, Shannon", title="Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study", journal="JMIR Form Res", year="2023", month="Feb", day="2", volume="7", pages="e38822", keywords="task shifting", keywords="human-centered design", keywords="supervision", keywords="global mental health", keywords="acceptability", keywords="feasibility", keywords="mobile phone", abstract="Background: Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered. Objective: Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision. Methods: Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants' choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis. Results: Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support. Conclusions: Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools. International Registered Report Identifier (IRRID): RR2-10.1186/s43058-020-00102-9 ", doi="10.2196/38822", url="https://formative.jmir.org/2023/1/e38822", url="http://www.ncbi.nlm.nih.gov/pubmed/36729591" } @Article{info:doi/10.2196/36807, author="Mu{\~n}oz Esquivel, Karla and Gillespie, James and Kelly, Daniel and Condell, Joan and Davies, Richard and McHugh, Catherine and Duffy, William and Nevala, Elina and Alam{\"a}ki, Antti and Jalovaara, Juha and Tedesco, Salvatore and Barton, John and Timmons, Suzanne and Nordstr{\"o}m, Anna", title="Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study", journal="JMIR Aging", year="2023", month="Jan", day="19", volume="6", pages="e36807", keywords="usability", keywords="older adults", keywords="remote sensing", keywords="sensor systems", keywords="wearable device", keywords="mobile phone", abstract="Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants' intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants' age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort ($\tau$=0.34) and whether the device was fit for purpose ($\tau$=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80\% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88\%. Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies. ", doi="10.2196/36807", url="https://aging.jmir.org/2023/1/e36807", url="http://www.ncbi.nlm.nih.gov/pubmed/36656636" } @Article{info:doi/10.2196/38736, author="Rouleau, Genevi{\`e}ve and Reis, Catherine and Ivers, Noah and Desveaux, Laura", title="Characterizing the Gaps Between Best-Practice Implementation Strategies and Real-world Implementation: Qualitative Study Among Family Physicians Who Engaged With Audit and Feedback Reports", journal="JMIR Hum Factors", year="2023", month="Jan", day="6", volume="10", pages="e38736", keywords="audit and feedback", keywords="family physicians", keywords="primary care", keywords="qualitative", abstract="Background: In Ontario, Canada, a government agency known as Ontario Health is responsible for making audit and feedback reports available to all family physicians to encourage ongoing quality improvement. The confidential report provides summary data on 3 key areas of practice: safe prescription, cancer screening, and diabetes management. Objective: This report was redesigned to improve its usability in line with evidence. The objective of this study was to explore how the redesign was perceived, with an emphasis on recipients' understanding of the report and their engagement with it. Methods: We conducted qualitative semistructured interviews with family physicians who had experience with both versions of the report recruited through purposeful and snowball sampling. We analyzed the transcripts following an emergent and iterative approach. Results: Saturation was reached after 17 family physicians participated. In total, 2 key themes emerged as factors that affected the perceived usability of the report: alignment between the report and the recipients' expectations and capacity to engage in quality improvement. Family physicians expected the report and its quality indicators to reflect best practices and to be valid and accurate. They also expected the report to offer feedback on the clinical activities they perceived to be within their control to change. Furthermore, family physicians expected the goal of the report to be aligned with their perspective on feasible quality improvement activities. Most of these expectations were not met, limiting the perceived usability of the report. The capacity to engage with audit and feedback was hindered by several organizational and physician-level barriers, including the lack of fit with the existing workflow, competing priorities, time constraints, and insufficient skills for bridging the gaps between their data and the corresponding desired actions. Conclusions: Despite recognized improvements in the design of the report to better align with best practices, it was not perceived as highly usable. Improvements in the presentation of the data could not overcome misalignment with family physicians' expectations or the limited capacity to engage with the report. Integrating iterative evaluations informed by user-centered design can complement evidence-based guidance for implementation strategies. Creating a space for bringing together audit and feedback designers and recipients may help improve usability and effectiveness. ", doi="10.2196/38736", url="https://humanfactors.jmir.org/2023/1/e38736", url="http://www.ncbi.nlm.nih.gov/pubmed/36607715" } @Article{info:doi/10.2196/38818, author="Schuetze, Leon and Srivastava, Siddharth and Missenye, Mtiba Abdallah and Rwezaula, Josephat Elizeus and Stoermer, Manfred and De Allegri, Manuela", title="Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff", journal="J Med Internet Res", year="2023", month="Jan", day="6", volume="25", pages="e38818", keywords="health financing", keywords="qualitative", keywords="digital health intervention", keywords="low-resource setting", keywords="strategic purchasing", keywords="scale", keywords="mobile phone", abstract="Background: Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. Objective: This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. Methods: We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. Results: Respondents appreciated IMIS's intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. Conclusions: Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage. ", doi="10.2196/38818", url="https://www.jmir.org/2023/1/e38818", url="http://www.ncbi.nlm.nih.gov/pubmed/36607708" } @Article{info:doi/10.2196/40400, author="Andreasen, Mari Eva and H{\o}igaard, Rune and Berg, Helen and Steinsbekk, Aslak and Haraldstad, Kristin", title="Usability Evaluation of the Preoperative ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Desktop Virtual Reality Application: Qualitative Observational Study", journal="JMIR Hum Factors", year="2022", month="Dec", day="29", volume="9", number="4", pages="e40400", keywords="desktop virtual reality", keywords="handover", keywords="ISBAR", keywords="preoperative", keywords="undergraduate nursing students", keywords="usability evaluation", keywords="usability", keywords="nursing", keywords="health care education", keywords="student", keywords="medical education", keywords="medical training", keywords="VR", keywords="virtual reality", keywords="surgery", keywords="surgical", keywords="System Usability Scale", keywords="communication", keywords="self-instruction", keywords="self-guided", keywords="nurse", keywords="training", keywords="undergraduate", keywords="health care professional", keywords="health care provider", abstract="Background: Systematic communication, such as the ISBAR (identification, situation, background, assessment, recommendation) approach, comprises a generic, transferable nontechnical skill. It can be used during the handover of patients set to undergo surgery and can be practiced in various ways, including virtual reality (VR). VR increasingly has been implemented and valued in nursing education as a positive contribution to teach students about pre- and postoperative nursing. A new nonimmersive 3D learning activity called the Preoperative ISBAR Desktop VR Application has been developed for undergraduate nursing students to learn preoperative handover using the ISBAR approach. However, the usability of this learning activity has not been studied. Objective: This study aimed to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application. Methods: This was a qualitative study with observation and interviews. The inclusion criteria were undergraduate second-year nursing students of varying ages, gender, and anticipated technological competence. The System Usability Scale (SUS) questionnaire was used to get a score on overall usability. Results: A total of 9 second-year nursing students aged 22-29 years participated in the study. The average score on the SUS was 83 (range 0-100), which equals a ``B'' on the graded scale and is excellent for an adjective-grade rating. The students expressed increased motivation to learn while working in self-instructed desktop VR. Still, a few technical difficulties occurred, and some students reported that they experienced some problems comprehending the instructions provided in the application. Long written instructions and a lack of self-pacing built into the application were considered limitations. Conclusions: The nursing students found the application to be usable overall, giving it an excellent usability score and noting that the application provided opportunities for active participation, which was motivational and facilitated their perceived learning outcomes. The next version of the application, to be used in a randomized controlled trial, will be upgraded to address technological and comprehension issues. ", doi="10.2196/40400", url="https://humanfactors.jmir.org/2022/4/e40400", url="http://www.ncbi.nlm.nih.gov/pubmed/36580357" } @Article{info:doi/10.2196/38748, author="Schlett, Christian and R{\"o}ttele, Nicole and van der Keylen, Piet and Sch{\"o}pf-Lazzarino, Christina Andrea and Klimmek, Miriam and K{\"o}rner, Mirjam and Schnitzius, Kathrin and Voigt-Radloff, Sebastian and Maun, Andy and Sofroniou, Mario and Farin-Glattacker, Erik", title="The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients", journal="JMIR Form Res", year="2022", month="Dec", day="29", volume="6", number="12", pages="e38748", keywords="general practice", keywords="primary care", keywords="lower back pain", keywords="digital health intervention", keywords="web-based health information", keywords="eHealth", keywords="patient education", keywords="adherence", keywords="qualitative research", keywords="framework analysis", keywords="mobile phone", abstract="Background: An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. Objective: In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. Methods: This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. Results: A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. Conclusions: Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. International Registered Report Identifier (IRRID): RR2-10.1186/s12875-019-0925-8 ", doi="10.2196/38748", url="https://formative.jmir.org/2022/12/e38748", url="http://www.ncbi.nlm.nih.gov/pubmed/36580365" } @Article{info:doi/10.2196/42057, author="Psavko, Simon and Katz, Noam and Mirchi, Tina and Green, R. Courtney", title="Usability and Teachability of Continuous Glucose Monitoring Devices in Older Adults and Diabetes Educators: Task Analysis and Ease-of-Use Survey", journal="JMIR Hum Factors", year="2022", month="Dec", day="15", volume="9", number="4", pages="e42057", keywords="medical devices", keywords="wearable devices", keywords="older adults", keywords="task analysis", keywords="usability testing", keywords="continuous glucose monitoring", keywords="glucose monitoring", keywords="glucose levels", keywords="diabetes", keywords="usability", abstract="Background: Continuous glucose monitoring (CGM) devices continuously sense and relay glucose concentration data from the interstitial fluid to a mobile phone or receiver. Older adults benefit from this continuous monitoring of glucose levels. Proper deployment of the sensing wire is facilitated by a specialized applicator. Objective: Our aim was to assess a new seventh-generation (G7) CGM device (Dexcom, Inc) for use by adults 65 years of age or older and certified diabetes care and education specialists (CDCESs). Ease of use related to intradermal insertion and mobile app setup will be assessed and compared to the fifth- and sixth-generation systems. Methods: Formal task analysis was conducted to enumerate the number and complexity of tasks associated with CGM deployment. We recruited 10 older adults with no prior CGM experience and 10 CDCESs to assess ease of use through hands-on insertion and initiation of a G7 system followed by a survey and, for older adults, a system usability scale survey. Results: About half as many tasks are needed to deploy G7 compared to G6. Older adults and CDCESs reported overall high usability of the G7 CGM device. CDCESs noted G7's easier setup compared to previous generations. The system usability scale score for the CGM system was 92.8, which reflects excellent usability. Conclusions: For CDCESs and for older adults using the G7 CGM system, cognitive burden is relatively low and reduced compared to previous CGM systems. Easing of this burden and simplification of the glucose monitoring aspect of proper diabetes management will likely contribute to improved outcomes in this population. ", doi="10.2196/42057", url="https://humanfactors.jmir.org/2022/4/e42057", url="http://www.ncbi.nlm.nih.gov/pubmed/36347498" } @Article{info:doi/10.2196/35933, author="Henriksen, Berg Hege and Knudsen, Dines Markus and Carlsen, Hauger Monica and Hjart{\aa}ker, Anette and Blomhoff, Rune", title="A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing", journal="JMIR Form Res", year="2022", month="Nov", day="8", volume="6", number="11", pages="e35933", keywords="digital assessment tool", keywords="assessment tool", keywords="food frequency questionnaire", keywords="food", keywords="diet", keywords="nutrition", keywords="questionnaire", keywords="focus group", keywords="interview", keywords="usability", keywords="physical activity", keywords="lifestyle factor", keywords="dietary intake", keywords="digital health", keywords="chronic disease", keywords="chronic condition", keywords="health promotion", keywords="cancer", keywords="survivor", keywords="thematic analysis", keywords="research tool", keywords="measurement tool", abstract="Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. ", doi="10.2196/35933", url="https://formative.jmir.org/2022/11/e35933", url="http://www.ncbi.nlm.nih.gov/pubmed/36346647" } @Article{info:doi/10.2196/36949, author="Jarvis, Tamika and Mah, L. Allison M. and Wang, H. Rosalie and Wilson, G. Michael", title="Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study", journal="JMIR Form Res", year="2022", month="Nov", day="3", volume="6", number="11", pages="e36949", keywords="assistive technology", keywords="program funding", keywords="usability testing", keywords="internet", keywords="web-based database", keywords="health services", abstract="Background: Assistive technology (AT) can contribute to how individuals participate and engage in everyday activities, such as communication and mobility, and facilitates access to the services they require. Navigating Canada's AT system has been described as fragmented and complex, presenting barriers for individuals who require AT, caregivers, and health service providers. AccessATCanada was developed as a centralized web-based resource to help support access to AT by providing information about the existing jurisdictional funding programs and services. Objective: This study aimed to evaluate the usability of AccessATCanada by gathering feedback about its features, functionality, and areas of strength and opportunity from potential end users. Methods: A usability testing study using a think-aloud approach and semistructured interviews was conducted to measure the effectiveness and efficiency of and user satisfaction with AccessATCanada and to identify issues with the interface during end-user interaction. A qualitative thematic analysis was used to generate insights into and core themes about user experiences. User feedback was used to inform subsequent updates of the database with the goal of enhancing website friendliness and functionality before its official launch. Results: A total of 10 participants (6 consumers, 1 caregiver, and 3 providers) participated in the usability testing study. The usability performance and scores tended to improve between the 2 testing cycles. Most participants were able to successfully complete all the tasks independently. The efficiency scores tended to improve as the users continued to engage with the interface. The website received an overall System Usability Score of 62.22, which was ranked as ``OK/fair to good.'' The users provided an overall positive evaluation of the beta version of the web-based resource tested over 2 cycles and helped to identify areas for improvement. They commented on the functionality and added value of the website, discovery of new programs and resources, and design aesthetics. Most usability issues were reported as minor challenges related to presentation, functionality, and language, and feedback was adopted into later iterations of the website. Conclusions: This study provides reflections on the value of usability testing and elements that are key to the creation of user-centered resources, such as the inclusion of participants with various abilities and considerations regarding website design and accessibility in an increasingly web-based world. AccessATCanada is now part of a growing global response to expand the reach of AT programs and services, improve the equity of access to AT, and reduce the complexity of navigating AT systems. ", doi="10.2196/36949", url="https://formative.jmir.org/2022/11/e36949", url="http://www.ncbi.nlm.nih.gov/pubmed/36326813" } @Article{info:doi/10.2196/40528, author="Isabet, Baptiste and Rigaud, Anne-Sophie and Li, Wanji and Pino, Maribel", title="Telepresence Robot Intervention to Reduce Loneliness and Social Isolation in Older Adults Living at Home (Project DOMIROB): Protocol for a Clinical Nonrandomized Study", journal="JMIR Res Protoc", year="2022", month="Oct", day="31", volume="11", number="10", pages="e40528", keywords="older adults", keywords="telepresence robot", keywords="feeling of loneliness", keywords="social isolation", keywords="home", keywords="acceptability", keywords="usability", abstract="Background: There is a growing prevalence of loneliness and social isolation among older adults (OAs). These problems are often associated with depressive states, cognitive decline, sleep disorders, addictions, and increased mortality. To limit loneliness and social isolation in OAs, some authors recommend the use of new communication technologies to maintain a social link with family members as well as with health and social care professionals. Among these communication tools, telepresence robots (TRs) seem to be a promising solution. These robots offer users the possibility of making video calls with their relatives, social workers, and health care professionals, to maintain social contact and access to support services while living at home. Nevertheless, TRs have been relatively unstudied in real-life environments. Objective: The main objective of this study is to measure the impact of a 12-week intervention using a TR on the feeling of loneliness and on social isolation of OAs living at home. Its secondary objective is to establish recommendations for the implementation of TRs in the studied context. Methods: A nonrandomized study will be conducted among 60 OAs living at home who will participate in the study for 24 weeks. During this period, they will host a TR for 12 weeks to use it in their home. After the end of the intervention a 12-week follow-up ensues. In total, 4 evaluations will be performed over the entire experimental phase for each participant at weeks 0, 6, 12, and 24. A multidimensional assessment of the impact of the robot will be performed using a multimethod approach including standardized scales and a semistructured interview. This assessment will also help to identify the ergonomic aspects that influence the robot's usability and acceptability among OAs. Results: Data collection started in September 2020 and is expected to be completed in early 2023. In August 2022, 56 participants were recruited for the study. Data analysis will take place between August 2022 and is expected to be completed in early 2023. Conclusions: The DOMIROB study will provide new knowledge on the impact of social TRs in OAs living at home. The results will make it possible to suggest technological, ethical, and organizational recommendations for the use and implementation of TRs for OAs in real-life settings. Trial Registration: ClinicalTrials.gov NCT04767100; https://clinicaltrials.gov/ct2/show/NCT04767100 International Registered Report Identifier (IRRID): DERR1-10.2196/40528 ", doi="10.2196/40528", url="https://www.researchprotocols.org/2022/10/e40528", url="http://www.ncbi.nlm.nih.gov/pubmed/36315231" } @Article{info:doi/10.2196/39954, author="Bendig, Jonas and Spanz, Anja and Leidig, Jana and Frank, Anika and Stahr, Marcus and Reichmann, Heinz and Loewenbr{\"u}ck, F. Kai and Falkenburger, H. Bj{\"o}rn", title="Measuring the Usability of eHealth Solutions for Patients With Parkinson Disease: Observational Study", journal="JMIR Form Res", year="2022", month="Oct", day="25", volume="6", number="10", pages="e39954", keywords="eHealth", keywords="usability", keywords="Parkinson disease", keywords="telehealth and telemonitoring", keywords="older adults", keywords="aging", keywords="older population", keywords="neurodegenerative disease", keywords="digital solution", keywords="wearable sensor", keywords="mobile health", keywords="system usability", keywords="eHealth solution", abstract="Background: Parkinson disease (PD) is a neurodegenerative disorder with a variety of motor and nonmotor symptoms. Many of these symptoms can be monitored by eHealth solutions, including smartphone apps, wearable sensors, and camera systems. The usability of such systems is a key factor in long-term use, but not much is known about the predictors of successful use and preferable methods to assess usability in patients with PD. Objective: This study tested methods to assess usability and determined prerequisites for successful use in patients with PD. Methods: We performed comprehensive usability assessments with 18 patients with PD using a mixed methods usability battery containing the System Usability Scale, a rater-based evaluation of device-specific tasks, and qualitative interviews. Each patient performed the usability battery with 2 of 3 randomly assigned devices: a tablet app, wearable sensors, and a camera system. The usability battery was administered at the beginning and at the end of a 4-day testing period. Between usability batteries, the systems were used by the patients during 3 sessions of motor assessments (wearable sensors and camera system) and at the movement disorder ward (tablet app). Results: In this study, the rater-based evaluation of tasks discriminated the best between the 3 eHealth solutions, whereas subjective modalities such as the System Usability Scale were not able to distinguish between the systems. Successful use was associated with different clinical characteristics for each system: eHealth literacy and cognitive function predicted successful use of the tablet app, and better motor function and lower age correlated with the independent use of the camera system. The successful use of the wearable sensors was independent of clinical characteristics. Unfortunately, patients who were not able to use the devices well provided few improvement suggestions in qualitative interviews. Conclusions: eHealth solutions should be developed with a specific set of patients in mind and subsequently tested in this cohort. For a complete picture, usability assessments should include a rater-based evaluation of task performance, and there is a need to develop strategies to circumvent the underrepresentation of poorly performing patients in qualitative usability research. ", doi="10.2196/39954", url="https://formative.jmir.org/2022/10/e39954", url="http://www.ncbi.nlm.nih.gov/pubmed/36282558" } @Article{info:doi/10.2196/37137, author="Kenter, Francisca Robin Maria and Sch{\o}nning, Adrian and Inal, Yavuz", title="Internet-Delivered Self-help for Adults With ADHD (MyADHD): Usability Study", journal="JMIR Form Res", year="2022", month="Oct", day="21", volume="6", number="10", pages="e37137", keywords="usability testing", keywords="user evaluation", keywords="attention-deficit/hyperactivity disorder", keywords="self-guided intervention", keywords="internet-delivered", keywords="self-help", keywords="adults with attention-deficit/hyperactivity disorder", keywords="intervention", keywords="usability study", keywords="care needs", keywords="usability", abstract="Background: Although effective pharmacological treatment exists, many adults with attention-deficit/hyperactivity disorder (ADHD) prefer a nonpharmacological option for managing their symptoms. Internet-delivered self-help interventions have the potential to address this unmet supportive care need reported by adults with ADHD, at relatively low costs. However, if the intervention does not offer optimal functions, content, and layout, it could decrease adherence and engagement and potentially compromise the effectiveness of such interventions. Thus, there is a need for examining the usability and factors that enhance and impair the usability of internet-delivered self-help interventions. Objective: This study evaluates the usability of an internet-delivered self-help intervention for adults with ADHD (MyADHD). The main goals were to (1) collect qualitative and quantitative data on usability and (2) identify usability problems. Methods: Individual think-aloud interviews and staged usability testing (N=5) were conducted to evaluate the usability of the MyADHD intervention in terms of function, content, and design. MyADHD end users provided iterative feedback to maximize engagement and usability. They performed tasks involved in operating the intervention and provided ``think-aloud'' commentary and postsession usability ratings. The interviews were recorded, transcribed verbatim, and analyzed. Results: Participants were satisfied with the overall usability of the program. The average perceived usability score out of 100 was 70 for the first round of testing and improved to 77.5 after applying modifications, with a mean score of 75.5 (SD 5.9) for all rounds of usability testing. The analysis of the interviews revealed 3 central themes: functionality, content, and layout. Conclusions: Optimizing the usability of internet-delivered self-guided interventions is a critical step in the design and development process. The usability testing in this study provided valuable information from users' perspectives on the content and platform of the intervention. Analysis revealed the need for intervention enhancement with regard to design, functionality, and content from the perspective of potential end users. Overall, participants saw value in the MyADHD intervention and were confident that they could use it for the self-management of symptoms and expressed the desire to use the entire intervention when it becomes available. Through this development process, we produced an intervention that is likely to be used successfully and is ready for deployment in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 ", doi="10.2196/37137", url="https://formative.jmir.org/2022/10/e37137", url="http://www.ncbi.nlm.nih.gov/pubmed/36269662" } @Article{info:doi/10.2196/37772, author="Tran-Nguyen, Kevin and Berger, Caroline and Bennett, Roxanne and Wall, Michelle and Morin, N. Suzanne and Rajabiyazdi, Fateme", title="Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach", journal="JMIR Aging", year="2022", month="Oct", day="17", volume="5", number="4", pages="e37772", keywords="older adults", keywords="mobile app", keywords="skeletal fracture", keywords="usability", keywords="patient-centered", keywords="human-centered design", keywords="digital health", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="acute pain self-management", keywords="mobile phone", abstract="Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. ", doi="10.2196/37772", url="https://aging.jmir.org/2022/4/e37772", url="http://www.ncbi.nlm.nih.gov/pubmed/36251348" } @Article{info:doi/10.2196/35592, author="Villalobos, Paola Jennifer and Bull, Salyers Sheana and Portz, Dickman Jennifer", title="Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study", journal="JMIR Aging", year="2022", month="Oct", day="6", volume="5", number="4", pages="e35592", keywords="mHealth", keywords="older adult", keywords="symptom", keywords="heart failure", keywords="palliative care", keywords="app", keywords="digital health", keywords="cardiology", keywords="heart", keywords="Convoy-Pal", keywords="mobile", keywords="tablet", keywords="smartwatch", keywords="adult", keywords="aging", abstract="Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients' caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. ", doi="10.2196/35592", url="https://aging.jmir.org/2022/4/e35592", url="http://www.ncbi.nlm.nih.gov/pubmed/36201402" } @Article{info:doi/10.2196/25886, author="Schmidt, Ekkehard Steffen Christian and Sell, Stefan and Woll, Alexander", title="The Use of Compression Stockings to Reduce Water Retention in the Legs During Gaming and Esports: Randomized Controlled Field Study", journal="Interact J Med Res", year="2022", month="Sep", day="29", volume="11", number="2", pages="e25886", keywords="esport", keywords="streaming", keywords="gaming", keywords="water retention", keywords="fluid balance", keywords="compression stockings", keywords="bioelectrical impedance", keywords="mobile phone", abstract="Background: With the increasing digitalization of daily life, internet-based entertainment such as gaming and streaming has advanced to one of the megatrends of the 21st century. Besides offering a multitude of controversially discussed opportunities for entertainment and social interaction, there is reasonable concern about health issues caused by the absence of physical activity among activities linked to gaming and streaming. Objective: The aim of this study is to compare the water balance of recreational gamers with and those without compression stockings during a gaming event. Methods: We measured body composition and water balance with 8-electrode bioelectrical impedance analysis among 46 recreational gamers with an average age of 27.1 (SD 6.5) years (5/46, 11\% women and 41/46, 89\% men) before and after 24 hours at a gaming event. Of the 46 gamers, 23 (50\%) gamers wore compression stockings for the duration of the study. Results: Our study shows that prolonged gaming and associated behaviors during a 24-hour time frame lead to an increase in total body water (+0.76 L; P<.001) and a decrease of phase angle in the lower extremities (?0.47{\textdegree}; P<.001) but not in the upper extremities (+0.09{\textdegree}; P=.80), when no compression is used. Gamers using compression socks did not show any significant negative effects on their body composition. Conclusions: Prolonged gaming and streaming are serious risk factors for diseases associated with water retention in the legs, and these risks can be measured by bioelectrical impedance and reduced by wearing compression stockings. We conclude that these findings should be discussed and replicated in larger studies and that there is a considerably large market for compression stockings among gamers and live streamers. ", doi="10.2196/25886", url="https://www.i-jmr.org/2022/2/e25886", url="http://www.ncbi.nlm.nih.gov/pubmed/36173666" } @Article{info:doi/10.2196/40001, author="Tuot, S. Delphine and Crowley, T. Susan and Katz, A. Lois and Leung, Joseph and Alcantara-Cadillo, K. Delly and Ruser, Christopher and Talbot-Montgomery, Elizabeth and Vassalotti, A. Joseph", title="Usability Testing of the Kidney Score Platform to Enhance Communication About Kidney Disease in Primary Care Settings: Qualitative Think-Aloud Study", journal="JMIR Form Res", year="2022", month="Sep", day="28", volume="6", number="9", pages="e40001", keywords="chronic kidney disease", keywords="CKD", keywords="awareness", keywords="usability", keywords="kidney", keywords="renal", keywords="think aloud", keywords="self-management", keywords="patient education", keywords="health education", abstract="Background: Patient awareness of chronic kidney disease (CKD) is low in part due to suboptimal testing for CKD among those at risk and lack of discussions about kidney disease between patients and clinicians. To bridge these gaps, the National Kidney Foundation developed the Kidney Score Platform, which is a web-based series of tools that includes resources for health care professionals as well as an interactive, dynamic patient-facing component that includes a brief questionnaire about risk factors for kidney disease, individualized assessment of risk for developing CKD, and self-management tools to manage one's kidney disease. Objective: The aim of this study is to perform usability testing of the patient component of the Kidney Score platform among veterans with and at risk for kidney disease and among clinicians working as primary care providers in Veterans Affairs administration. Methods: Think-aloud exercises were conducted, during which participants (veterans and clinicians) engaged with the platform while verbalizing their thoughts and making their perceptions, reasonings, and decision points explicit. A usability facilitator observed participants' behaviors and probed selectively to clarify their comprehension of the tool's instructions, content, and overall functionality. Thematic analysis on the audio-recording transcripts was performed, focusing on positive attributes, negative comments, and areas that required facilitator involvement. Results: Veterans (N=18) were 78\% (14/18) male with a mean age of 58.1 years. Two-thirds (12/18) were of non-White race/ethnicity, 28\% (5/18) had laboratory evidence of CKD without a formal diagnosis, and 50\% (9/18) carried a diagnosis of hypertension or diabetes. Clinicians (N=19) were 29\% (5/17) male, 30\% (5/17) of non-White race/ethnicity, and had a mean of 17 (range 4-32) years of experience. Veterans and clinicians easily navigated the online tool and appreciated the personalized results page as well as the inclusion of infographics to deliver key educational messages. Three major themes related to content and communication about risk for CKD emerged from the think-aloud exercises: (1) tension between lay and medical terminology when discussing kidney disease and diagnostic tests, (2) importance of linking general information to concrete self-management actions, and (3) usefulness of the tool as an adjunct to the office visit to prepare for patient-clinician communication. Importantly, these themes were consistent among interviews involving both veterans and clinicians. Conclusions: Veterans and clinicians both thought that the Kidney Score Platform would successfully promote communication and discussion about kidney disease in primary care settings. Tension between using medical terminology that is used regularly by clinicians versus lay terminology to promote CKD awareness was a key challenge, and knowledge of this can inform the development of future CKD educational materials. ", doi="10.2196/40001", url="https://formative.jmir.org/2022/9/e40001", url="http://www.ncbi.nlm.nih.gov/pubmed/36170008" } @Article{info:doi/10.2196/35114, author="Winston, Luke and McCann, Michael and Onofrei, George", title="Exploring Socioeconomic Status as a Global Determinant of COVID-19 Prevalence, Using Exploratory Data Analytic and Supervised Machine Learning Techniques: Algorithm Development and Validation Study", journal="JMIR Form Res", year="2022", month="Sep", day="27", volume="6", number="9", pages="e35114", keywords="COVID-19", keywords="machine learning", keywords="data analysis", keywords="epidemiology", keywords="human development index", abstract="Background: The COVID-19 pandemic represents the most unprecedented global challenge in recent times. As the global community attempts to manage the pandemic in the long term, it is pivotal to understand what factors drive prevalence rates and to predict the future trajectory of the virus. Objective: This study had 2 objectives. First, it tested the statistical relationship between socioeconomic status and COVID-19 prevalence. Second, it used machine learning techniques to predict cumulative COVID-19 cases in a multicountry sample of 182 countries. Taken together, these objectives will shed light on socioeconomic status as a global risk factor of the COVID-19 pandemic. Methods: This research used exploratory data analysis and supervised machine learning methods. Exploratory analysis included variable distribution, variable correlations, and outlier detection. Following this, the following 3 supervised regression techniques were applied: linear regression, random forest, and adaptive boosting (AdaBoost). Results were evaluated using k-fold cross-validation and subsequently compared to analyze algorithmic suitability. The analysis involved 2 models. First, the algorithms were trained to predict 2021 COVID-19 prevalence using only 2020 reported case data. Following this, socioeconomic indicators were added as features and the algorithms were trained again. The Human Development Index (HDI) metrics of life expectancy, mean years of schooling, expected years of schooling, and gross national income were used to approximate socioeconomic status. Results: All variables correlated positively with the 2021 COVID-19 prevalence, with R2 values ranging from 0.55 to 0.85. Using socioeconomic indicators, COVID-19 prevalence was predicted with a reasonable degree of accuracy. Using 2020 reported case rates as a lone predictor to predict 2021 prevalence rates, the average predictive accuracy of the algorithms was low (R2=0.543). When socioeconomic indicators were added alongside 2020 prevalence rates as features, the average predictive performance improved considerably (R2=0.721) and all error statistics decreased. Thus, adding socioeconomic indicators alongside 2020 reported case data optimized the prediction of COVID-19 prevalence to a considerable degree. Linear regression was the strongest learner with R2=0.693 on the first model and R2=0.763 on the second model, followed by random forest (0.481 and 0.722) and AdaBoost (0.454 and 0.679). Following this, the second model was retrained using a selection of additional COVID-19 risk factors (population density, median age, and vaccination uptake) instead of the HDI metrics. However, average accuracy dropped to 0.649, which highlights the value of socioeconomic status as a predictor of COVID-19 cases in the chosen sample. Conclusions: The results show that socioeconomic status is an important variable to consider in future epidemiological modeling, and highlights the reality of the COVID-19 pandemic as a social phenomenon and a health care phenomenon. This paper also puts forward new considerations about the application of statistical and machine learning techniques to understand and combat the COVID-19 pandemic. ", doi="10.2196/35114", url="https://formative.jmir.org/2022/9/e35114", url="http://www.ncbi.nlm.nih.gov/pubmed/36001798" } @Article{info:doi/10.2196/38352, author="Lowe, Cabella and Browne, Mitchell and Marsh, William and Morrissey, Dylan", title="Usability Testing of a Digital Assessment Routing Tool for Musculoskeletal Disorders: Iterative, Convergent Mixed Methods Study", journal="J Med Internet Res", year="2022", month="Aug", day="30", volume="24", number="8", pages="e38352", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="digital health", keywords="digital technology", keywords="musculoskeletal", keywords="triage", keywords="physiotherapy triage", keywords="usability", keywords="acceptability", keywords="mobile phone", abstract="Background: Musculoskeletal disorders negatively affect millions of patients worldwide, placing significant demand on health care systems. Digital technologies that improve clinical outcomes and efficiency across the care pathway are development priorities. We developed the musculoskeletal Digital Assessment Routing Tool (DART) to enable self-assessment and immediate direction to the right care. Objective: We aimed to assess and resolve all serious DART usability issues to create a positive user experience and enhance system adoption before conducting randomized controlled trials for the integration of DART into musculoskeletal management pathways. Methods: An iterative, convergent mixed methods design was used, with 22 adult participants assessing 50 different clinical presentations over 5 testing rounds across 4 DART iterations. Participants were recruited using purposive sampling, with quotas for age, habitual internet use, and English-language ability. Quantitative data collection was defined by the constructs within the International Organization for Standardization 9241-210-2019 standard, with user satisfaction measured by the System Usability Scale. Study end points were resolution of all grade 1 and 2 usability problems and a mean System Usability Scale score of ?80 across a minimum of 3 user group sessions. Results: All participants (mean age 48.6, SD 15.2; range 20-77 years) completed the study. Every assessment resulted in a recommendation with no DART system errors and a mean completion time of 5.2 (SD 4.44, range 1-18) minutes. Usability problems were reduced from 12 to 0, with trust and intention to act improving during the study. The relationship between eHealth literacy and age, as explored with a scatter plot and calculation of the Pearson correlation coefficient, was performed for all participants (r=--0.2; 20/22, 91\%) and repeated with a potential outlier removed (r=--0.23), with no meaningful relationships observed or found for either. The mean satisfaction for daily internet users was highest (19/22, 86\%; mean 86.5, SD 4.48; 90\% confidence level [CL] 1.78 or --1.78), with nonnative English speakers (6/22, 27\%; mean 78.1, SD 4.60; 90\% CL 3.79 or --3.79) and infrequent internet users scoring the lowest (3/22, 14\%; mean 70.8, SD 5.44; 90\% CL 9.17 or --9.17), although the CIs overlap. The mean score across all groups was 84.3 (SD 4.67), corresponding to an excellent system, with qualitative data from all participants confirming that DART was simple to use. Conclusions: All serious DART usability issues were resolved, and a good level of satisfaction, trust, and willingness to act on the DART recommendation was demonstrated, thus allowing progression to randomized controlled trials that assess safety and effectiveness against usual care comparators. The iterative, convergent mixed methods design proved highly effective in fully evaluating DART from a user perspective and could provide a blueprint for other researchers of mobile health systems. International Registered Report Identifier (IRRID): RR2-10.2196/27205 ", doi="10.2196/38352", url="https://www.jmir.org/2022/8/e38352", url="http://www.ncbi.nlm.nih.gov/pubmed/36040787" } @Article{info:doi/10.2196/34721, author="Stapinski, Ann Lexine and Nepal, Smriti and Guckel, Tara and Grummitt, Rachel Lucinda and Chapman, Cath and Lynch, Jane Samantha and Lawler, Maree Siobhan and Teesson, Maree and Newton, Clare Nicola", title="Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study", journal="JMIR Pediatr Parent", year="2022", month="Aug", day="26", volume="5", number="3", pages="e34721", keywords="alcohol and other drugs", keywords="prevention", keywords="adolescence", keywords="schools", keywords="drug prevention", keywords="drug prevention website", abstract="Background: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website's usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. Objective: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. Methods: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants' feedback about Positive Choices. Results: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8\% to 14\% among school staff and from 15\% to 22\% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants' suggestions for improvement informed a recent website update. Conclusions: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities. ", doi="10.2196/34721", url="https://pediatrics.jmir.org/2022/3/e34721", url="http://www.ncbi.nlm.nih.gov/pubmed/36018617" } @Article{info:doi/10.2196/34572, author="Bird, Marissa and Carter, Nancy and Lim, Audrey and Kazmie, Nadia and Fajardo, Cindy and Reaume, Shannon and McGillion, H. Michael", title="A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study", journal="JMIR Form Res", year="2022", month="Aug", day="12", volume="6", number="8", pages="e34572", keywords="usability testing", keywords="digital health", keywords="children with medical complexities", keywords="children", keywords="chronic disease", keywords="pediatrics", keywords="health care", keywords="parenting", keywords="virtual health", keywords="care provider", keywords="youth", keywords="family needs", keywords="home care", keywords="usability", abstract="Background: Children with medical complexity (CMC) are a group of young people who have severe complex chronic conditions, substantial family-identified service needs, functional limitations, and high health care resource use. Technology-enabled hospital-to-home interventions designed to deliver comprehensive care in the home setting are needed to ease CMC family stress, provide proactive and comprehensive care to this fragile population, and avoid hospital admissions, where possible. Objective: In this usability testing study, we aimed to assess areas of strength and opportunity within the DigiComp Kids system, a hospital-to-home intervention for CMC and their families and care providers. Methods: Hospital-based clinicians, family members of medically complex children, and home-based clinicians participated in DigiComp Kids usability testing. Participants were recorded and tasked to think aloud while completing usability testing tasks. Participants were scored on the metrics of effectiveness, efficiency, and satisfaction, and the total usability score was calculated using the Single Usability Metric. Participants also provided insights into user experiences during the postusability testing interviews. Results: A total of 15 participants (5 hospital-based clinicians, 6 family members, and 4 home-based clinicians) participated in DigiComp Kids usability testing. The participants were able to complete all assigned tasks independently. Error-free rates for tasks ranged from 58\% to 100\%; the average satisfaction rating across groups was ?80\%, as measured by the Single Ease Question. Task times of participants were variable compared with the task times of an expert DigiComp Kids user. Single Usability Metric scores ranged from 80.5\% to 89.5\%. In qualitative interviews, participants stressed the need to find the right fit between user needs and the effort required to use the system. Interviews also revealed that the value of the DigiComp Kids system was in its ability to create a digital bridge between hospital and home, enabling participants to foster and maintain connections across boundaries. Conclusions: Usability testing revealed strong scores across the groups. Insights gained include the importance of tailoring the implementation of the system to match individual user needs, streamlining key system features, and consideration of the meaning attached to system use by participants to allow for insight into system adoption and sustainment. ", doi="10.2196/34572", url="https://formative.jmir.org/2022/8/e34572", url="http://www.ncbi.nlm.nih.gov/pubmed/35969456" } @Article{info:doi/10.2196/37368, author="Lamaj, Ganimete and Pablo-Trinidad, Alberto and Butterworth, Ian and Bell, Nolan and Benasutti, Ryan and Bourquard, Aurelien and Sanchez-Ferro, Alvaro and Castro-Gonzalez, Carlos and Jim{\'e}nez-Ubieto, Ana and Baumann, Tycho and Rodriguez-Izquierdo, Antonia and Pottier, Elizabeth and Shelton, Anthony and Martinez-Lopez, Joaquin and Sloan, Mark John", title="Usability Evaluation of a Noninvasive Neutropenia Screening Device (PointCheck) for Patients Undergoing Cancer Chemotherapy: Mixed Methods Observational Study", journal="J Med Internet Res", year="2022", month="Aug", day="9", volume="24", number="8", pages="e37368", keywords="digital health", keywords="usability", keywords="patient-centered care", keywords="remote monitoring", keywords="decision support systems", keywords="white blood cells", keywords="diagnosis", keywords="medical device", keywords="cancer", keywords="chemotherapy", keywords="infection", keywords="white blood cell", keywords="technology", abstract="Background: Patients with cancer undergoing cytotoxic chemotherapy face an elevated risk of developing serious infection as a consequence of their treatment, which lowers their white blood cell count and, more specifically, their absolute neutrophil count. This condition is known as neutropenia. Neutropenia accompanied by a fever is referred to as febrile neutropenia, a common side effect of chemotherapy with a high mortality rate. The timely detection of severe neutropenia (<500 absolute neutrophil count/$\mu$L) is critical in detecting and managing febrile neutropenia. Current methods rely on blood draws, which limit them to clinical settings and do not allow frequent or portable monitoring. In this study, we demonstrated the usability of PointCheck, a noninvasive device for neutropenia screening, in a simulated home environment without clinical supervision. PointCheck automatically performs microscopy through the skin of the finger to image the blood flowing through superficial microcapillaries and enables the remote monitoring of neutropenia status, without requiring venipuncture. Objective: This study aimed to evaluate the usability of PointCheck, a noninvasive optical technology for screening severe neutropenia, with the goal of identifying potential user interface, functionality, and design issues from the perspective of untrained users. Methods: We conducted a multicenter study using quantitative and qualitative approaches to evaluate the usability of PointCheck across 154 untrained participants. We used a mixed method approach to gather usability data through user testing observations, a short-answer qualitative questionnaire, and a standardized quantitative System Usability Scale (SUS) survey to assess perceived usability and satisfaction. Results: Of the 154 participants, we found that 108 (70.1\%) scored above 80.8 on the SUS across all sites, with a mean SUS score of 86.1 across all sites. Furthermore, the SUS results indicated that, out of the 151 users who completed the SUS survey, 145 (96\%) found that they learned how to use PointCheck very quickly, and 141 (93.4\%) felt very confident when using the device. Conclusions: We have shown that PointCheck, a novel technology for noninvasive, home-based neutropenia detection, can be safely and effectively operated by first-time users. In a simulated home environment, these users found it easy to use, with a mean SUS score of 86.1, indicating an excellent perception of usability and placing this device within the top tenth percentile of systems evaluated for usability by the SUS. Trial Registration: ClinicalTrials.gov NCT04448314; https://clinicaltrials.gov/ct2/show/NCT04448314 (Hospital Universitario 12 de Octubre registration) and NCT04448301; https://clinicaltrials.gov/ct2/show/NCT04448301 (Boston Medical Center registration) ", doi="10.2196/37368", url="https://www.jmir.org/2022/8/e37368", url="http://www.ncbi.nlm.nih.gov/pubmed/35943786" } @Article{info:doi/10.2196/37434, author="Mahmoudi Asl, Aysan and Molinari Ulate, Mauricio and Franco Martin, Manuel and van der Roest, Henri{\"e}tte", title="Methodologies Used to Study the Feasibility, Usability, Efficacy, and Effectiveness of Social Robots For Elderly Adults: Scoping Review", journal="J Med Internet Res", year="2022", month="Aug", day="1", volume="24", number="8", pages="e37434", keywords="aged", keywords="dementia", keywords="social robots", keywords="pet-bots", keywords="community settings", keywords="long-term care", keywords="methods", keywords="scoping review", abstract="Background: New research fields to design social robots for older people are emerging. By providing support with communication and social interaction, these robots aim to increase quality of life. Because of the decline in functioning due to cognitive impairment in older people, social robots are regarded as promising, especially for people with dementia. Although study outcomes are hopeful, the quality of studies on the effectiveness of social robots for the elderly is still low due to many methodological limitations. Objective: We aimed to review the methodologies used thus far in studies evaluating the feasibility, usability, efficacy, and effectiveness of social robots in clinical and social settings for elderly people, including persons with dementia. Methods: Dedicated search strings were developed. Searches in MEDLINE (PubMed), Web of Science, PsycInfo, and CINAHL were performed on August 13, 2020. Results: In the 33 included papers, 23 different social robots were investigated for their feasibility, usability, efficacy, and effectiveness. A total of 8 (24.2\%) studies included elderly persons in the community, 9 (27.3\%) included long-term care facility residents, and 16 (48.5\%) included people with dementia. Most of the studies had a single aim, of which 7 (21.2\%) focused on efficacy and 7 (21.2\%) focused on effectiveness. Moreover, forms of randomized controlled trials were the most applied designs. Feasibility and usability were often studied together in mixed methods or experimental designs and were most often studied in individual interventions. Feasibility was often assessed with the Unified Theory of the Acceptance and Use of Technology model. Efficacy and effectiveness studies used a range of psychosocial and cognitive outcome measures. However, the included studies failed to find significant improvements in quality of life, depression, and cognition. Conclusions: This study identified several shortcomings in methodologies used to evaluate social robots, resulting in ambivalent study findings. To improve the quality of these types of studies, efficacy/effectiveness studies will benefit from appropriate randomized controlled trial designs with large sample sizes and individual intervention sessions. Experimental designs might work best for feasibility and usability studies. For each of the 3 goals (efficacy/effectiveness, feasibility, and usability) we also recommend a mixed method of data collection. Multiple interaction sessions running for at least 1 month might aid researchers in drawing significant results and prove the real long-term impact of social robots. ", doi="10.2196/37434", url="https://www.jmir.org/2022/8/e37434", url="http://www.ncbi.nlm.nih.gov/pubmed/35916695" } @Article{info:doi/10.2196/24306, author="Kiesewetter, Jan and Hege, Inga and Sailer, Michael and Bauer, Elisabeth and Schulz, Claudia and Platz, Manfred and Adler, Martin", title="Implementing Remote Collaboration in a Virtual Patient Platform: Usability Study", journal="JMIR Med Educ", year="2022", month="Jul", day="28", volume="8", number="3", pages="e24306", keywords="collaborative learning", keywords="clinical reasoning", keywords="webRTC", keywords="collaboration", keywords="collaborative", keywords="decision making", abstract="Background: Learning with virtual patients is highly popular for fostering clinical reasoning in medical education. However, little learning with virtual patients is done collaboratively, despite the potential learning benefits of collaborative versus individual learning. Objective: This paper describes the implementation of student collaboration in a virtual patient platform. Our aim was to allow pairs of students to communicate remotely with each other during virtual patient learning sessions. We hypothesized that we could provide a collaborative tool that did not impair the usability of the system compared to individual learning and that this would lead to better diagnostic accuracy for the pairs of students. Methods: Implementing the collaboration tool had five steps: (1) searching for a suitable software library, (2) implementing the application programming interface, (3) performing technical adaptations to ensure high-quality connections for the users, (4) designing and developing the user interface, and (5) testing the usability of the tool in 270 virtual patient sessions. We compared dyad to individual diagnostic accuracy and usability with the 10-item System Usability Scale. Results: We recruited 137 students who worked on 6 virtual patients. Out of 270 virtual patient sessions per group (45 dyads times 6 virtual patients, and 47 students working individually times 6 virtual patients minus 2 randomly selected deleted sessions) the students made successful diagnoses in 143/270 sessions (53\%, SD 26\%) when working alone and 192/270 sessions (71\%, SD 20\%) when collaborating (P=.04, $\eta$2=0.12). A usability questionnaire given to the students who used the collaboration tool showed a usability score of 82.16 (SD 1.31), representing a B+ grade. Conclusions: The collaboration tool provides a generic approach for collaboration that can be used with most virtual patient systems. The collaboration tool helped students diagnose virtual patients and had good overall usability. More broadly, the collaboration tool will provide an array of new possibilities for researchers and medical educators alike to design courses for collaborative learning with virtual patients. ", doi="10.2196/24306", url="https://mededu.jmir.org/2022/3/e24306", url="http://www.ncbi.nlm.nih.gov/pubmed/35900827" } @Article{info:doi/10.2196/38509, author="Ammann-Reiffer, Corinne and Kl{\"a}y, Andrina and Keller, Urs", title="Virtual Reality as a Therapy Tool for Walking Activities in Pediatric Neurorehabilitation: Usability and User Experience Evaluation", journal="JMIR Serious Games", year="2022", month="Jul", day="14", volume="10", number="3", pages="e38509", keywords="rehabilitation", keywords="pediatric", keywords="child", keywords="adolescent", keywords="walking", keywords="feasibility study", keywords="virtual reality", keywords="head-mounted display", keywords="therapy", keywords="tool", keywords="user", keywords="usability", keywords="visual", keywords="auditory", keywords="feedback", keywords="youth", abstract="Background: Many essential walking activities in daily life, such as crossing a street, are challenging to practice in conventional therapeutic settings. Virtual environments (VEs) delivered through a virtual reality (VR) head-mounted display (HMD) would allow training such activities in a safe and attractive environment. Furthermore, the game-like character and high degree of immersion in these applications might help maintain or increase children's motivation and active participation during the rehabilitation process. Objective: This study aimed to investigate the usability, user experience, and acceptability of an immersive VE experienced through a VR HMD to train everyday life walking activities in pediatric neurorehabilitation. Methods: In a cross-sectional study, 21 youths (median age 12.1 years; range 6.8-17.7 years) with a neuromotor impairment undergoing inpatient or outpatient neurorehabilitation tested a VE experienced through the VR HMD Oculus Quest. The participants, accompanied by their physiotherapists, moved freely around a 4.4 by 10-meter VE, displaying a magical forest and featuring various gamified everyday activities in different game designs. Using their hands, represented in the VE, the participants could interact with the virtual objects placed throughout the VE and trigger visual and auditory feedback. Symptoms of cybersickness were checked, and usability, user experience, and acceptability were evaluated using customized questionnaires with a visual analog scale for youths and a 5-point Likert scale for their therapists. Results: None of the participants reported any signs of cybersickness after 20 minutes of VR HMD exposure time. They rated comfort (median 10/10) and movement ability (median 10/10) with the VR HMD as high. The VE was perceived as being really there by the majority (median 8/10), and the participants had a strong feeling of spatial presence in the VE (median 9.5/10). They enjoyed exploring the virtual world (median 10/10) and liked this new therapy approach (median 10/10). Therapists' acceptance of the VR HMD was high (4/5). There were 5 patients that needed more support than usual, mainly for supervision, when moving around with the VR HMD. Otherwise, therapists felt that the VR HMD hardly affected their patients' movement behavior (median 4.75/5), whereas it seemed to increase their level of therapy engagement (median 4/5) compared to conventional physiotherapy sessions. Conclusions: This study demonstrates the usability of an immersive VE delivered through a VR HMD to engage youths in the training of everyday walking activities.The participants' and therapists' positive ratings on user experience and acceptance further support the promising application of this technology as a future therapeutic tool in pediatric neurorehabilitation. ", doi="10.2196/38509", url="https://games.jmir.org/2022/3/e38509", url="http://www.ncbi.nlm.nih.gov/pubmed/35834316" } @Article{info:doi/10.2196/38465, author="Chang, Chien-Hsiang and Yeh, Chung-Hsing and Chang, Chien-Cheng and Lin, Yang-Cheng", title="Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study", journal="JMIR Serious Games", year="2022", month="Jul", day="14", volume="10", number="3", pages="e38465", keywords="dementia", keywords="elderly", keywords="usability", keywords="gesture recognition", keywords="card recognition rehabilitation", keywords="interactive somatosensory game", abstract="Background: In aging societies, dementia risk increases with advancing age, increasing the incidence of dementia-related degenerative diseases and other complications, especially fall risk. Dementia also escalates the care burden, impacting patients, their families, social welfare institutions, and the social structure and medical system. Objective: In elderly dementia, traditional card recognition rehabilitation (TCRR) does not effectively increase one's autonomy. Therefore, from the usability perspective, we used the Tetris game as a reference to develop an interactive somatosensory game rehabilitation (ISGR) with nostalgic style for elders with mild cognitive impairment (MCI). Through intuitive gesture-controlled interactive games, we evaluated subjective feelings concerning somatosensory game integration into rehabilitation to explore whether the ISGR could improve the willingness to use and motivation for rehabilitation among elders with MCI. Methods: A total of 15 elders with MCI (7 males and 8 females with an average age of 78.4 years) underwent 2 experiments for 15 minutes. During experiment 1, TCRR was performed, followed by completing the questionnaire of the System Usability Scale (SUS). After 3-5 minutes, the second experiment (the ISGR) was conducted, followed by completing another SUS. We used SUS to explore differences in impacts of TCRR and ISGR on willingness to use among elders with MCI. In addition, we further investigated whether the factor of gender or prior rehabilitation experience would affect the rehabilitation willingness or not. Results: The novel ISGR made the elderly feel interested and improved their willingness for continuous rehabilitation. According to the overall SUS score, the ISGR had better overall usability performance (73.7) than the TCRR (58.0) (t28=--4.62, P<.001). Furthermore, the ISGR individual item scores of ``Willingness to Use'' (t28=--8.27, P<.001), ``Easy to Use'' (t28=--3.17, P<.001), ``System Integration'' (t28=--5.07, P<.001), and ``Easy to Learn'' (t28=--2.81, P<.001) were better than TCRR. The somatosensory game was easier to learn and master for females than for males (t13=2.71, P=.02). Besides, the ISGR was easier to use (t12=--2.50, P=.02) and learn (t14=--3.33, P<.001) for those without prior rehabilitation experience. The result indicates that for elders with no rehabilitation experience ISGR was easier to use and simpler to learn than TCRR. Conclusions: Regardless of prior rehabilitation experience, the ISGR developed in this study was easy to learn and effective in continuously improving willingness to use. Furthermore, the adoption of a nostalgic game design style served the function of cognitive training and escalated interest in rehabilitation. The ISGR also improved user stickiness by introducing different game scenarios and difficulties, increasing long-term interest and motivation for rehabilitation. For future research on the adoption of interactive somatosensory games in rehabilitation, additional rehabilitation movements can be developed to benefit the elderly with MCI. ", doi="10.2196/38465", url="https://games.jmir.org/2022/3/e38465", url="http://www.ncbi.nlm.nih.gov/pubmed/35834303" } @Article{info:doi/10.2196/37933, author="Shan, Yi and Ji, Meng and Xie, Wenxiu and Li, Rongying and Qian, Xiaobo and Zhang, Xiaomin and Hao, Tianyong", title="Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study", journal="JMIR Form Res", year="2022", month="Jul", day="6", volume="6", number="7", pages="e37933", keywords="mHealth app", keywords="usability", keywords="Chinese version of MAUQ", keywords="improved translation", keywords="validity", keywords="stability", keywords="reliability", keywords="cross-cultural adaptability", keywords="mobile phone", abstract="Background: The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable in assessing the usability of mHealth apps. However, this English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps. Objective: This study aims to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ; interactive for patients) on Left-handed Doctor, one of the most popular ``reaching out to patients'' interactive mHealth apps with chatbot function in China, to test the reliability and cross-cultural adaptability of the questionnaire. Methods: The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on Good Doctor, one of the most influential ``reaching out to patients'' mHealth apps without chatbot function in China. After asking for the researchers' approval to use this Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. Following a trial survey completed by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved version of the C-MAUQ (I-C-MAUQ) was finally used to evaluate the usability of Left-handed Doctor through an online questionnaire survey (answered by 322 participants) on wenjuanxing, to test its internal consistency, reliability, and validity. Results: The I-C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ, including (1) redundancy, (2) incompleteness, (3) misuse of parts of speech, (4) choice of inappropriate words, (5) incomprehensibility, and (6) cultural difference--induced improper translation, were improved. As shown in the analysis of data obtained through the online survey, the I-C-MAUQ had a better internal consistency (ie, the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861-0.938; P<.01), reliability (Cronbach $\alpha$=.988), and validity (Kaiser--Meyer--Olkin=0.973), compared with the C-MAUQ. It was effectively used to test the usability of Left-handed Doctor, eliciting over 80\% of informants' positive attitudes toward this mHealth app. Conclusions: The I-C-MAUQ is highly reliable and valid for Left-handed Doctor, and suitable for testing the usability of interactive mHealth apps used by patients in China. This finding further confirms the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users' age, gender, education, profession, and possibly previous experience with mHealth apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among young Chinese female college students who were more engaged in the interaction with health care chatbots. The age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America and Malaysia. This preference identifies areas for further research on the social, cultural, and gender adaptation of health technologies. ", doi="10.2196/37933", url="https://formative.jmir.org/2022/7/e37933", url="http://www.ncbi.nlm.nih.gov/pubmed/35793132" } @Article{info:doi/10.2196/36681, author="Soussi, Daniella and Vedi, Jade Chiara", title="Should Expert Surgeon Guidance Be Given Remotely? Comment on ``User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service''", journal="JMIR Hum Factors", year="2022", month="Jun", day="29", volume="9", number="2", pages="e36681", keywords="telemedicine", keywords="user experience", keywords="satisfaction", keywords="technology acceptance", keywords="usability", keywords="perioperative", keywords="surgery", keywords="consultation", keywords="surgeons", keywords="performance", keywords="evaluation", keywords="tele-guidance", keywords="telehealth", keywords="telemedicine implementation", keywords="telementoring", keywords="surgical consultation", keywords="usefulness", doi="10.2196/36681", url="https://humanfactors.jmir.org/2022/2/e36681", url="http://www.ncbi.nlm.nih.gov/pubmed/35767326" } @Article{info:doi/10.2196/38259, author="Johnson, Gr{\o}dem Susanne and Potrebny, Thomas and Larun, Lillebeth and Ciliska, Donna and Olsen, Rydland Nina", title="Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Scoping Review", journal="JMIR Med Educ", year="2022", month="Jun", day="29", volume="8", number="2", pages="e38259", keywords="user-computer interface", keywords="mobile apps", keywords="online learning", keywords="health education", keywords="students", abstract="Background: Mobile devices can provide extendable learning environments in higher education and motivate students to engage in adaptive and collaborative learning. Developers must design mobile apps that are practical, effective, and easy to use, and usability testing is essential for understanding how mobile apps meet users' needs. No previous reviews have investigated the usability of mobile apps developed for health care education. Objective: The aim of this scoping review is to identify usability methods and attributes in usability studies of mobile apps for health care education. Methods: A comprehensive search was carried out in 10 databases, reference lists, and gray literature. Studies were included if they dealt with health care students and usability of mobile apps for learning. Frequencies and percentages were used to present the nominal data, together with tables and graphical illustrations. Examples include a figure of the study selection process, an illustration of the frequency of inquiry usability evaluation and data collection methods, and an overview of the distribution of the identified usability attributes. We followed the Arksey and O'Malley framework for scoping reviews. Results: Our scoping review collated 88 articles involving 98 studies, mainly related to medical and nursing students. The studies were conducted from 22 countries and were published between 2008 and 2021. Field testing was the main usability experiment used, and the usability evaluation methods were either inquiry-based or based on user testing. Inquiry methods were predominantly used: 1-group design (46/98, 47\%), control group design (12/98, 12\%), randomized controlled trials (12/98, 12\%), mixed methods (12/98, 12\%), and qualitative methods (11/98, 11\%). User testing methods applied were all think aloud (5/98, 5\%). A total of 17 usability attributes were identified; of these, satisfaction, usefulness, ease of use, learning performance, and learnability were reported most frequently. The most frequently used data collection method was questionnaires (83/98, 85\%), but only 19\% (19/98) of studies used a psychometrically tested usability questionnaire. Other data collection methods included focus group interviews, knowledge and task performance testing, and user data collected from apps, interviews, written qualitative reflections, and observations. Most of the included studies used more than one data collection method. Conclusions: Experimental designs were the most commonly used methods for evaluating usability, and most studies used field testing. Questionnaires were frequently used for data collection, although few studies used psychometrically tested questionnaires. The usability attributes identified most often were satisfaction, usefulness, and ease of use. The results indicate that combining different usability evaluation methods, incorporating both subjective and objective usability measures, and specifying which usability attributes to test seem advantageous. The results can support the planning and conduct of future usability studies for the advancement of mobile learning apps in health care education. International Registered Report Identifier (IRRID): RR2-10.2196/19072 ", doi="10.2196/38259", url="https://mededu.jmir.org/2022/2/e38259", url="http://www.ncbi.nlm.nih.gov/pubmed/35767323" } @Article{info:doi/10.2196/34087, author="El Ayadi, M. Alison and Duggal, Mona and Bagga, Rashmi and Singh, Pushpendra and Kumar, Vijay and Ahuja, Alka and Kankaria, Ankita and Hosapatna Basavarajappa, Darshan and Kaur, Jasmeet and Sharma, Preetika and Gupta, Swati and Pendse, S. Ruchita and Weil, Laura and Swendeman, Dallas and Diamond-Smith, G. Nadia", title="A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study", journal="JMIR Form Res", year="2022", month="Jun", day="29", volume="6", number="6", pages="e34087", keywords="mHealth", keywords="group care", keywords="postpartum", keywords="postnatal", keywords="antenatal", keywords="India", keywords="pilot", keywords="mobile phone", abstract="Background: Structural and cultural barriers limit Indian women's access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. Objective: We sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy. Methods: Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52\%), and back-end technology data. Results: The participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59\%) had their own phones. Half of the participants (14/29, 48\%) attended ?3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84\%) and found the educational content (20/20, 100\%) and group discussions (17/20, 85\%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges. Conclusions: The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies. ", doi="10.2196/34087", url="https://formative.jmir.org/2022/6/e34087", url="http://www.ncbi.nlm.nih.gov/pubmed/35767348" } @Article{info:doi/10.2196/37192, author="H{\"a}gglund, Maria and Scandurra, Isabella", title="Usability of the Swedish Accessible Electronic Health Record: Qualitative Survey Study", journal="JMIR Hum Factors", year="2022", month="Jun", day="23", volume="9", number="2", pages="e37192", keywords="usability", keywords="evaluation", keywords="patient-accessible electronic health records", keywords="open notes", keywords="patient portals", keywords="mobile phone", abstract="Background: Patient portals are increasingly being implemented worldwide to ensure that patients have timely access to their health data, including patients' access to their electronic health records. In Sweden, the e-service Journalen is a national patient-accessible electronic health record (PAEHR), accessible on the web through the national patient portal. User characteristics and perceived benefits of using a PAEHR will influence behavioral intentions to use and adoption; however, poor usability, which increases effort expectancy, may have a negative impact. Therefore, it is of interest to further explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective: On the basis of the analysis of the survey respondents' experiences of the usability of the Swedish PAEHR, this study aimed to identify specific usability problems that may need to be addressed in the future. Methods: A survey study was conducted to elicit opinions and experiences of patients using Journalen. Data were collected from June to October 2016. The questionnaire included a free-text question regarding the usability of the system, and the responses were analyzed using content analysis with a sociotechnical framework as guidance when grouping identified usability issues. Results: During the survey period, 423,141 users logged into Journalen, of whom 2587 (0.61\%) completed the survey (unique users who logged in; response rate 0.61\%). Of the 2587 respondents, 186 (7.19\%) provided free-text comments on the usability questions. The analysis resulted in 19 categories, which could be grouped under 7 of the 8 dimensions in the sociotechnical framework of Sittig and Singh. The most frequently mentioned problems were related to regional access limitations, structure and navigation of the patient portal, and language and understanding. Conclusions: Although the survey respondents, who were also end users of the PAEHR Journalen, were overall satisfied with its usability, they also experienced important challenges when accessing their records. For all patients to be able to reap the benefits of record access, it is essential to understand both the usability challenges they encounter and, more broadly, how policies, regulations, and technical implementation decisions affect the usefulness of record access. The results presented here are specific to the Swedish PAEHR Journalen but also provide important insights into how design and implementation of record access can be improved in any context. ", doi="10.2196/37192", url="https://humanfactors.jmir.org/2022/2/e37192", url="http://www.ncbi.nlm.nih.gov/pubmed/35737444" } @Article{info:doi/10.2196/32354, author="Signorelli, Ruiz Gabriel and Monteiro-Guerra, Francisco and Rivera-Romero, Octavio and N{\'u}{\~n}ez-Benjumea, J. Francisco and Fern{\'a}ndez-Luque, Luis", title="Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study", journal="JMIR Form Res", year="2022", month="Jun", day="22", volume="6", number="6", pages="e32354", keywords="breast cancer", keywords="BC", keywords="mobile app", keywords="physical activity", keywords="mHealth", keywords="acceptability", keywords="user experience", keywords="mobile phone", abstract="Background: Physical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences. Objective: This study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement. Methods: A mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire--Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked. Results: The International Physical Activity Questionnaire--Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC. Conclusions: Early results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC. ", doi="10.2196/32354", url="https://formative.jmir.org/2022/6/e32354", url="http://www.ncbi.nlm.nih.gov/pubmed/35731554" } @Article{info:doi/10.2196/37585, author="Munson, A. Sean and Friedman, C. Emily and Osterhage, Katie and Allred, Ryan and Pullmann, D. Michael and Are{\'a}n, A. Patricia and Lyon, R. Aaron and ", title="Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis", journal="J Med Internet Res", year="2022", month="Jun", day="14", volume="24", number="6", pages="e37585", keywords="evidence-based psychosocial interventions", keywords="usability", keywords="implementation strategies", keywords="mental health", keywords="human-centered design", keywords="implementation science", abstract="Background: People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies. Objective: This study aimed to identify and categorize usability issues in EBPIs and their implementation strategies. Methods: We adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health---funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies. Results: The 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues. Conclusions: Usability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies. International Registered Report Identifier (IRRID): RR2-10.2196/14990 ", doi="10.2196/37585", url="https://www.jmir.org/2022/6/e37585", url="http://www.ncbi.nlm.nih.gov/pubmed/35700016" } @Article{info:doi/10.2196/33734, author="Petros, Gebrewold Nuhamin and Hadlaczky, Gergo and Carletto, Sara and Martinez, Gonzalez Sergio and Ostacoli, Luca and Ottaviano, Manuel and Meyer, Bj{\"o}rn and Scilingo, Pasquale Enzo and Carli, Vladimir", title="Sociodemographic Characteristics Associated With an eHealth System Designed to Reduce Depressive Symptoms Among Patients With Breast or Prostate Cancer: Prospective Study", journal="JMIR Form Res", year="2022", month="Jun", day="8", volume="6", number="6", pages="e33734", keywords="mental health", keywords="depression", keywords="eHealth", keywords="usability", keywords="breast cancer", keywords="prostate cancer", keywords="System Usability Scale", keywords="SUS", keywords="the user version of the Mobile App Rating Scale", keywords="uMARS", keywords="Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases", keywords="NEVERMIND system", abstract="Background: eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions. Objective: This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer. Methods: The study included a total of 129 patients diagnosed with breast (n=80, 62\%) or prostate (n=49, 38\%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period. Results: The analysis was based on 108 patients (n=68, 63\%, patients with breast cancer and n=40, 37\%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men ($\beta$=.16; P=.03, 95\% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use ($\beta$=--0.13; P=.04, 95\% CI ?0.25 to ?0.01), after adjusting for other covariates. Conclusions: The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability. Trial Registration: German Clinical Trials Register RKS00013391; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00013391 ", doi="10.2196/33734", url="https://formative.jmir.org/2022/6/e33734", url="http://www.ncbi.nlm.nih.gov/pubmed/35675116" } @Article{info:doi/10.2196/34884, author="Knobel, Johannes Samuel Elia and Kaufmann, Charlotte Brigitte and Geiser, Nora and Gerber, Moreno Stephan and M{\"u}ri, M. Ren{\'e} and Nef, Tobias and Nyffeler, Thomas and Cazzoli, Dario", title="Effects of Virtual Reality--Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study", journal="JMIR Serious Games", year="2022", month="May", day="25", volume="10", number="2", pages="e34884", keywords="virtual reality", keywords="search task", keywords="stroke", keywords="neglect, multimodal cueing", keywords="bird search task", abstract="Background: Virtual reality (VR) devices are increasingly being used in medicine and other areas for a broad spectrum of applications. One of the possible applications of VR involves the creation of an environment manipulated in a way that helps patients with disturbances in the spatial allocation of visual attention (so-called hemispatial neglect). One approach to ameliorate neglect is to apply cross-modal cues (ie, cues in sensory modalities other than the visual one, eg, auditory and tactile) to guide visual attention toward the neglected space. So far, no study has investigated the effects of audio-tactile cues in VR on the spatial deployment of visual attention in neglect patients. Objective: This pilot study aimed to investigate the feasibility and usability of multimodal (audio-tactile) cueing, as implemented in a 3D VR setting, in patients with neglect, and obtain preliminary results concerning the effects of different types of cues on visual attention allocation compared with noncued conditions. Methods: Patients were placed in a virtual environment using a head-mounted display (HMD). The inlay of the HMD was equipped to deliver tactile feedback to the forehead. The task was to find and flag appearing birds. The birds could appear at 4 different presentation angles (lateral and paracentral on the left and right sides), and with (auditory, tactile, or audio-tactile cue) or without (no cue) a spatially meaningful cue. The task usability and feasibility, and 2 simple in-task measures (performance and early orientation) were assessed in 12 right-hemispheric stroke patients with neglect (5 with and 7 without additional somatosensory impairment). Results: The new VR setup showed high usability (mean score 10.2, SD 1.85; maximum score 12) and no relevant side effects (mean score 0.833, SD 0.834; maximum score 21). A repeated measures ANOVA on task performance data, with presentation angle, cue type, and group as factors, revealed a significant main effect of cue type (F30,3=9.863; P<.001) and a significant 3-way interaction (F90,9=2.057; P=.04). Post-hoc analyses revealed that among patients without somatosensory impairment, any cue led to better performance compared with no cue, for targets on the left side, and audio-tactile cues did not seem to have additive effects. Among patients with somatosensory impairment, performance was better with both auditory and audio-tactile cueing than with no cue, at every presentation angle; conversely, tactile cueing alone had no significant effect at any presentation angle. Analysis of early orientation data showed that any type of cue triggered better orientation in both groups for lateral presentation angles, possibly reflecting an early alerting effect. Conclusions: Overall, audio-tactile cueing seems to be a promising method to guide patient attention. For instance, in the future, it could be used as an add-on method that supports attentional orientation during established therapeutic approaches. ", doi="10.2196/34884", url="https://games.jmir.org/2022/2/e34884", url="http://www.ncbi.nlm.nih.gov/pubmed/35612894" } @Article{info:doi/10.2196/37118, author="Kim, Sunyoung and Stanton, Kaitlyn and Park, Yunoh and Thomas, Stephen", title="A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study", journal="JMIR Form Res", year="2022", month="May", day="23", volume="6", number="5", pages="e37118", keywords="asthma", keywords="children", keywords="indoor air quality", keywords="mobile app", keywords="smartphone", keywords="mHealth", abstract="Background: Indoor air quality is an important environmental factor that triggers and exacerbates asthma, the most common chronic disease in children. A mobile app to monitor indoor air quality could help occupants keep their indoor air quality clean. However, no app is available that allows children to monitor and improve their indoor air quality. Objective: Previously, we conducted a series of user-centered design studies to identify user needs and design requirements toward creating a mobile app that helps children with asthma to engage in monitoring and improving indoor air quality as part of their asthma management. Based on the findings from these studies, we created AirBuddy, a child-friendly app that visualizes air quality indoors and outdoors. Methods: This paper reports on the findings from a field deployment with 7 pediatric asthma patients, where we evaluated AirBuddy's usability and usefulness in real-world settings by conducting weekly semistructured interviews for 8 weeks. Results: All participants positively responded to the usefulness and usability of AirBuddy, which we believe is thanks to the iterative, user-centered design approach that allowed us to identify and address potential usability issues early on and throughout the design process. Conclusions: This project contributes to the field of mHealth app design for children by demonstrating how a user-centered design process can lead to the development of digital devices that are more acceptable and relevant to target users' needs. ", doi="10.2196/37118", url="https://formative.jmir.org/2022/5/e37118", url="http://www.ncbi.nlm.nih.gov/pubmed/35604753" } @Article{info:doi/10.2196/34906, author="Patel, Tejal and Ivo, Jessica and Pitre, Teresa and Faisal, Sadaf and Antunes, Kristen and Oda, Kasumi", title="An In-Home Medication Dispensing System to Support Medication Adherence for Patients With Chronic Conditions in the Community Setting: Prospective Observational Pilot Study", journal="JMIR Form Res", year="2022", month="May", day="19", volume="6", number="5", pages="e34906", keywords="smart", keywords="medication adherence", keywords="usability", keywords="geriatric", keywords="in-home", keywords="community", keywords="chronic diseases", keywords="medication dispensing", keywords="eHealth", keywords="platform", keywords="self management", keywords="support tool", keywords="chronic disease", keywords="caregiver", keywords="satisfaction", abstract="Background: Innovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients' homes. One such smart medication dispenser, spencer, provides alerts to patients to take their medications and allows for tracking and reporting real-time medication adherence data. Objective: The objectives of this study were to examine the use of a smart medication dispenser as a medication adherence and self-management support tool for community dwelling adults over a 6-month period, in addition to usability, usefulness, satisfaction, and impact on caregiver support. Methods: This prospective, observational study invited community-dwelling adults aged 45 years and older taking at least one chronic medication and their caregivers to use this smart medication dispenser for their medication administration for 6 months. Adherence was defined as a dose intake within 2 hours post scheduled time. Real-time adherence data were collected using the smart medication dispenser and the AdhereNet platform. Usability, usefulness, and satisfaction were measured using the System Usability Scale and the Usefulness, Satisfaction, and Ease of Use questionnaire, respectively. Caregiver burden was measured on a visual analog scale at baseline and at the end of the 6-month study period. Results: A total of 58 participants were recruited, of which 55\% (32/58) were female with a mean age of 66.36 (SD 11.28; range 48-90) years. Eleven caregiver participants were recruited, of whom 91\% (10/11) were female. The average monthly adherence over 6 months was 98\% (SD 3.1\%; range 76.5\%-100\%). The average System Usability score was 85.74 (n=47; SD 12.7; range 47.5-100). Of the 46 participants who provided data, 44 (96\%) rated the product as easy, 43 (93\%) as simple to use, and 43 (93\%) were satisfied with the product. Caregiver burden prior to and following smart medication dispenser use for 6 months was found to be statistically significantly different (P<.001; CI 2.11-5.98). Conclusions: Smart medication adherence products such as spencer, when connected and clinically monitored, can be a useful solution for medication management and have the potential to improve caregiver burden. ", doi="10.2196/34906", url="https://formative.jmir.org/2022/5/e34906", url="http://www.ncbi.nlm.nih.gov/pubmed/35587371" } @Article{info:doi/10.2196/31758, author="Cho, Hwayoung and Keenan, Gail and Madandola, O. Olatunde and Dos Santos, Cristina Fabiana and Macieira, R. Tamara G. and Bjarnadottir, I. Ragnhildur and Priola, B. Karen J. and Dunn Lopez, Karen", title="Assessing the Usability of a Clinical Decision Support System: Heuristic Evaluation", journal="JMIR Hum Factors", year="2022", month="May", day="10", volume="9", number="2", pages="e31758", keywords="usability", keywords="heuristic", keywords="clinical decision support", keywords="electronic health record", keywords="expert review", keywords="evaluation", keywords="user interface", keywords="human-computer interaction", abstract="Background: Poor usability is a primary cause of unintended consequences related to the use of electronic health record (EHR) systems, which negatively impacts patient safety. Due to the cost and time needed to carry out iterative evaluations, many EHR components, such as clinical decision support systems (CDSSs), have not undergone rigorous usability testing prior to their deployment in clinical practice. Usability testing in the predeployment phase is crucial to eliminating usability issues and preventing costly fixes that will be needed if these issues are found after the system's implementation. Objective: This study presents an example application of a systematic evaluation method that uses clinician experts with human-computer interaction (HCI) expertise to evaluate the usability of an electronic clinical decision support (CDS) intervention prior to its deployment in a randomized controlled trial. Methods: We invited 6 HCI experts to participate in a heuristic evaluation of our CDS intervention. Each expert was asked to independently explore the intervention at least twice. After completing the assigned tasks using patient scenarios, each expert completed a heuristic evaluation checklist developed by Bright et al based on Nielsen's 10 heuristics. The experts also rated the overall severity of each identified heuristic violation on a scale of 0 to 4, where 0 indicates no problems and 4 indicates a usability catastrophe. Data from the experts' coded comments were synthesized, and the severity of each identified usability heuristic was analyzed. Results: The 6 HCI experts included professionals from the fields of nursing (n=4), pharmaceutical science (n=1), and systems engineering (n=1). The mean overall severity scores of the identified heuristic violations ranged from 0.66 (flexibility and efficiency of use) to 2.00 (user control and freedom and error prevention), in which scores closer to 0 indicate a more usable system. The heuristic principle user control and freedom was identified as the most in need of refinement and, particularly by nonnursing HCI experts, considered as having major usability problems. In response to the heuristic match between system and the real world, the experts pointed to the reversed direction of our system's pain scale scores (1=severe pain) compared to those commonly used in clinical practice (typically 1=mild pain); although this was identified as a minor usability problem, its refinement was repeatedly emphasized by nursing HCI experts. Conclusions: Our heuristic evaluation process is simple and systematic and can be used at multiple stages of system development to reduce the time and cost needed to establish the usability of a system before its widespread implementation. Furthermore, heuristic evaluations can help organizations develop transparent reporting protocols for usability, as required by Title IV of the 21st Century Cures Act. Testing of EHRs and CDSSs by clinicians with HCI expertise in heuristic evaluation processes has the potential to reduce the frequency of testing while increasing its quality, which may reduce clinicians' cognitive workload and errors and enhance the adoption of EHRs and CDSSs. ", doi="10.2196/31758", url="https://humanfactors.jmir.org/2022/2/e31758", url="http://www.ncbi.nlm.nih.gov/pubmed/35536613" } @Article{info:doi/10.2196/35065, author="Buss, Helen Vera and Varnfield, Marlien and Harris, Mark and Barr, Margo", title="A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="May", day="10", volume="9", number="2", pages="e35065", keywords="mobile health", keywords="behavior change intervention", keywords="primary prevention", keywords="health promotion", keywords="cardiovascular disease", keywords="diabetes mellitus, type 2", keywords="mobile phone", abstract="Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ?45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60\% (6/10) of the participants owned iPhone Operating System phones, and 40\% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30\% (3/10) of the participants from completing the registration process. Among the 70\% (7/10) of participants who were able to complete the registration process, 71\% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants' feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. ", doi="10.2196/35065", url="https://humanfactors.jmir.org/2022/2/e35065", url="http://www.ncbi.nlm.nih.gov/pubmed/35536603" } @Article{info:doi/10.2196/35994, author="Kumwichar, Ponlagrit and Chongsuvivatwong, Virasakdi and Prappre, Tagoon", title="Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study", journal="JMIR Form Res", year="2022", month="May", day="6", volume="6", number="5", pages="e35994", keywords="app", keywords="compliance", keywords="usability", keywords="remote monitoring", keywords="therapy", keywords="tuberculosis", keywords="lung", keywords="infectious disease", keywords="user experience", keywords="video directly observed therapy", keywords="video-enhanced therapy", keywords="video-observed therapy", keywords="digital health", keywords="health care system", keywords="disease monitoring", keywords="health monitoring", keywords="video consultation", keywords="online health", keywords="virtual therapy", abstract="Background: In Thailand, the health care system has struggled to cope with COVID-19, resulting in directly observed therapy for tuberculosis being de-emphasized. A video-observed therapy (VOT) system, or more specifically, the Thai VOT (TH VOT) system, was developed to replace directly observed therapy. According to the pilot study, the system needed notifications to improve usability and user compliance. The updated version of the TH VOT system thus enabled LINE (Line Corporation) notifications. Objective: This study aimed to reassess users' compliance with and the usability of the updated TH VOT system. Methods: This study was conducted in the Hat Yai and Mueang Songkhla districts in Songkhla Province, Southern Thailand, from September 18 to December 1, 2021. The system was used by not only patients with tuberculosis but also tuberculosis staff, who acted as observers in primary health care settings. Some of the observers used the simulated VOT system instead of the actual system due to the lack of participating patients in their jurisdiction. After 30 days of using the system, VOT session records were analyzed to determine the compliance of the patients and observers. The User Experience Questionnaire was administered to reassess the usability of the system and compare the ratings of the participants with the general benchmark scores of the User Experience Questionnaire. The results were summarized to reveal the degree of user compliance and usability in the following three groups: the patients, actual VOT observers, and simulated VOT observers. Results: Of the 19 observers, 10 used the actual VOT system, and the remaining 9 used the simulated VOT system; there were also 10 patients with tuberculosis. The patients, actual VOT observers, and simulated VOT observers exhibited about 70\%, 65\%, and 50\% compliance, respectively, in terms of following the standard operating procedures every day. The scores of all groups on all dimensions were well above the average scores. There was no significant difference in any of the dimensional scores among the three groups. Conclusions: The updated version of the TH VOT system was deemed usable by both the patients and the health care staff. Compliance with the use of the system was high among the patients but moderate among the observers. ", doi="10.2196/35994", url="https://formative.jmir.org/2022/5/e35994", url="http://www.ncbi.nlm.nih.gov/pubmed/35522469" } @Article{info:doi/10.2196/33594, author="Gelgoot, Noah Eden and Kruglova, Katya and Chan, Peter and Lo, Kirk and Rosberger, Zeev and Chown, Philippa and Kazdan, Jordana and O'Connell, Laura Siobhan Bernadette and Zelkowitz, Phyllis", title="Evaluation of a Mobile Health App Offering Fertility Information to Male Patients With Cancer: Usability Study", journal="JMIR Cancer", year="2022", month="May", day="4", volume="8", number="2", pages="e33594", keywords="mobile app", keywords="eHealth", keywords="male", keywords="cancer", keywords="infertility", keywords="fertility preservation", keywords="psycho-oncology", abstract="Background: Cancer and its treatment can adversely affect male fertility. Although sperm banking is an effective fertility preservation method, there is an unmet need for information and support surrounding these issues. Objective: This usability study evaluates a mobile health app providing male patients with cancer with credible information about the impact of cancer and its treatment on fertility and fertility preservation. Methods: Participants were recruited by a market research firm. Eligibility criteria were men who were 18-45 years of age, identified as male, diagnosed with new or recurring cancer within 1 year, not in fertility treatment, able to read and write in English or French, and had internet access. App usage was tracked for 2 weeks. After app use, participants provided qualitative feedback about their experiences using the app as well as quantitative data regarding their sperm banking decisions, perceived change in fertility knowledge, evaluation of the app's information on the Information Assessment Method, and the app's quality on the user version of the Mobile App Rating Scale. Results: The sample included 40 men aged 27-45 years. Approximately 68\% (27/40) indicated that no one had previously spoken to them about the impact of cancer on fertility, and 85\% (34/40) had not received information on fertility preservation. Approximately 83\% (33/40) found the app's information relevant, and 85\% (34/40) said that it increased their fertility knowledge. Approximately 23\% (9/40) made a decision about sperm banking after using the app. Participants rated the app's quality highly, with mean scores (out of 5) of 4.14 for information, 4.06 for functionality, 3.84 for aesthetics, and 3.63 for engagement. Conclusions: The app proved to be useful for male patients with cancer, suggesting that mobile health resources could be beneficial to incorporate into clinical care to enable shared decision-making about fertility. ", doi="10.2196/33594", url="https://cancer.jmir.org/2022/2/e33594", url="http://www.ncbi.nlm.nih.gov/pubmed/35507408" } @Article{info:doi/10.2196/35094, author="Pit, Sabrina and Ramsden, Robyn and Tan, JH Aaron and Payne, Kristy and Barr, James and Eames, Benjamin and Edwards, Mike and Colbran, Richard", title="Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help?", journal="JMIR Hum Factors", year="2022", month="May", day="2", volume="9", number="2", pages="e35094", keywords="health", keywords="wellness", keywords="mobile apps", keywords="persuasive strategies", keywords="behavior change", keywords="review", keywords="health workforce", keywords="capability", keywords="career", keywords="employment", keywords="rural", keywords="workforce planning", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="health professional", keywords="user experience", keywords="health application", keywords="task support", keywords="social support", keywords="dialog support", abstract="Background: Health professionals' perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals' perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini's Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific--based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals' perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. ", doi="10.2196/35094", url="https://humanfactors.jmir.org/2022/2/e35094", url="http://www.ncbi.nlm.nih.gov/pubmed/35499866" } @Article{info:doi/10.2196/35625, author="Perales-Puchalt, Jaime and Acosta-Rull{\'a}n, Mariola and Ram{\'i}rez-Mantilla, Mariana and Espinoza-Kissell, Paul and Vidoni, Eric and Niedens, Michelle and Ellerbeck, Edward and Hinton, Ladson and Loera, Linda and Ram{\'i}rez, Susana A. and Lara, Esther and Watts, Amber and Williams, Kristine and Resendez, Jason and Burns, Jeffrey", title="A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study", journal="JMIR Aging", year="2022", month="Apr", day="28", volume="5", number="2", pages="e35625", keywords="Latinx individuals", keywords="mHealth", keywords="dementia", keywords="caregiving", abstract="Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging--based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. Conclusions: CuidaTEXT's prototype demonstrated high usability among Latinx caregivers. CuidaTEXT's feasibility is ready to be tested. ", doi="10.2196/35625", url="https://aging.jmir.org/2022/2/e35625", url="http://www.ncbi.nlm.nih.gov/pubmed/35482366" } @Article{info:doi/10.2196/34543, author="Rian, Torbj{\o}rn and Sand, Kari and Skogvoll, Eirik and Klepstad, P{\aa}l and Wik, S. Tina", title="A Web-Based Communication Tool for Postoperative Follow-up and Pain Assessment at Home After Primary Knee Arthroplasty: Feasibility and Usability Study", journal="JMIR Form Res", year="2022", month="Apr", day="28", volume="6", number="4", pages="e34543", keywords="feasibility studies", keywords="postoperative follow-up", keywords="primary knee arthroplasty, pain assessment", keywords="mobile application", keywords="pain treatment", keywords="follow-up at home", abstract="Background: We report the use of an electronic tool, Eir (Eir Solutions AS, Norway), for symptom registration at home after knee arthroplasty. This electronic tool was used in a randomized controlled trial (RCT) comparing 3 different analgesic regimens with respect to postoperative pain and side effects. Objective: The aim of this substudy was to investigate this electronic tool for symptom registrations at home with respect to usability (ie, how easy it was to use) and feasibility (ie, how well the tool served its purpose). Methods: To assess the tool's usability, all participants were invited to fill out the 10-item System Usability Scale (SUS) after using the tool for 8 days. To assess feasibility, data regarding the participants' ability to use the tool with or without assistance or reminders were collected qualitatively on a daily basis during the study period. Results: A total of 134 patients completed the RCT. Data concerning feasibility of the web-based tool were collected from all 134 patients. The SUS was completed by 119 of the 134 patients; 70.2\% (94/134) of the patients managed to use the tool at home without any technical support. All technical challenges were related to the login procedure or internet access. The mean SUS score was 89.6 (median 92.5; range 22.5-100). Conclusions: This study showed high feasibility and high usability of the Eir web tool. The received reports gave the necessary information needed for both research data and clinical follow-up. Trial Registration: ClinicalTrials.gov NCT02604446; https://www.clinicaltrials.gov/ct2/show/NCT02604446 ", doi="10.2196/34543", url="https://formative.jmir.org/2022/4/e34543", url="http://www.ncbi.nlm.nih.gov/pubmed/35482392" } @Article{info:doi/10.2196/34606, author="Gooch, Daniel and Mehta, Vikram and Stuart, Avelie and Katz, Dmitri and Bennasar, Mohamed and Levine, Mark and Bandara, Arosha and Nuseibeh, Bashar and Bennaceur, Amel and Price, Blaine", title="Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="Apr", day="27", volume="9", number="2", pages="e34606", keywords="older adults", keywords="health", keywords="emotion", keywords="affect", keywords="well-being", keywords="tangible interaction", keywords="TUI", abstract="Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. ", doi="10.2196/34606", url="https://humanfactors.jmir.org/2022/2/e34606", url="http://www.ncbi.nlm.nih.gov/pubmed/35475781" } @Article{info:doi/10.2196/34903, author="Dennett, M. Amy and Tang, Y. Clarice and Chiu, April and Osadnik, Christian and Granger, L. Catherine and Taylor, F. Nicholas and Campbell, L. Kristin and Barton, Christian", title="A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study", journal="JMIR Cancer", year="2022", month="Apr", day="21", volume="8", number="2", pages="e34903", keywords="cancer", keywords="website", keywords="online learning", keywords="professional development", keywords="physiotherapy", keywords="exercise", keywords="cancer survivorship", keywords="cancer survivor", keywords="digital health", keywords="online health", keywords="online toolkit", abstract="Background: Access to exercise therapy for cancer survivors is poor. Professional development to support exercise professionals in delivering these interventions is needed. Few online resources exist for exercise professionals to address this issue. Objective: To develop and evaluate a freely available online toolkit to support exercise professionals working with cancer survivors. Methods: A 2-phase, experience-based co-design approach was used to develop and evaluate the online toolkit. The two phases were as follows: 1) needs identification and co-design of resources and platform and 2) pilot evaluation. Four co-design workshops were conducted, transcribed, and thematically analyzed to identify key elements for the toolkit. For the pilot evaluation, a customized survey (the Determinants of Implementation Behavior Questionnaire) was distributed to exercise professionals at baseline and 3 months after launch of the online toolkit to determine its usability, utility, and effectiveness in improving their knowledge, confidence, and behavior. Results were reported as the median and interquartile range and changes were calculated using non-parametric tests. Website analytics described site usage after the initial evaluation. Results: Twenty-five exercise professionals participated in co-designing 8 key elements of the online Cancer Exercise Toolkit: the homepage and pages for getting started, screening and safety, assessment, exercise prescription, education, locations, and resources. For the pilot evaluation, 277/320 respondents (87\% of whom were physiotherapists) from 26 countries completed the survey at baseline, with 58 exercise professionals completing follow-up surveys at 3 months. Exercise professionals' knowledge, skills, and confidence in delivering exercise therapy to cancer survivors increased 3 months after baseline (items 1, 6, and 8: median score 5, IQR 3 to 6) to follow-up (items 1 and 6: median score 6, IQR 5 to 6; item 8: median score 5, IQR 5 to 7; P<.001) on a 1 to 7 Likert scale. Most participants (35/44, 80\%) agreed or strongly agreed they would recommend the toolkit to colleagues. In the 6 months following the pilot evaluation, the toolkit received an average of 866 views per month. Conclusions: The co-designed online Cancer Exercise Toolkit was a useful resource for exercise professionals that may increase their knowledge, skills, and confidence in providing exercise therapy to cancer survivors. ", doi="10.2196/34903", url="https://cancer.jmir.org/2022/2/e34903", url="http://www.ncbi.nlm.nih.gov/pubmed/35451966" } @Article{info:doi/10.2196/33886, author="van Strien-Knippenberg, S. Inge and Altendorf, B. Maria and Hoving, Ciska and van Weert, M. Julia C. and Smit, S. Eline", title="Message Frame--Tailoring in Digital Health Communication: Intervention Redesign and Usability Testing", journal="JMIR Form Res", year="2022", month="Apr", day="21", volume="6", number="4", pages="e33886", keywords="digital health communication", keywords="web-based computer tailoring", keywords="smoking cessation intervention", keywords="message framing", keywords="usability testing", abstract="Background: Message frame--tailoring based on the need for autonomy is a promising strategy to improve the effectiveness of digital health communication interventions. An example of a digital health communication intervention is Personal Advice in Stopping smoking (PAS), a web-based content-tailored smoking cessation program. PAS was effective in improving cessation success rates, but its effect sizes were small and disappeared after 6 months. Therefore, investigating whether message frame--tailoring based on the individual's need for autonomy might improve effect rates is worthwhile. However, to our knowledge, this has not been studied previously. Objective: To investigate whether adding message frame--tailoring based on the need for autonomy increases the effectiveness of content-tailored interventions, the PAS program was redesigned to incorporate message frame--tailoring also. This paper described the process of redesigning the PAS program to include message frame--tailoring, providing smokers with autonomy-supportive or controlling message frames---depending on their individual need for autonomy. Therefore, we aimed to extend framing theory, tailoring theory, and self-determination theory. Methods: Extension of the framing theory, tailoring theory, and self-determination theory by redesigning the PAS program to include message frame--tailoring was conducted in close collaboration with scientific and nonscientific smoking cessation experts (n=10), smokers (n=816), and communication science students (n=19). Various methods were used to redesign the PAS program to include message frame--tailoring with optimal usability: usability testing, think-aloud methodology, heuristic evaluations, and a web-based experiment. Results: The most autonomy-supportive and controlling message frames were identified, the cutoff point for the need for autonomy to distinguish between people with high and those with low need for autonomy was determined, and the usability was optimized. Conclusions: This resulted in a redesigned digital health communication intervention that included message frame--tailoring and had optimal usability. A detailed description of the redesigning process of the PAS program is provided. Trial Registration: Netherlands Trial Register NL6512 (NRT6700); https://www.trialregister.nl/trial/6512 ", doi="10.2196/33886", url="https://formative.jmir.org/2022/4/e33886", url="http://www.ncbi.nlm.nih.gov/pubmed/35451988" } @Article{info:doi/10.2196/34626, author="Sch{\"o}pfer, C{\'e}line and Ehrler, Frederic and Berger, Antoine and Bollondi Pauly, Catherine and Buytaert, Laurence and De La Serna, Camille and Hartheiser, Florence and Fassier, Thomas and Clavien, Christine", title="A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="Apr", day="20", volume="9", number="2", pages="e34626", keywords="usability", keywords="mobile apps", keywords="advance directives", keywords="advance care planning", keywords="mHealth", keywords="mobile health", keywords="palliative care", keywords="mobile phone", abstract="Background: Advance care planning, including advance directives, is an important tool that allows patients to express their preferences for care if they are no longer able to express themselves. We developed Accordons-nous, a smartphone app that informs patients about advance care planning and advance directives, facilitates communication on these sensitive topics, and helps patients express their values and preferences for care. Objective: The first objective of this study is to conduct a usability test of this app. The second objective is to collect users' critical opinions on the usability and relevance of the tool. Methods: We conducted a usability test by means of a think-aloud method, asking 10 representative patients to complete 7 browsing tasks. We double coded the filmed sessions to obtain descriptive data on task completion (with or without help), time spent, number of clicks, and the types of problems encountered. We assessed the severity of the problems encountered and identified the modifications needed to address these problems. We evaluated the readability of the app using Scolarius, a French equivalent of the Flesch Reading Ease test. By means of a posttest questionnaire, we asked participants to assess the app's usability (System Usability Scale), relevance (Mobile App Rating Scale, section F), and whether they would recommend the app to the target groups: patients, health professionals, and patients' caring relatives. Results: Participants completed the 7 think-aloud tasks in 80\% (56/70) of the cases without any help from the experimenter, in 16\% (11/70) of the cases with some help, and failed in 4\% (3/70) of the cases. The analysis of failures and difficulties encountered revealed a series of major usability problems that could be addressed with minor modifications to the app. Accordons-nous obtained high scores on readability (overall score of 87.4 on Scolarius test, corresponding to elementary school level), usability (85.3/100 on System Usability Scale test), relevance (4.3/5 on the Mobile App Rating Scale, section F), and overall subjective endorsement on 3 I would recommend questions (4.7/5). Conclusions: This usability test helped us make the final changes to our app before its official launch. ", doi="10.2196/34626", url="https://humanfactors.jmir.org/2022/2/e34626", url="http://www.ncbi.nlm.nih.gov/pubmed/35442206" } @Article{info:doi/10.2196/36675, author="Burda, V{\'a}clav and Mr{\'a}z, Milo{\vs} and Schneider, Jakub and Nov{\'a}k, Daniel", title="Managing Diabetes Using Mobiab: Long-Term Case Study of the Impact of a Mobile App on Self-management", journal="JMIR Diabetes", year="2022", month="Apr", day="20", volume="7", number="2", pages="e36675", keywords="diabetes mellitus", keywords="self-management", keywords="mobile app", keywords="case study", keywords="long-term data", abstract="Background: This paper describes the development of a mobile app for diabetes mellitus (DM) control and self-management and presents the results of long-term usage of this system in the Czech Republic. DM is a chronic disease affecting large numbers of people worldwide, and this number is continuously increasing. There is massive potential to increase adherence to self-management of DM with the use of smartphones and digital therapeutics interventions. Objective: This study aims to describe the process of development of a mobile app, called Mobiab, for DM management and to investigate how individual features are used and how the whole system benefits its long-term users. Using at least 1 year of daily records from users, we analyzed the impact of the app on self-management of DM. Methods: We have developed a mobile app that serves as an alternative form to the classic paper-based protocol or diary. The development was based on cooperation with both clinicians and people with DM. The app consists of independent individual modules. Therefore, the user has the possibility to use only selected features that they find useful. Mobiab was available free of charge on Google Play Store from mid-2014 until 2019. No targeted recruitment was performed to attract users. Results: More than 500 users from the Czech Republic downloaded and signed up for the mobile app. Approximately 80\% of the users used Mobiab for less than 1 week. The rest of the users used it for a longer time and 8 of the users produced data that were suitable for long-term analysis. Additionally, one of the 8 users provided their medical records, which were compared with the gathered data, and the improvements in their glucose levels and overall metabolic stability were consistent with the way in which the mobile app was used. Conclusions: The results of this study showed that the usability of a DM-centered self-management smartphone mobile app and server-based systems could be satisfactory and promising. Nonetheless, some better ways of motivating people with diabetes toward participation in self-management are needed. Further studies involving a larger number of participants are warranted to assess the effect on long-term diabetes management. ", doi="10.2196/36675", url="https://diabetes.jmir.org/2022/2/e36675", url="http://www.ncbi.nlm.nih.gov/pubmed/35442201" } @Article{info:doi/10.2196/32960, author="Hollanda De Sa Neto, Herul and Habfast-Robertson, Ines and Hempel-Bruder, Christina and Durand, Marie-Anne and Jacot-Sadowski, Isabelle and Khazaal, Yasser and Berlin, Ivan and Selby, Kevin", title="Formative Provider Testing of a New Encounter Decision Aid for Smoking Cessation: Questionnaire Study", journal="JMIR Form Res", year="2022", month="Apr", day="20", volume="6", number="4", pages="e32960", keywords="decision aid", keywords="smoking cessation", keywords="electronic tool", keywords="shared decision-making", abstract="Background: Smoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments. Objective: We aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care. Methods: We developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians. Results: In all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments. Conclusions: The overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use. ", doi="10.2196/32960", url="https://formative.jmir.org/2022/4/e32960", url="http://www.ncbi.nlm.nih.gov/pubmed/35442200" } @Article{info:doi/10.2196/25880, author="Khowaja, Kamran and Syed, Waheeda Wafa and Singh, Meghna and Taheri, Shahrad and Chagoury, Odette and Al-Thani, Dena and Aupetit, Micha{\"e}l", title="A Participatory Design Approach to Develop Visualization of Wearable Actigraphy Data for Health Care Professionals: Case Study in Qatar", journal="JMIR Hum Factors", year="2022", month="Apr", day="8", volume="9", number="2", pages="e25880", keywords="participatory design", keywords="user-centered design", keywords="visualization", keywords="health care professional", keywords="persona", keywords="brainwriting", keywords="heuristic walkthrough", keywords="use case", keywords="interface walkthrough", abstract="Background: Several tools have been developed for health care professionals to monitor the physical activity of their patients, but most of these tools have been considering only the needs of users in North American and European countries and applicable for only specific analytic tasks. To our knowledge, no research study has utilized the participatory design (PD) approach in the Middle East region to develop such tools, involving all the stakeholders in the product development phases, and no clear use cases have been derived from such studies that could serve future development in the field. Objective: This study aims to develop an interactive visualization tool (ActiVis) to support local health care professionals in monitoring the physical activity of their patients measured through wearable sensors, with the overall objective of improving the health of the Qatari population. Methods: We used PD and user-centered design methodologies to develop ActiVis, including persona development, brainwriting, and heuristic walkthrough as part of user evaluation workshops; and use cases, heuristic walkthrough, interface walkthrough, and survey as part of expert evaluation sessions. Results: We derived and validated 6 data analysis use cases targeted at specific health care professionals from a collaborative design workshop and an expert user study. These use cases led to improving the design of the ActiVis tool to support the monitoring of patients' physical activity by nurses and family doctors. The ActiVis research prototype (RP) compared favorably with the Fitbit Dashboard, showing the importance of design tools specific to end users' needs rather than relying on repurposing existing tools designed for other types of users. The use cases we derived happen to be culturally agnostic, despite our assumption that the local Muslim and Arabic culture could impact the design of such visualization tools. At last, taking a step back, we reflect on running collaborative design sessions in a multicultural environment and oil-based economy. Conclusions: Beyond the development of the ActiVis tool, this study can serve other visualization and human--computer interaction designers in the region to prepare their design projects and encourage health care professionals to engage with designers and engineers to improve the tools they use for supporting their daily routine. The development of the ActiVis tool for nurses, and other visualization tools specific to family doctors and clinician researchers, is still ongoing and we plan to integrate them into an operational platform for health care professionals in Qatar in the near future. ", doi="10.2196/25880", url="https://humanfactors.jmir.org/2022/2/e25880", url="http://www.ncbi.nlm.nih.gov/pubmed/35394442" } @Article{info:doi/10.2196/35358, author="Tanaka, Hiroki and Nakamura, Satoshi", title="The Acceptability of Virtual Characters as Social Skills Trainers: Usability Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="29", volume="9", number="1", pages="e35358", keywords="social skills training", keywords="virtual agent design", keywords="virtual assistant", keywords="virtual trainer", keywords="chatbot", keywords="acceptability", keywords="realism", keywords="virtual agent", keywords="simulation", keywords="social skill", keywords="social interaction", keywords="design", keywords="training", keywords="crowdsourcing", abstract="Background: Social skills training by human trainers is a well-established method to provide appropriate social interaction skills and strengthen social self-efficacy. In our previous work, we attempted to automate social skills training by developing a virtual agent that taught social skills through interaction. Previous research has not investigated the visual design of virtual agents for social skills training. Thus, we investigated the effect of virtual agent visual design on automated social skills training. Objective: The 3 main purposes of this research were to investigate the effect of virtual agent appearance on automated social skills training, the relationship between acceptability and other measures (eg, likeability, realism, and familiarity), and the relationship between likeability and individual user characteristics (eg, gender, age, and autistic traits). Methods: We prepared images and videos of a virtual agent, and 1218 crowdsourced workers rated the virtual agents through a questionnaire. In designing personalized virtual agents, we investigated the acceptability, likeability, and other impressions of the virtual agents and their relationship to individual characteristics. Results: We found that there were differences between the virtual agents in all measures (P<.001). A female anime-type virtual agent was rated as the most likeable. We also confirmed that participants' gender, age, and autistic traits were related to their ratings. Conclusions: We confirmed the effect of virtual agent design on automated social skills training. Our findings are important in designing the appearance of an agent for use in personalized automated social skills training. ", doi="10.2196/35358", url="https://humanfactors.jmir.org/2022/1/e35358", url="http://www.ncbi.nlm.nih.gov/pubmed/35348468" } @Article{info:doi/10.2196/26461, author="Stambler, Mollie Danielle and Feddema, Erin and Riggins, Olivia and Campeau, Kari and Breuch, Kastman Lee-Ann and Kessler, M. Molly and Misono, Stephanie", title="REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="25", volume="9", number="1", pages="e26461", keywords="web-based intervention", keywords="REDCap", keywords="voice disorders", keywords="usability study", keywords="heuristics", keywords="eHealth", keywords="online", keywords="health", keywords="web-based participation", keywords="patients", keywords="web-based platform", abstract="Background: Web-based health interventions are increasingly common and are promising for patients with voice disorders because web-based participation does not require voice use. To address needs such as Health Insurance Portability and Accountability Act compliance, unique user access, the ability to send automated reminders, and a limited development budget, we used the Research Electronic Data Capture (REDCap) data management platform to deliver a patient-facing psychological intervention designed for patients with voice disorders. This was a novel use of REDCap. Objective: We aimed to evaluate the usability of the intervention, with this intervention serving as a use case for REDCap-based patient-facing interventions. Methods: We used REDCap survey instruments to develop the web-based voice intervention modules, then conducted usability evaluations using (1) heuristic evaluations by 2 evaluators, and (2) formal usability testing with 7 participants, consisting of predetermined tasks, a think-aloud protocol, ease-of-use measurements, a product reaction card, and a debriefing interview. Results: Heuristic evaluations found strengths in visibility of system status and real-world match, and weaknesses in user control and help documentation. Based on this feedback, changes to the intervention were made before usability testing. Overall, usability testing participants found the intervention useful and easy to use, although testing revealed some concerns with design, content, and terminology. Some concerns were readily addressed, and others required adaptations within REDCap. Conclusions: The REDCap version of a complex web-based patient-facing intervention performed well in heuristic evaluation and formal usability testing. REDCap can effectively be used for patient-facing intervention delivery, particularly if the limitations of the platform are anticipated and mitigated. ", doi="10.2196/26461", url="https://humanfactors.jmir.org/2022/1/e26461", url="http://www.ncbi.nlm.nih.gov/pubmed/35333191" } @Article{info:doi/10.2196/30130, author="Strauss, T. Alexandra and Morgan, Cameron and El Khuri, Christopher and Slogeris, Becky and Smith, G. Aria and Klein, Eili and Toerper, Matt and DeAngelo, Anthony and Debraine, Arnaud and Peterson, Susan and Gurses, P. Ayse and Levin, Scott and Hinson, Jeremiah", title="A Patient Outcomes--Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)", journal="JMIR Hum Factors", year="2022", month="Mar", day="23", volume="9", number="1", pages="e30130", keywords="emergency medicine", keywords="usability", keywords="human-centered design", keywords="health informatics", keywords="feedback", keywords="practice-based learning and improvement", keywords="emergency room", keywords="ER", keywords="platform", keywords="outcomes", keywords="closed-loop learning", abstract="Background: The availability of patient outcomes--based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning. Objective: This study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use. Methods: This multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ?30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR. Results: An initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63\% respondents identified as useful), escalation of care (20/24, 83\%), and return to ED (16/24, 67\%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from ``not easy'' to ``very easy'' to obtain and from ``not confident'' to ``very confident'' in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague. Conclusions: This study demonstrates the potential for human-centered design of a patient outcomes--driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning. ", doi="10.2196/30130", url="https://humanfactors.jmir.org/2022/1/e30130", url="http://www.ncbi.nlm.nih.gov/pubmed/35319469" } @Article{info:doi/10.2196/28353, author="Duggan, M. Nicole and Hasdianda, Adrian M. and Baker, Olesya and Jambaulikar, Guruprasad and Goldsmith, J. Andrew and Condella, Anna and Azizoddin, Desiree and Landry, I. Adaira and Boyer, W. Edward and Eyre, J. Andrew", title="The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study", journal="JMIR Form Res", year="2022", month="Mar", day="22", volume="6", number="3", pages="e28353", keywords="shift work", keywords="sleep", keywords="sleep aid", keywords="alertness", keywords="earbud", keywords="SleepBuds", keywords="healthcare worker", keywords="physician", keywords="health care", abstract="Background: Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being. Objective: We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift. Methods: Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights' sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post--overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls. Results: In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights' sleep quality increased by 0.5 points (P<.001, 95\% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95\% CI --0.90 to --0.34), and total daily tension decreased by 0.6 points (P<.001, 95\% CI --0.81 to --0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores. Conclusions: Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions' effect on other populations of shift workers' post--night shift alertness, users' long-term physical and mental health, and patient outcomes. ", doi="10.2196/28353", url="https://formative.jmir.org/2022/3/e28353", url="http://www.ncbi.nlm.nih.gov/pubmed/35315781" } @Article{info:doi/10.2196/31823, author="Happe, Lisa and Sgraja, Marie and Hein, Andreas and Diekmann, Rebecca", title="Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="16", volume="9", number="1", pages="e31823", keywords="older adults", keywords="rehabilitation", keywords="physical activity", keywords="nutrition", keywords="e-coach", keywords="usability testing", keywords="tablet computers", keywords="health behavior", keywords="mobile phone", abstract="Background: Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one's nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. Objective: This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (?65 years) based on individual health behavior change stages in a rehabilitation setting. Methods: Iterative testing was performed with patients aged ?65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). Results: In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49\% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1\%; T2: 26.5\%; T3: 17.2\%) than for comprehension questions (T1: 30.5\%; T2: 21.6\%; T3: 20\%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0\%, T2: 15.2\%, T3: 4.3\%) than for comprehension tasks (T1: 1.9\%, T2: 0\%, T3: 2.5\%). Conclusions: The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change. ", doi="10.2196/31823", url="https://humanfactors.jmir.org/2022/1/e31823", url="http://www.ncbi.nlm.nih.gov/pubmed/35293874" } @Article{info:doi/10.2196/25540, author="Rochat, Jessica and Ehrler, Fr{\'e}d{\'e}ric and Siebert, N. Johan and Ricci, Arnaud and Garretas Ruiz, Victor and Lovis, Christian", title="Usability Testing of a Patient-Centered Mobile Health App for Supporting and Guiding the Pediatric Emergency Department Patient Journey: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2022", month="Mar", day="15", volume="5", number="1", pages="e25540", keywords="usability", keywords="user-centered design", keywords="information systems", keywords="mobile apps", keywords="emergency service", keywords="hospital", keywords="pediatrics", keywords="mobile phone", abstract="Background: Patient experience in emergency departments (EDs) remains often suboptimal and can be a source of stress, particularly in pediatric settings. In an attempt to support patients and their families before, during, and after their visit to a pediatric ED, a mobile health (mHealth) app was developed by a multidisciplinary team based on patient-centered care principles. Objective: This study aims to evaluate the usability (effectiveness, efficiency, and satisfaction) of a new mHealth app, InfoKids, by potential end users through usability testing. Methods: The app was assessed through an in-laboratory, video-recorded evaluation in which participants had to execute 9 goal-oriented tasks, ranging from account creation to the reception of a diagnostic sheet at the end of the emergency care episode. Effectiveness was measured based on the task completion rate, efficiency on time on task, and user satisfaction according to answers to the System Usability Scale questionnaire. Think-aloud usability sessions were also transcribed and analyzed. Usability problems were rated for their severity and categorized according to ergonomic criteria. Results: A total of 17 parents participated in the study. The overall completion rate was 97.4\% (149/153). Overall, they reported good effectiveness, with the task successfully completed in 88.2\% (135/153) of cases (95\% CI 83\%-93\%). Each task, with the exception of the first, created difficulties for some participants but did not prevent their completion by most participants. Users reported an overall good to excellent perceived usability of the app. However, ergonomic evaluation identified 14 usability problems occurring 81 time. Among these, 50\% (7/14) were serious as their severity was rated as either major or catastrophic and indicated areas of improvements for the app. Following the suggested usability improvements by participants, mitigation measures were listed to further improve the app and avoid barriers to its adoption. Conclusions: Usability of the InfoKids app was evaluated as good to excellent by users. Areas of improvement were identified, and mitigation measures were proposed to inform its development toward a universal app for all ED patients visiting a digitalized institution. Its contribution could also be useful in paving the way for further research on mobile apps aimed at supporting and accompanying patients in their care episodes, as research in this area is scarce. ", doi="10.2196/25540", url="https://pediatrics.jmir.org/2022/1/e25540", url="http://www.ncbi.nlm.nih.gov/pubmed/35289754" } @Article{info:doi/10.2196/33571, author="Turesson, Christina and Liedberg, Gunilla and Bj{\"o}rk, Mathilda", title="Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach", journal="JMIR Hum Factors", year="2022", month="Mar", day="14", volume="9", number="1", pages="e33571", keywords="agile design process", keywords="chronic pain", keywords="digital support", keywords="eHealth", keywords="return to work", keywords="self-management", keywords="smartphone apps", keywords="user-centered design", keywords="mobile phone", abstract="Background: Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. Objective: This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). Methods: A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. Results: The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. Conclusions: This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting. ", doi="10.2196/33571", url="https://humanfactors.jmir.org/2022/1/e33571", url="http://www.ncbi.nlm.nih.gov/pubmed/35285814" } @Article{info:doi/10.2196/30655, author="Poncette, Akira-Sebastian and Mosch, Katharina Lina and Stablo, Lars and Spies, Claudia and Schieler, Monique and Weber-Carstens, Steffen and Feufel, A. Markus and Balzer, Felix", title="A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation", journal="JMIR Hum Factors", year="2022", month="Mar", day="11", volume="9", number="1", pages="e30655", keywords="digital health", keywords="patient monitoring", keywords="intensive care medicine", keywords="intensive care unit", keywords="technological innovation", keywords="user-centered design", keywords="usability", keywords="user experience", keywords="implementation science", keywords="qualitative research", keywords="interview", keywords="mixed methods", keywords="mobile phone", abstract="Background: Continuous monitoring of vital signs is critical for ensuring patient safety in intensive care units (ICUs) and is becoming increasingly relevant in general wards. The effectiveness of health information technologies such as patient-monitoring systems is highly determined by usability, the lack of which can ultimately compromise patient safety. Usability problems can be identified and prevented by involving users (ie, clinicians). Objective: In this study, we aim to apply a human-centered design approach to evaluate the usability of a remote patient-monitoring system user interface (UI) in the ICU context and conceptualize and evaluate design changes. Methods: Following institutional review board approval (EA1/031/18), a formative evaluation of the monitoring UI was performed. Simulated use tests with think-aloud protocols were conducted with ICU staff (n=5), and the resulting qualitative data were analyzed using a deductive analytic approach. On the basis of the identified usability problems, we conceptualized informed design changes and applied them to develop an improved prototype of the monitoring UI. Comparing the UIs, we evaluated perceived usability using the System Usability Scale, performance efficiency with the normative path deviation, and effectiveness by measuring the task completion rate (n=5). Measures were tested for statistical significance using a 2-sample t test, Poisson regression with a generalized linear mixed-effects model, and the N-1 chi-square test. P<.05 were considered significant. Results: We found 37 individual usability problems specific to monitoring UI, which could be assigned to six subcodes: usefulness of the system, response time, responsiveness, meaning of labels, function of UI elements, and navigation. Among user ideas and requirements for the UI were high usability, customizability, and the provision of audible alarm notifications. Changes in graphics and design were proposed to allow for better navigation, information retrieval, and spatial orientation. The UI was revised by creating a prototype with a more responsive design and changes regarding labeling and UI elements. Statistical analysis showed that perceived usability improved significantly (System Usability Scale design A: mean 68.5, SD 11.26, n=5; design B: mean 89, SD 4.87, n=5; P=.003), as did performance efficiency (normative path deviation design A: mean 8.8, SD 5.26, n=5; design B: mean 3.2, SD 3.03, n=5; P=.001), and effectiveness (design A: 18 trials, failed 7, 39\% times, passed 11, 61\% times; design B: 20 trials, failed 0 times, passed 20 times; P=.002). Conclusions: Usability testing with think-aloud protocols led to a patient-monitoring UI with significantly improved usability, performance, and effectiveness. In the ICU work environment, difficult-to-use technology may result in detrimental outcomes for staff and patients. Technical devices should be designed to support efficient and effective work processes. Our results suggest that this can be achieved by applying basic human-centered design methods and principles. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 ", doi="10.2196/30655", url="https://humanfactors.jmir.org/2022/1/e30655", url="http://www.ncbi.nlm.nih.gov/pubmed/35275071" } @Article{info:doi/10.2196/35092, author="Hopstock, Arnesdatter Laila and Medin, Christine Anine and Skeie, Guri and Henriksen, Andr{\'e} and Lundblad, Wasmuth Marie", title="Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study", journal="JMIR Form Res", year="2022", month="Mar", day="11", volume="6", number="3", pages="e35092", keywords="system usability score", keywords="older adults", keywords="measurements", keywords="nutrition", keywords="dietary intake", keywords="digital health", keywords="web tool", abstract="Background: A healthy diet throughout the life course improves health and reduces the risk of disease. There is a need for new knowledge of the relation between diet and health, but existing methods to collect information on food and nutrient intake have their limitations. Evaluations of new tools to assess dietary intake are needed, especially in old people, where the introduction of new technology might impose challenges. Objective: We aimed to examine the usability of a new web-based dietary assessment tool in older adult women and men. Methods: A total of 60 women and men (participation 83\%, 57\% women) aged 60-74 years recruited by convenience and snowball sampling completed a 24-hour web-based dietary recall using the newly developed Norwegian version of Measure Your Food On One Day (myfood24). Total energy and nutrient intakes were calculated in myfood24, primarily on the basis of the Norwegian Food Composition Table. No guidance or support was provided to complete the recall. Usability was assessed using the system usability scale (SUS), where an SUS score of ?68 was considered satisfactory. We examined the responses to single SUS items and the mean (SD) SUS score in groups stratified by sex, age, educational level, and device used to complete the recall (smartphone, tablet device, or computer). Results: The mean total energy intake was 5815 (SD 3093) kJ. A total of 14\% of participants had an energy intake of <2100 kJ (ie, 500 kilocalories) and none had an intake of >16,800 kJ (ie, 4000 kilocalories). Mean energy proportions from carbohydrates, fat, protein, alcohol, and fiber was within the national recommendations. The mean SUS score was 55.5 (SD 18.6), and 27\% of participants had SUS scores above the satisfactory product cut-off. Higher SUS scores were associated with younger age and lower education, but not with the type of device used. Conclusions: We found the overall usability of a new web-based dietary assessment tool to be less than satisfactory in accordance with standard usability criteria in a sample of 60-74--year-old Norwegians. The observed total energy intakes suggest that several of the participants underreported their intake during the completion of the dietary recall. Implementing web-based dietary assessment tools in older adults is feasible, but guidance and support might be needed to ensure valid completion. ", doi="10.2196/35092", url="https://formative.jmir.org/2022/3/e35092", url="http://www.ncbi.nlm.nih.gov/pubmed/35275079" } @Article{info:doi/10.2196/33038, author="Neale, Joanne and Bowen, May Alice", title="Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users", journal="JMIR Hum Factors", year="2022", month="Mar", day="8", volume="9", number="1", pages="e33038", keywords="apps", keywords="digital literacy", keywords="mHealth", keywords="substance use", keywords="recovery", keywords="qualitative", keywords="mobile phone", abstract="Background: Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non--treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective: The aim of this paper is to undertake a qualitative study to ascertain end users' views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods: Semistructured telephone interviews were conducted with 20 people (n=12, 60\%, men and n=8, 40\%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results: Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions: Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement. ", doi="10.2196/33038", url="https://humanfactors.jmir.org/2022/1/e33038", url="http://www.ncbi.nlm.nih.gov/pubmed/35258474" } @Article{info:doi/10.2196/31317, author="Abdulai, Abdul-Fatawu and Howard, Fuchsia A. and Yong, J. Paul and Noga, Heather and Parmar, Gurkiran and Currie, M. Leanne", title="Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis", journal="JMIR Hum Factors", year="2022", month="Mar", day="3", volume="9", number="1", pages="e31317", keywords="endometriosis", keywords="sexual pain", keywords="dyspareunia", keywords="usability testing", keywords="think-aloud", keywords="stigma", keywords="web sites", keywords="digital health", keywords="informatics", abstract="Background: Endometriosis is a chronic condition that affects approximately 10\% of women worldwide. Despite its wide prevalence, knowledge of endometriosis symptoms, such as pelvic pain, and treatments remains relatively low. This not only leads to a trivialization of symptoms and delayed diagnosis but also fuels myths and misconceptions about pain symptoms. At the same time, the use of web-based platforms for information seeking is particularly common among people with conditions that are perceived as stigmatizing and difficult to discuss. The Sex, Pain, and Endometriosis website is an educational resource designed to provide evidence-based information on endometriosis and sexual pain to help people understand the condition, feel empowered, dispel myths, and destigmatize endometriosis-associated sexual pain. Objective: The study objective is to evaluate the usability of the website and assess for destigmatizing properties of sexual health--related web-based resources. Methods: We conducted a usability analysis by using a think-aloud observation, a postsystem usability questionnaire, and follow-up interviews with 12 women with endometriosis. The think-aloud data were analyzed using the framework by Kushniruk and Patel for analyzing usability video data, the questionnaire data were analyzed using descriptive statistics, and the follow-up interviews were analyzed using simple content analysis. We conducted a usability assessment by deductively analyzing the interview data via a trauma-informed care framework and a content analysis approach. Results: Through usability analysis, we found the website to be simple, uncluttered, satisfying, and easy to use. However, 30 minor usability problems related to navigation; website response; the comprehension of graphics, icons, and tabs; the understanding of content; and mismatch between the website and users' expectations were reported. In our stigma analysis, we found the web content to be nonstigmatizing. The participants suggested ways in which websites could be designed to address stigma, including ensuring privacy, anonymity, inclusiveness, and factual and nonjudgmental content, as well as providing opportunities for web-based engagement. Conclusions: Overall, the participants found the website to be useful, easy to use, and satisfying. The usability problems identified were largely minor and informed the website redesign process. In the context of the limited literature on stigma and website design, this paper offers useful strategies on how sexual health--related websites can be designed to be acceptable and less stigmatizing to individuals with sensitive health issues. ", doi="10.2196/31317", url="https://humanfactors.jmir.org/2022/1/e31317", url="http://www.ncbi.nlm.nih.gov/pubmed/35238789" } @Article{info:doi/10.2196/35399, author="Siebert, N. Johan and Gosetto, La{\"e}titia and Sauvage, Manon and Bloudeau, Laurie and Suppan, Laurent and Rodieux, Fr{\'e}d{\'e}rique and Haddad, Kevin and Hugon, Florence and Gervaix, Alain and Lovis, Christian and Combescure, Christophe and Manzano, Sergio and Ehrler, Frederic and ", title="Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials", journal="JMIR Hum Factors", year="2022", month="Mar", day="1", volume="9", number="1", pages="e35399", keywords="cardiopulmonary resuscitation", keywords="drugs", keywords="emergency medical services", keywords="medication errors", keywords="mobile health", keywords="mobile apps", keywords="out-of-hospital cardiac arrest", keywords="paramedics", keywords="pediatrics", keywords="System Usability Scale", keywords="Unified Theory of Acceptance and Use of Technology", keywords="smartphone", keywords="mobile phone", abstract="Background: Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. Objective: This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. Methods: In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. Results: All 100\% (128/128) of nurses (crossover trial) and 49.3\% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95\% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95\% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. Conclusions: The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. Trial Registration: ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3726-4 ", doi="10.2196/35399", url="https://humanfactors.jmir.org/2022/1/e35399", url="http://www.ncbi.nlm.nih.gov/pubmed/35230243" } @Article{info:doi/10.2196/32704, author="van de Belt, H. Tom and de Croon, Aimee and Freriks, Faye and Blomseth Christiansen, Thomas and Eg Larsen, Jakob and de Groot, Martijn", title="Barriers to and Facilitators of Using a One Button Tracker and Web-Based Data Analytics Tool for Personal Science: Exploratory Study", journal="JMIR Form Res", year="2022", month="Mar", day="1", volume="6", number="3", pages="e32704", keywords="self-tracking", keywords="personal science", keywords="one-button-tracker", keywords="barriers", keywords="facilitators", keywords="quantified self", keywords="health promotion", keywords="button tracker", keywords="usability testing", keywords="One Button Tracker", keywords="health technology", keywords="system usability", abstract="Background: Individuals' self-tracking of subjectively experienced phenomena related to health can be challenging, as current options for instrumentation often involve too much effort in the moment or rely on retrospective self-reporting, which is likely to impair accuracy and compliance. Objective: This study aims to assess the usability and perceived usefulness of low-effort, in-the-moment self-tracking using simple instrumentation and to establish the amount of support needed when using this approach. Methods: In this exploratory study, the One Button Tracker---a press-button device that records time stamps and durations of button presses---was used for self-tracking. A total of 13 employees of an academic medical center chose a personal research question and used the One Button Tracker to actively track specific subjectively experienced phenomena for 2 to 4 weeks. To assess usability and usefulness, we combined qualitative data from semistructured interviews with quantitative results from the System Usability Scale. Results: In total, 29 barriers and 15 facilitators for using the One Button Tracker were found. Ease of use was the most frequently mentioned facilitator. The One Button Tracker's usability received a median System Usability Scale score of 75.0 (IQR 42.50), which is considered as good usability. Participants experienced effects such as an increased awareness of the tracked phenomenon, a confirmation of personal knowledge, a gain of insight, and behavior change. Support and guidance during all stages of the self-tracking process were judged as valuable. Conclusions: The low-effort, in-the-moment self-tracking of subjectively experienced phenomena has been shown to support personal knowledge gain and health behavior change for people with an interest in health promotion. After addressing barriers and formally validating the collected data, self-tracking devices may well be helpful for additional user types or health questions. ", doi="10.2196/32704", url="https://formative.jmir.org/2022/3/e32704", url="http://www.ncbi.nlm.nih.gov/pubmed/35230247" } @Article{info:doi/10.2196/23794, author="Chowdhary, Kuntal and Yu, Xie Daihua and Pramana, Gede and Mesoros, Matthew and Fairman, Andrea and Dicianno, Edward Brad and Parmanto, Bambang", title="User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="24", volume="9", number="1", pages="e23794", keywords="cellular phone", keywords="mobile apps", keywords="telemedicine", keywords="adaptive mHealth", keywords="rehabilitation", keywords="self-care", keywords="spinal cord injury", keywords="spina bifida", keywords="chronic disease", keywords="persons with disability", keywords="accessibility", keywords="dexterity impairments", keywords="mobile phone", abstract="Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules---MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants' dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. ", doi="10.2196/23794", url="https://humanfactors.jmir.org/2022/1/e23794", url="http://www.ncbi.nlm.nih.gov/pubmed/35200144" } @Article{info:doi/10.2196/32815, author="Blair, A. Rachel and Horn, E. Christine and Dias, M. Jennifer and McDonnell, E. Marie and Seely, W. Ellen", title="Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="22", volume="9", number="1", pages="e32815", keywords="gestational diabetes mellitus", keywords="SMS text messaging", keywords="mobile phone", keywords="mobile health", keywords="pregnancy", keywords="blood glucose self-monitoring", abstract="Background: Gestational diabetes mellitus (GDM) affects 5\%-10\% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective: This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods: An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results: Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93\%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93\% [25th-75th IQR 89\%-100\%] vs median 97\% [25th-75th IQR 92\%-100\%]). Conclusions: Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed. ", doi="10.2196/32815", url="https://humanfactors.jmir.org/2022/1/e32815", url="http://www.ncbi.nlm.nih.gov/pubmed/35191851" } @Article{info:doi/10.2196/29224, author="Koh, Qi Wei and Whelan, Sally and Heins, Pascale and Casey, Dympna and Toomey, Elaine and Dr{\"o}es, Rose-Marie", title="The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites", journal="JMIR Aging", year="2022", month="Feb", day="22", volume="5", number="1", pages="e29224", keywords="social robot", keywords="pet robots", keywords="low-cost robot", keywords="dementia", keywords="older adults", keywords="qualitative research", keywords="qualitative content analysis", abstract="Background: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to ``older adults,'' ``dementia,'' and ``institutional care'' and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets. ", doi="10.2196/29224", url="https://aging.jmir.org/2022/1/e29224", url="http://www.ncbi.nlm.nih.gov/pubmed/35191844" } @Article{info:doi/10.2196/34117, author="Sonney, Jennifer and Cho, E. Emily and Zheng, Qiming and Kientz, A. Julie", title="Refinement of a Parent--Child Shared Asthma Management Mobile Health App: Human-Centered Design Study", journal="JMIR Pediatr Parent", year="2022", month="Feb", day="17", volume="5", number="1", pages="e34117", keywords="parent--child shared management", keywords="school-age children", keywords="asthma", keywords="participatory design", keywords="mHealth", keywords="prototype", keywords="usability", keywords="family health informatics", abstract="Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent--child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent--child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent--child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. ", doi="10.2196/34117", url="https://pediatrics.jmir.org/2022/1/e34117", url="http://www.ncbi.nlm.nih.gov/pubmed/35175214" } @Article{info:doi/10.2196/33651, author="Fyhr, AnnSofie and Persson, Johanna and Ek, {\AA}sa", title="Usage and Usability of a National e-Library for Chemotherapy Regimens: Mixed Methods Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="17", volume="9", number="1", pages="e33651", keywords="chemotherapy regimens", keywords="user evaluation", keywords="standardization", keywords="patient safety", keywords="chemotherapy", keywords="safety", keywords="usability", keywords="e-library", keywords="medication errors", abstract="Background: Accurate information about chemotherapy drugs and regimens is needed to reduce chemotherapy errors. A national e-library, as a common knowledge source with standardized chemotherapy nomenclature and content, was developed. Since the information in the library is both complex and extensive, it is central that the users can use the resource as intended. Objective: The aim of this study was to evaluate the usage and usability of an extensive e-library for chemotherapy regimens developed to reduce medication errors, support the health care staff in their work, and increase patient safety. Methods: To obtain a comprehensive evaluation, a mixed methods study was performed for a broad view of the usage, including a compilation of subjective views of the users (web survey, spontaneous user feedback, and qualitative interviews), analysis of statistics from the website, and an expert evaluation of the usability of the webpage. Results: Statistics from the website show an average of just over 2500 visits and 870 unique visitors per month. Most visits took place Mondays to Fridays, but there were 5-10 visits per day on weekends. The web survey, with 292 answers, shows that the visitors were mainly physicians and nurses. Almost 80\% (224/292) of respondents searched for regimens and 90\% (264/292) found what they were looking for and were satisfied with their visit. The expert evaluation shows that the e-library follows many existing design principles, thus providing some useful improvement suggestions. A total of 86 emails were received in 2020 with user feedback, most of which were from nurses. The main part (78\%, 67/86) contained a question, and the rest had discovered errors mainly in some regimen. The interviews reveal that most hospitals use a computerized physician order entry system, and they use the e-library in various ways, import XML files, transfer information, or use it as a reference. One hospital without a system uses the administration schedules from the library. Conclusions: The user evaluation indicates that the e-library is used in the intended manner and that the users can interact without problems. Users have different needs depending on their profession and their workplace, and these can be supported. The combination of methods applied ensures that the design and content comply with the users' needs and serves as feedback for continuous design and learning. With a broad national usage, the e-library can become a source for organizational and national learning and a source for continuous improvement of cancer care in Sweden. ", doi="10.2196/33651", url="https://humanfactors.jmir.org/2022/1/e33651", url="http://www.ncbi.nlm.nih.gov/pubmed/35175199" } @Article{info:doi/10.2196/30091, author="Hawthorne, Grace and Greening, Neil and Esliger, Dale and Briggs-Price, Samuel and Richardson, Matthew and Chaplin, Emma and Clinch, Lisa and Steiner, C. Michael and Singh, J. Sally and Orme, W. Mark", title="Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="16", volume="9", number="1", pages="e30091", keywords="chronic obstructive pulmonary disease", keywords="digital health", keywords="physical activity", keywords="respiratory rate", keywords="wearable technology", keywords="wearable device", keywords="vital signs monitor", abstract="Background: Vital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD). Objective: This study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology. Methods: In total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ?85\% for HR and ?80\% for RR, based on the device's proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls. Results: In total, 84\% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76\%, SD 26\%). There was greater adherence in the stable group than in the post-AECOPD group (?5 weeks wear: 71.4\% vs 45.7\%; P=.02). For all 84 participants, the median HR signal quality was 90\% (IQR 80\%-94\%) and the median RR signal quality was 93\% (IQR 92\%-95\%). The median HR data quality was 81\% (IQR 58\%-91\%), and the median RR data quality was 85\% (IQR 77\%-91\%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=--0.49, P=.009; rs=--0.44, P=.02). In total, 36 (74\%) participants in the Stable group and 21 (60\%) participants in the AECOPD group accepted the technology, but 10 participants (12\%) expressed concerns with wearing a device around their chest. Conclusions: This wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context. ", doi="10.2196/30091", url="https://humanfactors.jmir.org/2022/1/e30091", url="http://www.ncbi.nlm.nih.gov/pubmed/35171101" } @Article{info:doi/10.2196/31448, author="Kohlbrenner, Dario and Clarenbach, F. Christian and Ivankay, Adam and Zimmerli, Lukas and Gross, S. Christoph and Kuhn, Manuel and Brunschwiler, Thomas", title="Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk", journal="JMIR Hum Factors", year="2022", month="Feb", day="16", volume="9", number="1", pages="e31448", keywords="home monitoring", keywords="digital health", keywords="respiratory disease", keywords="usability", keywords="feasibility", keywords="adherence", keywords="disease management", keywords="chronic disease", keywords="patient monitoring", abstract="Background: Research integrating multisensory home-monitoring in respiratory disease is scarce. Therefore, we created a novel multisensory home-monitoring device tailored for long-term respiratory disease management (named the CAir-Desk). We hypothesize that recent technological accomplishments can be integrated into a multisensory participant-driven platform. We also believe that this platform could improve chronic disease management and be accessible to large groups at an acceptable cost. Objective: This study aimed to report on user adherence and acceptance as well as system functionality of the CAir-Desk in a sample of participants with stable chronic obstructive pulmonary disease (COPD) or asthma. Methods: We conducted an observational usability study. Participants took part in 4 weeks of home-monitoring with the CAir-Desk. The CAir-Desk recorded data from all participants on symptom burden, physical activity, spirometry, and environmental air quality; data on sputum production, and nocturnal cough were only recorded for participants who experienced symptoms. After the study period, participants reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. We used descriptive statistics and visualizations to display results. Results: Ten participants, 5 with COPD and 5 with asthma took part in this study. They completed symptom burden questionnaires on a median of 96\% (25th percentile 14\%, 75th percentile 96\%), spirometry recordings on 55\% (20\%, 94\%), wrist-worn physical activity recordings on 100\% (97\%, 100\%), arm-worn physical activity recordings on 45\% (13\%, 63\%), nocturnal cough recordings on 34\% (9\%, 54\%), sputum recordings on 5\% (3\%, 12\%), and environmental air quality recordings on 100\% (99\%, 100\%) of the study days. The participants indicated that the measurements consumed a median of 13 (10, 15) min daily, and that they preferred the wrist-worn physical activity monitor to the arm-worn physical activity monitor. Conclusions: The CAir-Desk showed favorable technical performance and was well-accepted by our sample of participants with stable COPD and asthma. The obtained insights were used in a redesign of the CAir-Desk, which is currently applied in a randomized controlled trial including an interventional program. ", doi="10.2196/31448", url="https://humanfactors.jmir.org/2022/1/e31448", url="http://www.ncbi.nlm.nih.gov/pubmed/35171107" } @Article{info:doi/10.2196/33550, author="Mendes-Santos, Cristina and Nunes, Francisco and Weiderpass, Elisabete and Santana, Rui and Andersson, Gerhard", title="Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study", journal="JMIR Cancer", year="2022", month="Feb", day="15", volume="8", number="1", pages="e33550", keywords="acceptance and commitment therapy", keywords="anxiety", keywords="breast cancer survivors", keywords="cognitive behavioral therapy", keywords="depression", keywords="digital mental health", keywords="e-mental health", keywords="user-centered design", keywords="internet interventions", keywords="usability", keywords="mobile phone", abstract="Background: Despite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings. Objective: The aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy--influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC. Methods: iNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46\%) and mental health professionals (13/24, 54\%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC's usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed. Results: Overall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs' changing needs and along the cancer care continuum, was another suggestion that was identified. Conclusions: The study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors' changing needs and the cancer continuum. ", doi="10.2196/33550", url="https://cancer.jmir.org/2022/1/e33550", url="http://www.ncbi.nlm.nih.gov/pubmed/35166682" } @Article{info:doi/10.2196/32568, author="Bangash, Hana and Makkawy, Ahmed and Gundelach, H. Justin and Miller, A. Alexandra and Jacobson, A. Kimberly and Kullo, J. Iftikhar", title="Web-Based Tool (FH Family Share) to Increase Uptake of Cascade Testing for Familial Hypercholesterolemia: Development and Evaluation", journal="JMIR Hum Factors", year="2022", month="Feb", day="15", volume="9", number="1", pages="e32568", keywords="familial hypercholesterolemia", keywords="cascade testing", keywords="communication", keywords="genetic counselors", keywords="digital tools", keywords="website", keywords="usability", keywords="user experience", keywords="public health", abstract="Background: Familial hypercholesterolemia, a prevalent genetic disorder, remains significantly underdiagnosed in the United States. Cascade testing, wherein individuals diagnosed with familial hypercholesterolemia--- probands---contact their family members to inform them of their risk for familial hypercholesterolemia, has low uptake in the United States. Digital tools are needed to facilitate communication between familial hypercholesterolemia probands and their family members and to promote sharing of familial hypercholesterolemia--related risk information. Objective: We aimed to create and evaluate a web-based tool designed to enhance familial communication and promote cascade testing for familial hypercholesterolemia. Methods: A hybrid type 1 implementation science framework and a user-centered design process were used to develop an interactive web-based tool---FH Family Share---that enables familial hypercholesterolemia probands to communicate information about their familial hypercholesterolemia diagnosis with at-risk relatives. Probands can also use the tool to draw a family pedigree and learn more about familial hypercholesterolemia through education modules and curated knowledge resources. Usability guidelines and standards were taken into account during the design and development of the tool. The initial prototype underwent a cognitive walkthrough, which was followed by usability testing with key stakeholders including genetic counselors and patients with familial hypercholesterolemia. Participants navigated the prototype using the think-aloud technique, and their feedback was used to refine features of the tool. Results: Key themes that emerged from the cognitive walkthrough were design, format, navigation, terminology, instructions, and learnability. Expert feedback from the cognitive walkthrough resulted in a rebuild of the web-based tool to align it with institutional standards. Usability testing with genetic counselors and patients with familial hypercholesterolemia provided insights on user experience, satisfaction and interface design and highlighted specific modifications that were made to refine the features of FH Family Share. Genetic counselors and patients with familial hypercholesterolemia suggested inclusion of the following features in the web-based tool: (1) a letter-to-family-member email template, (2) education modules, and (3) knowledge resources. Surveys revealed that 6 of 9 (67\%) genetic counselors found information within FH Family Share very easy to find, and 5 of 9 (56\%) genetic counselors found information very easy to understand; 5 of 9 (56\%) patients found information very easy to find within the website, and 7 of 9 (78\%) patients found information very easy to understand. All genetic counselors and patients indicated that FH Family Share was a resource worth returning to. Conclusions: FH Family Share facilitates communication between probands and their relatives. Once informed, at-risk family members have the option to seek testing and treatment for familial hypercholesterolemia. ", doi="10.2196/32568", url="https://humanfactors.jmir.org/2022/1/e32568", url="http://www.ncbi.nlm.nih.gov/pubmed/35166678" } @Article{info:doi/10.2196/29393, author="Sheshadri, Ajay and Makhnoon, Sukh and Alousi, M. Amin and Bashoura, Lara and Andrade, Rene and Miller, J. Christopher and Stolar, R. Karen and Arain, Hasan Muhammad and Noor, Laila and Balagani, Amulya and Jain, Akash and Blanco, David and Ortiz, Abel and Taylor, S. Michael and Stenzler, Alex and Mehta, Rohtesh and Popat, R. Uday and Hosing, Chitra and Ost, E. David and Champlin, E. Richard and Dickey, F. Burton and Peterson, K. Susan", title="Home-Based Spirometry Telemonitoring After Allogeneic Hematopoietic Cell Transplantation: Mixed Methods Evaluation of Acceptability and Usability", journal="JMIR Form Res", year="2022", month="Feb", day="7", volume="6", number="2", pages="e29393", keywords="allogeneic hematopoietic cell transplantation", keywords="home-based spirometry", keywords="acceptability", keywords="usability", keywords="mixed methods evaluation", keywords="patient perspectives", keywords="spirometry", keywords="feasibility", keywords="mHealth", keywords="home-based", keywords="remote care", keywords="respirology", keywords="pulmonary medicine", keywords="mobile phone", abstract="Background: Home-based spirometry (HS) allows for the early detection of lung complications in recipients of an allogeneic hematopoietic cell transplant (AHCT). Although the usability and acceptability of HS are critical for adherence, patient-reported outcomes of HS use remain poorly understood in this setting. Objective: The aim of this study is to design a longitudinal, mixed methods study to understand the usability and acceptability of HS among recipients of AHCT. Methods: Study participants performed HS using a Bluetooth-capable spirometer that transmitted spirometry data to the study team in real time. In addition, participants completed usability questionnaires and in-depth interviews and reported their experiences with HS. Analysis of interview data was guided by the constructs of performance expectancy, effort expectancy, and social influence from the Unified Theory of Acceptance and Use of Technology model. Results: Recipients of AHCT found HS to be highly acceptable despite modest technological barriers. On average, participants believed that the HS was helpful in managing symptoms related to AHCT (scores ranging from 2.22 to 2.68 on a scale of 0-4) and for early detection of health-related problems (score range: 2.88-3.12). Participants viewed HS favorably and were generally supportive of continued use. No significant barriers to implementation were identified from the patient's perspective. Age and gender were not associated with the patient perception of HS. Conclusions: Study participants found HS acceptable and easy to use. Some modifiable technical barriers to performing HS were identified; however, wider implementation of pulmonary screening is feasible from the patient's perspective. ", doi="10.2196/29393", url="https://formative.jmir.org/2022/2/e29393", url="http://www.ncbi.nlm.nih.gov/pubmed/35129455" } @Article{info:doi/10.2196/28199, author="Scheder-Bieschin, Justus and Bl{\"u}mke, Bibiana and de Buijzer, Erwin and Cotte, Fabienne and Echterdiek, Fabian and Nacsa, J{\'u}lia and Ondresik, Marta and Ott, Matthias and Paul, Gregor and Schilling, Tobias and Schmitt, Anne and Wicks, Paul and Gilbert, Stephen", title="Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study", journal="JMIR Form Res", year="2022", month="Feb", day="7", volume="6", number="2", pages="e28199", keywords="symptom assessment application", keywords="anamnesis", keywords="health care system", keywords="patient history taking", keywords="diagnosis", keywords="emergency department", abstract="Background: Establishing rapport and empathy between patients and their health care provider is important but challenging in the context of a busy and crowded emergency department (ED). Objective: We explore the hypotheses that rapport building, documentation, and time efficiency might be improved in the ED by providing patients a digital tool that uses Bayesian reasoning--based techniques to gather relevant symptoms and history for handover to clinicians. Methods: A 2-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital that treats an average of 120 patients daily. Phase 1 observations guided iterative improvement of the digital tool, which was then further evaluated in phase 2. All patients who were willing and able to provide consent were invited to participate, excluding those with severe injury or illness requiring immediate treatment, with traumatic injury, incapable of completing a health assessment, and aged <18 years. Over an 18-day period with 1699 patients presenting to the ED, 815 (47.96\%) were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 (60\%) were included in the study. In a mixed methods evaluation, patients entered information into the tool, accessed by clinicians through a dashboard. All users completed evaluation Likert-scale questionnaires rating the tool's performance. The feasibility of a larger trial was evaluated through rates of recruitment and questionnaire completion. Results: Respondents strongly endorsed the tool for facilitating conversation (61/81, 75\% of patients, 57/78, 73\% of physician ratings, and 10/10, 100\% of nurse ratings). Most nurses judged the tool as potentially time saving, whereas most physicians only agreed for a subset of medical specialties (eg, surgery). Patients reported high usability and understood the tool's questions. The tool was recommended by most patients (63/81, 78\%), in 53\% (41/77) of physician ratings, and in 76\% (61/80) of nurse ratings. Questionnaire completion rates were 100\% (81/81) by patients and 96\% (78/81 enrolled patients) by physicians. Conclusions: This pilot confirmed that a larger study in the setting would be feasible. The tool has clear potential to improve patient--health care provider interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for whom the history-taking tool has clinical utility. Trial Registration: German Clinical Trials Register DRKS00024115; https://drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00024115 ", doi="10.2196/28199", url="https://formative.jmir.org/2022/2/e28199", url="http://www.ncbi.nlm.nih.gov/pubmed/35129452" } @Article{info:doi/10.2196/30989, author="Jaffar, Aida and Mohd-Sidik, Sherina and Foo, Nien Chai and Admodisastro, Novia and Abdul Salam, Nur Sobihatun and Ismail, Diana Noor", title="Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="3", volume="9", number="1", pages="e30989", keywords="User-centered design", keywords="mHealth app", keywords="Digital intervention", keywords="mHealth Development and Evaluation Framework", keywords="Usability", keywords="Acceptability", keywords="Pelvic Floor Muscle Training", keywords="Urinary incontinence", keywords="Pregnancy", abstract="Background: Mobile health apps, for example, the T{\"a}t, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9\% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design--11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. ", doi="10.2196/30989", url="https://humanfactors.jmir.org/2022/1/e30989", url="http://www.ncbi.nlm.nih.gov/pubmed/35113025" } @Article{info:doi/10.2196/27887, author="Khanbhai, Mustafa and Symons, Joshua and Flott, Kelsey and Harrison-White, Stephanie and Spofforth, Jamie and Klaber, Robert and Manton, David and Darzi, Ara and Mayer, Erik", title="Enriching the Value of Patient Experience Feedback: Web-Based Dashboard Development Using Co-design and Heuristic Evaluation", journal="JMIR Hum Factors", year="2022", month="Feb", day="3", volume="9", number="1", pages="e27887", keywords="patient experience", keywords="friends and family test", keywords="quality dashboard", keywords="co-design", keywords="heuristic evaluation", keywords="usability", abstract="Background: There is an abundance of patient experience data held within health care organizations, but stakeholders and staff are often unable to use the output in a meaningful and timely way to improve care delivery. Dashboards, which use visualized data to summarize key patient experience feedback, have the potential to address these issues. Objective: The aim of this study is to develop a patient experience dashboard with an emphasis on Friends and Family Test (FFT) reporting, as per the national policy drive. Methods: A 2-stage approach was used---participatory co-design involving 20 co-designers to develop a dashboard prototype, followed by iterative dashboard testing. Language analysis was performed on free-text patient experience data from the FFT, and the themes and sentiments generated were used to populate the dashboard with associated FFT metrics. Heuristic evaluation and usability testing were conducted to refine the dashboard and assess user satisfaction using the system usability score. Results: The qualitative analysis from the co-design process informed the development of the dashboard prototype with key dashboard requirements and a significant preference for bubble chart display. The heuristic evaluation revealed that most cumulative scores had no usability problems (18/20, 90\%), had cosmetic problems only (7/20, 35\%), or had minor usability problems (5/20, 25\%). The mean System Usability Scale score was 89.7 (SD 7.9), suggesting an excellent rating. Conclusions: The growing capacity to collect and process patient experience data suggests that data visualization will be increasingly important in turning feedback into improvements to care. Through heuristic usability, we demonstrated that very large FFT data can be presented in a thematically driven, simple visual display without the loss of the nuances and still allow for the exploration of the original free-text comments. This study establishes guidance for optimizing the design of patient experience dashboards that health care providers find meaningful, which in turn drives patient-centered care. ", doi="10.2196/27887", url="https://humanfactors.jmir.org/2022/1/e27887", url="http://www.ncbi.nlm.nih.gov/pubmed/35113022" } @Article{info:doi/10.2196/27781, author="Batchelor, Rachel and Gulshan, Sarah and Shritharan, Halpana and Williams, Elen and Henderson, Claire and Gillard, Steve and Woodham, A. Luke and Cornelius, Victoria and Elkes, Jack and Sin, Jacqueline", title="Perceived Acceptability and Experiences of a Digital Psychoeducation and Peer Support Intervention (COPe-support): Interview Study With Carers Supporting Individuals With Psychosis", journal="J Med Internet Res", year="2022", month="Feb", day="2", volume="24", number="2", pages="e27781", keywords="eHealth", keywords="family carers", keywords="qualitative research", keywords="psychosis", keywords="peer support", keywords="web-based psychoeducation", keywords="mobile phone", abstract="Background: Web-based mental health interventions offer a novel, accessible, and self-paced approach to care delivery to family carers (ie, relatives and close friends who support a loved one with psychosis). We coproduced COPe-support (Carers fOr People with Psychosis e-support), a psychoeducational intervention delivered via an enriched web-based learning environment with network support from professionals and peers. In addition to the rigorous investigation of the effectiveness of COPe-support on the well-being of carers and mental health outcomes, it is imperative to understand the experiences of using the web-based intervention by carers and its associated web-based implementation and facilitation strategies. Objective: This study aims to explore the experiences of carers and perceived acceptability of COPe-support and its different components, how carers found engagement with COPe-support affected their own well-being and caregiving, and the ideas of carers for improving COPe-support and its delivery to inform any future wider implementation. Methods: We conducted a qualitative study, individually interviewing 35 carers, following their use of COPe-support for 8 months through a web-based, randomized controlled trial across England. A semistructured guide with open-ended questions was used to explore the experiences of carers and perceived acceptability of the intervention and their ideas to improve the provision. All interviews were conducted remotely through mobile phones or internet communication media, audio recorded and transcribed verbatim. We used a thematic analysis framework to analyze the data. Results: Three key themes were identified: remote, flexible, and personalized support; impacts on well-being and outlook on caregiving; and future implementation and integration with existing services. Overall, carers found COPe-support a flexible source of knowledge and support from professionals and peers that they could personalize to suit their own needs and convenience. Participants described gaining self-confidence, hope, and a sense of connectivity with others in a similar situation, which helped ameliorate isolation and perceived stigma. Most importantly, COPe-support promoted self-care among the carers themselves. Participants' experiences, use, and activity on COPe-support varied greatly and differed among carers of various ages and levels of computer literacy. Conclusions: Nearly all participants had a positive experience with COPe-support and supported its wider implementation as a beneficial adjunctive support resource for carers in the future. Any future scale-up of such an intervention needs to consider feedback from carers and suggestions for further improvement. These included having more graphics and audiovisual content materials, improving the navigation, and building in more interactional and customization options to suit various user styles, such as emoji reactions, live web-based chat, opting in and out of updates, and choosing the frequency of reminders. To ensure successful implementation, we should also consider factors pertinent to reaching more carers and integrating the web-based resources with other conventional services. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 89563420; https://www.isrctn.com/ISRCTN89563420 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-02528-w ", doi="10.2196/27781", url="https://www.jmir.org/2022/2/e27781", url="http://www.ncbi.nlm.nih.gov/pubmed/35107439" } @Article{info:doi/10.2196/32112, author="Agachi, Elena and Bijmolt, A. Tammo H. and Mierau, O. Jochen and van Ittersum, Koert", title="Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="2", volume="9", number="1", pages="e32112", keywords="eHealth", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="internet", keywords="preventive health program", keywords="health disparities", keywords="NSES", keywords="program adoption", keywords="survival analysis", abstract="Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap--Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program's delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95\% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95\% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. ", doi="10.2196/32112", url="https://humanfactors.jmir.org/2022/1/e32112", url="http://www.ncbi.nlm.nih.gov/pubmed/35107433" } @Article{info:doi/10.2196/29595, author="Reifman, Jaques and Kumar, Kamal and Hartman, Luke and Frock, Andrew and Doty, J. Tracy and Balkin, J. Thomas and Ramakrishnan, Sridhar and Vital-Lopez, G. Francisco", title="2B-Alert Web 2.0, an Open-Access Tool for Predicting Alertness and Optimizing the Benefits of Caffeine: Utility Study", journal="J Med Internet Res", year="2022", month="Jan", day="27", volume="24", number="1", pages="e29595", keywords="alertness-prediction model", keywords="caffeine intervention", keywords="neurobehavioral performance", keywords="psychomotor vigilance test", keywords="PVT", keywords="sleep loss", abstract="Background: One-third of the US population experiences sleep loss, with the potential to impair physical and cognitive performance, reduce productivity, and imperil safety during work and daily activities. Computer-based fatigue-management systems with the ability to predict the effects of sleep schedules on alertness and identify safe and effective caffeine interventions that maximize its stimulating benefits could help mitigate cognitive impairment due to limited sleep. To provide these capabilities to broad communities, we previously released 2B-Alert Web, a publicly available tool for predicting the average alertness level of a group of individuals as a function of time of day, sleep history, and caffeine consumption. Objective: In this study, we aim to enhance the capability of the 2B-Alert Web tool by providing the means for it to automatically recommend safe and effective caffeine interventions (time and dose) that lead to optimal alertness levels at user-specified times under any sleep-loss condition. Methods: We incorporated a recently developed caffeine-optimization algorithm into the predictive models of the original 2B-Alert Web tool, allowing the system to search for and identify viable caffeine interventions that result in user-specified alertness levels at desired times of the day. To assess the potential benefits of this new capability, we simulated four sleep-deprivation conditions (sustained operations, restricted sleep with morning or evening shift, and night shift with daytime sleep) and compared the alertness levels resulting from the algorithm's recommendations with those based on the US Army caffeine-countermeasure guidelines. In addition, we enhanced the usability of the tool by adopting a drag-and-drop graphical interface for the creation of sleep and caffeine schedules. Results: For the 4 simulated conditions, the 2B-Alert Web--proposed interventions increased mean alertness by 36\% to 94\% and decreased peak alertness impairment by 31\% to 71\% while using equivalent or smaller doses of caffeine as the corresponding US Army guidelines. Conclusions: The enhanced capability of this evidence-based, publicly available tool increases the efficiency by which diverse communities of users can identify safe and effective caffeine interventions to mitigate the effects of sleep loss in the design of research studies and work and rest schedules. ", doi="10.2196/29595", url="https://www.jmir.org/2022/1/e29595", url="http://www.ncbi.nlm.nih.gov/pubmed/35084336" } @Article{info:doi/10.2196/27349, author="Passardi, Alessandro and Foca, Flavia and Caffo, Orazio and Tondini, Alberto Carlo and Zambelli, Alberto and Vespignani, Roberto and Bartolini, Giulia and Sullo, Giulio Francesco and Andreis, Daniele and Dianti, Marco and Eccher, Claudio and Piras, Maria Enrico and Forti, Stefano", title="A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training--Validation Trial", journal="J Med Internet Res", year="2022", month="Jan", day="26", volume="24", number="1", pages="e27349", keywords="adherence", keywords="oral anticancer drug", keywords="mHealth", keywords="ONCO-TreC", keywords="electronic diary", abstract="Background: A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient--health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective: The overall aims of the trial are to customize the platform; assess the system's ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods: Patients aged ?18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results: A total of 40 patients were enrolled, 38 (95\%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3\% (95\% CI 86.1\%-99.9\%) between the investigator and system pill count. Only 60\% (3/5) of grade 3, 54\% (13/24) of grade 2, and 19\% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94\% (33/35) of patients had ?1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71\% (27/38) and 68\% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions: ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration: ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724 ", doi="10.2196/27349", url="https://www.jmir.org/2022/1/e27349", url="http://www.ncbi.nlm.nih.gov/pubmed/35080505" } @Article{info:doi/10.2196/28701, author="Gagnon-Roy, Mireille and Pinard, St{\'e}phanie and Bottari, Carolina and Le Morellec, Fanny and Lalibert{\'e}, Catherine and Ben Lagha, Rym and Yaddaden, Amel and Pigot, H{\'e}l{\`e}ne and Giroux, Sylvain and Bier, Nathalie", title="Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study", journal="JMIR Rehabil Assist Technol", year="2022", month="Jan", day="26", volume="9", number="1", pages="e28701", keywords="usability testing and evaluation", keywords="user experience", keywords="qualitative methods", keywords="assistive technologies", keywords="rehabilitation", keywords="patient safety", abstract="Background: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. Objective: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. Methods: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. Results: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). Conclusions: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology. ", doi="10.2196/28701", url="https://rehab.jmir.org/2022/1/e28701", url="http://www.ncbi.nlm.nih.gov/pubmed/35080496" } @Article{info:doi/10.2196/26555, author="Svendsen, Jagd Malene and Sandal, Fleng Louise and Kj{\ae}r, Per and Nicholl, I. Barbara and Cooper, Kay and Mair, Frances and Hartvigsen, Jan and Stochkendahl, Jensen Mette and S{\o}gaard, Karen and Mork, Jarle Paul and Rasmussen, Charlotte", title="Using Intervention Mapping to Develop a Decision Support System--Based Smartphone App (selfBACK) to Support Self-management of Nonspecific Low Back Pain: Development and Usability Study", journal="J Med Internet Res", year="2022", month="Jan", day="24", volume="24", number="1", pages="e26555", keywords="intervention mapping", keywords="behavior change", keywords="low back pain", keywords="self-management", keywords="mHealth", keywords="app-based intervention", keywords="decision support system", keywords="digital health intervention", keywords="mobile phone", abstract="Background: International guidelines consistently endorse the promotion of self-management for people with low back pain (LBP); however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode of supporting self-management in people with chronic conditions, including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak, and detailed descriptions and documentation of the interventions are lacking. Structured intervention mapping (IM) constitutes a 6-step process that can be used to guide the development of complex interventions. Objective: The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of nonspecific LBP to reduce pain-related disability. Methods: The first 5 steps of the IM process were systematically applied. The core processes included literature reviews, brainstorming and group discussions, and the inclusion of stakeholders and representatives from the target population. Over a period of >2 years, the intervention content and the technical features of delivery were created, tested, and revised through user tests, feasibility studies, and a pilot study. Results: A behavioral outcome was identified as a proxy for reaching the overall program goal, that is, increased use of evidence-based self-management strategies. Physical exercises, education, and physical activity were the main components of the self-management intervention and were designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by the behavior change theory and the normalization process theory. Conclusions: We describe a detailed example of the application of the IM approach for the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency in the developmental process of the intervention and can be a possible blueprint for designing and creating future digital health interventions for self-management. ", doi="10.2196/26555", url="https://www.jmir.org/2022/1/e26555", url="http://www.ncbi.nlm.nih.gov/pubmed/35072645" } @Article{info:doi/10.2196/33716, author="Hogan, P. Timothy and Etingen, Bella and McMahon, Nicholas and Bixler, R. Felicia and Am, Linda and Wacks, E. Rachel and Shimada, L. Stephanie and Reilly, D. Erin and Frisbee, L. Kathleen and Smith, M. Bridget", title="Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation", journal="JMIR Form Res", year="2022", month="Jan", day="20", volume="6", number="1", pages="e33716", keywords="mobile health applications", keywords="pain", keywords="veterans", keywords="usability", abstract="Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1\%). These veterans received our outreach program; 236 (236/393, 60.1\%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2\% (24/236) used Pain Coach, and 58\% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3\%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. ", doi="10.2196/33716", url="https://formative.jmir.org/2022/1/e33716", url="http://www.ncbi.nlm.nih.gov/pubmed/35049515" } @Article{info:doi/10.2196/33470, author="Larsen, Kevin and Akindele, Bilikis and Head, Henry and Evans, Rick and Mehta, Purvi and Hlatky, Quinn and Krause, Brendan and Chen, Sydney and King, Dominic", title="Developing a User-Centered Digital Clinical Decision Support App for Evidence-Based Medication Recommendations for Type 2 Diabetes Mellitus: Prototype User Testing and Validation Study", journal="JMIR Hum Factors", year="2022", month="Jan", day="18", volume="9", number="1", pages="e33470", keywords="clinical decision support", keywords="user-centered design", keywords="user testing", keywords="type 2 diabetes mellitus", keywords="evidence-based guidelines", keywords="validation", keywords="workflows", keywords="electronic health record", keywords="decision support", keywords="design", keywords="diabetes", abstract="Background: Closing the gap between care recommended by evidence-based guidelines and care delivered in practice is an ongoing challenge across systems and delivery models. Clinical decision support systems (CDSSs) are widely deployed to augment clinicians in their complex decision-making processes. Despite published success stories, the poor usability of many CDSSs has contributed to fragmented workflows and alert fatigue. Objective: This study aimed to validate the application of a user-centered design (UCD) process in the development of a standards-based medication recommender for type 2 diabetes mellitus in a simulated setting. The prototype app was evaluated for effectiveness, efficiency, and user satisfaction. Methods: We conducted interviews with 8 clinical leaders with 8 rounds of iterative user testing with 2-8 prescribers in each round to inform app development. With the resulting prototype app, we conducted a validation study with 43 participants. The participants were assigned to one of two groups and completed a 2-hour remote user testing session. Both groups reviewed mock patient facts and ordered diabetes medications for the patients. The Traditional group used a mock electronic health record (EHR) for the review in Period 1 and used the prototype app in Period 2, while the Tool group used the prototype app during both time periods. The perceived cognitive load associated with task performance during each period was assessed with the National Aeronautics and Space Administration Task Load Index. Participants also completed the System Usability Scale (SUS) questionnaire and Kano Survey. Results: Average SUS scores from the questionnaire, taken at the end of 5 of the 8 user testing sessions, ranged from 68-86. The results of the validation study are as follows: percent adherence to evidence-based guidelines was greater with the use of the prototype app than with the EHR across time periods with the Traditional group (prototype app mean 96.2 vs EHR mean 72.0, P<.001) and between groups during Period 1 (Tool group mean 92.6 vs Traditional group mean 72.0, P<.001). Task completion times did not differ between groups (P=.23), but the Tool group completed medication ordering more quickly in Period 2 (Period 1 mean 130.7 seconds vs Period 2 mean 107.7 seconds, P<.001). Based on an adjusted $\alpha$ level owing to violation of the assumption of homogeneity of variance (Ps>.03), there was no effect on screens viewed and on perceived cognitive load (all Ps>.14). Conclusions: Through deployment of the UCD process, a point-of-care medication recommender app holds promise of improving adherence to evidence-based guidelines; in this case, those from the American Diabetes Association. Task-time performance suggests that with practice the T2DM app may support a more efficient ordering process for providers, and SUS scores indicate provider satisfaction with the app. ", doi="10.2196/33470", url="https://humanfactors.jmir.org/2022/1/e33470", url="http://www.ncbi.nlm.nih.gov/pubmed/34784293" } @Article{info:doi/10.2196/29889, author="Doyle, Sarah and Pavlos, Rebecca and Carlson, J. Samantha and Barton, Katherine and Bhuiyan, Mejbah and Boeing, Bernadett and Borland, L. Meredith and Hoober, Steven and Blyth, C. Christopher", title="Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians", journal="JMIR Form Res", year="2022", month="Jan", day="17", volume="6", number="1", pages="e29889", keywords="usability testing", keywords="REDCap", keywords="discharge instructions", keywords="acute respiratory infection", keywords="digital health technology", keywords="mobile technology", keywords="semistructured interview", keywords="pediatric acute respiratory infection", keywords="mobile phone", abstract="Background: Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools---a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform---into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective: The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods: Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results: Most parents (9/11, 82\%) indicated that they usually received verbal discharge advice, with some (5/11, 45\%) recalling receiving preprinted resources from their physician. Most (8/11, 73\%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88\%) described their usual practice as verbal discharge instructions, with some (3/8, 38\%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73\%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions: Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting. ", doi="10.2196/29889", url="https://formative.jmir.org/2022/1/e29889", url="http://www.ncbi.nlm.nih.gov/pubmed/35037889" } @Article{info:doi/10.2196/24483, author="Fox, Sarah and Brown, E. Laura J. and Antrobus, Steven and Brough, David and Drake, J. Richard and Jury, Francine and Leroi, Iracema and Parry-Jones, R. Adrian and Machin, Matthew", title="Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="14", volume="10", number="1", pages="e24483", keywords="agile", keywords="dementia", keywords="co-design", keywords="cognition", keywords="mHealth", keywords="patient public involvement", keywords="software development", keywords="mobile phone", abstract="Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner--led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. ", doi="10.2196/24483", url="https://mhealth.jmir.org/2022/1/e24483", url="http://www.ncbi.nlm.nih.gov/pubmed/35029539" } @Article{info:doi/10.2196/31567, author="Poduval, Shoba and Ross, Jamie and Pal, Kingshuk and Newhouse, Nikki and Hamilton, Fiona and Murray, Elizabeth", title="Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach", journal="JMIR Hum Factors", year="2022", month="Jan", day="14", volume="9", number="1", pages="e31567", keywords="type 2 diabetes", keywords="patient self-management", keywords="diabetes education", keywords="primary care", keywords="digital health", abstract="Background: Digital health research encompasses methods from human-computer interaction and health research. Objective: This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. Methods: The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. Results: The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. Conclusions: The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs. ", doi="10.2196/31567", url="https://humanfactors.jmir.org/2022/1/e31567", url="http://www.ncbi.nlm.nih.gov/pubmed/35029531" } @Article{info:doi/10.2196/32273, author="Feldman, G. Amy and Moore, Susan and Bull, Sheana and Morris, A. Megan and Wilson, Kumanan and Bell, Cameron and Collins, M. Margaret and Denize, M. Kathryn and Kempe, Allison", title="A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study", journal="JMIR Form Res", year="2022", month="Jan", day="13", volume="6", number="1", pages="e32273", keywords="vaccinations", keywords="transplantation", keywords="mobile app", keywords="agile development", keywords="immunization", keywords="mHealth", keywords="mobile health", keywords="children", keywords="transplant recipients", keywords="pediatric transplant recipients", keywords="pediatrics", abstract="Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20\% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87\% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. ", doi="10.2196/32273", url="https://formative.jmir.org/2022/1/e32273", url="http://www.ncbi.nlm.nih.gov/pubmed/35023840" } @Article{info:doi/10.2196/27631, author="Gunn, M. Kate and Skaczkowski, Gemma and Dollman, James and Vincent, D. Andrew and Short, E. Camille and Brumby, Susan and Barrett, Alison and Harrison, Nathan and Turnbull, Deborah", title="Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell", journal="JMIR Hum Factors", year="2022", month="Jan", day="11", volume="9", number="1", pages="e27631", keywords="farm", keywords="agriculture", keywords="rural", keywords="drought", keywords="mental health", keywords="stress", keywords="coping", keywords="online intervention", keywords="acceptance and commitment therapy", abstract="Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9\%) female, aged 21-73 years; 95.5\% (149/156) residing in inner regional to very remote Australia, and 68.2\% (107/157) ``sheep, cattle and/or grain farmers.'' Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies---ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health--related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1\% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions: Sequential integration of research evidence, expert knowledge, and farmers' preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526 ", doi="10.2196/27631", url="https://humanfactors.jmir.org/2022/1/e27631", url="http://www.ncbi.nlm.nih.gov/pubmed/35014963" } @Article{info:doi/10.2196/29302, author="Mattila, Elina and Hansen, Susanne and Bundgaard, Lise and Ramsey, Lauren and Dunning, Alice and Silva, N. Marlene and Harjumaa, Marja and Ermes, Miikka and Marques, M. Marta and Matos, Marcela and Larsen, C. Sofus and Encantado, Jorge and Santos, In{\^e}s and Horgan, Graham and O'Driscoll, Ruairi and Turicchi, Jake and Duarte, Cristiana and Palmeira, L. Ant{\'o}nio and Stubbs, James R. and Heitmann, Lilienthal Berit and L{\"a}hteenm{\"a}ki, Liisa", title="Users' Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Jan", day="10", volume="24", number="1", pages="e29302", keywords="digital behavior change intervention", keywords="user experience", keywords="technology acceptance", keywords="weight-loss maintenance", keywords="focus groups", keywords="mixed methods", keywords="mobile phone", abstract="Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)---a DBCI that targets weight loss maintenance---over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2{\texttimes}2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content. Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-029425 ", doi="10.2196/29302", url="https://www.jmir.org/2022/1/e29302", url="http://www.ncbi.nlm.nih.gov/pubmed/35006081" } @Article{info:doi/10.2196/27952, author="Shaikh, Ahmed and Bhatia, Abhishek and Yadav, Ghanshyam and Hora, Shashwat and Won, Chung and Shankar, Mark and Heerboth, Aaron and Vemulapalli, Prakash and Navalkar, Paresh and Oswal, Kunal and Heaton, Clay and Saunik, Sujata and Khanna, Tarun and Balsari, Satchit", title="Applying Human-Centered Design Principles to Digital Syndromic Surveillance at a Mass Gathering in India: Viewpoint", journal="J Med Internet Res", year="2022", month="Jan", day="10", volume="24", number="1", pages="e27952", keywords="mHealth", keywords="design", keywords="human centered design", keywords="intervention", keywords="syndromic surveillance", keywords="digital health", doi="10.2196/27952", url="https://www.jmir.org/2022/1/e27952", url="http://www.ncbi.nlm.nih.gov/pubmed/35006088" } @Article{info:doi/10.2196/27689, author="Rao, Nema and Perdomo, Sophy and Jonassaint, Charles", title="A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach", journal="JMIR Hum Factors", year="2022", month="Jan", day="7", volume="9", number="1", pages="e27689", keywords="pain", keywords="pain measurement", keywords="chronic pain", keywords="animations", keywords="mobile apps", keywords="human-centered design", abstract="Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. ", doi="10.2196/27689", url="https://humanfactors.jmir.org/2022/1/e27689", url="http://www.ncbi.nlm.nih.gov/pubmed/34994697" } @Article{info:doi/10.2196/28783, author="Savoy, April and Saleem, J. Jason and Barker, C. Barry and Patel, Himalaya and Kara, Areeba", title="Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists: Workflow Analysis Based on Semistructured Interviews", journal="JMIR Hum Factors", year="2022", month="Jan", day="4", volume="9", number="1", pages="e28783", keywords="electronic health records", keywords="hospital medicine", keywords="user-computer interface", keywords="human-computer interaction", keywords="usability", keywords="mental workload", keywords="workflow analysis", abstract="Background: The hospitalist workday is cognitively demanding and dominated by activities away from patients' bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use. Objective: The purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists' workflows. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists' perspectives on mobile technology and apps. Methods: We conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas. Results: Over 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized. Conclusions: Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists' workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists' memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine. ", doi="10.2196/28783", url="https://humanfactors.jmir.org/2022/1/e28783", url="http://www.ncbi.nlm.nih.gov/pubmed/34643530" } @Article{info:doi/10.2196/29494, author="Thirumalai, Mohanraj and Brown, Nashira and Niranjan, Soumya and Townsend, Sh'Nese and Powell, Anne Mary and Neal, Whitney and Schleicher, Erica and Raparla, Venkatadri and Oster, Robert and Demark-Wahnefried, Wendy and Pekmezi, Dori", title="An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study", journal="JMIR Hum Factors", year="2022", month="Jan", day="4", volume="9", number="1", pages="e29494", keywords="interactive voice response systems", keywords="usability", keywords="exercise", keywords="physical activity", keywords="rural health", keywords="telehealth", abstract="Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. ", doi="10.2196/29494", url="https://humanfactors.jmir.org/2022/1/e29494", url="http://www.ncbi.nlm.nih.gov/pubmed/34982714" } @Article{info:doi/10.2196/23236, author="Ogundaini, Oluwamayowa and de la Harpe, Retha", title="The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach", journal="JMIR Form Res", year="2022", month="Jan", day="4", volume="6", number="1", pages="e23236", keywords="agency", keywords="health care professionals", keywords="technology performativity", keywords="sub-Saharan Africa", keywords="service design", keywords="work activities", keywords="mobile phone", abstract="Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants' data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. ", doi="10.2196/23236", url="https://formative.jmir.org/2022/1/e23236", url="http://www.ncbi.nlm.nih.gov/pubmed/34982713" } @Article{info:doi/10.2196/29969, author="Wang, Hua and Gupta, Sneha and Singhal, Arvind and Muttreja, Poonam and Singh, Sanghamitra and Sharma, Poorva and Piterova, Alice", title="An Artificial Intelligence Chatbot for Young People's Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study", journal="J Med Internet Res", year="2022", month="Jan", day="3", volume="24", number="1", pages="e29969", keywords="artificial intelligence", keywords="chatbot", keywords="Facebook", keywords="affordance", keywords="sex education", keywords="sexual and reproductive health", keywords="contraception", keywords="case study", keywords="young people", keywords="India", keywords="transmedia", keywords="mobile apps", keywords="mobile health", keywords="technology design", keywords="user engagement", keywords="digital health", keywords="mobile phone", abstract="Background: Leveraging artificial intelligence (AI)--driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources. Objective: This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India. Methods: We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings. Results: SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience. Conclusions: SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good. ", doi="10.2196/29969", url="https://www.jmir.org/2022/1/e29969", url="http://www.ncbi.nlm.nih.gov/pubmed/34982034" } @Article{info:doi/10.2196/30474, author="Mariakakis, Alex and Karkar, Ravi and Patel, N. Shwetak and Kientz, A. Julie and Fogarty, James and Munson, A. Sean", title="Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology", journal="JMIR Hum Factors", year="2022", month="Jan", day="3", volume="9", number="1", pages="e30474", keywords="mobile health", keywords="survey instrument", keywords="health screening", keywords="health belief model", keywords="path analysis", keywords="user design", keywords="health technology", keywords="health intervention technology", keywords="digital health", keywords="mobile phone", abstract="Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people's decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. ", doi="10.2196/30474", url="https://humanfactors.jmir.org/2022/1/e30474", url="http://www.ncbi.nlm.nih.gov/pubmed/34982038" } @Article{info:doi/10.2196/27750, author="Gale, James Jonathan and Black, Collin Kameron and Calvano, David Joshua and Fundingsland Jr, Lauritz Edwin and Lai, Deborah and Silacci, Sara and He, Shuhan", title="An Analysis of US Academic Medical Center Websites: Usability Study", journal="J Med Internet Res", year="2021", month="Dec", day="21", volume="23", number="12", pages="e27750", keywords="website usability", keywords="digital health", keywords="health care website", keywords="academic medical center", keywords="usability testing", keywords="web crawler", abstract="Background: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out. Objective: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites. Methods: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital's website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall ``general usability'' score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final ``overall usability'' ranking. Results: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category. Conclusions: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user's experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability. ", doi="10.2196/27750", url="https://www.jmir.org/2021/12/e27750", url="http://www.ncbi.nlm.nih.gov/pubmed/34932015" } @Article{info:doi/10.2196/24114, author="O'Campo, Patricia and Velonis, Alisa and Buhariwala, Pearl and Kamalanathan, Janisha and Hassan, Awaiz Maha and Metheny, Nicholas", title="Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach", journal="J Med Internet Res", year="2021", month="Dec", day="21", volume="23", number="12", pages="e24114", keywords="intimate partner violence", keywords="web-based applications", keywords="women", keywords="user-centered design", abstract="Background: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions. ", doi="10.2196/24114", url="https://www.jmir.org/2021/12/e24114", url="http://www.ncbi.nlm.nih.gov/pubmed/34931998" } @Article{info:doi/10.2196/19543, author="Davies, Karen and Cheraghi-Sohi, Sudeh and Ong, Nio Bie and Perryman, Katherine and Sanders, Caroline", title="Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="20", volume="10", number="12", pages="e19543", keywords="design research", keywords="co-design", keywords="dementia", keywords="mobile app", keywords="communication", keywords="safety", keywords="mobile phone", abstract="Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice---championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 ", doi="10.2196/19543", url="https://www.researchprotocols.org/2021/12/e19543", url="http://www.ncbi.nlm.nih.gov/pubmed/34932011" } @Article{info:doi/10.2196/31130, author="Choemprayong, Songphan and Charoenlap, Chris and Piromsopa, Krerk", title="Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study", journal="JMIR Hum Factors", year="2021", month="Dec", day="20", volume="8", number="4", pages="e31130", keywords="teleconsultation", keywords="remote consultation", keywords="mobile applications", keywords="usability", keywords="orthopedics", keywords="physician-to-physician consultation", keywords="electronic medical records", keywords="mobile phone", abstract="Background: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective: This study aimed to explore usability issues emerging from users' interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated. ", doi="10.2196/31130", url="https://humanfactors.jmir.org/2021/4/e31130", url="http://www.ncbi.nlm.nih.gov/pubmed/34931991" } @Article{info:doi/10.2196/29731, author="Cooray, Nipuna and Sun, Louise Si and Ho, Catherine and Adams, Susan and Keay, Lisa and Nassar, Natasha and Brown, Julie", title="Toward a Behavior Theory--Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study", journal="JMIR Pediatr Parent", year="2021", month="Dec", day="20", volume="4", number="4", pages="e29731", keywords="child injury", keywords="Behaviour Change Wheel", keywords="mobile app", keywords="mobile phone", abstract="Background: Falls account for approximately 50\% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory--informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory-- and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn's mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory--informed mobile intervention for injury prevention refined using the person-based approach. ", doi="10.2196/29731", url="https://pediatrics.jmir.org/2021/4/e29731", url="http://www.ncbi.nlm.nih.gov/pubmed/34932004" } @Article{info:doi/10.2196/25498, author="Tossaint-Schoenmakers, Rosian and Kasteleyn, Marise and Goedhart, Annelijn and Versluis, Anke and Talboom-Kamp, Esther", title="The Impact of Patient Characteristics on Their Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study", journal="JMIR Form Res", year="2021", month="Dec", day="17", volume="5", number="12", pages="e25498", keywords="patient portal", keywords="eHealth impact questionnaire", keywords="laboratory test results", keywords="self-efficacy", keywords="usability", keywords="age", keywords="gender", keywords="chronic disease", keywords="education", keywords="patient characteristics", abstract="Background: Patient portals are promising tools to increase patient involvement and allow them to manage their health. To optimally facilitate patients, laboratory test results should be explained in easy language. Patient characteristics affect the usage of portals and the user satisfaction. However, limited research is available, specified for online communicating laboratory test results, on whether portal use and acceptance differ between groups. Objective: The aim of this study was to assess the effect of patient characteristics (gender, age, education, and chronic disease) on the self-efficacy and perceived usability of an online patient portal that communicates diagnostic test results. Methods: We used the online-administered eHealth impact questionnaire (eHIQ) to explore patients' attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire and to answer questions regarding gender, age, education, and chronic disease. The subscale ``information and presentation'' of the eHIQ assessed the usability of the patient portal and the subscale ``motivation and confidence to act'' assessed self-efficacy to determine whether patients were motivated to act on the presented information. Age, gender, education, and chronic disease were the determinants to analyze the effect on usability and self-efficacy. Descriptive analyses were performed to explore patient characteristics, usability, and self-efficacy. Univariable and multivariable regression analyses were performed with age, gender, education, and chronic disease as determinants, and usability and self-efficacy as outcomes. Results: The questionnaire was completed by 748 respondents, of which 428 (57.2\%) were female, 423 (56.6\%) were highly educated, and 509 (68\%) had no chronic disease. The mean age was 58.5 years (SD 16.4). Higher age, high education, and asthma or chronic obstructive pulmonary disease were significant determinants for decreased usability; respectively, b=-.094, 95\% CI -1147 to 0.042 (P<.001); b=-2.512, 95\% CI -4.791 to -0.232 (P=.03); and b=-3.630, 95\% CI -6.545 to -0.715 (P=.02). High education was also a significant determinant for a lower self-efficacy (b=-3.521, 95\% CI -6.469 to -0.572; P=.02). Other determinants were not significant. Conclusions: This study showed that the higher-educated users of a patient portal scored lower on usability and self-efficacy. Usability was also lower for older people and for patients with asthma or chronic obstructive pulmonary disease. The results portal is not tailored for different groups. Further research should investigate which factors from a patient's perspective are essential to tailor the portal for different groups and how a result portal can be optimally integrated within the daily practice of a doctor. ", doi="10.2196/25498", url="https://formative.jmir.org/2021/12/e25498", url="http://www.ncbi.nlm.nih.gov/pubmed/34927593" } @Article{info:doi/10.2196/26439, author="Chen, Yuling and Ji, Meihua and Wu, Ying and Wang, Qingyu and Deng, Ying and Liu, Yong and Wu, Fangqin and Liu, Mingxuan and Guo, Yiqiang and Fu, Ziyuan and Zheng, Xiaoying", title="An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="13", volume="9", number="12", pages="e26439", keywords="mobile health", keywords="health behavior", keywords="system", keywords="development", keywords="usability", keywords="coronary heart disease", abstract="Background: Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. Objective: The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. Methods: We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. Results: iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72\% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90\% (79/88) were satisfied with iCARE; 94\% (83/88) and 82\% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85\% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89\% (54/61) were satisfied with the use of iCARE, 93\% (57/61) perceived it as useful, and 70\% (43/61) as easy to use. Conclusions: This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients' adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew ", doi="10.2196/26439", url="https://mhealth.jmir.org/2021/12/e26439", url="http://www.ncbi.nlm.nih.gov/pubmed/34898449" } @Article{info:doi/10.2196/29748, author="Massanelli, Jackson and Sexton, W. Kevin and Lesher, T. Chris and Jensen, K. Hanna and Kimbrough, K. Mary and Privratsky, Anna and Taylor, R. John and Bhavaraju, Avi", title="Integration of Web Analytics Into Graduate Medical Education: Usability Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e29748", keywords="graduate medical education", keywords="website analysis", keywords="residency recruitment", keywords="medical education", keywords="website", keywords="analytics", keywords="usage", keywords="usability", keywords="user engagement", keywords="user-centered design", keywords="website design", abstract="Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department's website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70\% vs 0.23\%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website's efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. ", doi="10.2196/29748", url="https://formative.jmir.org/2021/12/e29748", url="http://www.ncbi.nlm.nih.gov/pubmed/34898459" } @Article{info:doi/10.2196/30762, author="Lee, W. Austin and Kenfield, A. Stacey and Wang, Y. Elizabeth and Enriquez, Anthony and Oni-Orisan, Akinyemi and Steinman, A. Michael and Sim, Ida and Breyer, N. Benjamin and Bauer, R. Scott", title="Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study", journal="JMIR Form Res", year="2021", month="Dec", day="10", volume="5", number="12", pages="e30762", keywords="LUTS", keywords="tamsulosin", keywords="mobile", keywords="app", keywords="mobile phone", abstract="Background: Continuous $\alpha$1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men. Objective: We aim to evaluate the feasibility and usability of the PERSONAL (Placebo--Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy. Methods: We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility. Results: We enrolled 19 men within 23 days, and 100\% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79\% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74\% vs 17/19, 89\% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95\% at baseline and at follow-up). In total, 58\% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms. Conclusions: This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men. ", doi="10.2196/30762", url="https://formative.jmir.org/2021/12/e30762", url="http://www.ncbi.nlm.nih.gov/pubmed/34889745" } @Article{info:doi/10.2196/27512, author="Harrington, Katharine and Zenk, N. Shannon and Van Horn, Linda and Giurini, Lauren and Mahakala, Nithya and Kershaw, N. Kiarri", title="The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study", journal="JMIR Form Res", year="2021", month="Dec", day="2", volume="5", number="12", pages="e27512", keywords="ecological momentary assessment", keywords="eating behaviors", keywords="crowdsourcing", keywords="food consumption images", keywords="food image processing", keywords="mobile phone", abstract="Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility---usability and acceptability---of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85\%) and high agreement for all other food categories (871/1014, 85.89\% for fruits; 847/1014, 83.53\% for salty snacks, and 833/1014, 81.15\% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. ", doi="10.2196/27512", url="https://formative.jmir.org/2021/12/e27512", url="http://www.ncbi.nlm.nih.gov/pubmed/34860666" } @Article{info:doi/10.2196/26370, author="Counson, Isabelle and Bartholomew, Alexandra and Crawford, Joanna and Petrie, Katherine and Basarkod, Geetanjali and Moynihan, Victoria and Pires, Josie and Cohen, Rachel and Glozier, Nicholas and Harvey, Samuel and Sanatkar, Samineh", title="Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing", journal="JMIR Form Res", year="2021", month="Dec", day="2", volume="5", number="12", pages="e26370", keywords="digital mental health", keywords="mHealth apps", keywords="help-seeking", keywords="junior physicians", keywords="co-design", keywords="user-centered design", keywords="mobile phone", abstract="Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were---needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians' needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. ", doi="10.2196/26370", url="https://formative.jmir.org/2021/12/e26370", url="http://www.ncbi.nlm.nih.gov/pubmed/34860662" } @Article{info:doi/10.2196/22390, author="Coumans, J. Juul M. and Oenema, Anke and Bolman, W. Catherine A. and Lechner, Lilian", title="Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors", journal="JMIR Form Res", year="2021", month="Dec", day="2", volume="5", number="12", pages="e22390", keywords="diet", keywords="physical activity", keywords="eHealth", keywords="self-determination theory", keywords="motivational interviewing", keywords="process evaluation", keywords="nonusage attrition", abstract="Background: eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions. Objective: This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants' flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores. Methods: This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores. Results: Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6\%), the PA module (2/12, 17\%), and both modules (58/273, 21.2\%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions). Conclusions: This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study. ", doi="10.2196/22390", url="https://formative.jmir.org/2021/12/e22390", url="http://www.ncbi.nlm.nih.gov/pubmed/34860670" } @Article{info:doi/10.2196/25071, author="Petracca, Francesco and Tempre, Rosaria and Cucciniello, Maria and Ciani, Oriana and Pompeo, Elena and Sannino, Luigi and Lovato, Valeria and Castaman, Giancarlo and Ghirardini, Alessandra and Tarricone, Rosanna", title="An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study", journal="JMIR Form Res", year="2021", month="Dec", day="1", volume="5", number="12", pages="e25071", keywords="mobile apps", keywords="mHealth", keywords="hemophilia A", keywords="rare diseases", keywords="usability", keywords="user-centered design", keywords="design science", keywords="mobile phone", abstract="Background: There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective: The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods: We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app's improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results: The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app's layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions: The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app's users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration: ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135 ", doi="10.2196/25071", url="https://formative.jmir.org/2021/12/e25071", url="http://www.ncbi.nlm.nih.gov/pubmed/34855619" } @Article{info:doi/10.2196/30867, author="Aminoff, Hedvig and Meijer, Sebastiaan and Groth, Kristina and Arnelo, Urban", title="User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service", journal="JMIR Hum Factors", year="2021", month="Nov", day="30", volume="8", number="4", pages="e30867", keywords="telemedicine", keywords="user experience", keywords="satisfaction", keywords="technology acceptance", keywords="usability", keywords="perioperative", keywords="surgery", keywords="consultation", keywords="surgeons", keywords="performance", keywords="evaluation", keywords="teleguidance", keywords="telehealth", keywords="telemedicine implementation", abstract="Background: Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective: We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology's usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. Methods: We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. Results: In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3\%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85\%) and support with assessment and decision-making (122/140, 87\%). Conclusions: Users' satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes. ", doi="10.2196/30867", url="https://humanfactors.jmir.org/2021/4/e30867", url="http://www.ncbi.nlm.nih.gov/pubmed/34851302" } @Article{info:doi/10.2196/30308, author="St{\"o}hr, R. Mark and G{\"u}nther, Andreas and Majeed, W. Raphael", title="The Collaborative Metadata Repository (CoMetaR) Web App: Quantitative and Qualitative Usability Evaluation", journal="JMIR Med Inform", year="2021", month="Nov", day="29", volume="9", number="11", pages="e30308", keywords="usability", keywords="metadata", keywords="data visualization", keywords="semantic web", keywords="data management", keywords="data warehousing", keywords="communication barriers", keywords="quality improvement", keywords="biological ontologies", keywords="data curation", abstract="Background: In the field of medicine and medical informatics, the importance of comprehensive metadata has long been recognized, and the composition of metadata has become its own field of profession and research. To ensure sustainable and meaningful metadata are maintained, standards and guidelines such as the FAIR (Findability, Accessibility, Interoperability, Reusability) principles have been published. The compilation and maintenance of metadata is performed by field experts supported by metadata management apps. The usability of these apps, for example, in terms of ease of use, efficiency, and error tolerance, crucially determines their benefit to those interested in the data. Objective: This study aims to provide a metadata management app with high usability that assists scientists in compiling and using rich metadata. We aim to evaluate our recently developed interactive web app for our collaborative metadata repository (CoMetaR). This study reflects how real users perceive the app by assessing usability scores and explicit usability issues. Methods: We evaluated the CoMetaR web app by measuring the usability of 3 modules: core module, provenance module, and data integration module. We defined 10 tasks in which users must acquire information specific to their user role. The participants were asked to complete the tasks in a live web meeting. We used the System Usability Scale questionnaire to measure the usability of the app. For qualitative analysis, we applied a modified think aloud method with the following thematic analysis and categorization into the ISO 9241-110 usability categories. Results: A total of 12 individuals participated in the study. We found that over 97\% (85/88) of all the tasks were completed successfully. We measured usability scores of 81, 81, and 72 for the 3 evaluated modules. The qualitative analysis resulted in 24 issues with the app. Conclusions: A usability score of 81 implies very good usability for the 2 modules, whereas a usability score of 72 still indicates acceptable usability for the third module. We identified 24 issues that serve as starting points for further development. Our method proved to be effective and efficient in terms of effort and outcome. It can be adapted to evaluate apps within the medical informatics field and potentially beyond. ", doi="10.2196/30308", url="https://medinform.jmir.org/2021/11/e30308", url="http://www.ncbi.nlm.nih.gov/pubmed/34847059" } @Article{info:doi/10.2196/28577, author="To, G. Quyen and Green, Chelsea and Vandelanotte, Corneel", title="Feasibility, Usability, and Effectiveness of a Machine Learning--Based Physical Activity Chatbot: Quasi-Experimental Study", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="26", volume="9", number="11", pages="e28577", keywords="conversational agent", keywords="virtual coach", keywords="intervention", keywords="exercise", keywords="acceptability", keywords="mobile phone", abstract="Background: Behavioral eHealth and mobile health interventions have been moderately successful in increasing physical activity, although opportunities for further improvement remain to be discussed. Chatbots equipped with natural language processing can interact and engage with users and help continuously monitor physical activity by using data from wearable sensors and smartphones. However, a limited number of studies have evaluated the effectiveness of chatbot interventions on physical activity. Objective: This study aims to investigate the feasibility, usability, and effectiveness of a machine learning--based physical activity chatbot. Methods: A quasi-experimental design without a control group was conducted with outcomes evaluated at baseline and 6 weeks. Participants wore a Fitbit Flex 1 (Fitbit LLC) and connected to the chatbot via the Messenger app. The chatbot provided daily updates on the physical activity level for self-monitoring, sent out daily motivational messages in relation to goal achievement, and automatically adjusted the daily goals based on physical activity levels in the last 7 days. When requested by the participants, the chatbot also provided sources of information on the benefits of physical activity, sent general motivational messages, and checked participants' activity history (ie, the step counts/min that were achieved on any day). Information about usability and acceptability was self-reported. The main outcomes were daily step counts recorded by the Fitbit and self-reported physical activity. Results: Among 116 participants, 95 (81.9\%) were female, 85 (73.3\%) were in a relationship, 101 (87.1\%) were White, and 82 (70.7\%) were full-time workers. Their average age was 49.1 (SD 9.3) years with an average BMI of 32.5 (SD 8.0) kg/m2. Most experienced technical issues were due to an unexpected change in Facebook policy (93/113, 82.3\%). Most of the participants scored the usability of the chatbot (101/113, 89.4\%) and the Fitbit (99/113, 87.6\%) as at least ``OK.'' About one-third (40/113, 35.4\%) would continue to use the chatbot in the future, and 53.1\% (60/113) agreed that the chatbot helped them become more active. On average, 6.7 (SD 7.0) messages/week were sent to the chatbot and 5.1 (SD 7.4) min/day were spent using the chatbot. At follow-up, participants recorded more steps (increase of 627, 95\% CI 219-1035 steps/day) and total physical activity (increase of 154.2 min/week; 3.58 times higher at follow-up; 95\% CI 2.28-5.63). Participants were also more likely to meet the physical activity guidelines (odds ratio 6.37, 95\% CI 3.31-12.27) at follow-up. Conclusions: The machine learning--based physical activity chatbot was able to significantly increase participants' physical activity and was moderately accepted by the participants. However, the Facebook policy change undermined the chatbot functionality and indicated the need to use independent platforms for chatbot deployment to ensure successful delivery of this type of intervention. ", doi="10.2196/28577", url="https://mhealth.jmir.org/2021/11/e28577", url="http://www.ncbi.nlm.nih.gov/pubmed/34842552" } @Article{info:doi/10.2196/30495, author="Shewchuk, Brittany and Green, A. Lee and Barber, Tanya and Miller, Jean and Teare, Sylvia and Campbell-Scherer, Denise and Mrklas, J. Kelly and Li, C. Linda and Marlett, Nancy and Wasylak, Tracy and Lopatina, Elena and McCaughey, Deirdre and Marshall, A. Deborah", title="Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study", journal="JMIR Form Res", year="2021", month="Nov", day="25", volume="5", number="11", pages="e30495", keywords="mobile health", keywords="mHealth", keywords="app", keywords="self-management", keywords="osteoarthritis", abstract="Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ?20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients' perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=?0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. ", doi="10.2196/30495", url="https://formative.jmir.org/2021/11/e30495", url="http://www.ncbi.nlm.nih.gov/pubmed/34842526" } @Article{info:doi/10.2196/29799, author="Wilroy, Jereme and Lai, Byron and Currie, Madison and Young, Hui-Ju and Thirumalai, Mohanraj and Mehta, Tapan and Giannone, John and Rimmer, James", title="Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study", journal="JMIR Form Res", year="2021", month="Nov", day="18", volume="5", number="11", pages="e29799", keywords="telehealth", keywords="disability", keywords="COVID-19", keywords="exercise", keywords="assessments", keywords="feasibility", keywords="mHealth", keywords="teleassessment", keywords="mobility impairment", keywords="home exercise", keywords="participation", keywords="physical disabilities", abstract="Background: The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. Objective: This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. Methods: The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants' home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ?90\% criteria set a priori. Efficiency was measured by a session duration of ?2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. Results: Data from 36 participants were included in this feasibility study, and 34 (94\%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. Conclusions: The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. Trial Registration: ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 ", doi="10.2196/29799", url="https://formative.jmir.org/2021/11/e29799", url="http://www.ncbi.nlm.nih.gov/pubmed/34792477" } @Article{info:doi/10.2196/31527, author="Burmann, Anja and Tischler, Max and Fa{\ss}bach, Mira and Schneitler, Sophie and Meister, Sven", title="The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study", journal="JMIR Med Inform", year="2021", month="Nov", day="11", volume="9", number="11", pages="e31527", keywords="digitalization", keywords="digital transformation", keywords="health care", keywords="human factor", keywords="physicians", keywords="digital natives", keywords="web-based survey", keywords="digital health", abstract="Background: Digitalization affects all areas of society, including the health care sector. However, the digitalization of health care provision is progressing slowly compared to other sectors. In the professional and political literature, physicians are partially portrayed as digitalization sceptics. Thus, the role of physicians in this process requires further investigation. The theory of ``digital natives'' suggests a lower hurdle for younger generations to engage with digital technologies. Objective: The objective of this study was to investigate the role of physicians in the process of digitalizing health care provision in Germany and to assess the age factor. Methods: We conducted a large-scale study to assess the role of this professional group in the progress of the digital transformation of the German health care sector. Therefore, in an anonymous online survey, we inquired about the current digital penetration of the personal working environment, expectations, attitude toward, and concerns regarding digitalization. Based on these data, we studied associations with the nominal variable age and variations across 2 age groups. Results: The 1274 participants included in the study generally showed a high affinity towards digitalization with a mean of 3.88 on a 5-point Likert scale; 723 respondents (56.75\%) stated they personally use mobile apps in their everyday working life, with a weak tendency to be associated with the respondents' age ($\eta$=0.26). Participants saw the most noticeable existing benefits through digitalization in data quality and readability (882/1274, 69.23\%) and the least in patient engagement (213/1274, 16.72\%). Medical practitioners preponderantly expect further improvements through increased digitalization across almost all queried areas but the most in access to medical knowledge (1136/1274, 89.17\%), treatment of orphan diseases (1016/1274, 79.75\%), and medical research (1023/1274, 80.30\%). Conclusions: Respondents defined their role in the digitalization of health care provision as ambivalent: ``scrutinizing'' on the one hand but ``active'' and ``open'' on the other. A gap between willingness to participate and digital sovereignty was indicated. Thus, education on digitalization as a means to support health care provision should not only be included in the course of study but also in the continuing process of further and advanced training. ", doi="10.2196/31527", url="https://medinform.jmir.org/2021/11/e31527", url="http://www.ncbi.nlm.nih.gov/pubmed/34545813" } @Article{info:doi/10.2196/30786, author="Baumgartner, L. Susan and Buffkin Jr, Eric D. and Rukavina, Elise and Jones, Jason and Weiler, Elizabeth and Carnes, C. Tony", title="A Novel Digital Pill System for Medication Adherence Measurement and Reporting: Usability Validation Study", journal="JMIR Hum Factors", year="2021", month="Nov", day="8", volume="8", number="4", pages="e30786", keywords="digital pills", keywords="digital medication", keywords="ingestible event marker", keywords="ingestible sensor", keywords="human factors", keywords="usability", keywords="validation study", keywords="medication adherence", keywords="medication nonadherence", keywords="remote patient monitoring", keywords="mobile phone", abstract="Background: Medication nonadherence is a costly problem that is common in clinical use and clinical trials alike, with significant adverse consequences. Digital pill systems have proved to be effective and safe solutions to the challenges of nonadherence, with documented success in improving adherence and health outcomes. Objective: The aim of this human factors validation study is to evaluate a novel digital pill system, the ID-Cap System from etectRx, for usability among patient users in a simulated real-world use environment. Methods: A total of 17 patients with diverse backgrounds who regularly take oral prescription medications were recruited. After training and a period of training decay, the participants were asked to complete 12 patient-use scenarios during which errors or difficulties were logged. The participants were also interviewed about their experiences with the ID-Cap System. Results: The participants ranged in age from 27 to 74 years (mean 51 years, SD 13.8 years), and they were heterogeneous in other demographic factors as well, such as education level, handedness, and sex. In this human factors validation study, the patient users completed 97.5\% (196/201) of the total use scenarios successfully; 75.1\% (151/201) were completed without any failures or errors. The participants found the ID-Cap System easy to use, and they were able to accurately and proficiently record ingestion events using the device. Conclusions: The participants demonstrated the ability to safely and effectively use the ID-Cap System for its intended use. The ID-Cap System has great potential as a useful tool for encouraging medication adherence and can be easily implemented by patient users. ", doi="10.2196/30786", url="https://humanfactors.jmir.org/2021/4/e30786", url="http://www.ncbi.nlm.nih.gov/pubmed/34747709" } @Article{info:doi/10.2196/29815, author="Lazard, J. Allison and Babwah Brennen, Scott J. and Belina, P. Stephanie", title="App Designs and Interactive Features to Increase mHealth Adoption: User Expectation Survey and Experiment", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="4", volume="9", number="11", pages="e29815", keywords="smartphone", keywords="interactive design", keywords="mobile apps", keywords="preventive health", keywords="mental models", keywords="prototypicality", keywords="attention", keywords="affordances", abstract="Background: Despite the ubiquity of smartphones, there is little guidance for how to design mobile health apps to increase use. Specifically, knowing what features users expect, grab their attention, encourage use (via predicted use or through positive app evaluations), and signal beneficial action possibilities can guide and focus app development efforts. Objective: We investigated what features users expect and how the design (prototypicality) impacts app adoption. Methods: In a web-based survey, we elicited expectations, including presence and placement, for 12 app features. Thereafter, participants (n=462) viewed 2 health apps (high prototypicality similar to top downloaded apps vs low prototypicality similar to research interventions) and reported willingness to download, attention, and predicted use of app features. Participants rated both apps (high and low) for aesthetics, ease of use, usefulness, perceived affordances, and intentions to use. Results: Most participants (425/462, 92\%) expected features for navigation or personal settings (eg, menu) in specific regions (eg, top corners). Features with summary graphs or statics were also expected by many (395-396 of 462, 86\%), with a center placement expectation. A feature to ``share with friends'' was least expected among participants (203/462, 44\%). Features fell into 4 unique categories based on attention and predicted use, including essential features with high (>50\% or >231 of 462) predicted use and attention (eg, calorie trackers), flashy features with high attention but lower predicted use (eg, links to specific diets), functional features with modest attention and low use (eg, settings), and mundane features with low attention and use (eg, discover tabs). When given a choice, 347 of 462 (75\%) participants would download the high-prototypicality app. High prototypicality apps (vs low) led to greater aesthetics, ease of use, usefulness, and intentions, (for all, P<.001). Participants thought that high prototypicality apps had more perceived affordances. Conclusions: Intervention designs that fail to meet a threshold of mHealth expectations will be dismissed as less usable or beneficial. Individuals who download health apps have shared expectations for features that should be there, as well as where these features should appear. Meeting these expectations can improve app evaluations and encourage use. Our typology should guide presence and placement of expected app features to signal value and increase use to impact preventive health behaviors. Features that will likely be used and are attention-worthy---essential, flashy, and functional---should be prioritized during app development. ", doi="10.2196/29815", url="https://mhealth.jmir.org/2021/11/e29815", url="http://www.ncbi.nlm.nih.gov/pubmed/34734829" } @Article{info:doi/10.2196/31649, author="Reichold, Michael and He{\ss}, Miriam and Kolominsky-Rabas, Peter and Gr{\"a}{\ss}el, Elmar and Prokosch, Hans-Ulrich", title="Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study", journal="JMIR Form Res", year="2021", month="Nov", day="3", volume="5", number="11", pages="e31649", keywords="dementia", keywords="usability", keywords="evaluation", keywords="mobile device", keywords="registry", keywords="electronic data collection", keywords="offline", keywords="mobile app", keywords="digital health", keywords="usability testing", abstract="Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project ``Digital Dementia Registry Bavaria (digiDEM Bayern),'' interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the ``Thinking Aloud'' method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the ``Thinking Aloud'' method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents ``good'' usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry--based research project. ", doi="10.2196/31649", url="https://formative.jmir.org/2021/11/e31649", url="http://www.ncbi.nlm.nih.gov/pubmed/34730543" } @Article{info:doi/10.2196/26181, author="Hill, R. Jordan and Brown, C. Janetta and Campbell, L. Noll and Holden, J. Richard", title="Usability-In-Place---Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review", journal="JMIR Form Res", year="2021", month="Nov", day="2", volume="5", number="11", pages="e26181", keywords="mobile usability testing", keywords="usability inspection", keywords="methods", keywords="aging", keywords="literature synthesis", keywords="usability study", keywords="mobile usability", keywords="elderly", keywords="older adults", keywords="remote usability", keywords="mobility restriction", abstract="Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature---a lack of remote usability testing methods, tools, and strategies for older adults, despite this population's increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals. ", doi="10.2196/26181", url="https://formative.jmir.org/2021/11/e26181", url="http://www.ncbi.nlm.nih.gov/pubmed/34726604" } @Article{info:doi/10.2196/30337, author="Bradwell, Louise Hannah and Edwards, Katie and Shenton, Deborah and Winnington, Rhona and Thill, Serge and Jones, B. Ray", title="User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="1", volume="8", number="4", pages="e30337", keywords="companion robots", keywords="social robots", keywords="Paro", keywords="older adults", keywords="dementia", keywords="care homes", keywords="engagement", keywords="acceptability", keywords="gerontology", keywords="Joy for All", keywords="social care", keywords="user-centered design", abstract="Background: Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective: In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods: We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results: Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions: This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations. ", doi="10.2196/30337", url="https://rehab.jmir.org/2021/4/e30337", url="http://www.ncbi.nlm.nih.gov/pubmed/34723825" } @Article{info:doi/10.2196/20739, author="Chin, Yun Winnie Szu and Kurowski, Alicia and Gore, Rebecca and Chen, Guanling and Punnett, Laura and ", title="Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Oct", day="28", volume="5", number="10", pages="e20739", keywords="mobile apps", keywords="usability testing", keywords="user experience design", keywords="mobile phone", keywords="mhealth", keywords="iterative testing", keywords="participatory research", keywords="user demographics", keywords="worker participation", abstract="Background: Process evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers', developers', and users' mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics. Objective: This study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users. Methods: An app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app's 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics. Results: In stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility andefficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics. Conclusions: Occupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data. ", doi="10.2196/20739", url="https://formative.jmir.org/2021/10/e20739", url="http://www.ncbi.nlm.nih.gov/pubmed/34709186" } @Article{info:doi/10.2196/27966, author="Luo, Yan and Dozier, Krystal and Ikenberg, Carin", title="Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis", journal="J Med Internet Res", year="2021", month="Oct", day="26", volume="23", number="10", pages="e27966", keywords="electronic personal health records", keywords="human-technology interaction factors", keywords="clinical notes", keywords="smartphone app", keywords="ease of understanding", abstract="Background: An electronic personal health record (ePHR), also known as a personal health record (PHR), has been broadly defined as an electronic application through which individuals can access, manage, and share their health information in a secure and confidential environment. Although ePHRs can benefit individuals as well as caregivers and health care providers, the use of ePHRs among individuals continues to remain low. Objective: The current study aims to examine the relationship between human-technology interaction factors and ePHR use among adults and then to compare the different effects of human-technology interaction factors on ePHR use between younger adults (18-54 years old) and older adults (55 years of age and over). Methods: We analyzed data from the Health Information National Trends Survey (HINTS 5 cycle 3) collected from US adults aged 18 years old and over in 2019. Descriptive analysis was conducted for all variables and each item of ePHR use. Bivariate tests (Pearson correlation coefficient for categorical variable and F test for continuous variables) were conducted over 2 age groups. Finally, after adjustments were made for sociodemographics and health care resources, a weighted multiple linear regression was conducted to examine the relationship between human-technology interaction factors and ePHR use. Results: The final sample size of 1363 (average age 51.19) was divided into 2 age groups: 18 to 54 years old and 55 years old and older. The average level of ePHR use was low (mean 2.76, range 0-8). There was no significant difference in average ePHR use between the 2 age groups. Including clinical notes was positively related to ePHR use in both groups: 18 to 54 years old ($\beta$=.28, P=.005), 55 years old and older ($\beta$=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults ($\beta$=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults ($\beta$=.13; P=.003). Conclusions: This study found that including clinical notes was positively related to ePHR use in both age groups, which suggested that including clinical notes as a part of ePHRs might improve the effective use of ePHRs among patients. Moreover, accessing ePHRs using a smartphone app was associated with higher ePHR use among younger adults while ease of understanding health information in ePHRs was linked to higher ePHR use among older adults. The design of ePHRs should provide the option of being accessible through mobile devices to promote greater ePHR use among young people. For older adults, providers could add additional notes to explain the health information recorded in the ePHRs. ", doi="10.2196/27966", url="https://www.jmir.org/2021/10/e27966", url="http://www.ncbi.nlm.nih.gov/pubmed/34698646" } @Article{info:doi/10.2196/30169, author="Wong, Jill and Foussat, C. Agathe and Ting, Steven and Acerbi, Enzo and van Elburg, M. Ruurd and Mei Chien, Chua", title="A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study", journal="JMIR Pediatr Parent", year="2021", month="Oct", day="26", volume="4", number="4", pages="e30169", keywords="chatbot", keywords="parental stress", keywords="parental sleep", keywords="infant feeding", keywords="preterm infants", keywords="term infants", keywords="sleep", keywords="stress", keywords="eHealth", keywords="support", keywords="anxiety", keywords="usability", abstract="Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ?21 years with infants aged ?6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as ``easy'' to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were ``satisfied'' (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to ``discomfort'' and ``tiredness'' were more prevalent in preterm group conversations, whereas the topic of ``positive feelings'' occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents' ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 ", doi="10.2196/30169", url="https://pediatrics.jmir.org/2021/4/e30169", url="http://www.ncbi.nlm.nih.gov/pubmed/34544679" } @Article{info:doi/10.2196/28618, author="Reese, J. Thomas and Del Fiol, Guilherme and Morgan, Keaton and Hurwitz, T. Jason and Kawamoto, Kensaku and Gomez-Lumbreras, Ainhoa and Brown, L. Mary and Thiess, Henrik and Vazquez, R. Sara and Nelson, D. Scott and Boyce, Richard and Malone, Daniel", title="A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study", journal="JMIR Hum Factors", year="2021", month="Oct", day="26", volume="8", number="4", pages="e28618", keywords="shared decision-making", keywords="user-centered design", keywords="drug interaction", keywords="clinical decision support", abstract="Background: Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. Objective: This study aims to design and study the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs. Methods: We used an SDM framework and user-centered design methods to guide the design and usability of DDInteract---an SDM electronic health record app to prevent harm from clinically significant DDIs. The design involved iterative prototypes, qualitative feedback from stakeholders, and a heuristic evaluation. The usability evaluation included patients and clinicians. Patients participated in a simulated SDM discussion using clinical vignettes. Clinicians were asked to complete eight tasks using DDInteract and to assess the tool using a survey adapted from the System Usability Scale. Results: The designed DDInteract prototype includes the following features: a patient-specific risk profile, dynamic risk icon array, patient education section, and treatment decision tree. A total of 4 patients and 11 clinicians participated in the usability study. After an SDM session where patients and clinicians review the tool concurrently, patients generally favored pain treatments with less risk of gastrointestinal bleeding. Clinicians successfully completed the tasks with a mean of 144 (SD 74) seconds and rated the usability of DDInteract as 4.32 (SD 0.52) of 5. Conclusions: This study expands the use of SDM to DDIs. The next steps are to determine if DDInteract can improve shared decision-making quality and to implement it across health systems using interoperable technology. ", doi="10.2196/28618", url="https://humanfactors.jmir.org/2021/4/e28618", url="http://www.ncbi.nlm.nih.gov/pubmed/34698649" } @Article{info:doi/10.2196/27628, author="Giang, W. Wayne C. and Bland, Emma and Chen, Jeffrey and Col{\'o}n-Morales, M. Coralys and Alvarado, M. Michelle", title="User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews", journal="JMIR Hum Factors", year="2021", month="Oct", day="26", volume="8", number="4", pages="e27628", keywords="insurance, health", keywords="health benefits plans", keywords="employee", keywords="decision aids", keywords="cognitive ergonomics", keywords="human factors engineering", abstract="Background: Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. Objective: This study aims to examine how individuals interact with two different types of health insurance decision aids (guided VBCs that mimic conversations with a real HR counselor and self-directed HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. Methods: In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. Results: Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. Conclusions: This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats. ", doi="10.2196/27628", url="https://humanfactors.jmir.org/2021/4/e27628", url="http://www.ncbi.nlm.nih.gov/pubmed/34698647" } @Article{info:doi/10.2196/32382, author="Doumas, M. Diana and Midgett, Aida and Myers, Valerie and Buller, Klein Mary", title="Usability of a Technology-Based Bystander Bullying Intervention for Middle School Students in Rural, Low-Income Communities: Mixed Methods Study", journal="JMIR Form Res", year="2021", month="Oct", day="26", volume="5", number="10", pages="e32382", keywords="technology-based bullying intervention", keywords="STAC-T", keywords="usability testing", keywords="middle school", keywords="rural", keywords="low-income", keywords="mobile phone", abstract="Background: Students who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming. Objective: The aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students. Methods: A sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17\%), 4 (66\%), and 1 (17\%) rated the program as 3, 4, and 5 stars, respectively; 80\% (8/10) of students said they would recommend the program; and 60\% (6/10) and 40\% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention. Conclusions: This study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement. Trial Registration: ClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495 ", doi="10.2196/32382", url="https://formative.jmir.org/2021/10/e32382", url="http://www.ncbi.nlm.nih.gov/pubmed/34582355" } @Article{info:doi/10.2196/25512, author="Barr, J. Paul and Haslett, William and Dannenberg, D. Michelle and Oh, Lisa and Elwyn, Glyn and Hassanpour, Saeed and Bonasia, L. Kyra and Finora, C. James and Schoonmaker, A. Jesse and Onsando, Moraa W. and Ryan, James and Bruce, L. Martha and Das, K. Amar and Arend, Roger and Piper, Sheryl and Ganoe, H. Craig", title="An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach", journal="J Med Internet Res", year="2021", month="Oct", day="22", volume="23", number="10", pages="e25512", keywords="patient-centered care", keywords="health communication", keywords="audiovisual aids", keywords="user-centered design", keywords="software", keywords="natural language processing", keywords="patients", keywords="caregivers", abstract="Background: Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective: This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods: Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients' primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results: We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63\%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one's own recordings and others' recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions: To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans. ", doi="10.2196/25512", url="https://www.jmir.org/2021/10/e25512", url="http://www.ncbi.nlm.nih.gov/pubmed/34677131" } @Article{info:doi/10.2196/33252, author="Bente, E. Britt and Wentzel, Jobke and Groeneveld, GH Rik and IJzerman, VH Ren{\'e}e and de Buisonj{\'e}, R. David and Breeman, D. Linda and Janssen, R. Veronica and Kraaijenhagen, Roderik and Pieterse, E. Marcel and Evers, WM Andrea and van Gemert-Pijnen, EWC Julia", title="Values of Importance to Patients With Cardiovascular Disease as a Foundation for eHealth Design and Evaluation: Mixed Methods Study", journal="JMIR Cardio", year="2021", month="Oct", day="22", volume="5", number="2", pages="e33252", keywords="patient values", keywords="health behavior", keywords="lifestyle", keywords="mobile app", keywords="user-centered design", keywords="eHealth", keywords="cardiovascular disease", keywords="behavior", keywords="app", keywords="design", keywords="cardiovascular", keywords="evaluation", keywords="platform", keywords="support", keywords="intervention", abstract="Background: eHealth interventions are developed to support and facilitate patients with lifestyle changes and self-care tasks after being diagnosed with a cardiovascular disease (CVD). Creating long-lasting effects on lifestyle change and health outcomes with eHealth interventions is challenging and requires good understanding of patient values. Objective: The aim of the study was to identify values of importance to patients with CVD to aid in designing a technological lifestyle platform. Methods: A mixed method?design was applied,?combining?data from usability testing?with an additional online survey study, to validate?the outcomes of the usability tests. Results: A total of 11 relevant patient values were identified, including the need for security, support, not wanting to feel anxious, tailoring of treatment, and personalized, accessible care. The validation survey shows that all values but one (value 9: To have extrinsic motivation to accomplish goals or activities [related to health/lifestyle]) were regarded as important/very important. A rating of very unimportant or unimportant was given by less than 2\% of the respondents (value 1: 4/641, 0.6\%; value 2: 10/641, 1.6\%; value 3: 9/641, 1.4\%; value 4: 5/641, 0.8\%; value 5: 10/641, 1.6\%; value 6: 4/641, 0.6\%; value 7: 10/639, 1.6\%; value 8: 4/639, 0.6\%; value 10: 3/636, 0.5\%; value 11: 4/636, 0.6\%) to all values except but one (value 9: 56/636, 8.8\%). Conclusions: There is a high consensus among patients regarding the identified values reflecting goals and themes central to their lives, while living with or managing their CVD. The identified values can serve as a foundation for future research to translate and integrate these values into the design of the eHealth technology. This may call for prioritization of values, as not all values can be met equally. ", doi="10.2196/33252", url="https://cardio.jmir.org/2021/2/e33252", url="http://www.ncbi.nlm.nih.gov/pubmed/34677130" } @Article{info:doi/10.2196/32921, author="Xiao, Jin and Luo, Jiebo and Ly-Mapes, Oriana and Wu, Tong Tong and Dye, Timothy and Al Jallad, Nisreen and Hao, Peirong and Ruan, Jinlong and Bullock, Sherita and Fiscella, Kevin", title="Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study", journal="JMIR Res Protoc", year="2021", month="Oct", day="22", volume="10", number="10", pages="e32921", keywords="artificial intelligence", keywords="smartphone app", keywords="mDentistry", keywords="dental caries", keywords="underserved population", keywords="mobile dentistry", abstract="Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55\% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85\% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence--powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence--powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 ", doi="10.2196/32921", url="https://www.researchprotocols.org/2021/10/e32921", url="http://www.ncbi.nlm.nih.gov/pubmed/34529582" } @Article{info:doi/10.2196/20458, author="Abujarad, Fuad and Peduzzi, Peter and Mun, Sophia and Carlson, Kristina and Edwards, Chelsea and Dziura, James and Brandt, Cynthia and Alfano, Sandra and Chupp, Geoffrey", title="Comparing a Multimedia Digital Informed Consent Tool With Traditional Paper-Based Methods: Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Oct", day="19", volume="5", number="10", pages="e20458", keywords="digital consent", keywords="digital health", keywords="e-consent", keywords="informed consent", keywords="mobile phone", abstract="Background: The traditional informed consent (IC) process rarely emphasizes research participants' comprehension of medical information, leaving them vulnerable to unknown risks and consequences associated with procedures or studies. Objective: This paper explores how we evaluated the feasibility of a digital health tool called Virtual Multimedia Interactive Informed Consent (VIC) for advancing the IC process and compared the results with traditional paper-based methods of IC. Methods: Using digital health and web-based coaching, we developed the VIC tool that uses multimedia and other digital features to improve the current IC process. The tool was developed on the basis of the user-centered design process and Mayer's cognitive theory of multimedia learning. This study is a randomized controlled trial that compares the feasibility of VIC with standard paper consent to understand the impact of interactive digital consent. Participants were recruited from the Winchester Chest Clinic at Yale New Haven Hospital in New Haven, Connecticut, and healthy individuals were recruited from the community using fliers. In this coordinator-assisted trial, participants were randomized to complete the IC process using VIC on the iPad or with traditional paper consent. The study was conducted at the Winchester Chest Clinic, and the outcomes were self-assessed through coordinator-administered questionnaires. Results: A total of 50 participants were recruited in the study (VIC, n=25; paper, n=25). The participants in both groups had high comprehension. VIC participants reported higher satisfaction, higher perceived ease of use, higher ability to complete the consent independently, and shorter perceived time to complete the consent process. Conclusions: The use of dynamic, interactive audiovisual elements in VIC may improve participants' satisfaction and facilitate the IC process. We believe that using VIC in an ongoing, real-world study rather than a hypothetical study improved the reliability of our findings, which demonstrates VIC's potential to improve research participants' comprehension and the overall process of IC. Trial Registration: ClinicalTrials.gov NCT02537886; https://clinicaltrials.gov/ct2/show/NCT02537886 ", doi="10.2196/20458", url="https://formative.jmir.org/2021/10/e20458", url="http://www.ncbi.nlm.nih.gov/pubmed/34665142" } @Article{info:doi/10.2196/25646, author="Cohen Rodrigues, R. Talia and de Buisonj{\'e}, R. David and Keesman, Mike and Reijnders, Thomas and van der Geer, E. Jessica and Janssen, R. Veronica and Kraaijenhagen, A. Roderik and Atsma, E. Douwe and Evers, M. Andrea W.", title="Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care", journal="J Med Internet Res", year="2021", month="Oct", day="15", volume="23", number="10", pages="e25646", keywords="eHealth", keywords="digital health", keywords="cardiovascular disease", keywords="cardiac care", keywords="lifestyle change", keywords="lifestyle support", keywords="intervention", keywords="health care professionals", keywords="implementation", keywords="interview", keywords="facilitators", keywords="barriers", abstract="Background: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers. Objective: This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD. Methods: In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care. Results: We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth. Conclusions: HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care. ", doi="10.2196/25646", url="https://www.jmir.org/2021/10/e25646", url="http://www.ncbi.nlm.nih.gov/pubmed/34652280" } @Article{info:doi/10.2196/32271, author="Suffoletto, Brian and Goldstein, Tina and Gotkiewicz, Dawn and Gotkiewicz, Emily and George, Brandie and Brent, David", title="Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Oct", day="14", volume="5", number="10", pages="e32271", keywords="college", keywords="mental health", keywords="self-management", keywords="digital intervention", keywords="mHealth", abstract="Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85\% female [45/52], 91\% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100\% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78\% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95\% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 ", doi="10.2196/32271", url="https://formative.jmir.org/2021/10/e32271", url="http://www.ncbi.nlm.nih.gov/pubmed/34647893" } @Article{info:doi/10.2196/23968, author="Halttu, Kirsi and Oinas-Kukkonen, Harri", title="Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study", journal="JMIR Form Res", year="2021", month="Oct", day="14", volume="5", number="10", pages="e23968", keywords="self-monitoring", keywords="wearables", keywords="physical activity tracking", keywords="mHealth", keywords="need for cognition", keywords="persuasive design", keywords="tailoring", keywords="user research", keywords="mobile phone", abstract="Background: Need for cognition (NFC) is among the most studied personality traits in psychology. Despite its apparent relevance for engaging with technology and the use of information, it has not been studied in the context of self-monitoring systems and wearables for health. This study is the first to explore the relationship between NFC and commercial self-monitoring systems among healthy users. Objective: This study aims to explore the effect of NFC levels on the selection of self-monitoring systems and evaluation of system features of self-monitoring and feedback, as well as perceived credibility and perceived persuasiveness. We also assessed perceived behavior change in the form of self-reported activity after adopting the system. Methods: Survey data were collected in October 2019 among university students and personnel. The invitation to respond to the questionnaire was addressed to those who had used a digital system to monitor their physical activity for at least two months. The web-based questionnaire comprised the following 3 parts: details of system use, partially randomly ordered theoretical measurement items, and user demographics. The data were analyzed using structural equation modeling. The effect of NFC was assessed both as 3 groups (low, moderate, and high) and as a continuous moderator variable. Results: In all, 238 valid responses to the questionnaire were obtained. Individuals with high NFC reported all tested system features with statistically significantly higher scores. The NFC also had some effect on system selection. Hypothesized relationships with perceived credibility gained support in a different way for individuals with low and high NFC; for those with low NFC, credibility increased the persuasiveness of the system, but this effect was absent among individuals with high NFC. For users with high NFC, credibility was related to feedback and self-monitoring and perhaps continuously evaluated during prolonged use instead of being a static system property. Furthermore, the relationship between perceived persuasiveness and self-reported activity after adopting the system had a large effect size (Cohen f2=0.355) for individuals with high NFC, a small effect size for individuals with moderate NFC (Cohen f2=0.107), and a nonsignificant path (P=.16) for those with low NFC. We also detected a moderating effect of NFC in two paths on perceived persuasiveness but only among women. Our research model explained 59.2\%, 63.9\%, and 47.3\% of the variance in perceived persuasiveness of the system among individuals with low, moderate, and high NFC, respectively. Conclusions: The system choices of individuals seem to reflect their intrinsic motivations to engage with rich data, and commercial systems might themselves be a tailoring strategy. Important characteristics of the system, such as perceived credibility, have different roles depending on the NFC levels. Our data demonstrate that NFC as a trait that differentiates information processing has several implications for the selection, design, and tailoring of self-monitoring systems. ", doi="10.2196/23968", url="https://formative.jmir.org/2021/10/e23968", url="http://www.ncbi.nlm.nih.gov/pubmed/34647894" } @Article{info:doi/10.2196/24865, author="Cruz, da Fl{\'a}via Oliveira de Almeida Marques and Faria, Tostes Edison and Ghobad, Cardelino Pabblo and Alves, Mano Leandro Yukio and Reis, dos Paula Elaine Diniz", title="A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study", journal="J Med Internet Res", year="2021", month="Oct", day="13", volume="23", number="10", pages="e24865", keywords="mobile applications", keywords="health education", keywords="nursing care", keywords="oncology nursing", keywords="educational technology", keywords="breast neoplasms", keywords="radiation therapy", abstract="Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80\% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80\%. Conclusions: The mobile app titled ``AMOR Mama'' was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. ", doi="10.2196/24865", url="https://www.jmir.org/2021/10/e24865", url="http://www.ncbi.nlm.nih.gov/pubmed/34643531" } @Article{info:doi/10.2196/31161, author="Bos, C. V{\'e}ronique L. L. and Jansen, Tessa and Klazinga, S. Niek and Kringos, S. Dionne", title="Development and Actionability of the Dutch COVID-19 Dashboard: Descriptive Assessment and Expert Appraisal Study", journal="JMIR Public Health Surveill", year="2021", month="Oct", day="12", volume="7", number="10", pages="e31161", keywords="COVID-19", keywords="dashboard", keywords="performance intelligence", keywords="Netherlands", keywords="actionability", keywords="communication", keywords="government", keywords="pandemic", keywords="public health", abstract="Background: Web-based public reporting by means of dashboards has become an essential tool for governments worldwide to monitor COVID-19 information and communicate it to the public. The actionability of such dashboards is determined by their fitness for purpose---meeting a specific information need---and fitness for use---placing the right information into the right hands at the right time and in a manner that can be understood. Objective: The aim of this study was to identify specific areas where the actionability of the Dutch government's COVID-19 dashboard could be improved, with the ultimate goal of enhancing public understanding of the pandemic. Methods: The study was conducted from February 2020 to April 2021. A mixed methods approach was carried out, using (1) a descriptive checklist over time to monitor changes made to the dashboard, (2) an actionability scoring of the dashboard to pinpoint areas for improvement, and (3) a reflection meeting with the dashboard development team to contextualize findings and discuss areas for improvement. Results: The dashboard predominantly showed epidemiological information on COVID-19. It had been developed and adapted by adding more in-depth indicators, more geographic disaggregation options, and new indicator themes. It also changed in target audience from policy makers to the general public; thus, a homepage was added with the most important information, using news-like items to explain the provided indicators and conducting research to enhance public understanding of the dashboard. However, disaggregation options such as sex, socioeconomic status, and ethnicity and indicators on dual-track health system management and social and economic impact that have proven to give important insights in other countries are missing from the Dutch COVID-19 dashboard, limiting its actionability. Conclusions: The Dutch COVID-19 dashboard developed over time its fitness for purpose and use in terms of providing epidemiological information to the general public as a target audience. However, to strengthen the Dutch health system's ability to cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, we advise (1) establishing timely indicators relating to health system capacity, (2) including relevant data disaggregation options (eg, sex, socioeconomic status), and (3) enabling interoperability between social, health, and economic data sources. ", doi="10.2196/31161", url="https://publichealth.jmir.org/2021/10/e31161", url="http://www.ncbi.nlm.nih.gov/pubmed/34543229" } @Article{info:doi/10.2196/28136, author="Kruglova, Katya and O'Connell, Laura Siobhan Bernadette and Dawadi, Shrinkhala and Gelgoot, Noah Eden and Miner, A. Skye and Robins, Stephanie and Schinazi, Joy and Zelkowitz, Phyllis", title="An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study", journal="JMIR Form Res", year="2021", month="Oct", day="12", volume="5", number="10", pages="e28136", keywords="mHealth app", keywords="mHealth development process", keywords="infertility", keywords="intervention design", keywords="mobile phone", abstract="Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app's content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app's content based on participants' feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. ", doi="10.2196/28136", url="https://formative.jmir.org/2021/10/e28136", url="http://www.ncbi.nlm.nih.gov/pubmed/34636741" } @Article{info:doi/10.2196/30165, author="Payne, H. Thomas and Keller, Carolyn and Arora, Pallavi and Brusati, Allison and Levin, Jesse and Salgaonkar, Monica and Li, Xi and Zech, Jennifer and Lees, Fischer A.", title="Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study", journal="J Med Internet Res", year="2021", month="Oct", day="6", volume="23", number="10", pages="e30165", keywords="electronic documentation", keywords="electronic health records", keywords="hospital progress notes", keywords="copy-paste", keywords="EHR", keywords="patient records", keywords="workflow", keywords="human factors", keywords="clinical communication", keywords="physician communication", keywords="hospital", abstract="Background: Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. Objective: We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. Methods: Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. Results: We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment \& Plan note section. A total of 29\% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26\% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader's professional role. Conclusions: Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements. ", doi="10.2196/30165", url="https://www.jmir.org/2021/10/e30165", url="http://www.ncbi.nlm.nih.gov/pubmed/34612825" } @Article{info:doi/10.2196/29558, author="Ziemssen, Tjalf and Giovannoni, Gavin and Alvarez, Enrique and Bhan, Virender and Hersh, Carrie and Hoffmann, Olaf and Oreja-Guevara, Celia and Robles-Cede{\~n}o, R. Rene and Trojano, Maria and Vermersch, Patrick and Dobay, Pamela and Khwaja, Mudeer and Stadler, Bianca and Rauser, Benedict and Hach, Thomas and Piani-Meier, Daniela and Burton, Jason", title="Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey", journal="J Med Internet Res", year="2021", month="Oct", day="6", volume="23", number="10", pages="e29558", keywords="multiple sclerosis", keywords="relapsing remitting multiple sclerosis", keywords="secondary progressive multiple sclerosis", keywords="transition", keywords="progression", keywords="digital", keywords="usability", abstract="Background: A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective: The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods: In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs' overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results: In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77\% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3\% (6786/6974; initial) to 98.2\% (269/274; final) of the cases. In 93.54\% (6524/6974; initial) to 97.1\% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47\% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76\% initial and 252/274, 92\% final) and cognitive function (5482/6974, 78.61\% initial and 271/274, 79.2\% final), as well as in discussing progression in general (6102/6974, 87.49\% initial and 246/274, 89.8\% final). While completing the final questionnaire, 94.9\% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9\%) and cognitive function (220/274, 80.3\%). Overall, 92\% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8\% (235/274) were willing to integrate it into their clinical practice. Conclusions: MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice. ", doi="10.2196/29558", url="https://www.jmir.org/2021/10/e29558", url="http://www.ncbi.nlm.nih.gov/pubmed/34612826" } @Article{info:doi/10.2196/28767, author="Rigamonti, Lia and Secchi, Matteo and Lawrence, B. Jimmy and Labianca, Luca and Wolfarth, Bernd and Peters, Harm and Bonaventura, Klaus and Back, Alexander David", title="An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study", journal="J Med Internet Res", year="2021", month="Oct", day="5", volume="23", number="10", pages="e28767", keywords="augmented reality", keywords="ultrasound", keywords="social media", keywords="remote", keywords="exercise science", abstract="Background: Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19--related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange. Objective: This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations. Methods: A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire. Results: In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians' examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive. Conclusions: The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination--based research questions. ", doi="10.2196/28767", url="https://www.jmir.org/2021/10/e28767", url="http://www.ncbi.nlm.nih.gov/pubmed/34609312" } @Article{info:doi/10.2196/31185, author="Snow-Hill, L. Nyssa and Donenberg, Geri and Feil, G. Edward and Smith, R. David and Floyd, R. Brenikki and Leve, Craig", title="A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Sep", day="30", volume="5", number="9", pages="e31185", keywords="health education", keywords="sexual behavior", keywords="juvenile delinquency", keywords="feasibility studies", keywords="evidence-based practice", keywords="adolescent health services", keywords="inservice training", keywords="implementation science", keywords="organizational innovation", keywords="technology", keywords="risk reduction behavior", keywords="mobile phone", keywords="health technology", keywords="health promotion", keywords="sexual health", abstract="Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth---PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. ", doi="10.2196/31185", url="https://formative.jmir.org/2021/9/e31185", url="http://www.ncbi.nlm.nih.gov/pubmed/34591028" } @Article{info:doi/10.2196/19794, author="Toonders, Johanna Suze Adriana and van Westrienen, Elisabeth Paula and Konings, Sophie and Nieboer, E. Marianne and Veenhof, Cindy and Pisters, F. Martijn", title="Patients' Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study", journal="J Med Internet Res", year="2021", month="Sep", day="28", volume="23", number="9", pages="e19794", keywords="usability", keywords="medically unexplained physical symptoms", keywords="blended care", abstract="Background: Medically unexplained physical symptoms are physical symptoms, such as pain, fatigue, and dizziness, that persist for more than a few weeks and cannot be explained after adequate medical examination. Treatment for preventing the chronicity of symptoms is recommended. A promising approach is identifying patients who are at risk and subsequently offering a blended care intervention that focuses on promoting self-management while using eHealth as a supportive tool. When these interventions match with a patient's expectations, their effectiveness grows. Objective: This study aimed to obtain more insights into usability from the patient perspective to improve future interventions. Methods: A mixed methods design (ie, the use of qualitative and quantitative data) was used. Through semistructured interviews, in-depth insights were gained into patients' perspectives on usability. The analysis process was continuous and iterative. Data were synthesized and categorized into different themes. The System Usability Scale, which measures the usability of a system, was used to compare participants that found usability to be low, medium, or high. This study was approved by the Medical Ethical Committee Utrecht (approval number: 17-391/C). Results: Saturation was reached after interviewing 13 participants. The following four themes emerged from the interviews: motivations and expectations prior to participating in the program, the applicability of e-coaching, the role of health care professionals, and the integrated design of the blended approach. Conclusions: The successful implementation of integrated blended care interventions based on patients' perspectives requires matching treatments to patients' individual situations and motivations. Furthermore, personalizing the relative frequency of face-to-face appointments and e-coaching can improve usability. ", doi="10.2196/19794", url="https://www.jmir.org/2021/9/e19794", url="http://www.ncbi.nlm.nih.gov/pubmed/34581674" } @Article{info:doi/10.2196/28698, author="Myhre, Leren Enid and Garnweidner-Holme, Lisa and Dahl, Bente and Reigstad, Myhre Marte and Lukasse, Mirjam", title="Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study", journal="JMIR Form Res", year="2021", month="Sep", day="27", volume="5", number="9", pages="e28698", keywords="early labor", keywords="latent phase", keywords="think aloud", keywords="usability", keywords="website", keywords="labor", keywords="pregnancy", keywords="user-friendliness", keywords="eHealth", keywords="user satisfaction", abstract="Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users' experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website's user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants' feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants' experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website's design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. ", doi="10.2196/28698", url="https://formative.jmir.org/2021/9/e28698", url="http://www.ncbi.nlm.nih.gov/pubmed/34569940" } @Article{info:doi/10.2196/22818, author="Smith-Turchyn, Jenna and Adams, C. Scott and Sabiston, M. Catherine", title="Testing of a Self-administered 6-Minute Walk Test Using Technology: Usability, Reliability and Validity Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Sep", day="23", volume="8", number="3", pages="e22818", keywords="exercise", keywords="physical activity", keywords="usability testing", keywords="applications", keywords="mobile phone", abstract="Background: The need to attend a medically supervised hospital- or clinic-based appointment is a well-recognized barrier to exercise participation. The development of reliable and accurate home-based functional tests has the potential to decrease the burden on the health care system while enabling support, information, and assessment. Objective: This study aims to explore the usability (ie, acceptability, satisfaction, accuracy, and practicality) of the EasyMeasure app to self-administer the 6-minute walk test (6MWT) in young, healthy adults and determine parallel form reliability and construct validity of conducting a self-administered 6MWT using technology. Methods: We used a usability study design. English-speaking, undergraduate university students who had access to an iPhone or iPad device running iOS 10 or later and self-reported ability to walk for 6 minutes were recruited for this study. Consenting participants were randomized to either a standard 6MWT group (ie, supervised without the use of the app) or a technology 6MWT group (ie, unsupervised with the app to mimic independent implementation of the test). All participants performed a maximal treadmill test. Participants in the 6MWT group completed the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire and a satisfaction questionnaire after completing the assessment. Parallel form reliability of the 6MWT using technology was analyzed by comparing participant self-administered scores and assessor scores using Pearson correlation coefficients across and between trials. Construct validity was assessed by comparing participant 6MWT scores (both standard and using technology) with maximum treadmill test variables (peak oxygen uptake and ventilatory threshold [VT]). Results: In total, 20 university students consented to participate in the study. All but 2 participants (8/10, 80\%) in the technology 6MWT group had deviations that prevented them from accurately conducting the 6MWT using the app, and none of the participants were able to successfully score the 6MWT. However, a significantly strong correlation was found (r=.834; P=.003) when comparing participants' scores for the 6MWT using technology with the assessors' scores. No significant correlations were found between maximal treadmill test peak oxygen uptake scores and 6MWT prediction equations using standard 6MWT scores (equation 1: r=0.119; P=.78; equation 2: r=0.095; P=.82; equation 3: r=0.119; P=.78); however, standard 6MWT scores were significantly correlated with VT values (r=0.810; P=.02). The calculated submaximal treadmill scores and assessor 6MWT scores using technology also demonstrated a significant correlation (r=0.661; P=.04). Conclusions: This study demonstrated significant usability concerns regarding the accuracy of a self-administered 6MWT using the EasyMeasure app. However, the strong and significant correlation between the 6MWT and VT values demonstrates the potential of the 6MWT to measure functional capacity for community-based exercise screening and patient monitoring. ", doi="10.2196/22818", url="https://rehab.jmir.org/2021/3/e22818", url="http://www.ncbi.nlm.nih.gov/pubmed/34554105" } @Article{info:doi/10.2196/28976, author="H{\"o}rhammer, Iiris and Kujala, Sari and Hilama, Pirjo and Heponiemi, Tarja", title="Building Primary Health Care Personnel's Support for a Patient Portal While Alleviating eHealth-Related Stress: Survey Study", journal="J Med Internet Res", year="2021", month="Sep", day="22", volume="23", number="9", pages="e28976", keywords="patient portal", keywords="implementation", keywords="adoption", keywords="health care personnel", keywords="eHealth-related stress", abstract="Background: Health care personnel's (HCP) engagement in patient portal implementation is necessary in embedding the use of the portal in everyday practices of a health care organization. While portal implementation may raise personnel's positive expectations of the benefits in patient care, it is often also stressful for them due to increased workloads and disruptions in clinical workflows. An understanding of social and technical factors that build personnel's support for patient portal implementation and alleviate their eHealth-related stress is therefore needed to realize the full potential of portals. Objective: The aim of this study was to explore the influence of managerial implementation practices, information technology (IT) usability, and personnel's eHealth competences on support for patient portal implementation and eHealth-related stress among primary HCP. Methods: The data were collected through a survey of 919 members at 2 health organizations in Finland. Linear and logistic regression models were fitted to study the associations between the variables. Results: Professionals' eHealth competence ($\beta$=.15, P<.001), usability ($\beta$=.11, P<.001), and implementation practices ($\beta$=.07, P<.001) were positively associated with professionals' support and negatively associated with professionals eHealth-related stress ($\beta$=?.07, P=.010; $\beta$=?.27, P<.001; and $\beta$=?.14, P<.001, respectively). Professionals' support was associated with their promotion of the portal to the patients (odds ratio 1.22, 95\% CI 1.07-1.40). Conclusions: The adoption of appropriate implementation practices and the usability of the technology can build personnel's support for a patient portal and alleviate their stress related to eHealth. Personnel's support is manifested in their promotion of the portal to patients. Health care managers are encouraged to consider the usability of the technology and the good implementation practices, such as proper informing, engagement of the personnel in planning the services, and allocation of resources to improve eHealth competence, as prerequisites for meaningful and sustainable use of patient portals. ", doi="10.2196/28976", url="https://www.jmir.org/2021/9/e28976", url="http://www.ncbi.nlm.nih.gov/pubmed/34550087" } @Article{info:doi/10.2196/22942, author="Stunden, Chelsea and Stratton, Kirsten and Zakani, Sima and Jacob, John", title="Comparing a Virtual Reality--Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial", journal="J Med Internet Res", year="2021", month="Sep", day="22", volume="23", number="9", pages="e22942", keywords="virtual reality", keywords="magnetic resonance imaging simulation", keywords="certified child life specialists", keywords="pediatrics", keywords="magnetic resonance imaging procedures", keywords="alternatives to sedation", keywords="preparing children for MRI", abstract="Background: The experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed. Objective: This study aims to compare the effectiveness of a virtual reality (VR)---based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers' reported anxiety, procedural data, caregiver usability, child satisfaction, and fun. Methods: This unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers' reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales). Results: A total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36\%; SPM: 24/84, 29\%; and CLP: 30/84, 36\%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children's reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37). Conclusions: Digital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting. Trial Registration: Clinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382 ", doi="10.2196/22942", url="https://www.jmir.org/2021/9/e22942", url="http://www.ncbi.nlm.nih.gov/pubmed/34550072" } @Article{info:doi/10.2196/27447, author="Kim, Sunyoung and Park, Yunoh and Ackerman, K. Matthew", title="Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach", journal="JMIR Form Res", year="2021", month="Sep", day="22", volume="5", number="9", pages="e27447", keywords="asthma", keywords="children", keywords="indoor air quality", keywords="mobile app", keywords="smartphone", keywords="user-centered design", abstract="Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. ", doi="10.2196/27447", url="https://formative.jmir.org/2021/9/e27447", url="http://www.ncbi.nlm.nih.gov/pubmed/34550080" } @Article{info:doi/10.2196/23877, author="Shikako, Keiko and Mogo, I. Ebele R. and Grand-Maison, Valerie and Simpson, Robert and Pritchard-Wiart, Lesley and Majnemer, Annette and ", title="Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Sep", day="16", volume="5", number="9", pages="e23877", keywords="implementation research", keywords="mobile health", keywords="children with disabilities", keywords="physical activity promotion", keywords="digital health", keywords="inclusive leisure participation", keywords="mobile phone", abstract="Background: The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors. Objective: In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities. Methods: We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework. Results: We developed a product that responds to users' identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users' active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population. Conclusions: Interactions between users and the app can sustain user engagement and behavior change. We will improve the app's next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups. ", doi="10.2196/23877", url="https://formative.jmir.org/2021/9/e23877", url="http://www.ncbi.nlm.nih.gov/pubmed/34528886" } @Article{info:doi/10.2196/28349, author="Keyworth, Chris and O'Connor, Rory and Quinlivan, Leah and Armitage, J. Christopher", title="Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation", journal="J Med Internet Res", year="2021", month="Sep", day="14", volume="23", number="9", pages="e28349", keywords="self-harm", keywords="implementation intentions", keywords="acceptability", keywords="online", keywords="volitional help sheet", keywords="digital health", keywords="mental health", abstract="Background: The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective: This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods: We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results: Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=?15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95\% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95\% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95\% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions: Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions. ", doi="10.2196/28349", url="https://www.jmir.org/2021/9/e28349", url="http://www.ncbi.nlm.nih.gov/pubmed/34518153" } @Article{info:doi/10.2196/30237, author="Crawford, D. Natalie and Josma, Dorie and Harrington, V. Kristin R. and Morris, Joseph and Quamina, Alvan and Birkett, Michelle and Phillips II, Gregory", title="Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis", journal="JMIR Form Res", year="2021", month="Sep", day="9", volume="5", number="9", pages="e30237", keywords="think-aloud", keywords="egocentric networks", keywords="sociogram", keywords="social networks", keywords="MSM", keywords="transgender", keywords="network canvas", keywords="black MSM", keywords="infectious disease transmission", keywords="stigma", abstract="Background: Characteristics of an individual's social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as ``easy to use,'' with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals' social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. ", doi="10.2196/30237", url="https://formative.jmir.org/2021/9/e30237", url="http://www.ncbi.nlm.nih.gov/pubmed/34499040" } @Article{info:doi/10.2196/27985, author="Cheung, Ting Yin and Lam, Hong Pok and Lam, Tai-Ning Teddy and Lam, Wai Henry Hon and Li, Kong Chi", title="Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study", journal="JMIR Form Res", year="2021", month="Sep", day="9", volume="5", number="9", pages="e27985", keywords="mobile health", keywords="mHealth", keywords="patients", keywords="expectations", keywords="hemophilia", keywords="chronic diseases", keywords="rare diseases", keywords="self-management", abstract="Background: The lifelong management of hemophilia is demanding and complex. In July 2019, we published a review in the Journal of Medical Internet Research, summarizing telehealth interventions that facilitate monitoring of bleeding events and promoting the appropriate use of clotting factors among patients with hemophilia. This work has led to the development of a community program that aims to harness technology to promote self-management among patients with hemophilia in Hong Kong. Objective: Before the inception of this program, we conducted a cross-sectional survey to evaluate the patients' level of technology acceptance and identify their expectations of the use of mobile technology for self-management of hemophilia. Methods: In total, 56 participants (75\% adult patients and 25\% parents of pediatric patients; 87.5\% with moderate to severe disease) were recruited from a local nongovernmental organization that serves patients with hemophilia. They rated their perceived confidence and acceptance in using the new mobile technology (score 1 to 5 for each item, with a higher score indicating better acceptance) using a structured questionnaire (adapted from the Technology Acceptance Model). They also identified the top features that they perceived to be the most important components of a mobile app for the self-management of hemophilia. The Mann--Whitney U test was used to compare technology acceptance scores across subgroups of different clinical and socioeconomic characteristics. Results: In general, the participants considered themselves skilled in using mobile apps (mean 4.3, 95\% CI 4.1-4.5). They were willing to learn to use the new mobile app to organize their bleeding records (mean 4.0, 95\% CI 3.7-4.3) and to manage their health (mean 4.2, 95\% CI 4.1-4.5). Participants who lived in public housing (a surrogate marker for lower socioeconomic status in Hong Kong) reported lower technology acceptance than those who lived in private housing (P=.04). The most important features identified by the participants concerned documenting of infusion logs (n=49, 87.5\%), bleeding events (n=48, 85.7\%), and the secure delivery of the bleeding information to health care professionals (n=40, 71.4\%). Conclusions: It is encouraging to infer that patients with hemophilia in Hong Kong are receptive to the use of mobile health technology. The findings of this survey are applicable in designing the key features of a patient-centered, multimodal program harnessing mobile technology to promote self-management among patients with hemophilia. Future studies should evaluate participants' acceptability and perceived usability of the mobile app via user metrics and assess clinical and humanistic outcomes of this program. ", doi="10.2196/27985", url="https://formative.jmir.org/2021/9/e27985", url="http://www.ncbi.nlm.nih.gov/pubmed/34499034" } @Article{info:doi/10.2196/28784, author="Murphy, Jane and McSharry, Jenny and Hynes, Lisa and Molloy, J. Gerard", title="A Smartphone App to Support Adherence to Inhaled Corticosteroids in Young Adults With Asthma: Multi-Methods Feasibility Study", journal="JMIR Form Res", year="2021", month="Sep", day="1", volume="5", number="9", pages="e28784", keywords="asthma", keywords="young adult", keywords="medication adherence", keywords="self-management", keywords="mobile applications", keywords="mHealth", keywords="intervention", keywords="usability", keywords="acceptability", keywords="feasibility", keywords="multi-methods", keywords="mobile phone", abstract="Background: Young adults with asthma often report low adherence to inhaled corticosteroids (ICS), leading to uncontrolled symptoms and poor disease outcomes. Technology-enabled digital supports such as mobile health (mHealth) asthma smartphone apps have the potential to support adherence to ICS and asthma self-management. There is a need for feasibility studies to determine the usability, acceptability, and feasibility of these interventions. In addition, it is essential to determine the feasibility of recruiting and retaining young adults to plan future efficacy and effectiveness trials and therefore, establish evidence-based asthma apps. Objective: This study aimed to determine (1) the feasibility of recruiting and retaining young adults to a trial and (2) the usability, acceptability, and feasibility of using the AsthmaMD app to support adherence to ICS in a population of young adults living with asthma. Methods: A multi-methods feasibility study was conducted. Young adults aged 18-30 years with asthma and current prescription for ICS were eligible and invited to take part through a university circular email, social media, and general practice sites. Participation involved completing a baseline self-report questionnaire, downloading and using the AsthmaMD app for 2 weeks, and completing the follow-up assessment, including self-report and open-ended questions about participants' experience of using the app. Primary outcomes included participant recruitment and retention and the usability, acceptability, and feasibility of using AsthmaMD. Quantitative self-report data were analyzed using descriptive statistics, and qualitative open-ended data were analyzed using inductive reflexive thematic analysis. Results: A total of 122 young adults (females, n=101, 82.8\%) with a mean age of 24.4 (SD 3.8) years were recruited and they completed baseline measures. Of the 122 young adults, 59 (48.4\%) completed the study. The AsthmaMD app received a mean score of 63.1/100 (SD 20.1) on the System Usability Scale (ie, a standardized measure of usability for technology-based apps), and an overall user satisfaction score of 5.8/10 (SD 2.2). Of the 59 participants who completed the study, 49 (83\%) participants used the app ?1 day per week. Two main themes were identified in the qualitative analysis of user experiences: (1) learning how to use the app to suit the individual and (2) benefits and relevance of using the app. Conclusions: The findings from this study indicate that it is feasible to recruit and retain young adults to examine efficacy and effectiveness in a future trial and that young adults living with asthma may find AsthmaMD to be usable, acceptable, and feasible to support adherence to ICS. Our findings also identified opportunities to further optimize the usability of AsthmaMD and similar apps. Based on our findings, we recommend providing more accessible information on how to use the app and replacing medical terminology with simplified language within the app to improve usability. Trial Registration: ISRCTN Registry ISRCTN11295269; https://www.isrctn.com/ISRCTN11295269 ", doi="10.2196/28784", url="https://formative.jmir.org/2021/9/e28784", url="http://www.ncbi.nlm.nih.gov/pubmed/34468325" } @Article{info:doi/10.2196/27454, author="Coleone, Diomara Joane and Bellei, Andrei Ericles and Roman, Klein Mateus and Kirsten, Ramos Vanessa and De Marchi, Bertoletti Ana Carolina", title="Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care", journal="JMIR Form Res", year="2021", month="Aug", day="27", volume="5", number="8", pages="e27454", keywords="eating", keywords="mobile applications", keywords="primary health care", keywords="aged", keywords="type 2 diabetes mellitus", abstract="Background: Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective: In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods: First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants' demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5\% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results: Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1\%), fruits (76.6\%), milk products (68.2\%), fried foods (72.7\%), savory biscuits (60.4\%), cookies or sweets (72.1\%), and sugary drinks (92.9\%) Meanwhile, the consumption of beans (59.7\%), pulses and cooked vegetables (73.4\%), and processed meat products (59.7\%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions: We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings. ", doi="10.2196/27454", url="https://formative.jmir.org/2021/8/e27454", url="http://www.ncbi.nlm.nih.gov/pubmed/34448711" } @Article{info:doi/10.2196/25900, author="Ranney, L. Megan and Pittman, K. Sarah and Moseley, Isabelle and Morgan, E. Kristen and Riese, Alison and Ybarra, Michele and Cunningham, Rebecca and Rosen, Rochelle", title="Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design", journal="JMIR Form Res", year="2021", month="Aug", day="27", volume="5", number="8", pages="e25900", keywords="adolescent", keywords="mobile health", keywords="digital health", keywords="cyberbullying", keywords="user-centered design", keywords="qualitative", keywords="mobile phone", abstract="Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58\% (11/19) female, 42\% (8/19) male, 63\% (12/19) Hispanic, 37\% (7/19) non-Hispanic, 79\% (15/19) people of color, and 21\% (4/19) White. A total of 73\% (14/19) self-identified as having a low socioeconomic status, and 37\% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34\% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0\% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50\% (2/4) of I2 participants and 86\% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9\% (235/392) of messages in I1, compared to 79.9\% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. ", doi="10.2196/25900", url="https://formative.jmir.org/2021/8/e25900", url="http://www.ncbi.nlm.nih.gov/pubmed/34448702" } @Article{info:doi/10.2196/14004, author="Ribanszki, Robert and Saez Fonseca, Andres Jose and Barnby, Matthew Joseph and Jano, Kimberly and Osmani, Fatima and Almasi, Soma and Tsakanikos, Elias", title="Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study", journal="JMIR Form Res", year="2021", month="Aug", day="27", volume="5", number="8", pages="e14004", keywords="qualitative", keywords="adolescents", keywords="mental health", keywords="digital smartphone app", keywords="digital mental health", keywords="mobile phone", abstract="Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. ", doi="10.2196/14004", url="https://formative.jmir.org/2021/8/e14004", url="http://www.ncbi.nlm.nih.gov/pubmed/34128814" } @Article{info:doi/10.2196/21186, author="Wong, Cheong Kam and Thiagalingam, Aravinda and Kumar, Saurabh and Marschner, Simone and Kunwar, Ritu and Bailey, Jannine and Kok, Cindy and Usherwood, Tim and Chow, K. Clara", title="User Perceptions and Experiences of a Handheld 12-Lead Electrocardiographic Device in a Clinical Setting: Usability Evaluation", journal="JMIR Cardio", year="2021", month="Aug", day="26", volume="5", number="2", pages="e21186", keywords="handheld", keywords="electrocardiogram", keywords="ECG", keywords="acceptability", keywords="usability", keywords="user perception", keywords="user experience", keywords="atrial fibrillation", keywords="long QT", keywords="screening", abstract="Background: Cardiac arrhythmias are a leading cause of death. The mainstay method for diagnosing arrhythmias (eg, atrial fibrillation) and cardiac conduction disorders (eg, prolonged corrected QT interval [QTc]) is by using 12-lead electrocardiography (ECG). Handheld 12-lead ECG devices are emerging in the market. In tandem with emerging technology options, evaluations of device usability should go beyond validation of the device in a controlled laboratory setting and assess user perceptions and experiences, which are crucial for successful implementation in clinical practice. Objective: This study aimed to evaluate clinician and patient perceptions and experiences, regarding the usability of a handheld 12-lead ECG device compared to a conventional 12-lead ECG machine, and generalizability of this user-centered approach. Methods: International Organization for Standardization Guidelines on Usability and the Technology Acceptance Model were integrated to form the framework for this study, which was conducted in outpatient clinics and cardiology wards at Westmead Hospital, New South Wales, Australia. Each patient underwent 2 ECGs (1 by each device) in 2 postures (supine and standing) acquired in random sequence. The times taken by clinicians to acquire the first ECG (efficiency) using the devices were analyzed using linear regression. Electrocardiographic parameters (QT interval, QTc interval, heart rate, PR interval, QRS interval) and participant satisfaction surveys were collected. Device reliability was assessed by evaluating the mean difference of QTc measurements within {\textpm}15 ms, intraclass correlation coefficient, and level of agreement of the devices in detecting atrial fibrillation and prolonged QTc. Clinicians' perceptions and feedback were assessed with semistructured interviews based on the Technology Acceptance Model. Results: A total of 100 patients (age: mean 57.9 years, SD 15.2; sex: male: n=64, female n=36) and 11 clinicians (experience acquiring ECGs daily or weekly 10/11, 91\%) participated, and 783 ECGs were acquired. Mean differences in QTc measurements of both handheld and conventional devices were within {\textpm}15 ms with high intraclass correlation coefficients (range 0.90-0.96), and the devices had a good level of agreement in diagnosing atrial fibrillation and prolonged QTc ($\kappa$=0.68-0.93). Regardless of device, QTc measurements when patients were standing were longer duration than QTc measurements when patients were supine. Clinicians' ECG acquisition times improved with usage (P<.001). Clinicians reported that device characteristics (small size, light weight, portability, and wireless ECG transmission) were highly desired features. Most clinicians agreed that the handheld device could be used for clinician-led mass screening with enhancement in efficiency by increasing user training. Regardless of device, patients reported that they felt comfortable when they were connected to the ECG devices. Conclusions: Reliability and usability of the handheld 12-lead ECG device were comparable to those of a conventional ECG machine. The user-centered evaluation approach helped us identify remediable action to improve the efficiency in using the device and identified highly desirable device features that could potentially help mass screening and remote assessment of patients. The approach could be applied to evaluate and better understand the acceptability and usability of new medical devices. ", doi="10.2196/21186", url="https://cardio.jmir.org/2021/2/e21186", url="http://www.ncbi.nlm.nih.gov/pubmed/34435958" } @Article{info:doi/10.2196/26227, author="Bae, Seul Ye and Kim, Hwan Kyung and Choi, Won Sae and Ko, Taehoon and Lim, Seo Jun and Piao, Meihua", title="Satisfaction and Usability of an Information and Communications Technology--Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study", journal="JMIR Form Res", year="2021", month="Aug", day="26", volume="5", number="8", pages="e26227", keywords="COVID-19", keywords="mobile app", keywords="telemedicine", keywords="wearable device", keywords="vital sign", keywords="satisfaction", keywords="usability", abstract="Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)--based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the ``self-reporting'' item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. ", doi="10.2196/26227", url="https://formative.jmir.org/2021/8/e26227", url="http://www.ncbi.nlm.nih.gov/pubmed/34254946" } @Article{info:doi/10.2196/24393, author="McCall, Terika and Ali, Osama Muhammad and Yu, Fei and Fontelo, Paul and Khairat, Saif", title="Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study", journal="JMIR Form Res", year="2021", month="Aug", day="17", volume="5", number="8", pages="e24393", keywords="African Americans", keywords="women", keywords="mental health", keywords="anxiety", keywords="depression", keywords="telemedicine", keywords="mHealth", keywords="mobile applications", keywords="digital health", keywords="user-centered design", keywords="mobile phone", abstract="Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants' visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants' acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. ", doi="10.2196/24393", url="https://formative.jmir.org/2021/8/e24393", url="http://www.ncbi.nlm.nih.gov/pubmed/34133313" } @Article{info:doi/10.2196/23834, author="Schoenmakers, Birgitte and Wens, Johan", title="Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study", journal="JMIR Form Res", year="2021", month="Aug", day="16", volume="5", number="8", pages="e23834", keywords="primary care", keywords="education", keywords="graduate", keywords="medical education", keywords="testing", keywords="assessment", keywords="app", keywords="COVID-19", keywords="efficiency", keywords="accuracy", abstract="Background: The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates' behaviors. Objective: We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure's impact on exam scores. Methods: The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students' exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results: Of the 593 candidates who subscribed to the exam, 472 (79.6\%) used the supervisor app and 121 (20.4\%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions: This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates' awareness of being monitored via a safe browser plug-in for exams. ", doi="10.2196/23834", url="https://formative.jmir.org/2021/8/e23834", url="http://www.ncbi.nlm.nih.gov/pubmed/34398786" } @Article{info:doi/10.2196/25781, author="Ara{\'u}jo, F{\'a}tima and Nogueira, Nilza Maria and Silva, Joana and Rego, S{\'i}lvia", title="A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="12", volume="10", number="8", pages="e25781", keywords="fall prevention", keywords="technological platform", keywords="elderly", keywords="Otago Exercise Program", abstract="Background: According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual's lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning. Objective: This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study. Methods: A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto. Results: This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021. Conclusions: The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context. Trial Registration: ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163 International Registered Report Identifier (IRRID): PRR1-10.2196/25781 ", doi="10.2196/25781", url="https://www.researchprotocols.org/2021/8/e25781", url="http://www.ncbi.nlm.nih.gov/pubmed/34387557" } @Article{info:doi/10.2196/25568, author="Rankine, Jacquelin and Yeramosu, Deepika and Matheo, Loreta and Sequeira, M. Gina and Miller, Elizabeth and Ray, N. Kristin", title="Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design", journal="JMIR Hum Factors", year="2021", month="Aug", day="5", volume="8", number="3", pages="e25568", keywords="referral", keywords="consultation", keywords="telemedicine", keywords="telehealth", keywords="adolescents", keywords="child health", keywords="child health services", keywords="confidentiality", keywords="access to health care", abstract="Background: e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. Objective: This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. Methods: We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. Results: Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. Conclusions: Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs. ", doi="10.2196/25568", url="https://humanfactors.jmir.org/2021/3/e25568", url="http://www.ncbi.nlm.nih.gov/pubmed/34383665" } @Article{info:doi/10.2196/29184, author="Park, Sang Hyun and Kim, Il Kwang and Chung, Ho-Young and Jeong, Sungmoon and Soh, Young Jae and Hyun, Ho Young and Kim, Sun Hwa", title="A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study", journal="JMIR Med Inform", year="2021", month="Aug", day="4", volume="9", number="8", pages="e29184", keywords="personal health record app", keywords="workplace health promotion", keywords="Fast Healthcare Interoperability Resources", keywords="national health care data set", keywords="human-centered design", abstract="Background: Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers' health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user's perspective in their design. Objective: Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods: This study considered the user's perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers' PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine--Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers' health information scattered across different Korean institutions through an interface method, and workers' PHRs were managed through a cloud server, using Azure API for FHIR. Results: In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions: The worker-centered PHR app integrates workers' health information from different institutions and provides a variety of health care services from linked institutions through workers' shared PHR. This app is expected to increase workers' autonomy over their health information and support medical personnel's decision making regarding workers' health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user's perspective, satisfies the prerequisites for its utilization in occupational health. ", doi="10.2196/29184", url="https://medinform.jmir.org/2021/8/e29184", url="http://www.ncbi.nlm.nih.gov/pubmed/34346894" } @Article{info:doi/10.2196/24112, author="Derksen, E. Marloes and Jaspers, WM Monique and van Strijp, Sander and Fransen, P. Mirjam", title="Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study", journal="JMIR Form Res", year="2021", month="Aug", day="4", volume="5", number="8", pages="e24112", keywords="think aloud", keywords="heuristic evaluation", keywords="usability", keywords="mHealth", keywords="game elements", keywords="smoking prevention", keywords="user-centered design", keywords="mobile phone", abstract="Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. ", doi="10.2196/24112", url="https://formative.jmir.org/2021/8/e24112", url="http://www.ncbi.nlm.nih.gov/pubmed/34346895" } @Article{info:doi/10.2196/27992, author="Abdulaal, Ahmed and Patel, Aatish and Al-Hindawi, Ahmed and Charani, Esmita and Alqahtani, A. Saleh and Davies, W. Gary and Mughal, Nabeela and Moore, Prockter Luke Stephen", title="Clinical Utility and Functionality of an Artificial Intelligence--Based App to Predict Mortality in COVID-19: Mixed Methods Analysis", journal="JMIR Form Res", year="2021", month="Jul", day="28", volume="5", number="7", pages="e27992", keywords="app", keywords="artificial intelligence", keywords="coronavirus", keywords="COVID-19", keywords="development", keywords="function", keywords="graphical user interface", keywords="machine learning", keywords="model", keywords="mortality", keywords="neural network", keywords="prediction", keywords="usability", keywords="utility", abstract="Background: The artificial neural network (ANN) is an increasingly important tool in the context of solving complex medical classification problems. However, one of the principal challenges in leveraging artificial intelligence technology in the health care setting has been the relative inability to translate models into clinician workflow. Objective: Here we demonstrate the development of a COVID-19 outcome prediction app that utilizes an ANN and assesses its usability in the clinical setting. Methods: Usability assessment was conducted using the app, followed by a semistructured end-user interview. Usability was specified by effectiveness, efficiency, and satisfaction measures. These data were reported with descriptive statistics. The end-user interview data were analyzed using the thematic framework method, which allowed for the development of themes from the interview narratives. In total, 31 National Health Service physicians at a West London teaching hospital, including foundation physicians, senior house officers, registrars, and consultants, were included in this study. Results: All participants were able to complete the assessment, with a mean time to complete separate patient vignettes of 59.35 (SD 10.35) seconds. The mean system usability scale score was 91.94 (SD 8.54), which corresponds to a qualitative rating of ``excellent.'' The clinicians found the app intuitive and easy to use, with the majority describing its predictions as a useful adjunct to their clinical practice. The main concern was related to the use of the app in isolation rather than in conjunction with other clinical parameters. However, most clinicians speculated that the app could positively reinforce or validate their clinical decision-making. Conclusions: Translating artificial intelligence technologies into the clinical setting remains an important but challenging task. We demonstrate the effectiveness, efficiency, and system usability of a web-based app designed to predict the outcomes of patients with COVID-19 from an ANN. ", doi="10.2196/27992", url="https://formative.jmir.org/2021/7/e27992", url="http://www.ncbi.nlm.nih.gov/pubmed/34115603" } @Article{info:doi/10.2196/23229, author="Ingvaldsen, Hegna Sigrid and Tronvik, Erling and Brenner, Eiliv and Winnberg, Ingunn and Olsen, Alexander and Gravdahl, Bruvik G{\o}ril and Stubberud, Anker", title="A Biofeedback App for Migraine: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="28", volume="5", number="7", pages="e23229", keywords="mHealth", keywords="headache", keywords="wearables", keywords="smartphone", abstract="Background: Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient. Objective: The objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine. Methods: In a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively. Results: A total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes. Conclusions: The app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps. ", doi="10.2196/23229", url="https://formative.jmir.org/2021/7/e23229", url="http://www.ncbi.nlm.nih.gov/pubmed/34319243" } @Article{info:doi/10.2196/24927, author="H{\"a}gglund, Maria and Scandurra, Isabella", title="User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale", journal="JMIR Hum Factors", year="2021", month="Jul", day="27", volume="8", number="3", pages="e24927", keywords="usability", keywords="system usability scale", keywords="evaluation", keywords="patient accessible electronic health records", keywords="open notes", keywords="patient portals", abstract="Background: Transparency is increasingly called for in health care, especially, when it comes to patients' access to their electronic health records. In Sweden, the e-service Journalen is a national patient accessible electronic health record (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefits of using a PAEHR influence behavioral intention for use and adoption, but poor usability that increases the effort expectancy can have a negative impact. It is, therefore, of interest to explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective: The aim of this study was to explore how the users of the Swedish PAEHR experience the usability of the system and to identify differences in these experiences based on the level of transparency of the region. Methods: A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data were collected from June to October 2016. The questionnaire included questions regarding the usability of the system from the System Usability Scale (SUS). The SUS analysis was the focus of this paper. Analysis was performed on different levels: nationally looking at the whole data set and breaking it down by focusing on 2 different regions to explore differences in experienced usability based on the level of transparency. Results: During the survey period, 423,141 users logged into Journalen, of which 2587 unique users completed the survey (response rate 0.61\%). The total mean score for all respondents to the SUS items was 79.81 (SD 14.25), which corresponds to a system with good usability. To further explore whether the level of transparency in a region would affect the user's experience of the usability of the system, we analyzed the 2 regions with the most respondents: Region Uppsala (the first to launch, with a high level of transparency), and Region Sk{\aa}ne (an early implementer, with a low level of transparency at the time of the survey). Of the participants who responded to at least 1 SUS statement, 520 stated that they had received care in Region Sk{\aa}ne, whereas 331 participants had received care in Region Uppsala. Uppsala's mean SUS score was 80.71 (SD 13.41), compared with Sk{\aa}ne's mean of 79.37 (SD 13.78). Conclusions: The Swedish national PAEHR Journalen has a reasonably good usability (mean SUS score 79.81, SD 14.25); however, further research into more specific usability areas are needed to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared with the region with low transparency could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required. ", doi="10.2196/24927", url="https://humanfactors.jmir.org/2021/3/e24927", url="http://www.ncbi.nlm.nih.gov/pubmed/34313596" } @Article{info:doi/10.2196/18198, author="Broekhuis, Marijke and van Velsen, Lex and Peute, Linda and Halim, Meilani and Hermens, Hermie", title="Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications", journal="JMIR Form Res", year="2021", month="Jul", day="27", volume="5", number="7", pages="e18198", keywords="usability benchmarking", keywords="eHealth systems", keywords="content analysis", keywords="usability framework", keywords="summative evaluation", keywords="mobile phone", abstract="Background: Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions. However, most summative usability tests do not consider eHealth-specific factors that could potentially affect the usability of a system. One of the reasons for this is the lack of fine-grained frameworks or models of usability factors that are unique to the eHealth domain. Objective: In this study, we aim to develop an ontology of usability problems, specifically for eHealth applications, with patients as primary end users. Methods: We analyzed 8 data sets containing the results of 8 formative usability tests for eHealth applications. These data sets contained 400 usability problems that could be used for analysis. Both inductive and deductive coding were used to create an ontology from 6 data sets, and 2 data sets were used to validate the framework by assessing the intercoder agreement. Results: We identified 8 main categories of usability factors, including basic system performance, task-technology fit, accessibility, interface design, navigation and structure, information and terminology, guidance and support, and satisfaction. These 8 categories contained a total of 21 factors: 14 general usability factors and 7 eHealth-specific factors. Cohen $\kappa$ was calculated for 2 data sets on both the category and factor levels, and all Cohen $\kappa$ values were between 0.62 and 0.67, which is acceptable. Descriptive analysis revealed that approximately 69.5\% (278/400) of the usability problems can be considered as general usability factors and 30.5\% (122/400) as eHealth-specific usability factors. Conclusions: Our ontology provides a detailed overview of the usability factors for eHealth applications. Current usability benchmarking instruments include only a subset of the factors that emerged from our study and are therefore not fully suited for summative evaluations of eHealth applications. Our findings support the development of new usability benchmarking tools for the eHealth domain. ", doi="10.2196/18198", url="https://formative.jmir.org/2021/7/e18198", url="http://www.ncbi.nlm.nih.gov/pubmed/34313594" } @Article{info:doi/10.2196/28083, author="Duffy, Anthony and Christie, Greg and Moreno, Sylvain", title="Examining Challenges to the Incorporation of End Users in the Design of Digital Health Interventions: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2021", month="Jul", day="26", volume="10", number="7", pages="e28083", keywords="digital health", keywords="end user(s)", keywords="user experience", keywords="UX", keywords="health behavior", keywords="intervention", keywords="co-design", keywords="mobile health", keywords="mHealth", abstract="Background: The process of designing a digital health intervention (DHI)---also referred to as mobile health or eHealth---spans needs assessments, technical functionality and feasibility, user satisfaction, effectiveness, impact, and value. These interventions are causing a rapid evolution in the landscape of health care. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI design is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries, both of which approach, understand, and involve end users differently in the framing of a DHI. Objective: The objective of this systematic review is to assess the challenges to incorporating end users in the design stage of digital health interventions, to identify key pain points, and to identify limitations and gaps for areas of future investigation. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist will be used to structure this protocol. A systematic search of the PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Scopus, and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal. Results: As of February 2021, we have completed a preliminary literature search examining challenges to the incorporation of end users in the design stage of DHIs. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by December 2021. Conclusions: This systematic review aims to provide an effective summary of key pain points toward incorporating end users in DHIs. Results from this review will provide an evidence base for a better approach to end user involvement in the interest of improving efficacy and uptake of DHIs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021238164; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=238164 International Registered Report Identifier (IRRID): PRR1-10.2196/28083 ", doi="10.2196/28083", url="https://www.researchprotocols.org/2021/7/e28083", url="http://www.ncbi.nlm.nih.gov/pubmed/34309578" } @Article{info:doi/10.2196/25531, author="Sch{\"u}ttler, Christina and Prokosch, Hans-Ulrich and Sedlmayr, Martin and Sedlmayr, Brita", title="Evaluation of Three Feasibility Tools for Identifying Patient Data and Biospecimen Availability: Comparative Usability Study", journal="JMIR Med Inform", year="2021", month="Jul", day="21", volume="9", number="7", pages="e25531", keywords="software tools", keywords="user interface", keywords="feasibility", keywords="evaluation", keywords="research", abstract="Background: To meet the growing importance of real-word data analysis, clinical data and biosamples must be timely made available. Feasibility platforms are often the first contact point for determining the availability of such data for specific research questions. Therefore, a user-friendly interface should be provided to enable access to this information easily. The German Medical Informatics Initiative also aims to establish such a platform for its infrastructure. Although some of these platforms are actively used, their tools still have limitations. Consequently, the Medical Informatics Initiative consortium MIRACUM (Medical Informatics in Research and Care in University Medicine) committed itself to analyzing the pros and cons of existing solutions and to designing an optimized graphical feasibility user interface. Objective: The aim of this study is to identify the system that is most user-friendly and thus forms the best basis for developing a harmonized tool. To achieve this goal, we carried out a comparative usability evaluation of existing tools used by researchers acting as end users. Methods: The evaluation included three preselected search tools and was conducted as a qualitative exploratory study with a randomized design over a period of 6 weeks. The tools in question were the MIRACUM i2b2 (Informatics for Integrating Biology and the Bedside) feasibility platform, OHDSI's (Observational Health Data Sciences and Informatics) ATLAS, and the Sample Locator of the German Biobank Alliance. The evaluation was conducted in the form of a web-based usability test (usability walkthrough combined with a web-based questionnaire) with participants aged between 26 and 63 years who work as medical doctors. Results: In total, 17 study participants evaluated the three tools. The overall evaluation of usability, which was based on the System Usability Scale, showed that the Sample Locator, with a mean System Usability Scale score of 77.03 (SD 20.62), was significantly superior to the other two tools (Wilcoxon test; Sample Locator vs i2b2: P=.047; Sample Locator vs ATLAS: P=.001). i2b2, with a score of 59.83 (SD 25.36), performed significantly better than ATLAS, which had a score of 27.81 (SD 21.79; Wilcoxon test; i2b2 vs ATLAS: P=.005). The analysis of the material generated by the usability walkthrough method confirmed these findings. ATLAS caused the most usability problems (n=66), followed by i2b2 (n=48) and the Sample Locator (n=22). Moreover, the Sample Locator achieved the highest ratings with respect to additional questions regarding satisfaction with the tools. Conclusions: This study provides data to develop a suitable basis for the selection of a harmonized tool for feasibility studies via concrete evaluation and a comparison of the usability of three different types of query builders. The feedback obtained from the participants during the usability test made it possible to identify user problems and positive design aspects of the individual tools and compare them qualitatively. ", doi="10.2196/25531", url="https://medinform.jmir.org/2021/7/e25531", url="http://www.ncbi.nlm.nih.gov/pubmed/34287211" } @Article{info:doi/10.2196/25368, author="S{\"a}{\"a}skilahti, Maria and Ahonen, Riitta and Timonen, Johanna", title="Pharmacy Customers' Experiences of Use, Usability, and Satisfaction of a Nationwide Patient Portal: Survey Study", journal="J Med Internet Res", year="2021", month="Jul", day="16", volume="23", number="7", pages="e25368", keywords="patient portal", keywords="electronic prescription", keywords="electronic health records", keywords="usability", keywords="pharmacy customer", keywords="perception", keywords="experience", keywords="survey", abstract="Background: Patient portals have been introduced in several countries in the last few decades. Despite worldwide objectives of introducing patient portals, nationwide portals are rare, and studies about their use are limited. Finland is one of the forerunners in developing nationwide health data systems. A nationwide patient portal, My Kanta, for viewing electronic prescriptions and health data has been phased in, starting in 2010. Objective: The aim of this study was to investigate what functions Finnish pharmacy customers use in My Kanta, their perceptions of the service's usability, and how satisfied users are with My Kanta overall. Methods: In spring 2019, questionnaires (N=2866) were distributed from 18 pharmacies of varying size across mainland Finland to adult pharmacy customers purchasing prescription medications for themselves or for their child under 18 years of age. Questions were asked about the use and usability of the patient portal by means of structured and Likert-scale questions. Statistical analyses included frequencies, means, medians, chi-square tests, Fisher exact tests, and Kruskal-Wallis tests. Results: In total, 994 completed questionnaires of 2866 delivered questionnaires (34.68\%) were returned. The most-used My Kanta functions were browsing prescription information (781/802, 97.4\%), records of health care visits (772/802, 96.3\%), and results of laboratory tests and x-ray examinations (722/804, 89.8\%). Most users (558/793, 70.4\%) had also requested a prescription renewal using the service. My Kanta was perceived as easy to log into (772/816, 94.6\%) and clear to view (709/808, 87.7\%). Most users considered the service useful for monitoring their health information (753/813, 92.6\%) and felt that it provides a good overall picture of the medications prescribed to them (711/813, 87.5\%). The majority of users found the information recorded about them easy to understand (684/800, 85.5\%). Of the users, 16.7\% (135/807) disagreed with the statement that the information they were looking for was easy to find. Approximately two-thirds (501/814, 61.5\%) of users did not know whether it is easy to view in which pharmacies and health care units their prescription information has been viewed, and over one-third (306/805, 38.0\%) did not know whether it is easy to view in which health care units their health information has been processed. Approximately one-fifth of participants (181/805, 22.5\%) feared that unauthorized persons might view their information and that their electronically saved prescription and health information might disappear (180/810, 22.2\%). In addition, 16.1\% (129/799) expressed interest in receiving guidance on My Kanta use. The vast majority of users (719/804, 89.4\%) were satisfied with the service overall. Conclusions: Pharmacy customers were satisfied with the nationwide patient portal. It was mostly used for browsing e-prescriptions and medical records. Overall, the usability of the service was good. However, users need to be better informed about data privacy and security issues, and guidance on using the portal needs to be improved. ", doi="10.2196/25368", url="https://www.jmir.org/2021/7/e25368", url="http://www.ncbi.nlm.nih.gov/pubmed/34269687" } @Article{info:doi/10.2196/24553, author="Rouzaud Laborde, Charlotte and Cenko, Erta and Mardini, T. Mamoun and Nerella, Subhash and Kheirkhahan, Matin and Ranka, Sanjay and Fillingim, B. Roger and Corbett, B. Duane and Weber, Eric and Rashidi, Parisa and Manini, Todd", title="Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study", journal="JMIR Aging", year="2021", month="Jul", day="14", volume="4", number="3", pages="e24553", keywords="ehealth", keywords="mobile health", keywords="ecological momentary assessment", keywords="real-time online assessment and mobility monitor", keywords="ROAMM", keywords="older adults", keywords="compliance", keywords="personal satisfaction", keywords="usability", keywords="smartwatch", keywords="knee osteoarthritis", keywords="pain", keywords="fatigue", keywords="wearable electronic device", keywords="mobile application", abstract="Background: Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. Objective: The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. Methods: Participants (N=28; mean age 73.2, SD 5.5 years; 70\% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night's sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). Results: A majority of participants reported that the text displayed was large enough to read (22/26, 85\%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54\%) and would consider wearing it as their personal watch (11/24, 46\%). Most participants were satisfied with its battery charging system (20/26, 77\%). A majority of participants (19/26, 73\%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83\% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88\% vs 16/26, 71\%) and among those who found the text too small to read (4/26, 86\% vs 22/26, 60\%). Conclusions: Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors. ", doi="10.2196/24553", url="https://aging.jmir.org/2021/3/e24553", url="http://www.ncbi.nlm.nih.gov/pubmed/34259638" } @Article{info:doi/10.2196/22510, author="Resnick, Daniel and Schapira, M. Marilyn and Smith, M. Jazmine and Bautista, Allison and Xu, Chang and Jones, Liz and Aysola, Jaya", title="Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App", journal="JMIR Form Res", year="2021", month="Jul", day="14", volume="5", number="7", pages="e22510", keywords="mHealth", keywords="cancer prevention", keywords="goal setting", keywords="social networks", keywords="health disparities", keywords="mobile phone", abstract="Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app's acceptability by qualitatively analyzing open-ended responses regarding participants' overall experience with the app. We assessed participants' engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76\% (31/41) were women. App use data were captured from all participants, and 83\% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app's ease of use and health behavior--promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76\% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal--setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. ", doi="10.2196/22510", url="https://formative.jmir.org/2021/7/e22510", url="http://www.ncbi.nlm.nih.gov/pubmed/34259162" } @Article{info:doi/10.2196/25285, author="Valaitis, Ruta and Cleghorn, Laura and Vassilev, Ivaylo and Rogers, Anne and Ploeg, Jenny and Kothari, Anita and Risdon, Cathy and Gillett, James and Guenter, Dale and Dolovich, Lisa", title="A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="12", volume="5", number="7", pages="e25285", keywords="web-based tool", keywords="usability", keywords="feasibility", keywords="self-management", keywords="social network", keywords="primary care", keywords="health and social services", keywords="linkages", keywords="high systems users", keywords="volunteers", abstract="Background: Primary care providers are well positioned to foster self-management through linking patients to community-based health and social services (HSSs). This study evaluated a web-based tool---GENIE (Generating Engagement in Network Involvement)---to support the self-management of adults. GENIE empowers patients to leverage their personal social networks and increase their access to HSSs. GENIE maps patients' personal social networks, elicits preferences, and filters local HSSs from a community service directory based on patient's interests. Trained volunteers (an extension of the primary care team) conducted home visits and conducted surveys related to life and health goals in the context of the Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) program, in which the GENIE tool was implemented. GENIE reports were uploaded to an electronic medical record for care planning by the team. Objective: This study aims to explore patients', volunteers', and clinicians' perceptions of the feasibility, usability, and perceived outcomes of GENIE---a tool for community-dwelling adults who are high users of the health care system. Methods: This study involved 2 primary care clinician focus groups and 1 clinician interview (n=15), 1 volunteer focus group (n=3), patient telephone interviews (n=8), field observations that captured goal-action sequences to complete GENIE, and GENIE utilization statistics. The patients were enrolled in a primary care program---Health TAPESTRY---and Ontario's Health Links Program, which coordinates care for the highest users of the health care system. NVivo 11 (QSR International) was used to support qualitative data analyses related to feasibility and perceived outcomes, and descriptive statistics were used for quantitative data. Results: Most participants reported positive overall perceptions of GENIE. However, feasibility testing showed that participants had a partial understanding of the tool; volunteer facilitation was critical to support the implementation of GENIE; clinicians perceived their navigation ability as superior to that of GENIE supported by volunteers; and tool completion took 39 minutes, which made the home visit too long for some. Usability challenges included difficulties completing some sections of the tool related to medical terminology and unclear instructions, limitations in the quality and quantity of HSSs results, and minor technological challenges. Almost all patients identified a community program or activity of interest. Half of the patients (4/8, 50\%) followed up on HSSs and added new members to their network, whereas 1 participant lost a member. Clinicians' strengthened their understanding of patients' personal social networks and needs, and patients felt less social isolation. Conclusions: This study demonstrated the potential of GENIE, when supported by volunteers, to expand patients' social networks and link them to relevant HSSs. Volunteers require training to implement GENIE for self-management support, which may help overcome the time limitations faced by primary care clinicians. Refining the filtering capability of GENIE to address adults' needs may improve primary care providers' confidence in using such tools. ", doi="10.2196/25285", url="https://formative.jmir.org/2021/7/e25285", url="http://www.ncbi.nlm.nih.gov/pubmed/34255654" } @Article{info:doi/10.2196/26873, author="Gowarty, A. Minda and Longacre, R. Meghan and Vilardaga, Roger and Kung, J. Nathan and Gaughan-Maher, E. Ashley and Brunette, F. Mary", title="Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study", journal="JMIR Ment Health", year="2021", month="Jul", day="7", volume="8", number="7", pages="e26873", keywords="smoking cessation", keywords="mHealth", keywords="serious mental illness", keywords="smartphone application", keywords="digital health", keywords="psychiatric illness", keywords="tobacco treatment", keywords="mobile phone", abstract="Background: Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute's [NCI's] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. Objective: The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI---QuitGuide and quitSTART---among young adult tobacco users with SMI. Methods: We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. Results: Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41\% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75\% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps' feedback. Conclusions: Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues. ", doi="10.2196/26873", url="https://mental.jmir.org/2021/7/e26873", url="http://www.ncbi.nlm.nih.gov/pubmed/34255699" } @Article{info:doi/10.2196/26817, author="Tawfik, S. Daniel and Sinha, Amrita and Bayati, Mohsen and Adair, C. Kathryn and Shanafelt, D. Tait and Sexton, Bryan J. and Profit, Jochen", title="Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study", journal="J Med Internet Res", year="2021", month="Jul", day="6", volume="23", number="7", pages="e26817", keywords="frustration with technology", keywords="emotional exhaustion", keywords="professional burnout", keywords="work-life integration", keywords="biomedical technology", keywords="work-life balance", keywords="user-centered design", keywords="electronic health records", keywords="medical informatics applications", keywords="health information systems", abstract="Background: New technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout. Objective: This study aimed to evaluate and quantify health care workers' frustration with technology and its relationship with emotional exhaustion, after controlling for measures of work-life integration that may indicate excessive job demands. Methods: This was a cross-sectional, observational study of health care workers across 31 Michigan hospitals. We used the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey to measure work-life integration and emotional exhaustion among the survey respondents. We used mixed-effects hierarchical linear regression to evaluate the relationship among frustration with technology, other components of work-life integration, and emotional exhaustion, with adjustment for unit and health care worker characteristics. Results: Of 15,505 respondents, 5065 (32.7\%) reported that they experienced frustration with technology on at least 3-5 days per week. Frustration with technology was associated with higher scores for the composite Emotional Exhaustion scale (r=0.35, P<.001) and each individual item on the Emotional Exhaustion scale (r=0.29-0.36, P<.001 for all). Each 10-point increase in the frustration with technology score was associated with a 1.2-point increase (95\% CI 1.1-1.4) in emotional exhaustion (both measured on 100-point scales), after adjustment for other work-life integration items and unit and health care worker characteristics. Conclusions: This study found that frustration with technology and several other markers of work-life integration are independently associated with emotional exhaustion among health care workers. Frustration with technology is common but not ubiquitous among health care workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with health care technology may be an effective approach in reducing burnout among health care workers. ", doi="10.2196/26817", url="https://www.jmir.org/2021/7/e26817", url="http://www.ncbi.nlm.nih.gov/pubmed/34255674" } @Article{info:doi/10.2196/28729, author="Heponiemi, Tarja and Kaihlanen, Anu-Marja and Gluschkoff, Kia and Saranto, Kaija and Nissinen, Sari and Laukka, Elina and Vehko, Tuulikki", title="The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study", journal="JMIR Med Inform", year="2021", month="Jul", day="6", volume="9", number="7", pages="e28729", keywords="stress related to information systems", keywords="time pressure", keywords="usability", keywords="stress", keywords="health and social care", abstract="Background: Mobile devices such as tablets and smartphones are increasingly being used in health care in many developed countries. Nurses form the largest group in health care that uses electronic health records (EHRs) and their mobile versions. Mobile devices are suggested to promote nurses' workflow, constant updating of patient information, and improve the communication within the health care team. However, little is known about their effect on nurses' well-being. Objective: This study aimed to examine the association between using a mobile version of the EHR and nurses' perceived time pressure, stress related to information systems, and self-rated stress. Moreover, we examined whether mobile device use modifies the associations of EHR usability (ease of use and technical quality), experience in using EHRs, and number of systems in daily use with these well-being indicators. Methods: This was a cross-sectional population-based survey study among 3610 Finnish registered nurses gathered in 2020. The aforesaid associations were examined using analyses of covariance and logistic regression adjusted for age, gender, and employment sector (hospital, primary care, social service, and other). Results: Nurses who used the mobile version of their EHR had higher levels of time pressure (F1,3537=14.96, P<.001) and stress related to information systems (F1,3537=6.11, P=.01), compared with those who did not use mobile versions. Moreover, the interactions of mobile device use with experience in using EHRs (F1,3581=14.93, P<.001), ease of use (F1,3577=10.16, P=.001), and technical quality (F1,3577=6.45, P=.01) were significant for stress related to information systems. Inexperience in using EHRs, low levels of ease of use, and technical quality were associated with higher stress related to information systems and this association was more pronounced among those who used mobile devices. That is, the highest levels of stress related to information systems were perceived among those who used mobile devices as well as among inexperienced EHR users or those who perceived usability problems in their EHRs. Conclusions: According to our results, it seems that at present mobile device use is not beneficial for the nurses' well-being. In addition, mobile device use seems to intensify the negative effects of usability issues related to EHRs. In particular, inexperienced users of EHRs seem to be at a disadvantage when using mobile devices. Thus, we suggest that EHRs and their mobile versions should be improved such that they would be easier to use and would better support the nurses' workflow (eg, improvements to problems related to small display, user interface, and data entry). Moreover, additional training on EHRs, their mobile versions, and workflow related to these should be provided to nurses. ", doi="10.2196/28729", url="https://medinform.jmir.org/2021/7/e28729", url="http://www.ncbi.nlm.nih.gov/pubmed/34255704" } @Article{info:doi/10.2196/15641, author="Piau, Antoine and Steinmeyer, Zara and Charlon, Yoann and Courbet, Laetitia and Rialle, Vincent and Lepage, Benoit and Campo, Eric and Nourhashemi, Fati", title="A Smart Shoe Insole to Monitor Frail Older Adults' Walking Speed: Results of Two Evaluation Phases Completed in a Living Lab and Through a 12-Week Pilot Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jul", day="5", volume="9", number="7", pages="e15641", keywords="frail older adults", keywords="walking speed", keywords="outpatient monitoring", keywords="activity tracker", keywords="shoe insert", abstract="Background: Recent World Health Organization reports propose wearable devices to collect information on activity and walking speed as innovative health indicators. However, mainstream consumer-grade tracking devices and smartphone apps are often inaccurate and require long-term acceptability assessment. Objective: Our aim is to assess the user acceptability of an instrumented shoe insole in frail older adults. This device monitors participants' walking speed and differentiates active walking from shuffling after step length calibration. Methods: A multiphase evaluation has been designed: 9 older adults were evaluated in a living lab for a day, 3 older adults were evaluated at home for a month, and a prospective randomized trial included 35 older adults at home for 3 months. A qualitative research design using face-to-face and phone semistructured interviews was performed. Our hypothesis was that this shoe insole was acceptable in monitoring long-term outdoor and indoor walking. The primary outcome was participants' acceptability, measured by a qualitative questionnaire and average time of insole wearing per day. The secondary outcome described physical frailty evolution in both groups. Results: Living lab results confirmed the importance of a multiphase design study with participant involvement. Participants proposed insole modifications. Overall acceptability had mixed results: low scores for reliability (2.1 out of 6) and high scores for usability (4.3 out of 6) outcomes. The calibration phase raised no particular concern. During the field test, a majority of participants (mean age 79 years) were very (10/16) or quite satisfied (3/16) with the insole's comfort at the end of the follow-up. Participant insole acceptability evolved as follows: 63\% (12/19) at 1 month, 50\% (9/18) at 2 months, and 75\% (12/16) at 3 months. A total of 9 participants in the intervention group discontinued the intervention because of technical issues. All participants equipped for more than a week reported wearing the insole every day at 1 month, 83\% (15/18) at 2 months, and 94\% (15/16) at 3 months for 5.8, 6.3, and 5.1 hours per day, respectively. Insole data confirmed that participants effectively wore the insole without significant decline during follow-up for an average of 13.5 days per 4 months and 5.6 hours per day. For secondary end points, the change in frailty parameters or quality of life did not differ for those randomly assigned to the intervention group compared to usual care. Conclusions: Our study reports acceptability data on an instrumented insole in indoor and outdoor walking with remote monitoring in frail older adults under real-life conditions. To date, there is limited data in this population set. This thin instrumentation, including a flexible battery, was a technical challenge and seems to provide an acceptable solution over time that is valued by participants. However, users still raised certain acceptability issues. Given the growing interest in wearable health care devices, these results will be useful for future developments. Trial Registration: ClinicalTrials.gov NCT02316600; https://clinicaltrials.gov/ct2/show/NCT02316600 ", doi="10.2196/15641", url="https://mhealth.jmir.org/2021/7/e15641", url="http://www.ncbi.nlm.nih.gov/pubmed/36260404" } @Article{info:doi/10.2196/29518, author="Herbst, Rachel and Rybak, Tiffany and Meisman, Andrea and Whitehead, Monica and Rosen, Brittany and Crosby, E. Lori and Klein, D. Melissa and Real, J. Francis", title="A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="29", volume="4", number="2", pages="e29518", keywords="resident education", keywords="virtual reality", keywords="behavioral health promotion", keywords="COVID-19", abstract="Background: Behavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines. Objective: This study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents. Methods: This mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents' perspectives on the curriculum's content and format. The interviews were analyzed using conventional content analysis. Results: Quantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79\%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills. Conclusions: Pilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families. ", doi="10.2196/29518", url="https://pediatrics.jmir.org/2021/2/e29518", url="http://www.ncbi.nlm.nih.gov/pubmed/34081601" } @Article{info:doi/10.2196/23293, author="Jamal, Amr and Tharkar, Shabana and Alenazi, Hanan and Julaidan, Saud Bedoor and Al Hindawi, Ali Dania and AlAkeel, Suleman Norah and AlNuhayer, Mohammed Ola and AlDubaikhi, Hamoud Raneem", title="Usability Analysis of a Health Sciences Digital Library by Medical Residents: Cross-sectional Survey", journal="JMIR Form Res", year="2021", month="Jun", day="24", volume="5", number="6", pages="e23293", keywords="digital library usability", keywords="medical education", keywords="system usability scale", keywords="medical residents", keywords="Saudi Arabia", abstract="Background: The usability of a digital library depends on a myriad of factors ranging from the end users' ability to website complexity. Although digital libraries provide instant access to online content, offering an efficient reference platform, their usability is highly variable. Objective: The aim of this study was to measure users' perspectives and usability of the digital library of the Saudi Commission for Health Specialties (SCFHS). Methods: A web-based questionnaire survey was conducted using a validated System Usability Scale (SUS) containing 5 positive and 5 negative items on the usability of the digital library. The SUS standard cut-off score of 68 was considered for interpretation. Results: The overall mean SUS score of digital library usability was 52.9 (SD 15.2) with a grade ``D'' categorization, indicating low usability. The perceived measures of attributes of the 10 SUS items of findability, complexity, consistency, and confidence obtained below average scores. Only item 1 relating to perceived willingness to use the digital library frequently obtained a score above the targeted benchmark score (mean score 3.6). Higher SUS scores were associated with training (P=.02). Men felt the digital library to be more complex (P=.04) and board-certified physicians perceived a greater need for training on digital library use (P=.05). Only the UpToDate database was widely used (72/90, 80\%). Conclusions: These findings demonstrate the low usability of the extensive facilities offered by the SCFHS digital library. It is pivotal to improve awareness of the availability of the digital library and popularize the databases. There is also a need for improved user training to enhance the accessibility and usability of the multiple databases. ", doi="10.2196/23293", url="https://formative.jmir.org/2021/6/e23293/", url="http://www.ncbi.nlm.nih.gov/pubmed/34184992" } @Article{info:doi/10.2196/26694, author="Persson, Johanna and Rydenf{\"a}lt, Christofer", title="Why Are Digital Health Care Systems Still Poorly Designed, and Why Is Health Care Practice Not Asking for More? Three Paths Toward a Sustainable Digital Work Environment", journal="J Med Internet Res", year="2021", month="Jun", day="22", volume="23", number="6", pages="e26694", keywords="digital systems", keywords="electronic health records", keywords="digital work environment", keywords="ergonomics", keywords="usability", keywords="human-centered design", doi="10.2196/26694", url="https://www.jmir.org/2021/6/e26694", url="http://www.ncbi.nlm.nih.gov/pubmed/34156336" } @Article{info:doi/10.2196/26012, author="Willis, Matthew and Brand Hein, Leah and Hu, Zhaoxian and Saran, Rajiv and Argentina, Marissa and Bragg-Gresham, Jennifer and Krein, L. Sarah and Gillespie, Brenda and Zheng, Kai and Veinot, C. Tiffany", title="Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study", journal="JMIR Hum Factors", year="2021", month="Jun", day="14", volume="8", number="2", pages="e26012", keywords="user interaction", keywords="dialysis", keywords="usability", keywords="informatics intervention", abstract="Background: Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)---low blood pressure during hemodialysis---is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based interventions hold promise as a platform for patient activation. However, little is known about the usability challenges that patients undergoing hemodialysis may face when using tablet-based informatics interventions, especially while dialyzing. Objective: This study aims to test the usability of a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing--based mentoring from patient peers via videoconferencing. Methods: We conducted a cross-sectional, mixed methods usability evaluation of the tablet-based intervention by using think-aloud methods, field notes, and structured observations. These qualitative data were evaluated by trained researchers using a structured data collection instrument to capture objective observational data. We calculated descriptive statistics for the quantitative data and conducted inductive content analysis using the qualitative data. Results: Findings from 14 patients cluster around general constraints such as the use of one arm, dexterity issues, impaired vision, and lack of experience with touch screen devices. Our task-by-task usability results showed that specific sections with the greatest difficulty for users were logging into the intervention (difficulty score: 2.08), interacting with the quizzes (difficulty score: 1.92), goal setting (difficulty score: 2.28), and entering and exiting videoconference rooms (difficulty score: 2.07) that are used to engage with peers during motivational interviewing sessions. Conclusions: In this paper, we present implications for designing informatics interventions for patients on dialysis and detail resulting changes to be implemented in the next version of this intervention. We frame these implications first through the context of the role the patients' physical body plays when interacting with the intervention and then through the digital considerations for software and interface interaction. ", doi="10.2196/26012", url="https://humanfactors.jmir.org/2021/2/e26012", url="http://www.ncbi.nlm.nih.gov/pubmed/34121664" } @Article{info:doi/10.2196/25741, author="Madar, Ronni and Ugon, Adrien and Ivankovi{\'c}, Damir and Tsopra, Rosy", title="A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach", journal="J Med Internet Res", year="2021", month="Jun", day="11", volume="23", number="6", pages="e25741", keywords="clinical decision support system", keywords="visualization", keywords="usability", keywords="clinical practice guidelines", keywords="antibiotic", keywords="primary care", abstract="Background: Antibiotic misuse is a serious public health problem worldwide. National health authorities release clinical practice guidelines (CPGs) to guide general practitioners (GPs) in their choice of antibiotics. However, despite the large-scale dissemination of CPGs, GPs continue to prescribe antibiotics that are not recommended as first-line treatments. This nonadherence to recommendations may be due to GPs misunderstanding the CPGs. A web interface displaying antibiotic prescription recommendations and their justifications could help to improve the comprehensibility and readability of CPGs, thereby increasing the adoption of recommendations regarding antibiotic treatment. Objective: This study aims to design and evaluate a web interface for antibiotic prescription displaying both the recommended antibiotics and their justifications in the form of antibiotic properties. Methods: A web interface was designed according to the same principles as e-commerce interfaces and was assessed by 117 GPs. These GPs were asked to answer 17 questions relating to the usefulness, user-friendliness, and comprehensibility and readability of the interface, and their satisfaction with it. Responses were recorded on a 4-point Likert scale (ranging from ``absolutely disagree'' to ``absolutely agree''). At the end of the evaluation, the GPs were allowed to provide optional, additional free comments. Results: The antibiotic prescription web interface consists of three main sections: a clinical summary section, a filter section, and a recommended antibiotics section. The majority of GPs appreciated the clinical summary (90/117, 76.9\%) and filter (98/117, 83.8\%) sections, whereas 48.7\% (57/117) of them reported difficulty reading some of the icons in the recommended antibiotics section. Overall, 82.9\% (97/117) of GPs found the display of drug properties useful, and 65.8\% (77/117) reported that the web interface improved their understanding of CPG recommendations. Conclusions: The web interface displaying antibiotic recommendations and their properties can help doctors understand the rationale underlying CPG recommendations regarding antibiotic treatment, but further improvements are required before its implementation into a clinical decision support system. ", doi="10.2196/25741", url="https://www.jmir.org/2021/6/e25741", url="http://www.ncbi.nlm.nih.gov/pubmed/34114958" } @Article{info:doi/10.2196/16304, author="Mascheroni, Alessandro and Choe, Kyoung Eun and Luo, Yuhan and Marazza, Michele and Ferlito, Clara and Caverzasio, Serena and Mezzanotte, Francesco and Kaelin-Lang, Alain and Faraci, Francesca and Puiatti, Alessandro and Ratti, Luca Pietro", title="The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jun", day="8", volume="9", number="6", pages="e16304", keywords="Parkinson disease", keywords="ecological momentary assessment", keywords="finger-tapping test", keywords="subjective scales", keywords="sleep diaries", keywords="tablet application", keywords="home-based system", abstract="Background: Parkinson disease (PD) is a common, multifaceted neurodegenerative disorder profoundly impacting patients' autonomy and quality of life. Assessment in real-life conditions of subjective symptoms and objective metrics of mobility and nonmotor symptoms such as sleep disturbance is strongly advocated. This information would critically guide the adaptation of antiparkinsonian medications and nonpharmacological interventions. Moreover, since the spread of the COVID-19 pandemic, health care practices are being reshaped toward a more home-based care. New technologies could play a pivotal role in this new approach to clinical care. Nevertheless, devices and information technology tools might be unhandy for PD patients, thus dramatically limiting their widespread employment. Objective: The goals of the research were development and usability evaluation of an application, SleepFit, for ecological momentary assessment of objective and subjective clinical metrics at PD patients' homes, and as a remote tool for researchers to monitor patients and integrate and manage data. Methods: An iterative and user-centric strategy was employed for the development of SleepFit. The core structure of SleepFit consists of (1) an electronic finger-tapping test; (2) motor, sleepiness, and emotional subjective scales; and (3) a sleep diary. Applicable design, ergonomic, and navigation principles have been applied while tailoring the application to the specific patient population. Three progressively enhanced versions of the application (alpha, v1.0, v2.0) were tested by a total of 56 patients with PD who were asked to perform multiple home assessments 4 times per day for 2 weeks. Patient compliance was calculated as the proportion of completed tasks out of the total number of expected tasks. Satisfaction on the latest version (v2.0) was evaluated as potential willingness to use SleepFit again after the end of the study. Results: From alpha to v1.0, SleepFit was improved in graphics, ergonomics, and navigation, with automated flows guiding the patients in performing tasks throughout the 24 hours, and real-time data collection and consultation were made possible thanks to a remote web portal. In v2.0, the kiosk-mode feature restricts the use of the tablet to the SleepFit application only, thus preventing users from accidentally exiting the application. A total of 52 (4 dropouts) patients were included in the analyses. Overall compliance (all versions) was 88.89\% (5707/6420). SleepFit was progressively enhanced and compliance increased from 87.86\% (2070/2356) to 89.92\% (2899/3224; P=.04). Among the patients who used v2.0, 96\% (25/26) declared they would use SleepFit again. Conclusions: SleepFit can be considered a state-of-the-art home-based system that increases compliance in PD patients, ensures high-quality data collection, and works as a handy tool for remote monitoring and data management in clinical research. Thanks to its user-friendliness and modular structure, it could be employed in other clinical studies with minimum adaptation efforts. Trial Registration: ClinicalTrials.gov NCT02723396; https://clinicaltrials.gov/ct2/show/NCT02723396 ", doi="10.2196/16304", url="https://mhealth.jmir.org/2021/6/e16304", url="http://www.ncbi.nlm.nih.gov/pubmed/34100767" } @Article{info:doi/10.2196/18167, author="Salari, Raheleh and R Niakan Kalhori, Sharareh and GhaziSaeedi, Marjan and Jeddi, Marjan and Nazari, Mahin and Fatehi, Farhad", title="Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation", journal="J Med Internet Res", year="2021", month="Jun", day="2", volume="23", number="6", pages="e18167", keywords="type 2 diabetes", keywords="mobile health", keywords="mHealth", keywords="mobile app, self-management", keywords="behavior change", abstract="Background: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. Objective: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. Methods: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. Results: The developed mobile app includes modules that support several features. A person's data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician's portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. Conclusions: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up. ", doi="10.2196/18167", url="https://www.jmir.org/2021/6/e18167", url="http://www.ncbi.nlm.nih.gov/pubmed/34076579" } @Article{info:doi/10.2196/24937, author="Norris, E. Anne and Thalasinos, Delcampo Roxana and Hecht, L. Michael", title="Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups", journal="JMIR Form Res", year="2021", month="Jun", day="2", volume="5", number="6", pages="e24937", keywords="implementation science", keywords="mobile apps", keywords="peer influence", keywords="early intervention", keywords="adolescent health", abstract="Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83\% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program's behavior change potency. ", doi="10.2196/24937", url="https://formative.jmir.org/2021/6/e24937", url="http://www.ncbi.nlm.nih.gov/pubmed/34076578" } @Article{info:doi/10.2196/22970, author="Ormel, Ilja and Onu, C. Charles and Magalhaes, Mona and Tang, Terence and Hughes, B. John and Law, Susan", title="Using a Mobile App--Based Video Recommender System of Patient Narratives to Prepare Women for Breast Cancer Surgery: Development and Usability Study Informed by Qualitative Data", journal="JMIR Form Res", year="2021", month="Jun", day="2", volume="5", number="6", pages="e22970", keywords="qualitative research", keywords="illness narratives", keywords="experiential information", keywords="breast cancer", keywords="surgery", keywords="tailored information", keywords="recommender system", keywords="patient information and communication", keywords="mobile app", keywords="mobile phone", abstract="Background: Women diagnosed with breast cancer are often bombarded with information. Such information overload can lead to misunderstandings and hamper women's capacity for making informed decisions about their care. For women with breast cancer, this uncertainty is particularly severe in the period before surgery. Personalized narratives about others' experiences can help patients better understand the disease course, the quality and type of care to be expected, the clinical decision-making processes, and the strategies for coping. Existing resources and eHealth apps rarely include experiential information, and no tools exist that tailor information for individual preferences and needs---offering the right information at the right time and in the right format. Combining high-quality experiential evidence with novel technical approaches may contribute to patient-centered solutions in this area. Objective: This study aims to design and seek preliminary feedback on a mobile app that will improve information access about surgery for patients with breast cancer, by drawing on a qualitative collection of personal narratives from a diverse sample of Canadian women and using video and audio recordings or audio recordings from the Canadian Health Experiences Research Network. Methods: In a previous study, we conducted in-depth interviews with 35 Canadian women and used video and audio recordings or audio recordings to collect stories about the lived experiences of breast cancer. The participants highlighted the need for more specific information between diagnosis and surgery that was relevant to their personal situations and preferences. They also wanted to learn from other women's experiences. We worked with patients, clinicians, and informatics experts to develop a mobile app that provides access to tailored experiential information relevant to women's personal situations and preferences. We completed focus groups and qualitative interviews, conducted a further analysis of the original qualitative data, designed novel software using artificial intelligence, and sought preliminary feedback from users on a new app via focus groups and a survey. Results: The secondary analysis of the breast cancer narratives revealed key themes and their interconnections relevant to the experience of surgery, including preparation, treatment decisions, aftercare, reconstruction, prostheses, lumpectomy and mastectomy, and complications. These themes informed the development of the structure and content of the app. We developed a recommender system within the app by using content matching (user and speaker profiles and user interests and video content) and collaborative filtering to identify clips marked as relevant by the user and by similar users. A 2-minute animated introductory video for users was developed. Pilot testing revealed generally positive responses regarding the content and value of this type of e-tool. Conclusions: Developing reliable, evidence-based tools and apps that are based on diverse collections of people's experiences of illness offers a novel approach to help manage the plethora of information that women face after a diagnosis of breast cancer. ", doi="10.2196/22970", url="https://formative.jmir.org/2021/6/e22970", url="http://www.ncbi.nlm.nih.gov/pubmed/34076582" } @Article{info:doi/10.2196/25787, author="Iftikhar, Aleeha and Bond, R. Raymond and McGilligan, Victoria and Leslie, J. Stephen and Rjoob, Khaled and Knoery, Charles and Quigg, Ciara and Campbell, Ryan and Boyd, Kyle and McShane, Anne and Peace, Aaron", title="Comparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study", journal="JMIR Hum Factors", year="2021", month="May", day="26", volume="8", number="2", pages="e25787", keywords="digital forms", keywords="health care", keywords="usability evaluation", keywords="single-page form", keywords="multipage form", keywords="conversational forms", abstract="Background: Even in the era of digital technology, several hospitals still rely on paper-based forms for data entry for patient admission, triage, drug prescriptions, and procedures. Paper-based forms can be quick and convenient to complete but often at the expense of data quality, completeness, sustainability, and automated data analytics. Digital forms can improve data quality by assisting the user when deciding on the appropriate response to certain data inputs (eg, classifying symptoms). Greater data quality via digital form completion not only helps with auditing, service improvement, and patient record keeping but also helps with novel data science and machine learning research. Although digital forms are becoming more prevalent in health care, there is a lack of empirical best practices and guidelines for their design. The study-based hospital had a definite plan to abolish the paper form; hence, it was not necessary to compare the digital forms with the paper form. Objective: This study aims to assess the usability of three different interactive forms: a single-page digital form (in which all data input is required on one web page), a multipage digital form, and a conversational digital form (a chatbot). Methods: The three digital forms were developed as candidates to replace the current paper-based form used to record patient referrals to an interventional cardiology department (Cath-Lab) at Altnagelvin Hospital. We recorded usability data in a counterbalanced usability test (60 usability tests: 20 subjects{\texttimes}3 form usability tests). The usability data included task completion times, System Usability Scale (SUS) scores, User Experience Questionnaire data, and data from a postexperiment questionnaire. Results: We found that the single-page form outperformed the other two digital forms in almost all usability metrics. The mean SUS score for the single-page form was 76 (SD 15.8; P=.01) when compared with the multipage form, which had a mean score of 67 (SD 17), and the conversational form attained the lowest scores in usability testing and was the least preferred choice of users, with a mean score of 57 (SD 24). An SUS score of >68 was considered above average. The single-page form achieved the least task completion time compared with the other two digital form styles. Conclusions: In conclusion, the digital single-page form outperformed the other two forms in almost all usability metrics; it had the least task completion time compared with those of the other two digital forms. Moreover, on answering the open-ended question from the final customized postexperiment questionnaire, the single-page form was the preferred choice. ", doi="10.2196/25787", url="https://humanfactors.jmir.org/2021/2/e25787", url="http://www.ncbi.nlm.nih.gov/pubmed/34037531" } @Article{info:doi/10.2196/25679, author="Lwin, O. May and Sheldenkar, Anita and Panchapakesan, Chitra", title="A Digital Mobile Community App for Caregivers in Singapore: Predevelopment and Usability Study", journal="JMIR Nursing", year="2021", month="May", day="26", volume="4", number="2", pages="e25679", keywords="caregiving", keywords="technological solution", keywords="mobile application", keywords="easy communication", keywords="caregiver", keywords="mobile app", keywords="communication", keywords="elderly", keywords="aging population", keywords="internet technology", keywords="community network", keywords="network", abstract="Background: With increasing life expectancy and aging populations, the global prevalence of chronic diseases and the long-term care required for people with comorbidities is rising. This has led to an ever-growing need for caregiving. Previous literature has shown that caregivers face problems of isolation and loneliness. However, many health organizations mainly focus their efforts on in-person community groups that require participants to meet physically. This is not always convenient or accessible for caregivers who are often juggling caring for their care recipient with family and work responsibilities. Objective: With medical advancements such as the proliferation of mobile phones and internet technology, caregivers may have opportunities for easier access to resources and support. Technological innovations could help empower the caregiving community to seek assistance for improving their quality of life at their convenience. A community network app called Caregivers' Circle was conceptualized in response to the needs of the caregivers on a day-to-day caregiving journey. This paper traces the predevelopment inquiry and technical details of this app to provide a clear understanding of its implementation along with a usability study to gauge user opinion of the app within Singapore. Methods: A predevelopment survey was conducted to identify specific needs of caregivers and gaps in the currently available web-based community networks. The survey consisted of questions on demographical data, health-related issues of the care recipient, mental and physical health--related issues of the caregiver, digital media use, information seeking, and support. This pre--app development survey was completed by 103 caregivers. Qualitative enquiries were also conducted with caregivers within Singapore to identify issues related to caregiving, support provided, and what caregivers would want from a caregiving mobile app. Results: From the feedback garnered from the caregivers, the developers were able to identify several caregivers' needs and gaps within the current support networks. This feedback was integrated into the mobile app called Caregivers' Circle upon development. The features of this app include a public forum for community discussions, a marketplace to buy and sell items, care groups to hold private discussions with friends or other users of the app, and a friends feature to search and add new caregiving friends. Conclusions: In general, the caregivers liked the Caregivers' Circle app and were confident that this app could help them have a better quality of life. The Caregivers' Circle app is unique in its integrated approach. The integration of many features that caregivers need on a daily basis into an easy app can save their time as well as help them navigate their life smoothly. ", doi="10.2196/25679", url="https://nursing.jmir.org/2021/2/e25679", url="http://www.ncbi.nlm.nih.gov/pubmed/34345796" } @Article{info:doi/10.2196/16536, author="Won, Stevenson Andrea and Barreau, C. Ariana and Gaertner, Mark and Stone, Tristan and Zhu, Joshua and Wang, Yao Cheng and Mackey, Sean", title="Assessing the Feasibility of an Open-Source Virtual Reality Mirror Visual Feedback Module for Complex Regional Pain Syndrome: Pilot Usability Study", journal="J Med Internet Res", year="2021", month="May", day="26", volume="23", number="5", pages="e16536", keywords="virtual reality", keywords="pain", keywords="complex regional pain syndrome", keywords="CRPS", keywords="open source", keywords="mirror visual feedback", abstract="Background: Complex regional pain syndrome (CRPS) is a rare and severe chronic pain condition, with effective treatment options not established for many patients. The underlying pathophysiology remains unclear, but there is a growing appreciation for the role of central mechanisms which have formed the basis for brain-based therapies such as transcranial magnetic stimulation and mirror visual feedback (MVF). MVF has been deployed in the treatment of CRPS using both conventional mirrors and virtual reality (VR). Objective: The aim of this study was to further investigate the use of VR in the treatment of patients with unilateral upper limb CRPS. VR has the potential advantage of more flexible and more motivating tasks, as well as the option of tracking patient improvement through the use of movement data. Methods: We describe the development, acceptability, feasibility, and usability of an open-source VR program MVF module designed to be used with consumer VR systems for the treatment of CRPS. The development team was an interdisciplinary group of physical therapists, pain researchers, and VR researchers. Patients recruited from a pain clinic completed 3-5 visits each to trial the system and assessed their experiences in pre- and post-treatment questionnaires. Results: All 9 (100\%) participants were able to use the system for 3, 4, or 5 trials each. None of the participants quit any trial due to cybersickness. All 9 (100\%) participants reported interest in using the module in the future. Participants' reported average pain scores in the affected limb were not significantly different from baseline during treatment or after treatment (P=.16). We did not find a statistically significant effect on participants' self-reported average pain scores. Conclusions: We propose that this module could be a useful starting point for modification and testing for other researchers. We share modifications to make this module usable with standalone headsets and finger tracking. Next steps include adapting this module for at-home use, or for use with participants with lower limb pain. ", doi="10.2196/16536", url="https://www.jmir.org/2021/5/e16536", url="http://www.ncbi.nlm.nih.gov/pubmed/34037530" } @Article{info:doi/10.2196/16491, author="Andrade, Evismar and Quinlan, Leo and Harte, Richard and Byrne, Dara and Fallon, Enda and Kelly, Martina and Casey, Siobhan and Kirrane, Frank and O'Connor, Paul and O'Hora, Denis and Scully, Michael and Laffey, John and Pladys, Patrick and Beuch{\'e}e, Alain and {\'O}Laighin, Gearoid", title="Augmenting Critical Care Patient Monitoring Using Wearable Technology: Review of Usability and Human Factors", journal="JMIR Hum Factors", year="2021", month="May", day="25", volume="8", number="2", pages="e16491", keywords="patient monitor", keywords="physiologic monitor", keywords="human factors", keywords="ergonomics", keywords="usability", keywords="user experience", keywords="wearable", keywords="mobile phone", keywords="critical care", abstract="Background: Continuous monitoring of the vital signs of critical care patients is an essential component of critical care medicine. For this task, clinicians use a patient monitor (PM), which conveys patient vital sign data through a screen and an auditory alarm system. Some limitations with PMs have been identified in the literature, such as the need for visual contact with the PM screen, which could result in reduced focus on the patient in specific scenarios, and the amount of noise generated by the PM alarm system. With the advancement of material science and electronic technology, wearable devices have emerged as a potential solution for these problems. This review presents the findings of several studies that focused on the usability and human factors of wearable devices designed for use in critical care patient monitoring. Objective: The aim of this study is to review the current state of the art in wearable devices intended for use by clinicians to monitor vital signs of critical care patients in hospital settings, with a focus on the usability and human factors of the devices. Methods: A comprehensive literature search of relevant databases was conducted, and 20 studies were identified and critically reviewed by the authors. Results: We identified 3 types of wearable devices: tactile, head-mounted, and smartwatch displays. In most cases, these devices were intended for use by anesthesiologists, but nurses and surgeons were also identified as potentially important users of wearable technology in critical care medicine. Although the studies investigating tactile displays revealed their potential to improve clinical monitoring, usability problems related to comfort need to be overcome before they can be considered suitable for use in clinical practice. Only a few studies investigated the usability and human factors of tactile displays by conducting user testing involving critical care professionals. The studies of head-mounted displays (HMDs) revealed that these devices could be useful in critical care medicine, particularly from an ergonomics point of view. By reducing the amount of time the user spends averting their gaze from the patient to a separate screen, HMDs enable clinicians to improve their patient focus and reduce the potential of repetitive strain injury. Conclusions: Researchers and designers of new wearable devices for use in critical care medicine should strive to achieve not only enhanced performance but also enhanced user experience for their users, especially in terms of comfort and ease of use. These aspects of wearable displays must be extensively tested with the intended end users in a setting that properly reflects the intended context of use before their adoption can be considered in clinical settings. ", doi="10.2196/16491", url="https://humanfactors.jmir.org/2021/2/e16491", url="http://www.ncbi.nlm.nih.gov/pubmed/34032574" } @Article{info:doi/10.2196/22915, author="McMaughan, Jones Darcy and Lin, Sherry and Ozmetin, Jennifer and Beverly, Gayle Judith and Brog, Joshua and Naiser, Emily", title="A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study", journal="JMIR Form Res", year="2021", month="May", day="25", volume="5", number="5", pages="e22915", keywords="youth with special health care needs", keywords="health care transitions", keywords="eHealth", keywords="usability", keywords="concurrent think aloud method", abstract="Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92\%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3\% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92\% (1065/1300) with a cutoff score of 73.33\% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76\%) and navigation (ease of use: 114/150, 76\%; hyperlinks: 163/200, 81.5\%; structure: 159/200, 79.5\%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68\%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75\%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. ", doi="10.2196/22915", url="https://formative.jmir.org/2021/5/e22915", url="http://www.ncbi.nlm.nih.gov/pubmed/34032579" } @Article{info:doi/10.2196/27205, author="Lowe, Cabella and Hanuman Sing, Harry and Browne, Mitchell and Alwashmi, F. Meshari and Marsh, William and Morrissey, Dylan", title="Usability Testing of a Digital Assessment Routing Tool: Protocol for an Iterative Convergent Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="May", day="18", volume="10", number="5", pages="e27205", keywords="mHealth", keywords="mobile health", keywords="eHealth", keywords="digital health", keywords="digital technology", keywords="musculoskeletal injury", keywords="musculoskeletal conditions", keywords="triage", keywords="physiotherapy triage", keywords="usability", keywords="acceptability", abstract="Background: Musculoskeletal conditions account for 16\% of global disability, resulting in a negative effect on millions of patients and an increasing burden on health care utilization. Digital technologies that improve health care outcomes and efficiency are considered a priority; however, innovations are often inadequately developed and poorly adopted. Further, they are rarely tested with sufficient rigor in clinical trials---the gold standard for clinical proof of efficacy. We have developed a new musculoskeletal Digital Assessment Routing Tool (DART) that allows users to self-assess and be directed to the right care. DART requires usability testing in preparation for clinical trials. Objective: This study will use the iterative convergent mixed methods design to assess and mitigate all serious usability issues to optimize user experience and adoption. Using this methodology, we will provide justifiable confidence to progress to full-scale randomized controlled trials when DART is integrated into clinical management pathways. This study protocol will provide a blueprint for future usability studies of mobile health solutions. Methods: We will collect qualitative and quantitative data from 20-30 participants aged 18 years and older for 4 months. The exact number of participants recruited will be dependent on the number of iterative cycles required to reach the study end points. Building on previous internal testing and stakeholder involvement, quantitative data collection is defined by the constructs within the ISO 9241-210-2019 standard and the system usability scale, providing a usability score for DART. Guided by the participant responses to quantitative questioning, the researcher will focus the qualitative data collection on specific usability problems. These will then be graded to provide the rationale for further DART system improvements throughout the iterative cycles. Results: This study received approval from the Queen Mary University of London Ethics of Research Committee (QMREC2018/48/048) on June 4, 2020. At manuscript submission, study recruitment was on-going, with data collection to be completed and results published in 2021. Conclusions: This study will provide evidence concerning mobile health DART system usability and acceptance determining system improvements required to support user adoption and minimize suboptimal system usability as a potential confounder within subsequent noninferiority clinical trials. Success should produce a safe effective system with excellent usability, facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This deliberately rigorous approach to mobile health innovation could be used as a guide for other developers of similar apps. International Registered Report Identifier (IRRID): DERR1-10.2196/27205 ", doi="10.2196/27205", url="https://www.researchprotocols.org/2021/5/e27205", url="http://www.ncbi.nlm.nih.gov/pubmed/34003135" } @Article{info:doi/10.2196/25316, author="Lopes, Filipa and Rodrigues, M{\'a}rio and Silva, G. Anabela", title="User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study", journal="JMIR Mhealth Uhealth", year="2021", month="May", day="14", volume="9", number="5", pages="e25316", keywords="pain assessment", keywords="mobile app", keywords="validity", keywords="reliability", keywords="usability", keywords="mHealth", keywords="pain", keywords="user-centered design", abstract="Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1---development of the AvaliaDor app; and phase 2---assessment of the apps' usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. ", doi="10.2196/25316", url="https://mhealth.jmir.org/2021/5/e25316", url="http://www.ncbi.nlm.nih.gov/pubmed/33988515" } @Article{info:doi/10.2196/26078, author="Jones, Chelsea and Miguel-Cruz, Antonio and Br{\'e}mault-Phillips, Suzette", title="Technology Acceptance and Usability of the BrainFx SCREEN in Canadian Military Members and Veterans With Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: Mixed Methods UTAUT Study", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="13", volume="8", number="2", pages="e26078", keywords="NCAT", keywords="PTSD", keywords="cognitive assessment", keywords="cognition", keywords="executive function", keywords="technology acceptance", keywords="UTAUT", keywords="Canadian Armed Forces", keywords="mTBI", keywords="concussion", keywords="digital health", keywords="neuropsychology", keywords="neurology", keywords="post concussive symptoms", keywords="military", abstract="Background: Canadian Armed Forces service members (CAF-SMs) and veterans exhibit higher rates of injuries and illnesses, such as posttraumatic stress disorder (PTSD) and traumatic brain injury, which can cause and exacerbate cognitive dysfunction. Computerized neurocognitive assessment tools have demonstrated increased reliability and efficiency compared with traditional cognitive assessment tools. Without assessing the degree of technology acceptance and perceptions of usability to end users, it is difficult to determine whether a technology-based assessment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in five domains. Objective: This study aims to determine the technology acceptance and usability of a neurocognitive assessment tool, which was titled BrainFx SCREEN, among CAF-SMs and veterans with PTSD by using the Unified Theory of Acceptance and Use of Technology model. Methods: This mixed methods embedded pilot study included CAF-SMs and veterans (N=21) aged 18-60 years with a diagnosis of PTSD who completed pre- and postquestionnaires on the same day the BrainFx SCREEN was used. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data were assessed using thematic analysis. Results: Facilitating conditions, which were the most notable predictors of behavioral intention, increased after using the BrainFx SCREEN, whereas effort expectancy decreased. Performance expectancy, effort expectancy, and social interaction were not factors that could predict behavioral intention. Participants who reported a previous mild traumatic brain injury were significantly more likely to report current symptoms of cognitive impairment. The BrainFx SCREEN is a feasible, usable, and accepted assessment tool for CAF-SMs and veterans who experience PTSD. Conclusions: As military health care systems integrate technological innovations to improve the services and care provided, research must continue to address the acceptability and use of these novel assessments and interventions. ", doi="10.2196/26078", url="https://rehab.jmir.org/2021/2/e26078", url="http://www.ncbi.nlm.nih.gov/pubmed/33983125" } @Article{info:doi/10.2196/22973, author="Rager, L. Theresa and Koepfli, Cristian and Khan, A. Wasif and Ahmed, Sabeena and Mahmud, Hayat Zahid and Clayton, N. Katherine", title="Usability of Rapid Cholera Detection Device (OmniVis) for Water Quality Workers in Bangladesh: Iterative Convergent Mixed Methods Study", journal="J Med Internet Res", year="2021", month="May", day="12", volume="23", number="5", pages="e22973", keywords="cholera", keywords="environmental surveillance", keywords="mHealth", keywords="usability", abstract="Background: Cholera poses a significant global health burden. In Bangladesh, cholera is endemic and causes more than 100,000 cases each year. Established environmental reservoirs leave millions at risk of infection through the consumption of contaminated water. The Global Task Force for Cholera Control has called for increased environmental surveillance to detect contaminated water sources prior to human infection in an effort to reduce cases and deaths. The OmniVis rapid cholera detection device uses loop-mediated isothermal amplification and particle diffusometry detection methods integrated into a handheld hardware device that attaches to an iPhone 6 to identify and map contaminated water sources. Objective: The aim of this study was to evaluate the usability of the OmniVis device with targeted end users to advance the iterative prototyping process and ultimately design a device that easily integrates into users' workflow. Methods: Water quality workers were trained to use the device and subsequently completed an independent device trial and usability questionnaire. Pretraining and posttraining knowledge assessments were administered to ensure training quality did not confound trial and questionnaire Results: Device trials identified common user errors and device malfunctions including incorrect test kit insertion and device powering issues. We did not observe meaningful differences in user errors or device malfunctions accumulated per participant across demographic groups. Over 25 trials, the mean time to complete a test was 47 minutes, a significant reduction compared with laboratory protocols, which take approximately 3 days. Overall, participants found the device easy to use and expressed confidence and comfort in using the device independently. Conclusions: These results are used to advance the iterative prototyping process of the OmniVis rapid cholera detection device so it can achieve user uptake, workflow integration, and scale to ultimately impact cholera control and elimination strategies. We hope this methodology will promote robust usability evaluations of rapid pathogen detection technologies in device development. ", doi="10.2196/22973", url="https://www.jmir.org/2021/5/e22973", url="http://www.ncbi.nlm.nih.gov/pubmed/33978590" } @Article{info:doi/10.2196/24669, author="Guay, Manon and Labb{\'e}, Mathieu and S{\'e}guin-Tremblay, No{\'e}mie and Auger, Claudine and Goyer, Genevi{\`e}ve and Veloza, Emily and Chevalier, Natalie and Polgar, Jan and Michaud, Fran{\c{c}}ois", title="Adapting a Person's Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App's Acceptability", journal="JMIR Rehabil Assist Technol", year="2021", month="May", day="11", volume="8", number="2", pages="e24669", keywords="occupational therapy", keywords="mobile phone", keywords="aging", keywords="disability", keywords="telehealth", keywords="3D visualization", keywords="universal design", keywords="built environment", keywords="camera", keywords="remote assessment", keywords="assistive technology", abstract="Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT's work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT's work when conducting assessments in which home representations are essential to fit a person's needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology's co-design over a span of 4 years. Fueled by the objective to enhance MapIt's acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders' perception was favorable regarding MapIt's acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person's occupational engagement. ", doi="10.2196/24669", url="https://rehab.jmir.org/2021/2/e24669", url="http://www.ncbi.nlm.nih.gov/pubmed/33973867" } @Article{info:doi/10.2196/25218, author="Helou, Samar and Abou-Khalil, Victoria and Iacobucci, Riccardo and El Helou, Elie and Kiyono, Ken", title="Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation", journal="J Med Internet Res", year="2021", month="May", day="10", volume="23", number="5", pages="e25218", keywords="computational ethnography", keywords="patient-physician communication", keywords="doctor-patient-computer interaction", keywords="electronic medical records", keywords="pose estimation", keywords="gaze", keywords="voice activity", keywords="dialogue", keywords="clinic layout", abstract="Background: The study of doctor-patient-computer interactions is a key research area for examining doctor-patient relationships; however, studying these interactions is costly and obtrusive as researchers usually set up complex mechanisms or intrude on consultations to collect, then manually analyze the data. Objective: We aimed to facilitate human-computer and human-human interaction research in clinics by providing a computational ethnography tool: an unobtrusive automatic classifier of screen gaze and dialogue combinations in doctor-patient-computer interactions. Methods: The classifier's input is video taken by doctors using their computers' internal camera and microphone. By estimating the key points of the doctor's face and the presence of voice activity, we estimate the type of interaction that is taking place. The classification output of each video segment is 1 of 4 interaction classes: (1) screen gaze and dialogue, wherein the doctor is gazing at the computer screen while conversing with the patient; (2) dialogue, wherein the doctor is gazing away from the computer screen while conversing with the patient; (3) screen gaze, wherein the doctor is gazing at the computer screen without conversing with the patient; and (4) other, wherein no screen gaze or dialogue are detected. We evaluated the classifier using 30 minutes of video provided by 5 doctors simulating consultations in their clinics both in semi- and fully inclusive layouts. Results: The classifier achieved an overall accuracy of 0.83, a performance similar to that of a human coder. Similar to the human coder, the classifier was more accurate in fully inclusive layouts than in semi-inclusive layouts. Conclusions: The proposed classifier can be used by researchers, care providers, designers, medical educators, and others who are interested in exploring and answering questions related to screen gaze and dialogue in doctor-patient-computer interactions. ", doi="10.2196/25218", url="https://www.jmir.org/2021/5/e25218", url="http://www.ncbi.nlm.nih.gov/pubmed/33970117" } @Article{info:doi/10.2196/28668, author="Petrocchi, Serena and Filipponi, Chiara and Montagna, Giacomo and Bonollo, Marta and Pagani, Olivia and Meani, Francesco", title="A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study", journal="JMIR Form Res", year="2021", month="May", day="10", volume="5", number="5", pages="e28668", keywords="breast cancer", keywords="decision-making process", keywords="breast cancer patient", keywords="smartphone app", keywords="empowerment", keywords="breast cancer journey", keywords="mobile app", abstract="Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35\%), organizing the cure path and being aware of the steps in cancer management (5/20, 25\%), facilitating doctor-patient communication (4/20, 20\%), and having detailed information about the resources offered by the hospital (2/20, 10\%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95\% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital's electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. ", doi="10.2196/28668", url="https://formative.jmir.org/2021/5/e28668", url="http://www.ncbi.nlm.nih.gov/pubmed/33970120" } @Article{info:doi/10.2196/18096, author="de Looff, Christiaan Pieter and Nijman, Henk and Didden, Robert and Noordzij, L. Matthijs", title="Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study", journal="JMIR Form Res", year="2021", month="May", day="10", volume="5", number="5", pages="e18096", keywords="forensic psychiatry", keywords="wearable biosensors", keywords="intellectual disabilities", keywords="usability", keywords="acceptance", keywords="continuous use", keywords="emotion regulation", keywords="behavior regulation", abstract="Background: The use of wearable biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behavior in clients and staff members. More so, if clients have mild intellectual disabilities (IQ 50-85), they might benefit from these biosensors as they are easy to use in everyday life, which ensures that clients can practice with the devices in multiple stress and arousal-inducing situations. However, research on (continuous) use and acceptance of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers is scarce. Although wearable biosensors show promise for health care, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective: The main goal of this study was to investigate the associations between and determinants of the expectation of usability, the actual experienced usability, and the intention for continuous use of biosensors. Methods: A total of 77 participants (31 forensic clients with mild intellectual disabilities and 46 forensic staff members) participated in a 1-week trial. Preceding the study, we selected 4 devices thought to benefit the participants in domains of self-regulation, physical health, or sleep. Qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance, and continuous use of biosensors. Questionnaires consisted of the System Usability Scale, the Technology Acceptance Model questionnaire, and the extended expectation confirmation model questionnaire. Results: Only the experienced usability of the devices was associated with intended continuous use. Forensic clients scored higher on acceptance and intention for continuous use than staff members. Moderate associations were found between usability with acceptance and continuous use. Staff members showed stronger associations between usability and acceptance (r=.80, P<.001) and usability and continuous use (r=.79, P<.001) than clients, who showed more moderate correlations between usability and acceptance (r=.46, P=.01) and usability and continuous use (r=.52, P=.003). The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions: Contrary to expectations, it was the actual perceived usability of wearing a biosensor that was associated with continuous use and to a much lesser extent the expectancy of usability. Clients scored higher on acceptance and intention for continuous use, but associations between usability and both acceptance and continuous use were markedly stronger in staff members. This study provides clear directions on how to further investigate these associations. For example, whether this is a true effect or due to a social desirability bias in the client group must be investigated. Clients with mild intellectual disabilities might benefit from the ease of use of these devices and their continuing monitoring and coaching apps. For these clients, it is especially important to develop easy-to-use biosensors with a minimum requirement on cognitive capacity to increase usability, acceptance, and continuous use. ", doi="10.2196/18096", url="https://formative.jmir.org/2021/5/e18096", url="http://www.ncbi.nlm.nih.gov/pubmed/33970115" } @Article{info:doi/10.2196/22826, author="Sch{\"a}ttin, Alexandra and H{\"a}fliger, Stephan and Meyer, Alain and Fr{\"u}h, Barbara and B{\"o}ckler, Sonja and Hungerb{\"u}hler, Yannic and de Bruin, D. Eling and Frese, Sebastian and Steinlin Egli, Regula and G{\"o}tz, Ulrich and Bauer, Ren{\'e} and Martin-Niedecken, Lisa Anna", title="Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies", journal="JMIR Serious Games", year="2021", month="May", day="7", volume="9", number="2", pages="e22826", keywords="multiple sclerosis", keywords="exergame", keywords="motor", keywords="physical", keywords="cognition", keywords="usability", keywords="feasibility", abstract="Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game--based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. Objective: The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. Methods: Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience--related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. Results: In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=?2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=?2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. Conclusions: The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS. ", doi="10.2196/22826", url="https://games.jmir.org/2021/2/e22826", url="http://www.ncbi.nlm.nih.gov/pubmed/33960956" } @Article{info:doi/10.2196/24014, author="Akbar, Fatema and Mark, Gloria and Prausnitz, Stephanie and Warton, Margaret E. and East, A. Jeffrey and Moeller, F. Mark and Reed, E. Mary and Lieu, A. Tracy", title="Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors", journal="JMIR Med Inform", year="2021", month="Apr", day="28", volume="9", number="4", pages="e24014", keywords="electronic health records", keywords="stress", keywords="wearables", keywords="HRV", keywords="inbox", keywords="EHR alerts", keywords="after-hours work", keywords="electronic mail", keywords="physician well-being", keywords="Inbasket", abstract="Background: Increased work through electronic health record (EHR) messaging is frequently cited as a factor of physician burnout. However, studies to date have relied on anecdotal or self-reported measures, which limit the ability to match EHR use patterns with continuous stress patterns throughout the day. Objective: The aim of this study is to collect EHR use and physiologic stress data through unobtrusive means that provide objective and continuous measures, cluster distinct patterns of EHR inbox work, identify physicians' daily physiologic stress patterns, and evaluate the association between EHR inbox work patterns and physician physiologic stress. Methods: Physicians were recruited from 5 medical centers. Participants (N=47) were given wrist-worn devices (Garmin Vivosmart 3) with heart rate sensors to wear for 7 days. The devices measured physiological stress throughout the day based on heart rate variability (HRV). Perceived stress was also measured with self-reports through experience sampling and a one-time survey. From the EHR system logs, the time attributed to different activities was quantified. By using a clustering algorithm, distinct inbox work patterns were identified and their associated stress measures were compared. The effects of EHR use on physician stress were examined using a generalized linear mixed effects model. Results: Physicians spent an average of 1.08 hours doing EHR inbox work out of an average total EHR time of 3.5 hours. Patient messages accounted for most of the inbox work time (mean 37\%, SD 11\%). A total of 3 patterns of inbox work emerged: inbox work mostly outside work hours, inbox work mostly during work hours, and inbox work extending after hours that were mostly contiguous to work hours. Across these 3 groups, physiologic stress patterns showed 3 periods in which stress increased: in the first hour of work, early in the afternoon, and in the evening. Physicians in group 1 had the longest average stress duration during work hours (80 out of 243 min of valid HRV data; P=.02), as measured by physiological sensors. Inbox work duration, the rate of EHR window switching (moving from one screen to another), the proportion of inbox work done outside of work hours, inbox work batching, and the day of the week were each independently associated with daily stress duration (marginal R2=15\%). Individual-level random effects were significant and explained most of the variation in stress (conditional R2=98\%). Conclusions: This study is among the first to demonstrate associations between electronic inbox work and physiological stress. We identified 3 potentially modifiable factors associated with stress: EHR window switching, inbox work duration, and inbox work outside work hours. Organizations seeking to reduce physician stress may consider system-based changes to reduce EHR window switching or inbox work duration or the incorporation of inbox management time into work hours. ", doi="10.2196/24014", url="https://medinform.jmir.org/2021/4/e24014", url="http://www.ncbi.nlm.nih.gov/pubmed/33908888" } @Article{info:doi/10.2196/18836, author="Joshi, Meera and Archer, Stephanie and Morbi, Abigail and Arora, Sonal and Kwasnicki, Richard and Ashrafian, Hutan and Khan, Sadia and Cooke, Graham and Darzi, Ara", title="Short-Term Wearable Sensors for In-Hospital Medical and Surgical Patients: Mixed Methods Analysis of Patient Perspectives", journal="JMIR Perioper Med", year="2021", month="Apr", day="22", volume="4", number="1", pages="e18836", keywords="patient feedback", keywords="patient evaluation", keywords="questionnaire", keywords="interview", keywords="qualitative", abstract="Background: Continuous vital sign monitoring using wearable sensors may enable early detection of patient deterioration and sepsis. Objective: This study aimed to explore patient experiences with wearable sensor technology and carry out continuous monitoring through questionnaire and interview studies in an acute hospital setting. Methods: Patients were recruited for a wearable sensor study and were asked to complete a 9-item questionnaire. Patients responses were evaluated using a Likert scale and with continuous variables. A subgroup of surgical patients wearing a Sensium Vital Sign Sensor was invited to participate in semistructured interviews. The Sensium wearable sensor measures the vital signs: heart rate, respiratory rate, and temperature. All interview data were subjected to thematic analysis. Results: Out of a total of 500 patients, 453 (90.6\%) completed the questionnaire. Furthermore, 427 (85.4\%) patients agreed that the wearable sensor was comfortable, 429 (85.8\%) patients agreed to wear the patch again when in hospital, and 398 (79.6\%) patients agreed to wear the patch at home. Overall, 12 surgical patients consented to the interviews. Five main themes of interest to patients emerged from the interviews: (1) centralized monitoring, (2) enhanced feelings of patient safety, (3) impact on nursing staff, (4) comfort and usability, and (5) future use and views on technology. Conclusions: Overall, the feedback from patients using wearable monitoring sensors was strongly positive with relatively few concerns raised. Patients felt that the wearable sensors would improve their sense of safety, relieve pressure on health care staff, and serve as a favorable aspect of future health care technology. ", doi="10.2196/18836", url="https://periop.jmir.org/2021/1/e18836", url="http://www.ncbi.nlm.nih.gov/pubmed/33885367" } @Article{info:doi/10.2196/25928, author="LaMonica, M. Haley and Roberts, E. Anna and Davenport, A. Tracey and Hickie, B. Ian", title="Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study", journal="JMIR Aging", year="2021", month="Apr", day="21", volume="4", number="2", pages="e25928", keywords="older adults", keywords="mental health", keywords="technology", keywords="community-based participatory research", keywords="stakeholder participation", keywords="smartphone", keywords="mobile phone", abstract="Background: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective: This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods: Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results: A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions: HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need. ", doi="10.2196/25928", url="https://aging.jmir.org/2021/2/e25928", url="http://www.ncbi.nlm.nih.gov/pubmed/33881410" } @Article{info:doi/10.2196/19564, author="Palotai, Miklos and Wallack, Max and Kujbus, Gergo and Dalnoki, Adam and Guttmann, Charles", title="Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="16", volume="9", number="4", pages="e19564", keywords="multiple sclerosis", keywords="fatigue", keywords="depression", keywords="mobile application", keywords="mobile phone", keywords="real-time assessment", abstract="Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88\%) used the app, of which 51 (91\%) completed all one-time questionnaires and 47 (84\%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. ", doi="10.2196/19564", url="https://mhealth.jmir.org/2021/4/e19564", url="http://www.ncbi.nlm.nih.gov/pubmed/33861208" } @Article{info:doi/10.2196/25657, author="Tremoulet, D. Patrice and Shah, D. Priyanka and Acosta, A. Alisha and Grant, W. Christian and Kurtz, T. Jon and Mounas, Peter and Kirchhoff, Michael and Wade, Elizabeth", title="Usability of Electronic Health Record--Generated Discharge Summaries: Heuristic Evaluation", journal="J Med Internet Res", year="2021", month="Apr", day="15", volume="23", number="4", pages="e25657", keywords="discharge summary", keywords="usability", keywords="electronic health record (EHR)", keywords="care coordination", keywords="elderly patients", keywords="patient safety", keywords="heuristic evaluation", keywords="human factors", abstract="Background: Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. Objective: This study aimed to (1) identify the information about elderly patients' recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)--generated discharge summaries, thereby increasing patient safety. Methods: A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. Results: The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 ``helpful, but not always necessary'' items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. Conclusions: Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition--related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization. ", doi="10.2196/25657", url="https://www.jmir.org/2021/4/e25657", url="http://www.ncbi.nlm.nih.gov/pubmed/33856353" } @Article{info:doi/10.2196/21270, author="Dauber-Decker, L. Katherine and Basile, Melissa and King, D'Arcy and Polo, Jennifer and Calise, Karina and Khan, Sundas and Solomon, Jeffrey and Dunne, Daniel and Hajizadeh, Negin", title="Developing a Decision Aid to Facilitate Informed Decision Making About Invasive Mechanical Ventilation and Lung Transplantation Among Adults With Cystic Fibrosis: Usability Testing", journal="JMIR Hum Factors", year="2021", month="Apr", day="14", volume="8", number="2", pages="e21270", keywords="usability", keywords="medical informatics", keywords="clinical decision support", keywords="cystic fibrosis", keywords="advance care planning", abstract="Background: Cystic fibrosis (CF) is a life-limiting genetic disease that causes chronic lung infections. We developed an internet-based decision aid (DA) to help patients with CF make better informed decisions regarding treatments and advance care planning. We built the DA around two major treatment decisions: whether to have a lung transplant and whether to agree to invasive mechanical ventilation (intubation). Objective: This study aims to conduct usability testing of the InformedChoices CF DA among key stakeholder groups. Methods: We performed a patient needs assessment using think-aloud usability testing with patients with CF, their surrogates, and CF clinicians. Think-aloud participants provided feedback while navigating the DA, and after viewing, they answered surveys. Transcripts from the think-aloud sessions and survey results were categorized into common, generalizable themes and optimizations for improving content, comprehension, and navigation. We assessed the ease of use of the DA (System Usability Scale) and also assessed the participants' perceptions regarding the overall tone, with an emphasis on emotional reactions to the DA content, level of detail, and usefulness of the information for making decisions about either intubation or lung transplantation, including how well they understood the information and were able to apply it to their own decision-making process. We also assessed the DA's ease of navigation, esthetics, and whether participants were able to complete a series of usability tasks (eg, locating specific information in the DA or using the interactive survival estimates calculator) to ensure that the website was easy to navigate during the clinic-based advance care planning discussions. Results: A total of 12 participants from 3 sites were enrolled from March 9 to August 30, 2018, for the usability testing: 5 CF clinicians (mean age 48.2, SD 12.0 years), 5 adults with CF, and 2 family and surrogate caregivers of people with CF (mean age of CF adults and family and surrogate caregivers 38.8, SD 10.8 years). Among the 12 participants, the average System Usability Scale score for the DA was 88.33 (excellent). Think-aloud analysis identified 3 themes: functionality, visibility and navigation, and content and usefulness. Areas for improvement included reducing repetition, enhancing comprehension, and changing the flow. Several changes to improve the content and usefulness of the DA were recommended, including adding information about alternatives to childbearing, such as adoption and surrogacy. On the basis of survey responses, we found that the navigation of the site was easy for clinicians, patients, and surrogates who participated in usability testing. Conclusions: Usability testing revealed areas of potential improvement. Testing also yielded positive feedback, suggesting the DA's future success. Integrating changes before implementation should improve the DA's comprehension, navigation, and usefulness and lead to greater adoption. ", doi="10.2196/21270", url="https://humanfactors.jmir.org/2021/2/e21270", url="http://www.ncbi.nlm.nih.gov/pubmed/33851921" } @Article{info:doi/10.2196/24998, author="Langlet, Sundstr{\"o}m Billy and Odegi, Dorothy and Zandian, Modjtaba and Nolstam, Jenny and S{\"o}dersten, Per and Bergh, Cecilia", title="Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study", journal="JMIR Serious Games", year="2021", month="Apr", day="13", volume="9", number="2", pages="e24998", keywords="feeding and eating disorders", keywords="anorexia nervosa", keywords="bulimia nervosa", keywords="binge eating disorder", keywords="immersive virtual reality", keywords="eating disorders", keywords="virtual reality", abstract="Background: Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50\%, a dropout rate from 20\% to 50\%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders. Objective: The aim of this study was to evaluate the feasibility and usability of an immersive virtual reality technology administered through an app for use by patients with eating disorders. Methods: Twenty-six participants, including 19 eating disorder clinic personnel and 5 information technology personnel, were recruited through emails and personal invitations. Participants handled virtual food and utensils on an app using immersive virtual reality technology comprising a headset and two hand controllers. In the app, the participants learned about the available actions through a tutorial and they were introduced to a food challenge. The challenge consisted of a meal type (meatballs, potatoes, sauce, and lingonberries) that is typically difficult for patients with anorexia nervosa to eat in real life. Participants were instructed, via visual feedback from the app, to eat at a healthy rate, which is also a challenge for patients. Participants rated the feasibility and usability of the app by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usability Scale, and the 20-point heuristic evaluation questionnaire. A cognitive walkthrough was performed using video recordings of participant interactions in the virtual environment. Results: The mean age of participants was 37.9 (SD 9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggested that implementation of the app would face minor infrastructural, technological, interoperability, financial, and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use; however, most of the participants agreed that the app should be used at least once per week. The app received a mean score of 73.4 (range 55-90), earning an overall ``good'' rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6 out of 5. The lowest score (2.6) was given to the ``accuracy'' item. During the cognitive walkthrough, 32\% of the participants displayed difficulty in understanding what to do at the initial selection screen. However, after passing the selection screen, all participants understood how to progress through the tasks. Conclusions: Participants found the app to be usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges in the current app, participants considered that the app requires improvement to offer environmental and social (eg, crowded room vs eating alone) challenges. ", doi="10.2196/24998", url="https://games.jmir.org/2021/2/e24998", url="http://www.ncbi.nlm.nih.gov/pubmed/33847593" } @Article{info:doi/10.2196/20461, author="Cerbas, Shannon and Kelemen, Arpad and Liang, Yulan and Sik-Lanyi, Cecilia and Van de Castle, Barbara", title="A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation", journal="JMIRx Med", year="2021", month="Apr", day="13", volume="2", number="2", pages="e20461", keywords="cancer", keywords="mobile app", keywords="gamification", keywords="bone marrow transplant", keywords="alpha testing", keywords="physical activity", abstract="Background: Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. Objective: The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. Methods: A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. Results: Internal consistency and the instrument's reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach $\alpha$=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). Conclusions: The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game's assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery. ", doi="10.2196/20461", url="https://xmed.jmir.org/2021/2/e20461", url="http://www.ncbi.nlm.nih.gov/pubmed/37725560" } @Article{info:doi/10.2196/24860, author="Zhang, Tianyi and Mosier, Jarrod and Subbian, Vignesh", title="Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery?", journal="JMIR Hum Factors", year="2021", month="Apr", day="9", volume="8", number="2", pages="e24860", keywords="telehealth", keywords="healthcare system", keywords="COVID-19", keywords="human factors", keywords="implementation", keywords="SEIPS", doi="10.2196/24860", url="https://humanfactors.jmir.org/2021/2/e24860", url="http://www.ncbi.nlm.nih.gov/pubmed/33779566" } @Article{info:doi/10.2196/21839, author="Kuhns, M. Lisa and Hereth, Jane and Garofalo, Robert and Hidalgo, Marco and Johnson, K. Amy and Schnall, Rebecca and Reisner, L. Sari and Belzer, Marvin and Mimiaga, J. Matthew", title="A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study", journal="J Med Internet Res", year="2021", month="Mar", day="31", volume="23", number="3", pages="e21839", keywords="transgender persons", keywords="HIV", keywords="mobile app", keywords="mHealth", keywords="mobile phone", abstract="Background: Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW. Objective: This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability. Methods: The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES). Results: YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88\%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80\%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants' suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text. Conclusions: We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW. ", doi="10.2196/21839", url="https://www.jmir.org/2021/3/e21839", url="http://www.ncbi.nlm.nih.gov/pubmed/33787503" } @Article{info:doi/10.2196/22099, author="Hwang, Youjin and Shin, Donghoon and Eun, Jinsu and Suh, Bongwon and Lee, Joonhwan", title="Design Guidelines of a Computer-Based Intervention for Computer Vision Syndrome: Focus Group Study and Real-World Deployment", journal="J Med Internet Res", year="2021", month="Mar", day="29", volume="23", number="3", pages="e22099", keywords="computer-based intervention", keywords="computer vision syndrome", keywords="system interface", keywords="deployment study", abstract="Background: Prolonged time of computer use increases the prevalence of ocular problems, including eye strain, tired eyes, irritation, redness, blurred vision, and double vision, which are collectively referred to as computer vision syndrome (CVS). Approximately 70\% of computer users have vision-related problems. For these reasons, properly designed interventions for users with CVS are required. To design an effective screen intervention for preventing or improving CVS, we must understand the effective interfaces of computer-based interventions. Objective: In this study, we aimed to explore the interface elements of computer-based interventions for CVS to set design guidelines based on the pros and cons of each interface element. Methods: We conducted an iterative user study to achieve our research objective. First, we conducted a workshop to evaluate the overall interface elements that were included in previous systems for CVS (n=7). Through the workshop, participants evaluated existing interface elements. Based on the evaluation results, we eliminated the elements that negatively affect intervention outcomes. Second, we designed our prototype system LiquidEye that includes multiple interface options (n=11). Interface options included interface elements that were positively evaluated in the workshop study. Lastly, we deployed LiquidEye in the real world to see how the included elements affected the intervention outcomes. Participants used LiquidEye for 14 days, and during this period, we collected participants' daily logs (n=680). Additionally, we conducted prestudy and poststudy surveys, and poststudy interviews to explore how each interface element affects participation in the system. Results: User data logs collected from the 14 days of deployment were analyzed with multiple regression analysis to explore the interface elements affecting user participation in the intervention (LiquidEye). Statistically significant elements were the instruction page of the eye resting strategy (P=.01), goal setting of the resting period (P=.009), compliment feedback after completing resting (P<.001), a mid-size popup window (P=.02), and CVS symptom-like effects (P=.004). Conclusions: Based on the study results, we suggested design implications to consider when designing computer-based interventions for CVS. The sophisticated design of the customization interface can make it possible for users to use the system more interactively, which can result in higher engagement in managing eye conditions. There are important technical challenges that still need to be addressed, but given the fact that this study was able to clarify the various factors related to computer-based interventions, the findings are expected to contribute greatly to the research of various computer-based intervention designs in the future. ", doi="10.2196/22099", url="https://www.jmir.org/2021/3/e22099", url="http://www.ncbi.nlm.nih.gov/pubmed/33779568" } @Article{info:doi/10.2196/20721, author="Calvano, David Joshua and Fundingsland Jr, Lauritz Edwin and Lai, Deborah and Silacci, Sara and Raja, S. Ali and He, Shuhan", title="Applying Website Rankings to Digital Health Centers in the United States to Assess Public Engagement: Website Usability Study", journal="JMIR Hum Factors", year="2021", month="Mar", day="29", volume="8", number="1", pages="e20721", keywords="website usability", keywords="digital health", keywords="health care website", keywords="usability testing", keywords="web interventions", keywords="digital health care", keywords="web crawler", abstract="Background: As the public increasingly uses the internet to search for resources and information regarding health and medicine, it is important that health care organizations provide adequate web resources. Website usability refers to the ease of user experience on a website. In this study, we conducted usability analyses on digital health center websites. Objective: The primary aims of this study were to (1) replicate a preexisting usability scoring methodology for digital health centers; (2) apply and test this replicated usability scoring methodology on a sample set of digital health center websites; and (3) derive recommendations from the results on potential areas of improvements for our sample of digital health center websites. Methods: Website usability testing was conducted from March 1, 2020, to March 15, 2020. We replicated a methodology and scoring system from previous literature and applied them to digital health center websites. Our sample included 67 digital health centers that were affiliated with US universities or hospital systems. Usability was split into the following four broad categories: accessibility, marketing, content quality, and technology. Usability tools were used to score websites in each of the four categories. The composite of the key factors of each category was used to generate a general usability and overall usability score for each website. Results: The category with the highest average score (6.3) was content quality. The content quality score also had the highest SD (2.18) and an SE of 0.27. The lowest performing category was technology, which had an average score of 0.9. The technology score also had the smallest SD (0.07) and an SE of 0.01. Conclusions: Our data suggest that content quality, on average, was the highest scoring variable among digital health center websites. As content is crucial to digital health knowledge, it is justified that digital health centers invest more resources into creating quality content. The overall lowest scoring variable was technology. Potential reasons for this finding include designated funding for servers, a lack of regulatory frameworks for social media presence and liability, and infrequent website audits. An easy approach for improving this variable is increasing website speed. Accessibility is another area that organizations can potentially improve. We recommend that these organizations perform periodic audits of their web presence with usability tools. ", doi="10.2196/20721", url="https://humanfactors.jmir.org/2021/1/e20721", url="http://www.ncbi.nlm.nih.gov/pubmed/33779564" } @Article{info:doi/10.2196/27882, author="Bente, Elise Britt and van 't Klooster, Roderick Jan Willem Jaap and Schreijer, Annemarie Maud and Berkemeier, Lea and van Gend, Elmar Joris and Slijkhuis, Hendrik Peter Jan and Kelders, Marion Saskia and van Gemert-Pijnen, Cornelia Julia Elisabeth Wilhelmina", title="The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study", journal="JMIR Form Res", year="2021", month="Mar", day="26", volume="5", number="3", pages="e27882", keywords="usability testing", keywords="user evaluation", keywords="user experience", keywords="contact tracing apps", keywords="CoronaMelder", keywords="COVID-19", keywords="pandemic", keywords="mobile apps", keywords="mHealth", keywords="public health", abstract="Background: Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective: The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods: Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results: Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions: The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app. ", doi="10.2196/27882", url="https://formative.jmir.org/2021/3/e27882", url="http://www.ncbi.nlm.nih.gov/pubmed/33724198" } @Article{info:doi/10.2196/23137, author="Rotondi, J. Armando and Grady, Jonathan and Hanusa, H. Barbara and Haas, L. Gretchen and Spring, R. Michael and Abebe, Z. Kaleab and Luther, James and Gurklis, John", title="Key Variables for Effective eHealth Designs for Individuals With and Without Mental Health Disorders: 2^12-4 Fractional Factorial Experiment", journal="J Med Internet Res", year="2021", month="Mar", day="24", volume="23", number="3", pages="e23137", keywords="schizophrenia", keywords="severe mental illness", keywords="eHealth", keywords="eHealth design", keywords="website", keywords="usability", keywords="website design", keywords="website usability", keywords="fractional factorial design", abstract="Background: eHealth applications not only offer the potential to increase service convenience and responsiveness but also expand the ability to tailor services to improve relevance, engagement, and use. To achieve these goals, it is critical that the designs are intuitive. Limited research exists on designs that work for those with a severe mental illness (SMI), many of whom have difficulty traveling for treatments, reject or infrequently seek treatment, and tend to discontinue treatments for significant periods. Objective: This study aims to evaluate the influence of 12 design variables (eg, navigational depth, reading level, and use of navigational lists) on the usability of eHealth application websites for those with and without SMI. Methods: A 212-4 fractional factorial experiment was used to specify the designs of 256 eHealth websites. This approach systematically varied the 12 design variables. The final destination contents of all websites were identical, and only the designs of the navigational pages varied. The 12 design elements were manipulated systematically to allow the assessment of combinations of design elements rather than only one element at a time. Of the 256 websites, participants (n=222) sought the same information on 8 randomly selected websites. Mixed effect regressions, which accounted for the dependency of the 8 observations within participants, were used to test for main effects and interactions on the ability and time to find information. Classification and regression tree analyses were used to identify effects among the 12 variables on participants' abilities to locate information, for the sample overall and each of the 3 diagnostic groups of participants (schizophrenia spectrum disorder [SSD], other mental illnesses, and no mental illness). Results: The best and worst designs were identified for each of these 4 groups. The depth of a website's navigation, that is, the number of screens users needed to navigate to find the desired content, had the greatest influence on usability (ability to find information) and efficiency (time to find information). The worst performing designs for those with SSD had a 9\% success rate, and the best had a 51\% success rate: the navigational designs made a 42\% difference in usability. For the group with other mental illnesses, the design made a 50\% difference, and for those with no mental illness, a 55\% difference was observed. The designs with the highest usability had several key design similarities, as did those with the poorest usability. Conclusions: It is possible to identify evidence-based strategies for designing eHealth applications that result in significantly better performance. These improvements in design benefit all users. For those with SSD or other SMIs, there are designs that are highly effective. Both the best and worst designs have key similarities but vary in some characteristics. ", doi="10.2196/23137", url="https://www.jmir.org/2021/3/e23137", url="http://www.ncbi.nlm.nih.gov/pubmed/33759796" } @Article{info:doi/10.2196/24062, author="Morse, S. Robert and Lambden, Kaley and Quinn, Erin and Ngoma, Twalib and Mushi, Beatrice and Ho, Xian Yun and Ngoma, Mamsau and Mahuna, Habiba and Sagan, B. Sarah and Mmari, Joshua and Miesfeldt, Susan", title="A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach", journal="JMIR Cancer", year="2021", month="Mar", day="23", volume="7", number="1", pages="e24062", keywords="mobile health", keywords="mHealth", keywords="user-centered design", keywords="palliative care", keywords="pain", keywords="cancer", keywords="sub-Saharan Africa", keywords="mobile phone", abstract="Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life--focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users---patients or caregivers, LHWs, and members of the palliative care team---and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. ", doi="10.2196/24062", url="https://cancer.jmir.org/2021/1/e24062", url="http://www.ncbi.nlm.nih.gov/pubmed/33755022" } @Article{info:doi/10.2196/21312, author="Bhattacharjya, Sutanuka and Cavuoto, Anne Lora and Reilly, Brandon and Xu, Wenyao and Subryan, Heamchand and Langan, Jeanne", title="Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study", journal="JMIR Hum Factors", year="2021", month="Mar", day="22", volume="8", number="1", pages="e21312", keywords="stroke", keywords="rehabilitation", keywords="smart technology", keywords="3-dimensional printing", keywords="usability", abstract="Background: Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. Objective: This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. Methods: A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants' qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. Results: Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. Conclusions: Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users' needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ", doi="10.2196/21312", url="https://humanfactors.jmir.org/2021/1/e21312", url="http://www.ncbi.nlm.nih.gov/pubmed/33749608" } @Article{info:doi/10.2196/19519, author="Richardson, Julie and Letts, Lori and Sinclair, Susanne and Chan, David and Miller, Jordan and Donnelly, Catherine and Smith-Turchyn, Jenna and Wojkowski, Sarah and Gravesande, Janelle and Loyola S{\'a}nchez, Adalberto", title="Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Mar", day="18", volume="8", number="1", pages="e19519", keywords="rehabilitation", keywords="physiotherapy", keywords="occupational therapy", keywords="self-management", keywords="function", keywords="web-based application", keywords="usability", keywords="user-centered design", abstract="Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ?45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. ", doi="10.2196/19519", url="https://rehab.jmir.org/2021/1/e19519", url="http://www.ncbi.nlm.nih.gov/pubmed/33734090" } @Article{info:doi/10.2196/24846, author="Chaniaud, No{\'e}mie and Megalakaki, Olga and Capo, Sophie and Loup-Escande, Emilie", title="Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study", journal="JMIR Hum Factors", year="2021", month="Mar", day="17", volume="8", number="1", pages="e24846", keywords="user characteristics", keywords="health literacy", keywords="home medical devices", keywords="usability study", keywords="remote health", keywords="home health", abstract="Background: The Smart Angel home medical device allows ambulatory surgery patients to monitor their own health by taking their blood pressure and oxygen levels and answering a health questionnaire from home. Currently, this device is a prototype in the design phase, and no usability evaluation has been performed. This preventive device must be usable by patients with different profiles; however, it is important to select patients carefully to ensure their safety when using the device. As such, it would be interesting to know how to select or exclude patients. However, the links between user characteristics and the usability of this home medical device remain unclear. Objective: This study aims to better understand the links between certain characteristics of potential patients (ie, age, education, technophilia, and health literacy) and the usability (ie, effectiveness, efficiency, and satisfaction) of Smart Angel, as defined by the ISO 9241-11. Methods: We conducted an experimental study involving 36 participants investigating the effects of 4 patient characteristics (ie, age, education, technophilia, and health literacy) on usability, measured in terms of effectiveness, efficiency, and satisfaction. A mixed methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). First, to help participants project themselves into the real use of the Smart Angel device, they watched a scenario in a video. Second, the participants completed a set of questionnaires to show the extent of their health literacy level (Newest Vital Sign [NVS] and the Health Literacy Survey [HLS]) and then operated Smart Angel devices. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (System Usability Scale [SUS]). The qualitative observational data were coded using inductive analysis by 2 independent researchers specialized in cognitive psychology and cognitive ergonomics. Results: The results show a moderate and positive correlation between age and effectiveness (r=0.359; P=.03) and efficiency (r=0.357; P=.03). There is strong correlation between health literacy scored by the NVS and effectiveness (r=0.417; P=.01), efficiency (r=-0.38; P=.02), and satisfaction (r=0.45; P=.006). However, there is a weak correlation between technophilia and usability and no relationship between education level and usability. Conclusions: Our results show that literacy level and age are 2 important factors to consider when selecting future users of the Smart Angel device to ensure patient safety. This study also serves as an example promoting mixed methodologies in assessments of medical device usability that cannot be performed under real-world conditions. ", doi="10.2196/24846", url="https://humanfactors.jmir.org/2021/1/e24846", url="http://www.ncbi.nlm.nih.gov/pubmed/33729161" } @Article{info:doi/10.2196/15032, author="Witteman, O. Holly and Vaisson, Gratianne and Provencher, Thierry and Chipenda Dansokho, Selma and Colquhoun, Heather and Dugas, Michele and Fagerlin, Angela and Giguere, MC Anik and Haslett, Lynne and Hoffman, Aubri and Ivers, M. Noah and L{\'e}gar{\'e}, France and Trottier, Marie-Eve and Stacey, Dawn and Volk, J. Robert and Renaud, Jean-S{\'e}bastien", title="An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation", journal="J Med Internet Res", year="2021", month="Mar", day="16", volume="23", number="3", pages="e15032", keywords="patient-centered care", keywords="patient participation", keywords="health services research", keywords="validation studies as topic", keywords="surveys and questionnaires", keywords="humans", keywords="user-centred design, human-centred design", keywords="user-centered design", keywords="human-centered design", keywords="co-design", keywords="instrument", keywords="scale", keywords="index", keywords="patient and public involvement", abstract="Background: Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. Objective: The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. Methods: We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. Results: We retained 11 items in a 3-factor structure explaining 68\% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. Conclusions: The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools. ", doi="10.2196/15032", url="https://www.jmir.org/2021/3/e15032", url="http://www.ncbi.nlm.nih.gov/pubmed/33724194" } @Article{info:doi/10.2196/25148, author="Otokiti, Umar Ahmed and Craven, K. Catherine and Shetreat-Klein, Avniel and Cohen, Stacey and Darrow, Bruce", title="Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System", journal="JMIR Res Protoc", year="2021", month="Mar", day="16", volume="10", number="3", pages="e25148", keywords="electronic health records", keywords="burnout, psychological", keywords="user-centered design", keywords="usability", keywords="EHR optimization", abstract="Background: Up to 60\% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective: This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods: Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results: The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6--month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions: The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID): PRR1-10.2196/25148 ", doi="10.2196/25148", url="https://www.researchprotocols.org/2021/3/e25148", url="http://www.ncbi.nlm.nih.gov/pubmed/33724202" } @Article{info:doi/10.2196/20890, author="Ratnanather, Tilak J. and Bhattacharya, Rohit and Heston, B. Margo and Song, Joanne and Fernandez, R. Lindsey and Lim, Seo Hong and Lee, Seung-Wook and Tam, Edric and Yoo, Sungho and Bae, Seung-Ho and Lam, Inez and Jeon, Won Hyoung and Chang, A. Son and Koo, Ja-Won", title="An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="15", volume="9", number="3", pages="e20890", keywords="speech therapy", keywords="mobile phone", keywords="computers, handheld", keywords="cochlear implants", keywords="hearing aids", abstract="Background: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. Objective: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users' progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. Methods: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. Results: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of ``good'' from 6 users, and the Korean app received a rating of ``OK'' from 16 users. Conclusions: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine. ", doi="10.2196/20890", url="https://mhealth.jmir.org/2021/3/e20890", url="http://www.ncbi.nlm.nih.gov/pubmed/33720025" } @Article{info:doi/10.2196/24122, author="Rizvi, Rubina and VanHouten, Courtney and Bright, J. Tiffani and McKillop, M. Mollie and Alevy, Shira and Brotman, David and Sands-Lincoln, Megan and Snowdon, Jane and Robinson, J. Barbie and Staats, Carolyn and Jackson, P. Gretchen and Kassler, J. William", title="The Perceived Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study", journal="J Med Internet Res", year="2021", month="Mar", day="12", volume="23", number="3", pages="e24122", keywords="vulnerable population", keywords="managed care", keywords="data integration", keywords="advanced technologies", keywords="usability", keywords="mixed methods study", abstract="Background: People with complex needs, such as those experiencing homelessness, require concurrent, seamless support from multiple social service agencies. Sonoma County, California has one of the nation's largest homeless populations among largely suburban communities. To support client-centered care, the county deployed a Care Management and Coordination System (CMCS). This system comprised the Watson Care Manager (WCM), a front-end system, and Connect 360, which is an integrated data hub that aggregates information from various systems into a single client record. Objective: The aim of this study is to evaluate the perceived impact and usability of WCM in delivering services to the homeless population in Sonoma County. Methods: A mixed methods study was conducted to identify ways in which WCM helps to coordinate care. Interviews, observations, and surveys were conducted, and transcripts and field notes were thematically analyzed and directed by a grounded theory approach. Responses to the Technology Acceptance Model survey were analyzed. Results: A total of 16 participants were interviewed, including WCM users (n=8) and department leadership members (n=8). In total, 3 interdisciplinary team meetings were observed, and 8 WCM users were surveyed. WCM provided a central shared platform where client-related, up-to-date, comprehensive, and reliable information from participating agencies was consolidated. Factors that facilitated WCM use were users' enthusiasm regarding the tool functionalities, scalability, and agency collaboration. Constraining factors included the suboptimal awareness of care delivery goals and functionality of the system among the community, sensitivities about data sharing and legal requirements, and constrained funding from government and nongovernment organizations. Overall, users found WCM to be a useful tool that was easy to use and helped to enhance performance. Conclusions: WCM supports the delivery of care to individuals with complex needs. Integration of data and information in a CMCS can facilitate coordinated care. Future research should examine WCM and similar CMCSs in diverse populations and settings. ", doi="10.2196/24122", url="https://www.jmir.org/2021/3/e24122", url="http://www.ncbi.nlm.nih.gov/pubmed/33709928" } @Article{info:doi/10.2196/24501, author="Lu{\vs}trek, Mitja and Bohanec, Marko and Cavero Barca, Carlos and Ciancarelli, Costanza Maria and Clays, Els and Dawodu, Adeyemo Amos and Derboven, Jan and De Smedt, Delphine and Dovgan, Erik and Lampe, Jure and Marino, Flavia and Mlakar, Miha and Pioggia, Giovanni and Puddu, Emilio Paolo and Rodr{\'i}guez, Mario Juan and Schiariti, Michele and Slapni{\v c}ar, Ga{\vs}per and Slegers, Karin and Tartarisco, Gennaro and Vali{\v c}, Jakob and Vodopija, Aljo{\vs}a", title="A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial", journal="JMIR Med Inform", year="2021", month="Mar", day="5", volume="9", number="3", pages="e24501", keywords="congestive heart failure", keywords="personal health system", keywords="mobile application", keywords="mobile phone", keywords="wearable electronic devices", keywords="decision support techniques", keywords="psychological support", keywords="human centered design", abstract="Background: Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated. Objective: The HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions. Methods: A mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psychological profile recognition. These methods feed a decision support system that provides recommendations on physical health and psychological support. The system was designed using a human-centered methodology involving the patients throughout development. It was evaluated in a proof-of-concept trial with 56 patients. Results: Fairly high accuracy of the patient-monitoring methods was observed. The mean absolute error of BP estimation was 9.0 mm Hg for systolic BP and 7.0 mm Hg for diastolic BP. The accuracy of psychological profile detection was 88.6\%. The F-measure for physical activity recognition was 71\%. The proof-of-concept clinical trial in 56 patients showed that the HeartMan system significantly improved self-care behavior (P=.02), whereas depression and anxiety rates were significantly reduced (P<.001), as were perceived sexual problems (P=.01). According to the Unified Theory of Acceptance and Use of Technology questionnaire, a positive attitude toward HeartMan was seen among end users, resulting in increased awareness, self-monitoring, and empowerment. Conclusions: The HeartMan project combined a range of advanced technologies with human-centered design to develop a complex system that was shown to help patients with CHF. More psychological than physical benefits were observed. Trial Registration: ClinicalTrials.gov NCT03497871; https://clinicaltrials.gov/ct2/history/NCT03497871. International Registered Report Identifier (IRRID): RR2-10.1186/s12872-018-0921-2 ", doi="10.2196/24501", url="https://medinform.jmir.org/2021/3/e24501", url="http://www.ncbi.nlm.nih.gov/pubmed/33666562" } @Article{info:doi/10.2196/26702, author="Hill, R. Jordan and Harrington, B. Addison and Adeoye, Philip and Campbell, L. Noll and Holden, J. Richard", title="Going Remote---Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="4", volume="9", number="3", pages="e26702", keywords="COVID-19", keywords="mobile usability testing", keywords="usability inspection", keywords="methods", keywords="aging", keywords="agile", keywords="mobile phone", abstract="Background: The COVID-19 pandemic necessitated ``going remote'' with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective: Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods: We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention---a medication management app---and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results: In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40\% to 50\% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions: The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them. Trial Registration: ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858 ", doi="10.2196/26702", url="https://mhealth.jmir.org/2021/3/e26702", url="http://www.ncbi.nlm.nih.gov/pubmed/33606655" } @Article{info:doi/10.2196/18607, author="Chung, Kyungmi and Cho, Young Hee and Park, Young Jin", title="A Chatbot for Perinatal Women's and Partners' Obstetric and Mental Health Care: Development and Usability Evaluation Study", journal="JMIR Med Inform", year="2021", month="Mar", day="3", volume="9", number="3", pages="e18607", keywords="chatbot", keywords="mobile phone", keywords="instant messaging", keywords="mobile health", keywords="perinatal care", keywords="usability", keywords="user experience", keywords="usability testing", abstract="Background: To motivate people to adopt medical chatbots, the establishment of a specialized medical knowledge database that fits their personal interests is of great importance in developing a chatbot for perinatal care, particularly with the help of health professionals. Objective: The objectives of this study are to develop and evaluate a user-friendly question-and-answer (Q\&A) knowledge database--based chatbot (Dr. Joy) for perinatal women's and their partners' obstetric and mental health care by applying a text-mining technique and implementing contextual usability testing (UT), respectively, thus determining whether this medical chatbot built on mobile instant messenger (KakaoTalk) can provide its male and female users with good user experience. Methods: Two men aged 38 and 40 years and 13 women aged 27 to 43 years in pregnancy preparation or different pregnancy stages were enrolled. All participants completed the 7-day-long UT, during which they were given the daily tasks of asking Dr. Joy at least 3 questions at any time and place and then giving the chatbot either positive or negative feedback with emoji, using at least one feature of the chatbot, and finally, sending a facilitator all screenshots for the history of the day's use via KakaoTalk before midnight. One day after the UT completion, all participants were asked to fill out a questionnaire on the evaluation of usability, perceived benefits and risks, intention to seek and share health information on the chatbot, and strengths and weaknesses of its use, as well as demographic characteristics. Results: Despite the relatively higher score of ease of learning (EOL), the results of the Spearman correlation indicated that EOL was not significantly associated with usefulness ($\rho$=0.26; P=.36), ease of use ($\rho$=0.19; P=.51), satisfaction ($\rho$=0.21; P=.46), or total usability scores ($\rho$=0.32; P=.24). Unlike EOL, all 3 subfactors and the total usability had significant positive associations with each other (all $\rho$>0.80; P<.001). Furthermore, perceived risks exhibited no significant negative associations with perceived benefits ($\rho$=?0.29; P=.30) or intention to seek (SEE; $\rho$=?0.28; P=.32) or share (SHA; $\rho$=?0.24; P=.40) health information on the chatbot via KakaoTalk, whereas perceived benefits exhibited significant positive associations with both SEE and SHA. Perceived benefits were more strongly associated with SEE ($\rho$=0.94; P<.001) than with SHA ($\rho$=0.70; P=.004). Conclusions: This study provides the potential for the uptake of this newly developed Q\&A knowledge database--based KakaoTalk chatbot for obstetric and mental health care. As Dr. Joy had quality contents with both utilitarian and hedonic value, its male and female users could be encouraged to use medical chatbots in a convenient, easy-to-use, and enjoyable manner. To boost their continued usage intention for Dr. Joy, its Q\&A sets need to be periodically updated to satisfy user intent by monitoring both male and female user utterances. ", doi="10.2196/18607", url="https://medinform.jmir.org/2021/3/e18607", url="http://www.ncbi.nlm.nih.gov/pubmed/33656442" } @Article{info:doi/10.2196/15846, author="Dekkers, Tessa and Melles, Marijke and Vehmeijer, W. Stephan B. and de Ridder, Huib", title="Effects of Information Architecture on the Effectiveness and User Experience of Web-Based Patient Education in Middle-Aged and Older Adults: Online Randomized Experiment", journal="J Med Internet Res", year="2021", month="Mar", day="3", volume="23", number="3", pages="e15846", keywords="user-computer interface", keywords="total joint replacement", keywords="user-centered design", keywords="health education", keywords="mobile phone", keywords="computer-assisted instruction", keywords="patient education as topic", keywords="models, theoretical", keywords="middle aged", keywords="aged", keywords="humans", keywords="internet", abstract="Background: Web-based patient education is increasingly offered to improve patients' ability to learn, remember, and apply health information. Efficient organization, display, and structural design, that is, information architecture (IA), can support patients' ability to independently use web-based patient education. However, the role of IA in the context of web-based patient education has not been examined systematically. Objective: To support intervention designers in making informed choices that enhance patients' learning, this paper describes a randomized experiment on the effects of IA on the effectiveness, use, and user experience of a patient education website and examines the theoretical mechanisms that explain these effects. Methods: Middle-aged and older adults with self-reported hip or knee joint complaints were recruited to use and evaluate 1 of 3 patient education websites containing information on total joint replacement surgery. Each website contained the same textual content based on an existing leaflet but differed in the employed IA design (tunnel, hierarchical, or matrix design). Participants rated the websites on satisfaction, engagement, control, relevance, trust, and novelty and completed an objective knowledge test. Analyses of variance and structural equation modeling were used to examine the effects of IA and construct a theoretical model. Results: We included 215 participants in our analysis. IA did not affect knowledge gain (P=.36) or overall satisfaction (P=.07) directly. However, tunnel (mean 3.22, SD 0.67) and matrix (mean 3.17, SD 0.69) architectures were found to provide more emotional support compared with hierarchical architectures (mean 2.86, SD 0.60; P=.002). Furthermore, increased perceptions of personal relevance in the tunnel IA ($\beta$=.18) were found to improve satisfaction ($\beta$=.17) indirectly. Increased perceptions of active control in the matrix IA ($\beta$=.11) also improved satisfaction ($\beta$=.27) indirectly. The final model of the IA effects explained 74.3\% of the variance in satisfaction and 6.8\% of the variance in knowledge and achieved excellent fit ($\chi$217,215=14.7; P=.62; root mean square error of approximation=0.000; 95\% CI [0.000-0.053]; comparative fit index=1.00; standardized root mean square residual=0.044). Conclusions: IA has small but notable effects on users' experiences with web-based health education interventions. Web-based patient education designers can employ tunnel IA designs to guide users through sequentially ordered content or matrix IA to offer users more control over navigation. Both improve user satisfaction by increasing user perceptions of relevance (tunnel) and active control (matrix). Although additional research is needed, hierarchical IA designs are currently not recommended, as hierarchical content is perceived as less supportive, engaging, and relevant, which may diminish the use and, in turn, the effect of the educational intervention. ", doi="10.2196/15846", url="https://www.jmir.org/2021/3/e15846", url="http://www.ncbi.nlm.nih.gov/pubmed/33656446" } @Article{info:doi/10.2196/18164, author="Abrantes, Diogo and Teles, Soraia and Tavares de Sousa, Rita and Freitas, Alberto and Vieira-Marques, Pedro and Ferreira, Ana", title="A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study", journal="JMIR Aging", year="2021", month="Mar", day="1", volume="4", number="1", pages="e18164", keywords="aging", keywords="ambient assisted living", keywords="elderly", keywords="usability testing", keywords="user-centered design", abstract="Background: Aging of the global population is slowly paving the way for new markets for care products and services. The desire of older people to maintain their independence while remaining at home is boosting the development of ambient assisted living (AAL) solutions. Lack of user awareness of AAL solutions paired with an insufficient use of user-centered and participatory design approaches in the development of these products has hindered the uptake of these solutions by end users. Objective: This study aims to describe the usability and users' experiences within a novel platform, ActiveAdvice, aimed at offering advice and a holistic market overview of AAL products and services. Methods: Usability tests were performed on the developed platform among identified prospective end users, with 32 older adults and informal carers from 4 European countries being part of the user tests. The usability and appeal of the web interface design, information flow, and information architecture were analyzed by collecting both objective and subjective measures. These would include pretest and posttest surveys, along with a series of think-aloud tasks to be performed within the platform. Results: The outcomes suggest that the ActiveAdvice platform's objectives and functionalities are mostly aligned with the needs and expectations of end users, who demonstrated interest in using it, stressing its purpose along with its simple and intuitive interaction. Task completion rates were high, and participants had good satisfaction rates when navigating the platform. However, the tests still advocate for an improved design at some points and better disclosure of information. Conclusions: Our findings shed light on a few peculiarities of interface design, information architecture, user needs, and preferred functionalities, which should be applied to future developments of similar platforms with related services. The AAL field could benefit from tools supporting the dissemination of available AAL solutions and how they can improve one's quality of life. These tools may benefit not only older adults but also caregivers, business owners, and governmental employees. ", doi="10.2196/18164", url="https://aging.jmir.org/2021/1/e18164", url="http://www.ncbi.nlm.nih.gov/pubmed/33646134" } @Article{info:doi/10.2196/21986, author="Kapoor, Alok and Andrade, Andreza and Hayes, Anna and Mazor, Kathleen and Possidente, Carl and Nolen, Kim and Hegeman-Dingle, Rozelle and McManus, David", title="Usability, Perceived Usefulness, and Shared Decision-Making Features of the AFib 2gether Mobile App: Protocol for a Single-Arm Intervention Study", journal="JMIR Res Protoc", year="2021", month="Feb", day="24", volume="10", number="2", pages="e21986", keywords="shared decision making", keywords="mobile health", keywords="stroke risk", keywords="anticoagulation risk", keywords="anticoagulation education", keywords="atrial fibrillation", keywords="anticoagulation therapy", keywords="anticoagulation", keywords="atrial flutter", keywords="mobile phone", abstract="Background: The Centers for Disease Control and Prevention has estimated that atrial fibrillation (AF) affects between 2.7 million and 6.1 million people in the United States. Those who have AF tend to have a much higher stroke risk than others. Although most individuals with AF benefit from anticoagulation (AC) therapy, a significant majority are hesitant to start it. To add, providers often struggle in helping patients negotiate the decision to start AC therapy. To assist in the communication between patients and providers regarding preferences and knowledge about AC therapy, different strategies are being used to try and solve this problem. In this research study, we will have patients and providers utilize the AFib 2gether app with hopes that it will create a platform for shared decision making regarding the prevention of stroke in patients with AF receiving AC therapy. Objective: The aim of our study is to measure several outcomes related to encounters between patients and their cardiology providers where AFib 2gether is used. These outcomes include usability and perceived usefulness of the app from the perspective of patients and providers. In addition, we will assess the extent and nature of shared decision making. Methods: Eligible patients and providers will evaluate the AFib 2gether mobile app for usability and perceived usefulness in facilitating shared decision making regarding understanding the patient's risk of stroke and whether or not to start AC therapy. Both patients and providers will review the app and complete multiple questionnaires about the usability and perceived usefulness of the mobile app in a clinical setting. We will also audio-record a subset of encounters to assess for evidence of shared decision making. Results: Enrollment in the AFib 2gether shared decision-making study is still ongoing for both patients and providers. The first participant enrolled on November 22, 2019. Analysis and publishing of results are expected to be completed in spring 2021. Conclusions: The AFib 2gether app emerged from a desire to increase the ability of patients and providers to engage in shared decision making around understanding the risk of stroke and AC therapy. We anticipate that the AFib 2gether mobile app will facilitate patient discussion with their cardiologist and other providers. Additionally, we hope the study will help us identify barriers that providers face when placing patients on AC therapy. We aim to demonstrate the usability and perceived usefulness of the app with a future goal of testing the value of our approach in a larger sample of patients and providers at multiple medical centers across the country. Trial Registration: ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID): DERR1-10.2196/21986 ", doi="10.2196/21986", url="https://www.researchprotocols.org/2021/2/e21986", url="http://www.ncbi.nlm.nih.gov/pubmed/33625361" } @Article{info:doi/10.2196/24561, author="Waselewski, Elise Marika and Flickinger, Elisabeth Tabor and Canan, Chelsea and Harrington, William and Franklin, Taylor and Otero, Nicole Kori and Huynh, Jacqueline and Waldman, Davila Ava Lena and Hilgart, Michelle and Ingersoll, Karen and Ait-Daoud Tiouririne, Nassima and Dillingham, Anne Rebecca", title="A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study", journal="JMIR Form Res", year="2021", month="Feb", day="23", volume="5", number="2", pages="e24561", keywords="opioid use disorder", keywords="mHealth", keywords="retention in care", keywords="self-management", keywords="opioids", keywords="public health", keywords="mobile phone", abstract="Background: Opioid use disorder (OUD) is a public health crisis with more than 2 million people living with OUD in the United States. Medication-assisted treatment (MAT) is an evidence-based approach for the treatment of OUD that relies on a combination of behavioral therapy and medication. Less than half of those living with OUD are accessing this treatment. Mobile technology can enhance the treatment of chronic diseases in readily accessible and cost-effective ways through self-monitoring and support. Objective: The aim of this study is to describe the adaptation of a mobile platform for patients undergoing treatment for OUD and preliminary pilot testing results. Methods: Our study was conducted with patient and provider participants at the University of Virginia MAT clinic and was approved by the institutional review board. The formative phase included semistructured interviews to understand the needs of patients with OUD, providers' perspectives, and opportunities for MAT support via a mobile app. A second round of formative interviews used mock-ups of app features to collect feedback on feature function and desirability. Formative participants' input from 16 interviews then informed the development of a functional smartphone app. Patient participants (n=25) and provider participants (n=3) were enrolled in a 6-month pilot study of the completed platform. Patient app use and usability interviews, including a system usability score and open-ended questions, were completed 1 month into the pilot study. Open-ended responses were analyzed for prevalent themes. Results: Formative interviews resulted in the development of a mobile app, named HOPE, which includes both evidence-based and participant-suggested features. The features included daily prompts for monitoring mood, stress, treatment adherence, and substance use; patient tracking of goals, reminders, and triggering or encouraging experiences; informational resources; an anonymous community board to share support with other patients; and secure messaging for communication between patients and providers. All patient participants engaged with at least one app feature during their first month of pilot study participation, and the daily self-monitoring prompts were the most used. Patients and providers reported high levels of system usability (mean 86.9, SD 10.2 and mean 83.3, SD 12.8, respectively). Qualitative analysis of open-ended usability questions highlighted the value of self-monitoring, access to support through the app, and perceived improvement in connection to care and communication for both patient and provider participants. Conclusions: The use of the HOPE program by pilot participants, high usability scoring, and positive perceptions from 1-month interviews indicate successful program development. By engaging with end users and eliciting feedback throughout the development process, we were able to create an app and a web portal that was highly usable and acceptable to study participants. Further work is needed to understand the program's effect on clinical outcomes, patient linkage, and engagement in care. ", doi="10.2196/24561", url="https://formative.jmir.org/2021/2/e24561", url="http://www.ncbi.nlm.nih.gov/pubmed/33620324" } @Article{info:doi/10.2196/14760, author="Jung, Hyunggu and Demiris, George and Tarczy-Hornoch, Peter and Zachry, Mark", title="A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Feb", day="17", volume="5", number="2", pages="e14760", keywords="mobile health", keywords="older adults", keywords="diabetes", keywords="dietary assessment", keywords="smartphone app", keywords="usability test", abstract="Background: More than 1 in 4 people in the United States aged 65 years and older have type 2 diabetes. For diabetes care, medical nutrition therapy is recommended as a clinically effective intervention. Previous researchers have developed and validated dietary assessment methods using images of food items to improve the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. Objective: The aims of this study were (1) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and (2) to evaluate the usability of FRADA for older adults with diabetes. Methods: For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on the design principles. For the usability assessment of FRADA, older adults aged 65 to 80 years (11 females and 3 males) were assigned to interact with FRADA in a lab-based setting. Participants' opinions of FRADA and its usability were determined by a follow-up survey and interview. As an evaluation indicator of usability, the responses to the survey, including an after-scenario questionnaire, were analyzed. Qualitative data from the interviews confirmed the responses to the survey. Results: We developed a smartphone app that enables older adults with diabetes to capture, view, and transmit images of food items they consumed. The findings of this study showed that FRADA and its instructions for capturing, viewing, and transmitting images of food items were usable for older adults with diabetes. The survey showed that participants found FRADA easy to use and would consider using FRADA daily. The analysis of the qualitative data from interviews revealed multiple categories, such as the usability of FRADA, potential benefits of using FRADA, potential features to be added to FRADA, and concerns of older adults with diabetes regarding interactions with FRADA. Conclusions: This study demonstrates in a lab-based setting not only the usability of FRADA by older adults with diabetes but also potential opportunities using FRADA in real-world settings. The findings suggest implications for creating a smartphone app for an image-assisted dietary assessment. Future work still remains to evaluate the feasibility and validity of FRADA with multiple stakeholders, including older adults with diabetes and dietitians. ", doi="10.2196/14760", url="http://formative.jmir.org/2021/2/e14760/", url="http://www.ncbi.nlm.nih.gov/pubmed/33493129" } @Article{info:doi/10.2196/18815, author="Bierbooms, A. Joyce J. P. and Sluis-Thiescheffer, W. Wouter R. J. and Feijt, A. Milou and IJsselsteijn, A. Wijnand and Bongers, B. Inge M.", title="Design of a Game-Based Training Environment to Enhance Health Care Professionals' E--Mental Health Skills: Protocol for a User Requirements Analysis", journal="JMIR Res Protoc", year="2021", month="Feb", day="17", volume="10", number="2", pages="e18815", keywords="mental health", keywords="skill development", keywords="eHealth", keywords="games", keywords="user-centered design", abstract="Background: E--mental health (EMH) offers various possibilities for mental health care delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental health care professionals remains to be low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has been shown to be effective in other areas but has not yet been applied to the development of EMH skills of mental health care professionals. Objective: The aim of this paper is to describe a study protocol for the user requirements analysis for the design of a game-based training environment for mental health care professionals to enhance their skills in EMH. Methods: The user requirements are formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). We collected the data using a questionnaire, co-design sessions, and interviews. The questionnaire was used to determine mental health care professionals' characteristics, attitudes, and skill levels regarding EMH and was distributed among mental health care professionals in the Netherlands. This led to a number of recognizable subuser groups as the basis for personas. Co-design sessions with mental health care professionals resulted in further specification of the personas and an identification of different user scenarios for the game-based training environment. Interviews with mental health care professionals helped to determine the preferences of mental health care professionals regarding training in EMH and the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirement elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) and an in-depth understanding of specific design requirements (through interviews and co-design). Results: The questionnaire was filled by 432 respondents; three co-design sessions with mental health care professionals and 17 interviews were conducted. The data have been analyzed, and a full paper on the results is expected to be submitted in the first half of 2021. Conclusions: To develop an environment that can effectively support professionals' EMH skill development, it is important to offer training possibilities that address the specific needs of mental health care professionals. The approach described in this protocol incorporates elements that enable the design of a playful training environment that is user driven and flexible and considers the technical and organizational prerequisites that influence its implementation in practice. It describes a protocol that is replicable and provides a methodology for user requirements analyses in other projects and health care areas. International Registered Report Identifier (IRRID): RR1-10.2196/18815 ", doi="10.2196/18815", url="http://www.researchprotocols.org/2021/2/e18815/", url="http://www.ncbi.nlm.nih.gov/pubmed/33595453" } @Article{info:doi/10.2196/23921, author="Furlong, Lisa and Serry, Tanya and Erickson, Shane and Morris, E. Meg", title="Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability", journal="JMIR Res Protoc", year="2021", month="Feb", day="11", volume="10", number="2", pages="e23921", keywords="app", keywords="appraisal", keywords="characteristics", keywords="COVID-19", keywords="health management", keywords="mHealth", keywords="mobile apps", keywords="phonics", keywords="phonological awareness", keywords="quality", keywords="reading", keywords="usability", abstract="Background: The use of mobile apps to manage and promote health is becoming increasingly popular. Mobile apps are gaining popularity particularly in educational and interventional settings owing to their perceived advantages including support for and engagement of individuals with reading difficulties. In the context of COVID-19, the need for technology-based tools has increased. For practitioners and educators who wish to use apps in their practice or recommend apps to individuals with reading difficulties, it is challenging to identify high-quality apps in app stores. Objective: This protocol describes a systematic search, selection, and appraisal process for tablet apps targeting phonics knowledge and phonological awareness skills. This protocol aimed to (1) provide a systematic method for identifying tablet apps targeting phonics knowledge and phonological awareness skills in the Google Play Store and Apple's App Store and (2) describe an evidence-based approach for quality appraisal of these apps by using structured tools. Methods: This protocol describes an evidence-based method guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to systematically search, select, and appraise apps targeting phonics knowledge and phonological awareness skills, present in Google Play and the App Store. We intend to perform a systematic and comprehensive search and a 2-step process for screening: (1) broad screening (app titles) and (2) narrow screening (marketing descriptions). Quality appraisal of the included apps will involve two structured appraisal tools: (1) the Mobile Application Rating Scale and (2) the Appraising Apps for Reading Checklist. Results: This method will help determine the number of apps targeting phonics knowledge and phonological awareness, present on the Android and iOS platforms. The content, quality, and usability of these apps will be determined using structured appraisal tools. We have planned to conduct searches on Google Play and the App Store in January-March 2021; broad and focused screening, from April 2021; and data extraction and quality appraisal in October 2021. Conclusions: This protocol provides a basis for locating and evaluating apps targeting phonics knowledge and phonological awareness skills. This protocol will support practitioners, educators, and families to make informed decisions when purchasing apps for instructional use. International Registered Report Identifier (IRRID): PRR1-10.2196/23921 ", doi="10.2196/23921", url="http://www.researchprotocols.org/2021/2/e23921/", url="http://www.ncbi.nlm.nih.gov/pubmed/33523827" } @Article{info:doi/10.2196/22164, author="Bhalodiya, Maganbhai Jayendra and Palit, Arnab and Giblin, Gerard and Tiwari, Kumar Manoj and Prasad, K. Sanjay and Bhudia, K. Sunil and Arvanitis, N. Theodoros and Williams, A. Mark", title="Identifying Myocardial Infarction Using Hierarchical Template Matching--Based Myocardial Strain: Algorithm Development and Usability Study", journal="JMIR Med Inform", year="2021", month="Feb", day="10", volume="9", number="2", pages="e22164", keywords="left ventricle", keywords="myocardial infarction", keywords="myocardium", keywords="strain", abstract="Background: Myocardial infarction (MI; location and extent of infarction) can be determined by late enhancement cardiac magnetic resonance (CMR) imaging, which requires the injection of a potentially harmful gadolinium-based contrast agent (GBCA). Alternatively, emerging research in the area of myocardial strain has shown potential to identify MI using strain values. Objective: This study aims to identify the location of MI by developing an applied algorithmic method of circumferential strain (CS) values, which are derived through a novel hierarchical template matching (HTM) method. Methods: HTM-based CS H-spread from end-diastole to end-systole was used to develop an applied method. Grid-tagging magnetic resonance imaging was used to calculate strain values in the left ventricular (LV) myocardium, followed by the 16-segment American Heart Association model. The data set was used with k-fold cross-validation to estimate the percentage reduction of H-spread among infarcted and noninfarcted LV segments. A total of 43 participants (38 MI and 5 healthy) who underwent CMR imaging were retrospectively selected. Infarcted segments detected by using this method were validated by comparison with late enhancement CMR, and the diagnostic performance of the applied algorithmic method was evaluated with a receiver operating characteristic curve test. Results: The H-spread of the CS was reduced in infarcted segments compared with noninfarcted segments of the LV. The reductions were 30\% in basal segments, 30\% in midventricular segments, and 20\% in apical LV segments. The diagnostic accuracy of detection, using the reported method, was represented by area under the curve values, which were 0.85, 0.82, and 0.87 for basal, midventricular, and apical slices, respectively, demonstrating good agreement with the late-gadolinium enhancement--based detections. Conclusions: The proposed applied algorithmic method has the potential to accurately identify the location of infarcted LV segments without the administration of late-gadolinium enhancement. Such an approach adds the potential to safely identify MI, potentially reduce patient scanning time, and extend the utility of CMR in patients who are contraindicated for the use of GBCA. ", doi="10.2196/22164", url="https://medinform.jmir.org/2021/2/e22164", url="http://www.ncbi.nlm.nih.gov/pubmed/33565992" } @Article{info:doi/10.2196/21737, author="Hemmings, R. Nicola and Kawadler, M. Jamie and Whatmough, Rachel and Ponzo, Sonia and Rossi, Alessio and Morelli, Davide and Bird, Geoffrey and Plans, David", title="Development and Feasibility of a Digital Acceptance and Commitment Therapy--Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study", journal="JMIR Form Res", year="2021", month="Feb", day="9", volume="5", number="2", pages="e21737", keywords="anxiety", keywords="depression", keywords="acceptance and commitment therapy", keywords="person-based approach", keywords="mHealth", keywords="mental health", keywords="digital", keywords="remote", keywords="smartphone", keywords="mobile phone", abstract="Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77\%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for?AAQ-II and?WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. ", doi="10.2196/21737", url="https://formative.jmir.org/2021/2/e21737", url="http://www.ncbi.nlm.nih.gov/pubmed/33560232" } @Article{info:doi/10.2196/21884, author="Ndabu, Theophile and Mulgund, Pavankumar and Sharman, Raj and Singh, Ranjit", title="Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study", journal="JMIR Hum Factors", year="2021", month="Feb", day="5", volume="8", number="1", pages="e21884", keywords="patient safety", keywords="medical errors", keywords="health information technology", keywords="sociotechnical framework", keywords="patient harm", abstract="Background: Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization. Objective: This pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors. Methods: Medical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework. Results: Of the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the ``gulf'' that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error ``Copied and pasted charting in the wrong window: Before, you could not easily get into someone else's chart accidentally...because you would have to pull the chart and open it,'' medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error. Conclusions: Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety. ", doi="10.2196/21884", url="http://humanfactors.jmir.org/2021/1/e21884/", url="http://www.ncbi.nlm.nih.gov/pubmed/33544089" } @Article{info:doi/10.2196/18396, author="Weaver, E. Kathryn and Klepin, D. Heidi and Wells, J. Brian and Dressler, V. Emily and Winkfield, M. Karen and Lamar, S. Zanetta and Avery, P. Tiffany and Pajewski, M. Nicholas and Hundley, Gregory W. and Johnson, Aimee and Davidson, C. Eleanor and Lopetegui, Marcelo and Foraker, E. Randi", title="Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study", journal="JMIR Cancer", year="2021", month="Jan", day="21", volume="7", number="1", pages="e18396", keywords="electronic health records", keywords="clinical decision support", keywords="usability testing", keywords="cardiovascular diseases", keywords="cancer survivors", keywords="breast cancer", abstract="Background: Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors' attainment or maintenance of cardiovascular health. Objective: We sought to evaluate survivors' awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers. Methods: Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability. Results: Enrolled breast cancer survivors (84\% White race, 4\% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92\%). Prior to viewing the tool, 65\% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45\% (range 0\%-86\%) of survivors' known cardiovascular health factors were at an ideal level. More than 50\% of survivors had ideal smoking status (45/48, 94\%) or blood glucose level (29/45, 64\%); meanwhile, less than 50\% had ideal blood pressure (12/49, 24\%), body mass index (12/49, 24\%), cholesterol level (17/35, 49\%), diet (7/49, 14\%), and physical activity (10/49. 20\%). More than 90\% of survivors thought the tool was easy to understand (46/47, 98\%), improved their understanding (43/47, 91\%), and was helpful (45/47, 96\%); overall, 94\% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94\%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60\%) oncology providers (female: 12/20, 60\%; physicians: 14/20, 70\%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90\%), would help their effectiveness (18/20, 90\%), was easy to use (20/20, 100\%), and presented information in a useful format (19/20, 95\%); and 85\% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care. Conclusions: These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record--enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes. ", doi="10.2196/18396", url="http://cancer.jmir.org/2021/1/e18396/", url="http://www.ncbi.nlm.nih.gov/pubmed/33475511" } @Article{info:doi/10.2196/19151, author="Yeong, Lee Jian and Thomas, Peter and Buller, James and Moosajee, Mariya", title="A Newly Developed Web-Based Resource on Genetic Eye Disorders for Users With Visual Impairment (Gene.Vision): Usability Study", journal="J Med Internet Res", year="2021", month="Jan", day="20", volume="23", number="1", pages="e19151", keywords="internet access", keywords="blindness", keywords="eye disease", keywords="genetic diseases", keywords="usability testing", keywords="qualitative research", keywords="internet-based intervention", keywords="consumer health information", keywords="mobile phone", abstract="Background: Despite the introduction of the Web Content Accessibility Guidelines and legislations, many websites remain poorly accessible to users with disability, especially those with visual impairment, as the internet has become a more visually complex environment. With increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, it is important that they are not overlooked when developing web-based materials. A significant proportion of those affected have irreversible vision loss due to rare genetic eye disorders, and many of them use the internet as a primary source of information for their conditions. However, access to high-quality web-based health information with an inclusive design remains a challenge for many. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals. Objective: Through a usability testing session of our website prototype, this study aims to identify key web-based accessibility features for internet users with vision impairment and to explore whether the contents provided in Gene.Vision are relevant and comprehensible. Methods: A face-to-face testing session with 8 participants (5 patients, 2 family members, and 1 member of the public) and 8 facilitators was conducted on a prototype website. Remote testing was performed with another patient due to COVID-19 restrictions. Home page design, navigation, content layout and quality, language, and readability were explored through direct observation and task completion using the think-aloud method. A patient focus group was organized to elicit further feedback. Qualitative data were gathered and analyzed to identify core themes through open and axial coding. Results: All participants had good computer literacy; 6 patients with visual impairment used visual aid software including iOS VoiceOver and Speak Screen, iOS Classic Invert, ZoomText 2020, Job Access With Speech, and Nonvisual Desktop Access. The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content. They reported that dynamic content (such as carousels) and large empty spaces reduced accessibility. Information on research, support available, practical advice, and links to charities were incentives for repeated website visits. Conclusions: We demonstrated the importance of developing a website with a user-based approach. Through end user testing, we identified several key web-based accessibility features for people with visual impairment. Target end users should always be involved early and throughout the design process to ensure their needs are met. Many of these steps can be implemented easily and will aid in search engine optimization. ", doi="10.2196/19151", url="http://www.jmir.org/2021/1/e19151/", url="http://www.ncbi.nlm.nih.gov/pubmed/33470932" } @Article{info:doi/10.2196/24424, author="Coughlin, N. Lara and Nahum-Shani, Inbal and Philyaw-Kotov, L. Meredith and Bonar, E. Erin and Rabbi, Mashfiqui and Klasnja, Predrag and Murphy, Susan and Walton, A. Maureen", title="Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="15", volume="9", number="1", pages="e24424", keywords="mHealth", keywords="adolescents", keywords="young adults", keywords="just-in-time adaptive intervention", keywords="alcohol misuse", keywords="cannabis", keywords="mobile phone", abstract="Background: Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use--related consequences. Objective: This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use. Methods: We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time. Results: The results show that most participants (31/39, 79\%) somewhat liked the app at least, with most (29/39, 74\%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92\%); however, most participants also desired more interactivity (27/39, 69\%). In addition, participants' substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often. Conclusions: The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy. ", doi="10.2196/24424", url="http://mhealth.jmir.org/2021/1/e24424/", url="http://www.ncbi.nlm.nih.gov/pubmed/33448931" } @Article{info:doi/10.2196/19690, author="Hawley-Hague, Helen and Tacconi, Carlo and Mellone, Sabato and Martinez, Ellen and Chiari, Lorenzo and Helbostad, Jorunn and Todd, Chris", title="One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Jan", day="12", volume="8", number="1", pages="e19690", keywords="aged", keywords="postural balance", keywords="telerehabilitation", keywords="patient compliance", keywords="accidental falls", keywords="mobile phone", abstract="Background: Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective: This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods: There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results: In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions: Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability. ", doi="10.2196/19690", url="http://rehab.jmir.org/2021/1/e19690/", url="http://www.ncbi.nlm.nih.gov/pubmed/33433398" } @Article{info:doi/10.2196/23402, author="van der Velde, Miriam and Valkenet, Karin and Geleijn, Edwin and Kruisselbrink, Marjoke and Marsman, Marije and Janssen, MJ Liedewij and Ruurda, P. Jelle and van der Peet, L. Donald and Aarden, J. Jesse and Veenhof, Cindy and van der Leeden, Marike", title="Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="7", volume="9", number="1", pages="e23402", keywords="preoperative care", keywords="smartphone", keywords="mhealth", keywords="risk behavior", keywords="prehabilitation", keywords="usability", abstract="Background: Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. Objective: The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. Methods: A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. Results: Seventy-nine people---40 in the intervention group and 39 in the control group---were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values ($\beta$=--2.4 [95\% CI --5.9 to 1.1]). Conclusions: The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. Trial Registration: Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623 ", doi="10.2196/23402", url="http://mhealth.jmir.org/2021/1/e23402/", url="http://www.ncbi.nlm.nih.gov/pubmed/33410758" } @Article{info:doi/10.2196/23382, author="Melnick, R. Edward and Harry, Elizabeth and Sinsky, A. Christine and Dyrbye, N. Liselotte and Wang, Hanhan and Trockel, Todd Mickey and West, P. Colin and Shanafelt, Tait", title="Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis", journal="J Med Internet Res", year="2020", month="Dec", day="22", volume="22", number="12", pages="e23382", keywords="electronic health record", keywords="EHR", keywords="usability", keywords="cognitive load", keywords="System Usability Scale", keywords="physician task load", keywords="NASA Task Load Index", keywords="physician", keywords="burnout", keywords="stress", abstract="Background: Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task load. Objective: This study aimed to determine the relationship between physician-perceived EHR usability and workload by specialty and evaluate for associations with professional burnout. Methods: A secondary analysis of a cross-sectional survey of US physicians from all specialties was conducted from October 2017 to March 2018. Among the 1250 physicians invited to respond to the subsurvey analyzed here, 848 (67.8\%) completed it. EHR usability was assessed with the System Usability Scale (SUS; range: 0-100). Provider task load (PTL) was assessed using the mental demand, physical demand, temporal demand, and effort required subscales of the National Aeronautics and Space Administration Task Load Index (range: 0-400). Burnout was measured using the Maslach Burnout Inventory. Results: The mean scores were 46.1 (SD 22.1) for SUS and 262.5 (SD 71.7) for PTL. On multivariable analysis adjusting for age, gender, relationship status, medical specialty, practice setting, hours worked per week, and number of nights on call per week, physician-rated EHR usability was associated with PTL, with each 1-point increase in SUS score (indicating more favorable) associated with a 0.57-point decrease in PTL score (P<.001). On mediation analysis, higher SUS score was associated with lower PTL score, which was associated with lower odds of burnout. Conclusions: A strong association was observed between EHR usability and workload among US physicians, with more favorable usability associated with less workload. Both outcomes were associated with the odds of burnout, with task load acting as a mediator between EHR usability and burnout. Improving EHR usability while decreasing task load has the potential to allow practicing physicians more working memory for medical decision making and patient communication. ", doi="10.2196/23382", url="http://www.jmir.org/2020/12/e23382/", url="http://www.ncbi.nlm.nih.gov/pubmed/33289493" } @Article{info:doi/10.2196/20633, author="Kim, Byeol and Loke, Yue-Hin and Mass, Paige and Irwin, R. Matthew and Capeland, Conrad and Olivieri, Laura and Krieger, Axel", title="A Novel Virtual Reality Medical Image Display System for Group Discussions of Congenital Heart Disease: Development and Usability Testing", journal="JMIR Cardio", year="2020", month="Dec", day="8", volume="4", number="1", pages="e20633", keywords="virtual reality", keywords="cardiac diagnostics", keywords="usability study", keywords="congenital heart disease", keywords="group collaboration", abstract="Background: The complex 3-dimensional (3D) nature of anatomical abnormalities in congenital heart disease (CHD) necessitates multidisciplinary group discussions centered around the review of medical images such as magnetic resonance imaging. Currently, group viewings of medical images are constrained to 2-dimensional (2D) cross-sectional displays of 3D scans. However, 2D display methods could introduce additional challenges since they require physicians to accurately reconstruct the images mentally into 3D anatomies for diagnosis, staging, and planning of surgery or other therapies. Virtual reality (VR) software may enhance diagnosis and care of CHD via 3D visualization of medical images. Yet, present-day VR developments for medicine lack the emphasis on multiuser collaborative environments, and the effect of displays and level of immersion for diagnosing CHDs have not been studied. Objective: The objective of the study was to evaluate and compare the diagnostic accuracies and preferences of various display systems, including the conventional 2D display and a novel group VR software, in group discussions of CHD. Methods: A total of 22 medical trainees consisting of 1 first-year, 10 second-year, 4 third-year, and 1 fourth-year residents and 6 medical students, who volunteered for the study, were formed into groups of 4 to 5 participants. Each group discussed three diagnostic cases of CHD with varying structural complexity using conventional 2D display and group VR software. A group VR software, Cardiac Review 3D, was developed by our team using the Unity engine. By using different display hardware, VR was classified into nonimmersive and full-immersive settings. The discussion time, diagnostic accuracy score, and peer assessment were collected to capture the group and individual diagnostic performances. The diagnostic accuracies for each participant were scored by two experienced cardiologists following a predetermined answer rubric. At the end of the study, all participants were provided a survey to rank their preferences of the display systems for performing group medical discussions. Results: Diagnostic accuracies were highest when groups used the full-immersive VR compared with the conventional and nonimmersive VR ($\chi$22=9.0, P=.01) displays. Differences between the display systems were more prominent with increasing case complexity ($\chi$22=14.1, P<.001) where full-immersive VR had accuracy scores that were 54.49\% and 146.82\% higher than conventional and nonimmersive VR, respectively. The diagnostic accuracies provided by the two cardiologists for each participant did not statistically differ from each other (t=--1.01, P=.31). The full-immersive VR was ranked as the most preferred display for performing group CHD discussions by 68\% of the participants. Conclusions: The most preferred display system among medical trainees for visualizing medical images during group diagnostic discussions is full-immersive VR, with a trend toward improved diagnostic accuracy in complex anatomical abnormalities. Immersion is a crucial feature of displays of medical images for diagnostic accuracy in collaborative discussions. ", doi="10.2196/20633", url="http://cardio.jmir.org/2020/1/e20633/", url="http://www.ncbi.nlm.nih.gov/pubmed/33289675" } @Article{info:doi/10.2196/23904, author="Levinson, J. Anthony and Bousfield, John and Douglas, William and Ayers, Stephanie and Sztramko, Richard", title="A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians", journal="JMIR Hum Factors", year="2020", month="Dec", day="4", volume="7", number="4", pages="e23904", keywords="dementia", keywords="caregiver", keywords="education prescription", keywords="online education", keywords="internet", keywords="eHealth", keywords="knowledge translation", keywords="implementation science", keywords="scale and spread", abstract="Background: It is estimated that 564,000 Canadians are currently living with dementia and there are approximately 486,000 to 1.1 million informal family/friend caregivers. Family/friend caregivers often receive little to no education or training about dementia but are expected to provide ongoing support for a complex condition. Web-based family/friend caregiver interventions may be helpful, but little is known about how best to implement them. Objective: The objectives of this study were to 1) design and develop a novel education prescription application to help scale and spread web-based dementia education to family/friend caregivers, 2) conduct user testing, and 3) conduct a larger-scale field trial. Methods: A novel education prescription web-based application was designed and developed. Initial user testing used task completion and the ``think aloud'' technique with a small sample of representative clinicians who work with people living with dementia and family/friend caregivers. Following iterative incorporation of feedback, a larger field trial was conducted with a convenience sample of clinicians. Account invitations were sent to 55 clinicians and, following a 2-month trial period, surveys were administered to participants including the System Usability Scale and the Net Promoter Score. Results: During the initial user testing phase, participants (N=7) from representative disciplines easily completed associated tasks, and had very positive feedback with respect to the usability of the application. The System Usability Scale score during this phase was 91.4. Suggestions from feedback were incorporated into the application. During the larger field trial phase, participants (total N=55; activated account n=17; did not activate account n=38) were given access to the iGeriCare education prescription application. During this period, 2 participants created educational prescriptions; a total of 3 educational prescriptions were sent. Survey completers who did not activate their account (n=5) identified that their lack of use was due to time constraints, competing priorities, or forgetting to use the application. Survey completers who activated their account (n=5) identified their lower use was due to lack of time, lack of eligible family/friend caregivers during trial period, and competing priorities due to the COVID-19 pandemic. The System Usability Scale score during this phase was 78.75, and the Net Promoter Score was 50. Conclusions: Study findings indicate a generally positive response for the usability of a web-based application for clinicians to prescribe dementia education to family/friend caregivers. The dissonance between the promising data and widespread enthusiasm for the design and purpose of the education prescription application found in the initial user testing phase and subsequent lack of significant adoption in the field trial represents both an important lesson for other novel health technologies and a potential area for further investigation. Further research is required to better understand factors associated with implementation of this type of intervention and impact on dissemination of education to family/friend caregivers. ", doi="10.2196/23904", url="http://humanfactors.jmir.org/2020/4/e23904/", url="http://www.ncbi.nlm.nih.gov/pubmed/33275103" } @Article{info:doi/10.2196/15833, author="Butler, Sonia and Sculley, Dean and Santos, Santos Derek and Fellas, Antoni and Giron{\`e}s, Xavier and Singh-Grewal, Davinder and Coda, Andrea", title="Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review", journal="JMIR Pediatr Parent", year="2020", month="Dec", day="1", volume="3", number="2", pages="e15833", keywords="juvenile idiopathic arthritis", keywords="child", keywords="adolescence", keywords="eHealth", keywords="mHealth", keywords="systematic review", keywords="mobile phone", keywords="pain", keywords="physical activity", keywords="self-management", keywords="quality of life", abstract="Background: Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. Objective: This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. Results: A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. Conclusions: The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA. ", doi="10.2196/15833", url="http://pediatrics.jmir.org/2020/2/e15833/", url="http://www.ncbi.nlm.nih.gov/pubmed/33258786" } @Article{info:doi/10.2196/22598, author="Asbj{\o}rnsen, Aune Rikke and Wentzel, Jobke and Smedsr{\o}d, Lien Mirjam and Hjelmes{\ae}th, J{\o}ran and Clark, M. Matthew and Solberg Nes, Lise and Van Gemert-Pijnen, C. Julia E. W.", title="Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study", journal="J Med Internet Res", year="2020", month="Nov", day="30", volume="22", number="11", pages="e22598", keywords="eHealth", keywords="weight loss maintenance", keywords="behavior change", keywords="design thinking", keywords="digital health interventions", keywords="persuasive technology", keywords="human-centered design", abstract="Background: An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance. Objective: This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs. Methods: This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs. Results: A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions. Conclusions: The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance. Trial Registration: ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988 ", doi="10.2196/22598", url="http://www.jmir.org/2020/11/e22598/", url="http://www.ncbi.nlm.nih.gov/pubmed/33252347" } @Article{info:doi/10.2196/23623, author="Kaihlanen, Anu-Marja and Gluschkoff, Kia and Hypp{\"o}nen, Hannele and Kaipio, Johanna and Puttonen, Sampsa and Vehko, Tuulikki and Saranto, Kaija and Karhe, Liisa and Heponiemi, Tarja", title="The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study", journal="JMIR Med Inform", year="2020", month="Nov", day="18", volume="8", number="11", pages="e23623", keywords="electronic health records", keywords="usability", keywords="stress", keywords="cognitive failure", keywords="nurse", abstract="Background: Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood. Objective: The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses. Methods: A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient's care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector. Results: Poor EHR usability was associated with higher levels of stress related to information systems ($\beta$=.38; P<.001). The strength of the association did not depend on user age. Poor EHR usability was also associated with higher levels of cognitive failures ($\beta$=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures ($\beta$=.04; P<.001). Young nurses who found the EHR difficult to use reported the most cognitive failures. Conclusions: Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice. ", doi="10.2196/23623", url="http://medinform.jmir.org/2020/11/e23623/", url="http://www.ncbi.nlm.nih.gov/pubmed/33206050" } @Article{info:doi/10.2196/21659, author="Roosan, Don and Chok, Jay and Karim, Mazharul and Law, V. Anandi and Baskys, Andrius and Hwang, Angela and Roosan, R. Moom", title="Artificial Intelligence--Powered Smartphone App to Facilitate Medication Adherence: Protocol for a Human Factors Design Study", journal="JMIR Res Protoc", year="2020", month="Nov", day="9", volume="9", number="11", pages="e21659", keywords="artificial intelligence", keywords="smartphone app", keywords="patient cognition", keywords="complex medication information", keywords="medication adherence", keywords="machine learning", keywords="mobile phone", abstract="Background: Medication Guides consisting of crucial interactions and side effects are extensive and complex. Due to the exhaustive information, patients do not retain the necessary medication information, which can result in hospitalizations and medication nonadherence. A gap exists in understanding patients' cognition of managing complex medication information. However, advancements in technology and artificial intelligence (AI) allow us to understand patient cognitive processes to design an app to better provide important medication information to patients. Objective: Our objective is to improve the design of an innovative AI- and human factor--based interface that supports patients' medication information comprehension that could potentially improve medication adherence. Methods: This study has three aims. Aim 1 has three phases: (1) an observational study to understand patient perception of fear and biases regarding medication information, (2) an eye-tracking study to understand the attention locus for medication information, and (3) a psychological refractory period (PRP) paradigm study to understand functionalities. Observational data will be collected, such as audio and video recordings, gaze mapping, and time from PRP. A total of 50 patients, aged 18-65 years, who started at least one new medication, for which we developed visualization information, and who have a cognitive status of 34 during cognitive screening using the TICS-M test and health literacy level will be included in this aim of the study. In Aim 2, we will iteratively design and evaluate an AI-powered medication information visualization interface as a smartphone app with the knowledge gained from each component of Aim 1. The interface will be assessed through two usability surveys. A total of 300 patients, aged 18-65 years, with diabetes, cardiovascular diseases, or mental health disorders, will be recruited for the surveys. Data from the surveys will be analyzed through exploratory factor analysis. In Aim 3, in order to test the prototype, there will be a two-arm study design. This aim will include 900 patients, aged 18-65 years, with internet access, without any cognitive impairment, and with at least two medications. Patients will be sequentially randomized. Three surveys will be used to assess the primary outcome of medication information comprehension and the secondary outcome of medication adherence at 12 weeks. Results: Preliminary data collection will be conducted in 2021, and results are expected to be published in 2022. Conclusions: This study will lead the future of AI-based, innovative, digital interface design and aid in improving medication comprehension, which may improve medication adherence. The results from this study will also open up future research opportunities in understanding how patients manage complex medication information and will inform the format and design for innovative, AI-powered digital interfaces for Medication Guides. International Registered Report Identifier (IRRID): PRR1-10.2196/21659 ", doi="10.2196/21659", url="http://www.researchprotocols.org/2020/11/e21659/", url="http://www.ncbi.nlm.nih.gov/pubmed/33164898" } @Article{info:doi/10.2196/22997, author="Bonet, Lucia and Torous, John and Arce, David and Blanquer, Ignacio and Sanjuan, Julio", title="ReMindCare App for Early Psychosis: Pragmatic Real World Intervention and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Nov", day="6", volume="8", number="11", pages="e22997", keywords="app", keywords="clinical practice", keywords="mental health", keywords="psychosis", keywords="real-world intervention", keywords="telemedicine", abstract="Background: eHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018. Objective: The objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients. Methods: The integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73\% (66/90) were males, 91\% (83/90) were White, and 81\% (74/90) were single. Results: Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20\% (12/59) of patients from the ReMindCare group had a relapse, while 58\% (18/31) of the TAU patients had one or more relapses ($\chi$2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units ($\chi$2=7.4, P=.006) and fewer hospitalizations than TAU patients ($\chi$2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04). Conclusions: To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis. International Registered Report Identifier (IRRID): RR2-10.1111/eip.12960 ", doi="10.2196/22997", url="https://mhealth.jmir.org/2020/11/e22997", url="http://www.ncbi.nlm.nih.gov/pubmed/33155986" } @Article{info:doi/10.2196/16632, author="Bennett, Michael Kyle and Clary, Lynn Kelly and Smith, Cary Douglas and Lee, Ann Carol", title="Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study", journal="J Med Internet Res", year="2020", month="Nov", day="5", volume="22", number="11", pages="e16632", keywords="young adults", keywords="substance abuse", keywords="peer influence", keywords="mobile applications", keywords="mobile phone", keywords="community-based participatory research", keywords="crowdsourcing", abstract="Background: Technology-assisted intervention and prevention strategies present opportunities for substance use--related research with emerging adults (EAs) and their peers. Emerging adulthood is a developmentally distinct period in which individuals between the ages of 18 and 29 years undergo unique emotional, cultural, developmental, and biological changes as they transition into adulthood. Crowdsourcing, or gathering feedback from a large group within web-based communities, offers researchers a unique and cost-effective way to obtain large amounts of information in a short period. Objective: This paper presents market feedback obtained via Amazon's Mechanical Turk from EAs (N=458) on the acceptability and utility of brief intervention scripts for a smartphone app currently under development. The mobile app, Harbor, teaches friends of EAs with substance use problems effective and supportive strategies for helping their friend make changes in their substance use behavior. Methods: We examined feedback on the wording of the intervention scripts and estimated the market size of EAs who may use this app. Furthermore, we calculated correlations between script ratings and measures of personal risky drinking (ie, Alcohol Use Disorder Identification Test) and the participants' use of confrontational, enabling, or supportive behaviors with an existing friend. Results: Approximately half of our sample (208/458, 45.4\%) indicated that they had a close friend for whom they had concerns about their substance use, suggesting a potentially high demand for an app such as Harbor. Initial findings suggest that peers who engage in less enabling behaviors with friends who have a substance use problem exhibited lower risky drinking behaviors overall (r206=?0.501; P<.001). Concerning acceptability, 98.0\% (449/458) of the sample rated the scripts' dialogue as either somewhat, moderately, or extremely realistic (mean 3.92, SD 0.48) on 5-point Likert scale items. Finally, 95.4\% (437/454) of respondents indicated that the scripts would be at least slightly helpful for training peers to help their friends with substance use issues. Finally, individuals who were better able to identify enabling language in enabling scripts self-reported fewer enabling behaviors toward their friend's substance use (r206=?0.236; P=.001). Conclusions: There exists a demonstrated level of desirability and acceptability among EAs for a mobile app such as Harbor. EAs who wish to engage in more supportive behaviors with their friends who engage in substance use and who are amenable to assisting their friends with sobriety likely would use and benefit from this app. ", doi="10.2196/16632", url="https://www.jmir.org/2020/11/e16632", url="http://www.ncbi.nlm.nih.gov/pubmed/33151158" } @Article{info:doi/10.2196/17999, author="M{\"u}ssener, Ulrika and Thomas, Kristin and Linderoth, Catharina and L{\"o}f, Marie and {\AA}sberg, Katarina and Henriksson, Pontus and Bendtsen, Marcus", title="Development of an Intervention Targeting Multiple Health Behaviors Among High School Students: Participatory Design Study Using Heuristic Evaluation and Usability Testing", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="29", volume="8", number="10", pages="e17999", keywords="mHealth intervention", keywords="health behavior", keywords="high school students", keywords="participatory design", keywords="heuristic evaluation", keywords="usability testing", keywords="mobile phone", abstract="Background: Mobile electronic platforms provide exciting possibilities for health behavior promotion. For instance, they can promote smoking cessation, moderate alcohol consumption, healthy eating, and physical activity. Young adults in Sweden are proficient in the use of technology, having been exposed to computers, smartphones, and the internet from an early age. However, with the high availability of mobile health (mHealth) interventions of varying quality, it is critical to optimize the usability of mHealth interventions to ensure long-term use of these health promotion interventions. Objective: This study aims to investigate the usability of an mHealth intervention (LIFE4YOUth) targeting health behaviors among high school students through heuristic evaluation and usability testing. Methods: A preliminary version of the LIFE4YOUth mHealth intervention, which was aimed at promoting healthy eating, physical activity, smoking cessation, and nonrisky drinking among high school students, was developed in early 2019. We completed a total of 15 heuristic evaluations and 5 usability tests to evaluate the usability of the mHealth intervention prototype to improve its functioning, content, and design. Results: Heuristic evaluation from a total of 15 experts (10 employees and 5 university students, both women and men, aged 18-25 years) revealed that the major usability problems and the worst ratings, a total of 17 problems termed usability catastrophes, concerned shortcomings in displaying easy-to-understand information to the users or technical errors. The results of the usability testing including 5 high school students (both girls and boys, aged 15-18 years) showed that the design, quality, and quantity of content in the intervention may impact the users' level of engagement. Poor functionality was considered a major barrier to usability. Of the 5 participants, one rated the LIFE4YOUth intervention as poor, 2 rated as average, and 2 assessed it as good, according to the System Usability Scale. Conclusions: High school students have high expectations of digital products. If an mHealth intervention does not offer optimal functions, they may cease to use it. Optimizing the usability of mHealth interventions is a critical step in the development process. Heuristic evaluation and usability testing in this study provided valuable knowledge about the prototype from a user's perspective. The findings may lead to the development of similar interventions targeting the high school population. ", doi="10.2196/17999", url="http://mhealth.jmir.org/2020/10/e17999/", url="http://www.ncbi.nlm.nih.gov/pubmed/33118942" } @Article{info:doi/10.2196/20353, author="Khowaja, Kamran and Al-Thani, Dena", title="New Checklist for the Heuristic Evaluation of mHealth Apps (HE4EH): Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="28", volume="8", number="10", pages="e20353", keywords="mHealth", keywords="eHealth", keywords="heuristic evaluation", keywords="expert evaluation", keywords="self-monitoring", keywords="behavior change", keywords="design guidelines", keywords="framework", abstract="Background: Diabetes is one of the leading causes of death in developing countries. Existing mobile health (mHealth) app design guidelines lack a description of the support of continuous self-monitoring of health status, behavior change to improve and adopt a healthy lifestyle, and communication with health educators and health care professionals in case of any need. Objective: This paper presents the development of a specialized set of heuristics called heuristic evaluation for mHealth apps (HE4EH) as an all-in-one tool and its applicability by performing a heuristic evaluation of an mHealth app. Methods: An extensive review of heuristics and checklists was used to develop the HE4EH. The HE4EH was evaluated by domain experts for heuristics, checklist items, severity ratings, and overall satisfaction. The OneTouch app, which helps individuals with diabetes manage their blood glucose levels, was evaluated using HE4EH to identify usability problems that need to be fixed in the app. Results: The expert evaluation of HE4EH revealed that the heuristics were important, relevant, and clear. The checklist items across the heuristics were clear, relevant, and acceptably grouped. In terms of evaluating the OneTouch app using the HE4EH, the most frequently violated heuristics included Content, Visibility, Match, and Self-monitoring. Most of the usability problems found were minor. The system usability scale score indicated that the OneTouch app is marginally acceptable. Conclusions: This heuristic evaluation using the OneTouch app shows that the HE4EH can play a vital role for designers, researchers, and practitioners to use HE4EH heuristics and checklist items as a tool to design a new or evaluate and improve an existing mHealth app. ", doi="10.2196/20353", url="http://mhealth.jmir.org/2020/10/e20353/", url="http://www.ncbi.nlm.nih.gov/pubmed/33112252" } @Article{info:doi/10.2196/22074, author="Alfonsi, E. Jeffrey and Choi, Y. Elizabeth E. and Arshad, Taha and Sammott, S. Stacie-Ann and Pais, Vanita and Nguyen, Cynthia and Maguire, R. Bryan and Stinson, N. Jennifer and Palmert, R. Mark", title="Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="28", volume="8", number="10", pages="e22074", keywords="carbohydrate counting", keywords="type 1 diabetes", keywords="image recognition", keywords="youth", keywords="digital health applications (apps)", keywords="mHealth", abstract="Background: Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. Objective: Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. Methods: Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. Results: Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43\% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. Conclusions: Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. Trial Registration: ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142 ", doi="10.2196/22074", url="http://mhealth.jmir.org/2020/10/e22074/", url="http://www.ncbi.nlm.nih.gov/pubmed/33112249" } @Article{info:doi/10.2196/23893, author="Bostr{\o}m, Katrine and B{\o}r{\o}sund, Elin and Varsi, Cecilie and Eide, Hilde and Flakk Nordang, Elise and Schreurs, MG Karlein and Waxenberg, B. Lori and Weiss, E. Karen and Morrison, J. Eleshia and Cvancarova Sm{\aa}stuen, Milada and Stubhaug, Audun and Solberg Nes, Lise", title="Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study", journal="JMIR Form Res", year="2020", month="Oct", day="23", volume="4", number="10", pages="e23893", keywords="chronic pain", keywords="feasibility", keywords="acceptability", keywords="self-management", keywords="eHealth", keywords="digital", keywords="cognitive-behavioral pain", keywords="usability", keywords="user centered", abstract="Background: Chronic pain can be complex and taxing to live with, and treatment and support require a multicomponent approach, which may not always be offered or available. Smartphones, tablets, and personal computers are already incorporated into patients' daily lives, and therefore, they can be used to communicate, educate, and support self-management. Although some web-based self-management interventions exist, research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is limited, findings are inconclusive, and new innovative ideas and solutions are needed. Objective: This feasibility pilot study aimed to explore the system use, perceived usefulness, ease of use, and preliminary effects of EPIO, an app-based cognitive-behavioral pain self-management intervention program for patients living with chronic pain. Methods: The EPIO intervention was delivered in a blended-care model containing (1) one face-to-face introduction session, (2) nine cognitive behavior--based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (3) one follow-up phone call at 2 to 3 weeks after the introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and 3 months after the introduction session, with registration of system use (ie, log data) until 6 months. The use, perceived usefulness, and ease of use of the EPIO program were examined through system use data, as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effects included the Brief Pain Inventory, health-related quality of life (HRQoL) scale, Hospital Anxiety and Depression Scale, Self-Regulatory Fatigue scale, Pain Catastrophizing Scale, and Chronic Pain Acceptance Questionnaire. Results: Participants (N=50) had a median age of 52 years (range 29-74 years) at inclusion and were mainly female (40/50, 80\%). Thirty-one participants completed at least six of the nine modules within the 3-month study period (62\% completion rate). Forty-five participants completed outcome measures at 3 months, and the EPIO program was rated as useful (ie, ``totally agree'' or ``agree''; 39/45, 87\%) and easy to use (42/45, 93\%), and as having easily understandable exercises (44/45, 98\%). The average overall system usability (SUS) score was 85.7, indicating grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily nonsignificant pre-post intervention improvements at 3 months, but with significant positive effects related to some aspects of HRQoL (bodily pain, P=.02 and change, P=.049). Conclusions: ?Digital self-management intervention programs may be of use and support for patients living with chronic pain. In this feasibility study, EPIO showed an acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large-scale randomized controlled trial are warranted and in progress. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 ", doi="10.2196/23893", url="http://formative.jmir.org/2020/10/e23893/", url="http://www.ncbi.nlm.nih.gov/pubmed/33094734" } @Article{info:doi/10.2196/18484, author="Senathirajah, Yalini and Kaufman, R. David and Cato, D. Kenrick and Borycki, M. Elizabeth and Fawcett, Allen Jaime and Kushniruk, W. Andre", title="Characterizing and Visualizing Display and Task Fragmentation in the Electronic Health Record: Mixed Methods Design", journal="JMIR Hum Factors", year="2020", month="Oct", day="21", volume="7", number="4", pages="e18484", keywords="electronic health record", keywords="electronic medical record", keywords="medical informatics", keywords="information technology", keywords="data visualization", keywords="user computer interface", abstract="Background: The complexity of health care data and workflow presents challenges to the study of usability in electronic health records (EHRs). Display fragmentation refers to the distribution of relevant data across different screens or otherwise far apart, requiring complex navigation for the user's workflow. Task and information fragmentation also contribute to cognitive burden. Objective: This study aims to define and analyze some of the main sources of fragmentation in EHR user interfaces (UIs); discuss relevant theoretical, historical, and practical considerations; and use granular microanalytic methods and visualization techniques to help us understand the nature of fragmentation and opportunities for EHR optimization or redesign. Methods: Sunburst visualizations capture the EHR navigation structure, showing levels and sublevels of the navigation tree, allowing calculation of a new measure, the Display Fragmentation Index. Time belt visualizations present the sequences of subtasks and allow calculation of proportion per instance, a measure that quantifies task fragmentation. These measures can be used separately or in conjunction to compare EHRs as well as tasks and subtasks in workflows and identify opportunities for reductions in steps and fragmentation. We present an example use of the methods for comparison of 2 different EHR interfaces (commercial and composable) in which subjects apprehend the same patient case. Results: Screen transitions were substantially reduced for the composable interface (from 43 to 14), whereas clicks (including scrolling) remained similar. Conclusions: These methods can aid in our understanding of UI needs under complex conditions and tasks to optimize EHR workflows and redesign. ", doi="10.2196/18484", url="https://humanfactors.jmir.org/2020/4/e18484", url="http://www.ncbi.nlm.nih.gov/pubmed/33084580" } @Article{info:doi/10.2196/21075, author="Lattie, Emily and Cohen, A. Katherine and Winquist, Nathan and Mohr, C. David", title="Examining an App-Based Mental Health Self-Care Program, IntelliCare for College Students: Single-Arm Pilot Study", journal="JMIR Ment Health", year="2020", month="Oct", day="10", volume="7", number="10", pages="e21075", keywords="mHealth", keywords="college students", keywords="depression", keywords="anxiety", keywords="mobile phone", abstract="Background: In recent years, there has been an increase in symptoms of depression, anxiety, and other mental illnesses in college student populations alongside a steady rise in the demand for counseling services. Digital mental health programs, such as those delivered through mobile apps, can add to the array of available services but must be tested for usability and acceptability before implementation. Objective: This study aims to examine how students used IntelliCare for College Students over an 8-week period to examine the preliminary associations between app use and psychosocial targets and to gather user feedback about usability issues that need to be remedied before a larger implementation study. Methods: IntelliCare for College Students is an app-based platform that provides symptom assessments with personalized feedback, information about campus resources, lessons on mental health and wellness topics, and access to the suite of interactive skill--focused IntelliCare apps. A total of 20 students were recruited to participate in an 8-week study. To test for a broad range of potential users, we recruited a mixed sample of students with elevated symptoms of depression or anxiety and students without elevated symptoms. Participants completed psychosocial questionnaires at baseline, week 4, and week 8. Participants also completed user feedback interviews at weeks 4 and 8 in which they provided feedback on their experience using the app and suggestions for changes they would like to be made to the app. Results: Of the 20 students who downloaded the app, 19 completed the study, indicating a high rate of retention. Over the study period, participants completed an average of 5.85 (SD 2.1; range 1-8) symptom assessments. Significant improvements were observed in the Anxiety Literacy Questionnaire scores (Z=?2.006; P=.045) and in the frequency with which participants used both cognitive (Z=?2.091; P=.04) and behavioral (Z=?2.249; P=.03) coping skills. In the feedback interviews, we identified a high degree of usability with minor bugs in the app software, which were quickly fixed. Furthermore, in feedback interviews, we identified that users found the app to be convenient and appreciated the ability to use the program in short bursts of time. Conclusions: The findings indicate that the IntelliCare for College Students program was perceived as largely usable and engaging. Although the program demonstrated usability and preliminary benefits to students, further testing is needed to determine its clinical utility among college students. Trial Registration: ClinicalTrials.gov NCT04035577; https://clinicaltrials.gov/ct2/show/NCT04035577 ", doi="10.2196/21075", url="http://mental.jmir.org/2020/10/e21075/", url="http://www.ncbi.nlm.nih.gov/pubmed/33037874" } @Article{info:doi/10.2196/18140, author="Widnall, Emily and Grant, Ellen Claire and Wang, Tao and Cross, Lauren and Velupillai, Sumithra and Roberts, Angus and Stewart, Robert and Simonoff, Emily and Downs, Johnny", title="User Perspectives of Mood-Monitoring Apps Available to Young People: Qualitative Content Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="10", volume="8", number="10", pages="e18140", keywords="mood monitoring", keywords="engagement", keywords="mobile applications", keywords="mHealth", keywords="mental health", keywords="smartphone", keywords="qualitative research", keywords="mobile phone", abstract="Background: Mobile health apps are increasingly available and used in a clinical context to monitor young people's mood and mental health. Despite the benefits of accessibility and cost-effectiveness, consumer engagement remains a hurdle for uptake and continued use. Hundreds of mood-monitoring apps are publicly available to young people on app stores; however, few studies have examined consumer perspectives. App store reviews held on Google and Apple platforms provide a large, rich source of naturally generated, publicly available user reviews. Although commercial developers use these data to modify and improve their apps, to date, there has been very little in-depth evaluation of app store user reviews within scientific research, and our current understanding of what makes apps engaging and valuable to young people is limited. Objective: This study aims to gain a better understanding of what app users consider useful to encourage frequent and prolonged use of mood-monitoring apps appropriate for young people. Methods: A systematic approach was applied to the selection of apps and reviews. We identified mood-monitoring apps (n=53) by a combination of automated application programming interface (API) methods. We only included apps appropriate for young people based on app store age categories (apps available to those younger than 18 years). We subsequently downloaded all available user reviews via API data scraping methods and selected a representative subsample of reviews (n=1803) for manual qualitative content analysis. Results: The qualitative content analysis revealed 8 main themes: accessibility (34\%), flexibility (21\%), recording and representation of mood (18\%), user requests (17\%), reflecting on mood (16\%), technical features (16\%), design (13\%), and health promotion (11\%). A total of 6 minor themes were also identified: notification and reminders; recommendation; privacy, security, and transparency; developer; adverts; and social/community. Conclusions: Users value mood-monitoring apps that can be personalized to their needs, have a simple and intuitive design, and allow accurate representation and review of complex and fluctuating moods. App store reviews are a valuable repository of user engagement feedback and provide a wealth of information about what users value in an app and what user needs are not being met. Users perceive mood-monitoring apps positively, but over 20\% of reviews identified the need for improvement. ", doi="10.2196/18140", url="http://mhealth.jmir.org/2020/10/e18140/", url="http://www.ncbi.nlm.nih.gov/pubmed/33037875" } @Article{info:doi/10.2196/17895, author="Green, P. Eric and Lai, Yihuan and Pearson, Nicholas and Rajasekharan, Sathyanath and Rauws, Michiel and Joerin, Angela and Kwobah, Edith and Musyimi, Christine and Jones, M. Rachel and Bhat, Chaya and Mulinge, Antonia and Puffer, S. Eve", title="Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study", journal="JMIR Form Res", year="2020", month="Oct", day="5", volume="4", number="10", pages="e17895", keywords="telemedicine", keywords="mental health", keywords="depression", keywords="artificial intelligence", keywords="Kenya", keywords="text messaging", keywords="mobile phone", abstract="Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods: We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results: We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76\%) and sent at least 1 message to Zuri (27/41, 66\%). A third of the sample engaged beyond registration (14/41, 34\%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7\% improvement in mood. Conclusions: Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11800 ", doi="10.2196/17895", url="https://formative.jmir.org/2020/10/e17895", url="http://www.ncbi.nlm.nih.gov/pubmed/33016883" } @Article{info:doi/10.2196/22299, author="Liu, Boxiang and Liu, Kaibo and Zhang, He and Zhang, Liang and Bian, Yuchen and Huang, Liang", title="CoV-Seq, a New Tool for SARS-CoV-2 Genome Analysis and Visualization: Development and Usability Study", journal="J Med Internet Res", year="2020", month="Oct", day="2", volume="22", number="10", pages="e22299", keywords="COVID-19", keywords="SARS-CoV-2", keywords="bioinformatics", keywords="genetics", keywords="genome", keywords="virus", keywords="sequence", keywords="data sets", keywords="programming", keywords="web server", abstract="Background: COVID-19 became a global pandemic not long after its identification in late 2019. The genomes of SARS-CoV-2 are being rapidly sequenced and shared on public repositories. To keep up with these updates, scientists need to frequently refresh and reclean data sets, which is an ad hoc and labor-intensive process. Further, scientists with limited bioinformatics or programming knowledge may find it difficult to analyze SARS-CoV-2 genomes. Objective: To address these challenges, we developed CoV-Seq, an integrated web server that enables simple and rapid analysis of SARS-CoV-2 genomes. Methods: CoV-Seq is implemented in Python and JavaScript. The web server and source code URLs are provided in this article. Results: Given a new sequence, CoV-Seq automatically predicts gene boundaries and identifies genetic variants, which are displayed in an interactive genome visualizer and are downloadable for further analysis. A command-line interface is available for high-throughput processing. In addition, we aggregated all publicly available SARS-CoV-2 sequences from the Global Initiative on Sharing Avian Influenza Data (GISAID), National Center for Biotechnology Information (NCBI), European Nucleotide Archive (ENA), and China National GeneBank (CNGB), and extracted genetic variants from these sequences for download and downstream analysis. The CoV-Seq database is updated weekly. Conclusions: We have developed CoV-Seq, an integrated web service for fast and easy analysis of custom SARS-CoV-2 sequences. The web server provides an interactive module for the analysis of custom sequences and a weekly updated database of genetic variants of all publicly accessible SARS-CoV-2 sequences. We believe CoV-Seq will help improve our understanding of the genetic underpinnings of COVID-19. ", doi="10.2196/22299", url="https://www.jmir.org/2020/10/e22299", url="http://www.ncbi.nlm.nih.gov/pubmed/32931441" } @Article{info:doi/10.2196/20317, author="Liu, Ying-Chieh and Chen, Chien-Hung and Lin, Yu-Sheng and Chen, Hsin-Yun and Irianti, Denisa and Jen, Ting-Ni and Yeh, Jou-Yin and Chiu, Yueh-Hsia Sherry", title="Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="28", volume="8", number="9", pages="e20317", keywords="voice-added design", keywords="food report", keywords="elderly", keywords="usability evaluation", keywords="automatic speech recognition", keywords="mHealth", keywords="randomized trial", abstract="Background: Advances in voice technology have raised new possibilities for apps related to daily health maintenance. However, the usability of such technologies for older users remains unclear and requires further investigation. Objective: We designed and evaluated two innovative mobile voice-added apps for food intake reporting, namely voice-only reporting (VOR) and voice-button reporting (VBR). Each app features a unique interactive procedure for reporting food intake. With VOR, users verbally report the main contents of each dish, while VBR provides both voice and existing touch screen inputs for food intake reporting. The relative usability of the two apps was assessed through the metrics of accuracy, efficiency, and user perception. Methods: The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. A group of 57 adults aged 60-90 years (12 male and 45 female participants) was recruited from a retirement community and randomized into two experimental groups, that is, VOR (n=30) and VBR (n=27) groups. Both groups were tested using the same set of 17 food items including dishes and beverages selected and allocated to present distinct breakfast, lunch, and dinner meals. All participants used a 7-inch tablet computer for the test. The resulting data were analyzed to evaluate reporting accuracy and time efficiency, and the system usability scale (SUS) was used to measure user perception. Results: For eight error types identified in the experiment, the VBR group participants were significantly (P<.001) more error prone owing to the required use of button-tapping actions. The highest error rates in the VOR group were related to incomprehensible reporting speech (28/420, 6.7\%), while the highest error rates in the VBR group were related to failure to make required button taps (39/378, 10.3\%). The VOR group required significantly (P<.001) less time to complete food reporting. The overall subjective reactions of the two groups based on the SUS surpassed the benchmark and were not significantly different (P=.20). Conclusions: Experimental results showed that VOR outperformed VBR, suggesting that voice-only food input reporting is preferable for elderly users. Voice-added apps offer a potential mechanism for the self-management of dietary intake by elderly users. Our study contributes an evidence-based evaluation of prototype design and selection under a user-centered design model. The results provide a useful reference for selecting optimal user interaction design. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN17335889; http://www.isrctn.com/ISRCTN17335889. ", doi="10.2196/20317", url="http://mhealth.jmir.org/2020/9/e20317/", url="http://www.ncbi.nlm.nih.gov/pubmed/32985999" } @Article{info:doi/10.2196/18407, author="Bruen, Jane Ashley and Wall, Abbie and Haines-Delmont, Alina and Perkins, Elizabeth", title="Exploring Suicidal Ideation Using an Innovative Mobile App-Strength Within Me: The Usability and Acceptability of Setting up a Trial Involving Mobile Technology and Mental Health Service Users", journal="JMIR Ment Health", year="2020", month="Sep", day="28", volume="7", number="9", pages="e18407", keywords="mobile applications", keywords="smartphone", keywords="mobile phone", keywords="mHealth", keywords="mental health", keywords="suicide", keywords="social media", abstract="Background: Suicide is a growing global public health problem that has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Although suicidal ideation has been shown to be linked to a higher risk of death by suicide, not everybody openly discloses their suicidal thoughts or plans to friends and family or seeks professional help before suicide. Therefore, new methods are needed to track suicide risk in real time together with a better understanding of the ways in which people communicate or express their suicidality. Considering the dynamic nature and challenges in understanding suicide ideation and suicide risk, mobile apps could be better suited to prevent suicide as they have the ability to collect real-time data. Objective: This study aims to report the practicalities and acceptability of setting up and trialing digital technologies within an inpatient mental health setting in the United Kingdom and highlight their implications for future studies. Methods: Service users were recruited from 6 inpatient wards in the north west of England. Service users who were eligible to participate and provided consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone app, Strength Within Me (SWiM). Interaction with the app involved journaling (recording daily activities, how this made them feel, and rating their mood) and the option to create safety plans for emotions causing difficulties (identifying strategies that helped with these emotions). Participants also had the option to allow the study to access their personal Facebook account to monitor their social media use and activity. In addition, clinical data (ie, assessments conducted by trained researchers targeting suicidality, depression, and sleep) were also collected. Results: Overall, 43.0\% (80/186 response rate) of eligible participants were recruited for the study. Of the total sample, 67 participants engaged in journaling, with the average number of entries per user being 8.2 (SD 8.7). Overall, only 24 participants created safety plans and the most common difficult emotion to be selected was feeling sad (n=21). This study reports on the engagement with the SWiM app, the technical difficulties the research team faced, the importance of building key relationships, and the implications of using Facebook as a source to detect suicidality. Conclusions: To develop interventions that can be delivered in a timely manner, prediction of suicidality must be given priority. This paper has raised important issues and highlighted lessons learned from implementing a novel mobile app to detect the risk of suicidality for service users in an inpatient setting. ", doi="10.2196/18407", url="http://mental.jmir.org/2020/9/e18407/", url="http://www.ncbi.nlm.nih.gov/pubmed/32985995" } @Article{info:doi/10.2196/17978, author="Novak, Lovett Laurie and Simpson, L. Christopher and Coco, Joseph and McNaughton, D. Candace and Ehrenfeld, M. Jesse and Bloos, M. Sean and Fabbri, Daniel", title="Understanding the Information Needs and Context of Trauma Handoffs to Design Automated Sensing Clinical Documentation Technologies: Qualitative Mixed-Method Study of Military and Civilian Cases", journal="J Med Internet Res", year="2020", month="Sep", day="25", volume="22", number="9", pages="e17978", keywords="trauma handoffs", keywords="military field medicine", keywords="documentation", keywords="trauma", keywords="health records", keywords="hospital", keywords="emergency", abstract="Background: Current methods of communication between the point of injury and receiving medical facilities rely on verbal communication, supported by brief notes and the memory of the field medic. This communication can be made more complete and reliable with technologies that automatically document the actions of field medics. However, designing state-of-the-art technology for military field personnel and civilian first responders is challenging due to the barriers researchers face in accessing the environment and understanding situated actions and cognitive models employed in the field. Objective: To identify design insights for an automated sensing clinical documentation (ASCD) system, we sought to understand what information is transferred in trauma cases between prehospital and hospital personnel, and what contextual factors influence the collection, management, and handover of information in trauma cases, in both military and civilian cases. Methods: Using a multi-method approach including video review and focus groups, we developed an understanding of the information needs of trauma handoffs and the context of field documentation to inform the design of an automated sensing documentation system that uses wearables, cameras, and environmental sensors to passively infer clinical activity and automatically produce documentation. Results: Comparing military and civilian trauma documentation and handoff, we found similarities in the types of data collected and the prioritization of information. We found that military environments involved many more contextual factors that have implications for design, such as the physical environment (eg, heat, lack of lighting, lack of power) and the potential for active combat and triage, creating additional complexity. Conclusions: An ineffectiveness of communication is evident in both the civilian and military worlds. We used multiple methods of inquiry to study the information needs of trauma care and handoff, and the context of medical work in the field. Our findings informed the design and evaluation of an automated documentation tool. The data illustrated the need for more accurate recordkeeping, specifically temporal aspects, during transportation, and characterized the environment in which field testing of the developed tool will take place. The employment of a systems perspective in this project produced design insights that our team would not have identified otherwise. These insights created exciting and interesting challenges for the technical team to resolve. ", doi="10.2196/17978", url="http://www.jmir.org/2020/9/e17978/", url="http://www.ncbi.nlm.nih.gov/pubmed/32975522" } @Article{info:doi/10.2196/17947, author="Siedlikowski, Maia and Rauch, Frank and Tsimicalis, Argerie", title="Giving Children With Osteogenesis Imperfecta a Voice: Participatory Approach for the Development of the Interactive Assessment and Communication Tool Sisom OI", journal="J Med Internet Res", year="2020", month="Sep", day="22", volume="22", number="9", pages="e17947", keywords="child health", keywords="symptom assessment, communication, mobile apps, software", abstract="Background: Children with osteogenesis imperfecta (OI) experience acute and chronic symptoms that expose them to physical, mental, and social challenges. Empowering these children by involving them in their care can help them to cope with OI. Sisom is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic illnesses express their symptoms. This tool has not yet been adapted to the unique needs of OI. Objective: The aim of this study was to develop a Sisom OI paper prototype by seeking the perspectives of end users. Methods: A participatory approach was adopted to develop the prototype overseen by an expert panel of 9 clinicians at a university-affiliated pediatric hospital. Purposive sampling was used to recruit 12 children with OI who were aged 6-12 years. The study was carried out over the course of 3 feedback cycles. Data were deductively interpreted using content analysis techniques. Results: Overall, 64\% (57/89) of the Sisom symptoms were deemed relevant for inclusion in Sisom OI, with 42\% (37/89) directly incorporated and 22\% (20/89) incorporated with changes. In total, 114 symptoms were used to create the prototype, of which 57 were newly generated. The relevant symptoms addressed children's thoughts and feelings about hospitalization and their wishes for participation in their own care. The new symptoms addressed fractures, body image, and social isolation related to difficulties with accessibility and intimidation. Conclusions: Once developed, Sisom OI will offer clinicians an innovative and child-centered approach to capture children's perspectives on their condition. ", doi="10.2196/17947", url="http://www.jmir.org/2020/9/e17947/", url="http://www.ncbi.nlm.nih.gov/pubmed/32960176" } @Article{info:doi/10.2196/19476, author="Ryan, Ann Kelly and Babu, Pallavi and Easter, Rebecca and Saunders, Erika and Lee, Jinseok Andy and Klasnja, Predrag and Verchinina, Lilia and Micol, Valerie and Doil, Brent and McInnis, G. Melvin and Kilbourne, M. Amy", title="A Smartphone App to Monitor Mood Symptoms in Bipolar Disorder: Development and Usability Study", journal="JMIR Ment Health", year="2020", month="Sep", day="22", volume="7", number="9", pages="e19476", keywords="bipolar disorder", keywords="momentary assessment", keywords="mood", keywords="mobile phone", keywords="mobile app", abstract="Background: There is considerable scientific interest in finding new and innovative ways to capture rapid fluctuations in functioning within individuals with bipolar disorder (BD), a severe, recurrent mental disorder associated with frequent shifts in symptoms and functioning. The use of smartphones can provide valid and real-world tools for use in measurement-based care and could be used to inform more personalized treatment options for this group, which can improve standard of care. Objective: We examined the feasibility and usability of a smartphone to capture daily fluctuations in mood within BD and to relate daily self-rated mood to smartphone use behaviors indicative of psychomotor activity or symptoms of the illness. Methods: Participants were 26 individuals with BD and 12 healthy control individuals who were recruited from the Prechter Longitudinal Study of BD. All were given a smartphone with a custom-built app and prompted twice a day to complete questions of mood for 28 days. The app automatically and unobtrusively collected phone usage data. A poststudy satisfaction survey was also completed. Results: Our sample showed a very high adherence rate to the daily momentary assessments (91\% of the 58 prompts completed). Multivariate mixed effect models showed that an increase in rapid thoughts over time was associated with a decrease in outgoing text messages ($\beta$=--.02; P=.04), and an increase in impulsivity self-ratings was related to a decrease in total call duration ($\beta$=--.29; P=.02). Participants generally reported positive experiences using the smartphone and completing daily prompts. Conclusions: Use of mobile technology shows promise as a way to collect important clinical information that can be used to inform treatment decision making and monitor outcomes in a manner that is not overly burdensome to the patient or providers, highlighting its potential use in measurement-based care. ", doi="10.2196/19476", url="http://mental.jmir.org/2020/9/e19476/", url="http://www.ncbi.nlm.nih.gov/pubmed/32960185" } @Article{info:doi/10.2196/17983, author="Chaniaud, No{\'e}mie and M{\'e}tayer, Natacha and Megalakaki, Olga and Loup-Escande, Emilie", title="Effect of Prior Health Knowledge on the Usability of Two Home Medical Devices: Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="21", volume="8", number="9", pages="e17983", keywords="usability", keywords="prior health knowledge", keywords="mHealth", keywords="home medical devices", keywords="blood pressure monitor", keywords="pulse oximeter", abstract="Background: Studies on the usability of health care devices are becoming more common, although usability standards are not necessarily specified and followed. Yet, there is little knowledge about the impact of the context of use on the usability outcome. It is specified in the usability standard (ISO 9241-11, 2018) of a device that it may be affected by its context of use and especially by the characteristics of its users. Among these, prior health knowledge (ie, knowledge about human body functioning) is crucial. However, no study has shown that prior health knowledge influences the usability of medical devices.? Objective: Our study aimed to fill this gap by analyzing the relationship between the usability of two home medical devices (soon to be used in the context of ambulatory surgery) and prior health knowledge through an experimental approach. Methods: For assessing the usability of two home medical devices (blood pressure monitor and pulse oximeter), user tests were conducted among 149 students. A mixed-methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). Participants completed a questionnaire to show the extent of their previous health knowledge and then operated both devices randomly. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (system usability scale [SUS]). The qualitative observational data were coded using inductive analysis by two independent researchers specialized in cognitive psychology and cognitive ergonomics. Correlational analyses and clusters were performed to test how usability relates to sociodemographic characteristics and prior health knowledge. Results: The results indicated a lack of usability for both devices. Regarding the blood pressure monitor (137 participants), users made approximately 0.77 errors (SD 1.49), and the mean SUS score was 72.4 (SD 21.07), which is considered ``satisfactory.'' The pulse oximeter (147 participants) appeared easier to use, but participants made more errors (mean 0.99, SD 0.92), and the mean SUS score was 71.52 (SD 17.29), which is considered ``satisfactory.'' The results showed a low negative and significant correlation only between the effectiveness of the two devices and previous knowledge (blood pressure monitor: r=?0.191, P=.03; pulse oximeter: r=?0.263, P=.001). More subtly, we experimentally identified the existence of a threshold level ($\chi${\texttwosuperior}2,146=10.9, P=.004) for health knowledge to correctly use the pulse oximeter, but this was missing for the blood pressure monitor. Conclusions: This study has the following two contributions: (1) a theoretical interest highlighting the importance of user characteristics including prior health knowledge on usability outcomes and (2) an applied interest to provide recommendations to designers and medical staff. ", doi="10.2196/17983", url="http://mhealth.jmir.org/2020/9/e17983/", url="http://www.ncbi.nlm.nih.gov/pubmed/32955454" } @Article{info:doi/10.2196/20165, author="Seppen, F. Bart and Wiegel, Jimmy and L'ami, J. Merel and Duarte dos Santos Rico, Sharon and Catarinella, S. Fabio and Turkstra, Franktien and Boers, Maarten and Bos, H. Wouter", title="Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies", journal="JMIR Form Res", year="2020", month="Sep", day="21", volume="4", number="9", pages="e20165", keywords="mHealth", keywords="eHealth", keywords="patient-reported outcome, smartphone app", keywords="rheumatoid arthritis", keywords="self-monitoring", keywords="telemonitoring", keywords="mobile phone", abstract="Background: Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective: The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app---an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients' perspectives on app usage and its intended purpose. Methods: This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients' perspectives and the promoters and barriers of app usage. Results: In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61\% (17/28) and 37\% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81\% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that ``experiencing more grip on their disease'' and ``improved communication with their physician'' were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions: This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway. ", doi="10.2196/20165", url="http://formative.jmir.org/2020/9/e20165/", url="http://www.ncbi.nlm.nih.gov/pubmed/32955447" } @Article{info:doi/10.2196/18412, author="Lattie, G. Emily and Bass, Michael and Garcia, F. Sofia and Phillips, M. Siobhan and Moreno, I. Patricia and Flores, Marie Ann and Smith, JD and Scholtens, Denise and Barnard, Cynthia and Penedo, J. Frank and Cella, David and Yanez, Betina", title="Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation", journal="JMIR Form Res", year="2020", month="Sep", day="21", volume="4", number="9", pages="e18412", keywords="cancer survivorship", keywords="eHealth", keywords="patient-reported outcomes", keywords="digital health", keywords="symptom management", keywords="supportive care", abstract="Background: Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective: This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods: A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results: Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions: Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform. ", doi="10.2196/18412", url="http://formative.jmir.org/2020/9/e18412/", url="http://www.ncbi.nlm.nih.gov/pubmed/32955450" } @Article{info:doi/10.2196/16989, author="Geerds, J. Merle A. and Nijmeijer, S. Wieke and Hegeman, H. J. and Vollenbroek-Hutten, R. Miriam M.", title="Mobile App for Monitoring 3-Month Postoperative Functional Outcome After Hip Fracture: Usability Study", journal="JMIR Hum Factors", year="2020", month="Sep", day="14", volume="7", number="3", pages="e16989", keywords="hip fracture", keywords="remote monitoring", keywords="elderly", keywords="telemedicine", keywords="orthogeriatric", keywords="mHealth", keywords="app", abstract="Background: As a result of an aging population, there has been an increasing incidence of hip fractures worldwide. In the Netherlands, in order to improve the quality of care for elderly patients with hip fractures, the multidisciplinary Centre for Geriatric Traumatology was established in 2008 at the Department of Trauma Surgery at Ziekenhuisgroep Twente hospital (located in Almelo and Hengelo in the Netherlands). Objective: Though the Dutch Hip Fracture audit is used to monitor the quality of care for patients with fractures of the hip, only 30.7\% of patients complete registration in the 3-month follow-up period. Mobile apps offer an opportunity for improvement in this area. The aim of this study was to investigate the usability and acceptance of a mobile app for gathering indicators of quality of care in a 3-month follow-up period after postoperative treatment of hip fracture. Methods: From July 2017 to December 2017, patients who underwent surgical treatment for hip fracture were recruited. Patients and caregivers, who were collectively considered the participant cohort, were asked to download the app and answer a questionnaire. Participants were divided into two groups---those who downloaded the app and those who did not download the app. A telephone interview that was based upon the Unified Theory of Acceptance and Use of Technology was conducted with a subset of participants from each group (1:1 ratio). This study was designated as not being subject to the Dutch Medical Research Involving Human Subjects Act according to the appropriate medical research ethics committees. Results: Of the patients and caregivers who participated, 26.4\% (29/110) downloaded the app, whereas 73.6\% (81/110) did not. Telephone interviews with the subset of participants (n=24 per group) revealed that 54.0\% (13/24) of the group of participants who did not download the app had forgotten the study. Among the group who downloaded the app, 95.8\% (23/24) had the intention of completing the questionnaire, but only 4.2\% (1/24) did so. The reasons for not completing the questionnaire included technical problems, cognitive disorders, or patient dependency on caregivers. Most participants in the group who downloaded the app self-reported a high level of expertise in using a smartphone (22/24, 91.7\%), and sufficient facilitating conditions for using a smartphone were self-reported in both groups (downloaded the app: 23/24, 95.8\%; did not download the app: 21/24, 87.5\%), suggesting that these factors were not barriers to completion. Conclusions: Despite self-reported intention to use the app, smartphone expertise, and sufficient facilitating conditions for smartphone use, implementation of the mobile app was infeasible for daily practice. This was due to a combination of technical problems, factors related to the implementation process, and the population of interest having cognitive disorders or a dependency on caregivers for mobile technology. ", doi="10.2196/16989", url="https://humanfactors.jmir.org/2020/3/e16989", url="http://www.ncbi.nlm.nih.gov/pubmed/32924949" } @Article{info:doi/10.2196/19100, author="Prinsenberg, Tamara and Zantkuijl, Paul and Zuilhof, Wim and Davidovich, Udi and Schinkel, Janke and Prins, Maria and van der Valk, Marc", title="Design and Implementation of a Multilevel Intervention to Reduce Hepatitis C Transmission Among Men Who Have Sex With Men in Amsterdam: Co-Creation and Usability Study", journal="JMIR Form Res", year="2020", month="Sep", day="11", volume="4", number="9", pages="e19100", keywords="co-creation", keywords="mHealth", keywords="intervention", keywords="hepatitis C", keywords="prevention", keywords="risk reduction", keywords="MSM", keywords="HCV", abstract="Background: In the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). Early HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Therefore, targeted socioculturally acceptable preventive measures, including behavioral interventions, are urgently needed. Currently, little contextually appropriate information about HCV or risk reduction interventions is available. Objective: The objective of this project was to develop an intervention to reduce HCV transmission among MSM in Amsterdam through a co-creation process, with the input of men from the targeted community directly impacting intervention content, design, and implementation. Methods: We developed a multilevel intervention targeting 6 levels: individual, community, professional, context, patient, and network. The intervention was developed in close cooperation between health professionals, gay community members, commercial stakeholders, and stakeholders from within the gay community. The co-creation process had 4 phases: a needs assessment, stakeholder engagement, co-creation, and implementation. The co-creation phase continued until consensus was reached between the researchers and community members on the intervention content and design. The final intervention, NoMoreC, was completed within 2 years, and implementation started in February 2018. Results: NoMoreC includes web-based and face-to-face components as well as an anonymous HCV testing service. The NoMoreC website provides information about hepatitis C, HCV transmission routes, risk reduction strategies, testing and treatment options, and partner notification. The face-to-face component comprises a risk reduction toolbox, training for health professionals, and providing tailored advice to sex on premises venues. NoMoreC is promoted by an active voluntary campaign team. Conclusions: Involving the community and stakeholders in the creation of NoMoreC has been the main strength of this project. It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection. The uptake and acceptability of the described intervention will be evaluated in the future. The description of the co-creation process and implementation of the project may serve as a rich and useful source for others who want to develop culturally and context appropriate HCV interventions. ", doi="10.2196/19100", url="http://formative.jmir.org/2020/9/e19100/", url="http://www.ncbi.nlm.nih.gov/pubmed/32915157" } @Article{info:doi/10.2196/17057, author="Moon, Youngjin and Oh, Jeongmin and Hyun, Jaeho and Kim, Youngkyu and Choi, Jaesoon and Namgoong, Jeongman and Kim, Ki Jun", title="Cost-Effective Smartphone-Based Articulable Endoscope Systems for Developing Countries: Instrument Validation Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="10", volume="8", number="9", pages="e17057", keywords="smartphone-based endoscope", keywords="mobile health", keywords="low-resource settings", keywords="continuum body", keywords="articulable endoscope", keywords="low-cost medical device", keywords="point of care diagnostics", abstract="Background: Endoscopes are widely used for visualizing the respiratory tract, urinary tract, uterus, and gastrointestinal tracts. Despite high demand, people in underdeveloped and developing countries cannot obtain proper access to endoscopy. Moreover, commercially available endoscopes are mostly nonarticulable as well as not actively controlled, limiting their use. Articulating endoscopes are required for some diagnosis procedures, due to their ability to image wide areas of internal organs. Furthermore, actively controlled articulating endoscopes are less likely to harm the lumen than rigid endoscopes because they can avoid contact with endothelial tissues. Objective: The study aimed to demonstrate the feasibility and acceptability of smartphone-based wide-field articulable endoscope system for minimally invasive clinical applications in developing and less developed countries. Methods: A thin articulable endoscope system that can be attached to and actively controlled by a smartphone was designed and constructed. The system consists of a flexible endoscopic probe with a continuum mechanism, 4 motor modules for articulation, a microprocessor for controlling the motor with a smartphone, and a homebuilt app for streaming, capturing, adjusting images and video, and controlling the motor module with a joystick-like user interface. The smartphone and motor module are connected via an integrated C-type On-The-Go (OTG) USB hub. Results: We tested the device in several human-organ phantoms to evaluate the usability and utility of the smartphone-based articulating endoscope system. The resolution (960 {\texttimes} 720 pixels) of the device was found to be acceptable for medical diagnosis. The maximum bending angle of 110{\textdegree} was designed. The distance from the base of the articulating module to the tip of the endoscope was 45 mm. The angle of the virtual arc was 40.0{\textdegree}, for a curvature of 0.013. The finest articulation resolution was 8.9{\textdegree}. The articulating module succeeded in imaging all 8 octants of a spherical target, as well as all 4 quadrants of the indices marked in human phantoms. Conclusions: The portable wide-field endoscope was successfully controlled using a smartphone, yielding clear images with a resolution of 960 {\texttimes} 720 pixels at realistic focal distances. Actively and precisely controlled articulating movements have resulted in minimally invasive monitoring in the narrow space of internal organs providing a wide-area view. We found our smartphone-based active articulated endoscope to be suitable for point-of-care applications in developing and less developed countries. ", doi="10.2196/17057", url="http://mhealth.jmir.org/2020/9/e17057/", url="http://www.ncbi.nlm.nih.gov/pubmed/32909951" } @Article{info:doi/10.2196/18729, author="Nordstoga, Lovise Anne and Bach, Kerstin and Sani, Sadiq and Wiratunga, Nirmalie and Mork, Jarle Paul and Villumsen, Morten and Cooper, Kay", title="Usability and Acceptability of an App (SELFBACK) to Support Self-Management of Low Back Pain: Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2020", month="Sep", day="9", volume="7", number="2", pages="e18729", keywords="low back pain", keywords="self-management", keywords="physical activity", keywords="exercise", keywords="patient education", keywords="smartphone", keywords="mHealth", keywords="eHealth", keywords="digital health", keywords="case-based reasoning", abstract="Background: Self-management is the key recommendation for managing nonspecific low back pain (LBP). However, there are well-documented barriers to self-management; therefore, methods of facilitating adherence are required. Smartphone apps are increasingly being used to support self-management of long-term conditions such as LBP. Objective: The aim of this study was to assess the usability and acceptability of the SELFBACK smartphone app, designed to support and facilitate self-management of non-specific LBP. The app provides weekly self-management plans, comprising physical activity, strength and flexibility exercises, and patient education. The plans are tailored to the patient's characteristics and symptom progress by using case-based reasoning methodology. Methods: The study was carried out in 2 stages using a mixed-methods approach. All participants undertook surveys, and semistructured telephone interviews were conducted with a subgroup of participants. Stage 1 assessed an app version with only the physical activity component and a web questionnaire that collects information necessary for tailoring the self-management plans. The physical activity component included monitoring of steps recorded by a wristband, goal setting, and a scheme for sending personalized, timely, and motivational notifications to the user's smartphone. Findings from Stage 1 were used to refine the app and inform further development. Stage 2 investigated an app version that incorporated 3 self-management components (physical activity, exercises, and education). A total of 16 participants (age range 23-71 years) with ongoing or chronic nonspecific LBP were included in Stage 1, and 11 participants (age range 32-56 years) were included in Stage 2. Results: In Stage 1, 15 of 16 participants reported that the baseline questionnaire was easy to answer, and 84\% (13/16) found the completion time to be acceptable. Overall, participants were positive about the usability of the physical activity component but only 31\% (5/16) found the app functions to be well integrated. Of the participants, 90\% (14/16) were satisfied with the notifications, and they were perceived as being personalized (12/16, 80\%). In Stage 2, all participants reported that the web questionnaire was easy to answer and the completion time acceptable. The physical activity and exercise components were rated useful by 80\% (8/10), while 60\% (6/10) rated the educational component useful. Overall, participants were satisfied with the usability of the app; however, only 50\% (5/10) found the functions to be well integrated, and 20\% (2/10) found them to be inconsistent. Overall, 80\% (8/10) of participants reported it to be useful for self-management. The interviews largely reinforced the survey findings in both stages. Conclusions: This study has demonstrated that participants considered the SELFBACK app to be acceptable and usable and that they thought it would be useful for supporting self-management of LBP. However, we identified some limitations and suggestions useful to guide further development of the SELFBACK app and other mobile health interventions. ", doi="10.2196/18729", url="http://rehab.jmir.org/2020/2/e18729/", url="http://www.ncbi.nlm.nih.gov/pubmed/32902393" } @Article{info:doi/10.2196/19472, author="Said, Sadiq and Gozdzik, Malgorzata and Roche, Raoul Tadzio and Braun, Julia and R{\"o}ssler, Julian and Kaserer, Alexander and Spahn, R. Donat and N{\"o}thiger, B. Christoph and Tscholl, Werner David", title="Validation of the Raw National Aeronautics and Space Administration Task Load Index (NASA-TLX) Questionnaire to Assess Perceived Workload in Patient Monitoring Tasks: Pooled Analysis Study Using Mixed Models", journal="J Med Internet Res", year="2020", month="Sep", day="7", volume="22", number="9", pages="e19472", keywords="workload", keywords="questionnaires", keywords="National Aeronautics and Space Administration Task Load Index", keywords="awareness", keywords="situation awareness", keywords="patient monitoring", keywords="thromboelastometry", abstract="Background: Patient monitoring is indispensable in any operating room to follow the patient's current health state based on measured physiological parameters. Reducing workload helps to free cognitive resources and thus influences human performance, which ultimately improves the quality of care. Among the many methods available to assess perceived workload, the National Aeronautics and Space Administration Task Load Index (NASA-TLX) provides the most widely accepted tool. However, only few studies have investigated the validity of the NASA-TLX in the health care sector. Objective: This study aimed to validate a modified version of the raw NASA-TLX in patient monitoring tasks by investigating its correspondence with expected lower and higher workload situations and its robustness against nonworkload-related covariates. This defines criterion validity. Methods: In this pooled analysis, we evaluated raw NASA-TLX scores collected after performing patient monitoring tasks in four different investigator-initiated, computer-based, prospective, multicenter studies. All of them were conducted in three hospitals with a high standard of care in central Europe. In these already published studies, we compared conventional patient monitoring with two newly developed situation awareness--oriented monitoring technologies called Visual Patient and Visual Clot. The participants were resident and staff anesthesia and intensive care physicians, and nurse anesthetists with completed specialization qualification. We analyzed the raw NASA-TLX scores by fitting mixed linear regression models and univariate models with different covariates. Results: We assessed a total of 1160 raw NASA-TLX questionnaires after performing specific patient monitoring tasks. Good test performance and higher self-rated diagnostic confidence correlated significantly with lower raw NASA-TLX scores and the subscores (all P<.001). Staff physicians rated significantly lower workload scores than residents (P=.001), whereas nurse anesthetists did not show any difference in the same comparison (P=.83). Standardized distraction resulted in higher rated total raw NASA-TLX scores (P<.001) and subscores. There was no gender difference regarding perceived workload (P=.26). The new visualization technologies Visual Patient and Visual Clot resulted in significantly lower total raw NASA-TLX scores and all subscores, including high self-rated performance, when compared with conventional monitoring (all P<.001). Conclusions: This study validated a modified raw NASA-TLX questionnaire for patient monitoring tasks. The scores obtained correctly represented the assumed influences of the examined covariates on the perceived workload. We reported high criterion validity. The NASA-TLX questionnaire appears to be a reliable tool for measuring subjective workload. Further research should focus on its applicability in a clinical setting. ", doi="10.2196/19472", url="http://www.jmir.org/2020/9/e19472/", url="http://www.ncbi.nlm.nih.gov/pubmed/32780712" } @Article{info:doi/10.2196/17162, author="Guhl, Emily and Althouse, D. Andrew and Pusateri, M. Alexandra and Kimani, Everlyne and Paasche-Orlow, K. Michael and Bickmore, W. Timothy and Magnani, W. Jared", title="The Atrial Fibrillation Health Literacy Information Technology Trial: Pilot Trial of a Mobile Health App for Atrial Fibrillation", journal="JMIR Cardio", year="2020", month="Sep", day="4", volume="4", number="1", pages="e17162", keywords="atrial fibrillation", keywords="health-related quality of life", keywords="medication adherence", keywords="health literacy", keywords="mobile phone", abstract="Background: Atrial fibrillation (AF) is a common arrhythmia that adversely affects health-related quality of life (HRQoL). We conducted a pilot trial of individuals with AF using a smartphone to provide a relational agent as well as rhythm monitoring. We employed our pilot to measure acceptability and adherence and to assess its effectiveness in improving HRQoL and adherence. Objective: This study aims to measure acceptability and adherence and to assess its effectiveness to improve HRQoL and adherence. Methods: Participants were recruited from ambulatory clinics and randomized to a 30-day intervention or usual care. We collected baseline characteristics and conducted baseline and 30-day assessments of HRQoL using the Atrial Fibrillation Effect on Quality of Life (AFEQT) measure and self-reported adherence to anticoagulation. The intervention consisted of a smartphone-based relational agent, which simulates face-to-face counseling and delivered content on AF education, adherence, and symptom monitoring with prompted rhythm monitoring. We compared differences in AFEQT and adherence at 30 days, adjusted for baseline values. We quantified participants' use and acceptability of the intervention. Results: A total of 120 participants were recruited and randomized (59 to control and 61 to intervention) to the pilot trial (mean age 72.1 years, SD 9.10; 62/120, 51.7\% women). The control group had a 95\% follow-up, and the intervention group had a 93\% follow-up. The intervention group demonstrated significantly higher improvement in total AFEQT scores (adjusted mean difference 4.5; 95\% CI 0.6-8.3; P=.03) and in daily activity (adjusted mean difference 7.1; 95\% CI 1.8-12.4; P=.009) compared with the control between baseline and 30 days. The intervention group showed significantly improved self-reported adherence to anticoagulation therapy at 30 days (intervention 3.5\%; control 23.2\%; adjusted difference 16.6\%; 95\% CI 2.8\%-30.4\%; P<.001). Qualitative assessments of acceptability identified that participants found the relational agent useful, informative, and trustworthy. Conclusions: Individuals randomized to a 30-day smartphone intervention with a relational agent and rhythm monitoring showed significant improvement in HRQoL and adherence. Participants had favorable acceptability of the intervention with both objective use and qualitative assessments of acceptability. ", doi="10.2196/17162", url="http://cardio.jmir.org/2020/1/e17162/", url="http://www.ncbi.nlm.nih.gov/pubmed/32886070" } @Article{info:doi/10.2196/18570, author="Vila-Blanco, Nicol{\'a}s and Freire, Vicente and Balsa-Castro, Carlos and Tom{\'a}s, Inmaculada and Carreira, J. Mar{\'i}a", title="DenTiUS Plaque, a Web-Based Application for the Quantification of Bacterial Plaque: Development and Usability Study", journal="J Med Internet Res", year="2020", month="Sep", day="3", volume="22", number="9", pages="e18570", keywords="computer-aided diagnoses", keywords="computer-based biomedical applications", keywords="dental health", keywords="dental plaque quantification", keywords="web-based tools", keywords="medical informatics", abstract="Background: In the dentistry field, the analysis of dental plaque is vital because it is the main etiological factor in the 2 most prevalent oral diseases: caries and periodontitis. In most of the papers published in the dental literature, the quantification of dental plaque is carried out using traditional, non-automated, and time-consuming indices. Therefore, the development of an automated plaque quantification tool would be of great value to clinicians and researchers. Objective: This study aimed to develop a web-based tool called DenTiUS and various clinical indices to evaluate dental plaque levels using image analysis techniques. Methods: The tool was executed as a web-based application to facilitate its use by researchers. Expert users are free to define experiments, including images from either a single patient (to observe an individual plaque growth pattern) or several patients (to perform a group characterization) at a particular moment or over time. A novel approach for detecting visible plaque has been developed as well as a new concept known as nonvisible plaque. This new term implies the classification of the remaining dental area into 3 subregions according to the risk of accumulating plaque in the near future. New metrics have also been created to describe visible and nonvisible plaque levels. Results: The system generates results tables of the quantitative analysis with absolute averages obtained in each image (indices about visible plaque) and relative measurements (indices about visible and nonvisible plaque) relating to the reference moment. The clinical indices that can be calculated are the following: plaque index of an area per intensity (API index, a value between 0 and 100), area growth index (growth rate of plaque per unit of time in hours; percentage area/hour), and area time index (the time in days needed to achieve a plaque area of 100\% concerning the initial area at the same moment). Images and graphics can be obtained for a moment from a patient in addition to a full report presenting all the processing data. Dentistry experts evaluated the DenTiUS Plaque software through a usability test, with the best-scoring questions those related to the workflow efficiency, value of the online help, attractiveness of the user interface, and overall satisfaction. Conclusions: The DenTiUS Plaque software allows automatic, reliable, and repeatable quantification of dental plaque levels, providing information about area, intensity, and growth pattern. Dentistry experts recognized that this software is suitable for quantification of dental plaque levels. Consequently, its application in the analysis of plaque evolution patterns associated with different oral conditions, as well as to evaluate the effectiveness of various oral hygiene measures, can represent an improvement in the clinical setting and the methodological quality of research studies. ", doi="10.2196/18570", url="https://www.jmir.org/2020/9/e18570", url="http://www.ncbi.nlm.nih.gov/pubmed/32663148" } @Article{info:doi/10.2196/17686, author="Liao, Chien-Hung and Wu, Yu-Tung and Cheng, Chi-Tung and Ooyang, Chun-Hsiang and Kang, Shih-Ching and Fu, Chih-Yuan and Hsu, Yu-Pao and Hsieh, Chi-Hsun and Chen, Chih-Chi", title="An Image-Based Mobile Health App for Postdrainage Monitoring: Usability Study", journal="J Med Internet Res", year="2020", month="Aug", day="28", volume="22", number="8", pages="e17686", keywords="telemedicine", keywords="smartphone", keywords="surgical drainage", keywords="postdrainage care, mHealth", abstract="Background: The application of mobile health (mHealth) platforms to monitor recovery in the postdischarge period has increased in recent years. Despite widespread enthusiasm for mHealth, few studies have evaluated the usability and user experience of mHealth in patients with surgical drainage. Objective: Our objectives were to (1) develop an image-based smartphone app, SurgCare, for postdrainage monitoring and (2) determine the feasibility and clinical value of the use of SurgCare by patients with drainage. Methods: We enrolled 80 patients with biliary or peritoneal drainage in this study. A total of 50 patients were assigned to the SurgCare group, who recorded drainage monitoring data with the smartphone app; and 30 patients who manually recorded the data were assigned to the conventional group. The patients continued to record data until drain removal. The primary aim was to validate feasibility for the user, which was defined as the proportion of patients using each element of the system. Moreover, the secondary aim was to evaluate the association of compliance with SurgCare and the occurrence of unexpected events. Results: The average submission duration was 14.98 days, and the overall daily submission rate was 84.2\%. The average system usability scale was 83.7 (SD 3.5). This system met the definition of ``definitely feasible'' in 34 patients, ``possibly feasible'' in 10 patients, and ``not feasible'' in 3 patients. We found that the occurrence rates of complications in the SurgCare group and the conventional group were 6\% and 26\%, respectively, with statistically significant differences P=.03. The rate of unexpected hospital return was lower in the SurgCare group (6\%) than in the conventional groups (26\%) (P=.03). Conclusions: Patients can learn to use a smartphone app for postdischarge drainage monitoring with high levels of user satisfaction. We also identified a high degree of compliance with app-based drainage-recording design features, which is an aspect of mHealth that can improve surgical care. ", doi="10.2196/17686", url="http://www.jmir.org/2020/8/e17686/", url="http://www.ncbi.nlm.nih.gov/pubmed/32857060" } @Article{info:doi/10.2196/15866, author="Patel, Devika and Sarlati, Siavash and Martin-Tuite, Patrick and Feler, Joshua and Chehab, Lara and Texada, Michael and Marquez, Ruben and Orellana, Julia F. and Henderson, L. Terrell and Nwabuo, Adaobi and Plevin, Rebecca and Dicker, Ami Rochelle and Juillard, Catherine and Sammann, Amanda", title="Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="24", volume="8", number="8", pages="e15866", keywords="human-centered design", keywords="violence intervention", keywords="information and communications technology", abstract="Background: Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective: Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods: We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results: Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions: Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community. ", doi="10.2196/15866", url="http://mhealth.jmir.org/2020/8/e15866/", url="http://www.ncbi.nlm.nih.gov/pubmed/32831179" } @Article{info:doi/10.2196/17739, author="Sch{\"u}ttler, Christina and Huth, Verena and von Jagwitz-Biegnitz, Magdal{\'e}na and Lablans, Martin and Prokosch, Hans-Ulrich and Griebel, Lena", title="A Federated Online Search Tool for Biospecimens (Sample Locator): Usability Study", journal="J Med Internet Res", year="2020", month="Aug", day="18", volume="22", number="8", pages="e17739", keywords="software tools", keywords="biological specimen banks", keywords="user interface", keywords="evaluation", keywords="research", abstract="Background: The German Biobank Alliance (GBA) aims to establish a cross-site biobank network. For this endeavor, the so-called Sample Locator, a federated search tool for biospecimens and related data, has been developed, forming the heart of its information technology (IT) infrastructure. Objective: To ensure the sustainable use of such a tool, we included researchers as participants in an end user--based usability evaluation. Methods: To develop a prototype ready for evaluation, we needed input from GBA IT experts. Thus, we conducted a 2-day workshop with 8 GBA IT team members. The focus was on the respective steps of a user-centered design process. With the acquired knowledge, the participants designed low-fidelity mock-ups. The main ideas of these mock-ups were discussed, extracted, and summarized into a comprehensive prototype using Microsoft PowerPoint. Furthermore, we created a questionnaire concerning the usability of the prototype, including the System Usability Scale (SUS), questions on negative and positive aspects, and typical tasks to be fulfilled with the tool. Subsequently, the prototype was pretested on the basis of this questionnaire with researchers who have a biobank background. Based on this preliminary work, the usability analysis was ultimately carried out with researchers and the results were evaluated. Results: Altogether, 27 researchers familiar with sample requests evaluated the prototype. The analysis of the feedback certified a good usability, given that the Sample Locator prototype was seen as intuitive and user-friendly by 74\% (20/27) of the participants. The total SUS score by the 25 persons that completed the questionnaire was 80.4, indicating good system usability. Still, the evaluation provided useful advice on optimization potential (eg, offering a help function). Conclusions: The findings of this usability analysis indicate that the considerations regarding a user-friendly application that have been made in the development process so far strongly coincide with the perception of the study participants. Nevertheless, it was important to engage prospective end users to ensure that the previous development is going in the desired direction and that the Sample Locator will be used in the future. The user comments and suggestions for improvement will be considered in upcoming iterations for refinement. ", doi="10.2196/17739", url="http://www.jmir.org/2020/8/e17739/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663150" } @Article{info:doi/10.2196/16725, author="Lopez, Cristina and Gilmore, K. Amanda and Moreland, Angela and Danielson, Kmett Carla and Acierno, Ron", title="Meeting Kids Where They Are At--A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study", journal="J Med Internet Res", year="2020", month="Aug", day="11", volume="22", number="8", pages="e16725", keywords="adolescents", keywords="substance use", keywords="sexual risk reduction", keywords="telehealth", keywords="prevention programs", keywords="mobile phone", abstract="Background: Rural African American youth lack access to drug and sexual risk--taking prevention programs available in more urban areas. Recent data indicate that rural youth now use substances at higher rates and at younger ages than their urban peers. Objective: This study aims to evaluate the initial usability and acceptability of a low-cost, technology-based approach to delivering effective, culturally tailored, integrated substance use disorder (SUD) and HIV risk behavior prevention programs to African American female youth to inform the use of this intervention via telemedicine for rural youth. Methods: Effective SUD prevention strategies and emotion regulation skills were integrated into an existing evidence-based HIV risk reduction program culturally tailored for African American female adolescents---Sisters Informing, Healing, Living, and Empowering (SIHLE)---and delivered to 39 African American female youth via group telehealth. The evaluation of the resulting program, 12-session SIHLEplus, was completed by 27 girls who also completed self-report measures that assessed sexual risk behaviors (eg, number of partners and age of sex initiation), substance use, exposure to traumatic events, and emotion regulation. Results: The descriptive and qualitative results of the pilot study demonstrate the initial usability and acceptability of delivering evidence-based prevention successfully via telehealth to help address health disparities in this vulnerable population. Conclusions: Although more research is needed, the findings from this study suggest that SIHLEplus has demonstrated initial usability and acceptability. ", doi="10.2196/16725", url="http://www.jmir.org/2020/8/e16725/", url="http://www.ncbi.nlm.nih.gov/pubmed/32780022" } @Article{info:doi/10.2196/16175, author="Guay, Manon and Latulippe, Karine and Auger, Claudine and Giroux, Dominique and S{\'e}guin-Tremblay, No{\'e}mie and Gauthier, Jos{\'e}e and Genest, Catherine and Morales, Ernesto and Vincent, Claude", title="Self-Selection of Bathroom-Assistive Technology: Development of an Electronic Decision Support System (Hygiene 2.0)", journal="J Med Internet Res", year="2020", month="Aug", day="10", volume="22", number="8", pages="e16175", keywords="hygiene", keywords="activities of daily living", keywords="decision aids", keywords="occupational therapy", keywords="aging", keywords="self-help devices", keywords="universal design", keywords="accidental falls", keywords="mobile phone", abstract="Background: A clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom. Objective: This study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly. Methods: On the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS. Results: Overall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H2.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify). Conclusions: The user-centered design of H2.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users' realities, tailoring the e-DSS to the implementation context. ", doi="10.2196/16175", url="https://www.jmir.org/2020/8/e16175", url="http://www.ncbi.nlm.nih.gov/pubmed/32773380" } @Article{info:doi/10.2196/16862, author="Petersen, Lee Curtis and Halter, Ryan and Kotz, David and Loeb, Lorie and Cook, Summer and Pidgeon, Dawna and Christensen, C. Brock and Batsis, A. John", title="Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="7", volume="8", number="8", pages="e16862", keywords="aged adults", keywords="sarcopenia", keywords="remote sensing technology", keywords="telemedicine", keywords="mobile phone", abstract="Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40\% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process. Objective: This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in NLP and sentiment analysis Methods: Through a user-centered design process, we conducted semistructured interviews during the development of a geriatric-friendly Bluetooth-connected resistance exercise band app. We interviewed patients and clinicians at weeks 0, 5, and 10 of the app development. Each semistructured interview consisted of heuristic evaluations, cognitive walkthroughs, and observations. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. Sentiment was defined as the sum of positive and negative words (each word with a +1 or ?1 value). To assess utility, we used quantitative assessment questionnaires---System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). Finally, we used multivariate linear models---adjusting for age, sex, subject group (clinician vs patient), and development---to explore the association between sentiment analysis and SUS and USE outcomes. Results: The mean age of the 22 participants was 68 (SD 14) years, and 17 (77\%) were female. The overall mean SUS and USE scores were 66.4 (SD 13.6) and 41.3 (SD 15.2), respectively. Both patients and clinicians provided valuable insights into the needs of older adults when designing and building an app. The mean positive-negative sentiment per sentence was 0.19 (SD 0.21) and 0.47 (SD 0.21) for patient and clinician interviews, respectively. We found a positive association with positive sentiment in an interview and SUS score ({\ss}=1.38; 95\% CI 0.37 to 2.39; P=.01). There was no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Conclusions: Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults. ", doi="10.2196/16862", url="https://mhealth.jmir.org/2020/8/e16862", url="http://www.ncbi.nlm.nih.gov/pubmed/32540843" } @Article{info:doi/10.2196/15156, author="Krzyzanowski, C. Michelle and Kizakevich, N. Paul and Duren-Winfield, Vanessa and Eckhoff, Randall and Hampton, Joel and Blackman Carr, T. Loneke and McCauley, Georgia and Roberson, B. Kristina and Onsomu, O. Elijah and Williams, John and Price, Alise Amanda", title="Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="5", volume="8", number="8", pages="e15156", keywords="exercise", keywords="cardiovascular disease", keywords="diary", keywords="diet", keywords="mHealth", keywords="mobile phone", abstract="Background: With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. Objective: We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. Methods: We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. Results: Of the 55 students in the intervention group, 27 (49\%) students in cohort 2 and 25 (45\%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. Conclusions: Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation. ", doi="10.2196/15156", url="https://mhealth.jmir.org/2020/8/e15156", url="http://www.ncbi.nlm.nih.gov/pubmed/32755883" } @Article{info:doi/10.2196/16004, author="King, D'Arcy and Khan, Sundas and Polo, Jennifer and Solomon, Jeffrey and Pekmezaris, Renee and Hajizadeh, Negin", title="Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study", journal="JMIR Rehabil Assist Technol", year="2020", month="Aug", day="4", volume="7", number="2", pages="e16004", keywords="chronic obstructive pulmonary disease", keywords="usability testing", keywords="telehealth", keywords="telerehabilitation", keywords="vulnerable populations", abstract="Background: Telehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices. Objective: The objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study. Methods: Usability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions. Results: During usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements. Conclusions: Usability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions. ", doi="10.2196/16004", url="http://rehab.jmir.org/2020/2/e16004/", url="http://www.ncbi.nlm.nih.gov/pubmed/32749229" } @Article{info:doi/10.2196/19072, author="Johnson, Gr{\o}dem Susanne and Potrebny, Thomas and Larun, Lillebeth and Ciliska, Donna and Olsen, Rydland Nina", title="Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2020", month="Aug", day="4", volume="9", number="8", pages="e19072", keywords="user-computer interface", keywords="mobile app", keywords="online learning", keywords="health education", keywords="students", abstract="Background: E-learning technologies, including mobile apps, are used to a large extent in health care education. Mobile apps can provide extendable learning environments and motivate students for adaptive and collaborative learning outside the classroom context. Developers should design practical, effective, and easy-to-use mobile apps. Usability testing is an important part of app development in order to understand if apps meet the needs of users. Objective: The aim of this study is to perform a scoping review of usability methods and attributes reported in usability studies of mobile apps for health care education. Methods: The scoping review is guided by the methodological framework developed by Arksey \& O'Malley and further developed by Levac et al and Kahlil et al. The stages we will follow are as follows: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) summarizing and reporting the results. We have developed two research questions to meet the aim of the study, which are as follows: (1) What usability methods are used to evaluate the usability of mobile apps for health care education? and (2) What usability attributes are reported in the usability studies of mobile apps for health care education? We will apply a comprehensive search of the literature, including 10 databases, a reference search, and a search for grey literature. Two review authors will independently screen articles for eligibility. Results: The initial electronic database searches were completed in March 2019. The literature search identified 14,297 unique references. Following title and abstract screening, the full texts of 369 records were obtained. The scoping review is expected to be completed in spring 2021. Conclusions: We expect the overview of usability methods and attributes reported in usability studies of mobile apps for health care education to contribute to the knowledge base for researchers and developers. It will give an overview of the research field and provide researchers and developers with relevant and important information on the usability research area, including highlighting possible research gaps. International Registered Report Identifier (IRRID): DERR1-10.2196/19072 ", doi="10.2196/19072", url="https://www.researchprotocols.org/2020/8/e19072", url="http://www.ncbi.nlm.nih.gov/pubmed/32750011" } @Article{info:doi/10.2196/18196, author="Giunti, Guido and Rivera-Romero, Octavio and Kool, Jan and Bansi, Jens and Sevillano, Luis Jose and Granja-Dominguez, Anabel and Izquierdo-Ayuso, Guillermo and Giunta, Diego", title="Evaluation of More Stamina, a Mobile App for Fatigue Management in Persons with Multiple Sclerosis: Protocol for a Feasibility, Acceptability, and Usability Study", journal="JMIR Res Protoc", year="2020", month="Aug", day="4", volume="9", number="8", pages="e18196", keywords="multiple sclerosis", keywords="mHealth", keywords="fatigue", keywords="fatigue management", keywords="apps", keywords="gamification", keywords="user-centered design", keywords="usability, physical activity", keywords="eHealth", keywords="chronic conditions", abstract="Background: Multiple sclerosis (MS) is one of the world's most common neurologic disorders leading to severe disability in young adults. MS-related fatigue directly impacts on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, an mHealth solution called More Stamina was created to help persons with MS manage their fatigue. Objective: The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. Methods: A mixed-methods, multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the third and fourth quarters of 2020 (Q3-Q4 2020) in 3 locations: Argentina, Spain, and Switzerland. A longitudinal cohort study will take place, and think-aloud protocols, open-ended interviews, and short answer questionnaires will be used. Persons with MS will be recruited from the different locations. This study seeks to enroll at least 20 patients that meet the criteria from each site for the longitudinal cohort study (total n=60). Results: Ethical approval has been granted in Argentina and is pending in Spain and Switzerland. Outcomes will be published in peer-reviewed medical journals and presented at international conferences. Conclusions: Findings from this study will be used to help understand the role that mHealth can play in fatigue management in MS. Trial Registration: ClinicalTrials.gov NCT04244214; https://clinicaltrials.gov/ct2/show/NCT04244214 International Registered Report Identifier (IRRID): PRR1-10.2196/18196 ", doi="10.2196/18196", url="https://www.researchprotocols.org/2020/8/e18196", url="http://www.ncbi.nlm.nih.gov/pubmed/32749995" } @Article{info:doi/10.2196/17658, author="Guo, Xujun and Yang, Yarui and Takiff, E. Howard and Zhu, Minmin and Ma, Jianping and Zhong, Tao and Fan, Yuzheng and Wang, Jian and Liu, Shengyuan", title="A Comprehensive App That Improves Tuberculosis Treatment Management Through Video-Observed Therapy: Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="31", volume="8", number="7", pages="e17658", keywords="tuberculosis", keywords="management", keywords="video-observed therapy", keywords="directly observed therapy", keywords="mobile phone", abstract="Background: Treatment of pulmonary tuberculosis (TB) requires at least six months and is compromised by poor adherence. In the directly observed therapy (DOT) scheme recommended by the World Health Organization, the patient is directly observed taking their medications at a health post. An alternative to DOT is video-observed therapy (VOT), in which the patients take videos of themselves taking the medication and the video is uploaded into the app and reviewed by a health care worker. We developed a comprehensive TB management system by using VOT that is installed as an app on the smartphones of both patients and health care workers. It was implemented into the routine TB control program of the Nanshan District of Shenzhen, China. Objective: The aim of this study was to compare the effectiveness of VOT with that of DOT in managing the treatment of patients with pulmonary TB and to evaluate the acceptance of VOT for TB management by patients and health care workers. Methods: Patients beginning treatment between September 2017 and August 2018 were enrolled into the VOT group and their data were compared with the retrospective data of patients who began TB treatment and were managed with routine DOT between January 2016 and August 2017. Sociodemographic characteristics, clinical features, treatment adherence, positive findings of sputum smears, reporting of side effects, time and costs of transportation, and satisfaction were compared between the 2 treatment groups. The attitudes of the health care workers toward the VOT-based system were also analyzed. Results: This study included 158 patients in the retrospective DOT group and 235 patients in the VOT group. The VOT group showed a significantly higher fraction of doses observed (P<.001), less missed observed doses (P<.001), and fewer treatment discontinuations (P<.05) than the DOT group. Over 79.1\% (186/235) of the VOT patients had >85\% of their doses observed, while only 16.4\% (26/158) of the DOT patients had >85\% of their doses observed. All patients were cured without recurrences. The VOT management required significantly (P<.001) less median patient time (300 minutes vs 1240 minutes, respectively) and transportation costs ({\textyen}53 [US \$7.57] vs {\textyen}276 [US \$39.43], respectively; P<.001) than DOT. Significantly more patients (191/235, 81.3\%) in the VOT group preferred their treatment method compared to those on DOT (37/131, 28.2\%) (P<.001), and 92\% (61/66) of the health care workers thought that the VOT method was more convenient than DOT for managing patients with TB. Conclusions: Implementation of the VOT-based system into the routine program of TB management was simple and it significantly increased patient adherence to their drug regimens. Our study shows that a comprehensive VOT-based TB management represents a viable and improved evolution of DOT. ", doi="10.2196/17658", url="https://mhealth.jmir.org/2020/7/e17658", url="http://www.ncbi.nlm.nih.gov/pubmed/32735222" } @Article{info:doi/10.2196/17481, author="O'Grady, Conor and Melia, Ruth and Bogue, John and O'Sullivan, Mary and Young, Karen and Duggan, Jim", title="A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan)", journal="J Med Internet Res", year="2020", month="Jul", day="30", volume="22", number="7", pages="e17481", keywords="mobile apps", keywords="suicide", keywords="mHealth", abstract="Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users' access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app's core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. ", doi="10.2196/17481", url="http://www.jmir.org/2020/7/e17481/", url="http://www.ncbi.nlm.nih.gov/pubmed/32729845" } @Article{info:doi/10.2196/12655, author="Arevian, C. Armen and O'Hora, Jennifer and Rosser, James and Mango, D. Joseph and Miklowitz, J. David and Wells, B. Kenneth", title="Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="29", volume="8", number="7", pages="e12655", keywords="mobile health", keywords="community-based participatory research", keywords="app development", keywords="technology platforms", keywords="personalized medicine", keywords="behavioral health", keywords="mobile phone", abstract="Background: Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective: We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods: In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results: Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90\%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80\%) agreed that the messages were effective at helping complete treatment plans. Conclusions: Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies. ", doi="10.2196/12655", url="http://mhealth.jmir.org/2020/7/e12655/", url="http://www.ncbi.nlm.nih.gov/pubmed/32723714" } @Article{info:doi/10.2196/17132, author="Dimaguila, Luis Gerardo and Gray, Kathleen and Merolli, Mark", title="Enabling Better Use of Person-Generated Health Data in Stroke Rehabilitation Systems: Systematic Development of Design Heuristics", journal="J Med Internet Res", year="2020", month="Jul", day="28", volume="22", number="7", pages="e17132", keywords="person-generated health data", keywords="patient-reported outcome measures", keywords="heuristics", keywords="stroke rehabilitation", keywords="consumer health informatics", keywords="evidence-based practice", keywords="information technology", abstract="Background: An established and well-known method for usability assessment of various human-computer interaction technologies is called heuristic evaluation (HE). HE has been adopted for evaluations in a wide variety of specialized contexts and with objectives that go beyond usability. A set of heuristics to evaluate how health information technologies (HITs) incorporate features that enable effective patient use of person-generated health data (PGHD) is needed in an era where there is a growing demand and variety of PGHD-enabled technologies in health care and where a number of remote patient-monitoring technologies do not yet enable patient use of PGHD. Such a set of heuristics would improve the likelihood of positive effects from patients' use of PGHD and lower the risk of negative effects. Objective: This study aims to describe the development of a set of heuristics for the design and evaluation of how well remote patient therapeutic technologies enable patients to use PGHD (PGHD enablement). We used the case of Kinect-based stroke rehabilitation systems (K-SRS) in this study. Methods: The development of a set of heuristics to enable better use of PGHD was primarily guided by the R3C methodology. Closer inspection of the methodology reveals that neither its development nor its application to a case study were described in detail. Thus, where relevant, each step was grounded through best practice activities in the literature and by using Nielsen's heuristics as a basis for determining the new set of heuristics. As such, this study builds on the R3C methodology, and the implementation of a mixed process is intended to result in a robust and credible set of heuristics. Results: A total of 8 new heuristics for PGHD enablement in K-SRS were created. A systematic and detailed process was applied in each step of heuristic development, which bridged the gaps described earlier. It is hoped that this would aid future developers of specialized heuristics, who could apply the detailed process of heuristic development for other domains of technology, and additionally for the case of PGHD enablement for other health conditions. The R3C methodology was also augmented through the use of qualitative studies with target users and domain experts, and it is intended to result in a robust and credible set of heuristics, before validation and refinement. Conclusions: This study is the first to develop a new set of specialized heuristics to evaluate how HITs incorporate features that enable effective patient use of PGHD, with K-SRS as a key case study. In addition, it is the first to describe how the identification of initial HIT features and concepts to enable PGHD could lead to the development of a specialized set of heuristics. ", doi="10.2196/17132", url="http://www.jmir.org/2020/7/e17132/", url="http://www.ncbi.nlm.nih.gov/pubmed/32720901" } @Article{info:doi/10.2196/18779, author="Park, Kyung Bu and Kim, Yoon Ji and Rogers, E. Valerie", title="Development and Usability Evaluation of a Facebook-Based Intervention Program for Childhood Cancer Patients: Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Jul", day="28", volume="22", number="7", pages="e18779", keywords="pediatric cancer patients", keywords="childhood cancer", keywords="social network site", keywords="Facebook", keywords="usability", abstract="Background: Childhood cancers previously considered to be incurable now have 5-year survival rates up to 84\%. Nevertheless, these patients remain at risk of morbidity and mortality from therapy-related complications. Thus, patient education and self-management strategies for promoting a healthy lifestyle are of tantamount importance for improving short- and long-term health outcomes. A Facebook-based ``Healthy Teens for Soaam'' (a Korean term for childhood cancers) program was developed to help improve knowledge and self-management practices of teens with cancer related to their disease and treatment. Objective: The two-fold purpose of this usability study was (1) to describe the process of developing an 8-week Facebook-based intervention program for teens with cancer, and (2) to evaluate its usability to refine the program. Methods: Multiple phases and methods were employed to develop and evaluate the usability of the program. Study phases included: (1) needs assessment through focus group interviews and qualitative content analysis, (2) development of module content, (3) expert review and feedback on module content, (4) Facebook-based program development, (5) usability evaluation by heuristic evaluation, (6) usability evaluation by targeted end-user testing, and (7) modification and final version of the program. Usability of the final version was confirmed through feedback loops of these phases. Results: Based on 6 focus group discussion sessions, it was determined that teens with cancer were interested in seeing stories of successful childhood cancer cases and self-management after discharge, and preferred multimedia content over text. Therefore, each Facebook module was redesigned to include multimedia materials such as relevant video clips tailored for teens. Usability assessed by heuristic evaluation and user testing revealed several critical usability issues, which were then revised. Potential end users tested the final program and perceived it to be usable and useful for teens with cancer. Conclusions: To our knowledge, ``Healthy Teens for Soaam'' is the first Facebook-based intervention program for teens with cancer. We actively worked with current childhood cancer patients and survivors to develop and improve this program, achieved good usability, and met the expressed needs and preferences of target end users. This 8-week Facebook-based educational program for teens with cancer, developed as the first step of an upcoming intervention study, will be useful for improving knowledge and self-management strategies of teens. ", doi="10.2196/18779", url="http://www.jmir.org/2020/7/e18779/", url="http://www.ncbi.nlm.nih.gov/pubmed/32720897" } @Article{info:doi/10.2196/16904, author="Rael, Tagliaferri Christine and Lentz, Cody and Carballo-Di{\'e}guez, Alex and Giguere, Rebecca and Dolezal, Curtis and Feller, Daniel and D'Aquila, T. Richard and Hope, J. Thomas", title="Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Jul", day="27", volume="22", number="7", pages="e16904", keywords="PrEP implant", keywords="YouTube", keywords="acceptability", keywords="long-acting PrEP", keywords="systemic PrEP", keywords="human-centered design", keywords="HIV prevention", keywords="removable implant", keywords="long-acting HIV prevention", keywords="gay and bisexual men", abstract="Background: A long-acting implant for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This could provide an alternative to oral PrEP. Objective: Our mixed methods study aimed to understand (1) users' experiences with a similar subdermal implant for contraception and (2) factors influencing the likelihood that gay and bisexual men (GBM) would use a proposed PrEP implant. Methods: Work was completed in 4 stages. In stage 1, we conducted a scientific literature review on existing subdermal implants, focusing on users' experiences with implant devices. In stage 2, we reviewed videos on YouTube, focusing on the experiences of current or former contraceptive implant users (as these implants are similar to those in development in SLAP-HIV). In stage 3, individuals who indicated use of a subdermal implant for contraception in the last 5 years were recruited via a web-based questionnaire. Eligible participants (n=12 individuals who liked implants a lot and n=12 individuals who disliked implants a lot) completed in-depth phone interviews (IDIs) about their experiences. In stage 4, results from IDIs were used to develop a web-based survey for HIV-negative GBM to rate their likelihood of using a PrEP implant on a scale (1=very unlikely and 5=very likely) based on likely device characteristics and implant concerns identified in the IDIs. Results: In the scientific literature review (stage 1), concerns about contraceptive implants that could apply to the PrEP implants in development included potential side effects (eg, headache), anticipated high cost of the device, misconceptions about PrEP implants (eg, specific contraindications), and difficulty accessing PrEP implants. In the stage 2 YouTube review, individuals who had used contraceptive implants reported mild side effects related to their device. In stage 3, implant users reported that devices were comfortable, unintrusive, and presented only minor discomfort (eg, bruising) before or after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (eg, prolonged menstruation). Participants in the stage 4 quantitative survey (N=304) were mainly gay (204/238, 85.7\%), white (125/238, 52.5\%), cisgender men (231/238, 97.1\%), and 42.0\% (73/174) of them were on oral PrEP. Not having to take a daily pill increased the likelihood of using PrEP implants (mean 4.13). Requiring >1 device to achieve 1 year of protection (mean range 1.79-2.94) mildly discouraged PrEP implant use. Participants did not mind moderate bruising, a small scar, tenderness, or bleeding after insertion or removal, and an implant with a size slightly larger than a matchstick (mean ratings 3.18-3.69). Conclusions: PrEP implants are promising among GBM. Implant features and insertion or removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP implants should require the fewest possible implants for the greatest protection duration. ", doi="10.2196/16904", url="https://www.jmir.org/2020/7/e16904", url="http://www.ncbi.nlm.nih.gov/pubmed/32348277" } @Article{info:doi/10.2196/19585, author="Kim, HyangHee and Lee, Sang-Ho and Cho, Nam-Bin and You, Heecheon and Choi, Teukgyu and Kim, Jinwon", title="User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="27", volume="8", number="7", pages="e19585", keywords="older adults", keywords="dysphagia", keywords="swallowing", keywords="mHealth", keywords="thematic analysis", keywords="usability", keywords="apps", keywords="education", keywords="experience", keywords="sociodemographic", abstract="Background: Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13\% to 54\% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective: The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults' self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods: A total of 11 participants (10 women, 91\%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results: The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=--2.023, P=.04). Additionally, the usability scores in the low-potential group were within the ``marginal acceptability'' range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions: To the best of the authors' knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program. ", doi="10.2196/19585", url="http://mhealth.jmir.org/2020/7/e19585/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663161" } @Article{info:doi/10.2196/17373, author="Doma?ska, Barbara and Vansant, Stijn and Mountian, Irina", title="A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study", journal="JMIR Form Res", year="2020", month="Jul", day="27", volume="4", number="7", pages="e17373", keywords="rheumatology", keywords="internet", keywords="digital health", keywords="mobile health", keywords="mHealth", keywords="smartphone", keywords="mobile phone", keywords="validation human factors study", abstract="Background: Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective: This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods: We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients' success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results: A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0\%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7\%) successes with difficulty and 13 (6.3\%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0\%) were completed without use errors. Conclusions: In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease. ", doi="10.2196/17373", url="http://formative.jmir.org/2020/7/e17373/", url="http://www.ncbi.nlm.nih.gov/pubmed/32716310" } @Article{info:doi/10.2196/16380, author="Mehra, Sumit and van den Helder, Jantine and Visser, Bart and Engelbert, H. Raoul H. and Weijs, M. Peter J. and Kr{\"o}se, A. Ben J.", title="Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Jul", day="23", volume="22", number="7", pages="e16380", keywords="frail elderly", keywords="aged", keywords="activities of daily living", keywords="exercise", keywords="health behavior", keywords="telemedicine", keywords="mobile devices", keywords="tablet computers", keywords="usability testing", keywords="evaluation", abstract="Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29\% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36\% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17\% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. ", doi="10.2196/16380", url="http://www.jmir.org/2020/7/e16380/", url="http://www.ncbi.nlm.nih.gov/pubmed/32459652" } @Article{info:doi/10.2196/19582, author="Langan, Jeanne and Bhattacharjya, Sutanuka and Subryan, Heamchand and Xu, Wenyao and Chen, Baicheng and Li, Zhengxiong and Cavuoto, Lora", title="In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e19582", keywords="stroke", keywords="rehabilitation", keywords="smart technology", keywords="3D printing", keywords="usability", abstract="Background: Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback. Objective: To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments. Methods: mRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user's perception of mRehab. Results: A total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant's perception of mRehab was positive. Conclusions: Despite heterogeneity in participants' use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ", doi="10.2196/19582", url="http://mhealth.jmir.org/2020/7/e19582/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706702" } @Article{info:doi/10.2196/16979, author="Garvelink, Marjolein Mirjam and Agbadj{\'e}, Tatiana Titilayo and Freitas, Adriana and Bergeron, Lysa and Petitjean, Thomas and Dugas, Mich{\`e}le and Blair, Louisa and Archambault, Patrick and Roy, No{\'e}mie and Jones, Allyson and L{\'e}gar{\'e}, France", title="Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e16979", keywords="internet-based intervention", keywords="frail elderly", keywords="caregivers", keywords="decision making", keywords="personal autonomy", keywords="housing for the elderly", abstract="Background: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ?65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors' accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website---Support for Older Adults to Stay Independent at Home (SUSTAIN)---will be implemented and made available to better assist older adults and caregivers in staying independent at home. ", doi="10.2196/16979", url="https://mhealth.jmir.org/2020/7/e16979", url="http://www.ncbi.nlm.nih.gov/pubmed/32412908" } @Article{info:doi/10.2196/18068, author="Meinert, Edward and Rahman, Em and Potter, Alison and Lawrence, Wendy and Van Velthoven, Michelle", title="Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2020", month="Jul", day="22", volume="9", number="7", pages="e18068", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="digital technology", keywords="weight loss", keywords="obesity", keywords="overweight", keywords="child health", keywords="cell phone", keywords="telecommunication", abstract="Background: Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care's national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity. Objective: This feasibility study assesses the usability and acceptability of Health Education England's NoObesity app for undertaking activities to improve families' diet and physical activity. The purpose of the study is to evaluate the app's influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. Methods: The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants. Results: This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021. Conclusions: This study will provide evidence on the NoObesity app's influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. International Registered Report Identifier (IRRID): PRR1-10.2196/18068 ", doi="10.2196/18068", url="http://www.researchprotocols.org/2020/7/e18068/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706703" } @Article{info:doi/10.2196/17703, author="Cornet, Philip Victor and Toscos, Tammy and Bolchini, Davide and Rohani Ghahari, Romisa and Ahmed, Ryan and Daley, Carly and Mirro, J. Michael and Holden, J. Richard", title="Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e17703", keywords="user-centered design", keywords="research methods", keywords="mobile health", keywords="digital health", keywords="mobile apps", keywords="usability", keywords="technology", keywords="evaluation", keywords="human-computer interaction", keywords="mobile phone", abstract="Background: User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective: This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods: Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results: We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers' assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions: UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories. ", doi="10.2196/17703", url="http://mhealth.jmir.org/2020/7/e17703/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706745" } @Article{info:doi/10.2196/15331, author="Hsiao, Po-Jen and Chiu, Chih-Chien and Lin, Ke-Hsin and Hu, Fu-Kang and Tsai, Pei-Jan and Wu, Chun-Ting and Pang, Yuan-Kai and Lin, Yu and Kuo, Ming-Hao and Chen, Kang-Hua and Wu, Yi-Syuan and Wu, Hao-Yi and Chang, Ya-Ting and Chang, Yu-Tien and Cheng, Chia-Shiang and Chuu, Chih-Pin and Lin, Fu-Huang and Chang, Chi-Wen and Li, Yuan-Kuei and Chan, Jenq-Shyong and Chu, Chi-Ming", title="Usability of Wearable Devices With a Novel Cardiac Force Index for Estimating the Dynamic Cardiac Function: Observational Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e15331", keywords="cardiac force", keywords="running", keywords="acceleration", keywords="physical activity", keywords="heart rate", abstract="Background: Long-distance running can be a form of stress to the heart. Technological improvements combined with the public's gradual turn toward mobile health (mHealth), self-health, and exercise effectiveness have resulted in the widespread use of wearable exercise products. The monitoring of dynamic cardiac function changes during running and running performance should be further studied. Objective: We investigated the relationship between dynamic cardiac function changes and finish time for 3000-meter runs. Using a wearable device based on a novel cardiac force index (CFI), we explored potential correlations among 3000-meter runners with stronger and weaker cardiac functions during running. Methods: This study used the American product BioHarness 3.0 (Zephyr Technology Corporation), which can measure basic physiological parameters including heart rate, respiratory rate, temperature, maximum oxygen consumption, and activity. We investigated the correlations among new physiological parameters, including CFI = weight * activity / heart rate, cardiac force ratio (CFR) = CFI of running / CFI of walking, and finish times for 3000-meter runs. Results: The results showed that waist circumference, smoking, and CFI were the significant factors for qualifying in the 3000-meter run. The prediction model was as follows: ln (3000 meters running performance pass probability / fail results probability) = --2.702 -- 0.096 {\texttimes} [waist circumference] -- 1.827 {\texttimes} [smoke] + 0.020 {\texttimes} [ACi7]. If smoking and the ACi7 were controlled, contestants with a larger waist circumference tended to fail the qualification based on the formula above. If waist circumference and ACi7 were controlled, smokers tended to fail more often than nonsmokers. Finally, we investigated a new calculation method for monitoring cardiac status during exercise that uses the CFI of walking for the runner as a reference to obtain the ratio between the cardiac force of exercise and that of walking (CFR) to provide a standard for determining if the heart is capable of exercise. A relationship is documented between the CFR and the performance of 3000-meter runs in a healthy 22-year-old person. During the running period, data are obtained while participant slowly runs 3000 meters, and the relationship between the CFR and time is plotted. The runner's CFR varies with changes in activity. Since the runner's acceleration increases, the CFR quickly increases to an explosive peak, indicating the runner's explosive power. At this period, the CFI revealed a 3-fold increase (CFR=3) in a strong heart. After a time lapse, the CFR is approximately 2.5 during an endurance period until finishing the 3000-meter run. Similar correlation is found in a runner with a weak heart, with the CFR at the beginning period being 4 and approximately 2.5 thereafter. Conclusions: In conclusion, the study results suggested that measuring the real-time CFR changes could be used in a prediction model for 3000-meter running performance. ", doi="10.2196/15331", url="https://mhealth.jmir.org/2020/7/e15331", url="http://www.ncbi.nlm.nih.gov/pubmed/32706725" } @Article{info:doi/10.2196/16844, author="van Haasteren, Afua and Vayena, Effy and Powell, John", title="The Mobile Health App Trustworthiness Checklist: Usability Assessment", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e16844", keywords="checklist", keywords="trustworthiness", keywords="trust", keywords="mobile health apps", keywords="validation", keywords="survey", abstract="Background: The mobile health (mHealth) app trustworthiness (mHAT) checklist was created to identify end users' opinions on the characteristics of trustworthy mHealth apps and to communicate this information to app developers. To ensure that the checklist is suited for all relevant stakeholders, it is necessary to validate its contents. Objective: The purpose of this study was to assess the feasibility of the mHAT checklist by modifying its contents according to ratings and suggestions from stakeholders familiar with the process of developing, managing, or curating mHealth apps. Methods: A 44-item online survey was administered to relevant stakeholders. The survey was largely comprised of the mHAT checklist items, which respondents rated on a 5-point Likert scale, ranging from completely disagree (1) to completely agree (5). Results: In total, seven professional backgrounds were represented in the survey: administrators (n=6), health professionals (n=7), information technology personnel (n=6), managers (n=2), marketing personnel (n=3), researchers (n=5), and user experience researchers (n=8). Aside from one checklist item---``the app can inform end users about errors in measurements''---the combined positive ratings (ie, completely agree and agree) of the checklist items overwhelmingly exceeded the combined negative ratings (ie, completely disagree and disagree). Meanwhile, two additional items were included in the checklist: (1) business or funding model of the app and (2) details on app uninstallation statistics. Conclusions: Our results indicate that the mHAT checklist is a valuable resource for a broad range of stakeholders to develop trustworthy mHealth apps. Future studies should examine if the checklist works best for certain mHealth apps or in specific settings. ", doi="10.2196/16844", url="http://mhealth.jmir.org/2020/7/e16844/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706733" } @Article{info:doi/10.2196/14778, author="Langlet, Billy and Maramis, Christos and Diou, Christos and Maglaveras, Nikolaos and Fagerberg, Petter and Heimeier, Rachel and Lekka, Irini and Delopoulos, Anastasios and Ioakimidis, Ioannis", title="Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e14778", keywords="mHealth", keywords="eHealth", keywords="dietary behavior", keywords="lifestyle behavioral monitoring", keywords="lifestyle interventions", keywords="obesity", keywords="mobile phone", keywords="smartphone", keywords="weight management", keywords="overweight", abstract="Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the ``mHealth evidence reporting and assessment checklist,'' and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100\% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a `Good' grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70\% the first week to 76\% the second week. Participants reported that 40\% of the registered meals were home-prepared, while 34\% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. ", doi="10.2196/14778", url="http://mhealth.jmir.org/2020/7/e14778/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706684" } @Article{info:doi/10.2196/18012, author="Mena, J. Luis and F{\'e}lix, G. Vanessa and Ostos, Rodolfo and Gonz{\'a}lez, J. Armando and Mart{\'i}nez-Pel{\'a}ez, Rafael and Melgarejo, D. Jesus and Maestre, E. Gladys", title="Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="20", volume="8", number="7", pages="e18012", keywords="mHealth", keywords="photoplethysmography", keywords="blood pressure monitoring", keywords="hypertension", abstract="Background: Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective: This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66\% women) to test the usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network model had good average accuracy (>90\%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations. ", doi="10.2196/18012", url="https://mhealth.jmir.org/2020/7/e18012", url="http://www.ncbi.nlm.nih.gov/pubmed/32459642" } @Article{info:doi/10.2196/19099, author="Patel, Ben and Thind, Arron", title="Usability of Mobile Health Apps for Postoperative Care: Systematic Review", journal="JMIR Perioper Med", year="2020", month="Jul", day="20", volume="3", number="2", pages="e19099", keywords="postoperative monitoring", keywords="postoperative care", keywords="mobile health app", keywords="telemedicine", keywords="smartphone", keywords="mobile phone", abstract="Background: Mobile health (mHealth) apps are increasingly used postoperatively to monitor, educate, and rehabilitate. The usability of mHealth apps is critical to their implementation. Objective: This systematic review evaluates the (1) methodology of usability analyses, (2) domains of usability being assessed, and (3) results of usability analyses. Methods: The A Measurement Tool to Assess Systematic Reviews checklist was consulted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was adhered to. Screening was undertaken by 2 independent reviewers. All included studies were assessed for risk of bias. Domains of usability were compared with the gold-standard mHealth App Usability Questionnaire (MAUQ). Results: A total of 33 of 720 identified studies were included for data extraction. Of the 5 included randomized controlled trials (RCTs), usability was never the primary end point. Methodology of usability analyses included interview (10/33), self-created questionnaire (18/33), and validated questionnaire (9/33). Of the 3 domains of usability proposed in the MAUQ, satisfaction was assessed in 28 of the 33 studies, system information arrangement was assessed in 11 of the 33 studies, and usefulness was assessed in 18 of the 33 studies. Usability of mHealth apps was above industry average, with median System Usability Scale scores ranging from 76 to 95 out of 100. Conclusions: Current analyses of mHealth app usability are substandard. RCTs are rare, and validated questionnaires are infrequently consulted. Of the 3 domains of usability, only satisfaction is regularly assessed. There is significant bias throughout the literature, particularly with regards to conflicts of interest. Future studies should adhere to the MAUQ to assess usability and improve the utility of mHealth apps. ", doi="10.2196/19099", url="https://periop.jmir.org/2020/2/e19099", url="http://www.ncbi.nlm.nih.gov/pubmed/33393925" } @Article{info:doi/10.2196/16338, author="Adrian, Molly and Coifman, Jessica and Pullmann, D. Michael and Blossom, B. Jennifer and Chandler, Casey and Coppersmith, Glen and Thompson, Paul and Lyon, R. Aaron", title="Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study", journal="JMIR Ment Health", year="2020", month="Jul", day="20", volume="7", number="7", pages="e16338", keywords="technology-enabled services", keywords="suicide prevention", keywords="school-based mental health", keywords="user-centered design", keywords="mobile phone", abstract="Background: Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. Objective: This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. Methods: A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. Results: Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. Conclusions: Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation. ", doi="10.2196/16338", url="https://mental.jmir.org/2020/7/e16338", url="http://www.ncbi.nlm.nih.gov/pubmed/32706691" } @Article{info:doi/10.2196/19274, author="Tajirian, Tania and Stergiopoulos, Vicky and Strudwick, Gillian and Sequeira, Lydia and Sanches, Marcos and Kemp, Jessica and Ramamoorthi, Karishini and Zhang, Timothy and Jankowicz, Damian", title="The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey", journal="J Med Internet Res", year="2020", month="Jul", day="15", volume="22", number="7", pages="e19274", keywords="electronic health record", keywords="physician", keywords="burnout", keywords="psychiatry", keywords="medical informatics", abstract="Background: Physician burnout has a direct impact on the delivery of high-quality health care, with health information technology tools such as electronic health records (EHRs) adding to the burden of practice inefficiencies. Objective: The aim of this study was to determine the extent of burnout among physicians and learners (residents and fellows); identify significant EHR-related contributors of physician burnout; and explore the differences between physicians and learners with regard to EHR-related factors such as time spent in EHR, documentation styles, proficiency, training, and perceived usefulness. In addition, the study aimed to address gaps in the EHR-related burnout research methodologies by determining physicians' patterns of EHR use through usage logs. Methods: This study used a cross-sectional survey methodology and a review of administrative data for back-end log measures of survey respondents' EHR use, which was conducted at a large Canadian academic mental health hospital. Chi-square and Fisher exact tests were used to examine the association of EHR-related factors with general physician burnout. The survey was sent out to 474 individuals between May and June 2019, including physicians (n=407), residents (n=53), and fellows (n=14), and we measured physician burnout and perceptions of EHR stressors (along with demographic and practice characteristics). Results: Our survey included 208 respondents, including physicians (n=176) and learners (n=32). The response rate was 43.2\% for physicians (full-time: 156/208, 75.0\%; part-time: 20/199, 10.1\%), and 48\% (32/67) for learners. A total of 25.6\% (45/176) of practicing physicians and 19\% (6/32) of learners reported having one or more symptoms of burnout, and 74.5\% (155/208) of all respondents who reported burnout symptoms identified the EHR as a contributor. Lower satisfaction and higher frustration with the EHRs were significantly associated with perceptions of EHR contributing toward burnout. Physicians' and learners' experiences with the EHR, gathered through open-ended survey responses, identified challenges around the intuitiveness and usability of the technology as well as workflow issues. Metrics gathered from back-end usage logs demonstrated a 13.6-min overestimation in time spent on EHRs per patient and a 5.63-hour overestimation of after-hours EHR time, when compared with self-reported survey data. Conclusions: This study suggests that the use of EHRs is a perceived contributor to physician burnout. There should be a focus on combating physician burnout by reducing the unnecessary administrative burdens of EHRs through efficient implementation of systems and effective postimplementation strategies. ", doi="10.2196/19274", url="https://www.jmir.org/2020/7/e19274", url="http://www.ncbi.nlm.nih.gov/pubmed/32673234" } @Article{info:doi/10.2196/19713, author="Miller, Stephen and Gilbert, Stephen and Virani, Vishaal and Wicks, Paul", title="Patients' Utilization and Perception of an Artificial Intelligence--Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study", journal="JMIR Hum Factors", year="2020", month="Jul", day="10", volume="7", number="3", pages="e19713", keywords="human-centered design", keywords="innovative", keywords="health care apps", keywords="eHealth", keywords="symptom checker", keywords="primary care", keywords="general practice", keywords="app", keywords="usability", keywords="acceptability", keywords="utility", abstract="Background: When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies. Objective: We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting. Methods: Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment. Results: Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1\%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6\%) of working-age individuals (aged 15-64) than the general population (66.0\%). Participants rated Ada's ease of use highly, with most (511/522, 97.8\%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1\%) and agreed they would recommend it to a friend or relative (444/520, 85.3\%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93\%, 18-24-year olds reported helpful) than older respondents (19/32, 59\%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0\%), a sizable minority (63/494, 12.8\%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22\%) than aged 70+ (0/28, 0\%). Conclusions: In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups. ", doi="10.2196/19713", url="https://humanfactors.jmir.org/2020/3/e19713", url="http://www.ncbi.nlm.nih.gov/pubmed/32540836" } @Article{info:doi/10.2196/16699, author="Taylor Jr, A. Herman and Francis, Sherilyn and Evans, Ray Chad and Harvey, Marques and Newton, A. Brittney and Jones, P. Camara and Akintobi, Henry Tabia and Clifford, Gari", title="Preventing Cardiovascular Disease Among Urban African Americans With a Mobile Health App (the MOYO App): Protocol for a Usability Study", journal="JMIR Res Protoc", year="2020", month="Jul", day="9", volume="9", number="7", pages="e16699", keywords="African Americans", keywords="mHealth", keywords="community-based participatory research", keywords="agile design", keywords="cardiovascular", abstract="Background: Cardiovascular disease (CVD) disparities are a particularly devastating manifestation of health inequity. Despite advancements in prevention and treatment, CVD is still the leading cause of death in the United States. Additionally, research indicates that African American (AA) and other ethnic-minority populations are affected by CVD at earlier ages than white Americans. Given that AAs are the fastest-growing population of smartphone owners and users, mobile health (mHealth) technologies offer the unparalleled potential to prevent or improve self-management of chronic disease among this population. Objective: To address the unmet need for culturally tailored primordial prevention CVD--focused mHealth interventions, the MOYO app was cocreated with the involvement of young people from this priority community. The overall project aims to develop and evaluate the effectiveness of a novel smartphone app designed to reduce CVD risk factors among urban-AAs, 18-29 years of age. Methods: The theoretical underpinning will combine the principles of community-based participatory research and the agile software development framework. The primary outcome goals of the study will be to determine the usability, acceptability, and functionality of the MOYO app, and to build a cloud-based data collection infrastructure suitable for digital epidemiology in a disparity population. Changes in health-related parameters over a 24-week period as determined by both passive (eg, physical activity levels, sleep duration, social networking) and active (eg, use of mood measures, surveys, uploading pictures of meals and blood pressure readings) measures will be the secondary outcome. Participants will be recruited from a majority AA ``large city'' school district, 2 historically black colleges or universities, and 1 urban undergraduate college. Following baseline screening for inclusion (administered in person), participants will receive the beta version of the MOYO app. Participants will be monitored during a 24-week pilot period. Analyses of varying data including social network dynamics, standard metrics of activity, percentage of time away from a given radius of home, circadian rhythm metrics, and proxies for sleep will be performed. Together with external variables (eg, weather, pollution, and socioeconomic indicators such as food access), these metrics will be used to train machine-learning frameworks to regress them on the self-reported quality of life indicators. Results: This 5-year study (2015-2020) is currently in the implementation phase. We believe that MOYO can build upon findings of classical epidemiology and longitudinal studies like the Jackson Heart Study by adding greater granularity to our knowledge of the exposures and behaviors that affect health and disease, and creating a channel for outreach capable of launching interventions, clinical trials, and enhancements of health literacy. Conclusions: The results of this pilot will provide valuable information about community cocreation of mHealth programs, efficacious design features, and essential infrastructure for digital epidemiology among young AA adults. International Registered Report Identifier (IRRID): DERR1-10.2196/16699 ", doi="10.2196/16699", url="https://www.researchprotocols.org/2020/7/e16699", url="http://www.ncbi.nlm.nih.gov/pubmed/32673258" } @Article{info:doi/10.2196/15605, author="Schleimer, Erica and Pearce, Jennifer and Barnecut, Andrew and Rowles, William and Lizee, Antoine and Klein, Arno and Block, J. Valerie and Santaniello, Adam and Renschen, Adam and Gomez, Refujia and Keshavan, Anisha and Gelfand, M. Jeffrey and Henry, G. Roland and Hauser, L. Stephen and Bove, Riley", title="A Precision Medicine Tool for Patients With Multiple Sclerosis (the Open MS BioScreen): Human-Centered Design and Development", journal="J Med Internet Res", year="2020", month="Jul", day="6", volume="22", number="7", pages="e15605", keywords="human-centered design", keywords="mobile phone", keywords="personal health record", keywords="participatory medicine", keywords="visualization in eHealth", keywords="human factors", abstract="Background: Patients with multiple sclerosis (MS) face several challenges in accessing clinical tools to help them monitor, understand, and make meaningful decisions about their disease course. The University of California San Francisco MS BioScreen is a web-based precision medicine tool initially designed to be clinician facing. We aimed to design a second, openly available tool, Open MS BioScreen, that would be accessible, understandable, and actionable by people with MS. Objective: This study aimed to describe the human-centered design and development approach (inspiration, ideation, and implementation) for creating the Open MS BioScreen platform. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and iterative feedback from users. Stakeholders included patients with MS along with their caregivers and family members, MS experts, generalist clinicians, industry representatives, and advocacy experts. Users consisted of anyone who wants to track MS measurements over time and access openly available tools for people with MS. Phase I (inspiration) consisted of empathizing with users and defining the problem. We sought to understand the main challenges faced by patients and clinicians and what they would want to see in a web-based app. In phase II (ideation), our multidisciplinary team discussed approaches to capture, display, and make sense of user data. Then, we prototyped a series of mock-ups to solicit feedback from clinicians and people with MS. In phase III (implementation), we incorporated all concepts to test and iterate a minimally viable product. We then gathered feedback through an agile development process. The design and development were cyclical---many times throughout the process, we went back to the drawing board. Results: This human-centered approach generated an openly available, web-based app through which patients with MS, their clinicians, and their caregivers can access the site and create an account. Users can enter information about their MS (basic level as well as more advanced concepts), visualize their data longitudinally, access a series of algorithms designed to empower them to make decisions about their treatments, and enter data from wearable devices to encourage realistic goal setting about their ambulatory activity. Agile development will allow us to continue to incorporate precision medicine tools, as these are validated in the clinical research arena. Conclusions: After engaging intended users into the iterative human-centered design of the Open MS BioScreen, we will now monitor the adaptation and dissemination of the tool as we expand its functionality and reach. The insights generated from this approach can be applied to the development of a number of self-tracking, self-management, and user engagement tools for patients with chronic conditions. ", doi="10.2196/15605", url="https://www.jmir.org/2020/7/e15605", url="http://www.ncbi.nlm.nih.gov/pubmed/32628124" } @Article{info:doi/10.2196/14161, author="Langer, L. Shelby and Ghosh, Neeta and Todd, Michael and Randall, K. Ashley and Romano, M. Joan and Bricker, B. Jonathan and Bolger, Niall and Burns, W. John and Hagan, C. Rachel and Porter, S. Laura", title="Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study", journal="JMIR Form Res", year="2020", month="Jul", day="6", volume="4", number="7", pages="e14161", keywords="ecological momentary assessment", keywords="smartphone", keywords="mobile phone", keywords="communication", keywords="disclosure", keywords="affect", abstract="Background: Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective: This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants' own handheld devices. Methods: Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results: Participants (N=27; mean age 36, SD 12 years; 24/27, 89\% female; 25/27, 93\% white and 2/27, 7\% Hispanic) responded to 79.2\% (555/701) of the total prompts sent and completed 553 (78.9\%) of those assessments. Of the responded prompts, 79.3\% (440/555) were characterized by a report of having conversed with one's partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions: The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood. ", doi="10.2196/14161", url="https://formative.jmir.org/2020/7/e14161", url="http://www.ncbi.nlm.nih.gov/pubmed/32628614" } @Article{info:doi/10.2196/15052, author="Andrade, Evismar and Quinlan, Leo and Harte, Richard and Byrne, Dara and Fallon, Enda and Kelly, Martina and Casey, Siobhan and Kirrane, Frank and O'Connor, Paul and O'Hora, Denis and Scully, Michael and Laffey, John and Pladys, Patrick and Beuch{\'e}e, Alain and {\'O}Laighin, Gear{\'o}id", title="Novel Interface Designs for Patient Monitoring Applications in Critical Care Medicine: Human Factors Review", journal="JMIR Hum Factors", year="2020", month="Jul", day="3", volume="7", number="3", pages="e15052", keywords="interface design", keywords="usability", keywords="situation awareness", keywords="graphical display", keywords="satisfaction", keywords="response time", keywords="accuracy", keywords="anesthesiology", keywords="critical care", keywords="performance", keywords="ecological display", abstract="Background: The patient monitor (PM) is one of the most commonly used medical devices in hospitals worldwide. PMs are used to monitor patients' vital signs in a wide variety of patient care settings, especially in critical care settings, such as intensive care units. An interesting observation is that the design of PMs has not significantly changed over the past 2 decades, with the layout and structure of PMs more or less unchanged, with incremental changes in design being made rather than transformational changes. Thus, we believe it well-timed to review the design of novel PM interfaces, with particular reference to usability and human factors. Objective: This paper aims to review innovations in PM design proposed by researchers and explore how clinicians responded to these design changes. Methods: A literature search of relevant databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified 16 related studies. A detailed description of the interface design and an analysis of each novel PM were carried out, including a detailed analysis of the structure of the different user interfaces, to inform future PM design. The test methodologies used to evaluate the different designs are also presented. Results: Most of the studies included in this review identified some level of improvement in the clinician's performance when using a novel display in comparison with the traditional PM. For instance, from the 16 reviewed studies, 12 studies identified an improvement in the detection and response times, and 10 studies identified an improvement in the accuracy or treatment efficiency. This indicates that novel displays have the potential to improve the clinical performance of nurses and doctors. However, the outcomes of some of these studies are weakened because of methodological deficiencies. These deficiencies are discussed in detail in this study. Conclusions: More careful study design is warranted to investigate the user experience and usability of future novel PMs for real time vital sign monitoring, to establish whether or not they could be used successfully in critical care. A series of recommendations on how future novel PM designs and evaluations can be enhanced are provided. ", doi="10.2196/15052", url="https://humanfactors.jmir.org/2020/3/e15052", url="http://www.ncbi.nlm.nih.gov/pubmed/32618574" } @Article{info:doi/10.2196/18391, author="LeRouge, M. Cynthia and Hah, Hyeyoung and Deckard, J. Gloria and Jiang, Haoqiang", title="Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="29", volume="8", number="6", pages="e18391", keywords="consumer health technologies", keywords="obesity care model", keywords="chronic care model", keywords="UTAUT", keywords="qualitative research", keywords="overweight", keywords="mobile phone", keywords="adolescent", keywords="couse", keywords="social support", keywords="obesity", keywords="social influence", keywords="consumer health informatics", abstract="Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents' intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. ", doi="10.2196/18391", url="http://mhealth.jmir.org/2020/6/e18391/", url="http://www.ncbi.nlm.nih.gov/pubmed/32597788" } @Article{info:doi/10.2196/17769, author="Peterson, M. Colleen and Mikal, P. Jude and McCarron, R. Hayley and Finlay, M. Jessica and Mitchell, L. Lauren and Gaugler, E. Joseph", title="The Feasibility and Utility of a Personal Health Record for Persons With Dementia and Their Family Caregivers for Web-Based Care Coordination: Mixed Methods Study", journal="JMIR Aging", year="2020", month="Jun", day="26", volume="3", number="1", pages="e17769", keywords="Alzheimer disease", keywords="technology", keywords="disease management", keywords="personal health record", keywords="family caregiving", keywords="informal caregiving", keywords="caregiver burnout", keywords="web-based intervention", keywords="assistive technology", abstract="Background: Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver's burden by simplifying ADRD health care management Objective: This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach. Methods: Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants' characteristics as well as PHR-ADRD use and experiences based on overall favorability status. Results: Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants. Conclusions: Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system. ", doi="10.2196/17769", url="http://aging.jmir.org/2020/1/e17769/", url="http://www.ncbi.nlm.nih.gov/pubmed/32589158" } @Article{info:doi/10.2196/19771, author="Vandekerckhove, Pieter and Vandekerckhove, Yves and Tavernier, Rene and De Jaegher, Kelly and de Mul, Marleen", title="Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights", journal="J Med Internet Res", year="2020", month="Jun", day="25", volume="22", number="6", pages="e19771", keywords="telemedicine", keywords="design thinking", keywords="cardiology", keywords="patient", keywords="COVID-19", keywords="user experience", doi="10.2196/19771", url="http://www.jmir.org/2020/6/e19771/", url="http://www.ncbi.nlm.nih.gov/pubmed/32519964" } @Article{info:doi/10.2196/19947, author="Parush, Avi and Wacht, Oren and Gomes, Ricardo and Frenkel, Amit", title="Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study", journal="J Med Internet Res", year="2020", month="Jun", day="17", volume="22", number="6", pages="e19947", keywords="COVID-19", keywords="personal protective equipment", keywords="PPE", keywords="human factors", keywords="cognitive functioning", keywords="multinational survey", keywords="pandemic", keywords="protection", keywords="infectious disease", keywords="infection", keywords="survey", abstract="Background: Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. Objective: This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19. Methods: The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research. Results: A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach $\alpha$ was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78\% in Israel; n=328/377, 87\% in Portugal), hearing (n=236/370, 64\% in Portugal; n=321/642, 50\% in Israel), seeing (n=697/763, 89\% in Israel; n=317/376, 84\% in Portugal), and doffing (n=290/374, 77\% in Portugal; n=315/713, 44\% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech. Conclusions: In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols. ", doi="10.2196/19947", url="http://www.jmir.org/2020/6/e19947/", url="http://www.ncbi.nlm.nih.gov/pubmed/32511099" } @Article{info:doi/10.2196/16072, author="Brick, R. Timothy and Mundie, James and Weaver, Jonathan and Fraleigh, Robert and Oravecz, Zita", title="Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study", journal="JMIR Form Res", year="2020", month="Jun", day="17", volume="4", number="6", pages="e16072", keywords="smartphone apps", keywords="ecological momentary assessment", keywords="real-time analysis", keywords="behavior change", abstract="Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention. ", doi="10.2196/16072", url="https://formative.jmir.org/2020/6/e16072", url="http://www.ncbi.nlm.nih.gov/pubmed/32554373" } @Article{info:doi/10.2196/17708, author="Cho, Hwayoung and Porras, Tiffany and Flynn, Gabriella and Schnall, Rebecca", title="Usability of a Consumer Health Informatics Tool Following Completion of a Clinical Trial: Focus Group Study", journal="J Med Internet Res", year="2020", month="Jun", day="15", volume="22", number="6", pages="e17708", keywords="consumer health informatics tool", keywords="mobile Health", keywords="mobile apps", keywords="clinical trial", keywords="symptom care", keywords="self-management", keywords="HIV-associated nonAIDS (HANA)", keywords="HANA conditions", keywords="HIV/AIDS", abstract="Background: Mobile health (mHealth) apps have the potential to be effective tools for encouraging patients with chronic diseases to self-manage their health. The success of mHealth apps is related to technology acceptance and its subsequent use by intended consumers. Therefore, it is essential to gain insights from consumers' perspectives about their use of mHealth apps in daily life. Objective: The purpose of this work was to understand consumers' perspectives on use of a self-management app following completion of a clinical trial that tested the efficacy of the app for improving health outcomes. Methods: We conducted five focus groups with paricipants of a clinical trial (NCT03182738) who were randomized to use the video information provider (VIP) for HIV-associated nonAIDS (HANA) conditions app (VIP-HANA) or an attention control app. Thematic analysis was conducted, and the themes were organized according to the two key constructs of the technology acceptance model framework: perceived usefulness and perceived ease of use. Results: Thirty-nine people living with HIV (20 from the intervention group and 19 from the control group) participated in the focus group sessions. Of the eight themes identified from focus group data, the five themes related to perceived usefulness were: (1) self-monitoring HIV-related symptoms of HANA conditions, (2) enhanced relationship with clinical providers, (3) improvement in physical and emotional health, (4) long-term impact of self-care strategies on improvement in symptoms of HANA conditions, and (5) inspired lifestyle changes to manage symptoms. The three themes related to perceived ease of use were: (1) easy to navigate, (2) avatar personalization, and (3) privacy/confidentiality maintained even when changing the location of app use. Conclusions: Perceived ease of use was similar in both study groups but perceived usefulness differed between study groups. Participants in both study groups found the VIP-HANA app to be useful in monitoring their symptoms and enhancing communication with their clinical care providers. However, only intervention group participants perceived the app to be useful in improving overall health and long-term symptom management. Findings from this study highlight factors that are essential to ensure the usefulness of self-management apps and facilitate sustained use of mHealth apps for people living with chronic illnesses. ", doi="10.2196/17708", url="http://www.jmir.org/2020/6/e17708/", url="http://www.ncbi.nlm.nih.gov/pubmed/32538796" } @Article{info:doi/10.2196/15449, author="Korpershoek, G. Yvonne J. and Hermsen, Sander and Schoonhoven, Lisette and Schuurmans, J. Marieke and Trappenburg, A. Jaap C.", title="User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Jun", day="15", volume="22", number="6", pages="e15449", keywords="mobile health", keywords="mHealth", keywords="user-centered design", keywords="behavior change", keywords="COPD", keywords="exacerbation", keywords="self-management", keywords="self-care", keywords="mobile phone", abstract="Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention---Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions. ", doi="10.2196/15449", url="https://www.jmir.org/2020/6/e15449", url="http://www.ncbi.nlm.nih.gov/pubmed/32538793" } @Article{info:doi/10.2196/17052, author="Heapy, Connor and Montgomery, Kerry and Ersser, Steven and Gass, Matt and Goad, Nina and Thompson, R. Andrew", title="A Psychosocial Support Website From the British Association of Dermatologists for People Living With a Skin Condition: Mixed Methods Evaluation", journal="JMIR Dermatol", year="2020", month="Jun", day="15", volume="3", number="1", pages="e17052", keywords="dermatology", keywords="psychology", keywords="surveys and questionnaires", keywords="interview", keywords="mobile phone", abstract="Background: There is a lack of psychological support for individuals with skin conditions, and few low-intensity self-help interventions are available. Objective: This study aimed to test the acceptability and usability of a support website and its embedded self-help resources. Methods: A mixed methods approach was utilized. A total of 583 participants (426 with a skin condition, 97 relatives and friends, and 60 dermatology professionals) viewed the British Association of Dermatologist's SkinSupport website and then completed a survey about their well-being and the usability of the website. A comparison group comprising 816 participants also completed the well-being measures. In total, 37 participants (19 living with a skin condition, and the relatives and friends of individuals with a skin condition, and 18 dermatology professionals) viewed the SkinSupport website and then took part in focus groups. Participants were recruited via social media, professional networks, and volunteer lists. Data from the survey were analyzed using descriptive and inferential statistics and qualitative content analysis. Results: Both quantitative and qualitative responses suggest that the SkinSupport website was viewed positively by both patients and health professionals. Overall, 79.8\% (417/523) of individuals with a skin condition, and the relatives and friends of individuals with a skin condition, said that they would use the website again; and 86.7\% (52/60) of dermatology professionals said that they would recommend the site to somebody with a skin condition. Qualitative responses related to the website fell into 4 key themes: (1) appearance, (2) use and navigation, (3) information, and (4) areas for development. Conclusions: The SkinSupport website was considered acceptable and usable. A range of areas requiring modification were identified. The website provides a useful resource that patients can access freely. Given the lack of services available to patients with skin conditions, health care professionals could routinely inform patients of this resource at assessment. ", doi="10.2196/17052", url="http://derma.jmir.org/2020/1/e17052/" } @Article{info:doi/10.2196/17114, author="Wessels, J. Nienke and Hulshof, Lisa and Loohuis, M. Anne M. and van Gemert-Pijnen, Lisette and Jellema, Petra and van der Worp, Henk and Blanker, H. Marco", title="User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="12", volume="8", number="6", pages="e17114", keywords="ehealth", keywords="mobile applications", keywords="self-management", keywords="qualitative research", abstract="Background: Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. Objective: The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. Methods: The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants' experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. Results: Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11\%), urgency UI (n=3, 33\%), or mixed UI (n=5, 56\%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. Conclusions: This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms. ", doi="10.2196/17114", url="http://mhealth.jmir.org/2020/6/e17114/", url="http://www.ncbi.nlm.nih.gov/pubmed/32530431" } @Article{info:doi/10.2196/18204, author="van Beek, Willemijn Judith Jantine and van Wegen, Henri Erwin Everardus and Rietberg, Berend Marc and Nyffeler, Thomas and Bohlhalter, Stephan and Kamm, Philipp Christian and Nef, Tobias and Vanbellingen, Tim", title="Feasibility of a Home-Based Tablet App for Dexterity Training in Multiple Sclerosis: Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="9", volume="8", number="6", pages="e18204", keywords="dexterity", keywords="feasibility", keywords="multiple sclerosis", keywords="rehabilitation", keywords="app", keywords="home-based training", abstract="Background: Persons with multiple sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins, or writing, therefore impacting their health-related quality of life. Mobile health (mHealth) solutions, such as tablet apps, may be used to train impaired dexterous skills. The feasibility of a tablet app--based dexterity home-based intervention in MS (TAD-MS) has not been explored yet in persons with MS. Objective: The aim of this pilot study was to evaluate the feasibility and usability of home-based dexterity training with a tablet app in both persons with MS and healthy subjects. Methods: A total of 9 persons with MS, aged 35-71 years, with an Expanded Disability Status Scale score between 2 and 7.5, performed the TAD-MS for 4 weeks, five times a week, with each training session lasting approximately 30 minutes. Participants' impaired dexterity was measured by the Nine-Hole Peg Test. A total of 10 age-matched healthy subjects also tested and rated the usability of the app. Outcome measures were the adherence rate as well as usability measured by the System Usability Scale and a Custom User Engagement Questionnaire (CUEQ). Results: High feasibility of the tablet app--based dexterity training program was shown by a 97\% adherence rate to the training protocol (ie, mean 19.4/20 sessions completed, SD 0.8). High system usability scores (ie, mean 85.39\%, SD 11.67) and overall high scores given in the CUEQ (ie, mean 8.2/10, SD 1.4) further point to high usability of the app. Neither demographic variables nor dexterity levels affected the use of the app. Conclusions: This pilot study is the first to demonstrate high feasibility and usability of a new tablet app--based dexterity home-based training program among both persons with MS and healthy individuals. Whether this kind of training improves dexterity will need to be evaluated in a randomized controlled trial. ", doi="10.2196/18204", url="http://mhealth.jmir.org/2020/6/e18204/", url="http://www.ncbi.nlm.nih.gov/pubmed/32515747" } @Article{info:doi/10.2196/14550, author="Siemer, Lutz and Ben Allouch, Somaya and Pieterse, E. Marcel and Brusse-Keizer, Marjolein and Sanderman, Robbert and Postel, G. Marloes", title="Patients' User Experience of a Blended Face-to-Face and Web-Based Smoking Cessation Treatment: Qualitative Study", journal="JMIR Form Res", year="2020", month="Jun", day="3", volume="4", number="6", pages="e14550", keywords="smoking cessation", keywords="cognitive therapy", keywords="blended treatment", keywords="smoking", keywords="user experience", keywords="tobacco", keywords="patient perspective", abstract="Background: Blended web-based and face-to-face (F2F) treatment is a promising electronic health service because the strengths of one mode of delivery should compensate for the weaknesses of the other. Objective: The aim of this study was to explore this compensation by examining patients' user experience (UX) in a blended smoking cessation treatment (BSCT) in routine care. Methods: Data on patients' UX were collected through in-depth interviews (n=10) at an outpatient smoking cessation clinic in the Netherlands. A content analysis of the semantic domains was used to analyze patients' UX. To describe the UX, the Hassenzahl UX model was applied, examining 4 of the 5 key elements of UX from a user's perspective: (1) patients' standards and expectations, (2) apparent character (pragmatic and hedonic attributes), (3) usage situation, and (4) consequences (appeal, emotions, and behavior). Results: BSCT appeared to be a mostly positively experienced service. Patients had a positive-pragmatic standard and neutral-open expectation toward BSCT at the treatment start. The pragmatic attributes of the F2F sessions were mostly perceived as positive, whereas the pragmatic attributes of the web sessions were perceived as both positive and negative. For the hedonic attributes, there seemed to be a difference between the F2F and web sessions. Specifically, the hedonic attributes of the web sessions were experienced as mostly negative, whereas those of the F2F sessions were experienced as mostly positive. For the usage situation, the physical and social contexts were experienced positively, whereas the task and technical contexts were experienced negatively. Nevertheless, the consequential appeal of BSCT was positive. However, the consequential emotions and behavior varied, ultimately resulting in diverse combinations of consequential appeal, emotions, and behavior (positive, negative, and mixed). Conclusions: This study provided insights into the UX of a blended treatment, and the results support the expectation that in a blended treatment, the strengths of one mode of delivery may compensate for the weaknesses of the other. However, in this certain setting, this is mainly achieved in only one way: F2F sessions compensated for the weaknesses of the web sessions. As a practical conclusion, this may mean that the web sessions, supported by the strengths of the F2F sessions, offer an interesting approach for further improving the blended treatment. Our theoretical findings reflect the relevance of the aspects of hedonism, such as fun, joy, or happiness in the UX, which were not mentioned in relation to the web sessions and were only scarcely mentioned in relation to the F2F sessions. Future research should further investigate the role of hedonistic aspects in a blended treatment and whether increased enjoyment of a blended treatment could increase treatment adherence and, ultimately, effectiveness. ", doi="10.2196/14550", url="https://formative.jmir.org/2020/6/e14550", url="http://www.ncbi.nlm.nih.gov/pubmed/32343245" } @Article{info:doi/10.2196/16420, author="Sengupta, Avijit and Beckie, Theresa and Dutta, Kaushik and Dey, Arup and Chellappan, Sriram", title="A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study", journal="JMIR Form Res", year="2020", month="Jun", day="3", volume="4", number="6", pages="e16420", keywords="coronary heart disease", keywords="mobile health technology", keywords="behavior change interventions", keywords="women", keywords="mobile phone", abstract="Background: Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40\% by 2035. In 2015, the estimated cost of caring for patients with CHD was US \$182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30\% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective: The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods: Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants' ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results: All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions: The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings. ", doi="10.2196/16420", url="https://formative.jmir.org/2020/6/e16420", url="http://www.ncbi.nlm.nih.gov/pubmed/32348270" } @Article{info:doi/10.2196/15581, author="Wegner, Stephan and Lohmeyer, Quentin and Wahlen, Dimitri and Neumann, Sandra and Groebli, Jean-Claude and Meboldt, Mirko", title="Value of Eye-Tracking Data for Classification of Information Processing--Intensive Handling Tasks: Quasi-Experimental Study on Cognition and User Interface Design", journal="JMIR Hum Factors", year="2020", month="Jun", day="3", volume="7", number="2", pages="e15581", keywords="human factors engineering", keywords="mobile eye tracking", keywords="benchmarking", keywords="home care", keywords="usability", keywords="self-management", keywords="quantitative research", keywords="quantitative evaluation", abstract="Background: In order to give a wide range of people the opportunity to ensure and support home care, one approach is to develop medical devices that are as user-friendly as possible. This allows nonexperts to use medical devices that were originally too complicated to use. For a user-centric development of such medical devices, it is essential to understand which user interface design best supports patients, caregivers, and health care professionals. Objective: Using the benefits of mobile eye tracking, this work aims to gain a deeper understanding of the challenges of user cognition. As a consequence, its goal is to identify the obstacles to the usability of the features of two different designs of a single medical device user interface. The medical device is a patient assistance device for home use in peritoneal dialysis therapy. Methods: A total of 16 participants, with a subset of seniors (8/16, mean age 73.7 years) and young adults (8/16, mean age 25.0 years), were recruited and participated in this study. The handling cycle consisted of seven main tasks. Data analysis started with the analysis of task effectiveness for searching for error-related tasks. Subsequently, the in-depth gaze data analysis focused on these identified critical tasks. In order to understand the challenges of user cognition in critical tasks, gaze data were analyzed with respect to individual user interface features of the medical device system. Therefore, it focused on the two dimensions of dwell time and fixation duration of the gaze. Results: In total, 97\% of the handling steps for design 1 and 96\% for design 2 were performed correctly, with the main challenges being task 1 insert, task 2 connect, and task 6 disconnect for both designs. In order to understand the two analyzed dimensions of the physiological measurements simultaneously, the authors propose a new graphical representation. It distinguishes four different patterns to compare the eye movements associated with the two designs. The patterns identified for the critical tasks are consistent with the results of the task performance. Conclusions: This study showed that mobile eye tracking provides insights into information processing in intensive handling tasks related to individual user interface features. The evaluation of each feature of the user interface promises an optimal design by combining the best found features. In this way, manufacturers are able to develop products that can be used by untrained people without prior knowledge. This would allow home care to be provided not only by highly qualified nurses and caregivers, but also by patients themselves, partners, children, or neighbors. ", doi="10.2196/15581", url="http://humanfactors.jmir.org/2020/2/e15581/", url="http://www.ncbi.nlm.nih.gov/pubmed/32490840" } @Article{info:doi/10.2196/17506, author="Hafiz, Pegah and Bardram, Eyvind Jakob", title="The Ubiquitous Cognitive Assessment Tool for Smartwatches: Design, Implementation, and Evaluation Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="1", volume="8", number="6", pages="e17506", keywords="cognition", keywords="memory", keywords="response time", keywords="attention", keywords="Stroop task", keywords="wearable devices", keywords="mobile phone", abstract="Background: Cognitive functioning plays a significant role in individuals' mental health, since fluctuations in memory, attention, and executive functions influence their daily task performance. Existing digital cognitive assessment tools cannot be administered in the wild and their test sets are not brief enough to capture frequent fluctuations throughout the day. The ubiquitous availability of mobile and wearable devices may allow their incorporation into a suitable platform for real-world cognitive assessment. Objective: The aims of this study were threefold: (1) to evaluate a smartwatch-based tool for the assessment of cognitive performance, (2) to investigate the usability of this tool, and (3) to understand participants' perceptions regarding the application of a smartwatch in cognitive assessment. Methods: We built the Ubiquitous Cognitive Assessment Tool (UbiCAT) on a smartwatch-based platform. UbiCAT implements three cognitive tests---an Arrow test, a Letter test, and a Color test---adapted from the two-choice reaction-time, N-back, and Stroop tests, respectively. These tests were designed together with domain experts. We evaluated the UbiCAT test measures against standard computer-based tests with 21 healthy adults by applying statistical analyses significant at the 95\% level. Usability testing for each UbiCAT app was performed using the Mobile App Rating Scale (MARS) questionnaire. The NASA-TLX (Task Load Index) questionnaire was used to measure cognitive workload during the N-back test. Participants rated perceived discomfort of wearing a smartwatch during the tests using a 7-point Likert scale. Upon finishing the experiment, an interview was conducted with each participant. The interviews were transcribed and semantic analysis was performed to group the findings. Results: Pearson correlation analysis between the total correct responses obtained from the UbiCAT and the computer-based tests revealed a significant strong correlation (r=.78, P<.001). One-way analysis of variance (ANOVA) showed a significant effect of the N-back difficulty level on the participants' performance measures. The study also demonstrated usability ratings above 4 out of 5 in terms of aesthetics, functionality, and information. Low discomfort (<3 out of 7) was reported by our participants after using the UbiCAT. Seven themes were extracted from the transcripts of the interviews conducted with our participants. Conclusions: UbiCAT is a smartwatch-based tool that assesses three key cognitive domains. Usability ratings showed that participants were engaged with the UbiCAT tests and did not feel any discomfort. The majority of the participants were interested in using the UbiCAT, although some preferred computer-based tests, which might be due to the widespread use of personal computers. The UbiCAT can be administered in the wild with mentally ill patients to assess their attention, working memory, and executive function. ", doi="10.2196/17506", url="https://mhealth.jmir.org/2020/6/e17506", url="http://www.ncbi.nlm.nih.gov/pubmed/32478664" } @Article{info:doi/10.2196/16137, author="Bowman, Cassandra and Lunyera, Joseph and Alkon, Aviel and Boulware, Ebony L. and St Clair Russell, Jennifer and Riley, Jennie and Fink, C. Jeffrey and Diamantidis, Clarissa", title="A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study", journal="JMIR Form Res", year="2020", month="May", day="28", volume="4", number="5", pages="e16137", keywords="patient safety", keywords="chronic kidney disease", keywords="patient education", keywords="mhealth", abstract="Background: Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective: We sought to develop and test the usability of a mobile tablet--based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods: We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, ``sick day protocol''); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked ``Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?'' Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results: The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58\%) and female (n=7, 58\%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3\%) and 15 critical errors (2.1\%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83\%) easily completed 90\% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58\%), the activity length as ``just right'' (rather than too long or too short) (n=10, 83\%), and the use of clinical vignettes as helpful (n=10, 83\%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions: A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population. ", doi="10.2196/16137", url="http://formative.jmir.org/2020/5/e16137/", url="http://www.ncbi.nlm.nih.gov/pubmed/32463366" } @Article{info:doi/10.2196/16747, author="Ma, Shu-Ching and Chou, Willy and Chien, Tsair-Wei and Chow, Chi Julie and Yeh, Yu-Tsen and Chou, Po-Hsin and Lee, Huan-Fang", title="An App for Detecting Bullying of Nurses Using Convolutional Neural Networks and Web-Based Computerized Adaptive Testing: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="20", volume="8", number="5", pages="e16747", keywords="nurse bullying", keywords="NAQ-R assessment", keywords="receiver operating characteristic curve", keywords="convolutional neural network", keywords="computerized adaptive testing", abstract="Background: Workplace bullying has been measured in many studies to investigate its effects on mental health issues. However, none have used web-based computerized adaptive testing (CAT) with bully classifications and convolutional neural networks (CNN) for reporting the extent of individual bullying in the workplace. Objective: This study aims to build a model using CNN to develop an app for automatic detection and classification of nurse bullying-levels, incorporated with online Rasch computerized adaptive testing, to help assess nurse bullying at an earlier stage. Methods: We recruited 960 nurses working in a Taiwan Ch-Mei hospital group to fill out the 22-item Negative Acts Questionnaire-Revised (NAQ-R) in August 2012. The k-mean and the CNN were used as unsupervised and supervised learnings, respectively, for: (1) dividing nurses into three classes (n=918, 29, and 13 with suspicious mild, moderate, and severe extent of being bullied, respectively); and (2) building a bully prediction model to estimate 69 different parameters. Finally, data were separated into training and testing sets in a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve [AUC]), along with the accuracy across studies for comparison. An app predicting the respondent bullying-level was developed, involving the model's 69 estimated parameters and the online Rasch CAT module as a website assessment. Results: We observed that: (1) the 22-item model yields higher accuracy rates for three categories, with an accuracy of 94\% for the total 960 cases, and accuracies of 99\% (AUC 0.99; 95\% CI 0.99-1.00) and 83\% (AUC 0.94; 95\% CI 0.82-0.99) for the lower and upper groups (cutoff points at 49 and 66 points) based on the 947 cases and 42 cases, respectively; and (2) the 700-case training set, with 95\% accuracy, predicts the 260-case testing set reaching an accuracy of 97. Thus, a NAQ-R app for nurses that predicts bullying-level was successfully developed and demonstrated in this study. Conclusions: The 22-item CNN model, combined with the Rasch online CAT, is recommended for improving the accuracy of the nurse NAQ-R assessment. An app developed for helping nurses self-assess workplace bullying at an early stage is required for application in the future. ", doi="10.2196/16747", url="https://mhealth.jmir.org/2020/5/e16747", url="http://www.ncbi.nlm.nih.gov/pubmed/32432557" } @Article{info:doi/10.2196/17203, author="Downie, Simon Aron and Hancock, Mark and Abdel Shaheed, Christina and McLachlan, J. Andrew and Kocaballi, Baki Ahmet and Williams, M. Christopher and Michaleff, A. Zoe and Maher, G. Chris", title="An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study", journal="JMIR Med Inform", year="2020", month="May", day="11", volume="8", number="5", pages="e17203", keywords="low back pain", keywords="community pharmacy", keywords="decision support systems, clinical", abstract="Background: People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist--client consultation. Objective: This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. Methods: A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. Results: Pharmacists' agreement with CDSS-generated self-care recommendations was 90\% (18/20), with medicines recommendations was 100\% (25/25), and with referral advice was 88\% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40\% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. Conclusions: A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development. ", doi="10.2196/17203", url="https://medinform.jmir.org/2020/5/e17203", url="http://www.ncbi.nlm.nih.gov/pubmed/32390593" } @Article{info:doi/10.2196/16043, author="Polhemus, Marie Ashley and Nov{\'a}k, Jan and Ferrao, Jose and Simblett, Sara and Radaelli, Marta and Locatelli, Patrick and Matcham, Faith and Kerz, Maximilian and Weyer, Janice and Burke, Patrick and Huang, Vincy and Dockendorf, Fallon Marissa and Temesi, Gergely and Wykes, Til and Comi, Giancarlo and Myin-Germeys, Inez and Folarin, Amos and Dobson, Richard and Manyakov, V. Nikolay and Narayan, A. Vaibhav and Hotopf, Matthew", title="Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="7", volume="8", number="5", pages="e16043", keywords="human-centric design", keywords="design thinking", keywords="patient centricity", keywords="device selection", keywords="technology selection", keywords="remote patient monitoring", keywords="remote measurement technologies", abstract="Background: Despite the increasing use of remote measurement technologies (RMT) such as wearables or biosensors in health care programs, challenges associated with selecting and implementing these technologies persist. Many health care programs that use RMT rely on commercially available, ``off-the-shelf'' devices to collect patient data. However, validation of these devices is sparse, the technology landscape is constantly changing, relative benefits between device options are often unclear, and research on patient and health care provider preferences is often lacking. Objective: To address these common challenges, we propose a novel device selection framework extrapolated from human-centered design principles, which are commonly used in de novo digital health product design. We then present a case study in which we used the framework to identify, test, select, and implement off-the-shelf devices for the Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) consortium, a research program using RMT to study central nervous system disease progression. Methods: The RADAR-CNS device selection framework describes a human-centered approach to device selection for mobile health programs. The framework guides study designers through stakeholder engagement, technology landscaping, rapid proof of concept testing, and creative problem solving to develop device selection criteria and a robust implementation strategy. It also describes a method for considering compromises when tensions between stakeholder needs occur. Results: The framework successfully guided device selection for the RADAR-CNS study on relapse in multiple sclerosis. In the initial stage, we engaged a multidisciplinary team of patients, health care professionals, researchers, and technologists to identify our primary device-related goals. We desired regular home-based measurements of gait, balance, fatigue, heart rate, and sleep over the course of the study. However, devices and measurement methods had to be user friendly, secure, and able to produce high quality data. In the second stage, we iteratively refined our strategy and selected devices based on technological and regulatory constraints, user feedback, and research goals. At several points, we used this method to devise compromises that addressed conflicting stakeholder needs. We then implemented a feedback mechanism into the study to gather lessons about devices to improve future versions of the RADAR-CNS program. Conclusions: The RADAR device selection framework provides a structured yet flexible approach to device selection for health care programs and can be used to systematically approach complex decisions that require teams to consider patient experiences alongside scientific priorities and logistical, technical, or regulatory constraints. ", doi="10.2196/16043", url="https://mhealth.jmir.org/2020/5/e16043", url="http://www.ncbi.nlm.nih.gov/pubmed/32379055" } @Article{info:doi/10.2196/15704, author="Keogh, Alison and Dorn, F. Jonas and Walsh, Lorcan and Calvo, Francesc and Caulfield, Brian", title="Comparing the Usability and Acceptability of Wearable Sensors Among Older Irish Adults in a Real-World Context: Observational Study", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="20", volume="8", number="4", pages="e15704", keywords="wearable technology", keywords="usability", keywords="mixed methods", keywords="user satisfaction", abstract="Background: Wearable devices are valuable assessment tools for patient outcomes in contexts such as clinical trials. To be successfully deployed, however, participants must be willing to wear them. Another concern is that usability studies are rarely published, often fail to test devices beyond 24 hours, and need to be repeated frequently to ensure that contemporary devices are assessed. Objective: This study aimed to compare multiple wearable sensors in a real-world context to establish their usability within an older adult (>50 years) population. Methods: Eight older adults wore seven devices for a minimum of 1 week each: Actigraph GT9x, Actibelt, Actiwatch, Biovotion, Hexoskin, Mc10 Biostamp\_RC, and Wavelet. Usability was established through mixed methods using semistructured interviews and three questionnaires, namely, the Intrinsic Motivation Inventory (IMI), the System Usability Scale (SUS), and an acceptability questionnaire. Quantitative data were reported descriptively and qualitative data were analyzed using deductive content analysis. Data were then integrated using triangulation. Results: Results demonstrated that no device was considered optimal as all scored below average in the SUS (median, IQR; min-max=57.5, 12.5; 47.5-63.8). Hexoskin was the lowest scored device based on the IMI (3.6; 3.4-4.5), while Biovotion, Actibelt, and Mc10 Biostamp\_RC achieved the highest median results on the acceptability questionnaire (3.6 on a 6-point Likert scale). Qualitatively, participants were willing to accept less comfort, less device discretion, and high charging burdens if the devices were perceived as useful, namely through the provision of feedback for the user. Participants agreed that the purpose of use is a key enabler for long-term compliance. These views were particularly noted by those not currently wearing an activity-tracking device. Participants believed that wrist-worn sensors were the most versatile and easy to use, and therefore, the most suitable for long-term use. In particular, Actiwatch and Wavelet stood out for their comfort. The convergence of quantitative and qualitative data was demonstrated in the study. Conclusions: Based on the results, the following context-specific recommendations can be made: (1) researchers should consider their device selection in relation to both individual and environmental factors, and not simply the primary outcome of the research study; (2) if researchers do not wish their participants to have access to feedback from the devices, then a simple, wrist-worn device that acts as a watch is preferable; (3) if feedback is allowed, then it should be made available to help participants remain engaged; this is likely to apply only to people without cognitive impairments; (4) battery life of 1 week should be considered as a necessary feature to enhance data capture; (5) researchers should consider providing additional information about the purpose of devices to participants to support their continued use. ", doi="10.2196/15704", url="http://mhealth.jmir.org/2020/4/e15704/", url="http://www.ncbi.nlm.nih.gov/pubmed/32310149" } @Article{info:doi/10.2196/16476, author="Chow, I. Philip and Showalter, L. Shayna and Gerber, Matthew and Kennedy, M. Erin and Brenin, David and Mohr, C. David and Lattie, G. Emily and Gupta, Alisha and Ocker, Gabrielle and Cohn, F. Wendy", title="Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study", journal="JMIR Cancer", year="2020", month="Apr", day="15", volume="6", number="1", pages="e16476", keywords="breast cancer", keywords="mental health", keywords="mHealth", abstract="Background: Nearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer. Objective: The aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer. Methods: This pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute--designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention. Results: The minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement. Conclusions: There is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone--delivered programs with additional phone support can be used to support patients with breast cancer. International Registered Report Identifier (IRRID): RR2-10.2196/11452 ", doi="10.2196/16476", url="http://cancer.jmir.org/2020/1/e16476/", url="http://www.ncbi.nlm.nih.gov/pubmed/32293570" } @Article{info:doi/10.2196/17901, author="Gannon, Brittany and Davis, Rindcy and Kuhns, M. Lisa and Rodriguez, Garibay Rafael and Garofalo, Robert and Schnall, Rebecca", title="A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation", journal="JMIR Form Res", year="2020", month="Apr", day="7", volume="4", number="4", pages="e17901", keywords="young adults", keywords="usability", keywords="HIV", keywords="mHealth", keywords="young men", keywords="mobile phone", abstract="Background: HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. Objective: The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. Methods: Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. Results: A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. Conclusions: Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group. ", doi="10.2196/17901", url="https://formative.jmir.org/2020/4/e17901", url="http://www.ncbi.nlm.nih.gov/pubmed/32254043" } @Article{info:doi/10.2196/14508, author="Fortunato, Michael and Adusumalli, Srinath and Chokshi, Neel and Harrison, Joseph and Rareshide, Charles and Patel, Mitesh", title="Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study", journal="JMIR Form Res", year="2020", month="Apr", day="7", volume="4", number="4", pages="e14508", keywords="sleep", keywords="wearable devices", keywords="ischemic heart disease", abstract="Background: There is growing interest in using wearable devices to remotely monitor patient behaviors. However, there has been little evaluation of how often these technologies are used to monitor sleep patterns over longer term periods, particularly among more high-risk patients. Objective: The goal of the research was to evaluate the proportion of time that patients with ischemic heart disease used wearable devices to monitor their sleep and identify differences in characteristics of patients with higher versus lower use. Methods: We evaluated wearable device data from a previously conducted clinical trial testing the use of wearable devices with personalized goal-setting and financial incentives. Patients with ischemic heart disease established a sleep baseline and were then followed for 24 weeks. The proportion of days that sleep data was collected was compared over the 24 weeks and by study arm. Characteristics of patients were compared to groups with high, low, or no sleep data. Results: The sample comprised 99 patients with ischemic heart disease, among which 79\% (78/99) used the wearable device to track their sleep. During the 6-month trial, sleep data were collected on 60\% (10,024/16,632) of patient-days. These rates declined over time from 77\% (4292/5544) in months 1 and 2 to 58\% (3188/5544) in months 3 and 4 to 46\% (2544/5544) in months 5 and 6. Sleep data were collected at higher rates among the intervention group compared with control (67\% vs 55\%, P<.001). In the main intervention period (months 3 and 4), patients with higher rates of sleep data were on average older (P=.03), had a history of smoking (P=.007), and had higher rates of commercial health insurance (P=.03). Conclusions: Among patients with ischemic heart disease in a physical activity trial, a high proportion used wearable devices to track their sleep; however, rates declined over time. Future research should consider larger evaluations coupled with behavioral interventions. Trial Registration: ClinicalTrials.gov NCT02531022; https://clinicaltrials.gov/ct2/show/NCT02531022 ", doi="10.2196/14508", url="https://formative.jmir.org/2020/4/e14508", url="http://www.ncbi.nlm.nih.gov/pubmed/32254044" } @Article{info:doi/10.2196/17142, author="Heiney, P. Sue and Donevant, B. Sara and Arp Adams, Swann and Parker, D. Pearman and Chen, Hongtu and Levkoff, Sue", title="A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study", journal="JMIR Aging", year="2020", month="Apr", day="3", volume="3", number="1", pages="e17142", keywords="heart failure", keywords="mobile health app", keywords="self-management", abstract="Background: Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective: The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods: Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results: A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions: An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population. ", doi="10.2196/17142", url="http://aging.jmir.org/2020/1/e17142/", url="http://www.ncbi.nlm.nih.gov/pubmed/32242822" } @Article{info:doi/10.2196/14405, author="Baker, Kevin and Maurel, Alice and Ward, Charlotte and Getachew, Dawit and Habte, Tedila and McWhorter, Cindy and LaBarre, Paul and Karlstr{\"o}m, Jonas and Petzold, Max and K{\"a}llander, Karin", title="Automated Respiratory Rate Counter to Assess Children for Symptoms of Pneumonia: Protocol for Cross-Sectional Usability and Acceptability Studies in Ethiopia and Nepal", journal="JMIR Res Protoc", year="2020", month="Mar", day="30", volume="9", number="3", pages="e14405", keywords="community health worker", keywords="pneumonia", keywords="child", keywords="respiratory rate", keywords="Nepal", keywords="Ethiopia", abstract="Background: Manually counting a child's respiratory rate (RR) for 60 seconds using an acute respiratory infection timer is the World Health Organization (WHO) recommended method for detecting fast breathing as a sign of pneumonia. However, counting the RR is challenging and misclassification of an observed rate is common, often leading to inappropriate treatment. To address this gap, the acute respiratory infection diagnostic aid (ARIDA) project was initiated in response to a call for better pneumonia diagnostic aids and aimed to identify and assess automated RR counters for classifying fast breathing pneumonia when used by front-line health workers in resource-limited community settings and health facilities. The Children's Automated Respiration Monitor (ChARM), an automated RR diagnostic aid using accelerometer technology developed by Koninklijke Philips NV, and the Rad-G, a multimodal RR diagnostic and pulse oximeter developed by Masimo, were the two devices tested in these studies conducted in the Southern Nations, Nationalities, and Peoples' Region in Ethiopia and in the Karnali region in Nepal. Objective: In these studies, we aimed to understand the usability of two new automated RR diagnostic aids for community health workers (CHWs; health extension workers [Ethiopia] and female community health volunteers [Nepal]) and their acceptability to CHWs in Ethiopia and Nepal, first-level health facility workers (FLHFWs) in Ethiopia only, and caregivers in both Ethiopia and Nepal. Methods: This was a prospective, cross-sectional study with a mixed methods design. CHWs and FLHFWs were trained to use both devices and provided with refresher training on all WHO requirements to assess fast breathing. Immediately after training, CHWs were observed using ARIDA on two children. Routine pneumonia case management consultations for children aged 5 years and younger and the device used for these consultations between the first and second consultations were recorded by CHWs in their patient log books. CHWs were observed a second time after 2 months. Semistructured interviews were also conducted with CHWs, FLHFWs, and caregivers. The proportion of consultations with children aged 5 years and younger where CHWs using an ARIDA and adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months will be calculated. Qualitative data from semistructured interviews will be analyzed using a thematic framework approach. Results: The ARIDA project was funded in November 2015, and data collection was conducted between April and December 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions: This is the first time the usability and acceptability of automated RR counters in low-resource settings have been evaluated. Outcomes will be relevant for policy makers and are important for future research of this new class of diagnostic aids for the management of children with suspected pneumonia. International Registered Report Identifier (IRRID): DERR1-10.2196/14405 ", doi="10.2196/14405", url="http://www.researchprotocols.org/2007/3/e14405/", url="http://www.ncbi.nlm.nih.gov/pubmed/32224491" } @Article{info:doi/10.2196/16252, author="Ali, Haneen and Li, Huiyang", title="Use of Notification and Communication Technology (Call Light Systems) in Nursing Homes: Observational Study", journal="J Med Internet Res", year="2020", month="Mar", day="27", volume="22", number="3", pages="e16252", keywords="communication systems", keywords="nursing home", keywords="response time", keywords="safety", keywords="quality of health care", keywords="observational study", abstract="Background: The call light system is one of the major communication technologies that link nursing home staff to the needs of residents. By providing residents the ability to request assistance, the system becomes an indispensable resource for patient-focused health care. However, little is known about how call light systems are being used in nursing homes and how the system contributes to safety and quality of care for seniors. Objective: This study aimed to understand the experiences of nursing home staff who use call light systems and to uncover usability issues and challenges associated with the implemented systems. Methods: A mix of 150 hours of hypothetico-deductive (unstructured) task analysis and 90 hours of standard procedure (structured) task analysis was conducted in 4 different nursing homes. The data collected included insights into the nursing home's work system and the process of locating and responding to call lights. Results: The data showed that the highest alarm rate is before and after mealtimes. The staff exceeded the administration's expectations of time to respond 50\% of the time. In addition, the staff canceled 10.0\% (20/201) of call lights and did not immediately assist residents because of high workload. Furthermore, the staff forgot to come back to assist residents over 3\% of the time. Usability issues such as broken parts, lack of feedback, lack of prioritization, and low or no discriminability also contributed to the long response time. More than 8\% of the time, residents notified the staff about call lights after they waited for a long time, and eventually, these residents were left unattended. Conclusions: Nursing homes that are still using old call light systems risk the continuation of usability issues that can affect the performance of the staff and contribute to declining staff and resident outcomes. By incorporating feedback from nurses, nursing home management will better understand the influence that the perceptions and usability of technology have on the quality of health care for their residents. In this study, it has been observed that the call light system is perceived to be an important factor affecting the outcomes of the care process and satisfaction of both residents and staff as well as the staff's performance. It is important to recognize that communication and notification technology contributes to the challenges the staff faced during their work, making their working conditions more difficult and challenging. ", doi="10.2196/16252", url="http://www.jmir.org/2020/3/e16252/", url="http://www.ncbi.nlm.nih.gov/pubmed/32217497" } @Article{info:doi/10.2196/15548, author="McGillion, Michael and Ouellette, Carley and Good, Amber and Bird, Marissa and Henry, Shaunattonie and Clyne, Wendy and Turner, Andrew and Ritvo, Paul and Ritvo, Sarah and Dvirnik, Nazari and Lamy, Andre and Whitlock, Richard and Lawton, Christopher and Walsh, Jake and Paterson, Ken and Duquette, Janine and Sanchez Medeiros, Karla and Elias, Fadi and Scott, Ted and Mills, Joseph and Harrington, Deborah and Field, Mark and Harsha, Prathiba and Yang, Stephen and Peter, Elizabeth and Bhavnani, Sanjeev and Devereaux, PJ", title="Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study", journal="J Med Internet Res", year="2020", month="Mar", day="18", volume="22", number="3", pages="e15548", keywords="monitoring, physiologic", keywords="postoperative care", keywords="user testing", abstract="Background: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. Objective: As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip's Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. Methods: Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. Results: A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. Conclusions: User testing indicated a high degree of user acceptance of Philips' Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery. ", doi="10.2196/15548", url="https://www.jmir.org/2020/3/e15548", url="http://www.ncbi.nlm.nih.gov/pubmed/32186521" } @Article{info:doi/10.2196/17161, author="De Ram{\'o}n Fern{\'a}ndez, Alberto and Ruiz Fern{\'a}ndez, Daniel and Marcos-Jorquera, Diego and Gilart Iglesias, Virgilio", title="Support System for Early Diagnosis of Chronic Obstructive Pulmonary Disease Based on the Service-Oriented Architecture Paradigm and Business Process Management Strategy: Development and Usability Survey Among Patients and Health Care Providers", journal="J Med Internet Res", year="2020", month="Mar", day="17", volume="22", number="3", pages="e17161", keywords="COPD", keywords="misdiagnosis", keywords="business process management strategy, support system", keywords="service-oriented architecture", keywords="hospital information system", keywords="early diagnosis", abstract="Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with a high global prevalence. The main scientific societies dedicated to the management of this disease have published clinical practice guidelines for quality practice. However, at present, there are important weaknesses in COPD diagnosis criteria that often lead to underdiagnosis or misdiagnosis. Objective: We sought to develop a new support system for COPD diagnosis. The system was designed to overcome the weaknesses detected in current guidelines with the goals of enabling early diagnosis, and improving the diagnostic accuracy and quality of care provided. Methods: We first analyzed the main clinical guidelines for COPD to detect weaknesses that exist in the current diagnostic process, and then proposed a redesign based on a business process management (BPM) strategy for its optimization. The BPM system acts as a backbone throughout the process of COPD diagnosis in this proposed approach. The newly developed support system was integrated into a health information system for validation of its use in a hospital environment. The system was qualitatively evaluated by experts (n=12) and patients (n=36). Results: Among the 12 experts, 10 (83\%) positively evaluated our system with respect to increasing the speed for making the diagnosis, helping in interpreting results, and encouraging opportunistic diagnosis. With an overall rating of 4.29 on a 5-point scale, 27/36 (75\%) of patients considered that the system was very useful in providing a warning about possible cases of COPD. The overall assessment of the system was 4.53 on a 5-point Likert scale with agreement to extend its use to all primary care centers. Conclusions: The proposed system provides a functional method to overcome the weaknesses detected in the current diagnostic process for COPD, which can help foster early diagnosis, while improving the diagnostic accuracy and quality of care provided. ", doi="10.2196/17161", url="https://www.jmir.org/2020/3/e17161", url="http://www.ncbi.nlm.nih.gov/pubmed/32181744" } @Article{info:doi/10.2196/15070, author="Tscholl, Werner David and R{\"o}ssler, Julian and Handschin, Lucas and Seifert, Burkhardt and Spahn, R. Donat and N{\"o}thiger, B. Christoph", title="The Mechanisms Responsible for Improved Information Transfer in Avatar-Based Patient Monitoring: Multicenter Comparative Eye-Tracking Study", journal="J Med Internet Res", year="2020", month="Mar", day="16", volume="22", number="3", pages="e15070", keywords="computers", keywords="diagnosis", keywords="visual perception", keywords="awareness", keywords="patient safety", abstract="Background: Patient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring. Objective: We aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring. Methods: In this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants' visual fixations of vital signs between the two technologies. Results: Participants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, P<.001; median of differences=3, 95\% CI 3-4). In multivariable linear regression, monitoring technology (conventional versus avatar-based monitoring, difference=?3.3, P<.001) was an independent predictor of the number of visually fixated vital signs. The difference was less prominent in the longer (10-second) scenarios (difference=?1.5, P=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all P<.001). Four critical vital signs (pulse rate, blood pressure, oxygen saturation, and respiratory rate) were visible almost the entire time of a scenario with the avatar; these were only visible for fractions of the observations with conventional monitoring. Visual fixation of a certain vital sign was associated with the correct perception of that vital sign in both technologies (avatar: phi coefficient=0.358; conventional monitoring: phi coefficient=0.515, both P<.001). Conclusions: This eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar's body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring. ", doi="10.2196/15070", url="http://www.jmir.org/2020/3/e15070/", url="http://www.ncbi.nlm.nih.gov/pubmed/32175913" } @Article{info:doi/10.2196/16235, author="Ta, Vivian and Griffith, Caroline and Boatfield, Carolynn and Wang, Xinyu and Civitello, Maria and Bader, Haley and DeCero, Esther and Loggarakis, Alexia", title="User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis", journal="J Med Internet Res", year="2020", month="Mar", day="6", volume="22", number="3", pages="e16235", keywords="artificial intelligence", keywords="social support", keywords="artificial agents", keywords="chatbots", keywords="interpersonal relations", abstract="Background: Previous research suggests that artificial agents may be a promising source of social support for humans. However, the bulk of this research has been conducted in the context of social support interventions that specifically address stressful situations or health improvements. Little research has examined social support received from artificial agents in everyday contexts. Objective: Considering that social support manifests in not only crises but also everyday situations and that everyday social support forms the basis of support received during more stressful events, we aimed to investigate the types of everyday social support that can be received from artificial agents. Methods: In Study 1, we examined publicly available user reviews (N=1854) of Replika, a popular companion chatbot. In Study 2, a sample (n=66) of Replika users provided detailed open-ended responses regarding their experiences of using Replika. We conducted thematic analysis on both datasets to gain insight into the kind of everyday social support that users receive through interactions with Replika. Results: Replika provides some level of companionship that can help curtail loneliness, provide a ``safe space'' in which users can discuss any topic without the fear of judgment or retaliation, increase positive affect through uplifting and nurturing messages, and provide helpful information/advice when normal sources of informational support are not available. Conclusions: Artificial agents may be a promising source of everyday social support, particularly companionship, emotional, informational, and appraisal support, but not as tangible support. Future studies are needed to determine who might benefit from these types of everyday social support the most and why. These results could potentially be used to help address global health issues or other crises early on in everyday situations before they potentially manifest into larger issues. ", doi="10.2196/16235", url="http://www.jmir.org/2020/3/e16235/", url="http://www.ncbi.nlm.nih.gov/pubmed/32141837" } @Article{info:doi/10.2196/15552, author="Drehlich, Mark and Naraine, Michael and Rowe, Katie and Lai, K. Samuel and Salmon, Jo and Brown, Helen and Koorts, Harriet and Macfarlane, Susie and Ridgers, D. Nicola", title="Using the Technology Acceptance Model to Explore Adolescents' Perspectives on Combining Technologies for Physical Activity Promotion Within an Intervention: Usability Study", journal="J Med Internet Res", year="2020", month="Mar", day="6", volume="22", number="3", pages="e15552", keywords="fitness trackers", keywords="social media", keywords="physical activity", keywords="youth", abstract="Background: Wearable activity trackers and social media have been identified as having the potential to increase physical activity among adolescents, yet little is known about the perceived ease of use and perceived usefulness of the technology by adolescents. Objective: The aim of this study was to use the technology acceptance model to explore adolescents' acceptance of wearable activity trackers used in combination with social media within a physical activity intervention. Methods: The Raising Awareness of Physical Activity study was a 12-week physical activity intervention that combined a wearable activity tracker (Fitbit Flex) with supporting digital materials that were delivered using social media (Facebook). A total of 124 adolescents aged 13 to 14 years randomized to the intervention group (9 schools) participated in focus groups immediately post intervention. Focus groups explored adolescents' perspectives of the intervention and were analyzed using pen profiles using a coding framework based on the technology acceptance model. Results: Adolescents reported that Fitbit Flex was useful as it motivated them to be active and provided feedback about their physical activity levels. However, adolescents typically reported that Fitbit Flex required effort to use, which negatively impacted on their perceived ease of use. Similarly, Facebook was considered to be a useful platform for delivering intervention content. However, adolescents generally noted preferences for using alternative social media websites, which may have impacted on negative perceptions concerning Facebook's ease of use. Perceptions of technological risks included damage to or loss of the device, integrity of data, and challenges with both Fitbit and Facebook being compatible with daily life. Conclusions: Wearable activity trackers and social media have the potential to impact adolescents' physical activity levels. The findings from this study suggest that although the adolescents recognized the potential usefulness of the wearable activity trackers and the social media platform, the effort required to use these technologies, as well as the issues concerning risks and compatibility, may have influenced overall engagement and technology acceptance. As wearable activity trackers and social media platforms can change rapidly, future research is needed to examine the factors that may influence the acceptance of specific forms of technology by using the technology acceptance model. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12616000899448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716 ", doi="10.2196/15552", url="https://www.jmir.org/2020/3/e15552", url="http://www.ncbi.nlm.nih.gov/pubmed/32141834" } @Article{info:doi/10.2196/16831, author="Kristjansdottir, Birna Ol{\"o}f and B{\o}r{\o}sund, Elin and Westeng, Marianne and Ruland, Cornelia and Stenberg, Una and Zangi, A. Heidi and Stange, Kurt and Mirkovic, Jelena", title="Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing", journal="JMIR Form Res", year="2020", month="Mar", day="4", volume="4", number="3", pages="e16831", keywords="mobile app", keywords="self-management", keywords="strengths", keywords="chronic illness", keywords="rheumatology", keywords="usability", keywords="formative evaluation", abstract="Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients' perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients' perceptions of the app's usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75\%) reported becoming more aware of their own strengths by using the app; 1 (8\%) disagreed and 2 (17\%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients' reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. ", doi="10.2196/16831", url="https://formative.jmir.org/2020/3/e16831", url="http://www.ncbi.nlm.nih.gov/pubmed/32130126" } @Article{info:doi/10.2196/15346, author="Joseph, P. Rodney and Keller, Colleen and Vega-L{\'o}pez, Sonia and Adams, A. Marc and English, Rebekah and Hollingshead, Kevin and Hooker, P. Steven and Todd, Michael and Gaesser, A. Glenn and Ainsworth, E. Barbara", title="A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="2", volume="8", number="3", pages="e15346", keywords="eHealth", keywords="mHealth", keywords="exercise", keywords="minority health", keywords="primary prevention", keywords="heart diseases", keywords="African-American", abstract="Background: Smart Walk is a culturally relevant, social cognitive theory--based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. ", doi="10.2196/15346", url="https://mhealth.jmir.org/2020/3/e15346", url="http://www.ncbi.nlm.nih.gov/pubmed/32130198" } @Article{info:doi/10.2196/14496, author="Milios, Athena and McGrath, Patrick and Baillie, Hannah", title="A Weekly, Evidence-Based Health Letter for Caregivers (90Second Caregiver): Usability Study", journal="JMIR Form Res", year="2020", month="Feb", day="12", volume="4", number="2", pages="e14496", keywords="caregivers", keywords="mental health", keywords="usability", keywords="depression", keywords="anxiety", keywords="stigma", keywords="hope", keywords="health information", keywords="persuasive design", abstract="Background: Informal caregivers are family members or close friends who provide unpaid help to individuals with acute or chronic health conditions so that they can manage daily life tasks. The greatest source of health information is the internet for meeting the needs of caregivers. However, information on the internet may not be scientifically valid, it may be written in language that is difficult to read, and is often in very large doses. 90Second Caregiver is a health letter whose aim is to disseminate knowledge to caregivers in a user-friendly, weekly format, in order to improve their wellbeing. Objective: The main objective was to test a sample of 90Second Caregiver health letters in order to assess their usability and to optimize the design and content of the health letters. Methods: Usability research themes were assessed using semi-structured phone interviews, incorporating the Think Aloud method with retrospective questioning. Results: Usability was assessed in the context of five main themes: understandability and learnability, completeness, relevance, and quality and credibility of the health letter content, as well as design and format. Caregivers generally provided positive feedback regarding the usability of the letters. The usability feedback was used to refine 90Second Caregiver in order to improve the design and content of the series. Based on the results of this study, it may be of maximum benefit to target the series towards individuals who are new to caregiving or part-time caregivers, given that these caregivers of the sample found the letters more useful and relevant and had the most positive usability experiences. Conclusions: The findings assisted in the improvement of the 90Second Caregiver template, which will be used to create future health letters and refine the letters that have already been created. The findings have implications for who the 90Second Caregiver series should be targeting (ie, newer or part-time caregivers) in order to be maximally impactful in improving mental health and wellbeing-related outcomes for caregivers, such as self-efficacy and caregiving knowledge. The results of this study may be generalizable to the examination of other electronic health information formats, making them valuable to future researchers testing the usability of health information products. In addition, the methods used in this study are useful for usability hypothesis generation. Lastly, our 90Second delivery approach can generate information useful for a set of similar products (eg, weekly health letters targeted towards other conditions/populations). ", doi="10.2196/14496", url="https://formative.jmir.org/2020/2/e14496", url="http://www.ncbi.nlm.nih.gov/pubmed/32049064" } @Article{info:doi/10.2196/11613, author="Arsenijevic, Jelena and Tummers, Lars and Bosma, Niels", title="Adherence to Electronic Health Tools Among Vulnerable Groups: Systematic Literature Review and Meta-Analysis", journal="J Med Internet Res", year="2020", month="Feb", day="6", volume="22", number="2", pages="e11613", keywords="eHealth", keywords="digital health", keywords="disparities in health care", keywords="meta-analysis", abstract="Background: Electronic health (eHealth) tools are increasingly being applied in health care. They are expected to improve access to health care, quality of health care, and health outcomes. Although the advantages of using these tools in health care are well described, it is unknown to what extent eHealth tools are effective when used by vulnerable population groups, such as the elderly, people with low socioeconomic status, single parents, minorities, or immigrants. Objective: This study aimed to examine whether the design and implementation characteristics of eHealth tools contribute to better use of these tools among vulnerable groups. Methods: In this systematic review, we assessed the design and implementation characteristics of eHealth tools that are used by vulnerable groups. In the meta-analysis, we used the adherence rate as an effect size measure. The adherence rate is defined as the number of people who are repetitive users (ie, use the eHealth tool more than once). We also performed a meta-regression analysis to examine how different design and implementation characteristics influenced the adherence rate. Results: Currently, eHealth tools are continuously used by vulnerable groups but to a small extent. eHealth tools that use multimodal content (such as videos) and have the possibility for direct communication with providers show improved adherence among vulnerable groups. Conclusions: eHealth tools that use multimodal content and provide the possibility for direct communication with providers have a higher adherence among vulnerable groups. However, most of the eHealth tools are not embedded within the health care system. They are usually focused on specific problems, such as diabetes or obesity. Hence, they do not provide comprehensive services for patients. This limits the use of eHealth tools as a replacement for existing health care services. ", doi="10.2196/11613", url="https://www.jmir.org/2020/2/e11613", url="http://www.ncbi.nlm.nih.gov/pubmed/32027311" } @Article{info:doi/10.2196/14146, author="Purkayastha, Saptarshi and Addepally, Abhishek Siva and Bucher, Sherri", title="Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial", journal="JMIR Hum Factors", year="2020", month="Feb", day="3", volume="7", number="1", pages="e14146", keywords="cognitive behavioral therapy", keywords="mHealth", keywords="mental health", keywords="heuristics", keywords="usability", abstract="Background: Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective: Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods: We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results: The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87\% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80\% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67\% (10/15) had the same opinion for MoodGYM. Furthermore, 67\% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80\% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions: As among the first studies to directly compare the usability of a mobile app--based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app. ", doi="10.2196/14146", url="http://humanfactors.jmir.org/2020/1/e14146/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012043" } @Article{info:doi/10.2196/15146, author="Chew, Sara and Lai, Mei Pauline Siew and Ng, Jenn Chirk", title="Usability and Utility of a Mobile App to Improve Medication Adherence Among Ambulatory Care Patients in Malaysia: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="31", volume="8", number="1", pages="e15146", keywords="medication adherence app", keywords="usability testing", keywords="utility testing", abstract="Background: To date, several medication adherence apps have been developed. However, the existing apps have been developed without involving relevant stakeholders and were not subjected to mobile health app guidelines. In addition, the usability and utility of these apps have not been tested with end users. Objective: This study aimed to describe the usability and utility testing of a newly developed medication adherence app---Med Assist---among ambulatory care patients in Malaysia. Methods: The Med Assist app was developed based on the Theory of Planned Behavior and the Nielson usability model. Beta testing was conducted from March to May 2016 at a primary care clinic in Kuala Lumpur. Ambulatory care patients who scored ?40\% on the electronic health literacy scale, were aged ?21 years, and were taking two or more long-term medications were recruited. Two rounds of in-depth interviews were conducted with each participant. The first interview, which was conducted upon participant recruitment, was to assess the usability of Med Assist. Participants were asked to download Med Assist on their phone and perform two tasks (register themselves on Med Assist and enter at least one medication). Participants were encouraged to ``concurrently think aloud'' when using Med Assist, while nonverbal cues were observed and recorded. The participants were then invited for a second interview (conducted ?7 days after the first interview) to assess the utility of Med Assist after using the app for 1 week. This was done using ``retrospective probing'' based on a topic guide developed for utilities that could improve medication adherence. Results: Usability and utility testing was performed for the Med Assist app (version P4). A total of 13 participants were recruited (6 men, 7 women) for beta testing. Three themes emerged from the usability testing, while three themes emerged from the utility testing. From the usability testing, participants found Med Assist easy to use and user friendly, as they were able to complete the tasks given to them. However, the details required when adding a new medication were found to be confusing despite displaying information in a hierarchical order. Participants who were caregivers as well as patients found the multiple-user support and pill buddy utility useful. This suggests that Med Assist may improve the medication adherence of patients on multiple long-term medications. Conclusions: The usability and utility testing of Med Assist with end users made the app more patient centered in ambulatory care. From the usability testing, the overall design and layout of Med Assist were simple and user friendly enough for participants to navigate through the app and add a new medication. From the participants' perspectives, Med Assist was a useful and reliable tool with the potential to improve medication adherence. In addition, utilities such as multiple user support and a medication refill reminder encouraged improved medication management. ", doi="10.2196/15146", url="http://mhealth.jmir.org/2020/1/e15146/", url="http://www.ncbi.nlm.nih.gov/pubmed/32003748" } @Article{info:doi/10.2196/15503, author="Quan, Linh Amanda My and Stiell, Ian and Perry, J. Jeffrey and Paradis, Michelle and Brown, Erica and Gignac, Jordan and Wilson, Lindsay and Wilson, Kumanan", title="Mobile Clinical Decision Tools Among Emergency Department Clinicians: Web-Based Survey and Analytic Data for Evaluation of The Ottawa Rules App", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="29", volume="8", number="1", pages="e15503", keywords="emergency departments", keywords="mHealth", keywords="clinical prediction rule", keywords="decision aids", abstract="Background: The Canadian CT Head Rule (CCHR), the Canadian Transient Ischemic Attack (TIA) Score, and the Subarachnoid Hemorrhage (SAH) Rule have all previously demonstrated the potential to significantly standardize care and improve the management of patients in emergency departments (EDs). On the basis of user feedback, we believe that the addition of these rules to the Ottawa Rules App has the potential to increase the app's usability and user acceptability. Objective: This study aimed to evaluate the perceived usefulness, acceptability, and uptake of the enhanced Ottawa Rules App (which now includes CCHR, TIA, and SAH Rules) among ED clinicians (medical students, residents, nurses, and physicians). Methods: The enhanced Ottawa Rules App was publicly released for free on iOS and Android operating systems in November 2018. This study was conducted across 2 tertiary EDs in Ottawa, Canada. Posters, direct enrollment, snowball sampling, and emails were used for study recruitment. A 24-question Web-based survey was administered to participants via email, and this was used to determine user acceptability of the app and Technology Readiness Index (TRI) scores. In-app user analytics were collected to track user behavior, such as the number of app sessions, length of app sessions, frequency of rule use, and the date app was first opened. Results: A total of 77 ED clinicians completed the study, including 34 nurses, 12 residents, 14 physicians, and 17 medical students completing ED rotations. The median TRI score for this group was 3.38, indicating a higher than average propensity to embrace and adopt new technologies to accomplish goals in their work or daily lives. The majority of respondents agreed or strongly agreed that the app helped participants accurately carry out the clinical rules (56/77, 73\%) and that they would recommend this app to their colleagues (64/77, 83\%). Feedback from study participants suggested further expansion of the app---more clinical decision rules (CDRs) and different versions of the app tailored to the clinician role. Analysis and comparison of Google Analytics data and in-app data revealed similar usage behavior among study-enrolled users and all app users globally. Conclusions: This study provides evidence that using the Ottawa Rules App (version 3.0.2) to improve and guide patient care would be feasible and widely accepted. The ability to verify self-reported user data (via a Web-based survey) against server analytics data is a notable strength of this study. Participants' continued app use and request for the addition of more CDRs warrant the further development of this app and call for additional studies to evaluate its feasibility and usability in different settings as well as assessment of clinical impact. ", doi="10.2196/15503", url="https://mhealth.jmir.org/2020/1/e15503", url="http://www.ncbi.nlm.nih.gov/pubmed/32012095" } @Article{info:doi/10.2196/14045, author="Cao, Jian and Truong, Lan Anh and Banu, Sophia and Shah, A. Asim and Sabharwal, Ashutosh and Moukaddam, Nidal", title="Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study", journal="JMIR Ment Health", year="2020", month="Jan", day="24", volume="7", number="1", pages="e14045", keywords="SOLVD-Teen and SOLVD-Parent App", keywords="adolescent depression", keywords="smartphone monitoring", keywords="self-evaluation", keywords="parental input", keywords="sensory data", abstract="Background: Depression carries significant financial, medical, and emotional burden on modern society. Various proof-of-concept studies have highlighted how apps can link dynamic mental health status changes to fluctuations in smartphone usage in adult patients with major depressive disorder (MDD). However, the use of such apps to monitor adolescents remains a challenge. Objective: This study aimed to investigate whether smartphone apps are useful in evaluating and monitoring depression symptoms in a clinically depressed adolescent population compared with the following gold-standard clinical psychometric instruments: Patient Health Questionnaire (PHQ-9), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A). Methods: We recruited 13 families with adolescent patients diagnosed with MDD with or without comorbid anxiety disorder. Over an 8-week period, daily self-reported moods and smartphone sensor data were collected by using the Smartphone- and OnLine usage--based eValuation for Depression (SOLVD) app. The evaluations from teens' parents were also collected. Baseline depression and anxiety symptoms were measured biweekly using PHQ-9, HAM-D, and HAM-A. Results: We observed a significant correlation between the self-evaluated mood averaged over a 2-week period and the biweekly psychometric scores from PHQ-9, HAM-D, and HAM-A (0.45?|r|?0.63; P=.009, P=.01, and P=.003, respectively). The daily steps taken, SMS frequency, and average call duration were also highly correlated with clinical scores (0.44?|r|?0.72; all P<.05). By combining self-evaluations and smartphone sensor data of the teens, we could predict the PHQ-9 score with an accuracy of 88\% (23.77/27). When adding the evaluations from the teens' parents, the prediction accuracy was further increased to 90\% (24.35/27). Conclusions: Smartphone apps such as SOLVD represent a useful way to monitor depressive symptoms in clinically depressed adolescents, and these apps correlate well with current gold-standard psychometric instruments. This is a first study of its kind that was conducted on the adolescent population, and it included inputs from both teens and their parents as observers. The results are preliminary because of the small sample size, and we plan to expand the study to a larger population. ", doi="10.2196/14045", url="http://mental.jmir.org/2020/1/e14045/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012072" } @Article{info:doi/10.2196/14601, author="Farias, Nathan and Rose-Davis, Benjamin and Hong, Paul and Wozney, Lori", title="An Automated Text Messaging System (Tonsil-Text-To-Me) to Improve Tonsillectomy Perioperative Experience: Exploratory Qualitative Usability and Feasibility Study", journal="JMIR Perioper Med", year="2020", month="Jan", day="15", volume="3", number="1", pages="e14601", keywords="short message service", keywords="tonsillectomy", keywords="pediatric otolaryngology", keywords="perioperative care", abstract="Background: Inexperience and forgetting perioperative care instruction are significant drivers of parental stress during pediatric tonsillectomy care. With the widespread use of mobile technology, parents now desire a system that provides them with information that is timely, accessible, and comprehensive. Tonsil-Text-To-Me (TTTM) is a text messaging system that sends out automated and timed texts to parents of children who are undergoing tonsillectomy. Objective: The objective of this study was to pilot-test TTTM to assess for feasibility and usability and collect suggestions for system improvements desired by parents from a pediatric otolaryngology text message service. Methods: Parents of pediatric patients who were being scheduled for tonsillectomy with or without adenoidectomy were prospectively enrolled. An exploratory qualitative study using a semistructured interview guide was performed after parents received the automated texts 2 weeks before and 1 week after their child's surgery. Results: A total of 7 parents were interviewed (data saturation was reached). Participants were all of maternal relation to the patient. Overall, all parents felt that the TTTM service was an improvement to the current standard model of information delivery. Parents also reported that the text messages reduced their anxiety and improved their performance when caring for their children during the perioperative period. No parents expressed privacy concerns about receiving texts and regarding the information included in the messages. Service suggestions showed that parents were eager for more information and had a high threshold for message reception regarding their child's surgical care. Conclusions: All parents expressed enthusiasm for a text message service during their child's tonsillectomy perioperative period. The care instructions and reminders provided to parents via automated and timed text messages may be a strategy to improve information delivery in a simple and accessible format that could empower families in their own health care. ", doi="10.2196/14601", url="https://periop.jmir.org/2020/1/e14601", url="http://www.ncbi.nlm.nih.gov/pubmed/33393931" } @Article{info:doi/10.2196/15337, author="Inal, Yavuz and Wake, Dugstad Jo and Guribye, Frode and Nordgreen, Tine", title="Usability Evaluations of Mobile Mental Health Technologies: Systematic Review", journal="J Med Internet Res", year="2020", month="Jan", day="6", volume="22", number="1", pages="e15337", keywords="systematic review", keywords="mobile", keywords="mHealth", keywords="mental health", keywords="usability evaluation", abstract="Background: Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice. Objective: This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. Methods: We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Results: A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. Conclusions: This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire. ", doi="10.2196/15337", url="https://www.jmir.org/2020/1/e15337", url="http://www.ncbi.nlm.nih.gov/pubmed/31904579" } @Article{info:doi/10.2196/15060, author="Zhou, Leming and Saptono, Andi and Setiawan, Agus I. Made and Parmanto, Bambang", title="Making Self-Management Mobile Health Apps Accessible to People With Disabilities: Qualitative Single-Subject Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="3", volume="8", number="1", pages="e15060", keywords="mobile app", keywords="self-management", keywords="accessibility", keywords="personalization", abstract="Background: Over the past decade, a large number of mobile health (mHealth) apps have been created to help individuals to better manage their own health. However, very few of these mHealth apps were specifically designed for people with disabilities, and only a few of them have been assessed for accessibility for people with disabilities. As a result, people with disabilities have difficulties using many of these mHealth apps. Objective: The objective of this study was to identify an approach that can be generally applied to improve the accessibility of mHealth apps. Methods: We recruited 5 study participants with a primary diagnosis of cerebral palsy or spinal cord injury. All the participants had fine motor impairment or lack of dexterity, and hence, they had difficulties using some mHealth apps. These 5 study participants were first asked to use multiple modules in the client app of a novel mHealth system (iMHere 2.0), during which their performance was observed. Interviews were conducted post use to collect study participants' desired accessibility features. These accessibility features were then implemented into the iMHere 2.0 client app as customizable options. The 5 participants were asked to use the same modules in the app again, and their performance was compared with that in the first round. A brief interview and a questionnaire were then performed at the end of the study to collect the 5 participants' comments and impression of the iMHere 2.0 app in general and of the customizable accessibility features. Results: Study results indicate that the study participants on their first use of the iMHere 2.0 client app experienced various levels of difficulty consistent with the severity of their lack of dexterity. Their performance was improved after their desired accessibility features were added into the app, and they liked the customizable accessibility features. These participants also expressed an interest in using this mHealth system for their health self-management tasks. Conclusions: The accessibility features identified in this study improved the accessibility of the mHealth app for people with dexterity issues. Our approach for improving mHealth app accessibility may also be applied to other mHealth apps to make those apps accessible to people with disabilities. ", doi="10.2196/15060", url="https://mhealth.jmir.org/2020/1/e15060", url="http://www.ncbi.nlm.nih.gov/pubmed/31899453" } @Article{info:doi/10.2196/15828, author="Hughes, Charmayne and Musselman, A. Elaine and Walsh, Lilia and Mariscal, Tatiana and Warner, Sam and Hintze, Amy and Rashidi, Neela and Gordon-Murer, Chloe and Tanha, Tiana and Licudo, Fahrial and Ng, Rachel and Tran, Jenna", title="The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study", journal="JMIR Nursing", year="2020", month="Jan", day="3", volume="3", number="1", pages="e15828", keywords="intimate partner violence", keywords="domestic violence", keywords="nursing education", keywords="learning", abstract="Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. ", doi="10.2196/15828", url="https://nursing.jmir.org/2020/1/e15828", url="http://www.ncbi.nlm.nih.gov/pubmed/34345778" } @Article{info:doi/10.2196/15008, author="Hangh{\o}j, Signe and Boisen, A. Kirsten and Hjerming, Maiken and Elsbernd, Abbey and Pappot, Helle", title="Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study", journal="JMIR Cancer", year="2020", month="Jan", day="2", volume="6", number="1", pages="e15008", keywords="AYA", keywords="adolescent and young adult", keywords="app", keywords="cancer", keywords="co-creation", keywords="mHealth", keywords="mobile phone", keywords="think-aloud test", keywords="usability", abstract="Background: Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kr{\ae}ftv{\ae}rket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience. Objective: The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kr{\ae}ftv{\ae}rket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app. Methods: A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kr{\ae}ftv{\ae}rket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results: The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization---female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app. Conclusions: Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kr{\ae}ftv{\ae}rket app with the input of more AYAs. ", doi="10.2196/15008", url="https://cancer.jmir.org/2020/1/e15008", url="http://www.ncbi.nlm.nih.gov/pubmed/31895046" } @Article{info:doi/10.2196/13917, author="Lelong, Romain and Soualmia, F. Lina and Grosjean, Julien and Taalba, Mehdi and Darmoni, J. St{\'e}fan", title="Building a Semantic Health Data Warehouse in the Context of Clinical Trials: Development and Usability Study", journal="JMIR Med Inform", year="2019", month="Dec", day="20", volume="7", number="4", pages="e13917", keywords="data warehousing", keywords="search engine", keywords="semantics", keywords="clinical trial", keywords="patient selection", abstract="Background: The huge amount of clinical, administrative, and demographic data recorded and maintained by hospitals can be consistently aggregated into health data warehouses with a uniform data model. In 2017, Rouen University Hospital (RUH) initiated the design of a semantic health data warehouse enabling both semantic description and retrieval of health information. Objective: This study aimed to present a proof of concept of this semantic health data warehouse, based on the data of 250,000 patients from RUH, and to assess its ability to assist health professionals in prescreening eligible patients in a clinical trials context. Methods: The semantic health data warehouse relies on 3 distinct semantic layers: (1) a terminology and ontology portal, (2) a semantic annotator, and (3) a semantic search engine and NoSQL (not only structured query language) layer to enhance data access performances. The system adopts an entity-centered vision that provides generic search capabilities able to express data requirements in terms of the whole set of interconnected conceptual entities that compose health information. Results: We assessed the ability of the system to assist the search for 95 inclusion and exclusion criteria originating from 5 randomly chosen clinical trials from RUH. The system succeeded in fully automating 39\% (29/74) of the criteria and was efficiently used as a prescreening tool for 73\% (54/74) of them. Furthermore, the targeted sources of information and the search engine--related or data-related limitations that could explain the results for each criterion were also observed. Conclusions: The entity-centered vision contrasts with the usual patient-centered vision adopted by existing systems. It enables more genericity in the information retrieval process. It also allows to fully exploit the semantic description of health information. Despite their semantic annotation, searching within clinical narratives remained the major challenge of the system. A finer annotation of the clinical texts and the addition of specific functionalities would significantly improve the results. The semantic aspect of the system combined with its generic entity-centered vision enables the processing of a large range of clinical questions. However, an important part of health information remains in clinical narratives, and we are currently investigating novel approaches (deep learning) to enhance the semantic annotation of those unstructured data. ", doi="10.2196/13917", url="http://medinform.jmir.org/2019/4/e13917/", url="http://www.ncbi.nlm.nih.gov/pubmed/31859675" } @Article{info:doi/10.2196/16511, author="Masi, Domitilla and Gomez-Rexrode, Elvira Amalia and Bardin, Rina and Seidman, Joshua", title="The ``Preparation for Shared Decision-Making'' Tool for Women With Advanced Breast Cancer: Qualitative Validation Study", journal="J Participat Med", year="2019", month="Dec", day="20", volume="11", number="4", pages="e16511", keywords="shared decision making", keywords="clinical decision making", keywords="patient preferences", keywords="cancer", keywords="breast cancer", keywords="human-centered design", keywords="patient care planning", abstract="Background: The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. Objective: Avalere Health developed the Preparation for Shared Decision-Making (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. Methods: We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. Results: Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. Conclusions: This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool's implementation in the clinical workflow and its impact on patient outcomes. ", doi="10.2196/16511", url="http://jopm.jmir.org/2019/4/e16511/" } @Article{info:doi/10.2196/12883, author="van der Vaart, Rosalie and van Driel, Dorine and Pronk, Kristel and Paulussen, Suzan and te Boekhorst, Selma and Rosmalen, M. Judith G. and Evers, M. Andrea W.", title="The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study", journal="JMIR Form Res", year="2019", month="Nov", day="21", volume="3", number="4", pages="e12883", keywords="internet-based cognitive behavior therapy", keywords="chronic pain", keywords="usability", keywords="digital health literacy skills", keywords="eHealth literacy", abstract="Background: Internet-based cognitive behavior therapy (iCBT) can be effective in mental and somatic health care. Research on the feasibility of internet interventions in clinical practice is, however, still scarce. Studies with a focus on the patient regarding usability of interventions and digital health literacy skills are especially lacking. Objective: The goal of this study was to assess the usability of an iCBT for chronic pain, Master Your Pain, and the relationship between its usability outcomes and the factors age, educational level, and digital health literacy skills. The aims were to determine what changes were needed in the program for sufficient usability and which individual characteristics were related to the usability of the program. Methods: Patients were recruited from two mental health care practices. A mixed methods approach was used in this study. A qualitative observational study comprising performance tasks in the iCBT program was used to test usability. A quantitative questionnaire was used to measure possible related constructs. Usability was operationalized as the number of tasks that could be completed and the type and number of problems that occurred while doing so. Performance tasks were set up to measure 6 digital skills: (1) operating the computer and internet browser, (2) navigation and orientation, (3) using search strategies, (4) evaluating relevance of content, (5) adding personal content, and (6) protecting and respecting privacy. Participants were asked to think aloud while performing the tasks, and screen activities and webcam recordings were captured. The qualitative observational data was coded using inductive analysis by two independent researchers. Correlational analyses were performed to test how usability relates to sociodemographics and digital health literacy. Results: A total of 32 patients participated, with a mean age of 49.9 years and 84\% (27/32) being female. All performance tasks except one (fill in a diary registration) could be completed independently by more than 50\% of the participants. On operational, navigation, and search levels, participants struggled most with logging in, logging out, and finding specific parts of the intervention. Half of the sample experienced problems evaluating the relevance and adding content to the program to some extent. Usability correlated moderately negatively with age and moderately positively with digital health literacy skills but not with educational level. Conclusions: The results provide insight into what is essential for proper usability regarding the design of an iCBT program considering variations in age, educational level, and digital health literacy. Furthermore, the results provide insight into what type of support is needed by patients to properly use the intervention. Tailoring support among the needs of certain age groups or skill levels could be beneficial and could range from no extra support (only online feedback, as intended) to practical support (an additional usability introduction session) to blended care (combined face-to-face sessions throughout the therapy). ", doi="10.2196/12883", url="http://formative.jmir.org/2019/4/e12883/", url="http://www.ncbi.nlm.nih.gov/pubmed/31750839" } @Article{info:doi/10.2196/14829, author="Silva, G. Anabela and Sim{\~o}es, Patr{\'i}cia and Santos, Rita and Queir{\'o}s, Alexandra and Rocha, P. Nelson and Rodrigues, M{\'a}rio", title="A Scale to Assess the Methodological Quality of Studies Assessing Usability of Electronic Health Products and Services: Delphi Study Followed by Validity and Reliability Testing", journal="J Med Internet Res", year="2019", month="Nov", day="15", volume="21", number="11", pages="e14829", keywords="quality of health care", keywords="eHealth", keywords="mHealth", keywords="efficiency", abstract="Background: The usability of electronic health (eHealth) and mobile health apps is of paramount importance as it impacts the quality of care. Methodological quality assessment is a common practice in the field of health for different designs and types of studies. However, we were unable to find a scale to assess the methodological quality of studies on the usability of eHealth products or services. Objective: This study aimed to develop a scale to assess the methodological quality of studies assessing usability of mobile apps and to perform a preliminary analysis of of the scale's feasibility, reliability, and construct validity on studies assessing usability of mobile apps, measuring aspects of physical activity. Methods: A 3-round Delphi panel was used to generate a pool of items considered important when assessing the quality of studies on the usability of mobile apps. These items were used to write the scale and the guide to assist its use. The scale was then used to assess the quality of studies on usability of mobile apps for physical activity, and it assessed in terms of feasibility, interrater reliability, and construct validity. Results: A total of 25 experts participated in the Delphi panel, and a 15-item scale was developed. This scale was shown to be feasible (time of application mean 13.10 [SD 2.59] min), reliable (intraclass correlation coefficient=0.81; 95\% CI 0.55-0.93), and able to discriminate between low- and high-quality studies (high quality: mean 9.22 [SD 0.36]; low quality: mean 6.86 [SD 0.80]; P=.01). Conclusions: The scale that was developed can be used both to assess the methodological quality of usability studies and to inform its planning. ", doi="10.2196/14829", url="http://www.jmir.org/2019/11/e14829/", url="http://www.ncbi.nlm.nih.gov/pubmed/31730036" } @Article{info:doi/10.2196/11346, author="Van de Ven, Pepijn and Araya, Ricardo and P de Paula Couto, Clara Maria and Henrique, Garcia Maiara and Meere, Damien and Vilela Mendes, Ana and Peters, J. Tim and Seabra, Ant{\^o}nio and Franzin, M. Renato and Carvalho Pereda, Paula and Scazufca, Marcia", title="Investigating Software Requirements for Systems Supporting Task-Shifted Interventions: Usability Study", journal="J Med Internet Res", year="2019", month="Nov", day="12", volume="21", number="11", pages="e11346", keywords="task-shifting", keywords="community health workers", keywords="depression", keywords="medical informatics", abstract="Background: There is a considerable shortfall in specialized health care professionals worldwide to deliver health services, and this shortfall is especially pronounced in low-middle-income countries. This has led to the implementation of task-shifted interventions, in which specific tasks are moved away from highly qualified health workers to health workers with less training. The World Health Organization (WHO) has published recommendations for such interventions, but guidelines for software and systems supporting such interventions are not included. Objective: The objective of this study was to formulate a number of software requirements for computer systems supporting task-shifted interventions. As the treatment of mental health problems is generally considered to be a task for highly trained health care professionals, it poses interesting case studies for task-shifted interventions. Therefore, we illustrated the use of the identified software requirements in a mobile system created for a task-shifted depression intervention to be provided to older adults in deprived areas of S{\~a}o Paulo, Brazil. Methods: Using a set of recommendations based on the WHO's guidance documentation for task-shifted interventions, we identified 9 software requirements that aim to support health workers in management and supervision, training, good relationship with other health workers, and community embeddedness of the intervention. These 9 software requirements were used to implement a system for the provision of a psychosocial depression intervention with mobile Android interfaces to structure interventions and collect data, and Web interfaces for supervision and support of the health care workers delivering the intervention. The system was tested in a 2-arm pilot study with 33 patients and 11 health workers. In all, 8 of these 11 health workers participated in a usability study subsequent to the pilot. Results: The qualitative and quantitative feedback obtained with the System Usability Scale suggest that the system was deemed to have a usability of between OK and Good. Nevertheless, some participants' responses indicated that they felt they needed technical assistance to use the system. This was reinforced by answers obtained with perceived usefulness and ease of use questionnaires, which indicated some users felt that they had issues around correct use of the system and perceived ability to become skillful at using the system. Conclusions: Overall, these high-level requirements adequately captured the functionality required to enable the health workers to provide the intervention successfully. Nevertheless, the analysis of results indicated that some improvements were required for the system to be useable in a task-shifted intervention. The most important of these were better access to a training environment, access for supervisors to metadata such as duration of sessions or exercises to identify issues, and a more robust and human-error--proof approach to the availability of patient data on the mobile devices used during the intervention. ", doi="10.2196/11346", url="https://www.jmir.org/2019/11/e11346", url="http://www.ncbi.nlm.nih.gov/pubmed/31714246" } @Article{info:doi/10.2196/12966, author="Appleton, Marie Katherine and Bray, Jeff and Price, Sarah and Liebchen, Gernot and Jiang, Nan and Mavridis, Ioannis and Saulais, Laure and Giboreau, Agn{\`e}s and Perez-Cueto, A. Federico J. and Coolen, Rebecca and Ronge, Manfred and Hartwell, Heather", title="A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation", journal="JMIR Form Res", year="2019", month="Nov", day="4", volume="3", number="4", pages="e12966", keywords="eating", keywords="eating behavior", keywords="food", keywords="diet", keywords="mhealth", keywords="mobile app", keywords="digitalhealth", keywords="smartphone", abstract="Background: Increasing pressure from governments, public health bodies, and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten outside the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: This paper aimed to describe the development and early assessment of a mobile phone app that allows the provision of accurate personalized food-based information while considering individual characteristics (allergies, diet type, and preferences) to enable informed consumer choice when eating out. Methods: An app was designed and developed to address these requirements using an agile approach. The developed app was then evaluated at 8 public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating-out situation, including the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalize the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: This paper details the successful development and early assessment of a novel mobile phone app designed to provide food-based information in an eating-out situation in a personalized manner. ", doi="10.2196/12966", url="http://formative.jmir.org/2019/4/e12966/", url="http://www.ncbi.nlm.nih.gov/pubmed/31682575" } @Article{info:doi/10.2196/12514, author="Bernard, Renaldo and Sabariego, Carla and Cieza, Alarcos", title="Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey", journal="J Med Internet Res", year="2019", month="Oct", day="31", volume="21", number="10", pages="e12514", keywords="World Wide Web", keywords="depression", keywords="anxiety", keywords="accessibility", keywords="interview", keywords="persona", keywords="expert study", keywords="eHealth", keywords="usability", keywords="user experience", keywords="facilitators", keywords="barriers", keywords="mental disorders", abstract="Background: Depression and anxiety are the most common mental health conditions, and they were identified as leading contributors to global disability in 2016. People with these conditions rely on Web-based resources as a source of accurate health information, convenient and effective treatment, and essential social support. However, a recent systematic review revealed several potentially limiting difficulties that this group experiences online and also suggested that there is a partial understanding of these difficulties as only difficulties associated with neurocognitive, but not sociocognitive, deficits were identified. Therefore, this study fills this knowledge gap and contributes to a more robust and fuller understanding of the difficulties this group experiences online. Objective: The objective of this study was to identify the difficulties people with depression and anxiety experience when using the Web and the Web activities that are most associated with the experience of difficulties. Methods: The study employed data triangulation using face-to-face semistructured interviews with 21 participants affected by depression and anxiety and a comparison group (7 participants) without mental disorders (study 1) as well as a persona-based expert online survey with 21 mental health practitioners (MHPs) who treated people with depression and anxiety (study 2). Framework analysis for both studies proceeded through 5 stages: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Results: In study 1, 167 difficulties were identified from the experiences of participants in the depression and anxiety group were discussed within the context of 81 Web activities, services, and features. From these, 4 themes and 12 subthemes describing the difficulties people with depression and anxiety experienced online were identified. Difficulties relating to the subtheme lack of control over access and usage were the most common difficulties experienced by participants in the depression and anxiety group (19/21). Sixteen difficulties identified from the experiences of participants in the comparison group were discussed within the context of 11 Web activities, services, and features. Most participants in the comparison group (6/7) contributed to the subtheme describing difficulties with unexpected and irrelevant content. In study 2, researchers identified 3 themes and 10 subthemes that described the perceived difficulties people with depression and anxiety might experience online as reported by MHPs. Practitioners linked these difficulties with 22 common impairments, limitations in activities of daily life, and diagnostic criteria associated with depression and anxiety. Conclusions: People with depression and anxiety also experience difficulties when using the Web that are related to the sociocognitive deficits associated with their conditions. MHPs have a good awareness of the difficulties that people with depression and anxiety are likely to experience when using the Web. This investigation has contributed to a fuller understanding of these difficulties and provides innovative guidance on how to remove and reduce them for people with depression and anxiety when using the Web. International Registered Report Identifier (IRRID): RR2-10.1007/978-3-319-21006-3\_3 ", doi="10.2196/12514", url="http://www.jmir.org/2019/10/e12514/", url="http://www.ncbi.nlm.nih.gov/pubmed/31674915" } @Article{info:doi/10.2196/12586, author="Vandenberk, Thijs and Storms, Valerie and Lanssens, Dorien and De Canni{\`e}re, H{\'e}l{\`e}ne and Smeets, JP Christophe and Thijs, M. Inge and Batool, Tooba and Vanrompay, Yves and Vandervoort, M. Pieter and Grieten, Lars", title="A Vendor-Independent Mobile Health Monitoring Platform for Digital Health Studies: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="29", volume="7", number="10", pages="e12586", keywords="information science", keywords="patient care management", keywords="mobile health", keywords="telemonitoring", keywords="monitoring, ambulatory", abstract="Background: Medical smartphone apps and mobile health devices are rapidly entering mainstream use because of the rising number of smartphone users. Consequently, a large amount of consumer-generated data is being collected. Technological advances in innovative sensory systems have enabled data connectivity and aggregation to become cornerstones in developing workable solutions for remote monitoring systems in clinical practice. However, few systems are currently available to handle such data, especially for clinical use. Objective: The aim of this study was to develop and implement the digital health research platform for mobile health (DHARMA) that combines data saved in different formats from a variety of sources into a single integrated digital platform suitable for mobile remote monitoring studies. Methods: DHARMA comprises a smartphone app, a Web-based platform, and custom middleware and has been developed to collect, store, process, and visualize data from different vendor-specific sensors. The middleware is a component-based system with independent building blocks for user authentication, study and patient administration, data handling, questionnaire management, patient files, and reporting. Results: A prototype version of the research platform has been tested and deployed in multiple clinical studies. In this study, we used the platform for the follow-up of pregnant women at risk of developing pre-eclampsia. The patients' blood pressure, weight, and activity were semi-automatically captured at home using different devices. DHARMA automatically collected and stored data from each source and enabled data processing for the end users in terms of study-specific parameters, thresholds, and visualization. Conclusions: The increasing use of mobile health apps and connected medical devices is leading to a large amount of data for collection. There has been limited investment in handling and aggregating data from different sources for use in academic and clinical research focusing on remote monitoring studies. In this study, we created a modular mobile health research platform to collect and integrate data from a variety of third-party devices in several patient populations. The functionality of the platform was demonstrated in a real-life setting among women with high-risk pregnancies. ", doi="10.2196/12586", url="https://mhealth.jmir.org/2019/10/e12586", url="http://www.ncbi.nlm.nih.gov/pubmed/31663862" } @Article{info:doi/10.2196/14769, author="Fernandez, P. Maria and Bron, M. Gebbiena and Kache, A. Pallavi and Larson, R. Scott and Maus, Adam and Gustafson Jr, David and Tsao, I. Jean and Bartholomay, C. Lyric and Paskewitz, M. Susan and Diuk-Wasser, A. Maria", title="Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="24", volume="7", number="10", pages="e14769", keywords="Lyme disease", keywords="ticks", keywords="ecological momentary assessment", keywords="citizen science", abstract="Background: Mobile health (mHealth) technology takes advantage of smartphone features to turn them into research tools, with the potential to reach a larger section of the population in a cost-effective manner, compared with traditional epidemiological methods. Although mHealth apps have been widely implemented in chronic diseases and psychology, their potential use in the research of vector-borne diseases has not yet been fully exploited. Objective: This study aimed to assess the usability and feasibility of The Tick App, the first tick research--focused app in the United States. Methods: The Tick App was designed as a survey tool to collect data on human behaviors and movements associated with tick exposure while engaging users in tick identification and reporting. It consists of an enrollment survey to identify general risk factors, daily surveys to collect data on human activities and tick encounters (Tick Diaries), a survey to enter the details of tick encounters coupled with tick identification services provided by the research team (Report a Tick), and educational material. Using quantitative and qualitative methods, we evaluated the enrollment strategy (passive vs active), the user profile, location, longitudinal use of its features, and users' feedback. Results: Between May and September 2018, 1468 adult users enrolled in the app. The Tick App users were equally represented across genders and evenly distributed across age groups. Most users owned a pet (65.94\%, 962/1459; P<.001), did frequent outdoor activities (recreational or peridomestic; 75.24\%, 1094/1454; P<.001 and 64.58\%, 941/1457; P<.001, respectively), and lived in the Midwest (56.55\%, 824/1457) and Northeast (33.0\%, 481/1457) regions in the United States, more specifically in Wisconsin, southern New York, and New Jersey. Users lived more frequently in high-incidence counties for Lyme disease (incidence rate ratio [IRR] 3.5, 95\% CI 1.8-7.2; P<.001) and in counties with cases recently increasing (IRR 1.8, 95\% CI 1.1-3.2; P=.03). Recurring users (49.25\%, 723/1468) had a similar demographic profile to all users but participated in outdoor activities more frequently (80.5\%, 575/714; P<.01). The number of Tick Diaries submitted per user (median 2, interquartile range [IQR] 1-11) was higher for older age groups (aged >55 years; IRR 3.4, 95\% CI 1.5-7.6; P<.001) and lower in the Northeast (IRR[NE] 0.4, 95\% CI 0.3-0.7; P<.001), whereas the number of tick reports (median 1, IQR 1-2) increased with the frequency of outdoor activities (IRR 1.5, 95\% CI 1.3-1.8; P<.001). Conclusions: This assessment allowed us to identify what fraction of the population used The Tick App and how it was used during a pilot phase. This information will be used to improve future iterations of The Tick App and tailor potential tick prevention interventions to the users' characteristics. ", doi="10.2196/14769", url="http://mhealth.jmir.org/2019/10/e14769/", url="http://www.ncbi.nlm.nih.gov/pubmed/31651409" } @Article{info:doi/10.2196/15153, author="Stiles-Shields, Colleen and Garcia, Brittney and Villota, Kimberly and Wartman, Elicia and Winning, M. Adrien and Holmbeck, N. Grayson", title="Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study", journal="JMIR Pediatr Parent", year="2019", month="Oct", day="10", volume="2", number="2", pages="e15153", keywords="spina bifida occulta", keywords="mHealth", keywords="mobile apps", keywords="usability testing", keywords="adolescent", keywords="young adult", keywords="weight reduction programs", keywords="body weight maintenance", abstract="Background: Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. Objective: This study aimed to evaluate the usability of a high-quality, publicly available, weight management--focused mobile BIT (smartphone app) for AYA-SBs. Methods: Overall, 28 AYA-SBs attending a Young Men's Christian Association--based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. Results: The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. Conclusions: AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs. ", doi="10.2196/15153", url="https://pediatrics.jmir.org/2019/2/e15153", url="http://www.ncbi.nlm.nih.gov/pubmed/31603432" } @Article{info:doi/10.2196/14990, author="Lyon, R. Aaron and Munson, A. Sean and Renn, N. Brenna and Atkins, C. David and Pullmann, D. Michael and Friedman, Emily and Are{\'a}n, A. Patricia", title="Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability?", journal="JMIR Res Protoc", year="2019", month="Oct", day="9", volume="8", number="10", pages="e14990", keywords="implementation science", keywords="human-centered design", keywords="evidence-based psychosocial interventions", abstract="Background: This paper presents the protocol for the National Institute of Mental Health (NIMH)--funded University of Washington's ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center (UWAC), which uses human-centered design (HCD) methods to improve the implementation of evidence-based psychosocial interventions (EBPIs). We propose that usability---the degree to which interventions and implementation strategies can be used with ease, efficiency, effectiveness, and satisfaction---is a fundamental, yet poorly understood determinant of implementation. Objective: We present a novel Discover, Design/Build, and Test (DDBT) framework to study usability as an implementation determinant. DDBT will be applied across Center projects to develop scalable and efficient implementation strategies (eg, training tools), modify existing EBPIs to enhance usability, and create usable and nonburdensome decision support tools for quality delivery of EBPIs. Methods: Stakeholder participants will be implementation practitioners/intermediaries, mental health clinicians, and patients with mental illness in nonspecialty mental health settings in underresourced communities. Three preplanned projects and 12 pilot studies will employ the DDBT model to (1) identify usability challenges in implementing EBPIs in underresourced settings; (2) iteratively design solutions to overcome these challenges; and (3) compare the solution to the original version of the EPBI or implementation strategy on usability, quality of care, and patient-reported outcomes. The final products from the center will be a streamlined modification and redesign model that will improve the usability of EBPIs and implementation strategies (eg, tools to support EBPI education and decision making); a matrix of modification targets (ie, usability issues) that are both common and unique to EBPIs, strategies, settings, and patient populations; and a compilation of redesign strategies and the relative effectiveness of the redesigned solution compared to the original EBPI or strategy. Results: The UWAC received institutional review board approval for the three separate studies in March 2018 and was funded in May 2018. Conclusions: The outcomes from this center will inform the implementation of EBPIs by identifying cross-cutting features of EBPIs and implementation strategies that influence the use and acceptability of these interventions, actively involving stakeholder clinicians and implementation practitioners in the design of the EBPI modification or implementation strategy solution and identifying the impact of HCD-informed modifications and solutions on intervention effectiveness and quality. Trial Registration: ClinicalTrials.gov NCT03515226 (https://clinicaltrials.gov/ct2/show/NCT03515226), NCT03514394 (https://clinicaltrials.gov/ct2/show/NCT03514394), and NCT03516513 (https://clinicaltrials.gov/ct2/show/NCT03516513). International Registered Report Identifier (IRRID): DERR1-10.2196/14990 ", doi="10.2196/14990", url="https://www.researchprotocols.org/2019/10/e14990", url="http://www.ncbi.nlm.nih.gov/pubmed/31599736" } @Article{info:doi/10.2196/15231, author="Sezgin, Emre and Militello, Lisa and Huang, Yungui and Lin, Simon", title="Look to the Future and SMILE: Feasibility of Interactive Voice Assistant Technology to Support Maternal Infant Health", journal="iproc", year="2019", month="Oct", day="2", volume="5", number="1", pages="e15231", keywords="behavioral health", keywords="interactive voice response", keywords="mobile health", keywords="mothers", keywords="pregnancy", keywords="self care", keywords="self-management", abstract="Background: Both maternal and infant mortality rates serve as indicators of population health and are unacceptably high worldwide. Voice assistant (VA) technologies present a potential new modality to support maternal child health. We developed an interactive VA intervention app (SMILE) to deliver brief, maternal-infant education and management skills (eg, perinatal care, stress management, breast feeding, infant-care) using evidence-based content. Objective: The objective was to understand the feasibility and usability of an interactive VA intervention to support maternal and infant health among a group of pregnant women. Methods: We employed a mixed methods study design. Pregnant women were recruited via email and word of mouth. Participants completed a baseline demographic and technology-use survey and were asked to use the intervention over the course of two weeks. Postintervention, participants were invited to participate in an individual or group interview. Interviews were conducted to elicit feedback regarding thoughts and attitudes towards VA technology to support the health of mothers and infants. Descriptive analysis was used to summarize quantitative data (ie, survey responses, app logs) and thematic analysis was used for qualitative data (ie, transcriptions of voice recordings collected from SMILE, transcriptions of follow-up interviews). Results: Out of 46 respondents, 19 participants were consented, completed baseline surveys and used SMILE. Approximately 63\% (n=12) of participants participated in exit interviews. The sample was predominantly 25-34 years old (n=16, 84\%), part of a two-parent household (n=19, 100\%), white (n=15, 79\%), and pregnant with their first child (n=12, 63\%). Nine participants (47.4\%) reported that they practice stress management, and favorable stress-management activities were mainly comprised of exercise activities, yoga, and outdoor activities without technology involvement. Over half of the participants reported using technology to support pregnancy self-management (n=10, 53\%). However, participants preferred mobile apps for education and self-management support during pregnancy and relied on the Internet to access health-related information. More than half of participants reported using default VAs on their phone (n=11, 58\%) and on smart speakers (n=10, 53\%). Yet, VA technology was mainly reported as being used for basic tasks, such as setting a timer or reminder, checking the weather, turning on/off the lights, or playing music. Postintervention, participants verbalized that VA technology was a potential medium for receiving health information, pregnancy-related information, and could be a strategy to engage other family members in the process. Major concerns revolved around security, privacy, trust, and concerns regarding interacting via voice when in public. Conclusions: Although this research is limited by the small and predominantly white sample size, this research represents one of the first studies to explore perceptions and attitudes towards VA to promote maternal-infant health. As VA technology increases in popularity, adoption and utility to support health and well-being among pregnant women is nascent. While VA technology offers some benefits (eg, reduce literacy barriers, hands-free), familiarity and trust of nonvoice digital health tools (eg, mobile apps, Web-based content) remain important in supporting maternal-child health. Digital health solutions that incorporate multiple platforms (eg, mobile apps, Internet, voice) warrant further exploration to optimize support for maternal child health. ", doi="10.2196/15231", url="https://www.iproc.org/2019/1/e15231" } @Article{info:doi/10.2196/14429, author="Ravindran, Vijay and Osgood, Monica and Sazawal, Vibha and Solorzano, Rita and Turnacioglu, Sinan", title="Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study", journal="JMIR Pediatr Parent", year="2019", month="Sep", day="30", volume="2", number="2", pages="e14429", keywords="autism spectrum disorder", keywords="interpersonal skills", keywords="virtual reality, instructional", abstract="Background: Advances in virtual reality (VR) technology offer new opportunities to design supports for the core behaviors associated with autism spectrum disorder (ASD) that promote progress toward optimal outcomes. Floreo has developed a novel mobile VR platform that pairs a user receiving instruction on target skills with an adult monitor. Objective: The primary objective of this pilot study was to explore the feasibility of using Floreo's Joint Attention Module in school-aged children with autism in a special education setting. A secondary objective was to explore a novel joint attention measure designed for use with school-aged children and to observe whether there was a suggestion of change in joint attention skills from preintervention to postintervention. Methods: A total of 12 participants (age range: 9 to 16 years) received training with the Joint Attention Module for 14 sessions over 5 weeks. Results: No serious side effects were reported, and no participants dropped out of the study because of undesirable side effects. On the basis of monitor data, 95.4\% (126/132) of the time participants tolerated the headset, 95.4\% (126/132) of the time participants seemed to enjoy using Floreo's platform, and 95.5\% (128/134) of the time the VR experience was reported as valuable. In addition, scoring of the joint attention measure suggested a positive change in participant skills related to the total number of interactions, use of eye contact, and initiation of interactions. Conclusions: The study results suggest that Floreo's Joint Attention Module is safe and well tolerated by students with ASD, and preliminary data also suggest that its use is related to improvements in fundamental joint attention skills. ", doi="10.2196/14429", url="http://pediatrics.jmir.org/2019/2/e14429/", url="http://www.ncbi.nlm.nih.gov/pubmed/31573921" } @Article{info:doi/10.2196/11617, author="Welbie, Marlies and Wittink, Harriet and Westerman, J. Marjan and Topper, Ilse and Snoei, Josca and Devill{\'e}, M. Walter L. J.", title="A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment", journal="JMIR Form Res", year="2019", month="Sep", day="27", volume="3", number="3", pages="e11617", keywords="mHealth", keywords="eHealth", keywords="surveys and questionnaires", keywords="physical therapy specialty", keywords="qualitative research", abstract="Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies. ", doi="10.2196/11617", url="https://formative.jmir.org/2019/3/e11617", url="http://www.ncbi.nlm.nih.gov/pubmed/31573909" } @Article{info:doi/10.2196/13887, author="Ijaz, Kiran and Ahmadpour, Naseem and Naismith, L. Sharon and Calvo, A. Rafael", title="An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study", journal="JMIR Ment Health", year="2019", month="Sep", day="03", volume="6", number="9", pages="e13887", keywords="virtual reality", keywords="healthy aging", keywords="memory", keywords="cognition", keywords="dementia", abstract="Background: Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements. Objective: This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC). Methods: VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup. Results: Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87). Conclusions: The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future. ", doi="10.2196/13887", url="https://mental.jmir.org/2019/9/e13887/", url="http://www.ncbi.nlm.nih.gov/pubmed/31482851" } @Article{info:doi/10.2196/13875, author="Turk, Amadea and Fairclough, Emma and Grason Smith, Gillian and Lond, Benjamin and Nanton, Veronica and Dale, Jeremy", title="Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive Study", journal="JMIR Aging", year="2019", month="Aug", day="20", volume="2", number="2", pages="e13875", keywords="caregivers", keywords="information technology", keywords="internet", abstract="Background: Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers' resilience. It aims to provide personalized access to information and resources that are responsive to individuals' caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. Objective: This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. Methods: We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Results: Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. Conclusions: The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation. ", doi="10.2196/13875", url="https://aging.jmir.org/2019/2/e13875", url="http://www.ncbi.nlm.nih.gov/pubmed/31518272" } @Article{info:doi/10.2196/12824, author="Davis, C. Angela and Wright, C. Cassandra J. and Temple-Smith, J. Meredith and Hellard, E. Margaret and Lim, C. Megan S.", title="A Health Education Website Developed to Meet Young People's Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study", journal="JMIR Form Res", year="2019", month="Aug", day="13", volume="3", number="3", pages="e12824", keywords="adolescent", keywords="pornography", keywords="health promotion", keywords="internet", keywords="sex education", abstract="Background: Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. Objective: This study aimed to test the usability of a resource about online pornography and sexting among young people. Methods: Semistructured interviews were conducted with 17 participants aged 15 to 29 years. Results: We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. ", doi="10.2196/12824", url="http://formative.jmir.org/2019/3/e12824/", url="http://www.ncbi.nlm.nih.gov/pubmed/31411140" } @Article{info:doi/10.2196/13559, author="G{\"o}rges, Matthias and West, C. Nicholas and Petersen, L. Christian and Ansermino, Mark J.", title="Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study", journal="JMIR Perioper Med", year="2019", month="Aug", day="05", volume="2", number="2", pages="e13559", keywords="communication systems", keywords="patient monitoring", keywords="user-centered design", keywords="human factors", keywords="anesthesia", abstract="Background: In the perioperative environment, a multidisciplinary clinical team continually observes and evaluates patient information. However, data availability may be restricted to certain locations, cognitive workload may be high, and team communication may be constrained by availability and priorities. We developed the remote Portable Operating Room Tracker app (the telePORT app) to improve information exchange and communication between anesthesia team members. The telePORT app combines a real-time feed of waveforms and vital signs from the operating rooms with messaging, help request, and reminder features. Objective: The aim of this paper is to describe the development of the app and the back-end infrastructure required to extract monitoring data, facilitate data exchange and ensure privacy and safety, which includes results from clinical feasibility testing. Methods: telePORT's client user interface was developed using user-centered design principles and workflow observations. The server architecture involves network-based data extraction and data processing. Baseline user workload was assessed using step counters and communication logs. Clinical feasibility testing analyzed device usage over 11 months. Results: telePORT was more commonly used for help requests (approximately 4.5/day) than messaging between team members (approximately 1/day). Passive operating room monitoring was frequently utilized (34\% of screen visits). Intermittent loss of wireless connectivity was a major barrier to adoption (decline of 0.3\%/day). Conclusions: The underlying server infrastructure was repurposed for real-time streaming of vital signs and their collection for research and quality improvement. Day-to-day activities of the anesthesia team can be supported by a mobile app that integrates real-time data from all operating rooms. ", doi="10.2196/13559", url="http://periop.jmir.org/2019/2/e13559/", url="http://www.ncbi.nlm.nih.gov/pubmed/33393912" } @Article{info:doi/10.2196/13621, author="Weichelt, Bryan and Heimonen, Tomi and Gorucu, Serap and Redmond, Emily and Vechinski, Josef and Pflughoeft, Kurt and Bendixsen, Casper and Salzwedel, Marsha and Scott, Erika and Namkoong, Kang and Purschwitz, Mark and Rautiainen, Risto and Murphy, J. Dennis", title="Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study", journal="JMIR Form Res", year="2019", month="Aug", day="02", volume="3", number="3", pages="e13621", keywords="agriculture", keywords="risk", keywords="wounds and injuries", keywords="safety", keywords="farms", keywords="news", keywords="newspaper article", abstract="Background: Injury data and reports provide valuable information for both public and private organizations to guide programming, policy, and prevention, but in the increasingly complex and dangerous industry of US agriculture, the injury surveillance needed to produce this data is lacking. To address the gap, AgInjuryNews was established in 2015. The system includes fatal and nonfatal injury cases derived from publicly available reports, including occupational and nonoccupational injuries, occurring in the agricultural, forestry, and fishing (AFF) industry. Objective: The study aimed to develop a stakeholder-engaged redesign of the interactive, up-to-date, and publicly available dataset of US AFF injury and fatality reports. Methods: Instructor-led heuristic evaluations within a 15-student undergraduate course, data from 8 student participants of laboratory-based usability testing and 2016 and 2017 AgInjuryNews-registered user surveys, coupled with input from the National Steering Committee informed the development priorities for 2018. An interdisciplinary team employed an agile methodology of 2-week sprints developing in ASP.NET and Structured Query Language to deliver an intuitive frontend and a flexible, yet structured, backend, including a case report input form for capturing more than 50 data points on each injury report. Results: AgInjuryNews produced 17,714 page views from 43 countries in 2018 captured via Google Analytics, whereas 623 injury reports were coded and loaded, totaling more than 31,000 data points. Newly designed features include customizable email alerts, an interactive map, and expanded search and filter options. User groups such as the Bureau of Labor Statistics and the Agricultural Safety and Health Council of America have endorsed the system within their networks. News media have cited or referenced the system in national outlets such as the New York Times, Politico, and the Washington Post. Conclusions: The new system's features, functions, and improved data granularity have sparked innovative lines of research and increased collaborative interest domestically and abroad. It is anticipated that this nontraditional sentinel surveillance system and its dataset will continue to serve many purposes for public and private agricultural safety and health stakeholders in the years to come.\emspace ", doi="10.2196/13621", url="http://formative.jmir.org/2019/3/e13621/", url="http://www.ncbi.nlm.nih.gov/pubmed/31376278" } @Article{info:doi/10.2196/13041, author="Pfarr, Juliane and Ganter, T. Michael and Spahn, R. Donat and Noethiger, B. Christoph and Tscholl, W. David", title="Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study", journal="J Med Internet Res", year="2019", month="Jul", day="17", volume="21", number="7", pages="e13041", keywords="anesthesia", keywords="critical care", keywords="computers", keywords="diagnosis", keywords="patient monitoring", keywords="situation awareness", keywords="perception", keywords="vision", abstract="Background: Continuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms. Objective: In this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers' perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only. Methods: We conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision. Results: Overall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 (P<.001) in scenario 1, and more than doubled from 3 to 8 (P<.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 (P<.001), and very unconfident in scenario 2 (P=.024) with conventional monitoring. Conclusions: This study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior to a standard numeric display for peripheral vision. Avatar-based monitoring could potentially make much more of the patient monitoring information available to caregivers for longer time periods per case. Our results indicate that the optimal information transmission would consist of a combination of auditory and avatar-based monitoring. ", doi="10.2196/13041", url="http://www.jmir.org/2019/7/e13041/", url="http://www.ncbi.nlm.nih.gov/pubmed/31317870" } @Article{info:doi/10.2196/12305, author="Dunsmuir, Dustin and Wu, Helen and Sun, Terri and West, C. Nicholas and Lauder, R. Gillian and G{\"o}rges, Matthias and Ansermino, Mark J.", title="A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility", journal="JMIR Perioper Med", year="2019", month="Jul", day="04", volume="2", number="2", pages="e12305", keywords="pain management", keywords="pain, postoperative period", keywords="outpatients", keywords="mobile apps", keywords="child", keywords="parents", abstract="Background: Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child's pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting. Objective: The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents' satisfaction. Methods: Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child's pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user's adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app's ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round. Results: Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30\% (interquartile range [IQR] 22\%-33\%) of alerts within 1 hour in round 1, and subsequently to median 60\% (IQR 44\%-64\%) in round 2 and median 64\% (IQR 56\%-72\%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts. Conclusions: It is feasible for parents or guardians to use Panda at home to manage their child's medication schedule and track their pain. Simple modifications to the app's alert sounds and user interface improved response times. ", doi="10.2196/12305", url="https://periop.jmir.org/2019/2/e12305/", url="http://www.ncbi.nlm.nih.gov/pubmed/33393928" } @Article{info:doi/10.2196/12695, author="Kersting, Christine and Weltermann, Birgitta", title="Evaluating the Feasibility of a Software Prototype Supporting the Management of Multimorbid Seniors: Mixed Methods Study in General Practices", journal="JMIR Hum Factors", year="2019", month="Jul", day="04", volume="6", number="3", pages="e12695", keywords="patient care management", keywords="primary health care", keywords="clinical decision support systems", keywords="electronic health record", keywords="reminder system", keywords="health information technology", abstract="Background: Longitudinal, patient-centered care represents a challenge for general practices. Decision support and reminder systems can offer targeted support. Objective: The objective of this study was to follow a user-oriented, stepwise approach to develop an add-on for German electronic health record (EHR) systems, which aims to support longitudinal care management of multimorbid seniors, using a flag system displaying patient-centered information relevant for comprehensive health care management. This study evaluated the prototype's feasibility from both a technical and users' perspective. Methods: The study was conducted with 18 general practitioners (GPs) and practice assistants (PAs) from 9 general practices using a mixed methods approach. In all practices, 1 GP and 1 PA tested the software each for 4 multimorbid seniors selected from the practice patient data. Technical feasibility was evaluated by documenting all technical problems. To evaluate the feasibility from the users' perspective, participants' responses during the software test were documented. In addition, they completed a self-administered questionnaire, including the validated System Usability Scale (SUS). Data were merged by transforming qualitative data into quantitative data. Analyses were performed using univariate statistics in IBM SPSS statistics. Results: From a technical perspective, the new software was easy to install and worked without problems. Difficulties during the installation occurred in practices lacking a 64-bit system or a current version of Microsoft .NET. As EHRs used in German practices do not provide an interface to extract the data needed, additional software was required. Incomplete flags for some laboratory data occurred, although this function was implemented in our software as shown in previous tests. From the users' perspective, the new add-on provided a better overview of relevant patient information, reminded more comprehensively about upcoming examinations, and better supported guideline-based care when compared with their individual practice strategies. A total of 14 out of 18 participants (78\%) were interested in using the software long-term. Furthermore, 8 of 9 GPs were willing to pay 5 to 25 Euros (mean 14.75, SD 5.93) monthly for its use. The usability was rated as 75\% (43\%-95\%). Conclusions: The new EHR add-on was well accepted and achieved a good usability rating measured by the validated SUS. In perspective, the legally consolidated, standardized interface to German EHRs will facilitate the technical integration. In view of the high feasibility, we plan to study the software's effectiveness in everyday primary care. Trial Registration: German Clinical Trials Register DRKS00008777; https://www.drks.de/drks\_web/navigate.do? navigationId=trial.HTML\&TRIAL\_ID=DRKS00008777 ", doi="10.2196/12695", url="https://humanfactors.jmir.org/2019/3/e12695/", url="http://www.ncbi.nlm.nih.gov/pubmed/31274115" } @Article{info:doi/10.2196/13627, author="Garvin, Hornung Jennifer and Ducom, Julie and Matheny, Michael and Miller, Anne and Westerman, Dax and Reale, Carrie and Slagle, Jason and Kelly, Natalie and Beebe, Russ and Koola, Jejo and Groessl, J. Erik and Patterson, S. Emily and Weinger, Matthew and Perkins, M. Amy and Ho, B. Samuel", title="Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis", journal="JMIR Med Inform", year="2019", month="Jul", day="03", volume="7", number="3", pages="e13627", keywords="clinical decision support", keywords="human factors engineering", keywords="liver cirrhosis", keywords="interview", abstract="Background: There are gaps in delivering evidence-based care for patients with chronic liver disease and cirrhosis. Objective: Our objective was to use interactive user-centered design methods to develop the Cirrhosis Order Set and Clinical Decision Support (CirrODS) tool in order to improve clinical decision-making and workflow. Methods: Two work groups were convened with clinicians, user experience designers, human factors and health services researchers, and information technologists to create user interface designs. CirrODS prototypes underwent several rounds of formative design. Physicians (n=20) at three hospitals were provided with clinical scenarios of patients with cirrhosis, and the admission orders made with and without the CirrODS tool were compared. The physicians rated their experience using CirrODS and provided comments, which we coded into categories and themes. We assessed the safety, usability, and quality of CirrODS using qualitative and quantitative methods. Results: We created an interactive CirrODS prototype that displays an alert when existing electronic data indicate a patient is at risk for cirrhosis. The tool consists of two primary frames, presenting relevant patient data and allowing recommended evidence-based tests and treatments to be ordered and categorized. Physicians viewed the tool positively and suggested that it would be most useful at the time of admission. When using the tool, the clinicians placed fewer orders than they placed when not using the tool, but more of the orders placed were considered to be high priority when the tool was used than when it was not used. The physicians' ratings of CirrODS indicated above average usability. Conclusions: We developed a novel Web-based combined clinical decision-making and workflow support tool to alert and assist clinicians caring for patients with cirrhosis. Further studies are underway to assess the impact on quality of care for patients with cirrhosis in actual practice. ", doi="10.2196/13627", url="https://medinform.jmir.org/2019/3/e13627/", url="http://www.ncbi.nlm.nih.gov/pubmed/31271153" } @Article{info:doi/10.2196/12580, author="Araujo Almeida, Vanessa and Littlejohn, Paula and Cop, Irene and Brown, Erin and Afroze, Rimi and Davison, M. Karen", title="Comparison of Nutrigenomics Technology Interface Tools for Consumers and Health Professionals: A Sequential Explanatory Mixed Methods Investigation", journal="J Med Internet Res", year="2019", month="Jun", day="28", volume="21", number="6", pages="e12580", keywords="nutrigenomics", keywords="nutrigenetics", keywords="genomics", keywords="epigenomics", keywords="interface, user-computer", abstract="Background: Nutrigenomics forms the basisof personalized nutrition by customizing an individual's dietaryplan based on the integration of life stage, current health status,and genome information. Some common genes that are includedin nutrition-based multigene test panels include CYP1A2 (rateof caffeine break down), MTHFR (folate usage),NOS3 (risk of elevated triglyceride levels related to omega-3fat intake), and ACE (blood pressure response in related tosodium intake). The complexity of gene test--based personalized nutrition presents barriers to its implementation. Objective: This study aimed to compare a self-driven approach to gene test--based nutrition education versus an integrated practitioner-facilitated method to help develop improved interface tools for personalized nutrition practice. Methods: A sequential, explanatory mixed methods investigation of 55 healthy adults (35 to 55 years) was conducted that included (1) a 9-week randomized controlled trial where participants were randomized to receive a standard nutrition-based gene test report (control; n=19) or a practitioner-facilitated personalized nutrition intervention (intervention; n=36) and (2) an interpretative thematic analysis of focus group interview data. Outcome measures included differences in the diet quality score (Healthy Eating Index--Canadian [HEI-C]; proportion [\%] of calories from total fat, saturated fat, and sugar; omega 3 fatty acid intake [grams]; sodium intake [milligrams]); as well as health-related quality of life (HRQoL) scale score. Results: Of the 55 (55/58 enrolled, 95\%) participants who completed the study, most were aged between 40 and 51 years (n=37, 67\%), were female (n=41, 75\%), and earned a high household income (n=32, 58\%). Compared with baseline measures, group differences were found for the percentage of calories from total fat (mean difference [MD]=?5.1\%; Wilks lambda ($\lambda$)=0.817, F1,53=11.68; P=.001; eta-squared [$\eta${\texttwosuperior}]=0.183) and saturated fat (MD=?1.7\%; $\lambda$=0.816; F1,53=11.71; P=.001; $\eta${\texttwosuperior}=0.18) as well as HRQoL scores (MD=8.1 points; $\lambda$=0.914; F1,53=4.92; P=.03; $\eta${\texttwosuperior}=0.086) compared with week 9 postintervention measures. Interactions of time-by-group assignment were found for sodium intakes ($\lambda$=0.846; F1,53=9.47; P=.003; $\eta${\texttwosuperior}=0.15) and HEI-C scores ($\lambda$=0.660; F1,53=27.43; P<.001; $\eta${\texttwosuperior}=0.35). An analysis of phenotypic and genotypic information by group assignment found improved total fat (MD=?5\%; $\lambda$=0.815; F1,51=11.36; P=.001; $\eta${\texttwosuperior}=0.19) and saturated fat (MD=?1.3\%; $\lambda$=0.822; F1,51=10.86; P=.002; $\eta${\texttwosuperior}=0.18) intakes. Time-by-group interactions were found for sodium ($\lambda$=0.844; F3,51=3.09; P=.04; $\eta${\texttwosuperior}=0.16); a post hoc analysis showed pre/post differences for those in the intervention group that did (preintervention mean 3611 mg, 95\% CI 3039-4182; postintervention mean 2135 mg, 95\% CI 1564-2705) and did not have the gene risk variant (preintervention mean 3722 mg, 95\% CI 2949-4496; postintervention mean 2071 mg, 95\% CI 1299-2843). Pre- and postdifferences related to the Dietary Reference Intakes showed increases in the proportion of intervention participants within the acceptable macronutrient distribution ranges for fat (pre/post mean difference=41.2\%; P=.02). Analysis of textual data revealed 3 categories of feedback: (1) translation of nutrition-related gene test information to action; (2) facilitation of eating behavior change, particularly for the macronutrients and sodium; and (3) directives for future personalized nutrition practice. Conclusions: Although improvements were observed in both groups, healthy adults appear to derive more health benefits from practitioner-led personalized nutrition interventions. Further work is needed to better facilitate positive changes in micronutrient intakes. Trial Registration: ClinicalTrials.gov NCT03310814; http://clinicaltrials.gov/ct2/show/NCT03310814 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9846 ", doi="10.2196/12580", url="http://www.jmir.org/2019/6/e12580/", url="http://www.ncbi.nlm.nih.gov/pubmed/31254340" } @Article{info:doi/10.2196/humanfactors.9481, author="Jalil, Sakib and Myers, Trina and Atkinson, Ian and Soden, Muriel", title="Complementing a Clinical Trial With Human-Computer Interaction: Patients' User Experience With Telehealth", journal="JMIR Hum Factors", year="2019", month="Jun", day="06", volume="6", number="2", pages="e9481", keywords="clinical user-experience evaluation", keywords="telehealth", keywords="type 2 diabetes", keywords="user experience", keywords="human-computer interaction", keywords="patient-centered", keywords="patient-technology interaction", keywords="eHealth", abstract="Background: The use of telehealth to monitor patients from home is on the rise. Telehealth technology is evaluated in a clinical trial with measures of health outcomes and cost-effectiveness. However, what happens between a technology and the patients is not investigated during a clinical trial---the telehealth technology remains as a ``black box.'' Meanwhile, three decades of research in the discipline of human-computer interaction (HCI) presents design, implementation, and evaluation of technologies with a primary emphasis on users. HCI research has exposed the importance of user experience (UX) as an essential part of technology development and evaluation. Objective: This research investigates the UX of patients with type 2 diabetes mellitus (T2D) with a telehealth in-home monitoring device to manage T2D from home. We investigate how the UX during a clinical trial can be researched and what a clinical trial can learn from HCI research. Methods: We adopted an ethnographic philosophy and conducted a contextual inquiry due to time limitations followed by semistructured interviews of 9 T2D patients. We defined the method as Clinical User-experience Evaluation (CUE). The patients were enrolled in a telehealth clinical trial of T2D; however, this research was an independent study conducted by information technologists and health researchers for a user-centered evaluation of telehealth. Results: Key analytical findings were that patients valued the benefits of in-home monitoring, but the current device did not possess all functionalities that patients wanted. The results include patients' experiences and emotions while using the device, patients' perceived benefits of the device, and how patients domesticated the device. Further analysis showed the influence of the device on patients' awareness, family involvement, and design implications for telehealth for T2D. Conclusions: HCI could complement telehealth clinical trials and uncover knowledge about T2D patients' UX and future design implications. Through HCI we can look into the ``black box'' phenomenon of clinical trials and create patient-centered telehealth solutions. ", doi="10.2196/humanfactors.9481", url="http://humanfactors.jmir.org/2019/2/e9481/", url="http://www.ncbi.nlm.nih.gov/pubmed/31172958" } @Article{info:doi/10.2196/12940, author="Grasaas, Erik and Fegran, Liv and Helseth, S{\o}lvi and Stinson, Jennifer and Martinez, Santiago and Lalloo, Chitra and Haraldstad, Kristin", title="iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway", journal="JMIR Res Protoc", year="2019", month="Jun", day="03", volume="8", number="6", pages="e12940", keywords="health", keywords="self-management", keywords="adolescent", keywords="chronic pain", keywords="translating", keywords="mobile app", abstract="Background: Persistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management. Objective: The objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app's usability using a phased approach. Methods: Phase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app's usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data. Results: End users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used. Conclusions: This study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample. ", doi="10.2196/12940", url="https://www.researchprotocols.org/2019/6/e12940/", url="http://www.ncbi.nlm.nih.gov/pubmed/31162132" } @Article{info:doi/10.2196/10388, author="Rodriguez, Sarah and Hwang, Kevin and Wang, Jing", title="Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers", journal="JMIR Form Res", year="2019", month="May", day="23", volume="3", number="2", pages="e10388", keywords="patient-generated health data", keywords="connected health", keywords="remote monitoring", keywords="electronic health record", keywords="hypertension", keywords="patient reported outcome", keywords="self-measured blood pressure", keywords="self-monitoring of blood pressure", abstract="Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider's preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. ", doi="10.2196/10388", url="http://formative.jmir.org/2019/2/e10388/", url="http://www.ncbi.nlm.nih.gov/pubmed/31124468" } @Article{info:doi/10.2196/13502, author="Zhang, Lingling and Babu, V. Sabarish and Jindal, Meenu and Williams, E. Joel and Gimbel, W. Ronald", title="A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study", journal="JMIR Res Protoc", year="2019", month="May", day="23", volume="8", number="5", pages="e13502", keywords="heart failure", keywords="mobile health", keywords="self-management", keywords="patient engagement", keywords="virtual human", abstract="Background: Heart failure (HF) causes significant economic and humanistic burden for patients and their families, especially those with a low income, partly due to high hospital readmission rates. Optimal self-care is considered an important nonpharmacological aspect of HF management that can improve health outcomes. Emerging evidence suggests that self-management assisted by smartphone apps may reduce rehospitalization rates and improve the quality of life of patients. We developed a virtual human--assisted, patient-centered mobile health app (iHeartU) for patients with HF to enhance their engagement in self-management and improve their communication with health care providers and family caregivers. iHeartU may help patients with HF in self-management to reduce the technical knowledge and usability barrier while maintaining a low cost and natural, effective social interaction with the user. Objective: With a standardized systematic usability assessment, this study had two objectives: (1) to determine the obstacles to effective and efficient use of iHeartU in patients with HF and (2) to evaluate of HF patients' adoption, satisfaction, and engagement with regard to the of iHeartU app. Methods: The basic methodology to develop iHeartU systems consists of a user-centric design, development, and mixed methods formative evaluation. The iterative design and evaluation are based on the guidelines of the American College of Cardiology Foundation and American Heart Association for the management of heart failure and the validated ``Information, Motivation, and Behavioral skills'' behavior change model. Our hypothesis is that this method of a user-centric design will generate a more usable, useful, and easy-to-use mobile health system for patients, caregivers, and practitioners. Results: The prototype of iHeartU has been developed. It is currently undergoing usability testing. As of September 2018, the first round of usability testing data have been collected. The final data collection and analysis are expected to be completed by the end of 2019. Conclusions: The main contribution of this project is the development of a patient-centered self-management system, which may support HF patients' self-care at home and aid in the communication between patients and their health care providers in a more effective and efficient way. Widely available mobile phones serve as care coordination and ``no-cost'' continuum of care. For low-income patients with HF, a mobile self-management tool will expand their accessibility to care and reduce the cost incurred due to emergency visits or readmissions. The user-centered design will improve the level of engagement of patients and ultimately lead to better health outcomes. Developing and testing a novel mobile system for patients with HF that incorporates chronic disease management is critical for advancing research and clinical practice of care for them. This research fills in the gap in user-centric design and lays the groundwork for a large-scale population study in the next phase. International Registered Report Identifier (IRRID): DERR1-10.2196/13502 ", doi="10.2196/13502", url="http://www.researchprotocols.org/2019/5/e13502/", url="http://www.ncbi.nlm.nih.gov/pubmed/31124472" } @Article{info:doi/10.2196/mhealth.9232, author="Ferrara, Giannina and Kim, Jenna and Lin, Shuhao and Hua, Jenna and Seto, Edmund", title="A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates", journal="JMIR Mhealth Uhealth", year="2019", month="May", day="17", volume="7", number="5", pages="e9232", keywords="diet", keywords="nutrition assessment", keywords="behavior and behavior mechanisms", abstract="Background: Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied. Objective: The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding. Methods: The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference. Results: Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4\% for calories, 1.0\% for carbohydrates, 10.4\% for protein, and ?6.5\% for fat. Conclusions: Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies. ", doi="10.2196/mhealth.9232", url="http://mhealth.jmir.org/2019/5/e9232/", url="http://www.ncbi.nlm.nih.gov/pubmed/31102369" } @Article{info:doi/10.2196/12875, author="Hypp{\"o}nen, Hannele and Kaipio, Johanna and Heponiemi, Tarja and L{\"a}{\"a}veri, Tinja and Aalto, Anna-Mari and V{\"a}nsk{\"a}, Jukka and Elovainio, Marko", title="Developing the National Usability-Focused Health Information System Scale for Physicians: Validation Study", journal="J Med Internet Res", year="2019", month="May", day="16", volume="21", number="5", pages="e12875", keywords="physicians", keywords="health information systems", keywords="questionnaire", keywords="validation studies", abstract="Background: Problems in the usability of health information systems (HISs) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HISs.?Such questionnaires are needed not only for research but also for developing usability of HISs from the viewpoint of end-user experiences. Objective: This study aimed to develop and test the validity of the questionnaire measuring the National Usability-Focused HIS-Scale (NuHISS) among a nationally representative sample of Finnish physicians. Methods: We utilized 2 cross-sectional data collected from a random sample of Finnish physicians in 2014?(N=3781; of which 2340 [61.9\%] were women) and 2017 (N=4018; of which 2604 [64.8\%] were women).?Exploratory and confirmatory factor analyses (structural equation modeling [SEM]) were applied to test the structural validity of the NuHISS.?As the concurrent validity measure, we used the self-reported overall quality of the electronic health record system (school grade) provided by the participants using marginal structural models. Results: The exploratory factor analyses with Varimax rotation suggested that the 7-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and?C2=2109.83 in 2017, both P<.001). Moreover, structural equation modelling analyses, using comparative fit index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), root mean squared error of approximation (RMSEA), and Standardized Root Mean square Residual (SRMR), showed that the 7-factor solution provided an acceptable fit in both samples (CFI=0.92/0.91, TLI=0.92/0.91, NFI=0.92/0.91, RMSEA=0.048/0.049, and SRMR=0.040/0.039). In addition, concurrent validity of this solution was shown to be acceptable. Ease of use, but also all other dimensions, was especially associated with overall quality reports independent of measured confounders. The 7-factor solution included dimensions of technical quality, information quality, feedback, ease of use, benefits, internal collaboration, and cross-organizational collaboration. Conclusions: NuHISS provides a useful tool for measuring usability of HISs among physicians and offers a valid measure for monitoring the long-term development of HISs on a large scale. The relative importance of items needs to be assessed against national electronic health policy goals and complemented with items that have remained outside the NuHISS from the questionnaire when appropriate. ", doi="10.2196/12875", url="https://www.jmir.org/2019/5/e12875/", url="http://www.ncbi.nlm.nih.gov/pubmed/31099336" } @Article{info:doi/10.2196/12664, author="Ponum, Mahvish and Hasan, Osman and Khan, Saadia", title="EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases", journal="Interact J Med Res", year="2019", month="May", day="14", volume="8", number="2", pages="e12664", keywords="infectious diseases", keywords="mHealth", keywords="causes of death", abstract="Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. ", doi="10.2196/12664", url="http://www.i-jmr.org/2019/2/e12664/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094329" } @Article{info:doi/10.2196/13963, author="Kawakyu, Nami and Nduati, Ruth and Munguambe, Kh{\'a}tia and Coutinho, Joana and Mburu, Nancy and DeCastro, Georgina and Inguane, Celso and Zunt, Andrew and Abburi, Neil and Sherr, Kenneth and Gimbel, Sarah", title="Development and Implementation of a Mobile Phone--Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique", journal="JMIR Mhealth Uhealth", year="2019", month="May", day="13", volume="7", number="5", pages="e13963", keywords="mHealth", keywords="quality improvement", keywords="engineering", keywords="HIV", keywords="mother to child transmission", keywords="implementation science", abstract="Background: Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses' clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone--based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. Objective: The objective of this study was to understand and improve the mPCAT's core usability factors and assess the health workers' experience with using the mPCAT. Methods: Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT's core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. Results: Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff---critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. Conclusions: The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements. ", doi="10.2196/13963", url="http://mhealth.jmir.org/2019/5/e13963/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094351" } @Article{info:doi/10.2196/10318, author="Bhattacharyya, Onil and Mossman, Kathryn and Gustafsson, Lovisa and Schneider, C. Eric", title="Using Human-Centered Design to Build a Digital Health Advisor for Patients With Complex Needs: Persona and Prototype Development", journal="J Med Internet Res", year="2019", month="May", day="09", volume="21", number="5", pages="e10318", keywords="chronic disease", keywords="user-centered design", keywords="medical applications", abstract="Background: Twenty years ago, a ``Guardian Angel'' or comprehensive digital health advisor was proposed to empower patients to better manage their own health. This is now technically feasible, but most digital applications have narrow functions and target the relatively healthy, with few designed for those with the greatest needs. Objective: The goal of the research was to identify unmet needs and key features of a general digital health advisor for frail elderly and people with multiple chronic conditions and their caregivers. Methods: In-depth interviews were used to develop personas and use cases, and iterative feedback from participants informed the creation of a low-fidelity prototype of a digital health advisor. Results were shared with developers, investors, regulators, and health system leaders for suggestions on how this could be developed and disseminated. Results: Patients highlighted the following goals: ``live my life,'' ``love my life,'' ``manage my health,'' and ``feel understood.'' Patients and caregivers reported interest in four functions to address these goals: tracking and insights, advice and information, providing a holistic picture of the patient, and coordination and communication. Experts and system stakeholders felt the prototype was technically feasible, and that while health care delivery organizations could help disseminate such a tool, it should be done in partnership with consumer-focused organizations. Conclusions: This study describes the key features of a comprehensive digital health advisor, but to spur its development, we need to clarify the business case and address the policy, organizational, and cultural barriers to creating tools that put patients and their goals at the center of the health system. ", doi="10.2196/10318", url="https://www.jmir.org/2019/5/e10318/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094334" } @Article{info:doi/10.2196/12553, author="Ohligs, Marian and Pereira, Carina and Voigt, Verena and Koeny, Marcus and Jan{\ss}, Armin and Rossaint, Rolf and Czaplik, Michael", title="Evaluation of an Anesthesia Dashboard Functional Model Based on a Manufacturer-Independent Communication Standard: Comparative Feasibility Study", journal="JMIR Hum Factors", year="2019", month="May", day="01", volume="6", number="2", pages="e12553", keywords="operating room", keywords="anesthesia", keywords="interconnection", keywords="networking", keywords="human-computer interaction", keywords="process optimization", keywords="intelligent alarms", keywords="decision-support systems", keywords="11073 SDC", keywords="service-oriented device connectivity", abstract="Background: Current anesthesia workspaces consist of several technical devices, such as patient monitors, anesthesia machines, among others. Commonly, they are produced by different manufacturers; thus, they differ in terms of their modus operandi, user interface, and representation of alarms. Merging the information from these devices using a single joint protocol and displaying it in a single graphical user interface could lead to a general improvement in perioperative management. For this purpose, the recently approved and published Institute of Electrical and Electronics Engineers 11073 service-oriented device connectivity standard was implemented. Objective: This paper aims to develop and then evaluate an anesthesia workstation (ANWS) functional model in terms of usability, fulfillment of clinical requirements, and expected improvements in patient safety. Methods: To compare the self-developed ANWS with the conventional system, a pilot observational study was conducted at the University Hospital Aachen, Germany. A total of 5 anesthesiologists were asked to perform different tasks using the ANWS and then the conventional setup. For evaluation purposes, response times were measured and an interaction-centered usability test with an eye-tracking system was carried out. Finally, the subjects were asked to fill in a questionnaire in order to measure user satisfaction. Results: Response times were significantly higher when using the ANWS, but decreased considerably after one repetition. Furthermore, usability was rated as excellent (?95) according to the System Usability Scale score, and the majority of clinical requirements were met. Conclusions: In general, the results were highly encouraging, considering that the ANWS was only a functional model, as well as the lack of training of the participants. However, further studies are necessary to improve the universal user interface and the interplay of the various networked devices. ", doi="10.2196/12553", url="http://humanfactors.jmir.org/2019/2/e12553/", url="http://www.ncbi.nlm.nih.gov/pubmed/31042150" } @Article{info:doi/10.2196/11462, author="Fu, NC Helen and Adam, J. Terrence and Konstan, A. Joseph and Wolfson, A. Julian and Clancy, R. Thomas and Wyman, F. Jean", title="Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial", journal="JMIR Diabetes", year="2019", month="Apr", day="30", volume="4", number="2", pages="e11462", keywords="mHealth", keywords="diabetes", keywords="self-management", keywords="usability", keywords="Self-Determination Theory", keywords="mobile apps", keywords="user satisfaction", abstract="Background: More than 1100 diabetes mobile apps are available, but app usage by patients is low. App usability may be influenced by patient factors such as age, sex, and psychological needs. Objective: Guided by Self-Determination Theory, the purposes of this study were to (1) assess the effect of patient characteristics on app usability, and (2) determine whether patient characteristics and psychological needs (competence, autonomy, and connectivity)---important for motivation in diabetes care---are associated with app usability. Methods: Using a crossover randomized design, 92 adults with type 1 or 2 diabetes tested two Android apps (mySugr and OnTrack) for seven tasks including data entry, blood glucose (BG) reporting, and data sharing. We used multivariable linear regression models to examine associations between patient characteristics, psychological needs, user satisfaction, and user performance (task time, success, and accuracy). Results: Participants had a mean age of 54 (range 19-74) years, and were predominantly white (62\%, 57/92), female (59\%, 54/92), with type 2 diabetes (70\%, 64/92), and had education beyond high school (67\%, 61/92). Participants rated an overall user satisfaction score of 62 (SD 18), which is considered marginally acceptable. The satisfaction mean score for each app was 55 (SD 18) for mySugr and 68 (SD 15) for OnTrack. The mean task completion time for all seven tasks was 7 minutes, with a mean task success of 82\% and an accuracy rate of 68\%. Higher user satisfaction was observed for patients with less education (P=.04) and those reporting more competence (P=.02), autonomy (P=.006), or connectivity with a health care provider (P=.03). User performance was associated with age, sex, education, diabetes duration, and autonomy. Older patients required more time (95\% CI 1.1-3.2) and had less successful task completion (95\% CI 3.5-14.3\%). Men needed more time (P=.01) and more technical support than women (P=.04). High school education or less was associated with lower task success (P=.003). Diabetes duration of ?10 years was associated with lower task accuracy (P=.02). Patients who desired greater autonomy and were interested in learning their patterns of BG and carbohydrates had greater task success (P=.049). Conclusions: Diabetes app usability was associated with psychological needs that are important for motivation. To enhance patient motivation to use diabetes apps for self-management, clinicians should address competence, autonomy, and connectivity by teaching BG pattern recognition and lifestyle planning, customizing BG targets, and reviewing home-monitored data via email. App usability could be improved for older male users and those with less education and greater diabetes duration by tailoring app training and providing ongoing technical support. ", doi="10.2196/11462", url="https://diabetes.jmir.org/2019/2/e11462/", url="http://www.ncbi.nlm.nih.gov/pubmed/31038468" } @Article{info:doi/10.2196/13163, author="Gerber, Moreno Stephan and Sch{\"u}tz, Narayan and Uslu, Sinan Arif and Schmidt, Nadine and R{\"o}thlisberger, Carina and Wyss, Patric and Perny, Sandra and Wyss, Corina and Koenig-Bruhin, Monica and Urwyler, Prabitha and Nyffeler, Thomas and Marchal-Crespo, Laura and Mosimann, Peter Urs and M{\"u}ri, Martin Ren{\'e} and Nef, Tobias", title="Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study", journal="JMIR Rehabil Assist Technol", year="2019", month="Apr", day="26", volume="6", number="1", pages="e13163", keywords="aphasia", keywords="high-intensity training", keywords="telerehabilitation", keywords="multiplatform system", abstract="Background: Aphasia is the loss or impairment of language functions and affects everyday social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer--based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists. Objective: The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient's progress as well as creation of new individual exercises. Methods: The system consists of two main parts: (1) the patient's interface, which allows the patient to exercise, and (2) the therapist's interface, which allows the therapist to assign new exercises to the patient and supervise the patient's progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory). Results: A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z=--1.90; P=.03) and therapists rated the app as good (score >85; Z=--1.75; P=.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z=--1.66; P=.049). Conclusions: Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer--based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy. ", doi="10.2196/13163", url="http://rehab.jmir.org/2019/1/e13163/", url="http://www.ncbi.nlm.nih.gov/pubmed/31025946" } @Article{info:doi/10.2196/12982, author="Setiawan, Agus I. Made and Zhou, Leming and Alfikri, Zakiy and Saptono, Andi and Fairman, D. Andrea and Dicianno, Edward Brad and Parmanto, Bambang", title="An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies", journal="JMIR Form Res", year="2019", month="Apr", day="25", volume="3", number="2", pages="e12982", keywords="mHealth", keywords="adaptive mHealth", keywords="mobile apps", keywords="telemedicine", keywords="personalized medicine", keywords="self-management", keywords="self-care", keywords="caregivers", keywords="chronic disease", keywords="persons with disabilities", abstract="Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs' self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs' evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. ", doi="10.2196/12982", url="http://formative.jmir.org/2019/2/e12982/", url="http://www.ncbi.nlm.nih.gov/pubmed/31021324" } @Article{info:doi/10.2196/10256, author="Tarver, L. Will and Haggstrom, A. David", title="The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review", journal="J Med Internet Res", year="2019", month="Apr", day="23", volume="21", number="4", pages="e10256", keywords="underserved populations", keywords="medical informatics", keywords="cancer", abstract="Background: In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective: The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods: Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results: This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions: There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability. ", doi="10.2196/10256", url="http://www.jmir.org/2019/4/e10256/", url="http://www.ncbi.nlm.nih.gov/pubmed/31012855" } @Article{info:doi/10.2196/12471, author="Richardson, Safiya and Feldstein, David and McGinn, Thomas and Park, S. Linda and Khan, Sundas and Hess, Rachel and Smith, D. Paul and Mishuris, Grochow Rebecca and McCullagh, Lauren and Mann, Devin", title="Live Usability Testing of Two Complex Clinical Decision Support Tools: Observational Study", journal="JMIR Hum Factors", year="2019", month="Apr", day="15", volume="6", number="2", pages="e12471", keywords="usability", keywords="usability testing", keywords="user experience", keywords="clinical decision support", keywords="health informatics", keywords="provider adoption", keywords="workflow", keywords="live usability", keywords="clinical prediction rules", abstract="Background: Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction with complex CDS in the real clinical environment. Objective: This study aimed to further understand the barriers and facilitators of meaningful CDS usage within a real clinical context. Methods: This qualitative observational study was conducted with 3 primary care providers during 6 patient care sessions. In patients with the chief complaint of sore throat, a CDS tool built with the Centor Score was used to stratify the risk of group A Streptococcus pharyngitis. In patients with a chief complaint of cough or upper respiratory tract infection, a CDS tool built with the Heckerling Rule was used to stratify the risk of pneumonia. During usability testing, all human-computer interactions, including audio and continuous screen capture, were recorded using the Camtasia software. Participants' comments and interactions with the tool during clinical sessions and participant comments during a postsession brief interview were placed into coding categories and analyzed for generalizable themes. Results: In the 6 encounters observed, primary care providers toggled between addressing either the computer or the patient during the visit. Minimal time was spent listening to the patient without engaging the EHR. Participants mostly used the CDS tool with the patient, asking questions to populate the calculator and discussing the results of the risk assessment; they reported the ability to do this as the major benefit of the tool. All providers were interrupted during their use of the CDS tool by the need to refer to other sections of the chart. In half of the visits, patients' clinical symptoms challenged the applicability of the tool to calculate the risk of bacterial infection. Primary care providers rarely used the incorporated incentives for CDS usage, including progress notes and patient instructions. Conclusions: Live usability testing of these CDS tools generated insights about their role in the patient-provider interaction. CDS may contribute to the interaction by being simultaneously viewed by the provider and patient. CDS can improve usability and lessen the strain it places on providers by being short, flexible, and customizable to unique provider workflow. A useful component of CDS is being as widely applicable as possible and ensuring that its functions represent the fastest way to perform a particular task. ", doi="10.2196/12471", url="http://humanfactors.jmir.org/2019/2/e12471/", url="http://www.ncbi.nlm.nih.gov/pubmed/30985283" } @Article{info:doi/10.2196/10187, author="Boceta, Jaime and Samper, Daniel and de la Torre, Alejandro and S{\'a}nchez-de la Rosa, Rainel and Gonz{\'a}lez, Gloria", title="Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain", journal="JMIR Cancer", year="2019", month="Apr", day="01", volume="5", number="1", pages="e10187", keywords="breakthrough cancer pain", keywords="mHealth", keywords="mobile app", keywords="App INES{\textperiodcentered}DIO", abstract="Background: Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). Objective: This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES{\textperiodcentered}DIO developed for the management of patients with BTcP. Methods: This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. Results: Of the 175 physicians, 96\% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43\%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80\% (140/175) of physicians. The majority (157/175, 90\%) answered that App INES{\textperiodcentered}DIO was well designed and 94\% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients' clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES{\textperiodcentered}DIO. Conclusions: Our study showed that App INES{\textperiodcentered}DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP. ", doi="10.2196/10187", url="https://cancer.jmir.org/2019/1/e10187/", url="http://www.ncbi.nlm.nih.gov/pubmed/30932862" } @Article{info:doi/10.2196/12378, author="Buitenweg, C. David and Bongers, L. Ilja and van de Mheen, Dike and van Oers, AM Hans and van Nieuwenhuizen, Chijs", title="Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems", journal="JMIR Ment Health", year="2019", month="Mar", day="28", volume="6", number="3", pages="e12378", keywords="mobile app", keywords="quality of life", keywords="mental health", keywords="homeless persons", keywords="medical informatics", abstract="Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language?based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. ", doi="10.2196/12378", url="http://mental.jmir.org/2019/3/e12378/", url="http://www.ncbi.nlm.nih.gov/pubmed/30920381" } @Article{info:doi/10.2196/jmir.9958, author="Prince, M. Rebecca and Soung Yee, Anthony and Parente, Laura and Enright, A. Katherine and Grunfeld, Eva and Powis, Melanie and Husain, Amna and Gandhi, Sonal and Krzyzanowska, K. Monika", title="User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients", journal="J Med Internet Res", year="2019", month="Mar", day="28", volume="21", number="3", pages="e9958", keywords="prototype", keywords="Web-based tool", keywords="toxicity management", keywords="chemotherapy", keywords="self-management", abstract="Background: Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population. Objective: This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities. Methods: User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users. Results: Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information. Conclusions: Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption. ", doi="10.2196/jmir.9958", url="http://www.jmir.org/2019/3/e9958/", url="http://www.ncbi.nlm.nih.gov/pubmed/30920373" } @Article{info:doi/10.2196/11374, author="Moraes Carrilho, Juliana and Oliveira, Ramos Isaias Jos{\'e} and Santos, Dimitri and Osanan, Costa Gabriel and Cruz-Correia, Jo{\~a}o Ricardo and Reis, Nogueira Zilma Silveira", title="Pregnant Users' Perceptions of the Birth Plan Interface in the ``My Prenatal Care'' App: Observational Validation Study", journal="JMIR Form Res", year="2019", month="Mar", day="28", volume="3", number="1", pages="e11374", keywords="birth plan", keywords="perinatal care", keywords="usability, mobile health", keywords="mobile app", keywords="pregnancy", keywords="prenatal care", keywords="mobile phone", abstract="Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users' positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women's perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user's perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users' performance in accomplishing previously prepared tasks, we found that 10 of 11 (91\%) women were capable of completing at least 6 of 8 (75\%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. ", doi="10.2196/11374", url="http://formative.jmir.org/2019/1/e11374/", url="http://www.ncbi.nlm.nih.gov/pubmed/30920372" } @Article{info:doi/10.2196/11852, author="Mugisha, Alice and Babic, Ankica and Wakholi, Peter and Tyllesk{\"a}r, Thorkild", title="High-Fidelity Prototyping for Mobile Electronic Data Collection Forms Through Design and User Evaluation", journal="JMIR Hum Factors", year="2019", month="Mar", day="22", volume="6", number="1", pages="e11852", keywords="high-fidelity prototype", keywords="group user testing", keywords="mobile electronic data collection forms", keywords="usability evaluation", abstract="Background: Mobile data collection systems are often difficult to use for nontechnical or novice users. This can be attributed to the fact that developers of such tools do not adequately involve end users in the design and development of product features and functions, which often creates interaction challenges. Objective: The main objective of this study was to assess the guidelines for form design using high-fidelity prototypes developed based on end-user preferences. We also sought to investigate the association between the results from the System Usability Scale (SUS) and those from the Study Tailored Evaluation Questionnaire (STEQ) after the evaluation. In addition, we sought to recommend some practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. Methods: We developed a Web-based high-fidelity prototype using Axure RP 8. A total of 30 research assistants (RAs) evaluated this prototype in March 2018 by completing the given tasks during 1 common session. An STEQ comprising 13 affirmative statements and the commonly used and validated SUS were administered to evaluate the usability and user experience after interaction with the prototype. The STEQ evaluation was summarized using frequencies in an Excel sheet while the SUS scores were calculated based on whether the statement was positive (user selection minus 1) or negative (5 minus user selection). These were summed up and the score contributions multiplied by 2.5 to give the overall form usability from each participant. Results: Of the RAs, 80\% (24/30) appreciated the form progress indication, found the form navigation easy, and were satisfied with the error messages. The results gave a SUS average score of 70.4 (SD 11.7), which is above the recommended average SUS score of 68, meaning that the usability of the prototype was above average. The scores from the STEQ, on the other hand, indicated a 70\% (21/30) level of agreement with the affirmative evaluation statements. The results from the 2 instruments indicated a fair level of user satisfaction and a strong positive association as shown by the Pearson correlation value of .623 (P<.01). Conclusions: A high-fidelity prototype was used to give the users experience with a product they would likely use in their work. Group testing was done because of scarcity of resources such as costs and time involved especially in low-income countries. If embraced, this approach could help assess user needs of the diverse user groups. With proper preparation and the right infrastructure at an affordable cost, usability testing could lead to the development of highly usable forms. The study thus makes recommendations on the practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. ", doi="10.2196/11852", url="http://humanfactors.jmir.org/2019/1/e11852/", url="http://www.ncbi.nlm.nih.gov/pubmed/30900995" } @Article{info:doi/10.2196/11678, author="Lang, Alexandra and Simmonds, Mark and Pinchin, James and Sharples, Sarah and Dunn, Lorrayne and Clarke, Susan and Bennett, Owen and Wood, Sally and Swinscoe, Caron", title="The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation", journal="JMIR Med Inform", year="2019", month="Mar", day="06", volume="7", number="1", pages="e11678", keywords="health information technology", keywords="early warning score", keywords="mobile health", keywords="staff workload", keywords="clinical deterioration", keywords="patient safety", keywords="mixed methods", abstract="Background: Patient safety literature has long reported the need for early recognition of deteriorating patients. Early warning scores (EWSs) are commonly implemented as ``track and trigger,'' or rapidresponse systems for monitoring and early recognition of acute patient deterioration. This study presents a human factors evaluation of a hospital-wide transformation in practice, engendered by the deployment of an innovative electronic observations (eObs) and handover system. This technology enables real-time information processing at the patient's bedside, improves visibility of patient data, and streamlines communication within clinical teams. Objective: The aim of this study was to identify improvement and deterioration in workplace efficiency and quality of care resulting from the large-scale imposition of new technology. Methods: A total of 85 hours of direct structured observations of clinical staff were carried out before and after deployment. We conducted 40 interviews with a range of clinicians. A longitudinal analysis of critical care audit and electronically recorded patient safety incident reports was conducted. The study was undertaken in a large secondary-care facility in the United Kingdom. Results: Roll-out of eObs was associated with approximately 10\% reduction in total unplanned admissions to critical care units from eObs-equipped wards. Over time, staff appropriated the technology as a tool for communication, workload management, and improving awareness of team capacity. A negative factor was perceived as lack of engagement with the system by senior clinicians. Doctors spent less time in the office (68.7\% to 25.6\%). More time was spent at the nurses' station (6.6\% to 41.7\%). Patient contact time was more than doubled (2.9\% to 7.3\%). Conclusions: Since deployment, clinicians have more time for patient care because of reduced time spent inputting and accessing data. The formation of a specialist clinical team to lead the roll-out was universally lauded as the reason for success. Staff valued the technology as a tool for managing workload and identified improved situational awareness as a key benefit. For future technology deployments, the staff requested more training preroll-out, in addition to engagement and support from senior clinicians. ", doi="10.2196/11678", url="http://medinform.jmir.org/2019/1/e11678/", url="http://www.ncbi.nlm.nih.gov/pubmed/30839278" } @Article{info:doi/10.2196/humanfactors.9317, author="Kavuma, Michael", title="The Usability of Electronic Medical Record Systems Implemented in Sub-Saharan Africa: A Literature Review of the Evidence", journal="JMIR Hum Factors", year="2019", month="Feb", day="25", volume="6", number="1", pages="e9317", keywords="review", keywords="computer systems", keywords="delivery of health care", keywords="sub-Saharan Africa", abstract="Background: Electronic medical record (EMR) systems hold the exciting promise of accurate, real-time access to patient health care data and great potential to improve the quality of patient care through decision support to clinicians. This review evaluated the usability of EMR systems implemented in sub-Saharan Africa based on a usability evaluation criterion developed by the Healthcare Information and Management Systems Society (HIMSS). Objective: This review aimed to evaluate EMR system implementations in sub-Saharan Africa against a well-defined evaluation methodology and assess their usability based on a defined set of metrics. In addition, the review aimed to identify the extent to which usability has been an enabling or hindering factor in the implementation of EMR systems in sub-Saharan Africa. Methods: Five key metrics for evaluating EMR system usability were developed based on the methodology proposed by HIMSS. These were efficiency, effectiveness, ease of learning, cognitive load, and user satisfaction. A 5-point rating system was developed for the review. EMR systems in 19 reviewed publications were scored based on this rating system. It awarded 5 points per metric to any EMR system that was identified as excellent, 4 points for good, 3 points for fair, 2 points for poor, and 1 point for bad. In addition, each of the 5 key metrics carried a maximum weighted score of 20. The percentage scores for each metric were then computed from the weighted scores from which the final overall usability score was derived. Results: In possibly contributing to the usability of implemented EMR systems, ease of learning obtained the highest percentage score of 71\% (SD 1.09) followed by cognitive load in second place with a score of 68\% (SD 1.62). Effectiveness followed closely in third place at 67\% (SD 1.47) and efficiency was in fourth place at 64\% (SD 1.04). User satisfaction came in last at 63\% (SD 1.70). The overall usability score for all systems was calculated to be 66\%. Conclusions: The usability of EMR systems implemented in sub-Saharan Africa has been good with ease of learning possibly being the biggest positive contributor to this rating. Cognitive load and effectiveness have also possibly positively influenced the usability of EMR systems, whereas efficiency and user satisfaction have perhaps contributed least to positively influencing EMR system usability. ", doi="10.2196/humanfactors.9317", url="http://humanfactors.jmir.org/2019/1/e9317/", url="http://www.ncbi.nlm.nih.gov/pubmed/30801251" } @Article{info:doi/10.2196/11598, author="Mehra, Sumit and Visser, Bart and Cila, Nazli and van den Helder, Jantine and Engelbert, HH Raoul and Weijs, JM Peter and Kr{\"o}se, JA Ben", title="Supporting Older Adults in Exercising With a Tablet: A Usability Study", journal="JMIR Hum Factors", year="2019", month="Feb", day="01", volume="6", number="1", pages="e11598", keywords="frail elderly", keywords="aged", keywords="activities of daily living", keywords="exercise", keywords="health behavior", keywords="telemedicine", keywords="mobile devices", keywords="tablet computers", keywords="usability testing", keywords="mobile phone", abstract="Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79\% (11/14)-100\% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. ", doi="10.2196/11598", url="http://humanfactors.jmir.org/2019/1/e11598/", url="http://www.ncbi.nlm.nih.gov/pubmed/30707106" } @Article{info:doi/10.2196/11779, author="Heynsbergh, Natalie and Heckel, Leila and Botti, Mari and Livingston, M. Patricia", title="A Smartphone App to Support Carers of People Living With Cancer: A Feasibility and Usability Study", journal="JMIR Cancer", year="2019", month="Jan", day="31", volume="5", number="1", pages="e11779", keywords="cancer", keywords="carer", keywords="mobile app", keywords="smartphone", keywords="technology", keywords="mobile phone", abstract="Background: Carers experience unique needs while caring for someone with cancer. Interventions that address carers' needs and well-being have been developed and tested; however, the use of smartphone apps to support adult carers looking after another adult with cancer has not been assessed. Objective: The objective of this study was to test the feasibility, usability, and acceptability of a smartphone app, called the Carer Guide App, for carers of people with colorectal cancer. Methods: We recruited carers of people with colorectal cancer from outpatient day oncology units and provided them with access to the smartphone app for 30 days. Carers had access to video instructions and email contact details for technical support. Carers received 2 email messages per week that directed them to resources available within the app. Carers completed demographic questions at baseline and questions related to feasibility and usability at 30 days post app download. We used recruitment and attrition rates to determine feasibility and relevance of content to carers' needs as self-reported by carers. We assessed usability through the ease of navigation and design and use of technical support or instructional videos. Acceptability was measured through self-reported usage, usage statistics provided by Google Analytics, and comments for improvement. Results: We recruited 31\% (26/85) eligible carers into the trial. Of the 26 carers, the majority were female (19, 73\%), on average 57 years of age, were caring for a spouse with cancer (19, 73\%), and held a university degree (19, 73\%). Regarding feasibility, carers perceived the content of the Carer Guide App as relevant to the information they were seeking. Regarding usability, carers perceived the navigation and design of the app as easy to use. Of the 26 carers, 4 (15\%) viewed the downloading and navigation video and 7 (27\%) used the contact email address for queries and comments. Acceptability: On average, carers used the smartphone app for 22 minutes (SD 21 minutes) over the 30-day trial. Of 26 participants, 19 completed a follow-up questionnaire. Of 19 carers, 7 (37\%) logged on 3 to 4 times during the 30 days and 5 (26\%) logged on more than 5 times. The majority (16/19, 84\%) of carers stated that they would recommend the app be available for all carers. Comments for improvement included individualized requests for specific content. Conclusions: The Carer Guide App was feasible and usable among carers of people with colorectal cancer. Acceptability can be improved through the inclusion of a variety of information and resources. A randomized controlled trial is required to assess the impact of the Carer Guide App on carers' health and well-being. ", doi="10.2196/11779", url="http://cancer.jmir.org/2019/1/e11779/", url="http://www.ncbi.nlm.nih.gov/pubmed/30702432" } @Article{info:doi/10.2196/12128, author="Adam, Maya and McMahon, A. Shannon and Prober, Charles and B{\"a}rnighausen, Till", title="Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach", journal="J Med Internet Res", year="2019", month="Jan", day="30", volume="21", number="1", pages="e12128", keywords="human-centered design", keywords="health promotion", keywords="health behavior", keywords="health knowledge, attitudes, practice", keywords="community health workers", keywords="telemedicine", keywords="eHealth", keywords="mHealth", doi="10.2196/12128", url="http://www.jmir.org/2019/1/e12128/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698531" } @Article{info:doi/10.2196/jmir.9711, author="Weichelt, Bryan and Bendixsen, Casper and Keifer, Matthew", title="Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project", journal="J Med Internet Res", year="2019", month="Jan", day="29", volume="21", number="1", pages="e9711", keywords="agriculture", keywords="farmworkers", keywords="injuries", keywords="occupational medicine", keywords="return to work", keywords="software application", abstract="Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers' compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners' and managers' attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company's human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software's impact on patients and employers. ", doi="10.2196/jmir.9711", url="https://www.jmir.org/2019/1/e9711/", url="http://www.ncbi.nlm.nih.gov/pubmed/30694202" } @Article{info:doi/10.2196/12456, author="Allman-Farinelli, Margaret and Ijaz, Kiran and Tran, Helen and Pallotta, Hermes and Ramos, Sidney and Liu, Junya and Wellard-Cole, Lyndal and Calvo, A. Rafael", title="A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability", journal="JMIR Formativ Res", year="2019", month="Jan", day="09", volume="3", number="1", pages="e12456", keywords="virtual reality", keywords="nutrition promotion", keywords="food policy", keywords="take-out food", keywords="obesity", keywords="young adults", abstract="Background: Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. Objective: The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. Methods: Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. Results: One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). Conclusions: Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy. ", doi="10.2196/12456", url="http://formative.jmir.org/2019/1/e12456/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684440" } @Article{info:doi/10.2196/10804, author="Kakarmath, S. Sujay and de Redon, Emily and Centi, Jayne Amanda and Palacholla, Ramya and Kvedar, Joseph and Jethwani, Kamal and Agboola, Stephen", title="Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study", journal="JMIR Pediatr Parent", year="2018", month="Dec", day="21", volume="1", number="2", pages="e10804", keywords="connected health", keywords="continuous monitoring", keywords="mobile phone", keywords="pediatric", keywords="temperature", abstract="Background: Fever is an important vital sign and often the first one to be assessed in a sick child. In acutely ill children, caregivers are expected to monitor a child's body temperature at home after an initial medical consult. Fever literacy of many caregivers is known to be poor, leading to fever phobia. In children with a serious illness, the responsibility of periodically monitoring temperature can add substantially to the already stressful experience of caring for a sick child. Objective: The objective of this pilot study was to assess the feasibility of using the iThermonitor, an automated temperature measurement device, for continuous temperature monitoring in postoperative and postchemotherapy pediatric patients. Methods: We recruited 25 patient-caregiver dyads from the Pediatric Surgery Department at the Massachusetts General Hospital (MGH) and the Pediatric Cancer Centers at the MGH and the Dana Farber Cancer Institute. Enrolled dyads were asked to use the iThermonitor device for continuous temperature monitoring over a 2-week period. Surveys were administered to caregivers at enrollment and at study closeout. Caregivers were also asked to complete a daily event-monitoring log. The Generalized Anxiety Disorder-7 item questionnaire was also used to assess caregiver anxiety at enrollment and closeout. Results: Overall, 19 participant dyads completed the study. All 19 caregivers reported to have viewed temperature data on the study-provided iPad tablet at least once per day, and more than a third caregivers did so six or more times per day. Of all participants, 74\% (14/19) reported experiencing an out-of-range temperature alert at least once during the study. Majority of caregivers reported that it was easy to learn how to use the device and that they felt confident about monitoring their child's temperature with it. Only 21\% (4/9) of caregivers reported concurrently using a device other than the iThermonitor to monitor their child's temperature during the study. Continuous temperature monitoring was not associated with an increase in caregiver anxiety. Conclusions: The study results reveal that the iThermonitor is a highly feasible and easy-to-use device for continuous temperature monitoring in pediatric oncology and surgery patients. Trial Registration: ClinicalTrials.gov NCT02410252; https://clinicaltrials.gov/ct2/show/NCT02410252 (Archived by WebCite at http://www.webcitation.org/73LnO7hel) ", doi="10.2196/10804", url="http://pediatrics.jmir.org/2018/2/e10804/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518304" } @Article{info:doi/10.2196/10932, author="Moradian, Saeed and Krzyzanowska, K. Monika and Maguire, Roma and Morita, P. Plinio and Kukreti, Vishal and Avery, Jonathan and Liu, Geoffrey and Cafazzo, Joseph and Howell, Doris", title="Usability Evaluation of a Mobile Phone--Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study", journal="JMIR Cancer", year="2018", month="Dec", day="21", volume="4", number="2", pages="e10932", keywords="mobile apps", keywords="mobile health", keywords="mobile phone", keywords="patient-centered care", keywords="patient remote monitoring", keywords="self-care", keywords="symptom management", keywords="usability testing", abstract="Background: As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system. Objective: This study aims to evaluate the usability of the ASyMS, a mobile phone--based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS. Methods: We used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence. Results: The thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80\% (8/10) of participants had great motivation to use the ASyMS, 70\% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100\%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation. Conclusions: The ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed. ", doi="10.2196/10932", url="http://cancer.jmir.org/2018/2/e10932/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578238" } @Article{info:doi/10.2196/11048, author="Chokshi, Kuppin Sara and Mann, M. Devin", title="Innovating From Within: A Process Model for User-Centered Digital Development in Academic Medical Centers", journal="JMIR Hum Factors", year="2018", month="Dec", day="19", volume="5", number="4", pages="e11048", keywords="academic medical centers", keywords="digital health", keywords="heath information technology", keywords="innovation", keywords="process model", keywords="user-centered design", abstract="Background: Design thinking and human-centered design approaches have become increasingly common in health care literature, particularly in relation to health information technology (HIT), as a pathway toward the development of usable, diffusible tools and processes. There is a need in academic medical centers tasked with digital innovation for a comprehensive process model to guide development that incorporates current industry trends, including design thinking and lean and agile approaches to digital development. Objective: This study aims to describe the foundations and phases of our model for user-centered HIT development. Methods: Based on our experience, we established an integrated approach and rigorous process for HIT development that leverages design thinking and lean and agile strategies in a pragmatic way while preserving methodological integrity in support of academic research goals. Results: A four-phased pragmatic process model was developed for user-centered digital development in HIT. Conclusions: The model for user-centered HIT development that we developed is the culmination of diverse innovation projects and represents a multiphased, high-fidelity process for making more creative, flexible, efficient, and effective tools. This model is a critical step in building a rigorous approach to HIT design that incorporates a multidisciplinary, pragmatic perspective combined with academic research practices and state-of-the-art approaches to digital product development to meet the unique needs of health care. ", doi="10.2196/11048", url="http://humanfactors.jmir.org/2018/4/e11048/", url="http://www.ncbi.nlm.nih.gov/pubmed/30567688" } @Article{info:doi/10.2196/11661, author="Deady, Mark and Johnston, David and Milne, David and Glozier, Nick and Peters, Dorian and Calvo, Rafael and Harvey, Samuel", title="Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="04", volume="6", number="12", pages="e11661", keywords="depression", keywords="workplace", keywords="mHealth", keywords="smartphone", keywords="eHealth", keywords="pilot", abstract="Background: The workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app--based intervention designed to reduce depressive symptoms and increase well-being in these populations. Objective: This paper presents the development and pilot testing of the app's usability, acceptability, feasibility, and preliminary effectiveness. Methods: The development process took place from January 2016 to August 2017. Participants for prototype testing (n=21; stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84; stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected. Results: The majority of respondents felt HeadGear was easy to use (92\%), easily understood (92\%), were satisfied with the app (67\%), and would recommend it to a friend (75\%; stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up (t30=2.53; P=.02 and t30=2.18; P=.04, respectively), days of sick leave in past month (t28=2.38; P=.02), and higher self-reported job performance (t28=?2.09; P=.046; stage 2). Over 90\% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages. Conclusions: Overall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group. ", doi="10.2196/11661", url="https://mhealth.jmir.org/2018/12/e11661/", url="http://www.ncbi.nlm.nih.gov/pubmed/30514694" } @Article{info:doi/10.2196/10128, author="Shtrichman, Ronit and Conrad, Stefan and Schimo, Kai and Shachar, Ran and Machluf, Ehud and Mindal, Enrique and Epstein, Howard and Epstein, Shirli and Paz, Alan", title="Use of a Digital Medication Management System for Effective Assessment and Enhancement of Patient Adherence to Therapy (ReX): Feasibility Study", journal="JMIR Hum Factors", year="2018", month="Nov", day="26", volume="5", number="4", pages="e10128", keywords="medication adherence", keywords="medication nonadherence", keywords="personalized medicine", keywords="therapy management", abstract="Background: Medication nonadherence is a major problem in health care, imposing poor clinical outcomes and a heavy financial burden on all stakeholders. Current methods of medication adherence assessment are severely limited: they are applied only periodically, do not relate to actual pill intake, and suffer from patient bias due to errors, misunderstanding, or intentional nonadherence. ReX is an innovative medication management system designed to address poor patient adherence and enhance patient engagement with their therapy. ReX controls and tracks pills from the point of packaging right through to the patient's mouth. ReX generates robust, real-time adherence data. The system enables patients to report outcomes, complete surveys, and receive messages and instructions. ReX includes a reusable drug dispensing unit, disposable cassette containing pills, and a cloud-based data portal. Objective: We aimed to evaluate ReX feasibility by human factor studies including evaluation of ReX safety; ReX acceptance and usability; and ReX efficacy of providing pills according to a preprogrammed dose regimen, managing reminders and adherence data, and enhancing the adherence rate compared with the standard of care. Methods: The ReX system was evaluated in 2 human factor, nonclinical feasibility studies. Human subjects used ReX for the administration of pill-shaped Tic Tac sweets. The initial study evaluated ReX use and pill intake administration; second was a self-controlled, 4-day home-use study. All subjects took pills at home, according to a preprogrammed dose regimen, for 4 days each via the device (ReX test) or from standard packaging (control test). The adherence rate (percent of pills taken) was measured by the study subject's report, remaining pills count, and ReX records (in the ReX test). ReX safety and usability were evaluated by a questionnaire filled out by the subject. Results: The initial feasibility study evaluated usability and acceptance of the ReX novel approach to pill dispensing. All subjects successfully managed 2 pill intakes. The ReX device was rated as easy to use by 81\% (48/59) of subjects. The 4-day home-use study evaluated the safety, efficacy, and usability of the ReX system. No adverse event occurred; no pill overdose or pill malformation was reported. The overall adherence rate in the ReX test was 97.6\% compared with 76.3\% in the control test (P<.001). Real-time, personalized reminders provided in the event of a delay in pill intake contributed to 18.0\% of doses taken during the ReX test. The ReX system was found easy to use by 87\% (35/40) of subjects; 90\% (36/40) felt comfortable using it for their medication. Conclusions: ReX's novel ``tracking to the mouth'' technology was found usable and accepted by subjects. The assessment of adherence rates was reliable; adherence of subjects to the dose regimen was significantly enhanced when using ReX compared with the standard of care. ", doi="10.2196/10128", url="http://humanfactors.jmir.org/2018/4/e10128/", url="http://www.ncbi.nlm.nih.gov/pubmed/30478020" } @Article{info:doi/10.2196/cancer.9918, author="Asfaw, Ayele Alemseged and Yan, H. Connie and Sweiss, Karen and Wirth, Scott and Ramirez, H. Victor and Patel, R. Pritesh and Sharp, K. Lisa", title="Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study", journal="JMIR Cancer", year="2018", month="Nov", day="12", volume="4", number="2", pages="e12", keywords="antineoplastic therapy", keywords="challenges", keywords="race/ethnicity", keywords="medication adherence", keywords="multiple myeloma", abstract="Background: Many recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested. Objective: This study aimed to explore patients' (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs. Methods: An in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology---Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance. Results: A total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80\% (16/20) were African American. In addition, 18 (90\%, 18/20) owned a smartphone and 85\% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70\%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60\% (12/20) of the patients expressed interest in trying a bottle in the future. Conclusions: Results identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned. ", doi="10.2196/cancer.9918", url="http://cancer.jmir.org/2018/2/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/30425032" } @Article{info:doi/10.2196/11066, author="Liang, Jun and Xian, Deqiang and Liu, Xingyu and Fu, Jing and Zhang, Xingting and Tang, Buzhou and Lei, Jianbo", title="Usability Study of Mainstream Wearable Fitness Devices: Feature Analysis and System Usability Scale Evaluation", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="08", volume="6", number="11", pages="e11066", keywords="wearable devices", keywords="usability", keywords="System Usability Scale", keywords="function comparison", keywords="fitness", abstract="Background: Wearable devices have the potential to promote a healthy lifestyle because of their real-time data monitoring capabilities. However, device usability is a critical factor that determines whether they will be adopted on a large scale. Usability studies on wearable devices are still scarce. Objective: This study aims to compare the functions and attributes of seven mainstream wearable devices and to evaluate their usability. Methods: The wearable devices selected were the Apple Watch, Samsung Gear S, Fitbit Surge, Jawbone Up3, Mi Band, Huawei Honor B2, and Misfit Shine. A mixed method of feature comparison and a System Usability Scale (SUS) evaluation based on 388 participants was applied; the higher the SUS score, the better the usability of the product. Results: For features, all devices had step counting, an activity timer, and distance recording functions. The Samsung Gear S had a unique sports track recording feature and the Huawei Honor B2 had a unique wireless earphone. The Apple Watch, Samsung Gear S, Jawbone Up3, and Fitbit Surge could measure heart rate. All the devices were able to monitor sleep, except the Apple Watch. For product characteristics, including attributes such as weight, battery life, price, and 22 functions such as step counting, activity time, activity type identification, sleep monitoring, and expandable new features, we found a very weak negative correlation between the SUS scores and price (r=?.10, P=.03) and devices that support expandable new features (r=?.11, P=.02), and a very weak positive correlation between the SUS scores and devices that support the activity type identification function (r=.11, P=.02). The Huawei Honor B2 received the highest score of mean 67.6 (SD 16.1); the lowest Apple Watch score was only 61.4 (SD 14.7). No significant difference was observed among brands. The SUS score had a moderate positive correlation with the user's experience (length of time the device was used) (r=.32, P<.001); participants in the medical and health care industries gave a significantly higher score (mean 61.1, SD 17.9 vs mean 68.7, SD 14.5, P=.03). Conclusions: The functions of wearable devices tend to be homogeneous and usability is similar across various brands. Overall, Mi Band had the lowest price and the lightest weight. Misfit Shine had the longest battery life and most functions, and participants in the medical and health care industries had the best evaluation of wearable devices. The perceived usability of mainstream wearable devices is unsatisfactory and customer loyalty is not high. A consumer's SUS rating for a wearable device is related to their personal situation instead of the device brand. Device manufacturers should put more effort into developing innovative functions and improving the usability of their products by integrating more cognitive behavior change techniques. ", doi="10.2196/11066", url="http://mhealth.jmir.org/2018/11/e11066/", url="http://www.ncbi.nlm.nih.gov/pubmed/30409767" } @Article{info:doi/10.2196/12136, author="Wellard-Cole, Lyndal and Potter, Melisa and Jung, (Joseph) Jisu and Chen, Juliana and Kay, Judy and Allman-Farinelli, Margaret", title="A Tool to Measure Young Adults' Food Intake: Design and Development of an Australian Database of Foods for the Eat and Track Smartphone App", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="07", volume="6", number="11", pages="e12136", keywords="diet surveys", keywords="smartphone", keywords="mobile phone", keywords="young adult", abstract="Background: Dietary assessment is reliant on the collection of accurate food and beverage consumption data. Technology has been harnessed to standardize recording and provide automatic nutritional analysis to reduce cost and researcher burden. Objective: To better assess the diet of young adults, especially relating to the contribution of foods prepared outside the home, a database was needed to support a mobile phone data collection app. The app also required usability testing to assure ease of entry of foods and beverages. This paper describes the development of the Eat and Track app (EaT app) and the database underpinning it. Methods: The Australian Food and Nutrient Database 2011-13, consisting of 5740 food items was modified. Four steps were undertaken: (1) foods not consumed by young adults were removed, (2) nutritionally similar foods were merged, (3) foods available from the 30 largest ready-to-eat food chains in Australia were added, and (4) long generic food names were shortened and simplified. This database was used to underpin the EaT app. Qualitative, iterative usability testing of the EaT app was conducted in three phases using the ``Think Aloud'' method. Responses were sorted and coded using content analysis. The System Usability Scale (SUS) was administered to measure the EaT app's perceived usability. Results: In total, 1694 (29.51\%) foods were removed from the Australian Food and Nutrient Database, including 608 (35.89\%) ingredients, 81 (4.78\%) foods already captured in the fast food chain information, 52 (3.07\%) indigenous foods, 25 (1.48\%) nutrients/dietary supplements, and 16 (0.94\%) child-specific foods. The remaining 912 (53.84\%) foods removed were not consumed by young adults in previous surveys or were ``not defined'' in the Australian Food and Nutrient Database. Another 220 (3.83\%) nutritionally similar foods were combined. The final database consisted of 6274 foods. Fifteen participants completed usability testing. Issues identified by participants fell under six themes: keywords for searching, history list of entered foods, amounts and units, the keypad, food names, and search function. Suggestions for improvement were collected, incorporated, and tested in each iteration of the app. The SUS of the final version of the EaT app was rated 69. Conclusions: A food and beverage database has been developed to underpin the EaT app, enabling data collection on the eating-out habits of 18- to 30-year-old Australians. The development process has resulted in a database with commonly used food names, extensive coverage of foods from ready-to-eat chains, and commonly eaten portion sizes. Feedback from app usability testing led to enhanced keyword searching and the addition of functions to enhance usability such as adding brief instructional screens. There is potential for the features of the EaT app to facilitate the collection of more accurate dietary intake data. The database and the app will be valuable dietary assessment resources for researchers. ", doi="10.2196/12136", url="http://mhealth.jmir.org/2018/11/e12136/", url="http://www.ncbi.nlm.nih.gov/pubmed/30404768" } @Article{info:doi/10.2196/formative.9935, author="Lo, L. Louisa and Collins, M. Ian and Bressel, Mathias and Butow, Phyllis and Emery, Jon and Keogh, Louise and Weideman, Prue and Steel, Emma and Hopper, L. John and Trainer, H. Alison and Mann, B. Gregory and Bickerstaffe, Adrian and Antoniou, C. Antonis and Cuzick, Jack and Phillips, Kelly-Anne", title="The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing", journal="JMIR Formativ Res", year="2018", month="Nov", day="07", volume="2", number="2", pages="e24", keywords="clinical decision support", keywords="breast cancer", keywords="BRCA1 gene", keywords="BRCA2 gene", keywords="risk", keywords="preventive health", keywords="screening", abstract="Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68\% (13/19) clinicians and 76\% (28/37) patients. The amount of information provided by iPrevent was reported as ``about right'' by 89\% (17/19) clinicians and 89\% (33/37) patients and 95\% (18/19) and 97\% (36/37), respectively, would recommend iPrevent to others, although 53\% (10/19) clinicians and 27\% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent. ", doi="10.2196/formative.9935", url="http://formative.jmir.org/2018/2/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684421" } @Article{info:doi/10.2196/formative.9747, author="Verdaguer, Sandra and Mateo, F. Katrina and Wyka, Katarzyna and Dennis-Tiwary, A. Tracy and Leung, May May", title="A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study", journal="JMIR Formativ Res", year="2018", month="Nov", day="01", volume="2", number="2", pages="e21", keywords="usability testing", keywords="interactive technology", keywords="mHealth, childhood obesity", keywords="minority", keywords="health nutrition", keywords="health education", abstract="Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth. ", doi="10.2196/formative.9747", url="http://formative.jmir.org/2018/2/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684417" } @Article{info:doi/10.2196/humanfactors.9541, author="Bromley, Sally and Drew, Michael and Talpey, Scott and McIntosh, Andrew and Finch, Caroline", title="Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System", journal="JMIR Hum Factors", year="2018", month="Oct", day="09", volume="5", number="4", pages="e27", keywords="online", keywords="health", keywords="injury \& prevention", keywords="athletic performance", keywords="internet", keywords="mobile phone", abstract="Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, may provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs may be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13\% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data---22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0\% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors may have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there may be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes. ", doi="10.2196/humanfactors.9541", url="http://humanfactors.jmir.org/2018/4/e27/", url="http://www.ncbi.nlm.nih.gov/pubmed/30305257" } @Article{info:doi/10.2196/humanfactors.9569, author="Martinez, William and Threatt, L. Anthony and Rosenbloom, Trent S. and Wallston, A. Kenneth and Hickson, B. Gerald and Elasy, A. Tom", title="A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing", journal="JMIR Hum Factors", year="2018", month="Sep", day="24", volume="5", number="3", pages="e26", keywords="diabetes mellitus, type 2", keywords="patient portals", keywords="qualitative research", keywords="consumer health informatics", abstract="Background: Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use. Objective: The aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record. Methods: We applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met). Results: The sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants' mean age was 63 years (range 45-78 years), 57\% (8/14) were female, and 50\% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients' diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80\% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5). Conclusions: Our results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use. ", doi="10.2196/humanfactors.9569", url="http://humanfactors.jmir.org/2018/3/e26/", url="http://www.ncbi.nlm.nih.gov/pubmed/30249579" } @Article{info:doi/10.2196/mhealth.9975, author="Piegari, Giuseppe and Iovane, Valentina and Carletti, Vincenzo and Fico, Rosario and Costagliola, Alessandro and De Biase, Davide and Prisco, Francesco and Paciello, Orlando", title="Assessment of Google Glass for Photographic Documentation in Veterinary Forensic Pathology: Usability Study", journal="JMIR Mhealth Uhealth", year="2018", month="Sep", day="21", volume="6", number="9", pages="e180", keywords="Google Glass", keywords="necropsy", keywords="pictures", keywords="documentation", keywords="veterinary forensic pathology", keywords="mobile phone", abstract="Background: Google Glass is a head-mounted device designed in the shape of a pair of eyeglasses equipped with a 5.0-megapixel integrated camera and capable of taking pictures with simple voice commands. Objective: The objective of our study was to determine whether Google Glass is fit for veterinary forensic pathology purposes. Methods: A total of 44 forensic necropsies of 2 different species (22 dogs and 22 cats) were performed by 2 pathologists; each pathologist conducted 11 necropsies of each species and, for each photographic acquisition, the images were taken with a Google Glass device and a Nikon D3200 digital single-lens reflex (DSLR) camera. The pictures were collected, divided into 3 groups (based on the external appearance of the animal, organs, and anatomical details), and evaluated by 5 forensic pathologists using a 5-point score system. The parameters assessed were overall color settings, region of interest, sharpness, and brightness. To evaluate the difference in mean duration between necropsies conduced with Google Glass and DSLR camera and to assess the battery consumption of the devices, an additional number of 16 necropsies were performed by the 2 pathologists. In these cases, Google Glass was used for photographic reports in 8 cases (4 dogs and 4 cats) and a Nikon D3200 reflex camera in the other 8 cases. Statistical evaluations were performed to assess the differences in ratings between the quality of the images taken with both devices. Results: The images taken with Google Glass received significantly lower ratings than those acquired with reflex camera for all 4 assessed parameters (P<.001). In particular, for the pictures of Groups A and B taken with Google Glass, the sum of frequency of ratings 5 (very good) and 4 (good) was between 50\% and 77\% for all 4 assessed parameters. The lowest ratings were observed for the pictures of Group C, with a sum of frequency of ratings 5 and 4 of 21.1\% (342/1602) for region of interest, 26\% (421/1602) for sharpness, 35.5\% (575/1602) for overall color settings, and 61.4\% (995/1602) for brightness. Furthermore, we found a significant reduction in the mean execution time for necropsy conduced with the Google Glass with respect to the reflex group (P<.001). However, Google Glass drained the battery very quickly. Conclusions: These findings suggest that Google Glass is usable in veterinary forensic pathology. In particular, the image quality of Groups A and B seemed adequate for forensic photographic documentation purposes, although the quality was lower than that with the reflex camera. However, in this step of development, the high frequency of poor ratings observed for the pictures of Group C suggest that the device is not suitable for taking pictures of small anatomical details or close-ups of the injuries. ", doi="10.2196/mhealth.9975", url="http://mhealth.jmir.org/2018/9/e180/", url="http://www.ncbi.nlm.nih.gov/pubmed/30249586" } @Article{info:doi/10.2196/11450, author="Cho, Hwayoung and Powell, Dakota and Pichon, Adrienne and Thai, Jennie and Bruce, Josh and Kuhns, M. Lisa and Garofalo, Robert and Schnall, Rebecca", title="A Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation", journal="JMIR Mhealth Uhealth", year="2018", month="Sep", day="07", volume="6", number="9", pages="e11450", keywords="mobile apps", keywords="mobile health", keywords="information technology", keywords="health information technology", keywords="usability evaluation", keywords="adolescents", keywords="HIV prevention", keywords="men who have sex with men", abstract="Background: Mobile health (mHealth) apps have the potential to be a useful mode of delivering HIV prevention information, particularly for young men (13-24 years) who account for 21\% of new HIV diagnoses in the United States. We translated an existing evidence-based, face-to-face HIV prevention curriculum into a portable platform and developed a mobile Web app: MyPEEPS Mobile. Objective: The purpose of this study was to assess the usability of MyPEEPS Mobile from both expert and end user perspectives. Methods: We conducted a heuristic evaluation with five experts in informatics to identify violations of usability principles and end user usability testing with 20 young men aged 15 to 18 years in New York, NY, Birmingham, AL, and Chicago, IL to identify potential obstacles to their use of the app. Results: Mean scores of the overall severity of the identified heuristic violations rated by experts ranged from 0.4 and 2.6 (0=no usability problem to 4=usability catastrophe). Overall, our end users successfully completed the tasks associated with use case scenarios and provided comments/recommendations on improving usability of MyPEEPS Mobile. The mean of the overall Post-Study System Usability Questionnaire scores rated by the end users was 1.63 (SD 0.65), reflecting strong user acceptance of the app. Conclusions: The comments made by experts and end users will be used to refine MyPEEPS Mobile prior to a pilot study assessing the acceptability of the app across diverse sexual minority young men in their everyday lives. ", doi="10.2196/11450", url="http://mhealth.jmir.org/2018/9/e11450/", url="http://www.ncbi.nlm.nih.gov/pubmed/30194060" } @Article{info:doi/10.2196/formative.9954, author="B{\o}r{\o}sund, Elin and Mirkovic, Jelena and Clark, M. Matthew and Ehlers, L. Shawna and Andrykowski, A. Michael and Bergland, Anne and Westeng, Marianne and Solberg Nes, Lise", title="A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing", journal="JMIR Formativ Res", year="2018", month="Sep", day="06", volume="2", number="2", pages="e19", keywords="stress management", keywords="mindfulness", keywords="cancer", keywords="eHealth", keywords="mHealth", keywords="mobile apps", keywords="development", keywords="usability", keywords="user-centered design", keywords="mobile phones", abstract="Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) ", doi="10.2196/formative.9954", url="http://formative.jmir.org/2018/2/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684438" } @Article{info:doi/10.2196/mental.9445, author="Fuller-Tyszkiewicz, Matthew and Richardson, Ben and Klein, Britt and Skouteris, Helen and Christensen, Helen and Austin, David and Castle, David and Mihalopoulos, Cathrine and O'Donnell, Renee and Arulkadacham, Lilani and Shatte, Adrian and Ware, Anna", title="A Mobile App--Based Intervention for Depression: End-User and Expert Usability Testing Study", journal="JMIR Ment Health", year="2018", month="Aug", day="23", volume="5", number="3", pages="e54", keywords="depression", keywords="eHealth", keywords="mHealth", keywords="young adult", abstract="Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. ", doi="10.2196/mental.9445", url="http://mental.jmir.org/2018/3/e54/", url="http://www.ncbi.nlm.nih.gov/pubmed/30139722" } @Article{info:doi/10.2196/10205, author="Sharma, Kumar Deepak and Peterson, Jerrold Kevin and Hong, Na and Jiang, Guoqian", title="The D2Refine Platform for the Standardization of Clinical Research Study Data Dictionaries: Usability Study", journal="JMIR Hum Factors", year="2018", month="Jul", day="25", volume="5", number="3", pages="e10205", keywords="usability study", keywords="data dictionary", keywords="interoperability", keywords="electronic health records", keywords="usability framework", keywords="metadata", keywords="standardization", abstract="Background: D2Refine provides a Web-based environment to create clinical research study data dictionaries and enables standardization and harmonization of its variable definitions with controlled terminology resources. Objective: To assess the usability of the functions D2Refine offers, a usability study was designed and executed. Methods: We employed the TURF (task, user, representation, and function) Usability Framework of electronic health record usability to design, configure, and execute the usability study and performed quantitative analyses. D2Refine was compared for its usability metrics against two other comparable solutions, OntoMaton and RightField, which have very similar functionalities for creating, managing, and standardizing data dictionaries. We first conducted the function analysis by conducting one-on-one interviews armed with questionnaires to catalog expected functionality. The enrolled participants carried out the steps for selected tasks to accomplish specific goals and their feedback was captured to conduct the task analysis. Results: We enrolled a group (n=27) of study developers, managers, and software professionals to execute steps of analysis as specified by the TURF framework. For the within-model domain function saturation, D2Refine had 96\% saturation, which was 4 percentage points better than OntoMaton and 28 percentage points better than RightField. The manual examination and statistical analysis of the data were conducted for task analysis, and the results demonstrated a significant difference for favorability toward D2Refine (P<.001) with a 95\% CI. Overall, 17 out of 27 (63\%) participants indicated that D2Refine was their favorite of the three options. Conclusions: D2Refine is a useful and promising platform that can help address the emerging needs related to clinical research study data dictionary standardization and harmonization. ", doi="10.2196/10205", url="http://humanfactors.jmir.org/2018/3/e10205/", url="http://www.ncbi.nlm.nih.gov/pubmed/30045832" } @Article{info:doi/10.2196/10070, author="Schoen, W. Martin and Basch, Ethan and Hudson, L. Lori and Chung, E. Arlene and Mendoza, R. Tito and Mitchell, A. Sandra and St. Germain, Diane and Baumgartner, Paul and Sit, Laura and Rogak, J. Lauren and Shouery, Marwan and Shalley, Eve and Reeve, B. Bryce and Fawzy, R. Maria and Bhavsar, A. Nrupen and Cleeland, Charles and Schrag, Deborah and Dueck, C. Amylou and Abernethy, P. Amy", title="Software for Administering the National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study", journal="JMIR Hum Factors", year="2018", month="Jul", day="16", volume="5", number="3", pages="e10070", keywords="usability", keywords="patient-reported outcomes", keywords="symptoms", keywords="adverse events", keywords="PRO-CTCAE", keywords="cancer clinical trials", abstract="Background: The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). Objective: The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. Methods: Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. Results: Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02; P=.001). Conclusions: Software modifications, informed by rigorous assessment, rendered a usable system, which is currently used in multiple NCI-sponsored multicenter cancer clinical trials. Trial Registration: ClinicalTrials.gov NCT01031641; https://clinicaltrials.gov/ct2/show/NCT01031641 (Archived by WebCite at http://www.webcitation.org/708hTjlTl) ", doi="10.2196/10070", url="http://humanfactors.jmir.org/2018/3/e10070/", url="http://www.ncbi.nlm.nih.gov/pubmed/30012546" } @Article{info:doi/10.2196/10413, author="Nazi, M. Kim and Turvey, L. Carolyn and Klein, M. Dawn and Hogan, P. Timothy", title="A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design", journal="J Med Internet Res", year="2018", month="Jul", day="10", volume="20", number="7", pages="e10413", keywords="patient portal", keywords="user-centered design", keywords="eHealth", keywords="veteran", abstract="Background: Health care systems have entered a new era focused on patient engagement. Patient portals linked to electronic health records are recognized as a promising multifaceted tool to help achieve patient engagement goals. Achieving significant growth in adoption and use requires agile evaluation methods to complement periodic formal research efforts. Objective: This paper describes one of the implementation strategies that the Department of Veterans Affairs (VA) has used to foster the adoption and sustained use of its patient portal, My HealtheVet, over the last decade: an ongoing focus on user-centered design (UCD). This strategy entails understanding the users and their tasks and goals and optimizing portal design and functionality accordingly. Using a case study approach, we present a comparison of early user demographics and preferences with more recent data and several examples to illustrate how a UCD can serve as an effective implementation strategy for a patient portal within a large integrated health care system. Methods: VA has employed a customer experience analytics (CXA) survey on its patient portal since 2007 to enable ongoing direct user feedback. In a continuous cycle, a random sample of site visitors is invited to participate in the Web-based survey. CXA model questions are used to track and trend satisfaction, while custom questions collect data about users' characteristics, needs, and preferences. In this case study, we performed analyses of descriptive statistics comparing user characteristics and preferences from FY2008 (wherein ``FY'' means ``fiscal year'') to FY2017 and user trends regarding satisfaction with and utilization of specific portal functions over the last decade, as well as qualitative content analysis of user's open-ended survey comments. Results: User feedback has guided the development of enhancements to core components of the My HealtheVet portal including available features, content, interface design, prospective functional design, and related policies. Ten-year data regarding user characteristics and portal utilization demonstrate trends toward greater patient engagement and satisfaction. Administration of a continuous voluntary Web-based survey is an efficient and effective way to capture veterans' voices about who they are, how they use the patient portal, needed system improvements, and desired additional services. Conclusions: Leveraging ``voice-of-the-customer'' techniques as part of patient portal implementation can ensure that such systems meet users' needs in ways that are agile and most effective. Through this strategy, VA has fostered significant adoption and use of My HealtheVet to engage patients in managing their health. ", doi="10.2196/10413", url="http://www.jmir.org/2018/7/e10413/", url="http://www.ncbi.nlm.nih.gov/pubmed/29991468" } @Article{info:doi/10.2196/10517, author="Gayed, Aim{\'e}e and LaMontagne, D. Anthony and Milner, Allison and Deady, Mark and Calvo, A. Rafael and Christensen, Helen and Mykletun, Arnstein and Glozier, Nick and Harvey, B. Samuel", title="A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness", journal="JMIR Ment Health", year="2018", month="Jul", day="03", volume="5", number="3", pages="e10517", keywords="manager; supervisor training; workplace mental health; mental health education; online intervention; knowledge; attitudes; behaviour; eHealth", abstract="Background: Mental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization's response to a mentally ill worker. Objective: This pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers' confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace. Methods: In total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired samples t tests. Results: Of all the invited managers, 59.1\% (39/66) participated in the trial, with complete pre--post data available for 56.4\% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers' knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P<.001) significantly increased. In addition, a significant increase was observed from the baseline in managers' self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02). Conclusions: Although caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff. ", doi="10.2196/10517", url="http://mental.jmir.org/2018/3/e10517/", url="http://www.ncbi.nlm.nih.gov/pubmed/29970359" } @Article{info:doi/10.2196/mhealth.9826, author="Schobel, Johannes and Pryss, R{\"u}diger and Probst, Thomas and Schlee, Winfried and Schickler, Marc and Reichert, Manfred", title="Learnability of a Configurator Empowering End Users to Create Mobile Data Collection Instruments: Usability Study", journal="JMIR Mhealth Uhealth", year="2018", month="Jun", day="29", volume="6", number="6", pages="e148", keywords="mHealth", keywords="data collection", keywords="mobile apps", abstract="Background: Many research domains still heavily rely on paper-based data collection procedures, despite numerous associated drawbacks. The QuestionSys framework is intended to empower researchers as well as clinicians without programming skills to develop their own smart mobile apps in order to collect data for their specific scenarios. Objective: In order to validate the feasibility of this model-driven, end-user programming approach, we conducted a study with 80 participants. Methods: Across 2 sessions (7 days between Session 1 and Session 2), participants had to model 10 data collection instruments (5 at each session) with the developed configurator component of the framework. In this context, performance measures like the time and operations needed as well as the resulting errors were evaluated. Participants were separated into two groups (ie, novices vs experts) based on prior knowledge in process modeling, which is one fundamental pillar of the QuestionSys framework. Results: Statistical analysis (t tests) revealed that novices showed significant learning effects for errors (P=.04), operations (P<.001), and time (P<.001) from the first to the last use of the configurator. Experts showed significant learning effects for operations (P=.001) and time (P<.001), but not for errors as the experts' errors were already very low at the first modeling of the data collection instrument. Moreover, regarding the time and operations needed, novices got significantly better at the third modeling task than experts were at the first one (t tests; P<.001 for time and P=.002 for operations). Regarding errors, novices did not get significantly better at working with any of the 10 data collection instruments than experts were at the first modeling task, but novices' error rates for all 5 data collection instruments at Session 2 were not significantly different anymore from those of experts at the first modeling task. After 7 days of not using the configurator (from Session 1 to Session 2), the experts' learning effect at the end of Session 1 remained stable at the beginning of Session 2, but the novices' learning effect at the end of Session 1 showed a significant decay at the beginning of Session 2 regarding time and operations (t tests; P<.001 for time and P=.03 for operations). Conclusions: In conclusion, novices were able to use the configurator properly and showed fast (but unstable) learning effects, resulting in their performances becoming as good as those of experts (which were already good) after having little experience with the configurator. Following this, researchers and clinicians can use the QuestionSys configurator to develop data collection apps for smart mobile devices on their own. ", doi="10.2196/mhealth.9826", url="http://mhealth.jmir.org/2018/6/e148/", url="http://www.ncbi.nlm.nih.gov/pubmed/29959107" } @Article{info:doi/10.2196/10457, author="Srikesavan, Cynthia and Williamson, Esther and Cranston, Tim and Hunter, John and Adams, Jo and Lamb, E. Sarah", title="An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing", journal="J Med Internet Res", year="2018", month="Jun", day="27", volume="20", number="6", pages="e10457", keywords="rheumatoid arthritis", keywords="hand joints", keywords="exercise training", keywords="web-based", abstract="Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. Objective: We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. Methods: We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. Results: A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. Conclusions: mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences. ", doi="10.2196/10457", url="http://www.jmir.org/2018/6/e10457/", url="http://www.ncbi.nlm.nih.gov/pubmed/29950288" } @Article{info:doi/10.2196/diabetes.9202, author="Bernier, Angelina and Fedele, David and Guo, Yi and Chavez, Sarah and Smith, D. Megan and Warnick, Jennifer and Lieberman, Leora and Modave, Fran{\c{c}}ois", title="New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study", journal="JMIR Diabetes", year="2018", month="Jun", day="06", volume="3", number="2", pages="e10", keywords="mHealth", keywords="information technology", keywords="diabetes education", keywords="pediatrics", abstract="Background: Diabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients. Objective: Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis. Methods: We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group. Results: We recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium ($\Delta$=0.56). Usability ratings of NODE were excellent. Conclusions: NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease. ", doi="10.2196/diabetes.9202", url="http://diabetes.jmir.org/2018/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/30291069" } @Article{info:doi/10.2196/cancer.9210, author="Katapodi, C. Maria and Jung, Miyeon and Schafenacker, M. Ann and Milliron, J. Kara and Mendelsohn-Victor, E. Kari and Merajver, D. Sofia and Northouse, L. Laurel", title="Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study", journal="JMIR Cancer", year="2018", month="Apr", day="13", volume="4", number="1", pages="e7", keywords="BRCA families", keywords="family-based intervention study", keywords="Web-based intervention study", keywords="psycho-educational and skills-building intervention study", keywords="communication and coping", keywords="patient decision-aid", keywords="genetic testing", abstract="Background: Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer. Objective: The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master's prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23\%), completion rate was 71\% (10/14) for intervention and 40\% (4/10) for wait-listed control groups. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented. Trial Registration: ClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv) ", doi="10.2196/cancer.9210", url="http://cancer.jmir.org/2018/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/29653920" } @Article{info:doi/10.2196/jmir.8666, author="Bernhard, Gerda and Mahler, Cornelia and Seidling, Marita Hanna and St{\"u}tzle, Marion and Ose, Dominik and Baudendistel, Ines and Wensing, Michel and Szecsenyi, Joachim", title="Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements", journal="J Med Internet Res", year="2018", month="Mar", day="27", volume="20", number="3", pages="e105", keywords="medication", keywords="self-management", keywords="patient portal", keywords="patient participation", keywords="type 2 diabetes mellitus", keywords="focus groups", keywords="primary care", abstract="Background: Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients' knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user' adoption is optimal. Objective: The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. Methods: This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. Results: Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients' ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align the platform to users' workflow. Conclusions: By employing a UCD, this study provides insight into the desired functionalities and usability of patients and HCPs regarding a shared patient-centered, Web-based medication platform, thus increasing the likelihood to achieve a functional and useful system. Substantial and ongoing engagement by all intended user groups is necessary to reconcile differences in requirements of patients and HCPs, especially regarding medication safety alerts and access control. Moreover, effective training of patients and HCPs on medication self-management (support) and optimal use of the tool will be a prerequisite to unfold the platform's full potential. ", doi="10.2196/jmir.8666", url="http://www.jmir.org/2018/3/e105/", url="http://www.ncbi.nlm.nih.gov/pubmed/29588269" } @Article{info:doi/10.2196/jmir.8889, author="Zikmund-Fisher, J. Brian and Scherer, M. Aaron and Witteman, O. Holly and Solomon, B. Jacob and Exe, L. Nicole and Fagerlin, Angela", title="Effect of Harm Anchors in Visual Displays of Test Results on Patient Perceptions of Urgency About Near-Normal Values: Experimental Study", journal="J Med Internet Res", year="2018", month="Mar", day="26", volume="20", number="3", pages="e98", keywords="decision making", keywords="education of patients", keywords="electronic health record", keywords="computer graphics", keywords="clinical laboratory information systems", abstract="Background: Patient-facing displays of laboratory test results typically provide patients with one reference point (the ``standard range''). Objective: To test the effect of including an additional harm anchor reference point in visual displays of laboratory test results, which indicates how far outside of the standard range values would need to be in order to suggest substantial patient risk. Methods: Using a demographically diverse, online sample, we compared the reactions of 1618 adults in the United States who viewed visual line displays that included both standard range and harm anchor reference points (``Many doctors are not concerned until here'') to displays that included either (1) only a standard range, (2) standard range plus evaluative categories (eg, ``borderline high''), or (3) a color gradient showing degree of deviation from the standard range. Results: Providing the harm anchor reference point significantly reduced perceived urgency of close-to-normal alanine aminotransferase and creatinine results (P values <.001) but not generally for platelet count results. Notably, display type did not significantly alter perceptions of more extreme results in potentially harmful ranges. Harm anchors also substantially reduced the number of participants who wanted to contact their doctor urgently or go to the hospital about these test results. Conclusions: Presenting patients with evaluative cues regarding when test results become clinically concerning can reduce the perceived urgency of out-of-range results that do not require immediate clinical action. ", doi="10.2196/jmir.8889", url="http://www.jmir.org/2018/3/e98/", url="http://www.ncbi.nlm.nih.gov/pubmed/29581088" } @Article{info:doi/10.2196/jmir.9690, author="Wallin, Emma and Norlund, Fredrika and Olsson, Gustaf Erik Martin and Burell, Gunilla and Held, Claes and Carlsson, Tommy", title="Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study", journal="J Med Internet Res", year="2018", month="Mar", day="16", volume="20", number="3", pages="e87", keywords="mental health", keywords="internet", keywords="cognitive behavioral therapy", keywords="computer-assisted therapy", keywords="myocardial infarction", keywords="attrition", keywords="adherence", abstract="Background: Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care. Objective: The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction. Methods: This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis. Results: Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6\%), and about half (63/117, 53.9\%) of all participants completed the introductory module, but only 18 (15.4\%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties. Conclusions: Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population. ", doi="10.2196/jmir.9690", url="http://www.jmir.org/2018/3/e87/", url="http://www.ncbi.nlm.nih.gov/pubmed/29549067" } @Article{info:doi/10.2196/formative.9083, author="Zafeiridi, Paraskevi and Paulson, Kevin and Dunn, Rosie and Wolverson, Emma and White, Caroline and Thorpe, Adrian Jonathan and Antomarini, Marco and Cesaroni, Francesca and Scocchera, Francesca and Landrin-Dutot, Isabelle and Malherbe, La{\"e}titia and Lingiah, Hendi and B{\'e}rard, Marie and Giron{\`e}s, Xavier and Quintana, Maria and Cort{\'e}s, Ulises and Barru{\'e}, Cristian and Cort{\'e}s, Atia and Paliokas, Ioannis and Votis, Konstantinos and Tzovaras, Dimitrios", title="A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability", journal="JMIR Formativ Res", year="2018", month="Mar", day="12", volume="2", number="1", pages="e4", keywords="dementia", keywords="technology", keywords="social support", keywords="caregivers", abstract="Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10\% (6/58). Results: After 1 week of platform use, the system was useful for 90\% (20.75/23) of the caregivers and for 89\% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82\%, 18.75/23; professionals: 97\%, 5.82/6) and their satisfaction with the platform (caregivers: 79\%, 18.08/23; professionals: 73\%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57\%, 13/23), ease of use (41\%, 9.4/23), and overall satisfaction (47\%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions. ", doi="10.2196/formative.9083", url="http://formative.jmir.org/2018/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684403" } @Article{info:doi/10.2196/humanfactors.8319, author="Dijkstra, Elske Nienke and Sino, Maria Carolina Geertruida and Heerdink, Rob Eibert and Schuurmans, Joanna Marieke", title="Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study", journal="JMIR Hum Factors", year="2018", month="Mar", day="07", volume="5", number="1", pages="e10", keywords="primary care", keywords="home care", keywords="eHealth", keywords="mHealth", abstract="Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice--based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. ", doi="10.2196/humanfactors.8319", url="http://humanfactors.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29514771" } @Article{info:doi/10.2196/rehab.8003, author="Thirumalai, Mohanraj and Kirkland, B. William and Misko, R. Samuel and Padalabalanarayanan, Sangeetha and Malone, A. Laurie", title="Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation", journal="JMIR Rehabil Assist Technol", year="2018", month="Mar", day="06", volume="5", number="1", pages="e2", keywords="sedentary lifestyle", keywords="video games", keywords="active video gaming", keywords="Wii Fit", keywords="equipment design", keywords="physical activity", keywords="exercise", keywords="wheelchairs", keywords="physical disability", keywords="rehabilitation", keywords="usability", abstract="Background: Active video game (AVG) playing, also known as ``exergaming,'' is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play. Objective: The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments. Methods: In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants' perceived usability. Results: The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users' range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as ``good,'' while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as ``excellent.'' We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable. Conclusions: This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller's potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf) ", doi="10.2196/rehab.8003", url="http://rehab.jmir.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/29510972" } @Article{info:doi/10.2196/mental.9441, author="Radovic, Ana and Gmelin, Theresa and Hua, Jing and Long, Cassandra and Stein, D. Bradley and Miller, Elizabeth", title="Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study", journal="JMIR Ment Health", year="2018", month="Feb", day="26", volume="5", number="1", pages="e17", keywords="adolescent", keywords="adolescent health services", keywords="technology", keywords="depression", keywords="anxiety", abstract="Background: Supporting Our Valued Adolescents (SOVA), a social media website for adolescents, was designed to increase mental health literacy and address negative health beliefs toward depression and/or anxiety diagnosis and treatment. This stakeholder-informed site underwent iterative user testing to evolve into its current version with daily blog posts, round-the-clock site moderation, and Web-based peer interaction to create an online support community. Objective: The aim of this study was to evaluate the technological feasibility (at least 100 users on the site, logging in 12 to 18 times in the first 6 weeks) and acceptability of the SOVA site determined by the System Usability Scale (SUS). Methods: Adolescents and young adults (aged 14-26 years) with a self-reported history of depressive and/or anxiety symptoms were recruited to access the research website (sova.pitt.edu). Participants were screened out if they reported active suicidality or a prior suicide attempt. Baseline survey measures included demographics, symptomatology using the Patient Health Questionnaire-9 modified for adolescents (PHQ-9A) and Screen for Child Anxiety Related Disorders (SCARED-C), and mental health treatment history. The 6-week follow-up measures taken in addition to the symptomatology, included feasibility (total number of log-ins), usability, and acceptability of SOVA using SUS. Results: Most of the 96 participants identified as female (75\% [72/96]) and white (67\% [64/96]). Most participants (73\% [70/96]) reported having taken prior professional psychological help. The average PHQ-9A score was 11.8 (SD 5.5), and for SCARED-C, 85\% (80/94) of the participants reported a score consistent with being susceptible to a diagnosed anxiety disorder. There were 46\% (41/90) of eligible users who ever logged in. Out of the total users who ever logged in, the mean of total log-ins over the entire study was 4.1 (SD 6.9). Median number of users rated the user-friendliness of the site as ``good.'' The average SUS score was 71.2\% (SD 18.7), or a ``C-grade,'' which correlated to an acceptable range. The participants reported to have liked the ``easy-to-understand format'' and ``positive, helpful atmosphere,'' but they also reported a desire for greater social interaction. Iterative recruitment resulted in incremental improvements to the site. Conclusions: The SOVA site met feasibility goals of recruiting almost 100 users and establishing acceptable usability. Subsequent interventions are planned to increase site engagement and to evaluate efficacy in increasing uptake of primary care--recommended depression and/or anxiety treatment. ", doi="10.2196/mental.9441", url="http://mental.jmir.org/2018/1/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/29483067" } @Article{info:doi/10.2196/diabetes.8160, author="Schmocker, S. Kaspar and Zwahlen, S. Fabian and Denecke, Kerstin", title="Mobile App for Simplifying Life With Diabetes: Technical Description and Usability Study of GlucoMan", journal="JMIR Diabetes", year="2018", month="Feb", day="26", volume="3", number="1", pages="e6", keywords="diabetes management", keywords="patient empowerment", keywords="mobile health", keywords="self-care", keywords="chronic disease management", keywords="diabetes mellitus", keywords="mobile apps", abstract="Background: Patients with diabetes can be affected by several comorbidities that require immediate action when occurring as they may otherwise cause fatal or consequential damage. For this reason, patients must closely monitor their metabolism and inject insulin when necessary. The documentation of glucose values and other relevant measurements is often still on paper in a diabetes diary. Objective: The goal of this work is to develop and implement a novel mobile health system for the secure collection of relevant data referring to a person's metabolis and to digitize the diabetes diary to enable continuous monitoring for both patients and treating physicians. One specific subgoal is to enable data transmission of health parameters to secure data storage. Methods: The process of implementing the system consists of (1) requirements analysis with patients and physicians to identify patient needs and specify relevant functionalities, (2) design and development of the app and the data transmission, and (3) usability study. Results: We developed and implemented the mobile app GlucoMan to support data collection pertaining to a person's metabolism. An automated transfer of measured values from a glucometer was implemented. Medication and nutrition data could be entered using product barcodes. Relevant background knowledge such as information on carbohydrates was collected from existing databases. The recorded data was transmitted using international interoperability standards to the MIDATA.coop storage platform. The usability study revealed some design issues that needs to be solved, but in principle, the study results show that the app is easy to use and provides useful features. Conclusions: Data collection on a patient's metabolism can be supported with a multifunctional app such as GlucoMan. Besides monitoring, continuous data can be documented and made available to the treating physician. GlucoMan allows patients to monitor disease-relevant parameters and decide who accesses their health data. In this way, patients are empowered not only to manage diabetes but also manage their health data. ", doi="10.2196/diabetes.8160", url="http://diabetes.jmir.org/2018/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/30291070" } @Article{info:doi/10.2196/humanfactors.8948, author="Thomson, Karen and Brouwers, Corline and Damman, C. Olga and de Bruijne, C. Martine and Timmermans, RM Danielle and Melles, Marijke", title="How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study", journal="JMIR Hum Factors", year="2018", month="Feb", day="20", volume="5", number="1", pages="e7", keywords="medication adherence", keywords="eHealth", keywords="shared decision making", keywords="self-management", keywords="patient engagement", abstract="Background: Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence. Objective: The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods: A Web-based prototype of the eHealth app---MIK---was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians' evaluations. Results: On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient's understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow. Conclusions: The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM. ", doi="10.2196/humanfactors.8948", url="http://humanfactors.jmir.org/2018/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/29463494" } @Article{info:doi/10.2196/humanfactors.9371, author="Ratanawongsa, Neda and Matta, Y. George and Bohsali, B. Fuad and Chisolm, S. Margaret", title="Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis", journal="JMIR Hum Factors", year="2018", month="Feb", day="06", volume="5", number="1", pages="e4", keywords="electronic health records", keywords="physician-patient relations", keywords="patient safety", abstract="Background: Clinicians' use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians' EHR workload, stress, and burnout. Objective: We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. Methods: This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with ``misses'' (errors that were not caught at the time) or ``near misses'' (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results: All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about ``misses we don't even know about.'' Risk factors included the computer's position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. Conclusions: CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships. ", doi="10.2196/humanfactors.9371", url="http://humanfactors.jmir.org/2018/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/29410388" } @Article{info:doi/10.2196/mhealth.8115, author="O'Reilly, Aidan Martin and Slevin, Patrick and Ward, Tomas and Caulfield, Brian", title="A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="31", volume="6", number="1", pages="e33", keywords="mHealth", keywords="feedback", keywords="posture", keywords="exercise therapy", keywords="biomedical technology", keywords="lower extremity", keywords="physical therapy specialty", abstract="Background: Formulift is a newly developed mobile health (mHealth) app that connects to a single inertial measurement unit (IMU) worn on the left thigh. The IMU captures users' movements as they exercise, and the app analyzes the data to count repetitions in real time and classify users' exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of this study was to assess the Formulift system with three different and realistic types of potential users (beginner gym-goers, experienced gym-goers, and qualified strength and conditioning [S\&C] coaches) under a number of categories: (1) usability, (2) functionality, (3) the perceived impact of the system, and (4) the subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: A total of 15 healthy volunteers participated (12 males; 3 females; age: 23.8 years [SD 1.80]; height: 1.79 m [SD 0.07], body mass: 78.4 kg [SD 9.6]). Five participants were beginner gym-goers, 5 were experienced gym-goers, and 5 were qualified and practicing S\&C coaches. IMU data were first collected from each participant to create individualized exercise classifiers for them. They then completed a number of nonexercise-related tasks with the app. Following this, a workout was completed using the system, involving squats, deadlifts, lunges, and single-leg squats. Participants were then interviewed about their user experience and completed the System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts, and survey results were analyzed. Results: Qualitative and quantitative analysis found the system has ``good'' to ``excellent'' usability. The system achieved a mean (SD) SUS usability score of 79.2 (8.8). Functionality was also deemed to be good, with many users reporting positively on the systems repetition counting, technique classification, and feedback. A number of bugs were found, and other suggested changes to the system were also made. The overall subjective quality of the app was good, with a median star rating of 4 out of 5 (interquartile range, IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them, and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of Formulift in the categories of usability, functionality, perceived impact, and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor-based exercise biofeedback systems. ", doi="10.2196/mhealth.8115", url="http://mhealth.jmir.org/2018/1/e33/", url="http://www.ncbi.nlm.nih.gov/pubmed/29386171" } @Article{info:doi/10.2196/mhealth.8337, author="Wang, Chih-Jau and Chaovalit, Pimwadee and Pongnumkul, Suporn", title="A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="26", volume="6", number="1", pages="e27", keywords="mobile health", keywords="breast feeding", keywords="mobile applications", keywords="health promotion", keywords="usability", keywords="usefulness", abstract="Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20\% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women. Methods: Our study was reviewed and approved by Thailand's National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis. Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system. ", doi="10.2196/mhealth.8337", url="http://mhealth.jmir.org/2018/1/e27/", url="http://www.ncbi.nlm.nih.gov/pubmed/29374000" } @Article{info:doi/10.2196/cancer.8430, author="Kinner, M. Ellen and Armer, S. Jessica and McGregor, A. Bonnie and Duffecy, Jennifer and Leighton, Susan and Corden, E. Marya and Gauthier Mullady, Janine and Penedo, J. Frank and Lutgendorf, K. Susan", title="Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results", journal="JMIR Cancer", year="2018", month="Jan", day="15", volume="4", number="1", pages="e1", keywords="ovarian cancer", keywords="quality of life", keywords="feasibility studies", keywords="eHealth", keywords="psychological stress", abstract="Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. ", doi="10.2196/cancer.8430", url="http://cancer.jmir.org/2018/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/29335233" } @Article{info:doi/10.2196/humanfactors.7882, author="Kurahashi, M. Allison and Stinson, N. Jennifer and van Wyk, Margaret and Luca, Stephanie and Jamieson, Trevor and Weinstein, Peter and Cafazzo, A. Joseph and Lokuge, Bhadra and Cohen, Eyal and Rapoport, Adam and Husain, Amna", title="The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System", journal="JMIR Hum Factors", year="2018", month="Jan", day="09", volume="5", number="1", pages="e2", keywords="patient-centered care", keywords="patient participation", keywords="chronic disease", keywords="communication", keywords="internet communication tools", keywords="usability testing", keywords="interdisciplinary communication", keywords="health communication", keywords="continuity of patient care", keywords="patient care team", keywords="inventions", abstract="Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system's uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users' perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions---composing, posting, and reading messages---with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. ", doi="10.2196/humanfactors.7882", url="http://humanfactors.jmir.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/29317386" } @Article{info:doi/10.2196/mhealth.8851, author="Schnall, Rebecca and Cho, Hwayoung and Liu, Jianfang", title="Health Information Technology Usability Evaluation Scale (Health-ITUES) for Usability Assessment of Mobile Health Technology: Validation Study", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="05", volume="6", number="1", pages="e4", keywords="mobile technology", keywords="usability", keywords="mobile health apps", keywords="psychometric evaluation", abstract="Background: Mobile technology has become a ubiquitous technology and can be particularly useful in the delivery of health interventions. This technology can allow us to deliver interventions to scale, cover broad geographic areas, and deliver technologies in highly tailored ways based on the preferences or characteristics of users. The broad use of mobile technologies supports the need for usability assessments of these tools. Although there have been a number of usability assessment instruments developed, none have been validated for use with mobile technologies. Objective: The goal of this work was to validate the Health Information Technology Usability Evaluation Scale (Health-ITUES), a customizable usability assessment instrument in a sample of community-dwelling adults who were testing the use of a new mobile health (mHealth) technology. Methods: A sample of 92 community-dwelling adults living with HIV used a new mobile app for symptom self-management and completed the Health-ITUES to assess the usability of the app. They also completed the Post-Study System Usability Questionnaire (PSSUQ), a widely used and well-validated usability assessment tool. Correlations between these scales and each of the subscales were assessed. Results: The subscales of the Health-ITUES showed high internal consistency reliability (Cronbach alpha=.85-.92). Each of the Health-ITUES subscales and the overall scale was moderately to strongly correlated with the PSSUQ scales (r=.46-.70), demonstrating the criterion validity of the Health-ITUES. Conclusions: The Health-ITUES has demonstrated reliability and validity for use in assessing the usability of mHealth technologies in community-dwelling adults living with a chronic illness. ", doi="10.2196/mhealth.8851", url="http://mhealth.jmir.org/2018/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/29305343" } @Article{info:doi/10.2196/jmir.8877, author="Reid, Kathy and Hartling, Lisa and Ali, Samina and Le, Anne and Norris, Allison and Scott, D. Shannon", title="Development and Usability Evaluation of an Art and Narrative-Based Knowledge Translation Tool for Parents With a Child With Pediatric Chronic Pain: Multi-Method Study", journal="J Med Internet Res", year="2017", month="Dec", day="14", volume="19", number="12", pages="e412", keywords="pain", keywords="child health", keywords="parents", keywords="art", abstract="Background: Chronic pain in childhood is increasingly being recognized as a significant clinical problem for children and their families. Previous research has identified that families want information about the causes of their child's chronic pain, treatment options, and effective strategies to help their child cope with the pain. Unfortunately, parents have reported that finding this information can be challenging. Objective: The aim of this study was to actively work together with children attending a pediatric chronic pain clinic and their parents to develop, refine, and evaluate the usability of an art and narrative-based electronic book (e-book) for pediatric chronic pain. Methods: A multiphase, multi-method research design employing patient engagement techniques was used to develop, refine, and evaluate the usability of an art and narrative based e-book for pediatric chronic pain management to facilitate knowledge translation for parents with a child with chronic pain. The multiple phases included the following: (1) qualitative interviews to compile parents' narratives using qualitative interviews; (2) qualitative data analysis; (3) development of an e-book prototype; (4) expert clinician feedback; (5) parent usability evaluation, knowledge change, and confidence in knowledge responses using an electronic survey; (6) e-book refinement; and (7) dissemination of the e-book. Results: A 48-page e-book was developed to characterize the experiences of a family living with a child with chronic pain. The e-book was a composite narrative of the parent interviews and encompassed descriptions of the effects the condition has on each member of the family. This was merged with the best available research evidence on the day-to-day management of pediatric chronic pain. The e-book was vetted for clinical accuracy by expert pediatric pain clinicians. All parents that participated in the usability evaluation (N=14) agreed or strongly agreed the content of the e-book was easy to understand and stated that they would recommend the e-book to other families who have children with chronic pain. Our research identified up to a 21.4\% increase in knowledge after using the e-book, and paired t tests demonstrated a statistically significant difference in confidence in answering two of the five knowledge questions (chronic pain is a disease involving changes in the nervous system; the use of ibuprofen is usually effective at controlling chronic pain); t13=0.165, P=.001 and t13=0.336, P=.002, respectively, after being exposed to the e-book. Conclusions: Our results demonstrate that parents positively rated an e-book developed for parents with a child with chronic pain. Our results also identify that overall, parents' knowledge increased after using the e-book, and confidence in their knowledge about chronic pain and its management increased in two aspects after e-book exposure. These results suggest that art and narrative-based knowledge translation interventions may be useful in transferring complex health information to parents. ", doi="10.2196/jmir.8877", url="http://www.jmir.org/2017/12/e412/", url="http://www.ncbi.nlm.nih.gov/pubmed/29242180" } @Article{info:doi/10.2196/jmir.8424, author="Srikesavan, Swarnalatha Cynthia and Williamson, Esther and Eldridge, Lucy and Heine, Peter and Adams, Jo and Cranston, Tim and Lamb, E. Sarah", title="A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing", journal="J Med Internet Res", year="2017", month="Dec", day="13", volume="19", number="12", pages="e411", keywords="hand function", keywords="hand exercises", keywords="rheumatoid arthritis", keywords="online training", keywords="implementation", abstract="Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. ", doi="10.2196/jmir.8424", url="http://www.jmir.org/2017/12/e411/", url="http://www.ncbi.nlm.nih.gov/pubmed/29237581" } @Article{info:doi/10.2196/mhealth.7927, author="Gray, Justin and Beatty, R. Jessica and Svikis, S. Dace and Puder, S. Karoline and Resnicow, Ken and Konkel, Janine and Rice, Shetoya and McGoron, Lucy and Ondersma, J. Steven", title="Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers", journal="JMIR Mhealth Uhealth", year="2017", month="Nov", day="08", volume="5", number="11", pages="e172", keywords="pregnancy", keywords="marijuana", keywords="intervention study", keywords="text messaging", abstract="Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective: The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate. ", doi="10.2196/mhealth.7927", url="http://mhealth.jmir.org/2017/11/e172/", url="http://www.ncbi.nlm.nih.gov/pubmed/29117931" } @Article{info:doi/10.2196/mededu.8100, author="Hege, Inga and Kononowicz, A. Andrzej and Adler, Martin", title="A Clinical Reasoning Tool for Virtual Patients: Design-Based Research Study", journal="JMIR Med Educ", year="2017", month="Nov", day="02", volume="3", number="2", pages="e21", keywords="learning", keywords="educational technology", keywords="computer-assisted instruction", keywords="clinical decision-making", abstract="Background: Clinical reasoning is a fundamental process medical students have to learn during and after medical school. Virtual patients (VP) are a technology-enhanced learning method to teach clinical reasoning. However, VP systems do not exploit their full potential concerning the clinical reasoning process; for example, most systems focus on the outcome and less on the process of clinical reasoning. Objectives: Keeping our concept grounded in a former qualitative study, we aimed to design and implement a tool to enhance VPs with activities and feedback, which specifically foster the acquisition of clinical reasoning skills. Methods: We designed the tool by translating elements of a conceptual clinical reasoning learning framework into software requirements. The resulting clinical reasoning tool enables learners to build their patient's illness script as a concept map when they are working on a VP scenario. The student's map is compared with the experts' reasoning at each stage of the VP, which is technically enabled by using Medical Subject Headings, which is a comprehensive controlled vocabulary published by the US National Library of Medicine. The tool is implemented using Web technologies, has an open architecture that enables its integration into various systems through an open application program interface, and is available under a Massachusetts Institute of Technology license. Results: We conducted usability tests following a think-aloud protocol and a pilot field study with maps created by 64 medical students. The results show that learners interact with the tool but create less nodes and connections in the concept map than an expert. Further research and usability tests are required to analyze the reasons. Conclusions: The presented tool is a versatile, systematically developed software component that specifically supports the clinical reasoning skills acquisition. It can be plugged into VP systems or used as stand-alone software in other teaching scenarios. The modular design allows an extension with new feedback mechanisms and learning analytics algorithms. ", doi="10.2196/mededu.8100", url="http://mededu.jmir.org/2017/2/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/29097355" } @Article{info:doi/10.2196/humanfactors.7964, author="Himes, Park Katherine and Donovan, Heidi and Wang, Stephanie and Weaver, Carrie and Grove, Rae Jillian and Facco, Lucia Francesca", title="Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial", journal="JMIR Hum Factors", year="2017", month="Oct", day="10", volume="4", number="4", pages="e26", keywords="postpartum visit", keywords="behavioral economics", keywords="Medicaid", keywords="intervention", keywords="usability", abstract="Background: During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit. Objectives: The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention. Methods: We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception. Results: The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users' experience and further improved the program. A total of 34 postpartum women with Medicaid insurance were approached for the pilot trial, and 30 (88\%) were consented and randomized. All women randomized to Healthy Beyond Pregnancy completed the Web-based program, had text-enabled cell phones, and were willing to receive text messages from the study team. Women in the Healthy Beyond Pregnancy arm were more likely to return for a postpartum visit compared with women in the control arm with 85\% of women in Healthy Beyond Pregnancy returning versus 53\% in the control arm (odds ratio in the Healthy Beyond Pregnancy group: 5.3; 95\% CI 0.9-32.0; P=.06). Conclusions: We have developed a highly usable and acceptable Web-based program designed to increase attendance at the postpartum visit. Our pilot trial demonstrates that women are willing and able to participate in a randomized trial of a Web-based program and text messaging system. Trial Registration: Clinicaltrials.gov NCT03296774; https://clinicaltrials.gov/ct2/show/NCT03296774 (Archived by WebCite at http://www.webcitation.org/6tpgXFzyk) ", doi="10.2196/humanfactors.7964", url="http://humanfactors.jmir.org/2017/4/e26/", url="http://www.ncbi.nlm.nih.gov/pubmed/29017990" } @Article{info:doi/10.2196/humanfactors.7709, author="Thies, Kathleen and Anderson, Daren and Cramer, Benjamin", title="Lack of Adoption of a Mobile App to Support Patient Self-Management of Diabetes and Hypertension in a Federally Qualified Health Center: Interview Analysis of Staff and Patients in a Failed Randomized Trial", journal="JMIR Hum Factors", year="2017", month="Oct", day="03", volume="4", number="4", pages="e24", keywords="telehealth", keywords="mobile health", keywords="mHealth", keywords="underserved patients", keywords="HIT", keywords="usability", abstract="Background: Thousands of mobile health (mHealth) apps have been developed to support patients' management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers' adoption of these technologies. Objective: The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) with uncontrolled diabetes and/or hypertension. Patients entered clinical data into the app, which also supported messaging between patients and providers. After a 4-month period of vigorous recruitment, the trial was suspended due to low enrollment and inconsistent use of the app by enrolled patients. The project aim was changed to understanding why the trial was unsuccessful. Methods: We used the user-task-context (eUTC) usability framework to develop a set of interview questions for patients and staff who were involved in the trial. All interviews were done by phone and lasted 20 to 30 minutes. Interviews were not recorded. Results: There was a poor fit between the app, end users, and recruitment and treatment approaches in our setting. Usability testing might have revealed this prior to launch but was not an option. There was not sufficient time during routine care for clinical staff to familiarize patients with the app or to check clinical data and messages, which are unreimbursed activities. Some patients did not use the app appropriately. The lack of integration with the electronic health record (EHR) was cited as a problem for both patients and staff who also said the app was just one more thing to attend to. Conclusions: This brief trial underscores the pitfalls in the utilization of mHealth apps. Effective use of mHealth tools requires a good fit between the app, the users' electronic health (eHealth) literacy, the treatment approach, staff time, and reimbursement for services. The last 3 are contextual factors of the setting that affected the adoption of the app and context is an important factor in implementation science. We recommend that researchers address contextual factors in the trial and adoption of mHealth technologies. ", doi="10.2196/humanfactors.7709", url="https://humanfactors.jmir.org/2017/4/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/28974481" } @Article{info:doi/10.2196/mhealth.7836, author="Milward, Joanna and Deluca, Paolo and Drummond, Colin and Watson, Rod and Dunne, Jacklyn and Kimerg{\aa}rd, Andreas", title="Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults", journal="JMIR Mhealth Uhealth", year="2017", month="Aug", day="08", volume="5", number="8", pages="e109", keywords="alcohol", keywords="drinking", keywords="young adults", keywords="mHealth", keywords="brief intervention", keywords="apps", keywords="usability testing", keywords="user experience", keywords="focus group", abstract="Background: Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As ``Digital Natives,'' young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. Objective: The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. Methods: The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. Results: The first theme, ``Functionality'' referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, ``Design'' described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, ``Content'' described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. Conclusions: There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. ", doi="10.2196/mhealth.7836", url="http://mhealth.jmir.org/2017/8/e109/", url="http://www.ncbi.nlm.nih.gov/pubmed/28790022" } @Article{info:doi/10.2196/cancer.7443, author="Groen, G. Wim and Kuijpers, Wilma and Oldenburg, SA Hester and Wouters, WJM Michel and Aaronson, K. Neil and van Harten, H. Wim", title="Supporting Lung Cancer Patients With an Interactive Patient Portal: Feasibility Study", journal="JMIR Cancer", year="2017", month="Aug", day="08", volume="3", number="2", pages="e10", keywords="non-small cell lung cancer", keywords="patient empowerment", keywords="patient portal", keywords="supportive care", keywords="eHealth", keywords="feasibility", abstract="Background: MyAVL is an interactive portal for cancer patients that aims to support lung cancer patients. Objective: We aimed to evaluate the feasibility and usability of the patient portal and generate preliminary evidence on its impact. Methods: Lung cancer patients currently or recently treated with curative intent could use MyAVL noncommittally for 4 months. Feasibility, usability, and preliminary impact (ie, patient activation, quality of life, and physical activity) were studied by means of questionnaires, a focus group, and analysis of user log data. Results: We included 37 of 123 eligible patients (mean age 59.6 years). The majority of responses (82\%) were positive about using MyAVL, 69\% saw it as a valuable addition to care, and 56\% perceived increased control over their health. No positive effects could be substantiated on the impact measures. Conclusions: MyAVL appears to be a feasible and user-friendly, multifunctional eHealth program for a selected group of lung cancer patients. However, it needs further improvements to positively impact patient outcomes. ", doi="10.2196/cancer.7443", url="http://cancer.jmir.org/2017/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/28790025" } @Article{info:doi/10.2196/resprot.7826, author="Zhou, Leming and Bao, Jie and Parmanto, Bambang", title="Systematic Review Protocol to Assess the Effectiveness of Usability Questionnaires in mHealth App Studies", journal="JMIR Res Protoc", year="2017", month="Aug", day="01", volume="6", number="8", pages="e151", keywords="usability", keywords="questionnaire", keywords="mobile health app", keywords="systematic review", abstract="Background: Usability questionnaires have a wide use in mobile health (mHealth) app usability studies. However, no systematic review has been conducted for assessing the effectiveness of these questionnaires. Objective: This paper describes a protocol for conducting a systematic review of published questionnaire-based mHealth app usability studies. Methods: In this systematic review, we will select recently published (2008-2017) articles from peer-reviewed journals and conferences that describe mHealth app usability studies and implement at least one usability questionnaire. The search strategy will include terms such as ``mobile app'' and ``usability.'' Multiple databases such as PubMed, CINAHL, IEEE Xplore, ACM Digital Library, and INSPEC will be searched. There will be 2 independent reviewers in charge of screening titles and abstracts as well as determining those articles that should be included for a full-text review. The third reviewer will act as a mediator between the other 2 reviewers. Moreover, a data extraction form will be created and used during the full article data analysis. Notably, the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines will be followed in reporting this protocol. Results: A preliminary search produced 1271 articles, 40 of which are duplicate records. The inclusion-exclusion criteria are being strictly followed in performing the ongoing study selection. Conclusions: Usability questionnaires are an important tool in mHealth app usability studies. This review will summarize the usability questionnaires used in published research articles while assessing the efficacy of these questionnaires in determining the usability of mHealth apps. ", doi="10.2196/resprot.7826", url="http://www.researchprotocols.org/2017/8/e151/", url="http://www.ncbi.nlm.nih.gov/pubmed/28765101" } @Article{info:doi/10.2196/cancer.7120, author="Henton, Michelle and Gaglio, Bridget and Cynkin, Laurie and Feuer, J. Eric and Rabin, A. Borsika", title="Development, Feasibility, and Small-Scale Implementation of a Web-Based Prognostic Tool---Surveillance, Epidemiology, and End Results Cancer Survival Calculator", journal="JMIR Cancer", year="2017", month="Jul", day="20", volume="3", number="2", pages="e9", keywords="clinical decision-making", keywords="communication", keywords="neoplasms", keywords="patient care team", keywords="Internet", abstract="Background: Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information. Objective: The aim of this study was to develop, test, and implement SEER*CSC. Methods: An iterative approach was used to develop the SEER*CSC. Based on input from cancer patient advocacy groups and physicians, an initial version of the tool was developed. Next, providers from 4 health care delivery systems were recruited to do formal usability testing of SEER*CSC. A revised version of SEER*CSC was then implemented in two health care delivery sites using a real-world clinical implementation approach, and usage data were collected. Post-implementation follow-up interviews were conducted with site champions. Finally, patients from two cancer advocacy groups participated in usability testing. Results: Overall feedback of SEER*CSC from both providers and patients was positive, with providers noting that the tool was professional and reliable, and patients finding it to be informational and helpful to use when discussing their diagnosis with their provider. However, use during the small-scale implementation was low. Reasons for low usage included time to enter data, not having treatment options in the tool, and the tool not being incorporated into the electronic health record (EHR). Patients found the language in its current version to be too complex. Conclusions: The implementation and usability results showed that participants were enthusiastic about the use and features of SEER*CSC, but sustained implementation in a real-world clinical setting faced significant challenges. As a result of these findings, SEER*CSC is being redesigned with more accessible language for a public facing release. Meta-tools, which put different tools in context of each other, are needed to assist in understanding the strengths and limitations of various tools and their place in the clinical decision-making pathway. The continued development and eventual release of prognostic tools should include feedback from multidisciplinary health care teams, various stakeholder groups, patients, and caregivers. ", doi="10.2196/cancer.7120", url="http://cancer.jmir.org/2017/2/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/28729232" } @Article{info:doi/10.2196/humanfactors.7161, author="Hamm, Julian and Money, Arthur and Atwal, Anita", title="Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges", journal="JMIR Hum Factors", year="2017", month="Jun", day="19", volume="4", number="2", pages="e15", keywords="health informatics", keywords="falls", keywords="occupational therapy", keywords="assistive equipment provision process", keywords="self-assessment", keywords="measurement guidance", keywords="extrinsic risk factors", keywords="3D visualization", keywords="technology-based systems", abstract="Background: In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as ``poor fit'' of equipment due to inaccurate measurements taken and recorded, resulting in more than 50\% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. Objective: The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. Methods: Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. Results: The quantitative SUS results revealed that the application may be described as having ``marginal-high'' and ``good'' levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. Conclusions: Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets. ", doi="10.2196/humanfactors.7161", url="http://humanfactors.jmir.org/2017/2/e15/", url="http://www.ncbi.nlm.nih.gov/pubmed/28630034" } @Article{info:doi/10.2196/resprot.7172, author="Rodrigues, M. Angela and Sniehotta, F. Falko and Birch-Machin, A. Mark and Olivier, Patrick and Ara{\'u}jo-Soares, Vera", title="Systematic and Iterative Development of a Smartphone App to Promote Sun-Protection Among Holidaymakers: Design of a Prototype and Results of Usability and Acceptability Testing", journal="JMIR Res Protoc", year="2017", month="Jun", day="12", volume="6", number="6", pages="e112", keywords="sun-protection", keywords="sunburn", keywords="sunscreening agents", keywords="sunbathing", keywords="health behavior", keywords="health promotion", keywords="formative research", keywords="intervention", abstract="Background: Sunburn and intermittent exposure to ultraviolet rays are risk factors for melanoma. Sunburn is a common experience during holidays, making tourism settings of particular interest for skin cancer prevention. Holidaymakers are a volatile populations found at different locations, which may make them difficult to reach. Given the widespread use of smartphones, evidence suggests that this might be a novel, convenient, scalable, and feasible way of reaching the target population. Objective: The main objective of this study was to describe and appraise the process of systematically developing a smartphone intervention (mISkin app) to promote sun-protection during holidays. Methods: The iterative development process of the mISkin app was conducted over four sequential stages: (1) identify evidence on the most effective behavior change techniques (BCTs) used (active ingredients) as well as theoretical predictors and theories, (2) evidence-based intervention design, (3) co-design with users of the mISkin app prototype, and (4) refinement of the app. Each stage provided key findings that were subsequently used to inform the design of the mISkin app. Results: The sequential approach to development integrates different strands of evidence to inform the design of an evidence-based intervention. A systematic review on previously tested interventions to promote sun-protection provided cues and constraints for the design of this intervention. The development and design of the mISkin app also incorporated other sources of information, such as other literature reviews and experts' consultations. The developed prototype of the mISkin app was evaluated by engaging potential holidaymakers in the refinement and further development of the mISkin app through usability (ease-of-use) and acceptability testing of the intervention prototype. All 17 participants were satisfied with the mISkin prototype and expressed willingness to use it. Feedback on the app was integrated in the optimization process of the mISkin app. Conclusions: The mISkin app was designed to promote sun-protection among holidaymakers and was based on current evidence, experts' knowledge and experience, and user involvement. Based on user feedback, the app has been refined and a fully functional version is ready for formal testing in a feasibility pilot study. ", doi="10.2196/resprot.7172", url="http://www.researchprotocols.org/2017/6/e112/", url="http://www.ncbi.nlm.nih.gov/pubmed/28606892" } @Article{info:doi/10.2196/mhealth.7046, author="Harte, Richard and Quinlan, R. Leo and Glynn, Liam and Rodr{\'i}guez-Molinero, Alejandro and Baker, MA Paul and Scharf, Thomas and {\'O}Laighin, Gear{\'o}id", title="Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users", journal="JMIR Mhealth Uhealth", year="2017", month="May", day="30", volume="5", number="5", pages="e71", keywords="human-centered design", keywords="user-centered design", keywords="human-computer interface", keywords="human factors engineering", keywords="eHealth", keywords="engineering psychology", keywords="mHealth", abstract="Background: Design processes such as human-centered design (HCD), which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of HCD can often conflict with the necessary rapid product development life-cycles associated with the competitive connected health industry. Objective: The aim of this study was to apply a structured HCD methodology to the development of a smartphone app that was to be used within a connected health fall risk detection system. Our methodology utilizes so called discount usability engineering techniques to minimize the burden on resources during development and maintain a rapid pace of development. This study will provide prospective designers a detailed description of the application of a HCD methodology. Methods: A 3-phase methodology was applied. In the first phase, a descriptive ``use case'' was developed by the system designers and analyzed by both expert stakeholders and end users. The use case described the use of the app and how various actors would interact with it and in what context. A working app prototype and a user manual were then developed based on this feedback and were subjected to a rigorous usability inspection. Further changes were made both to the interface and support documentation. The now advanced prototype was exposed to user testing by end users where further design recommendations were made. Results: With combined expert and end-user analysis of a comprehensive use case having originally identified 21 problems with the system interface, we have only seen and observed 3 of these problems in user testing, implying that 18 problems were eliminated between phase 1 and 3. Satisfactory ratings were obtained during validation testing by both experts and end users, and final testing by users shows the system requires low mental, physical, and temporal demands according to the NASA Task Load Index (NASA-TLX). Conclusions: From our observation of older adults' interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials. ", doi="10.2196/mhealth.7046", url="http://mhealth.jmir.org/2017/5/e71/", url="http://www.ncbi.nlm.nih.gov/pubmed/28559227" } @Article{info:doi/10.2196/jmir.7846, author="Melnick, R. Edward and Hess, P. Erik and Guo, George and Breslin, Maggie and Lopez, Kevin and Pavlo, J. Anthony and Abujarad, Fuad and Powsner, M. Seth and Post, A. Lori", title="Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department", journal="J Med Internet Res", year="2017", month="May", day="19", volume="19", number="5", pages="e174", keywords="clinical decision support", keywords="decision aids", keywords="head injury, minor", keywords="medical informatics", keywords="spiral computed tomography", keywords="health services overuse", keywords="patient-centered outcomes research", abstract="Background: The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions. Objective: Our objective is to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients' specific concerns. Methods: User-centered design with practice-based and participatory decision aid development was used to design, develop, and evaluate patient-centered decision support regarding CT use in minor head injury in the emergency department. User experience and user interface (UX/UI) development involved successive iterations with incremental refinement in 4 phases: (1) initial prototype development, (2) usability assessment, (3) field testing, and (4) beta testing. This qualitative approach involved input from patients, emergency care clinicians, health services researchers, designers, and clinical informaticists at every stage. Results: The Concussion or Brain Bleed app is the product of 16 successive iterative revisions in accordance with UX/UI industry design standards. This useful and usable final product integrates clinical decision support with a patient decision aid. It promotes shared use by emergency clinicians and patients at the point of care within the emergency department context. This tablet computer app facilitates evidence-based conversations regarding CT in minor head injury. It is adaptable to individual clinician practice styles. The resultant tool includes a patient injury evaluator based on the Canadian CT Head Rule and provides patient specific risks using pictographs with natural frequencies and cues for discussion about patient concerns. Conclusions: This tool was designed to align evidence-based practices about CT in minor head injury patients. It establishes trust, empowers active participation, and addresses patient concerns and uncertainty about their condition. We hypothesize that, when implemented, the Concussion or Brain Bleed app will support---not hinder---the clinician-patient relationship, safely reduce CT use, and improve the patient experience of care. ", doi="10.2196/jmir.7846", url="http://www.jmir.org/2017/5/e174/", url="http://www.ncbi.nlm.nih.gov/pubmed/28526667" } @Article{info:doi/10.2196/humanfactors.7567, author="Aakre, Ansel Christopher and Kitson, E. Jaben and Li, Man and Herasevich, Vitaly", title="Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection", journal="JMIR Hum Factors", year="2017", month="May", day="18", volume="4", number="2", pages="e14", keywords="automation", keywords="organ dysfunction scores", keywords="software design", keywords="user-computer interface", abstract="Background: The new sepsis definition has increased the need for frequent sequential organ failure assessment (SOFA) score recalculation and the clerical burden of information retrieval makes this score ideal for automated calculation. Objective: The aim of this study was to (1) estimate the clerical workload of manual SOFA score calculation through a time-motion analysis and (2) describe a user-centered design process for an electronic medical record (EMR) integrated, automated SOFA score calculator with subsequent usability evaluation study. Methods: First, we performed a time-motion analysis by recording time-to-task-completion for the manual calculation of 35 baseline and 35 current SOFA scores by 14 internal medicine residents over a 2-month period. Next, we used an agile development process to create a user interface for a previously developed automated SOFA score calculator. The final user interface usability was evaluated by clinician end users with the Computer Systems Usability Questionnaire. Results: The overall mean (standard deviation, SD) time-to-complete manual SOFA score calculation time was 61.6 s (33). Among the 24\% (12/50) usability survey respondents, our user-centered user interface design process resulted in >75\% favorability of survey items in the domains of system usability, information quality, and interface quality. Conclusions: Early stakeholder engagement in our agile design process resulted in a user interface for an automated SOFA score calculator that reduced clinician workload and met clinicians' needs at the point of care. Emerging interoperable platforms may facilitate dissemination of similarly useful clinical score calculators and decision support algorithms as ``apps.'' A user-centered design process and usability evaluation should be considered during creation of these tools. ", doi="10.2196/humanfactors.7567", url="http://humanfactors.jmir.org/2017/2/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/28526675" } @Article{info:doi/10.2196/jmir.6816, author="Boudreaux, D. Edwin and Brown, K. Gregory and Stanley, Barbara and Sadasivam, S. Rajani and Camargo, A. Carlos and Miller, W. Ivan", title="Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing", journal="J Med Internet Res", year="2017", month="May", day="15", volume="19", number="5", pages="e149", keywords="technology", keywords="safety", keywords="health planning", keywords="suicide", keywords="computers", keywords="telemedicine", abstract="Background: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. Objective: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. Methods: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. Results: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90\% (27/30) of participants completing at least 5 steps and 67\% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t27=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t27=?2.03, P=.05. Conclusions: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft. ", doi="10.2196/jmir.6816", url="http://www.jmir.org/2017/5/e149/", url="http://www.ncbi.nlm.nih.gov/pubmed/28506957" } @Article{info:doi/10.2196/games.6894, author="Ingadottir, Brynja and Blondal, Katrin and Thue, David and Zoega, Sigridur and Thylen, Ingela and Jaarsma, Tiny", title="Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study", journal="JMIR Serious Games", year="2017", month="May", day="10", volume="5", number="2", pages="e10", keywords="evaluation studies", keywords="knowledge", keywords="pain management", keywords="patient education", keywords="self care", keywords="surgical procedures, operative", keywords="video games", abstract="Background: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain. Objective: The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game. Methods: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information. Results: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001). Conclusions: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game's usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required. ", doi="10.2196/games.6894", url="http://games.jmir.org/2017/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/28490419" } @Article{info:doi/10.2196/jmir.6673, author="Lauritsen, Lise and Andersen, Louise and Olsson, Emilia and S{\o}ndergaard, Rauff Stine and N{\o}rregaard, Benn Lasse and L{\o}ventoft, Kaare Philip and Svendsen, Dunker Signe and Fr{\o}kj{\ae}r, Erik and Jensen, M{\o}rch Hans and Hageman, Ida and Kessing, Vedel Lars and Martiny, Klaus", title="Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards", journal="J Med Internet Res", year="2017", month="Apr", day="21", volume="19", number="4", pages="e123", keywords="depressive disorder, major", keywords="electronic monitoring", keywords="graph drawing", keywords="sleep", keywords="self-assessment", keywords="observational study", keywords="inpatients", keywords="patient participation", keywords="chronotherapeutics", abstract="Background: Patients suffering from depression have a high risk of relapse and readmission in the weeks following discharge from inpatient wards. Electronic self-monitoring systems that offer patient-communication features are now available to offer daily support to patients, but the usability, acceptability, and adherence to these systems has only been sparsely investigated. Objective: We aim to test the usability, acceptability, adherence, and clinical outcome of a newly developed computer-based electronic self-assessment system (the Daybuilder system) in patients suffering from depression, in the period from discharge until commencing outpatient treatment in the Intensive Outpatient Unit for Affective Disorders. Methods: Patients suffering from unipolar major depression that were referred from inpatient wards to an intensive outpatient unit were included in this study before their discharge, and were followed for four weeks. User satisfaction was assessed using semiqualitative questionnaires and the System Usability Scale (SUS). Patients were interviewed at baseline and at endpoint with the Hamilton depression rating scale (HAM-D17), the Major Depression Inventory (MDI), and the 5-item World Health Organization Well-Being Index (WHO-5). In this four-week period patients used the Daybuilder system to self-monitor mood, sleep, activity, and medication adherence on a daily basis. The system displayed a graphical representation of the data that was simultaneously displayed to patients and clinicians. Patients were phoned weekly to discuss their data entries. The primary outcomes were usability, acceptability, and adherence to the system. The secondary outcomes were changes in: the electronically self-assessed mood, sleep, and activity scores; and scores from the HAM-D17, MDI, and WHO-5 scales. Results: In total, 76\% of enrolled patients (34/45) completed the four-week study. Five patients were readmitted due to relapse. The 34 patients that completed the study entered data for mood on 93.8\% of the days (872/930), sleep on 89.8\% of the days (835/930), activity on 85.6\% of the days (796/930), and medication on 88.0 \% of the days (818/930). SUS scores were 86.2 (standard deviation [SD] 9.7) and 79\% of the patients (27/34) found that the system lived up to their expectations. A significant improvement in depression severity was found on the HAM-D17 from 18.0 (SD 6.5) to 13.3 (SD 7.3; P<.01), on the MDI from 27.1 (SD 13.1) to 22.1 (SD 12.7; P=.006), and in quality of life on the WHO-5 from 31.3 (SD 22.9) to 43.4 (SD 22.1; P<.001) scales, but not on self-assessed mood (P=.08). Mood and sleep parameters were highly variable from day-to-day. Sleep-offset was significantly delayed from baseline, averaging 48 minutes (standard error 12 minutes; P<.001). Furthermore, when estimating delay of sleep-onset (with sleep quality included in the model) during the study period, this showed a significant negative effect on mood (P=.03) Conclusions: The Daybuilder systems performed well technically, and patients were satisfied with the system and had high adherence to self-assessments. The dropout rate and the gradual delay in sleep emphasize the need for continued clinical support for these patients, especially when considering sleep guidance. ", doi="10.2196/jmir.6673", url="http://www.jmir.org/2017/4/e123/", url="http://www.ncbi.nlm.nih.gov/pubmed/28432040" } @Article{info:doi/10.2196/resprot.7105, author="Hayashi, Aki and Yamaguchi, Satoko and Waki, Kayo and Fujiu, Katsuhito and Hanafusa, Norio and Nishi, Takahiro and Tomita, Hyoe and Kobayashi, Haruka and Fujita, Hideo and Kadowaki, Takashi and Nangaku, Masaomi and Ohe, Kazuhiko", title="Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study", journal="JMIR Res Protoc", year="2017", month="Apr", day="20", volume="6", number="4", pages="e63", keywords="telemedicine", keywords="mobile phone app", keywords="hemodialysis", keywords="self-management", abstract="Background: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D's usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89\% (SD 23), 95\% (SD 7), and 78\% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86\%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. ", doi="10.2196/resprot.7105", url="http://www.researchprotocols.org/2017/4/e63/", url="http://www.ncbi.nlm.nih.gov/pubmed/28428168" } @Article{info:doi/10.2196/humanfactors.6481, author="Alnosayan, Nagla and Chatterjee, Samir and Alluhaidan, Ala and Lee, Edward and Houston Feenstra, Linda", title="Design and Usability of a Heart Failure mHealth System: A Pilot Study", journal="JMIR Hum Factors", year="2017", month="Mar", day="24", volume="4", number="1", pages="e9", keywords="mHealth", keywords="telehealth", keywords="heart failure", keywords="human factors engineering", keywords="self-management", abstract="Background: Despite the advances in mobile health (mHealth) systems, little is known about patients' and providers' experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants' feedback on the system's design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users' satisfaction with the system ranked 73\%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users' experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. ", doi="10.2196/humanfactors.6481", url="http://humanfactors.jmir.org/2017/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/28341615" } @Article{info:doi/10.2196/mhealth.7199, author="Sullivan, S. Patrick and Driggers, Robert and Stekler, D. Joanne and Siegler, Aaron and Goldenberg, Tamar and McDougal, J. Sarah and Caucutt, Jason and Jones, Jeb and Stephenson, Rob", title="Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study", journal="JMIR Mhealth Uhealth", year="2017", month="Mar", day="09", volume="5", number="3", pages="e26", keywords="homosexuality, male", keywords="mobile applications", keywords="pilot projects", keywords="sexual minorities", keywords="condoms", keywords="pre-exposure prophylaxis", abstract="Background: Men who have sex with men (MSM) are the group most impacted by the human immunodeficiency virus (HIV) epidemic and the only subgroup in the United States among which new HIV diagnoses are not decreasing. To achieve the US National HIV/AIDS (acquired immunodeficiency syndrome) Strategy goals of reducing new diagnoses by 25\%, high (eg, 30-50\%) coverage of multiple HIV prevention interventions is needed in both urban and rural areas. Mobile phone ``apps'' are an important channel through which prevention services could be provided at scale and at low marginal cost. Objective: The aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention. Methods: The app included self-assessment tools; prevention recommendations; commodity (condoms, HIV self-tests) ordering; reminders to MSM for basic HIV prevention services, HIV testing, condom use, screening for preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP); and prevention and treatment provider locators. The study recruited HIV-negative, Android-using MSM in Atlanta and Seattle who were asked to use the app for 4 months and complete a post-use survey. We measured the use of the app and its features, ordering of commodities, self-report of establishing an HIV testing plan, being HIV tested in the community, and starting PrEP or using nPEP. Usability was assessed using the system usability scale (SUS). Results: A total of 121 MSM were enrolled (59.5\%, 72/121 from Atlanta; 40.5\%, 49/121 from Seattle). Median age was 28. Nearly half (48.8\%, 59/121) were nonwhite, and most (85.9\%, 104/121) were gay-identified. Most had tested for HIV in the past (85.1\%, 103/121), and 52 (43.0\%, 52/121) had a plan to test for HIV regularly. Men used the app for an average of 17.7 minutes over the first 4 months. Over the 4-month period, over half ordered condoms (63.6\%, 77/121) and HIV test kits (52.8\%, 64/121) on the app. Eight of 86 (9\%) PrEP-eligible MSM started PrEP during the 4-month period; of those, 6 of the 8 reported that the app influenced their decision to start PrEP. The mean SUS was 73 (above average). Conclusions: A theory-based mobile phone app was acceptable to MSM and was rated as having above-average usability. Most men used the commodity-ordering features of the app during the 4-month evaluation period, and nearly 1 in 10 PrEP-eligible men started PrEP, with most attributing their decision to start PrEP in part to the app. A broader, randomized controlled study of the impact of the app on uptake of prevention behaviors for MSM is warranted. ", doi="10.2196/mhealth.7199", url="http://mhealth.jmir.org/2017/3/e26/", url="http://www.ncbi.nlm.nih.gov/pubmed/28279949" } @Article{info:doi/10.2196/humanfactors.5933, author="Ferron, C. Joelle and Brunette, F. Mary and Geiger, Pamela and Marsch, A. Lisa and Adachi-Mejia, M. Anna and Bartels, J. Stephen", title="Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis", journal="JMIR Hum Factors", year="2017", month="Mar", day="03", volume="4", number="1", pages="e7", keywords="mHealth", keywords="mobile apps", keywords="smoking cessation", keywords="schizophrenia", keywords="psychotic disorders", abstract="Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly---66\% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills. ", doi="10.2196/humanfactors.5933", url="http://humanfactors.jmir.org/2017/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28258047" } @Article{info:doi/10.2196/publichealth.6949, author="Munro, Sarah and Hui, Amber and Salmons, Vanessa and Solomon, Carolyn and Gemmell, Emily and Torabi, Nahal and Janssen, A. Patricia", title="SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions", journal="JMIR Public Health Surveill", year="2017", month="Feb", day="07", volume="3", number="1", pages="e7", keywords="pregnancy", keywords="text messaging", keywords="prenatal education", keywords="health behavior", abstract="Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women's preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women's perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98\%), used text messages ``all the time'' (28/40, 70\%), and surfed the Internet on their phone (37/40, 93\%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. ", doi="10.2196/publichealth.6949", url="http://publichealth.jmir.org/2017/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28174149" } @Article{info:doi/10.2196/rehab.6376, author="Meiland, Franka and Innes, Anthea and Mountain, Gail and Robinson, Louise and van der Roest, Henri{\"e}tte and Garc{\'i}a-Casal, Antonio J. and Gove, Dianne and Thyrian, Ren{\'e} Jochen and Evans, Shirley and Dr{\"o}es, Rose-Marie and Kelly, Fiona and Kurz, Alexander and Casey, Dympna and Szcze?niak, Dorota and Dening, Tom and Craven, P. Michael and Span, Marijke and Felzmann, Heike and Tsolaki, Magda and Franco-Martin, Manuel", title="Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics", journal="JMIR Rehabil Assist Technol", year="2017", month="Jan", day="16", volume="4", number="1", pages="e1", keywords="dementia", keywords="technology", keywords="evaluation studies", keywords="diffusion of innovation", keywords="ethics", abstract="Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them. ", doi="10.2196/rehab.6376", url="http://rehab.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582262" } @Article{info:doi/10.2196/cancer.6750, author="Pereira-Azevedo, Nuno and Os{\'o}rio, Lu{\'i}s and Fraga, Avelino and Roobol, J. Monique", title="Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App", journal="JMIR Cancer", year="2017", month="Jan", day="06", volume="3", number="1", pages="e1", keywords="mHealth", keywords="prostate cancer", keywords="nomogram", abstract="Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ?7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high---92\% (27.7/30), 87\% (26.2/30), and 89\% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app's interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. ", doi="10.2196/cancer.6750", url="http://cancer.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410180" } @Article{info:doi/10.2196/humanfactors.6221, author="Rotondi, J. Armando and Spring, R. Michael and Hanusa, H. Barbara and Eack, M. Shaun and Haas, L. Gretchen", title="Designing eHealth Applications to Reduce Cognitive Effort for Persons With Severe Mental Illness: Page Complexity, Navigation Simplicity, and Comprehensibility", journal="JMIR Hum Factors", year="2017", month="Jan", day="05", volume="4", number="1", pages="e1", keywords="Internet technology", keywords="mobile application", keywords="cognitive impairment", keywords="eHealth", keywords="eHealth design", keywords="e-mental health", keywords="schizophrenia", keywords="severe mental illness", keywords="usability", keywords="website design", abstract="Background: eHealth technologies offer great potential for improving the use and effectiveness of treatments for those with severe mental illness (SMI), including schizophrenia and schizoaffective disorder. This potential can be muted by poor design. There is limited research on designing eHealth technologies for those with SMI, others with cognitive impairments, and those who are not technology savvy. We previously tested a design model, the Flat Explicit Design Model (FEDM), to create eHealth interventions for individuals with SMI. Subsequently, we developed the design concept page complexity, defined via the design variables we created of distinct topic areas, distinct navigation areas, and number of columns used to organize contents and the variables of text reading level, text reading ease (a newly added variable to the FEDM), and the number of hyperlinks and number of words on a page. Objective: The objective of our study was to report the influence that the 19 variables of the FEDM have on the ability of individuals with SMI to use a website, ratings of a website's ease of use, and performance on a novel usability task we created termed as content disclosure (a measure of the influence of a homepage's design on the understanding user's gain of a website). Finally, we assessed the performance of 3 groups or dimensions we developed that organize the 19 variables of the FEDM, termed as page complexity, navigational simplicity, and comprehensibility. Methods: We measured 4 website usability outcomes: ability to find information, time to find information, ease of use, and a user's ability to accurately judge a website's contents. A total of 38 persons with SMI (chart diagnosis of schizophrenia or schizoaffective disorder) and 5 mental health websites were used to evaluate the importance of the new design concepts, as well as the other variables in the FEDM. Results: We found that 11 of the FEDM's 19 variables were significantly associated with all 4 usability outcomes. Most other variables were significantly related to 2 or 3 of these usability outcomes. With the 5 tested websites, 7 of the 19 variables of the FEDM overlapped with other variables, resulting in 12 distinct variable groups. The 3 design dimensions had acceptable coefficient alphas. Both navigational simplicity and comprehensibility were significantly related to correctly identifying whether information was available on a website. Page complexity and navigational simplicity were significantly associated with the ability and time to find information and ease-of-use ratings. Conclusions: The 19 variables and 3 dimensions (page complexity, navigational simplicity, and comprehensibility) of the FEDM offer evidence-based design guidance intended to reduce the cognitive effort required to effectively use eHealth applications, particularly for persons with SMI, and potentially others, including those with cognitive impairments and limited skills or experience with technology. The new variables we examined (topic areas, navigational areas, columns) offer additional and very simple ways to improve simplicity. ", doi="10.2196/humanfactors.6221", url="http://humanfactors.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28057610" } @Article{info:doi/10.2196/medinform.5728, author="Lobach, F. David and Johns, B. Ellis and Halpenny, Barbara and Saunders, Toni-Ann and Brzozowski, Jane and Del Fiol, Guilherme and Berry, L. Donna and Braun, M. Ilana and Finn, Kathleen and Wolfe, Joanne and Abrahm, L. Janet and Cooley, E. Mary", title="Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention", journal="JMIR Med Inform", year="2016", month="Nov", day="08", volume="4", number="4", pages="e36", keywords="rule-based clinical decision support", keywords="clinical algorithms", keywords="Web services", keywords="software as a service", keywords="symptom management", keywords="patient-reported outcomes", keywords="lung cancer", abstract="Background: Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care. Objective: The objective of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care. Methods: This study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived from clinical practice guidelines into a rules engine that used Web services to communicate with the end-user application. Unit testing of algorithms was conducted using a stack-traversal tree-spanning methodology to identify all possible permutations of pathways through each algorithm, to validate accuracy. In Phase 3, we evaluated clinical use of the system among patients and HCPs in the two clinics via observations, structured interviews, and questionnaires. Results: In Phase 1, 13 patients and 5 HCPs engaged in two rounds of formative testing, and suggested improvements leading to revisions until overall usability scores met a priori benchmarks. In Phase 2, symptom management algorithms contained between 29 and 1425 decision nodes, resulting in 19 to 3194 unique pathways per algorithm. Unit testing required 240 person-hours, and integration testing required 40 person-hours. In Phase 3, both patients and HCPs found the system usable and acceptable, and offered suggestions for improvements. Conclusions: A rule-based CDS system for complex symptom management was systematically developed and tested. The complexity of the algorithms required extensive development and innovative testing. The Web service-based approach allowed remote access to CDS knowledge, and could enable scaling and sharing of this knowledge to accelerate availability, and reduce duplication of effort. Patients and HCPs found the system to be usable and useful. ", doi="10.2196/medinform.5728", url="http://medinform.jmir.org/2016/4/e36/", url="http://www.ncbi.nlm.nih.gov/pubmed/27826132" } @Article{info:doi/10.2196/jmir.5618, author="Bolle, Sifra and Romijn, Geke and Smets, A. Ellen M. and Loos, F. Eugene and Kunneman, Marleen and van Weert, M. Julia C.", title="Older Cancer Patients' User Experiences With Web-Based Health Information Tools: A Think-Aloud Study", journal="J Med Internet Res", year="2016", month="Jul", day="25", volume="18", number="7", pages="e208", keywords="user experience", keywords="eHealth", keywords="usability", keywords="think aloud", keywords="aging", keywords="cancer", abstract="Background: Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective: This study evaluates user experiences with existing Web-based health information tools among older (? 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods: We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results: Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions: Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients. ", doi="10.2196/jmir.5618", url="http://www.jmir.org/2016/7/e208/", url="http://www.ncbi.nlm.nih.gov/pubmed/27457709" } @Article{info:doi/10.2196/resprot.5040, author="Hattink, Bart and Droes, Rose-Marie and Sikkes, Sietske and Oostra, Ellen and Lemstra, W. Afina", title="Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers", journal="JMIR Res Protoc", year="2016", month="Jul", day="21", volume="5", number="3", pages="e144", keywords="dementia", keywords="Alzheimer disease", keywords="patient portal", keywords="electronic health record", keywords="eHealth", abstract="Background: Dementia is a progressive and highly disabling neurodegenerative disease that will likely become highly prevalent in the future due to the globally aging population. To improve health care efficiency and quality for dementia care, eHealth could help with, for example, an online portal, such as the Digital Alzheimer Center (DAC) of the Vrije Universiteit Medical Center Amsterdam. It provides up-to-date disease information, peer-to-peer contact, and methods for contacting the hospital and health professionals. Objective: We aimed to investigate the usability and usefulness of the DAC for patients with dementia and carers to get insight into the feasibility and value of this eHealth app in dementia care and to recommend potential improvements. Methods: A descriptive study among patients, carers, and health care professionals was performed. Mixed methods were used, consisting of observations (n=10, 4 people with dementia, 6 carers), an online survey (n=287; 88 patients, 199 carers), and semistructured interviews (n=18; 6 patients, 6 carers, 6 health care professionals). During the observations, participants performed a set of five different prescribed tasks on the portal. Speed, number of errors, and navigation were noted. The online survey aimed to assess users' opinions on the portal's usability and usefulness. Semistructured interviews were conducted in a subsample of patients, carers, and health care professionals to gain more in-depth information. Results: In the usability assessment, eight categories of errors were distinguished, of which three were of critical, two of medium, and three of low severity. In the survey, 45\% (40/88) of the patients and 53\% (105/199) of the carers indicated they used the portal. In all, 33\% (12/36) of patients and 61\% (62/102) of carers found it easy to learn to work with the portal. Most considered the DAC generally useful: 65\% (17/26) of patients and 78\% (67/86) of carers found the DAC useful, especially for understanding dementia (patients: 64\%, 16/25; carers: 62\%, 53/86). In the semistructured interviews, the site was generally rated positively on usability and usefulness and being well designed. People with dementia and carers indicated it helped them to understand and deal with dementia. Conclusions: To our knowledge, this is the first study investigating the usability and usefulness of an Internet portal especially designed for people with dementia and their carers. An online patient portal could be a useful means to help to support patients and carers in dealing with dementia: the majority of users positively evaluated usability and usefulness of the portal, and appreciated the information on it. However, only a minority of patients found it easy to work with the portal. Good design and frequent usability testing is essential to offer a good online portal. ", doi="10.2196/resprot.5040", url="http://www.researchprotocols.org/2016/3/e144/", url="http://www.ncbi.nlm.nih.gov/pubmed/27444209" } @Article{info:doi/10.2196/humanfactors.5820, author="Press, Anne and DeStio, Catherine and McCullagh, Lauren and Kapoor, Sandeep and Morley, Jeanne and and Conigliaro, Joseph", title="Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records", journal="JMIR Hum Factors", year="2016", month="Jul", day="08", volume="3", number="2", pages="e18", keywords="clinical decision support", keywords="adoption", keywords="primary care", keywords="usability", keywords="SBIRT", abstract="Background: Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods. Objective: The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home. Methods: Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version. Results: Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient's visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade ``1'' for the statement, ``I would like to use this system frequently'' during the first round of testing but a ``5'' during the second round of analysis. Conclusions: The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers' perceptions of the SBIRT tool and their specific clinical workflow. ", doi="10.2196/humanfactors.5820", url="http://humanfactors.jmir.org/2016/2/e18/", url="http://www.ncbi.nlm.nih.gov/pubmed/27393643" } @Article{info:doi/10.2196/mhealth.5715, author="Arvidsson, Susann and Gilljam, Britt-Mari and Nygren, Jens and Ruland, Maria Cornelia and Nordby-B{\o}e, Trude and Svedberg, Petra", title="Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer", journal="JMIR Mhealth Uhealth", year="2016", month="Jun", day="24", volume="4", number="2", pages="e76", keywords="cancer", keywords="children", keywords="communication", keywords="mobile app", keywords="participation", keywords="validation", abstract="Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a ``traditional'' conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym ``Si det som det er'' or ``Tell it how it is'') is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a ``voice'' in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children's views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. ", doi="10.2196/mhealth.5715", url="http://mhealth.jmir.org/2016/2/e76/", url="http://www.ncbi.nlm.nih.gov/pubmed/27343004" } @Article{info:doi/10.2196/resprot.5735, author="Ammerlaan, W. Judy and Mulder, K. Olga and de Boer-Nijhof, C. Nienke and Maat, Bertha and Kruize, A. Aike and van Laar, Jaap and van Os-Medendorp, Harmieke and Geenen, Rinie", title="Building a Tailored, Patient-Guided, Web-Based Self-Management Intervention `ReumaUitgedaagd!' for Adults With a Rheumatic Disease: Results of a Usability Study and Design for a Randomized Control Trail", journal="JMIR Res Protoc", year="2016", month="Jun", day="23", volume="5", number="2", pages="e113", keywords="Web-based", keywords="self-management", keywords="tailored", keywords="intervention", keywords="pilot study", keywords="randomized controlled trial", keywords="personal goal", keywords="rheumatic diseases", abstract="Background: The chronic nature of rheumatic diseases imposes daily challenges upon those affected and causes patients to make daily decisions about the way they self-manage their illness. Although there is attention to self-management and evidence for the desirability of tailored interventions to support people with a rheumatic disease, interventions based on individual needs and preferences are scarce. Objective: To provide a systematic and comprehensive description of the theoretical considerations for building a Web-based, expert, patient-guided, and tailored intervention for adult patients with a rheumatic disease. Also, to present the results of a usability study on the feasibility of this intervention, and its study design in order to measure the effectiveness. Methods: To fit the intervention closely to the autonomy, needs, and preferences of the individual patient, a research team comprising patient representatives, health professionals, Web technicians, and communication experts was formed. The research team followed the new guidance by the Medical Research Council (MRC) for developing and evaluating complex interventions as a guide for the design of the intervention. Results: Considerations from self-determination theory and a comprehensive assessment of preferences and needs in patients with a rheumatic disease guided the development of the Web-based intervention. The usability study showed that the intervention was useful, easy to use, and accepted and appreciated by the target group of patients. The planned randomized controlled trial is designed to be conducted among 120 adults with a rheumatic disease, who are assigned to the self-management intervention or a self-help control group. Both groups will be asked to formulate personal goals they want to achieve concerning their self-management. Progress toward the personal goal is the primary outcome measure of this study. Self-reported Web-based measures will be assessed before randomization at baseline, and 3 and 6 months after randomization. Also, feasibility and adherence to the Web-based self-management intervention as process outcomes will be evaluated. Conclusion: By identifying the individual goals at the beginning of the intervention and customizing the intervention to the individual patient, we aim to improve the usefulness and effectiveness of the Web-based self-management intervention. If proven effective, ReumaUitgedaagd! Online will be implemented in the Netherlands. ", doi="10.2196/resprot.5735", url="http://www.researchprotocols.org/2016/2/e113/", url="http://www.ncbi.nlm.nih.gov/pubmed/27339472" } @Article{info:doi/10.2196/humanfactors.5440, author="Williams, A. Pamela and Furberg, D. Robert and Bagwell, E. Jacqueline and LaBresh, A. Kenneth", title="Usability Testing and Adaptation of the Pediatric Cardiovascular Risk Reduction Clinical Decision Support Tool", journal="JMIR Hum Factors", year="2016", month="Jun", day="21", volume="3", number="1", pages="e17", keywords="adaptation", keywords="cardiovascular diseases", keywords="clinical decision support", keywords="decision aids", keywords="guidelines", keywords="mHealth", keywords="pediatrics", keywords="risk factors", keywords="usability", abstract="Background: Cardiovascular disease (CVD) is 1 of the leading causes of death, years of life lost, and disability-adjusted years of life lost worldwide. CVD prevention for children and teens is needed, as CVD risk factors and behaviors beginning in youth contribute to CVD development. In 2012, the National Heart, Lung, and Blood Institute released their ``Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents'' for clinicians, describing CVD risk factors they should address with patients at primary care preventative visits. However, uptake of new guidelines is slow. Clinical decision support (CDS) tools can improve guideline uptake. In this paper, we describe our process of testing and adapting a CDS tool to help clinicians evaluate patient risk, recommend behaviors to prevent development of risk, and complete complex calculations to determine appropriate interventions as recommended by the guidelines, using a user-centered design approach. Objective: The objective of the study was to assess the usability of a pediatric CVD risk factor tool by clinicians. Methods: The tool was tested using one-on-one in-person testing and a ``think aloud'' approach with 5 clinicians and by using the tool in clinical practice along with formal usability metrics with 14 pediatricians. Thematic analysis of the data from the in-person testing and clinical practice testing identified suggestions for change in 3 major areas: user experience, content refinement, and technical deployment. Descriptive statistical techniques were employed to summarize users' overall experience with the tool. Results: Data from testers showed that general reactions toward the CDS tool were positive. Clinical practice testers suggested revisions to make the application more user-friendly, especially for clinicians using the application on the iPhone, and called for refining recommendations to be more succinct and better tailored to the patient. Tester feedback was incorporated into the design when feasible, including streamlining data entry during clinical visits, reducing the volume of results displayed, and highlighting critical results. Conclusions: This study found support for the usability of our pediatric CVD risk factor tool. Insights shared about this tool may be applicable for designing other mHealth applications and CDS tools. The usability of decision support tools in clinical practice depends critically on receiving (ie, through an accessible device) and adapting the tool to meet the needs of clinicians in the practice setting. ", doi="10.2196/humanfactors.5440", url="http://humanfactors.jmir.org/2016/1/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/27328761" } @Article{info:doi/10.2196/jmir.5576, author="Staziaki, Vin{\'i}cius Pedro and Kim, Phillip and Vadvala, V. Harshna and Ghoshhajra, B. Brian", title="Medical Registry Data Collection Efficiency: A Crossover Study Comparing Web-Based Electronic Data Capture and a Standard Spreadsheet", journal="J Med Internet Res", year="2016", month="Jun", day="08", volume="18", number="6", pages="e141", keywords="electronic data capture", keywords="clinical research", keywords="translational research", keywords="registry", keywords="data management", abstract="Background: Electronic medical records and electronic data capture (EDC) have changed data collection in clinical and translational research. However, spreadsheet programs, such as Microsoft Excel, are still used as data repository to record and organize patient data for research. Objective: The objective of this study is to assess the efficiency of EDC as against a standard spreadsheet in regards to time to collect data and data accuracy, measured in number of errors after adjudication. Methods: This was a crossover study comparing the time to collect data in minutes between EDC and a spreadsheet. The EDC tool used was Research Electronic Data Capture (REDCap), whereas the spreadsheet was Microsoft Excel. The data collected was part of a registry of patients who underwent coronary computed tomography angiography in the emergency setting. Two data collectors with the same experience went over the same patients and collected relevant data on a case report form identical to the one used in our Emergency Department (ED) registry. Data collection tool was switched after the patient that represented half the cohort. For this, the patient cohort was exactly 30 days of our ED coronary Computed Tomography Angiography registry and the point of crossover was determined beforehand to be 15 days. We measured the number of patients admitted, and time to collect data. Accuracy was defined as absence of blank fields and errors, and was assessed by comparing data between data collectors and counting every time the data differed. Statistical analysis was made using paired t -test. Results: The study included 61 patients (122 observations) and 55 variables. The crossover occurred after the 30th patient. Mean time to collect data using EDC in minutes was 6.2{\textpm}2.3, whereas using Excel was 8.0{\textpm}2.0 (P <.001), a difference of 1.8 minutes between both means (22\%). The cohort was evenly distributed with 3 admissions in the first half of the crossover and 4 in the second half. We saw 2 (<0.1\%) continuous variable typos in the spreadsheet that a single data collector made. There were no blank fields. The data collection tools showed no differences in accuracy of data on comparison. Conclusions: Data collection for our registry with an EDC tool was faster than using a spreadsheet, which in turn allowed more efficient follow-up of cases. ", doi="10.2196/jmir.5576", url="http://www.jmir.org/2016/6/e141/", url="http://www.ncbi.nlm.nih.gov/pubmed/27277523" } @Article{info:doi/10.2196/jmir.5661, author="Pang, Cheong-Iao Patrick and Chang, Shanton and Verspoor, Karin and Pearce, Jon", title="Designing Health Websites Based on Users' Web-Based Information-Seeking Behaviors: A Mixed-Method Observational Study", journal="J Med Internet Res", year="2016", month="Jun", day="06", volume="18", number="6", pages="e145", keywords="consumer health information", keywords="public health informatics", keywords="exploratory behavior", keywords="hypermedia", abstract="Background: Laypeople increasingly use the Internet as a source of health information, but finding and discovering the right information remains problematic. These issues are partially due to the mismatch between the design of consumer health websites and the needs of health information seekers, particularly the lack of support for ``exploring'' health information. Objective: The aim of this research was to create a design for consumer health websites by supporting different health information--seeking behaviors. We created a website called Better Health Explorer with the new design. Through the evaluation of this new design, we derive design implications for future implementations. Methods: Better Health Explorer was designed using a user-centered approach. The design was implemented and assessed through a laboratory-based observational study. Participants tried to use Better Health Explorer and another live health website. Both websites contained the same content. A mixed-method approach was adopted to analyze multiple types of data collected in the experiment, including screen recordings, activity logs, Web browsing histories, and audiotaped interviews. Results: Overall, 31 participants took part in the observational study. Our new design showed a positive result for improving the experience of health information seeking, by providing a wide range of information and an engaging environment. The results showed better knowledge acquisition, a higher number of page reads, and more query reformulations in both focused and exploratory search tasks. In addition, participants spent more time to discover health information with our design in exploratory search tasks, indicating higher engagement with the website. Finally, we identify 4 design considerations for designing consumer health websites and health information--seeking apps: (1) providing a dynamic information scope; (2) supporting serendipity; (3) considering trust implications; and (4) enhancing interactivity. Conclusions: Better Health Explorer provides strong support for the heterogeneous and shifting behaviors of health information seekers and eases the health information--seeking process. Our findings show the importance of understanding different health information--seeking behaviors and highlight the implications for designers of consumer health websites and health information--seeking apps. ", doi="10.2196/jmir.5661", url="http://www.jmir.org/2016/6/e145/", url="http://www.ncbi.nlm.nih.gov/pubmed/27267955" } @Article{info:doi/10.2196/humanfactors.5320, author="Wipfli, Rolf and Ehrler, Frederic and Bediang, Georges and B{\'e}trancourt, Mireille and Lovis, Christian", title="How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians' Prescription Behavior: Results of a Crossover Randomized Trial", journal="JMIR Human Factors", year="2016", month="Jun", day="02", volume="3", number="1", pages="e15", keywords="medical order entry systems", keywords="clinical decision support systems", keywords="adverse drug reaction reporting systems", keywords="User-Computer Interface", keywords="eye tracking", abstract="Background: As demonstrated in several publications, low positive predictive value alerts in computerized physician order entry (CPOE) induce fatigue and may interrupt physicians unnecessarily during prescription of medication. Although it is difficult to increase the consideration of medical alerts by physician through an improvement of their predictive value, another approach consists to act on the way they are presented. The interruption management model inspired us to propose an alternative alert display strategy of regrouping the alerts in the screen layout, as a possible solution for reducing the interruption in physicians' workflow. Objective: In this study, we compared 2 CPOE designs based on a particular alert presentation strategy: one design involved regrouping the alerts in a single place on the screen, and in the other, the alerts were located next to the triggering information. Our objective was to evaluate experimentally whether the new design led to fewer interruptions in workflow and if it affected alert handling. Methods: The 2 CPOE designs were compared in a controlled crossover randomized trial. All interactions with the system and eye movements were stored for quantitative analysis. Results: The study involved a group of 22 users consisting of physicians and medical students who solved medical scenarios containing prescription tasks. Scenario completion time was shorter when the alerts were regrouped (mean 117.29 seconds, SD 36.68) than when disseminated on the screen (mean 145.58 seconds, SD 75.07; P=.045). Eye tracking revealed that physicians fixated longer on alerts in the classic design (mean 119.71 seconds, SD 76.77) than in the centralized alert design (mean 70.58 seconds, SD 33.53; P=.001). Visual switches between prescription and alert areas, indicating interruption, were reduced with centralized alerts (mean 41.29, SD 21.26) compared with the classic design (mean 57.81, SD 35.97; P=.04). Prescription behavior (ie, prescription changes after alerting), however, did not change significantly between the 2 strategies of display. The After-Scenario Questionnaire (ASQ) that was filled out after each scenario showed that overall satisfaction was significantly rated lower when alerts were regrouped (mean 4.37, SD 1.23) than when displayed next to the triggering information (mean 5.32, SD 0.94; P=.02). Conclusions: Centralization of alerts in a table might be a way to motivate physicians to manage alerts more actively, in a meaningful way, rather than just being interrupted by them. Our study could not provide clear recommendations yet, but provides objective data through a cognitive psychological approach. Future tests should work on standardized scenarios that would enable to not only measure physicians' behavior (visual fixations and handling of alerts) but also validate those actions using clinical criteria. ", doi="10.2196/humanfactors.5320", url="http://humanfactors.jmir.org/2016/1/e15/", url="http://www.ncbi.nlm.nih.gov/pubmed/27255612" } @Article{info:doi/10.2196/humanfactors.5106, author="Price, M. Margaux and Crumley-Branyon, J. Jessica and Leidheiser, R. William and Pak, Richard", title="Effects of Information Visualization on Older Adults' Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study", journal="JMIR Hum Factors", year="2016", month="Jun", day="01", volume="3", number="1", pages="e16", keywords="Information visualization", keywords="aging", keywords="health-related websites", keywords="working memory", abstract="Background: Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults' decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. Objective: The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Methods: Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Results: Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Conclusions: Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan. ", doi="10.2196/humanfactors.5106", url="http://humanfactors.jmir.org/2016/1/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/27251110" } @Article{info:doi/10.2196/resprot.4219, author="Neville, Carolyn and Da Costa, Deborah and Rochon, Murray and Peschken, A. Christine and Pineau, A. Christian and Bernatsky, Sasha and Keeling, Stephanie and Avina-Zubieta, Antonio and Lye, Elizabeth and Eng, Davy and Fortin, R. Paul", title="Development of the Lupus Interactive Navigator as an Empowering Web-Based eHealth Tool to Facilitate Lupus Management: Users Perspectives on Usability and Acceptability", journal="JMIR Res Protoc", year="2016", month="May", day="30", volume="5", number="2", pages="e44", keywords="Systemic lupus erythematosus", keywords="web-based eHealth tool", keywords="self-management", keywords="empowerment", keywords="usability", keywords="navigation", abstract="Background: Systemic Lupus Erythematosus (SLE) is a serious, complex, and chronic illness. Similar to most other chronic illness states, there is great interest in helping persons with SLE engage in their disease management. Objective: The objectives of this study were to (1) develop the Lupus Interactive Navigator (LIN), a web-based self-management program for persons with SLE, and (2) test the LIN for usability and acceptability. Methods: The LIN development platform was based on the results of preliminary comprehensive needs assessments and adapted from the Oncology Interactive Navigator, a web-based tool developed for persons with cancer. Medical researchers, writers, designers, and programmers worked with clinical experts and persons with SLE to develop content for the LIN. Usability and acceptability of the LIN was tested on individuals with SLE meeting American College of Rheumatology criteria, who were recruited from five Canadian SLE clinics. Participants were provided with access to the LIN and were asked to use it over a two-week period. Following the testing period, participants were contacted for a 30-minute telephone interview to assess usability and acceptability. Results: The content for the LIN was subdivided into six primary information topics with interview videos featuring rheumatologists, allied health professionals, and persons with SLE. Usability and acceptability of the LIN was tested on 43 females with SLE. Of these, 37 (86\%) completed telephone interviews. The average age was 43.6 (SD 15.9) years and disease duration averaged 14.1 (SD 10.8) years. Median time spent on LIN was 16.3 (interquartile range [IQR]:13.7, 53.5) minutes and median number of sessions was 2 (IQR: 1, 3). Overall, Likert ratings (0=strongly disagree; 7=strongly agree) of website usability and content were very high, with 75\% scoring >6 out of 7 on all items. All participants agreed that LIN was easy to use, would recommend it to others with SLE, and would refer to it for future questions about SLE. Very high ratings were also given to relevancy, credibility, and usefulness of the information provided. Overall, 73\% of the participants rated all topics helpful to very helpful. Participants who reported more prior knowledge about SLE rated items regarding improvement in knowledge and helpfulness relatively lower than persons with less prior knowledge. Most participants commented that the LIN would be very useful to those newly diagnosed with SLE. Minor revisions were recommended. Conclusions: This study furthers the understanding of the needs in the SLE community and delivers a unique eHealth tool to promote self-management in persons with SLE. The LIN was found to be highly acceptable in content and usability. The information provided on LIN may be most helpful for individuals with less experience with the disease, such as those newly diagnosed, indicating the need to tailor the content for persons with more SLE experience. ", doi="10.2196/resprot.4219", url="http://www.researchprotocols.org/2016/2/e44/", url="http://www.ncbi.nlm.nih.gov/pubmed/27240666" } @Article{info:doi/10.2196/medinform.4756, author="Thilakanathan, Danan and Calvo, A. Rafael and Chen, Shiping and Nepal, Surya and Glozier, Nick", title="Facilitating Secure Sharing of Personal Health Data in the Cloud", journal="JMIR Med Inform", year="2016", month="May", day="27", volume="4", number="2", pages="e15", keywords="self care", keywords="telemedicine", keywords="privacy", keywords="computer security", keywords="information dissemination", abstract="Background: Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective: This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods: We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results: We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70\%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions: We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. ", doi="10.2196/medinform.4756", url="http://medinform.jmir.org/2016/2/e15/", url="http://www.ncbi.nlm.nih.gov/pubmed/27234691" } @Article{info:doi/10.2196/games.5687, author="LeGrand, Sara and Muessig, Elizabeth Kathryn and McNulty, Tobias and Soni, Karina and Knudtson, Kelly and Lemann, Alex and Nwoko, Nkechinyere and Hightow-Weidman, B. Lisa", title="Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men", journal="JMIR Serious Games", year="2016", month="May", day="13", volume="4", number="1", pages="e6", keywords="mobile applications", keywords="video games", keywords="serious games", keywords="HIV", keywords="medication adherence", keywords="health knowledge, attitudes, practice", keywords="youth", keywords="men who have sex with men", abstract="Background: In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM. Objective: This study used a multiphase, iterative development process to create an ART adherence app for YMSM. Methods: The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population's ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype. Results: The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably. Conclusions: An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM. ", doi="10.2196/games.5687", url="http://games.jmir.org/2016/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/27178752" } @Article{info:doi/10.2196/humanfactors.5177, author="Nelson, A. Lyndsay and Bethune, C. Magaela and Lagotte, E. Andrea and Osborn, Y. Chandra", title="The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence", journal="JMIR Human Factors", year="2016", month="May", day="12", volume="3", number="1", pages="e13", keywords="Website", keywords="Usability Testing", keywords="Type 2 Diabetes Mellitus", keywords="Medication Adherence", keywords="Intervention", abstract="Background: Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website's benefits can identify barriers to user engagement and maximize future use. Objective: We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial. Methods: We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants' favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP. Results: Enrolled participants (N=32) were an average of 51.7 {\textpm} 11.8 years old, 66\% (21/32) female, 60\% (19/32) non-Hispanic White, 88\% (28/32) had more than 12 years of education, half had household incomes over \$50,000, and 78\% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 {\textpm} 6.3 years, average A1c was 7.4 {\textpm} 2.0, and 38\% (12/32) were prescribed insulin. Of enrolled participants, 91\% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an unspecified format). Participants also reported difficulty accessing the site and, once accessed, using all of its features. Participants recommended improving the site's user interface to facilitate quick, efficient access to all features and content. Conclusions: Adults with T2DM rated the Diabetes MAP website favorably on surveys, but focus groups gave more in-depth feedback on the user experience (eg, difficulty accessing the site, maximizing all of the site's features and content, and recovering from errors). Appropriate usability testing methods ensure Web-delivered interventions work as intended and any benefits are not diminished by usability challenges. ", doi="10.2196/humanfactors.5177", url="http://humanfactors.jmir.org/2016/1/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/27174496" } @Article{info:doi/10.2196/humanfactors.4800, author="Barbara, M. Angela and Dobbins, Maureen and Haynes, Brian R. and Iorio, Alfonso and Lavis, N. John and Raina, Parminder and Levinson, J. Anthony", title="The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website", journal="JMIR Human Factors", year="2016", month="May", day="11", volume="3", number="1", pages="e14", keywords="online health information", keywords="health informatics", keywords="elderly", keywords="consumer health information", keywords="qualitative research", keywords="usability testing", keywords="Internet", keywords="evidence-based medicine", keywords="knowledge translation", keywords="aging", keywords="website", abstract="Background: Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Objective: Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Methods: Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. Results: A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal's strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. Conclusions: The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites. ", doi="10.2196/humanfactors.4800", url="http://humanfactors.jmir.org/2016/1/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/27170443" } @Article{info:doi/10.2196/mhealth.4546, author="Choo, Seryung and Kim, Young Ju and Jung, Young Se and Kim, Sarah and Kim, Eun Jeong and Han, Soo Jong and Kim, Sohye and Kim, Hyun Jeong and Kim, Jeehye and Kim, Yongseok and Kim, Dongouk and Steinhubl, Steve", title="Development of a Weight Loss Mobile App Linked With an Accelerometer for Use in the Clinic: Usability, Acceptability, and Early Testing of its Impact on the Patient-Doctor Relationship", journal="JMIR mHealth uHealth", year="2016", month="Mar", day="31", volume="4", number="1", pages="e24", keywords="mobile apps", keywords="electronic health record", keywords="weight reduction programs", keywords="physician-patient relations", abstract="Background: Although complications of obesity are well acknowledged and managed by clinicians, management of obesity itself is often difficult, which leads to its underdiagnosis and undertreatment in hospital settings. However, tools that could improve the management of obesity, including self-monitoring, engagement with a social network, and open channels of communication between the patient and doctor, are limited in a clinic-based setting. Objective: The objective of our study was to evaluate the usability and acceptability of a newly developed mobile app linked with an accelerometer and its early effects on patient-doctor relationships. Methods: From September 2013 to February 2014, we developed a mobile app linked with an accelerometer as a supportive tool for a clinic-based weight loss program. The app used information from electronic health records and delivered tailored educational material. Personal goal setting, as well as monitoring of weight changes and physical activity combined with feedback, are key features of the app. We also incorporated an interactive message board for patients and doctors. During the period of March 2014 to May 2014, we tested our mobile app for 1 month in participants in a hospital clinic setting. We assessed the app's usability and acceptability, as well as the patient-doctor relationship, via questionnaires and analysis of app usage data. Results: We recruited 30 individuals (18 male and 12 female) for the study. The median number of log-ins per day was 1.21, with the most frequently requested item being setting goals, followed by track physical activities and view personal health status. Scales of the depth of the patient-doctor relationship decreased from 27.6 (SD 4.8) to 25.1 (SD 4.5) by a Wilcoxon signed rank test (P=.02). Conclusions: A mobile phone app linked with an accelerometer for a clinic-based weight loss program is useful and acceptable for weight management but exhibited less favorable early effects on patient-doctor relationships. ", doi="10.2196/mhealth.4546", url="http://mhealth.jmir.org/2016/1/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/27032541" } @Article{info:doi/10.2196/humanfactors.4996, author="Kurahashi, M. Allison and Weinstein, B. Peter and Jamieson, Trevor and Stinson, N. Jennifer and Cafazzo, A. Joseph and Lokuge, Bhadra and Morita, P. Plinio and Cohen, Eyal and Rapoport, Adam and Bezjak, Andrea and Husain, Amna", title="In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System", journal="JMIR Human Factors", year="2016", month="Mar", day="24", volume="3", number="1", pages="e12", keywords="collaborative care", keywords="patient-centered care", keywords="patient engagement", keywords="chronic disease", keywords="communication", keywords="Internet communication tools", keywords="Internet communication technologies", abstract="Background: We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space. Objective: The objectives of this paper are to present the iterative design of the separate views for health care providers (HCPs) within each patient's secure space and examine patients', caregivers', and HCPs' perspectives on this separate view for HCP-only communication. Methods: The overall research program includes cycles of ethnography, prototyping, usability testing, and pilot testing. This paper describes the usability testing phase that directly informed development. A descriptive qualitative approach was used to analyze participant perspectives that emerged during usability testing. Results: During usability testing, we sampled 89 participants from three user groups: 23 patients, 19 caregivers, and 47 HCPs. Almost all perspectives from the three user groups supported the need for an HCP-only communication view. In an earlier prototype, the visual presentation caused confusion among HCPs when reading and composing messages about whether a message was visible to the patient. Usability testing guided us to design a more deliberate distinction between posting in the Patient and Team view and the Health Care Provider Only view at the time of composing a message, which once posted is distinguished by an icon. Conclusions: The team made a decision to incorporate an HCP-only communication view based on findings during earlier phases of work. During usability testing we tested the separate communication views, and all groups supported this partition. We spent considerable effort designing the partition; however, preliminary findings from the next phase of evaluation, pilot testing, show that the Patient and Team communication is predominantly being used. This demonstrates the importance of a subsequent phase of the clinical trial of Loop to validate the concept and design. ", doi="10.2196/humanfactors.4996", url="http://humanfactors.jmir.org/2016/1/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025912" } @Article{info:doi/10.2196/humanfactors.4896, author="Boudreaux, D. Edwin and Fischer, Christopher Andrew and Haskins, Lyn Brianna and Saeed Zafar, Zubair and Chen, Guanling and Chinai, A. Sneha", title="Implementation of a Computerized Screening Inventory: Improved Usability Through Iterative Testing and Modification", journal="JMIR Human Factors", year="2016", month="Mar", day="09", volume="3", number="1", pages="e10", keywords="behavioral medicine", keywords="computers", keywords="electronic health records", keywords="public health", keywords="screening", keywords="telemedicine", abstract="Background: The administration of health screeners in a hospital setting has traditionally required (1) clinicians to ask questions and log answers, which can be time consuming and susceptible to error, or (2) patients to complete paper-and-pencil surveys, which require third-party entry of information into the electronic health record and can be vulnerable to error and misinterpretation. A highly promising method that avoids these limitations and bypasses third-party interpretation is direct entry via a computerized inventory. Objective: To (1) computerize medical and behavioral health screening for use in general medical settings, (2) optimize patient acceptability and feasibility through iterative usability testing and modification cycles, and (3) examine how age relates to usability. Methods: A computerized version of 15 screeners, including behavioral health screeners recommended by a National Institutes of Health Office of Behavioral and Social Sciences Research collaborative workgroup, was subjected to systematic usability testing and iterative modification. Consecutive adult, English-speaking patients seeking treatment in an urban emergency department were enrolled. Acceptability was defined as (1) the percentage of eligible patients who agreed to take the assessment (initiation rate) and (2) average satisfaction with the assessment (satisfaction rate). Feasibility was defined as the percentage of the screening items completed by those who initiated the assessment (completion rate). Chi-square tests, analyses of variance, and Pearson correlations were used to detect whether improvements in initiation, satisfaction, and completion rates were seen over time and to examine the relation between age and outcomes. Results: Of 2157 eligible patients approached, 1280 agreed to complete the screening (initiation rate=59.34\%). Statistically significant increases were observed over time in satisfaction (F3,1061=3.35, P=.019) and completion rates (F3,1276=25.44, P<.001). Younger age was associated with greater initiation (initiated, mean [SD], 46.6 [18.7] years; declined: 53.0 [19.5] years, t2,155=?7.6, P<.001), higher completion (r=?.20, P<.001), and stronger satisfaction (r=?.23, P<.001). Conclusions: In a rapid-paced emergency department with a heterogeneous patient population, 59.34\% (1280/2157) of all eligible patients initiated the computerized screener with a completion rate reaching over 90\%. Usability testing revealed several critical principles for maximizing usability of the computerized medical and behavioral health screeners used in this study. Further work is needed to identify usability issues pertaining to other screeners, racially and ethnically diverse patient groups, and different health care settings. ", doi="10.2196/humanfactors.4896", url="http://humanfactors.jmir.org/2016/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025766" } @Article{info:doi/10.2196/humanfactors.4601, author="Clarke, A. Martina and Belden, L. Jeffery and Kim, Soon Min", title="How Does Learnability of Primary Care Resident Physicians Increase After Seven Months of Using an Electronic Health Record? A Longitudinal Study", journal="JMIR Human Factors", year="2016", month="Feb", day="15", volume="3", number="1", pages="e9", keywords="primary care, physicians, usability, electronic health records, computerized physician order entry, user-computer interface", abstract="Background: Electronic health records (EHRs) with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error-prone use of EHRs in medical practice by new resident physicians. Objective: The study goal was to determine learnability gaps between expert and novice primary care resident physician groups by comparing performance measures when using EHRs. Methods: We compared performance measures after two rounds of learnability tests (November 12, 2013 to December 19, 2013; February 12, 2014 to April 22, 2014). In Rounds 1 and 2, 10 novice and 6 expert physicians, and 8 novice and 4 expert physicians participated, respectively. Laboratory-based learnability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed 19 tasks, using a think-aloud strategy, based on an artificial but typical patient visit note. We used quantitative performance measures (percent task success, time-on-task, mouse activities), a system usability scale (SUS), and qualitative narrative feedback during the participant debriefing session. Results: There was a 6-percentage-point increase in novice physicians' task success rate (Round 1: 92\%, 95\% CI 87-99; Round 2: 98\%, 95\% CI 95-100) and a 7-percentage-point increase in expert physicians' task success rate (Round 1: 90\%, 95\% CI 83-97; Round 2: 97\%, 95\% CI 93-100); a 10\% decrease in novice physicians' time-on-task (Round 1: 44s, 95\% CI 32-62; Round 2: 40s, 95\% CI 27-59) and 21\% decrease in expert physicians' time-on-task (Round 1: 39s, 95\% CI 29-51; Round 2: 31s, 95\% CI 22-42); a 20\% decrease in novice physicians mouse clicks (Round 1: 8 clicks, 95\% CI 6-13; Round 2: 7 clicks, 95\% CI 4-12) and 39\% decrease in expert physicians' mouse clicks (Round 1: 8 clicks, 95\% CI 5-11; Round 2: 3 clicks, 95\% CI 1-10); a 14\% increase in novice mouse movements (Round 1: 9247 pixels, 95\% CI 6404-13,353; Round 2: 7991 pixels, 95\% CI 5350-11,936) and 14\% decrease in expert physicians' mouse movements (Round 1: 7325 pixels, 95\% CI 5237-10,247; Round 2: 6329 pixels, 95\% CI 4299-9317). The SUS measure of overall usability demonstrated only minimal change in the novice group (Round 1: 69, high marginal; Round 2: 68, high marginal) and no change in the expert group (74; high marginal for both rounds). Conclusions: This study found differences in novice and expert physicians' performance, demonstrating that physicians' proficiency increased with EHR experience. Our study may serve as a guideline to improve current EHR training programs. Future directions include identifying usability issues faced by physicians when using EHRs, through a more granular task analysis to recognize subtle usability issues that would otherwise be overlooked. ", doi="10.2196/humanfactors.4601", url="http://humanfactors.jmir.org/2016/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025237" } @Article{info:doi/10.2196/mhealth.5167, author="English, Lacey Lauren and Dunsmuir, Dustin and Kumbakumba, Elias and Ansermino, Mark John and Larson, P. Charles and Lester, Richard and Barigye, Celestine and Ndamira, Andrew and Kabakyenga, Jerome and Wiens, O. Matthew", title="The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda", journal="JMIR mHealth uHealth", year="2016", month="Feb", day="15", volume="4", number="1", pages="e16", keywords="infectious disease", keywords="postdischarge mortality", keywords="mHealth", keywords="prediction model", keywords="risk assessment", keywords="usability", keywords="Africa", keywords="resource-limited settings", abstract="Background: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation. Objective: Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool. Methods: Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children's Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient's risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements. Results: The average time to complete the PARA app decreased by 30\% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen saturation interface, but modifications following Phase 1 cut this time by half. The average time-to-completion (during Phase 2) for doctors/medical students was 3 minutes 56 seconds. All participants agreed they would use the PARA app if available at their health facility. Given a high PARA risk score, participants suggested several interventions that would be appropriate for the sociocultural context in southwestern Uganda, which involved strengthening discharge and referral procedures within the current health care system. Conclusions: Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly app, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. Doctors and medical students had shorter task completion times, though all participants reported the usefulness of this tool to improve postdischarge outcomes. ", doi="10.2196/mhealth.5167", url="http://mhealth.jmir.org/2016/1/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/26879041" } @Article{info:doi/10.2196/jmir.4912, author="Jay, Caroline and Harper, Simon and Dunlop, Ian and Smith, Sam and Sufi, Shoaib and Goble, Carole and Buchan, Iain", title="Natural Language Search Interfaces: Health Data Needs Single-Field Variable Search", journal="J Med Internet Res", year="2016", month="Jan", day="14", volume="18", number="1", pages="e13", keywords="searching behavior", keywords="search engine", keywords="research data archives", keywords="user-computer interface", abstract="Background: Data discovery, particularly the discovery of key variables and their inter-relationships, is key to secondary data analysis, and in-turn, the evolving field of data science. Interface designers have presumed that their users are domain experts, and so they have provided complex interfaces to support these ``experts.'' Such interfaces hark back to a time when searches needed to be accurate first time as there was a high computational cost associated with each search. Our work is part of a governmental research initiative between the medical and social research funding bodies to improve the use of social data in medical research. Objective: The cross-disciplinary nature of data science can make no assumptions regarding the domain expertise of a particular scientist, whose interests may intersect multiple domains. Here we consider the common requirement for scientists to seek archived data for secondary analysis. This has more in common with search needs of the ``Google generation'' than with their single-domain, single-tool forebears. Our study compares a Google-like interface with traditional ways of searching for noncomplex health data in a data archive. Methods: Two user interfaces are evaluated for the same set of tasks in extracting data from surveys stored in the UK Data Archive (UKDA). One interface, Web search, is ``Google-like,'' enabling users to browse, search for, and view metadata about study variables, whereas the other, traditional search, has standard multioption user interface. Results: Using a comprehensive set of tasks with 20 volunteers, we found that the Web search interface met data discovery needs and expectations better than the traditional search. A task {\texttimes} interface repeated measures analysis showed a main effect indicating that answers found through the Web search interface were more likely to be correct (F1,19=37.3, P<.001), with a main effect of task (F3,57=6.3, P<.001). Further, participants completed the task significantly faster using the Web search interface (F1,19=18.0, P<.001). There was also a main effect of task (F2,38=4.1, P=.025, Greenhouse-Geisser correction applied). Overall, participants were asked to rate learnability, ease of use, and satisfaction. Paired mean comparisons showed that the Web search interface received significantly higher ratings than the traditional search interface for learnability (P=.002, 95\% CI [0.6-2.4]), ease of use (P<.001, 95\% CI [1.2-3.2]), and satisfaction (P<.001, 95\% CI [1.8-3.5]). The results show superior cross-domain usability of Web search, which is consistent with its general familiarity and with enabling queries to be refined as the search proceeds, which treats serendipity as part of the refinement. Conclusions: The results provide clear evidence that data science should adopt single-field natural language search interfaces for variable search supporting in particular: query reformulation; data browsing; faceted search; surrogates; relevance feedback; summarization, analytics, and visual presentation. ", doi="10.2196/jmir.4912", url="http://www.jmir.org/2016/1/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/26769334" } @Article{info:doi/10.2196/humanfactors.4853, author="Gustafson Jr, H. David and Maus, Adam and Judkins, Julianne and Dinauer, Susan and Isham, Andrew and Johnson, Roberta and Landucci, Gina and Atwood, K. Amy", title="Using the NIATx Model to Implement User-Centered Design of Technology for Older Adults", journal="JMIR Human Factors", year="2016", month="Jan", day="14", volume="3", number="1", pages="e2", keywords="eHealth", keywords="user-centered design", keywords="technology", keywords="aging in place", keywords="independent living", keywords="consumer participation", keywords="accessibility", doi="10.2196/humanfactors.4853", url="http://humanfactors.jmir.org/2016/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025985" } @Article{info:doi/10.2196/jmir.4281, author="Jing, Xia and Cimino, J. James and Del Fiol, Guilherme", title="Usability and Acceptance of the Librarian Infobutton Tailoring Environment: An Open Access Online Knowledge Capture, Management, and Configuration Tool for OpenInfobutton", journal="J Med Internet Res", year="2015", month="Nov", day="30", volume="17", number="11", pages="e272", keywords="clinical decision support systems/instrumentation", keywords="evaluation studies as topic", keywords="knowledge management tool", keywords="The Librarian Infobutton Tailoring Environment", abstract="Background: The Librarian Infobutton Tailoring Environment (LITE) is a Web-based knowledge capture, management, and configuration tool with which users can build profiles used by OpenInfobutton, an open source infobutton manager, to provide electronic health record users with context-relevant links to online knowledge resources. Objective: We conducted a multipart evaluation study to explore users' attitudes and acceptance of LITE and to guide future development. Methods: The evaluation consisted of an initial online survey to all LITE users, followed by an observational study of a subset of users in which evaluators' sessions were recorded while they conducted assigned tasks. The observational study was followed by administration of a modified System Usability Scale (SUS) survey. Results: Fourteen users responded to the survey and indicated good acceptance of LITE with feedback that was mostly positive. Six users participated in the observational study, demonstrating average task completion time of less than 6 minutes and an average SUS score of 72, which is considered good compared with other SUS scores. Conclusions: LITE can be used to fulfill its designated tasks quickly and successfully. Evaluators proposed suggestions for improvements in LITE functionality and user interface. ", doi="10.2196/jmir.4281", url="http://www.jmir.org/2015/11/e272/", url="http://www.ncbi.nlm.nih.gov/pubmed/26621250" } @Article{info:doi/10.2196/jmir.4999, author="Rowsell, Alison and Muller, Ingrid and Murray, Elizabeth and Little, Paul and Byrne, D. Christopher and Ganahl, Kristin and M{\"u}ller, Gabriele and Gibney, Sarah and Lyles, R. Courtney and Lucas, Antonia and Nutbeam, Don and Yardley, Lucy", title="Views of People With High and Low Levels of Health Literacy About a Digital Intervention to Promote Physical Activity for Diabetes: A Qualitative Study in Five Countries", journal="J Med Internet Res", year="2015", month="Oct", day="12", volume="17", number="10", pages="e230", keywords="health literacy, digital intervention, diabetes, qualitative, physical activity", abstract="Background: Low health literacy is associated with poor health-related knowledge, illness self-management, health service use, health, and survival, and thus addressing issues related to low health literacy has been highlighted as a pressing international priority. Objective: To explore views of a digital health promotion intervention designed to be accessible to people with lower levels of health literacy, in particular examining reactions to the interactive and audiovisual elements of the intervention. Methods: Qualitative think-aloud interviews were carried out with 65 adults with type 2 diabetes in the UK, Ireland, USA, Germany, and Austria, with purposive sampling to ensure representation of people with lower levels of health literacy. Inductive thematic analysis was used to identify common themes. We then systematically compared views in subgroups based on country, health literacy level, age, gender, and time since diagnosis. Results: Most participants from the chosen countries expressed positive views of most elements and features of the intervention. Some interactive and audiovisual elements required modification to increase their usability and perceived credibility and relevance. There were some differences in views based on age and gender, but very few differences relating to health literacy level or time since diagnosis. Conclusions: In general, participants found the intervention content and format accessible, appropriate, engaging, and motivating. Digital interventions can and should be designed to be accessible and engaging for people with a wide range of health literacy levels. ", doi="10.2196/jmir.4999", url="http://www.jmir.org/2015/10/e230/", url="http://www.ncbi.nlm.nih.gov/pubmed/26459743" } @Article{info:doi/10.2196/humanfactors.4570, author="Kortum, Philip and Peres, Camille S.", title="Evaluation of Home Health Care Devices: Remote Usability Assessment", journal="JMIR Human Factors", year="2015", month="Jun", day="05", volume="2", number="1", pages="e10", keywords="health care evaluation mechanisms", keywords="human-computer interaction design and evaluation methods", keywords="patient satisfaction", keywords="usability testing", abstract="Background: An increasing amount of health care is now performed in a home setting, away from the hospital. While there is growing anecdotal evidence about the difficulty patients and caregivers have using increasingly complex health care devices in the home, there has been little systematic scientific study to quantify the global nature of home health care device usability in the field. Research has tended to focus on a handful of devices, making it difficult to gain a broad view of the usability of home-care devices in general. Objective: The objective of this paper is to describe a remote usability assessment method using the System Usability Scale (SUS), and to report on the usability of a broad range of health care devices using this metric. Methods: A total of 271 participants selected and rated up to 10 home health care devices of their choice using the SUS, which scores usability from 0 (unusable) to 100 (highly usable). Participants rated a total of 455 devices in their own home without an experimenter present. Results: Usability scores ranged from 98 (oxygen masks) to 59 (home hormone test kits). An analysis conducted on devices that had at least 10 ratings showed that the effect of device on SUS scores was significant (P<.001), and that the usability of these devices was on the low end when compared with other commonly used items in the home, such as microwave ovens and telephones. Conclusions: A large database of usability scores for home health care devices collected using this remote methodology would be beneficial for physicians, patients, and their caregivers. ", doi="10.2196/humanfactors.4570", url="http://humanfactors.jmir.org/2015/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025664" } @Article{info:doi/10.2196/humanfactors.3696, author="Kayser, Lars and Kushniruk, Andre and Osborne, H. Richard and Norgaard, Ole and Turner, Paul", title="Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs", journal="JMIR Human Factors", year="2015", month="May", day="20", volume="2", number="1", pages="e9", keywords="eHealth literacy", keywords="requirements", keywords="user involvement", abstract="Background: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. Objective: The objective of this paper is to propose how users' needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. Methods: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users' competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. Results: The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users' needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Conclusions: Developing effective eHealth products requires complete understanding of the end-users' needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users' needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems. ", doi="10.2196/humanfactors.3696", url="http://humanfactors.jmir.org/2015/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025228" } @Article{info:doi/10.2196/humanfactors.4125, author="Payne, YM Ada and Surikova, Jelena and Liu, Sam and Ross, Heather and Mechetiuc, Teodora and Nolan, P. Robert", title="Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure", journal="JMIR Human Factors", year="2015", month="May", day="08", volume="2", number="1", pages="e7", keywords="chronic heart failure", keywords="self-care behaviors", keywords="e-counseling", keywords="usability assessment", abstract="Background: Chronic heart failure (CHF) is a major cause of hospitalization and mortality. In order to maintain heart function and quality of life, patients with CHF need to follow recommended self-care guidelines (ie, eating a heart healthy diet, exercising regularly, taking medications as prescribed, monitoring their symptoms, and living a smoke-free life). Yet, adherence to self-care is poor. We have developed an Internet-based e-Counseling platform, Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT), that aims to improve self-care adherence and quality of life in people with CHF. Before assessing the efficacy of this e-platform in a multisite, double-blind, randomized controlled trial, we evaluated the usability of the prototype website. Objective: The objective of the study was to assess the usability of the CHF-CePPORT e-Counseling platform in terms of navigation, content, and layout. Methods: CHF patients were purposively sampled from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network, to participate in this study. We asked the consented participants to perform specific tasks on the website. These tasks included watching self-help videos and reviewing content as directed. Their interactions with the website were captured using the ``think aloud'' protocol. After completing the tasks, research personnel conducted a semi-structured interview with each participant to assess their experience with the website. Content analysis of the transcripts from the ``think aloud'' sessions and the interviews was conducted to identify themes related to navigation, content, and layout of the website. Descriptive statistics were used to summarize the satisfaction data. Results: A total of 7 men and women (ages 39-77) participated in 2 iterative rounds of testing. Overall, all participants were very satisfied with the content and layout of the website. They reported that the content was helpful to their management of CHF and that it reflected their experiences in coping with CHF. The layout was professional and friendly. The use of videos made the learning process entertaining. However, they experienced many navigation errors in the first round of testing. For example, some participants were not sure how to navigate across a series of Web pages. Based on the experiences that were reported in the first round, we made several changes to the navigation structure. This included using large navigation buttons to direct users to each section and providing tutorial videos to familiarize users with our website. We assessed whether these changes improved user navigation in the second round of testing. The major finding is that participants made fewer navigation errors and they did not identify any new problems. Conclusions: We found evidence to support the usability of our CHF-CePPORT e-Counseling platform. Our findings highlight the importance of a clear and easy-to-follow navigation structure on user experience. ", doi="10.2196/humanfactors.4125", url="http://humanfactors.jmir.org/2015/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/27026267" } @Article{info:doi/10.2196/humanfactors.3787, author="Hong, Yan and Goldberg, Daniel and Dahlke, Vollmer Deborah and Ory, G. Marcia and Cargill, S. Jessica and Coughlin, Rachel and Hernandez, Edgar and Kellstedt, K. Debra and Peres, Camille S.", title="Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults", journal="JMIR Human Factors", year="2014", month="Oct", day="13", volume="1", number="1", pages="e2", keywords="physical activity", keywords="mobile health, older adults", keywords="usability testing", keywords="user experience", abstract="Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants' comments were addressed to improve the site's senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56\% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users' experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway. ", doi="10.2196/humanfactors.3787", url="http://humanfactors.jmir.org/2014/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/27025254" } @Article{info:doi/10.2196/jmir.3195, author="Vermeulen, Joan and Verwey, Ren{\'e}e and Hochstenbach, MJ Laura and van der Weegen, Sanne and Man, Ping Yan and de Witte, P. Luc", title="Experiences of Multidisciplinary Development Team Members During User-Centered Design of Telecare Products and Services: A Qualitative Study", journal="J Med Internet Res", year="2014", month="May", day="19", volume="16", number="5", pages="e124", keywords="user-centered design", keywords="telecare", keywords="eHealth", keywords="participation", keywords="multidisciplinary team", keywords="barriers and facilitators", abstract="Background: User-centered design (UCD) methodologies can help take the needs and requirements of potential end-users into account during the development of innovative telecare products and services. Understanding how members of multidisciplinary development teams experience the UCD process might help to gain insight into factors that members with different backgrounds consider critical during the development of telecare products and services. Objective: The primary objective of this study was to explore how members of multidisciplinary development teams experienced the UCD process of telecare products and services. The secondary objective was to identify differences and similarities in the barriers and facilitators they experienced. Methods: Twenty-five members of multidisciplinary development teams of four Research and Development (R\&D) projects participated in this study. The R\&D projects aimed to develop telecare products and services that can support self-management in elderly people or patients with chronic conditions. Seven participants were representatives of end-users (elderly persons or patients with chronic conditions), three were professional end-users (geriatrician and nurses), five were engineers, four were managers (of R\&D companies or engineering teams), and six were researchers. All participants were interviewed by a researcher who was not part of their own development team. The following topics were discussed during the interviews: (1) aim of the project, (2) role of the participant, (3) experiences during the development process, (4) points of improvement, and (5) what the project meant to the participant. Results: Experiences of participants related to the following themes: (1) creating a development team, (2) expectations regarding responsibilities and roles, (3) translating user requirements into technical requirements, (4) technical challenges, (5) evaluation of developed products and services, and (6) valorization. Multidisciplinary team members from different backgrounds often reported similar experienced barriers (eg, different members of the development team speak a ``different language'') and facilitators (eg, team members should voice expectations at the start of the project to prevent miscommunication at a later stage). However, some experienced barriers and facilitators were reported only by certain groups of participants. For example, only managers reported the experience that having different ideas about what a good business case is within one development team was a barrier, whereas only end-users emphasized the facilitating role of project management in end-user participation and the importance of continuous feedback from researchers on input of end-users. Conclusions: Many similarities seem to exist between the experienced barriers and facilitators of members of multidisciplinary development teams during UCD of telecare products and services. However, differences in experiences between team members from various backgrounds exist as well. Insights into these similarities and differences can improve understanding between team members from different backgrounds, which can optimize collaboration during the development of telecare products and services. ", doi="10.2196/jmir.3195", url="http://www.jmir.org/2014/5/e124/", url="http://www.ncbi.nlm.nih.gov/pubmed/24840245" } @Article{info:doi/10.2196/jmir.2968, author="Arnhold, Madlen and Quade, Mandy and Kirch, Wilhelm", title="Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older", journal="J Med Internet Res", year="2014", month="Apr", day="09", volume="16", number="4", pages="e104", keywords="mobile applications", keywords="apps", keywords="mobile health", keywords="mHealth", keywords="diabetes mellitus", keywords="market analysis", keywords="systematic review", keywords="elderly", keywords="usability test", keywords="expert review", abstract="Background: A multitude of mhealth (mobile health) apps have been developed in recent years to support effective self-management of patients with diabetes mellitus type 1 or 2. Objective: We carried out a systematic review of all currently available diabetes apps for the operating systems iOS and Android. We considered the number of newly released diabetes apps, range of functions, target user groups, languages, acquisition costs, user ratings, available interfaces, and the connection between acquisition costs and user ratings. Additionally, we examined whether the available applications serve the special needs of diabetes patients aged 50 or older by performing an expert-based usability evaluation. Methods: We identified relevant keywords, comparative categories, and their specifications. Subsequently, we performed the app review based on the information given in the Google Play Store, the Apple App Store, and the apps themselves. In addition, we carried out an expert-based usability evaluation based on a representative 10\% sample of diabetes apps. Results: In total, we analyzed 656 apps finding that 355 (54.1\%) offered just one function and 348 (53.0\%) provided a documentation function. The dominating app language was English (85.4\%, 560/656), patients represented the main user group (96.0\%, 630/656), and the analysis of the costs revealed a trend toward free apps (53.7\%, 352/656). The median price of paid apps was {\texteuro}1.90. The average user rating was 3.6 stars (maximum 5). Our analyses indicated no clear differences in the user rating between free and paid apps. Only 30 (4.6\%) of the 656 available diabetes apps offered an interface to a measurement device.We evaluated 66 apps within the usability evaluation. On average, apps were rated best regarding the criterion ``comprehensibility'' (4.0 out of 5.0), while showing a lack of ``fault tolerance'' (2.8 out of 5.0). Of the 66 apps, 48 (72.7\%) offered the ability to read the screen content aloud. The number of functions was significantly negative correlated with usability. The presence of documentation and analysis functions reduced the usability score significantly by 0.36 and 0.21 points. Conclusions: A vast number of diabetes apps already exist, but the majority offer similar functionalities and combine only one to two functions in one app. Patients and physicians alike should be involved in the app development process to a greater extent. We expect that the data transmission of health parameters to physicians will gain more importance in future applications.The usability of diabetes apps for patients aged 50 or older was moderate to good. But this result applied mainly to apps offering a small range of functions. Multifunctional apps performed considerably worse in terms of usability. Moreover, the presence of a documentation or analysis function resulted in significantly lower usability scores. The operability of accessibility features for diabetes apps was quite limited, except for the feature ``screen reader''. ", doi="10.2196/jmir.2968", url="http://www.jmir.org/2014/4/e104/", url="http://www.ncbi.nlm.nih.gov/pubmed/24718852" } @Article{info:doi/10.2196/jmir.2617, author="Spook, Eline Jorinde and Paulussen, Theo and Kok, Gerjo and Van Empelen, Pepijn", title="Monitoring Dietary Intake and Physical Activity Electronically: Feasibility, Usability, and Ecological Validity of a Mobile-Based Ecological Momentary Assessment Tool", journal="J Med Internet Res", year="2013", month="Sep", day="24", volume="15", number="9", pages="e214", keywords="mobile-based Ecological Momentary Assessment (mEMA)", keywords="feasibility", keywords="usability", keywords="ecological validity", keywords="dietary intake", keywords="physical activity", abstract="Background: Despite the growing body of research on complex lifestyle behaviors (eg, Dietary Intake [DI] and Physical Activity [PA]), monitoring of these behaviors has been hampered by a lack of suitable methods. A possible solution to this deficiency is mobile-based Ecological Momentary Assessment (mEMA), which enables researchers to collect data on participants' states in real-time by means of a smartphone application. However, feasibility, usability, and ecological validity need to be anticipated and managed in order to enhance the validity of mEMA. Objective: To examine the feasibility, usability, and ecological validity of a mEMA application (app) with regard to DI and PA among Dutch vocational education students. Methods: The students (n=30) participated in the mEMA study for seven consecutive days. They downloaded the mEMA app on their smartphone. Feasibility and usability of the mEMA app were evaluated by completing an online evaluation after seven days of participation. Ecological validity was measured by assessing the degree to which the content of the mEMA app approximated the real-world setting that was being examined, through several multiple-choice questions. Results: Compliance rates, as registered by the mEMA app, declined 46\% over a seven-day period, while self-reported compliance, as measured with an online evaluation questionnaire afterwards, indicated a smaller decrease in compliance (29\%). The students evaluated the mEMA app as feasible and usable. Ecological validity analyses showed that all DI and almost all PA multiple-choice options were covered with the compound response categories. Conclusions: The mEMA app offers the opportunity to assess complex health behaviors (eg, DI and PA) in real-time settings, in which specifically routinized behaviors are involved. However, the mEMA app faced several challenges that needed to be overcome in order to improve its validity. Overall, the present study showed that the mEMA app is a usable and ecologically valid tool to measure DI and PA behaviors among vocational education students, but compliance is still limited. ", doi="10.2196/jmir.2617", url="http://www.jmir.org/2013/9/e214/", url="http://www.ncbi.nlm.nih.gov/pubmed/24067298" } @Article{info:doi/10.2196/jmir.2513, author="Yu, Bei and Willis, Matt and Sun, Peiyuan and Wang, Jun", title="Crowdsourcing Participatory Evaluation of Medical Pictograms Using Amazon Mechanical Turk", journal="J Med Internet Res", year="2013", month="Jun", day="03", volume="15", number="6", pages="e108", keywords="crowdsourcing", keywords="Amazon Mechanical Turk", keywords="participatory design", keywords="medical instruction", keywords="pictogram", keywords="patient communication", keywords="readability", keywords="health literacy", abstract="Background: Consumer and patient participation proved to be an effective approach for medical pictogram design, but it can be costly and time-consuming. We proposed and evaluated an inexpensive approach that crowdsourced the pictogram evaluation task to Amazon Mechanical Turk (MTurk) workers, who are usually referred to as the ``turkers''. Objective: To answer two research questions: (1) Is the turkers' collective effort effective for identifying design problems in medical pictograms? and (2) Do the turkers' demographic characteristics affect their performance in medical pictogram comprehension? Methods: We designed a Web-based survey (open-ended tests) to ask 100 US turkers to type in their guesses of the meaning of 20 US pharmacopeial pictograms. Two judges independently coded the turkers' guesses into four categories: correct, partially correct, wrong, and completely wrong. The comprehensibility of a pictogram was measured by the percentage of correct guesses, with each partially correct guess counted as 0.5 correct. We then conducted a content analysis on the turkers' interpretations to identify misunderstandings and assess whether the misunderstandings were common. We also conducted a statistical analysis to examine the relationship between turkers' demographic characteristics and their pictogram comprehension performance. Results: The survey was completed within 3 days of our posting the task to the MTurk, and the collected data are publicly available in the multimedia appendix for download. The comprehensibility for the 20 tested pictograms ranged from 45\% to 98\%, with an average of 72.5\%. The comprehensibility scores of 10 pictograms were strongly correlated to the scores of the same pictograms reported in another study that used oral response--based open-ended testing with local people. The turkers' misinterpretations shared common errors that exposed design problems in the pictograms. Participant performance was positively correlated with their educational level. Conclusions: The results confirmed that crowdsourcing can be used as an effective and inexpensive approach for participatory evaluation of medical pictograms. Through Web-based open-ended testing, the crowd can effectively identify problems in pictogram designs. The results also confirmed that education has a significant effect on the comprehension of medical pictograms. Since low-literate people are underrepresented in the turker population, further investigation is needed to examine to what extent turkers' misunderstandings overlap with those elicited from low-literate people. ", doi="10.2196/jmir.2513", url="http://www.jmir.org/2013/6/e108/", url="http://www.ncbi.nlm.nih.gov/pubmed/23732572" } @Article{info:doi/10.2196/jmir.1967, author="Daugherty, L. Bethany and Schap, E. TusaRebecca and Ettienne-Gittens, Reynolette and Zhu, M. Fengqing and Bosch, Marc and Delp, J. Edward and Ebert, S. David and Kerr, A. Deborah and Boushey, J. Carol", title="Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents", journal="J Med Internet Res", year="2012", month="Apr", day="13", volume="14", number="2", pages="e58", keywords="Mobile telephone food record", keywords="dietary assessment", keywords="technology", keywords="image analysis", keywords="volume estimation", abstract="Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38\% vs 58\%, P = .03) and after (25\% vs 50\%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. ", doi="10.2196/jmir.1967", url="http://www.jmir.org/2012/2/e58/", url="http://www.ncbi.nlm.nih.gov/pubmed/22504018" } @Article{info:doi/10.2196/jmir.1921, author="van der Krieke, Lian and Emerencia, C. Ando and Aiello, Marco and Sytema, Sjoerd", title="Usability Evaluation of a Web-Based Support System for People With a Schizophrenia Diagnosis", journal="J Med Internet Res", year="2012", month="Feb", day="06", volume="14", number="1", pages="e24", keywords="Schizophrenia", keywords="Web-Based systems", keywords="Recommendation systems", keywords="usability testing", keywords="self-management", abstract="Background: Routine Outcome Monitoring (ROM) is a systematic way of assessing service users' health conditions for the purpose of better aiding their care. ROM consists of various measures used to assess a service user's physical, psychological, and social condition. While ROM is becoming increasingly important in the mental health care sector, one of its weaknesses is that ROM is not always sufficiently service user-oriented. First, clinicians tend to concentrate on those ROM results that provide information about clinical symptoms and functioning, whereas it has been suggested that a service user-oriented approach needs to focus on personal recovery. Second, service users have limited access to ROM results and they are often not equipped to interpret them. These problems need to be addressed, as access to resources and the opportunity to share decision making has been indicated as a prerequisite for service users to become a more equal partner in communication with their clinicians. Furthermore, shared decision making has been shown to improve the therapeutic alliance and to lead to better care. Objective: Our aim is to build a web-based support system which makes ROM results more accessible to service users and to provide them with more concrete and personalized information about their functioning (ie, symptoms, housing, social contacts) that they can use to discuss treatment options with their clinician. In this study, we will report on the usability of the web-based support system for service users with schizophrenia. Methods: First, we developed a prototype of a web-based support system in a multidisciplinary project team, including end-users. We then conducted a usability study of the support system consisting of (1) a heuristic evaluation, (2) a qualitative evaluation and (3) a quantitative evaluation. Results: Fifteen service users with a schizophrenia diagnosis and four information and communication technology (ICT) experts participated in the study. The results show that people with a schizophrenia diagnosis were able to use the support system easily. Furthermore, the content of the advice generated by the support system was considered meaningful and supportive. Conclusions: This study shows that the support system prototype has valuable potential to improve the ROM practice and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to prior research into web applications for people with psychotic disorders, in that it shows that this group of end users can work with web-based and computer-based systems, despite the cognitive problems they experience. ", doi="10.2196/jmir.1921", url="http://www.jmir.org/2012/1/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/22311883" } @Article{info:doi/10.2196/jmir.1917, author="Hall, Valerie and Conboy-Hill, Suzanne and Taylor, Dave", title="Using Virtual Reality to Provide Health Care Information to People With Intellectual Disabilities: Acceptability, Usability, and Potential Utility", journal="J Med Internet Res", year="2011", month="Nov", day="14", volume="13", number="4", pages="e91", keywords="Learning disabilities", keywords="intellectual disabilities", keywords="virtual reality", keywords="health information", keywords="participatory research", keywords="capacity to consent", keywords="presence", abstract="Background: People with intellectual disabilities have poor access to health care, which may be further compromised by a lack of accessible health information. To be effective, health information must be easily understood and remembered. People with intellectual disabilities learn better from multimodal information sources, and virtual reality offers a 3-dimensional (3D) computer-generated environment that can be used for providing information and learning. To date, research into virtual reality experiences for people with intellectual disabilities has been limited to skill-based training and leisure opportunities within the young to mid age ranges. Objective: This study assessed the acceptability, usability, and potential utility of a virtual reality experience as a means of providing health care-related information to people with intellectual disabilities. We designed a prototype multimodal experience based on a hospital scenario and situated on an island in the Second Life 3D virtual world. We wanted to know how people of different ages and with varying levels of cognitive function would participate in the customized virtual environment, what they understood from being there, and what they remembered a week later. Methods: The study drew on qualitative data. We used a participatory research approach that involved working alongside people with intellectual disabilities and their supporters in a community setting. Cognitive function was assessed, using the Matrix Analogies Test and the British Picture Vocabulary Scale, to describe the sample. Participants, supported by facilitators, were video recorded accessing and engaging with the virtual environment. We assessed recall 1 week later, using a specialized interview technique. Data were downloaded into NVivo 8 and analyzed using the framework analysis technique. Results: Study participants were 20 people aged between 20 and 80 years with mild to severe intellectual disabilities. All participants were able to access the environment and voluntarily stayed there for between 23 and 57 minutes. With facilitator support, all participants moved the avatar themselves. Participants engaged with the scenario as if they were actually there, indicating cognitive presence. Some referred back to previous medical experiences, indicating the potential for experiential knowledge to become the foundation of new learning and retention of knowledge. When interviewed, all participants remembered some aspects of the environment. Conclusions: A sample of adults with intellectual disabilities of all ages, and with varying levels of cognitive function, accessed and enjoyed a virtual-world environment that drew on a health care-related scenario, and remembered aspects of it a week later. The small sample size limits generalizability of findings, but the potential shown for experiential learning to aid retention of knowledge on which consent is based appears promising. Successfully delivering health care-related information in a non-National Health Service setting indicates potential for delivery in institutional, community, or home settings, thereby widening access to the information. ", doi="10.2196/jmir.1917", url="http://www.jmir.org/2011/4/e91/", url="http://www.ncbi.nlm.nih.gov/pubmed/22082765" }