TY - JOUR AU - Cronin, M. Robert AU - Quaye, Nives AU - Liu, Xin AU - Landes, Kristina AU - Crosby, E. Lori AU - Kassim, A. Adetola AU - DeBaun, R. Michael AU - Schnell, M. Patrick PY - 2025/6/5 TI - Usage of a Multipurpose mHealth App Among Adults With Sickle Cell Disease: Randomized Controlled Trial JO - JMIR Form Res SP - e67906 VL - 9 KW - sickle cell disease KW - mHealth KW - patient engagement KW - hospitalizations KW - consumer health informatics KW - guidelines N2 - 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 UR - https://formative.jmir.org/2025/1/e67906 UR - http://dx.doi.org/10.2196/67906 ID - info:doi/10.2196/67906 ER - TY - JOUR AU - Dutta, Anirban AU - Hatjipanagioti, Katerina AU - Newsham, Alexander Matthew AU - Leyland, Lewis AU - Rickson, Lindsey AU - Buchanan, Alastair AU - Farkhatdinov, Ildar AU - Twamley, Jacqueline AU - Das, Abhijit PY - 2025/6/3 TI - Extended Reality Biofeedback for Functional Upper Limb Weakness: Mixed Methods Usability Evaluation JO - JMIR XR Spatial Comput SP - e68580 VL - 2 KW - extended reality KW - haptics KW - functional neurological disorder KW - biofeedback KW - usability KW - co-design KW - System Usability Scale N2 - 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. UR - https://xr.jmir.org/2025/1/e68580 UR - http://dx.doi.org/10.2196/68580 ID - info:doi/10.2196/68580 ER - TY - JOUR AU - Hong, Seojin AU - Choi, Hyun AU - Kweon, Hyosun PY - 2025/5/30 TI - Usability Evaluation of an Electrically Powered Orthopedic Exerciser: Focus Group Interview and Satisfaction Survey Study JO - JMIR Hum Factors SP - e60607 VL - 12 KW - usability evaluation KW - usability KW - electrically powered orthopedic exerciser KW - focus group interview KW - satisfaction survey N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e60607 UR - http://dx.doi.org/10.2196/60607 ID - info:doi/10.2196/60607 ER - TY - JOUR AU - Turner, Jessica AU - Stawarz, Katarzyna PY - 2025/5/27 TI - Understanding Device Integrations Within Diabetes Apps: Mixed Methods Analysis of App Features and User Reviews JO - JMIR Diabetes SP - e62926 VL - 10 KW - diabetes mellitus KW - health apps KW - mHealth KW - mobile health KW - mobile apps KW - self-management KW - user experience N2 - 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. UR - https://diabetes.jmir.org/2025/1/e62926 UR - http://dx.doi.org/10.2196/62926 ID - info:doi/10.2196/62926 ER - TY - JOUR AU - Harris, Richard AU - Murray, Deirdre AU - McSweeney, Angela AU - Adam, Frederic PY - 2025/5/26 TI - Clinician-Focused Connected Health Requirements Gathering for Attention-Deficit/Hyperactivity Disorder Through Clinical Journey Mapping: Design Science Study JO - JMIR Form Res SP - e53617 VL - 9 KW - connected health KW - ADHD KW - Dundee clinical care pathway KW - integrated patient journey mapping tool KW - neurodevelopmental KW - design science KW - journey KW - map KW - mapping KW - diagram KW - visualization KW - attention deficit KW - information system KW - care pathway KW - design KW - implementation KW - integration KW - attention-deficit/hyperactivity disorder N2 - 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. UR - https://formative.jmir.org/2025/1/e53617 UR - http://dx.doi.org/10.2196/53617 ID - info:doi/10.2196/53617 ER - TY - JOUR AU - Fosbrooke, Vera AU - Riguzzi, Marco AU - Raab, M. Anja PY - 2025/5/16 TI - Stakeholders and Contextual Factors in the Implementation of Assistive Robotic Arms for Persons With Tetraplegia: Deductive Content Analysis of Focus Group Interviews JO - JMIR Rehabil Assist Technol SP - e65759 VL - 12 KW - assistive technologies KW - robotic arm KW - implementation KW - barriers KW - facilitators KW - Consolidated Framework for Implementation Research N2 - 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. UR - https://rehab.jmir.org/2025/1/e65759 UR - http://dx.doi.org/10.2196/65759 UR - http://www.ncbi.nlm.nih.gov/pubmed/40378404 ID - info:doi/10.2196/65759 ER - TY - JOUR AU - Trieu, Phillip AU - Fetzer, Dominique AU - McLeod, Briana AU - Schweickert, Kathryn AU - Gutstein, Lauren AU - Egleston, Brian AU - Domchek, Susan AU - Fleisher, Linda AU - Wagner, Lynne AU - Wen, Kuang-Yi AU - Cacioppo, Cara AU - Ebrahimzadeh, E. Jessica AU - Falcone, Dana AU - Langer, Claire AU - Wood, Elisabeth AU - Karpink, Kelsey AU - Posen, Shelby AU - Selmani, Enida AU - Bradbury, R. Angela PY - 2025/5/14 TI - Developing the MyCancerGene Digital Health Portal to Improve Patients? Understanding of Germline Cancer Genetic Test Results: Development, User, and Usability Testing Study JO - JMIR Form Res SP - e56282 VL - 9 KW - genetic health portal KW - digital intervention development KW - health portal KW - usability KW - digital health KW - germline cancer KW - multigene panels KW - clinical practice KW - likelihood KW - effectiveness KW - medical history KW - genetic medicine KW - risk information KW - digital tool KW - intervention KW - longitudinal care KW - patient-centered content KW - electronic information N2 - 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. UR - https://formative.jmir.org/2025/1/e56282 UR - http://dx.doi.org/10.2196/56282 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56282 ER - TY - JOUR AU - Zargham, Nima AU - Reinschluessel, V. Anke AU - Mühlenbrock, Andre AU - Muender, Thomas AU - Cetin, Timur AU - Uslar, Nicole Verena AU - Weyhe, Dirk AU - Malaka, Rainer AU - Döring, Tanja PY - 2025/5/12 TI - Using Gesture and Speech to Control Surgical Lighting Systems: Mixed Methods Study JO - JMIR Hum Factors SP - e70628 VL - 12 KW - speech interaction KW - gesture recognition KW - operating theater KW - surgical lighting systems KW - smart lighting KW - artificial intelligence N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e70628 UR - http://dx.doi.org/10.2196/70628 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70628 ER - TY - JOUR AU - Seidl, Fritz AU - Hinterwimmer, Florian AU - Vogt, Ferdinand AU - Edenharter, M. Günther AU - Braun, F. Karl AU - von Eisenhart-Rothe, Rüdiger AU - AU - Biberthaler, Peter AU - Pförringer, Dominik PY - 2025/5/8 TI - Use and Acceptance of Innovative Digital Health Solutions Among Patients and Professionals: Survey Study JO - JMIR Hum Factors SP - e60779 VL - 12 KW - eHealth KW - digital health KW - medical data use KW - information KW - survey KW - adoption N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e60779 UR - http://dx.doi.org/10.2196/60779 ID - info:doi/10.2196/60779 ER - TY - JOUR AU - Rubyan, Michael AU - Gouseinov, Yana AU - Morgan, Mikayla AU - Rubyan, Deborah AU - Jahagirdar, Divya AU - Choberka, David AU - Boyd, J. Carol AU - Shuman, Clayton PY - 2025/5/8 TI - 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 JO - JMIR Hum Factors SP - e67685 VL - 12 KW - digital platform KW - nurse training KW - usability KW - user experience KW - user interface KW - mixed methods KW - theatre testing KW - stigma KW - perinatal substance use KW - art intervention KW - acceptability KW - perinatal KW - substance use KW - pregnancy KW - perinatal nurse KW - feasibility KW - interactive responsive platform N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e67685 UR - http://dx.doi.org/10.2196/67685 UR - http://www.ncbi.nlm.nih.gov/pubmed/40146964 ID - info:doi/10.2196/67685 ER - TY - JOUR AU - Adnan, Ahmer AU - Irvine, Eilish Rebecca AU - Williams, Allison AU - Harris, Matthew AU - Antonacci, Grazia PY - 2025/5/7 TI - Improving Acceptability of mHealth Apps?The Use of the Technology Acceptance Model to Assess the Acceptability of mHealth Apps: Systematic Review JO - J Med Internet Res SP - e66432 VL - 27 KW - technology acceptance model KW - mHealth KW - mobile health apps KW - health information technology acceptance model N2 - 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 UR - https://www.jmir.org/2025/1/e66432 UR - http://dx.doi.org/10.2196/66432 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66432 ER - TY - JOUR AU - Guo, Rongrong AU - Zheng, Ziling AU - Yang, Fangyu AU - Wu, Ying PY - 2025/5/2 TI - Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Health Information Technology Usability Evaluation Scale in China: Instrument Validation Study JO - J Med Internet Res SP - e67948 VL - 27 KW - cross-cultural adaptation KW - digital health application KW - reliability KW - translation KW - usability KW - validity N2 - 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 ? and McDonald ?>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. UR - https://www.jmir.org/2025/1/e67948 UR - http://dx.doi.org/10.2196/67948 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67948 ER - TY - JOUR AU - Yang, Ting-ting AU - Zheng, Hong-xia AU - Cao, Sha AU - Jing, Mei-ling AU - Hu, Ju AU - Zuo, Yan AU - Chen, Qing-yong AU - Zhang, Jian-jun PY - 2025/4/30 TI - Harnessing an Artificial Intelligence?Based Large Language Model With Personal Health Record Capability for Personalized Information Support in Postsurgery Myocardial Infarction: Descriptive Qualitative Study JO - J Med Internet Res SP - e68762 VL - 27 KW - myocardial infarction KW - post-surgery recovery KW - personalized health support KW - artificial intelligence KW - large language model KW - personal health record KW - digital health tools KW - health information accessibility KW - qualitative study KW - mobile phone N2 - 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. UR - https://www.jmir.org/2025/1/e68762 UR - http://dx.doi.org/10.2196/68762 UR - http://www.ncbi.nlm.nih.gov/pubmed/40305084 ID - info:doi/10.2196/68762 ER - TY - JOUR AU - Muñoz Olivar, Carolina AU - Pineiro, Miguel AU - Gómez Quintero, Sebastián Juan AU - Avendaño-Vásquez, Javier Carlos AU - Ormeño-Arriagada, Pablo AU - Palma Rivadeneira, Silvia AU - Taramasco Toro, Carla PY - 2025/4/28 TI - Education and Symptom Reporting in an mHealth App for Patients With Cancer: Mixed Methods Development and Validation Study JO - JMIR Hum Factors SP - e60169 VL - 12 KW - cancer KW - patient-reported outcome measures KW - software design KW - unpleasant symptom KW - toxicity KW - mHealth KW - mobile health KW - surveys and questionnaires KW - application KW - design KW - evaluation KW - chemotherapy KW - health care communication KW - mixed methods KW - validation KW - efficiency KW - security N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e60169 UR - http://dx.doi.org/10.2196/60169 ID - info:doi/10.2196/60169 ER - TY - JOUR AU - Moylan, Kayley AU - Doherty, Kevin PY - 2025/4/25 TI - Expert and Interdisciplinary Analysis of AI-Driven Chatbots for Mental Health Support: Mixed Methods Study JO - J Med Internet Res SP - e67114 VL - 27 KW - mental health KW - therapy KW - design KW - chatbots KW - artificial intelligence KW - AI KW - ethics KW - emotional dependence KW - self-reliance N2 - 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. UR - https://www.jmir.org/2025/1/e67114 UR - http://dx.doi.org/10.2196/67114 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67114 ER - TY - JOUR AU - He, Xing AU - Bian, Jiang AU - Berlinski, Ariel AU - Guo, Yi AU - Simmons, Larry A. AU - Marshall, Alexandra S. AU - Greene, J. Carolyn AU - Brown, Hudson Rita AU - Turner, Jessica AU - Perry, T. Tamara PY - 2025/4/24 TI - Mobile Health App for Adolescent Asthma Self-Management: Development and Usability Study of the Pulmonary Education and Knowledge Mobile Asthma Action Plan JO - JMIR Form Res SP - e64212 VL - 9 KW - asthma self-management KW - mobile health KW - user-centered design KW - usability KW - adolescents KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2025/1/e64212 UR - http://dx.doi.org/10.2196/64212 ID - info:doi/10.2196/64212 ER - TY - JOUR AU - Popoff, Benjamin AU - Cabon, Sandie AU - Cuggia, Marc AU - Bouzillé, Guillaume AU - Clavier, Thomas PY - 2025/4/23 TI - Expectations of Intensive Care Physicians Regarding an AI-Based Decision Support System for Weaning From Continuous Renal Replacement Therapy: Predevelopment Survey Study JO - JMIR Med Inform SP - e63709 VL - 13 KW - clinical decision support system KW - artificial intelligence KW - decision support KW - decision making KW - clinical decision making KW - survey study KW - intensive care physicians KW - renal replacement therapy KW - therapeutic KW - ICU KW - user-centered design KW - cross-sectional survey KW - survey KW - French KW - physician KW - questionnaire KW - AI tools KW - user-centered N2 - 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 ?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. UR - https://medinform.jmir.org/2025/1/e63709 UR - http://dx.doi.org/10.2196/63709 ID - info:doi/10.2196/63709 ER - TY - JOUR AU - Hollman, Heather AU - Sui, Wuyou AU - Zhang, Haowei AU - Rhodes, E. Ryan PY - 2025/4/23 TI - A Mobile Health App Informed by the Multi-Process Action Control Framework to Promote Physical Activity Among Inactive Adults: Iterative Usability Study JO - JMIR Form Res SP - e59477 VL - 9 KW - physical activity KW - mobile apps KW - mobile health KW - mHealth KW - usability study KW - inactive adults KW - smartphone N2 - 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. UR - https://formative.jmir.org/2025/1/e59477 UR - http://dx.doi.org/10.2196/59477 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59477 ER - TY - JOUR AU - Butorac, Isobel AU - McNaney, Roisin AU - Seguin, Paolo Joshua AU - Olivier, Patrick AU - Northam, C. Jaimie AU - Tully, A. Lucy AU - Carl, Talia AU - Carter, Adrian PY - 2025/4/22 TI - Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study JO - JMIR Pediatr Parent SP - e65163 VL - 8 KW - digital mental health KW - young people KW - cultural diversity KW - web-based and mobile health interventions KW - qualitative methods KW - user-centered design KW - human-computer interaction N2 - 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. UR - https://pediatrics.jmir.org/2025/1/e65163 UR - http://dx.doi.org/10.2196/65163 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65163 ER - TY - JOUR AU - Buchan, Claire M. AU - Katapally, Reddy Tarun AU - Bhawra, Jasmin PY - 2025/4/17 TI - Application of an Innovative Methodology to Build Infrastructure for Digital Transformation of Health Systems: Developmental Program Evaluation JO - JMIR Form Res SP - e53339 VL - 9 KW - digital health platform KW - citizen science KW - evaluation KW - health systems KW - digital health KW - app KW - innovative KW - digital transformation KW - public health KW - crises KW - communicable disease KW - coronavirus KW - chronic diseases KW - decision-making KW - assessment KW - thematic analysis KW - self-report survey KW - risk KW - artificial intelligence KW - AI N2 - 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. UR - https://formative.jmir.org/2025/1/e53339 UR - http://dx.doi.org/10.2196/53339 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53339 ER - TY - JOUR AU - ?erban, Bianca Irina AU - Fruytier, Lonneke AU - Houben, Steven AU - Colombo, Sara AU - van de Sande, Danny AU - Kemps, Hareld AU - Brombacher, Aarnout PY - 2025/4/17 TI - Design Requirements for Cardiac Telerehabilitation Technologies Supporting Athlete Values: Qualitative Interview Study JO - JMIR Rehabil Assist Technol SP - e62986 VL - 12 KW - athletes with established coronary artery disease KW - cardiac telerehabilitation KW - value-sensitive design KW - sports monitoring KW - card sorting KW - qualitative research KW - artificial intelligence KW - AI N2 - 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. UR - https://rehab.jmir.org/2025/1/e62986 UR - http://dx.doi.org/10.2196/62986 UR - http://www.ncbi.nlm.nih.gov/pubmed/40245391 ID - info:doi/10.2196/62986 ER - TY - JOUR AU - Zeitlin, Anya AU - Mathenjwa, Thulile AU - Zuma, Thembelihle AU - Wyke, Sally AU - Matthews, Philippa AU - McGrath, Nuala AU - Seeley, Janet AU - Shahmanesh, Maryam AU - Blandford, Ann PY - 2025/4/17 TI - 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 JO - JMIR Form Res SP - e65185 VL - 9 KW - person-based approach KW - HIV KW - resource-constrained settings KW - digital intervention KW - user-centered design KW - behavior change techniques KW - digital health N2 - 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. UR - https://formative.jmir.org/2025/1/e65185 UR - http://dx.doi.org/10.2196/65185 UR - http://www.ncbi.nlm.nih.gov/pubmed/40244652 ID - info:doi/10.2196/65185 ER - TY - JOUR AU - de França, Galvão Caroline Villela AU - Segalla, Boaro Paola AU - Reis, Assis Felipe Sebastião de AU - Pereira, Silveira José Ricardo AU - de Mattos, Oliveira Alexandre AU - Ferron, Moura Roberta de AU - de Oliveira, Zanardo Cleyton AU - Borges, Bassani Jéssica AU - Hoffmann, Quintal Lilian AU - Caboclo, Giaimo Edmundo Di PY - 2025/4/16 TI - Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study JO - JMIR Hum Factors SP - e55430 VL - 12 KW - telemedicine cabin KW - telehealth KW - teleservice KW - e-health KW - connected offices N2 - 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 Beneficência Portuguesa de São 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. UR - https://humanfactors.jmir.org/2025/1/e55430 UR - http://dx.doi.org/10.2196/55430 ID - info:doi/10.2196/55430 ER - TY - JOUR AU - Keinert, Marie AU - Schindler-Gmelch, Lena AU - Rupp, Helene Lydia AU - Sadeghi, Misha AU - Richer, Robert AU - Capito, Klara AU - Eskofier, M. Bjoern AU - Berking, Matthias PY - 2025/4/14 TI - The EmpkinS-EKSpression Reappraisal Training Augmented With Kinesthesia in Depression: One-Armed Feasibility Study JO - JMIR Form Res SP - e65357 VL - 9 KW - depression KW - cognitive reappraisal KW - facial expression KW - kinesthesia KW - smartphone-based intervention KW - mobile phone N2 - 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/ UR - https://formative.jmir.org/2025/1/e65357 UR - http://dx.doi.org/10.2196/65357 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65357 ER - TY - JOUR AU - Somerville, Mari AU - Wozney, Lori AU - Gallant, Allyson AU - Curran, A. Janet PY - 2025/4/14 TI - Designing eHealth Interventions for Pediatric Emergency Departments: Protocol for a Usability Testing Study With Youth, Parent, and Clinician Participants JO - JMIR Res Protoc SP - e64350 VL - 14 KW - eHealth intervention KW - emergency department KW - usability testing KW - youth KW - health services KW - parents KW - pediatric KW - digital health tools KW - mixed methods KW - quantitative surveys N2 - 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 UR - https://www.researchprotocols.org/2025/1/e64350 UR - http://dx.doi.org/10.2196/64350 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64350 ER - TY - JOUR AU - Mackey, Tim AU - Cuomo, E. Raphael AU - Xu, Qing AU - McMann, J. Tiana AU - Li, Zhuoran AU - Cai, Mingxiang AU - Wenzel, Christine AU - Yang, S. Joshua PY - 2025/4/11 TI - Approach to Design and Evaluate Digital Tools to Enhance Young Adult Participation in Clinical Trials: Co-Design and Controlled Intercept Study JO - J Med Internet Res SP - e70852 VL - 27 KW - health KW - clinical trials KW - COVID-19 KW - digital health KW - coronavirus disease N2 - 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 (?=0.74 on a 10-point scale, P<.01) and website (?=0.93, P<.01) compared to those exposed to a Facebook ad (?=0.21) but not a digital flyer (?=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 (?=0.74, P<.01) or website (?=0.93, P<.001) compared to a Facebook ad (?=0.21), but the digital flyer (?=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. UR - https://www.jmir.org/2025/1/e70852 UR - http://dx.doi.org/10.2196/70852 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70852 ER - TY - JOUR AU - Ibrahim, Hussein Radhwan AU - Yaas, Hussein Marghoob AU - Hamarash, Qadir Mariwan AU - Al-Mukhtar, Hazim Salwa AU - Abdulghani, Faris Mohammed AU - Al Mushhadany, Osama PY - 2025/4/11 TI - Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes JO - JMIR Pediatr Parent SP - e67137 VL - 8 KW - cognitive behavioral therapy KW - CBT KW - psychotherapy KW - mHealth KW - app KW - adolescents KW - teenager KW - mental health KW - usability KW - engagement KW - anxiety KW - depression KW - user experience KW - UX KW - focus group KW - interview KW - digital health N2 - 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. UR - https://pediatrics.jmir.org/2025/1/e67137 UR - http://dx.doi.org/10.2196/67137 ID - info:doi/10.2196/67137 ER - TY - JOUR AU - Hutchison, G. Michael AU - Di Battista, P. Alex AU - Pyndiura, L. Kyla PY - 2025/4/11 TI - Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study JO - JMIR Form Res SP - e67275 VL - 9 KW - mild traumatic brain injury KW - recovery KW - mHealth KW - app KW - digital health KW - smartphone KW - eHealth KW - digital KW - technology KW - usability KW - concussion rehabilitation KW - brain injury KW - rehabilitation protocols KW - evidence-based exercise KW - single-arm pilot study KW - home-based rehabilitation KW - user-friendly KW - questionnaire KW - telehealth KW - telemedicine N2 - 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. UR - https://formative.jmir.org/2025/1/e67275 UR - http://dx.doi.org/10.2196/67275 ID - info:doi/10.2196/67275 ER - TY - JOUR AU - Biernetzky, A. Olga AU - Thyrian, René Jochen AU - Boekholt, Melanie AU - Berndt, Matthias AU - Hoffmann, Wolfgang AU - Teipel, J. Stefan AU - Kilimann, Ingo PY - 2025/4/7 TI - Identifying Unmet Needs of Informal Dementia Caregivers in Clinical Practice: User-Centered Development of a Digital Assessment Tool JO - JMIR Aging SP - e59942 VL - 8 KW - unmet needs KW - assessment development KW - family caregivers of people with dementia KW - dementia KW - need KW - Alzheimer KW - self-guided KW - self-reported KW - caregiver KW - informal care KW - spousal care KW - interview KW - qualitative KW - thematic KW - usability KW - mHealth KW - tablet KW - self-completed KW - aging KW - patient care KW - health interventions KW - care giver KW - digital health KW - ehealth KW - digital assessment KW - memory N2 - 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 Angehörige 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 UR - https://aging.jmir.org/2025/1/e59942 UR - http://dx.doi.org/10.2196/59942 ID - info:doi/10.2196/59942 ER - TY - JOUR AU - Coletta, Giulia AU - Noguchi, S. Kenneth AU - Beaudoin, Kayla AU - McQuarrie, Angelica AU - Tang, Ada AU - Ganann, Rebecca AU - Phillips, M. Stuart AU - Griffin, Meridith PY - 2025/4/3 TI - Older Adults? Perspectives on Participating in a Synchronous Online Exercise Program: Qualitative Study JO - JMIR Aging SP - e66473 VL - 8 KW - exercise KW - older adults KW - qualitative study KW - qualitative KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - interview KW - internet KW - kinesiology KW - physiotherapy KW - synchronous KW - online KW - home-based KW - gerontology KW - geriatric KW - older KW - aging KW - physical activity N2 - 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 UR - https://aging.jmir.org/2025/1/e66473 UR - http://dx.doi.org/10.2196/66473 ID - info:doi/10.2196/66473 ER - TY - JOUR AU - Dougherty, Kylie AU - Tesfaye, Yihenew AU - Biza, Heran AU - Belew, Mulusew AU - Benda, Natalie AU - Gebremariam Gobezayehu, Abebe AU - Cranmer, John AU - Bakken, Suzanne PY - 2025/4/3 TI - User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study JO - JMIR Hum Factors SP - e64131 VL - 12 KW - health information technology KW - design and evaluation KW - Ethiopia KW - usability KW - nursing informatics KW - user-centered design KW - basic emergency obstetric care KW - obstetric KW - nurse KW - user-centered KW - design KW - maternal mortality KW - maternal KW - develop KW - sub-Saharan Africa KW - Africa KW - dashboard KW - tracking KW - emergency care N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e64131 UR - http://dx.doi.org/10.2196/64131 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64131 ER - TY - JOUR AU - Hong, Seojin AU - Choi, Hyun AU - Kweon, Hyosun PY - 2025/4/1 TI - Medical Device Based on a Virtual Reality?Based Upper Limb Rehabilitation Software: Usability Evaluation Through Cognitive Walkthrough JO - JMIR Form Res SP - e68149 VL - 9 KW - usability KW - cognitive walkthrough KW - virtual reality-based upper limb rehabilitation software KW - upper limb KW - limb rehabilitation KW - rehabilitation KW - therapist KW - virtual reality KW - VR KW - medical device KW - formative evaluation KW - quantitative KW - qualitative KW - occupational therapy KW - user safety KW - usability testing KW - software KW - risk factor N2 - 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. UR - https://formative.jmir.org/2025/1/e68149 UR - http://dx.doi.org/10.2196/68149 ID - info:doi/10.2196/68149 ER - TY - JOUR AU - Flaucher, Madeleine AU - Berzins, Sabrina AU - Jaeger, M. Katharina AU - Nissen, Michael AU - Rolny, Jana AU - Trißler, Patricia AU - Eckl, Sebastian AU - Eskofier, M. Bjoern AU - Leutheuser, Heike PY - 2025/3/31 TI - Perception and Evaluation of a Knowledge Transfer Concept in a Digital Health Application for Patients With Heart Failure: Mixed Methods Study JO - JMIR Hum Factors SP - e56798 VL - 12 KW - health literacy KW - digital Literacy KW - user-centered design KW - digital health app KW - heart failure KW - mixed methods study KW - user centered deign KW - usability KW - patient engagement KW - mHealth app KW - development N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e56798 UR - http://dx.doi.org/10.2196/56798 ID - info:doi/10.2196/56798 ER - TY - JOUR AU - Wittmar, Silke AU - Frankenstein, Tom AU - Timm, Vincent AU - Frei, Peter AU - Kurpiers, Nicolas AU - Wölwer, Stefan AU - Schäfer, Meender Axel Georg PY - 2025/3/28 TI - User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study JO - JMIR Form Res SP - e64384 VL - 9 KW - usability testing KW - health promotion KW - exercise KW - smartphone app KW - mHealth KW - physical activity KW - user experience KW - user KW - university student KW - undergraduate KW - college KW - student KW - mixed methods KW - physical fitness KW - digital intervention KW - mobile health KW - promote KW - engagement KW - mobile phone N2 - 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 (?=0.232, P=.04), and between age and the perspicuity (Kendall ?b=0.132, P=.03) and stimulation subscales (Kendall ?b=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (?=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. UR - https://formative.jmir.org/2025/1/e64384 UR - http://dx.doi.org/10.2196/64384 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64384 ER - TY - JOUR AU - Rookes, Alanna Tasmin AU - Batla, Amit AU - Armstrong, Megan AU - Ambler, Gareth AU - Walters, Kate AU - Schrag, Anette PY - 2025/3/25 TI - Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study JO - JMIR Form Res SP - e63704 VL - 9 KW - Parkinson disease KW - feasibility KW - remote monitoring KW - Parkinson KW - acceptability KW - reliability KW - wearable devices KW - wearable KW - self-management KW - quantitative assessments KW - quantitative KW - qualitative KW - monitoring KW - patient N2 - 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 UR - https://formative.jmir.org/2025/1/e63704 UR - http://dx.doi.org/10.2196/63704 ID - info:doi/10.2196/63704 ER - TY - JOUR AU - Rivas, Vincent Eric AU - Lesley, Ulf AU - Davoody, Nadia PY - 2025/3/24 TI - Health Care Professionals? Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study JO - JMIR Hum Factors SP - e60582 VL - 12 KW - eHealth KW - mobile health KW - mHealth KW - advanced home care KW - content analysis KW - nurse KW - staff-patient relationship KW - aging population KW - patient engagement KW - personalized care KW - patient experience N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e60582 UR - http://dx.doi.org/10.2196/60582 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60582 ER - TY - JOUR AU - Hooten, Michael W. AU - Erickson, J. Darin AU - Chawarski, Marek AU - Scholz, A. Natalie AU - Waljee, F. Jennifer AU - Brummett, M. Chad AU - Jeffery, M. Molly PY - 2025/3/24 TI - Unintended Prolonged Opioid Use: Protocol for a Case-Controlled Trial JO - JMIR Res Protoc SP - e72032 VL - 14 KW - opioid use KW - case-control KW - unintended opioid use KW - prolonged opioid use KW - prospective N2 - 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 UR - https://www.researchprotocols.org/2025/1/e72032 UR - http://dx.doi.org/10.2196/72032 UR - http://www.ncbi.nlm.nih.gov/pubmed/39992690 ID - info:doi/10.2196/72032 ER - TY - JOUR AU - Kauttonen, Janne AU - Rousi, Rebekah AU - Alamäki, Ari PY - 2025/3/21 TI - Trust and Acceptance Challenges in the Adoption of AI Applications in Health Care: Quantitative Survey Analysis JO - J Med Internet Res SP - e65567 VL - 27 KW - artificial intelligence KW - AI KW - health care technology KW - technology adoption KW - predictive modeling KW - user trust KW - user acceptance N2 - 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. UR - https://www.jmir.org/2025/1/e65567 UR - http://dx.doi.org/10.2196/65567 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65567 ER - TY - JOUR AU - Folch-Sanchez, Daniel AU - Pellicer-Roca, Maria AU - Sestelo, Agustina María AU - Zuluaga, Paola AU - Arias, Francisco AU - Guzmán Cortez, Pablo AU - Amechat, Salma AU - Gil-Berrozpe, Gustavo AU - Lopez Montes, Estefania AU - Mercadé, Clara AU - Fonseca, Francina AU - Miquel, Laia AU - Mestre-Pintó, I. Joan PY - 2025/3/19 TI - Evaluating Perceptions of the CANreduce 2.0 eHealth Intervention for Cannabis Use: Focus Group Study JO - J Med Internet Res SP - e65025 VL - 27 KW - addiction KW - cannabis KW - drug use disorder KW - eHealth KW - digital health intervention KW - qualitative research KW - focus groups KW - user-centered design KW - user-centered intervention N2 - 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. UR - https://www.jmir.org/2025/1/e65025 UR - http://dx.doi.org/10.2196/65025 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65025 ER - TY - JOUR AU - Kang, Hyunjin AU - Yang, Tingting AU - Banu, Nazira AU - Ng, Ting Sheryl Wei AU - Lee, Kyu Jeong PY - 2025/3/19 TI - Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study JO - JMIR Aging SP - e69008 VL - 8 KW - smart health wearables KW - self-determination theory KW - AI anxiety KW - perceived privacy risk KW - health consciousness N2 - 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. UR - https://aging.jmir.org/2025/1/e69008 UR - http://dx.doi.org/10.2196/69008 ID - info:doi/10.2196/69008 ER - TY - JOUR AU - Thell, Maria AU - Edvardsson, Kerstin AU - Aljeshy, Reem AU - Ibrahim, Kalid AU - Warner, Georgina PY - 2025/3/18 TI - A Trauma Support App for Young People: Co-design and Usability Study JO - JMIR Form Res SP - e57789 VL - 9 KW - co-design KW - young people KW - trauma KW - app development KW - usability testing N2 - 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. UR - https://formative.jmir.org/2025/1/e57789 UR - http://dx.doi.org/10.2196/57789 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57789 ER - TY - JOUR AU - Ghorbanian Zolbin, Maedeh AU - Kujala, Sari AU - Huvila, Isto PY - 2025/3/14 TI - Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study JO - J Med Internet Res SP - e64249 VL - 27 KW - eHealth services KW - older adults KW - immigrant KW - usability KW - user experience KW - emotion KW - self-determination theory N2 - 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. UR - https://www.jmir.org/2025/1/e64249 UR - http://dx.doi.org/10.2196/64249 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64249 ER - TY - JOUR AU - Haegens, L. Lex AU - Huiskes, B. Victor J. AU - van den Bemt, F. Bart J. AU - Bekker, L. Charlotte PY - 2025/3/13 TI - Factors Influencing the Intentions of Patients With Inflammatory Rheumatic Diseases to Use a Digital Human for Medication Information: Qualitative Study JO - J Med Internet Res SP - e57697 VL - 27 KW - digital human KW - information provision KW - intention to use KW - qualitative study KW - focus groups KW - drug-related problems KW - medication safety KW - safety information KW - information seeking KW - Netherlands KW - Pharmacotherapy KW - medication KW - telehealth KW - communication technologies KW - medication information KW - rheumatic diseases KW - rheumatology N2 - 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. UR - https://www.jmir.org/2025/1/e57697 UR - http://dx.doi.org/10.2196/57697 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57697 ER - TY - JOUR AU - Wolfe, H. Brooke AU - Oh, Jung Yoo AU - Choung, Hyesun AU - Cui, Xiaoran AU - Weinzapfel, Joshua AU - Cooper, Amanda R. AU - Lee, Hae-Na AU - Lehto, Rebecca PY - 2025/3/13 TI - Caregiving Artificial Intelligence Chatbot for Older Adults and Their Preferences, Well-Being, and Social Connectivity: Mixed-Method Study JO - J Med Internet Res SP - e65776 VL - 27 KW - older adults KW - technology use KW - AI chatbots KW - artificial intelligence KW - well-being KW - social connectedness KW - mobile phone N2 - 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. UR - https://www.jmir.org/2025/1/e65776 UR - http://dx.doi.org/10.2196/65776 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65776 ER - TY - JOUR AU - Park, Suhyun AU - Marquard, L. Jenna AU - Austin, R. Robin AU - Martin, L. Christie AU - Pieczkiewicz, S. David AU - Delaney, W. Connie PY - 2025/3/11 TI - Exploratory Co-Design on Electronic Health Record Nursing Summaries: Case Study JO - JMIR Form Res SP - e68906 VL - 9 KW - electronic health records KW - interview KW - nurses KW - user-computer interface KW - co-design N2 - 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. UR - https://formative.jmir.org/2025/1/e68906 UR - http://dx.doi.org/10.2196/68906 ID - info:doi/10.2196/68906 ER - TY - JOUR AU - Groninger, Hunter AU - Arem, Hannah AU - Ayangma, Lylian AU - Gong, Lisa AU - Zhou, Eric AU - Greenberg, Daniel PY - 2025/3/10 TI - Development of a Voice-Activated Virtual Assistant to Improve Insomnia Among Young Adult Cancer Survivors: Mixed Methods Feasibility and Acceptability Study JO - JMIR Form Res SP - e64869 VL - 9 KW - cancer KW - survivor KW - insomnia KW - cognitive behavioral therapy KW - technology KW - app KW - oncology KW - mobile health KW - artificial intelligence KW - young adults KW - sleep KW - mHealth KW - CBT KW - voice-activated virtual assistant KW - virtual assistants KW - focus group KW - qualitative research N2 - 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 UR - https://formative.jmir.org/2025/1/e64869 UR - http://dx.doi.org/10.2196/64869 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64869 ER - TY - JOUR AU - Pozzar, A. Rachel AU - Tulsky, A. James AU - Berry, L. Donna AU - Batista, Jeidy AU - Barwick, Paige AU - Lindvall, J. Charlotta AU - Dykes, C. Patricia AU - Manni, Michael AU - Matulonis, A. Ursula AU - McCleary, J. Nadine AU - Wright, A. Alexi PY - 2025/3/10 TI - Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study JO - JMIR Cancer SP - e66801 VL - 11 KW - ovarian neoplasm KW - ovarian cancer KW - cancer KW - oncology KW - oncologist KW - metastases KW - communication KW - physician-patient relations KW - electronic health record KW - EHR KW - electronic medical record KW - EMR KW - implementation science KW - digital KW - digital health KW - digital technology KW - digital intervention KW - mobile phone N2 - 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. UR - https://cancer.jmir.org/2025/1/e66801 UR - http://dx.doi.org/10.2196/66801 ID - info:doi/10.2196/66801 ER - TY - JOUR AU - Buawangpong, Nida AU - Sirikul, Wachiranun AU - Siviroj, Penprapa PY - 2025/3/7 TI - Factors Associated With the Intention to Use mHealth Among Thai Middle-Aged Adults and Older Adults: Cross-Sectional Study JO - JMIR Hum Factors SP - e63607 VL - 12 KW - mHealth KW - mobile healthcare KW - older adults KW - elderly KW - aging KW - questionnaire KW - smartphone KW - mHealth usage KW - intention to use N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e63607 UR - http://dx.doi.org/10.2196/63607 ID - info:doi/10.2196/63607 ER - TY - JOUR AU - Lee, Yura AU - Park, Ye-Eun PY - 2025/3/7 TI - Authors? Reply: Advancing Digital Health Integration in Oncology JO - J Med Internet Res SP - e72477 VL - 27 KW - mHealth KW - user experience KW - cancer KW - technology acceptance model KW - structural equation modeling KW - health care app KW - mixed-method study KW - medical care KW - digital health care KW - cancer survivors KW - disparities KW - health status KW - behavioral intervention KW - clinician UR - https://www.jmir.org/2025/1/e72477 UR - http://dx.doi.org/10.2196/72477 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053760 ID - info:doi/10.2196/72477 ER - TY - JOUR AU - Khan, Umar Rai Muhammad AU - Tariq, Hassan PY - 2025/3/7 TI - Advancing Digital Health Integration in Oncology JO - J Med Internet Res SP - e70316 VL - 27 KW - mHealth KW - user experience KW - cancer KW - technology acceptance model KW - structural equation modeling KW - health care app KW - mixed-method study KW - medical care KW - digital health care KW - cancer survivors KW - disparities KW - health status KW - behavioral intervention KW - clinician UR - https://www.jmir.org/2025/1/e70316 UR - http://dx.doi.org/10.2196/70316 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053796 ID - info:doi/10.2196/70316 ER - TY - JOUR AU - Beerbaum, Julian AU - Robens, Sibylle AU - Fehring, Leonard AU - Mortsiefer, Achim AU - Meister, Sven PY - 2025/3/5 TI - Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study JO - JMIR Form Res SP - e58867 VL - 9 KW - technology acceptance KW - UTAUT KW - family doctor KW - digital health KW - eHealth KW - video consultation KW - electronic health records KW - digital anamnesis KW - online appointment scheduling N2 - 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; ?=.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; ?=.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; ?=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; ?=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; ?=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; ?=.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; ?=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; ?=.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. UR - https://formative.jmir.org/2025/1/e58867 UR - http://dx.doi.org/10.2196/58867 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053731 ID - info:doi/10.2196/58867 ER - TY - JOUR AU - Francis, Karlee AU - Francis, Julie AU - Latimer, Margot AU - Gould, Hayley AU - Blackmore, Shante AU - MacLeod, Emily PY - 2025/3/3 TI - Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study JO - JMIR Hum Factors SP - e48370 VL - 12 KW - app KW - eHealth KW - pain KW - Indigenous KW - First Nations KW - children KW - youths KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e48370 UR - http://dx.doi.org/10.2196/48370 ID - info:doi/10.2196/48370 ER - TY - JOUR AU - de Thurah, Lena AU - Kiekens, Glenn AU - Weermeijer, Jeroen AU - Uyttebroek, Lotte AU - Wampers, Martien AU - Bonnier, Rafaël AU - Myin-Germeys, Inez PY - 2025/3/3 TI - Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis JO - JMIR Hum Factors SP - e60096 VL - 12 KW - digital self-monitoring KW - technology appropriation KW - experience sampling method KW - mental health care KW - mental health KW - self-monitoring KW - digital health KW - adoption KW - implementation KW - thematic KW - usability KW - interview KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - acceptance N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e60096 UR - http://dx.doi.org/10.2196/60096 ID - info:doi/10.2196/60096 ER - TY - JOUR AU - Connelly, Jenni AU - Swingler, Kevin AU - Rodriguez-Sanchez, Nidia AU - Whittaker, C. Anna PY - 2025/3/3 TI - Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool JO - JMIR Aging SP - e64661 VL - 8 KW - ageing KW - digital technology KW - dietary measurement KW - care homes KW - co-design KW - dietary intake KW - food diary N2 - 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. UR - https://aging.jmir.org/2025/1/e64661 UR - http://dx.doi.org/10.2196/64661 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053797 ID - info:doi/10.2196/64661 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Peralta, Claudia AU - Peck, Matt AU - Reilly, Blaine AU - Buller, K. Mary PY - 2025/2/21 TI - Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study JO - JMIR Hum Factors SP - e67962 VL - 12 KW - technology-based bullying intervention KW - STAC-T KW - usability testing KW - middle school KW - rural N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e67962 UR - http://dx.doi.org/10.2196/67962 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67962 ER - TY - JOUR AU - Dauber-Decker, L. Katherine AU - Feldstein, David AU - Hess, Rachel AU - Mann, Devin AU - Kim, Ji Eun AU - Gautam-Goyal, Pranisha AU - Solomon, Jeffrey AU - Khan, Sundas AU - Malik, Fatima AU - Xu, Lynn AU - Huffman, Ainsley AU - Smith, D. Paul AU - Halm, Wendy AU - Yuroff, Alice AU - Richardson, Safiya PY - 2025/2/18 TI - Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study JO - JMIR Form Res SP - e55316 VL - 9 KW - clinical decision support KW - CDS KW - decision aid KW - clinical aid KW - cough KW - sore throat KW - strep pharyngitis KW - snowball group usability testing KW - snowball group KW - usability testing N2 - 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 UR - https://formative.jmir.org/2025/1/e55316 UR - http://dx.doi.org/10.2196/55316 ID - info:doi/10.2196/55316 ER - TY - JOUR AU - Heuvelink, Annerieke AU - Saini, Privender AU - Ta?ar, Özgür AU - Nauts, Sanne PY - 2025/2/13 TI - Improving Pediatric Patients? Magnetic Resonance Imaging Experience With an In-Bore Solution: Design and Usability Study JO - JMIR Serious Games SP - e55720 VL - 13 KW - MRI KW - magnetic resonance imaging KW - imaging KW - radiology KW - pediatrics KW - children KW - patient guidance KW - patient experience KW - design KW - usability KW - breath hold N2 - 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. UR - https://games.jmir.org/2025/1/e55720 UR - http://dx.doi.org/10.2196/55720 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55720 ER - TY - JOUR AU - Seo, Woosuk AU - Jain, Shruti AU - Le, Vivian AU - Li, Jiaqi AU - Zhang, Zhan AU - Singh, Hardeep AU - Pasupathy, Kalyan AU - Mahajan, Prashant AU - Park, Young Sun PY - 2025/2/12 TI - Designing Patient-Centered Interventions for Emergency Care: Participatory Design Study JO - JMIR Form Res SP - e63610 VL - 9 KW - emergency department KW - participatory design KW - patient KW - technology KW - intervention N2 - 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 UR - https://formative.jmir.org/2025/1/e63610 UR - http://dx.doi.org/10.2196/63610 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63610 ER - TY - JOUR AU - Jacob, Christine AU - Müller, Roman AU - Schüler, Sonja AU - Rey, Alix AU - Rey, Guillaume AU - Armenian, Berj AU - Vonlaufen, Alain AU - Drepper, Michael AU - Zimmerli, Marius PY - 2025/2/12 TI - Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study JO - JMIR Hum Factors SP - e67043 VL - 12 KW - eHealth KW - mobile health KW - mHealth KW - digital health KW - technology assessment KW - technology adoption KW - technology implementation KW - usability study KW - colonoscopy KW - app KW - application KW - examinations KW - smartphone KW - usability N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e67043 UR - http://dx.doi.org/10.2196/67043 ID - info:doi/10.2196/67043 ER - TY - JOUR AU - Grieve, Natalie AU - Braaten, Kyra AU - MacPherson, Megan AU - Liu, Sam AU - Jung, E. Mary PY - 2025/2/11 TI - Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study JO - JMIR Form Res SP - e59386 VL - 9 KW - usability evaluation KW - mHealth KW - usability testing KW - app KW - end-user KW - focus group KW - participant KW - survey KW - diabetes KW - user-centered KW - cognitive walkthrough KW - cognitive walkthroughs KW - questionnaire KW - mobile phone KW - digital health KW - prediabetes N2 - 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. UR - https://formative.jmir.org/2025/1/e59386 UR - http://dx.doi.org/10.2196/59386 ID - info:doi/10.2196/59386 ER - TY - JOUR AU - Zuidhof, Niek AU - Peters, Oscar AU - Verbeek, Peter-Paul AU - Ben Allouch, Somaya PY - 2025/2/11 TI - Social Acceptance of Smart Glasses in Health Care: Model Evaluation Study of Anticipated Adoption and Social Interaction JO - JMIR Form Res SP - e49610 VL - 9 KW - smart glasses KW - technology adoption KW - social interaction KW - instrument development KW - structural equation modeling N2 - 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 (?>.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. UR - https://formative.jmir.org/2025/1/e49610 UR - http://dx.doi.org/10.2196/49610 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49610 ER - TY - JOUR AU - Perez Ramirez, Alejandra AU - Ortega, Adrian AU - Stephenson, Natalie AU - Muñoz Osorio, Angel AU - Kazak, Anne AU - Phan, Thao-Ly PY - 2025/2/11 TI - mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study JO - JMIR Form Res SP - e60495 VL - 9 KW - obesity KW - user testing KW - mHealth KW - mobile health KW - Spanish KW - child KW - rural population N2 - 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. UR - https://formative.jmir.org/2025/1/e60495 UR - http://dx.doi.org/10.2196/60495 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932772 ID - info:doi/10.2196/60495 ER - TY - JOUR AU - Elkourdi, Farah AU - Asan, Onur PY - 2025/2/10 TI - Community Caregivers? Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study JO - JMIR Pediatr Parent SP - e67289 VL - 8 KW - pediatric care KW - children with medical complexity KW - family-centered care KW - health information technology KW - health care software solutions KW - mobile phone KW - artificial intelligence N2 - 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. UR - https://pediatrics.jmir.org/2025/1/e67289 UR - http://dx.doi.org/10.2196/67289 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67289 ER - TY - JOUR AU - Serck-Hanssen, Ingrid AU - Solheim-Witt, Marit AU - Anker, J. Justin AU - Sugarman, E. Dawn PY - 2025/2/10 TI - 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 JO - JMIR Form Res SP - e63819 VL - 9 KW - alcohol misuse KW - stress KW - drinking to cope KW - DTC KW - negative affect KW - positive psychology intervention KW - PPI KW - cognitive behavior therapy KW - CBT KW - alcohol use KW - drinking KW - usability KW - descriptive study KW - behavior KW - emotion KW - coping skill KW - positive psychology KW - psychology KW - online resource KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2025/1/e63819 UR - http://dx.doi.org/10.2196/63819 ID - info:doi/10.2196/63819 ER - TY - JOUR AU - Astill Wright, Laurence AU - Moore, Matthew AU - Reeves, Stuart AU - Vallejos, Perez Elvira AU - Morriss, Richard PY - 2025/2/7 TI - Improving the Utility, Safety, and Ethical Use of a Passive Mood-Tracking App for People With Bipolar Disorder Using Coproduction: Qualitative Focus Group Study JO - JMIR Form Res SP - e65140 VL - 9 KW - mood monitoring KW - ecological momentary assessment KW - EMA KW - passive ecological momentary assessment KW - passive EMA KW - bipolar disorder KW - implementation KW - qualitative KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2025/1/e65140 UR - http://dx.doi.org/10.2196/65140 UR - http://www.ncbi.nlm.nih.gov/pubmed/39918865 ID - info:doi/10.2196/65140 ER - TY - JOUR AU - Kelly, Charlotte Sofia AU - Wegener, Kauffeldt Emilie AU - Kayser, Lars PY - 2025/2/5 TI - Creation of Text Vignettes Based on Patient-Reported Data to Facilitate a Better Understanding of the Patient Perspective: Design Study JO - JMIR Hum Factors SP - e58077 VL - 12 KW - patient-reported outcome KW - text vignette KW - data representation KW - Readiness and Enablement Index for Health Technology KW - understanding KW - health care system KW - data analysis KW - clinical training KW - clinician KW - health professional N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e58077 UR - http://dx.doi.org/10.2196/58077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58077 ER - TY - JOUR AU - Rudin, S. Robert AU - Herman, M. Patricia AU - Vining, Robert PY - 2025/2/4 TI - Addressing the ?Black Hole? of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study JO - JMIR Form Res SP - e66666 VL - 9 KW - low back pain KW - clinical decision support KW - user-centered design KW - usability KW - back pain KW - low back pain care KW - pain KW - clinical decision KW - societal burden KW - substantial KW - burden KW - evidence-based KW - treatment KW - diagnosis KW - support tool KW - clinicians KW - chiropractic KW - chiropractor KW - reviews KW - scenario-based interviews KW - interviews N2 - 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. UR - https://formative.jmir.org/2025/1/e66666 UR - http://dx.doi.org/10.2196/66666 ID - info:doi/10.2196/66666 ER - TY - JOUR AU - Nakikj, Drashko AU - Kreda, David AU - Luthria, Karan AU - Gehlenborg, Nils PY - 2025/2/3 TI - 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 JO - JMIR Hum Factors SP - e50331 VL - 12 KW - mobile health KW - patients KW - electronic health records KW - sensemaking KW - data organization KW - collections KW - awareness KW - proactivity KW - self-advocacy KW - patient?health care provider communication N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e50331 UR - http://dx.doi.org/10.2196/50331 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50331 ER - TY - JOUR AU - Hsu, Wan-Chen PY - 2025/2/3 TI - eHealth Literacy and Cyberchondria Severity Among Undergraduate Students: Mixed Methods Study JO - JMIR Form Res SP - e63449 VL - 9 KW - eHealth literacy KW - undergraduate student KW - cyberchondria KW - compucondria KW - web-based health information KW - health information seeking KW - college students N2 - 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 (? coefficient=0.12; P<.05) and web-based physician-patient interaction (? 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. UR - https://formative.jmir.org/2025/1/e63449 UR - http://dx.doi.org/10.2196/63449 ID - info:doi/10.2196/63449 ER - TY - JOUR AU - Thigpen, Nina AU - Patel, Shyamal AU - Zhang, Xi PY - 2025/1/31 TI - Oura Ring as a Tool for Ovulation Detection: Validation Analysis JO - J Med Internet Res SP - e60667 VL - 27 KW - ovulation KW - digital medicine KW - physiology KW - body temperature KW - menstrual cycles KW - wearable KW - fertility KW - nonhormonal contraception KW - reproductive health KW - women?s health KW - calendar method KW - mHealth KW - mobile health KW - detection N2 - 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. UR - https://www.jmir.org/2025/1/e60667 UR - http://dx.doi.org/10.2196/60667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60667 ER - TY - JOUR AU - Puttkammer, Nancy AU - Dunbar, Elizabeth AU - Germanovych, Myroslava AU - Rosol, Mariia AU - Golden, Matthew AU - Hubashova, Anna AU - Fedorchenko, Vladyslav AU - Hetman, Larisa AU - Legkostup, Liudmyla AU - Flowers, Jan AU - Nesterova, Olena PY - 2025/1/30 TI - Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study JO - JMIR Form Res SP - e66132 VL - 9 KW - human-centered design KW - mobile health KW - mHealth KW - Ukraine KW - HIV testing KW - war and humanitarian settings N2 - 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. UR - https://formative.jmir.org/2025/1/e66132 UR - http://dx.doi.org/10.2196/66132 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66132 ER - TY - JOUR AU - Saleem, Maham AU - Zafar, Shamsa AU - Klein, Thomas AU - Koesters, Markus AU - Bashir, Adnan AU - Fuhr, C. Daniela AU - Sikander, Siham AU - Zeeb, Hajo PY - 2025/1/28 TI - 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 JO - JMIR Form Res SP - e59414 VL - 9 KW - digital mental health KW - digital technology KW - digital intervention KW - Problem Management Plus KW - lay health worker programme KW - common mental health disorders KW - low- and middle-income countries KW - co-production N2 - 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. UR - https://formative.jmir.org/2025/1/e59414 UR - http://dx.doi.org/10.2196/59414 UR - http://www.ncbi.nlm.nih.gov/pubmed/39874072 ID - info:doi/10.2196/59414 ER - TY - JOUR AU - Barbazi, Neda AU - Shin, Youn Ji AU - Hiremath, Gurumurthy AU - Lauff, Anne Carlye PY - 2025/1/27 TI - Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy JO - JMIR Form Res SP - e63818 VL - 9 KW - assessment KW - congenital heart disease KW - children health literacy KW - health education KW - caregiving KW - patient-centered care KW - design KW - qualitative pilot KW - children health KW - educational interventions N2 - 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. UR - https://formative.jmir.org/2025/1/e63818 UR - http://dx.doi.org/10.2196/63818 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63818 ER - TY - JOUR AU - Daniels, Kim AU - Vonck, Sharona AU - Robijns, Jolien AU - Quadflieg, Kirsten AU - Bergs, Jochen AU - Spooren, Annemie AU - Hansen, Dominique AU - Bonnechère, Bruno PY - 2025/1/27 TI - 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 JO - JMIR Aging SP - e63348 VL - 8 KW - mobile health KW - mHealth KW - feasibility KW - physical activity KW - older adults KW - health promotion KW - usability KW - mobile phone N2 - 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 UR - https://aging.jmir.org/2025/1/e63348 UR - http://dx.doi.org/10.2196/63348 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63348 ER - TY - JOUR AU - Glaser, Caterina Savannah Lucia AU - Fraterman, Itske AU - van Brummelen, Noah AU - Tibollo, Valentina AU - Del Campo, Maria Laura AU - Mallo, Henk AU - Wilgenhof, Sofie AU - Wilk, Szymon AU - Gisko, Vitali AU - Khadakou, Vadzim AU - Cornet, Ronald AU - Ottaviano, Manuel AU - Medlock, Stephanie PY - 2025/1/23 TI - Usability and Usefulness of a Symptom Management Coaching System for Patients With Cancer Treated With Immune Checkpoint Inhibitors: Comparative Mixed Methods Study JO - JMIR Form Res SP - e57659 VL - 9 KW - oncology KW - usability KW - usefulness KW - symptom management KW - coaching system KW - patients with cancer KW - immune checkpoint inhibitors KW - comparative qualitative study KW - medication KW - eHealth applications KW - caregivers KW - cancer treatment KW - patient education KW - well-being interventions KW - acceptability KW - melanoma KW - renal cell carcinoma KW - immunotherapy N2 - 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. UR - https://formative.jmir.org/2025/1/e57659 UR - http://dx.doi.org/10.2196/57659 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57659 ER - TY - JOUR AU - McMullan, Christel AU - Turner, Grace AU - Retzer, Ameeta AU - Belli, Antonio AU - Davies, Haf Elin AU - Nice, Laura AU - Flavell, Luke AU - Flavell, Jackie AU - Calvert, Melanie PY - 2025/1/23 TI - Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study JO - JMIR Form Res SP - e58128 VL - 9 KW - usability study KW - usability KW - patient reported outcome KW - PRO KW - electronic patient reported outcome KW - ePRO KW - traumatic brain injury KW - TBI KW - think aloud KW - cognitive interviews KW - early warning KW - early detection KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2025/1/e58128 UR - http://dx.doi.org/10.2196/58128 ID - info:doi/10.2196/58128 ER - TY - JOUR AU - Martikainen, Susanna AU - Viitanen, Johanna AU - Salovaara, Samuel AU - Kinnunen, Ulla-Mari AU - Lääveri, Tinja PY - 2025/1/22 TI - Comparisons of Physicians?, Nurses?, and Social Welfare Professionals? Experiences With Participation in Information System Development: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e51495 VL - 12 KW - participation KW - development KW - usability KW - user experience KW - physician KW - nurse KW - social worker KW - information system KW - national survey KW - system development KW - users KW - user feedback KW - cross-sectional survey KW - Finland KW - Finnish N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e51495 UR - http://dx.doi.org/10.2196/51495 ID - info:doi/10.2196/51495 ER - TY - JOUR AU - Hultman, Lisa AU - Eklund, Caroline AU - von Heideken Wågert, Petra AU - Söderlund, Anne AU - Lindén, Maria AU - Elfström, L. Magnus PY - 2025/1/20 TI - Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study JO - JMIR Form Res SP - e63567 VL - 9 KW - behavior change intervention KW - adherence KW - integrated behavior change model KW - autonomous motivation KW - affective determinants N2 - 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. UR - https://formative.jmir.org/2025/1/e63567 UR - http://dx.doi.org/10.2196/63567 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63567 ER - TY - JOUR AU - Salwei, Elizabeth Megan AU - Anders, Shilo AU - Reale, Carrie AU - Slagle, M. Jason AU - Ricketts, Todd AU - Weinger, B. Matthew PY - 2025/1/20 TI - 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 JO - JMIR Hum Factors SP - e65142 VL - 12 KW - usability KW - human factors KW - patient safety KW - over-the-counter hearing aids KW - direct-to-consumer hearing aids KW - medical device KW - hearing loss KW - adult KW - hearing impairment KW - hearing aid use KW - hearing care KW - formative usability test KW - safety KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e65142 UR - http://dx.doi.org/10.2196/65142 ID - info:doi/10.2196/65142 ER - TY - JOUR AU - Ezimora, Ifunanya AU - Lundberg, Tylia AU - Miars, Dylan AU - Trujeque, Jeruel AU - Papias, Ashley AU - Del Cid, V. Margareth AU - Folk, B. Johanna AU - Tolou-Shams, Marina PY - 2025/1/20 TI - Reflections of Foster Youth Engaging in the Co-Design of Digital Mental Health Technology: Duoethnography Study JO - JMIR Form Res SP - e53231 VL - 9 KW - foster youth KW - digital health technology KW - co-design KW - app development KW - mental health KW - adolescent KW - young adult KW - mobile health KW - mHealth KW - foster care KW - duoethnography N2 - 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. UR - https://formative.jmir.org/2025/1/e53231 UR - http://dx.doi.org/10.2196/53231 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53231 ER - TY - JOUR AU - Ramos, Aurélien AU - Boisvert, Maxence AU - Traverse, Elodie AU - Levac, Danielle AU - Lemay, Martin AU - Demers, Marika AU - Bordeleau, Martine AU - Ruest, Sarah-Maude AU - Périnet-Lacroix, Roxanne AU - Best, L. Krista AU - Robert, T. Maxime PY - 2025/1/17 TI - 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 JO - JMIR Serious Games SP - e59704 VL - 13 KW - virtual reality KW - physical activity KW - community organizations KW - accessibility KW - physical disability N2 - 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. UR - https://games.jmir.org/2025/1/e59704 UR - http://dx.doi.org/10.2196/59704 ID - info:doi/10.2196/59704 ER - TY - JOUR AU - Åvik Persson, Helene AU - Castor, Charlotte AU - Andersson, Nilla AU - Hylén, Mia PY - 2025/1/16 TI - Swedish Version of the System Usability Scale: Translation, Adaption, and Psychometric Evaluation JO - JMIR Hum Factors SP - e64210 VL - 12 KW - application KW - Swedish KW - System Usability Scale KW - usability KW - validation N2 - 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 ? 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 UR - https://humanfactors.jmir.org/2025/1/e64210 UR - http://dx.doi.org/10.2196/64210 ID - info:doi/10.2196/64210 ER - TY - JOUR AU - Simioni, Lisa AU - Tessitore, Elena AU - Hagberg, Hamdi AU - Schneider-Paccot, Aurélie AU - Blondon, Katherine AU - Gschwind, Liliane AU - Meyer, Philippe AU - Ehrler, Frederic PY - 2025/1/15 TI - Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study JO - JMIR Form Res SP - e63941 VL - 9 KW - usability KW - medication KW - mobile health KW - mHealth KW - Cardiomeds KW - mobile app KW - patient empowerment KW - eHealth KW - smartphone KW - heart failure KW - HF KW - chronic disease KW - interactive KW - self-monitoring KW - usability test KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2025/1/e63941 UR - http://dx.doi.org/10.2196/63941 UR - http://www.ncbi.nlm.nih.gov/pubmed/39813081 ID - info:doi/10.2196/63941 ER - TY - JOUR AU - Sørensen, Linda AU - Sagen Johannesen, Tomas Dag AU - Melkas, Helinä AU - Johnsen, Mari Hege PY - 2025/1/13 TI - User Acceptance of a Home Robotic Assistant for Individuals With Physical Disabilities: Explorative Qualitative Study JO - JMIR Rehabil Assist Technol SP - e63641 VL - 12 KW - physical artificial intelligence KW - physical AI KW - health care robotics KW - assistive technology KW - content analysis KW - qualitative KW - health care KW - robotics KW - assistive KW - robot interaction KW - physical disabilities KW - readiness KW - amputations N2 - 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. UR - https://rehab.jmir.org/2025/1/e63641 UR - http://dx.doi.org/10.2196/63641 UR - http://www.ncbi.nlm.nih.gov/pubmed/39805579 ID - info:doi/10.2196/63641 ER - TY - JOUR AU - Kwek, Peng Siong AU - Leong, Ying Qiao AU - Lee, Vien V. AU - Lau, Yin Ni AU - Vijayakumar, Smrithi AU - Ng, Ying Wei AU - Rai, Bina AU - Raczkowska, Natalia Marlena AU - Asplund, L. Christopher AU - Remus, Alexandria AU - Ho, Dean PY - 2025/1/13 TI - Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study JO - JMIR Form Res SP - e63568 VL - 9 KW - older adults KW - cognitive training KW - digital therapeutic KW - DTx KW - remote KW - usability KW - acceptance KW - interviews KW - gerontology KW - geriatric KW - elderly KW - experiences KW - attitudes KW - opinions KW - perceptions KW - perspectives KW - interview KW - cognition KW - digital health KW - qualitative KW - thematic N2 - 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. UR - https://formative.jmir.org/2025/1/e63568 UR - http://dx.doi.org/10.2196/63568 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63568 ER - TY - JOUR AU - Fan, Lok Heidi Sze AU - Leung, Yan Emily Tsz AU - Lau, Wing Ka AU - Wong, Ha Janet Yuen AU - Choi, Hang Edmond Pui AU - Lam, Christine AU - Tarrant, Marie AU - Ngan, Sheung Hextan Yuen AU - Ip, Patrick AU - Lin, Chin Chia AU - Lok, Wan Kris Yuet PY - 2025/1/10 TI - A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study JO - JMIR Form Res SP - e64191 VL - 9 KW - Baby-Friendly Community Initiative KW - Baby-Friendly Hospital Initiative KW - breastfeeding KW - community KW - stakeholders KW - mobile app KW - friendly communities KW - baby-friendly KW - well-being KW - mother KW - infant KW - application KW - mHealth KW - qualitative KW - user-friendly KW - self-management N2 - 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. UR - https://formative.jmir.org/2025/1/e64191 UR - http://dx.doi.org/10.2196/64191 ID - info:doi/10.2196/64191 ER - TY - JOUR AU - Lee, Heui Yoon AU - Choi, Hanna AU - Lee, Soo-Kyoung PY - 2025/1/8 TI - Development of Personas and Journey Maps for Artificial Intelligence Agents Supporting the Use of Health Big Data: Human-Centered Design Approach JO - JMIR Form Res SP - e67272 VL - 9 KW - analysis KW - health big data KW - human-centered design KW - persona KW - user journey map KW - artificial intelligence KW - human-AI KW - interviews KW - users? experiences N2 - 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. UR - https://formative.jmir.org/2025/1/e67272 UR - http://dx.doi.org/10.2196/67272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67272 ER - TY - JOUR AU - Bosco, Cristina AU - Otenen, Ege AU - Osorio Torres, John AU - Nguyen, Vivian AU - Chheda, Darshil AU - Peng, Xinran AU - Jessup, M. Nenette AU - Himes, K. Anna AU - Cureton, Bianca AU - Lu, Yvonne AU - Hill, V. Carl AU - Hendrie, C. Hugh AU - Barnes, A. Priscilla AU - Shih, C. Patrick PY - 2025/1/8 TI - 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 JO - JMIR Aging SP - e60566 VL - 8 KW - multimodality KW - artificial intelligence KW - AI KW - generative AI KW - usability KW - black KW - African American KW - cultural KW - Alzheimer's KW - dementia KW - caregivers KW - mobile app KW - interaction KW - cognition KW - user opinion KW - geriatrics KW - smartphone KW - mHealth KW - digital health KW - aging N2 - 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. UR - https://aging.jmir.org/2025/1/e60566 UR - http://dx.doi.org/10.2196/60566 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60566 ER - TY - JOUR AU - Bierbooms, A. Joyce J. P. AU - Sluis-Thiescheffer, W. Wouter R. J. AU - Feijt, Anne Milou AU - Bongers, B. Inge M. PY - 2025/1/7 TI - Co-Design of an Escape Room for e-Mental Health Training of Mental Health Care Professionals: Research Through Design Study JO - JMIR Form Res SP - e58650 VL - 9 KW - serious gaming KW - mental health care professionals KW - e-mental health KW - skill enhancement KW - training N2 - 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. UR - https://formative.jmir.org/2025/1/e58650 UR - http://dx.doi.org/10.2196/58650 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58650 ER - TY - JOUR AU - Burrell, Joanna AU - Baker, Felicity AU - Bennion, Russell Matthew PY - 2025/1/6 TI - Resilience Training Web App for National Health Service Keyworkers: Pilot Usability Study JO - JMIR Med Educ SP - e51101 VL - 11 KW - resilience KW - workplace stress KW - National Health Service KW - NHS keyworker KW - digital learning KW - digital health KW - usability KW - feasibility KW - mental health KW - pilot study KW - learning KW - training KW - exercise KW - primary care provider KW - health care professional KW - occupational health KW - worker KW - hospital KW - emergency KW - survey KW - questionnaire KW - mobile phone N2 - 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. UR - https://mededu.jmir.org/2025/1/e51101 UR - http://dx.doi.org/10.2196/51101 ID - info:doi/10.2196/51101 ER - TY - JOUR AU - Malhotra, Chetna AU - Yee, Alethea AU - Ramakrishnan, Chandrika AU - Kaurani, Naraindas Sanam AU - Chua, Ivy AU - Lakin, R. Joshua AU - Sim, David AU - Balakrishnan, Iswaree AU - Ling, Jin Vera Goh AU - Weiliang, Huang AU - Ling, Fong Lee AU - Pollak, I. Kathryn PY - 2024/12/18 TI - Development and Usability of an Advance Care Planning Website (My Voice) to Empower Patients With Heart Failure and Their Caregivers: Mixed Methods Study JO - JMIR Aging SP - e60117 VL - 7 KW - advance care planning KW - decision aid KW - heart KW - website KW - heart failure KW - care plan KW - caregiver KW - usability KW - acceptability N2 - 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 UR - https://aging.jmir.org/2024/1/e60117 UR - http://dx.doi.org/10.2196/60117 ID - info:doi/10.2196/60117 ER - TY - JOUR AU - Park, Ye-Eun AU - Tak, Won Yae AU - Kim, Inhye AU - Lee, Jeong Hui AU - Lee, Bok Jung AU - Lee, Won Jong AU - Lee, Yura PY - 2024/12/18 TI - User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study JO - J Med Internet Res SP - e55176 VL - 26 KW - mHealth KW - user experience KW - cancer KW - technology acceptance model KW - structural equation modeling KW - health care app KW - mixed-method study KW - medical care KW - digital health care KW - cancer survivors KW - disparities KW - health status KW - behavioral intervention KW - clinician N2 - 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 (?=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. UR - https://www.jmir.org/2024/1/e55176 UR - http://dx.doi.org/10.2196/55176 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55176 ER - TY - JOUR AU - Probst, Freya AU - Rees, Jessica AU - Aslam, Zayna AU - Mexia, Nikitia AU - Molteni, Erika AU - Matcham, Faith AU - Antonelli, Michela AU - Tinker, Anthea AU - Shi, Yu AU - Ourselin, Sebastien AU - Liu, Wei PY - 2024/12/17 TI - Evaluating a Smart Textile Loneliness Monitoring System for Older People: Co-Design and Qualitative Focus Group Study JO - JMIR Aging SP - e57622 VL - 7 KW - loneliness KW - smart textiles KW - wearable technology KW - health monitoring KW - older people KW - co-design KW - design requirement KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2024/1/e57622 UR - http://dx.doi.org/10.2196/57622 UR - http://www.ncbi.nlm.nih.gov/pubmed/39688889 ID - info:doi/10.2196/57622 ER - TY - JOUR AU - Bunnell, E. Brian AU - Schuler, R. Kaitlyn AU - Ivanova, Julia AU - Flynn, Lea AU - Barrera, F. Janelle AU - Niazi, Jasmine AU - Turner, Dylan AU - Welch, M. Brandon PY - 2024/12/12 TI - Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study JO - JMIR Hum Factors SP - e56567 VL - 11 KW - mental health KW - mental illness KW - mental disease KW - mental disorder KW - homework KW - homework challenge KW - therapy KW - therapist KW - barriers KW - adult client KW - adult KW - technology-based solution KW - health technology KW - digital health KW - digital technology KW - digital intervention KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e56567 UR - http://dx.doi.org/10.2196/56567 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56567 ER - TY - JOUR AU - Schnitzbauer, A. Andreas AU - Detemble, Charlotte AU - Faqar-Uz-Zaman, Fatima Sara AU - Dreilich, Julia AU - Mohr, Lisa AU - Sliwinski, Svenja AU - Zmuc, Dora AU - Siller, Mark AU - Fleckenstein, Johannes PY - 2024/12/11 TI - Usability Testing of a Digitized Interventional Prehabilitation Tool for Health Care Professionals and Patients Before Major Surgeries: Formative and Summative Evaluation JO - JMIR Form Res SP - e59513 VL - 8 KW - usability testing KW - prehabilitation KW - MARS KW - Mobile Application Rating Scale KW - trustworthiness KW - surgical research KW - usability KW - prerehabilitation tool KW - tool KW - medical device KW - surgery KW - device KW - application KW - design KW - engineering KW - development N2 - 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 UR - https://formative.jmir.org/2024/1/e59513 UR - http://dx.doi.org/10.2196/59513 UR - http://www.ncbi.nlm.nih.gov/pubmed/39661439 ID - info:doi/10.2196/59513 ER - TY - JOUR AU - Fobelets, Kristel AU - Mohanty, Nikita AU - Thielemans, Mara AU - Thielemans, Lieze AU - Lake-Thompson, Gillian AU - Liu, Meijing AU - Jopling, Kate AU - Yang, Kai PY - 2024/12/10 TI - User Perceptions of Wearability of Knitted Sensor Garments for Long-Term Monitoring of Breathing Health: Thematic Analysis of Focus Groups and a Questionnaire Survey JO - JMIR Biomed Eng SP - e58166 VL - 9 KW - health technology KW - wearability of knitted sensors KW - focus groups KW - asthma observation KW - medical device KW - wearable device KW - medical instrument KW - medical equipment KW - medical tool KW - sensor KW - physiological sensor KW - focus group KW - breathing KW - respiratory KW - respirology KW - lung KW - monitoring KW - monitor KW - health monitoring N2 - 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. UR - https://biomedeng.jmir.org/2024/1/e58166 UR - http://dx.doi.org/10.2196/58166 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58166 ER - TY - JOUR AU - Nuseibeh, Zenk Betsey AU - Johns, A. Shelley AU - Shih, C. Patrick AU - Lewis, F. Gregory AU - Gowan, M. Tayler AU - Jordan, J. Evan PY - 2024/12/9 TI - Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach JO - JMIR Form Res SP - e59426 VL - 8 KW - breast cancer survivors KW - acceptance and commitment therapy KW - mHealth app KW - user-centered design KW - depression KW - anxiety KW - therapy KW - app KW - breast cancer KW - expert KW - designer KW - psychosocial KW - need KW - co-design KW - MOSAIC KW - mobile acceptance and commitment therapy stress intervention KW - interviews N2 - 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. UR - https://formative.jmir.org/2024/1/e59426 UR - http://dx.doi.org/10.2196/59426 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59426 ER - TY - JOUR AU - Bruni, Francesca AU - Mancuso, Valentina AU - Panigada, Jonathan AU - Stramba-Badiale, Marco AU - Cipresso, Pietro AU - Pedroli, Elisa PY - 2024/12/5 TI - Exploring How Older Adults Experience semAPP, a 360° Media?Based Tool for Memory Assessment: Qualitative Study JO - JMIR Aging SP - e56796 VL - 7 KW - assessment KW - virtual reality KW - 360-degree videos KW - user experience KW - memory KW - aging KW - psycho gerontology N2 - 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° 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. UR - https://aging.jmir.org/2024/1/e56796 UR - http://dx.doi.org/10.2196/56796 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56796 ER - TY - JOUR AU - Golsong, Konstanze AU - Kaufmann, Luisa AU - Baldofski, Sabrina AU - Kohls, Elisabeth AU - Rummel-Kluge, Christine PY - 2024/12/4 TI - 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 JO - JMIR Form Res SP - e60461 VL - 8 KW - mental health KW - eHealth KW - app KW - health care KW - app-based support KW - psychiatric symptoms KW - mobile phone KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2024/1/e60461 UR - http://dx.doi.org/10.2196/60461 UR - http://www.ncbi.nlm.nih.gov/pubmed/39630503 ID - info:doi/10.2196/60461 ER - TY - JOUR AU - Richardson, Leanne AU - Noori, Nihal AU - Fantham, Jack AU - Timlin, Gregor AU - Siddle, James AU - Godec, Thomas AU - Taylor, Mike AU - Baum, Charles PY - 2024/12/3 TI - 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 JO - JMIR Mhealth Uhealth SP - e53430 VL - 12 KW - digital diary KW - hypertension KW - blood pressure KW - remote monitoring KW - smartphone app KW - mobile phone KW - app KW - monitoring KW - COVID-19 KW - SARS-CoV-2 KW - digital intervention KW - management KW - observational study KW - deployment KW - feasibility KW - use KW - safety KW - medication KW - symptoms KW - community KW - systolic KW - diastolic KW - utilization N2 - 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. UR - https://mhealth.jmir.org/2024/1/e53430 UR - http://dx.doi.org/10.2196/53430 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53430 ER - TY - JOUR AU - Jolliff, Anna AU - Holden, J. Richard AU - Valdez, Rupa AU - Coller, J. Ryan AU - Patel, Himalaya AU - Zuraw, Matthew AU - Linden, Anna AU - Ganci, Aaron AU - Elliott, Christian AU - Werner, E. Nicole PY - 2024/12/3 TI - Investigating the Best Practices for Engagement in Remote Participatory Design: Mixed Methods Analysis of 4 Remote Studies With Family Caregivers JO - J Med Internet Res SP - e60353 VL - 26 KW - user-centered design KW - family caregivers KW - mobile health KW - digital health KW - web-based intervention KW - stakeholder engagement KW - patient engagement KW - community-based participatory action research KW - community participation KW - qualitative evaluation N2 - 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. UR - https://www.jmir.org/2024/1/e60353 UR - http://dx.doi.org/10.2196/60353 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60353 ER - TY - JOUR AU - McCann, Lisa AU - Lewis, Liane AU - Oduntan, Olubukola AU - Harris, Jenny AU - Darley, Andrew AU - Berg, V. Geir AU - Lubowitzki, Simone AU - Cheevers, Katy AU - Miller, Morven AU - Armes, Jo AU - Ream, Emma AU - Fox, Patricia AU - Furlong, Patricia Eileen AU - Gaiger, Alexander AU - Kotronoulas, Grigorios AU - Patiraki, Elisabeth AU - Katsaragakis, Stylianos AU - McCrone, Paul AU - Miaskowski, Christine AU - Cardone, Antonella AU - Orr, Dawn AU - Flowerday, Adrian AU - Skene, Simon AU - Moore, Margaret AU - De Souza, Nicosha AU - Donnan, Peter AU - Maguire, Roma PY - 2024/12/3 TI - Patients? and Clinicians? Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study JO - J Med Internet Res SP - e53834 VL - 26 KW - cancer KW - clinician experiences KW - digital interventions KW - patient experiences KW - remote monitoring KW - qualitative methods N2 - 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 UR - https://www.jmir.org/2024/1/e53834 UR - http://dx.doi.org/10.2196/53834 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53834 ER - TY - JOUR AU - Zhang, Zhan AU - Bai, Enze AU - Xu, Yincao AU - Stepanian, Aram AU - Kutzin, M. Jared AU - Adelgais, Kathleen AU - Ozkaynak, Mustafa PY - 2024/11/29 TI - A Smart Glass Telemedicine Application for Prehospital Communication: User-Centered Design Study JO - J Med Internet Res SP - e53157 VL - 26 KW - smart glass KW - telemedicine KW - participatory design KW - emergency medical service KW - health care KW - prehospital care KW - mobile health KW - mHealth KW - augmented reality N2 - 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. UR - https://www.jmir.org/2024/1/e53157 UR - http://dx.doi.org/10.2196/53157 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53157 ER - TY - JOUR AU - Mengistu, Meron AU - Tom, Kris AU - Gebremikael, Liben AU - Massaquoi, Notisha AU - Ezezika, Obidimma PY - 2024/11/29 TI - Tracking Implementation Outcomes of an Intensive Case Management Program for HIV: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e57452 VL - 13 KW - implementation science KW - intensive case management KW - ICM KW - human immunodeficiency virus KW - HIV KW - tracking KW - outcome KW - fidelity KW - reach KW - sustainability KW - implementation outcomes KW - perspective KW - perception KW - Toronto KW - Canada KW - descriptive statistics KW - evidence-based intervention KW - effectiveness KW - barriers KW - facilitators KW - adoption N2 - 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 UR - https://www.researchprotocols.org/2024/1/e57452 UR - http://dx.doi.org/10.2196/57452 UR - http://www.ncbi.nlm.nih.gov/pubmed/39612213 ID - info:doi/10.2196/57452 ER - TY - JOUR AU - Lancioni, E. Giulio AU - Alberti, Gloria AU - Filippini, Chiara AU - Singh, N. Nirbhay AU - O?Reilly, F. Mark AU - Sigafoos, Jeff AU - Orlando, Isabella AU - Desideri, Lorenzo PY - 2024/11/27 TI - A Technology System to Help People With Intellectual Disability and Blindness Find Room Destinations During Indoor Traveling: Case Series Study JO - JMIR Rehabil Assist Technol SP - e65680 VL - 11 KW - barcode reader KW - barcode KW - blindness KW - intellectual disability KW - indoor traveling KW - indoor travel KW - digital health KW - travel KW - navigation KW - wayfinding KW - patient care KW - patient support KW - mobile health KW - patient assessment KW - health intervention KW - user engagement KW - technology use KW - telerehabilitation KW - rehabilitation KW - disability KW - support tools KW - mobility KW - orientation KW - mobile phone N2 - 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. UR - https://rehab.jmir.org/2024/1/e65680 UR - http://dx.doi.org/10.2196/65680 UR - http://www.ncbi.nlm.nih.gov/pubmed/39602792 ID - info:doi/10.2196/65680 ER - TY - JOUR AU - Wosny, Marie AU - Strasser, Maria Livia AU - Kraehenmann, Simone AU - Hastings, Janna PY - 2024/11/27 TI - Practical Recommendations for Navigating Digital Tools in Hospitals: Qualitative Interview Study JO - JMIR Med Educ SP - e60031 VL - 10 KW - health care KW - hospital KW - information system KW - information technology KW - technology implementation KW - training KW - medical education KW - digital literacy KW - curriculum development KW - health care workforce development KW - mobile phone N2 - 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. UR - https://mededu.jmir.org/2024/1/e60031 UR - http://dx.doi.org/10.2196/60031 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60031 ER - TY - JOUR AU - Jain, Ekta AU - Gupta, Srishti AU - Yadav, Vandana AU - Kachnowski, Stan PY - 2024/11/25 TI - Assessing the Usability and Effectiveness of an AI-Powered Telehealth Platform: Mixed Methods Study on the Perspectives of Patients and Providers JO - JMIR Form Res SP - e62742 VL - 8 KW - usability study KW - telemedicine KW - web platform KW - patient-provider feedback KW - artificial intelligence KW - AI triage N2 - 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. UR - https://formative.jmir.org/2024/1/e62742 UR - http://dx.doi.org/10.2196/62742 UR - http://www.ncbi.nlm.nih.gov/pubmed/39418632 ID - info:doi/10.2196/62742 ER - TY - JOUR AU - Chua, Chien Mei AU - Hadimaja, Matthew AU - Wong, Jill AU - Mukherjee, Subhra Sankha AU - Foussat, Agathe AU - Chan, Daniel AU - Nandal, Umesh AU - Yap, Fabian PY - 2024/11/22 TI - 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 JO - JMIR Pediatr Parent SP - e59564 VL - 7 KW - computer vision KW - length estimation KW - artificial intelligence KW - smartphone images KW - children KW - AI KW - algorithm KW - imaging KW - height KW - length KW - measure KW - pediatric KW - infant KW - neonatal KW - newborn KW - smartphone KW - mHealth KW - mobile health KW - mobile phone N2 - 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 UR - https://pediatrics.jmir.org/2024/1/e59564 UR - http://dx.doi.org/10.2196/59564 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59564 ER - TY - JOUR AU - Wettstein, Reto AU - Sedaghat-Hamedani, Farbod AU - Heinze, Oliver AU - Amr, Ali AU - Reich, Christoph AU - Betz, Theresa AU - Kayvanpour, Elham AU - Merzweiler, Angela AU - Büsch, Christopher AU - Mohr, Isabell AU - Friedmann-Bette, Birgit AU - Frey, Norbert AU - Dugas, Martin AU - Meder, Benjamin PY - 2024/11/22 TI - A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e58441 VL - 12 KW - wearable KW - consumer device KW - mobile phone KW - mobile health KW - telemedicine KW - remote patient monitoring KW - usability KW - Health Level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - cardiology KW - heart failure KW - dilated cardiomyopathy N2 - 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. UR - https://mhealth.jmir.org/2024/1/e58441 UR - http://dx.doi.org/10.2196/58441 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58441 ER - TY - JOUR AU - Ahumada-Newhart, Veronica AU - Wood, Taffeta AU - Satake, Noriko AU - Marcin, P. James PY - 2024/11/21 TI - Health Perceptions and Practices of a Telewellness Fitness Program: Exploratory Case Study JO - JMIR Form Res SP - e50710 VL - 8 KW - telehealth KW - telewellness KW - online fitness KW - health equity KW - community health KW - group exercise KW - mobile phone KW - mobile device N2 - 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. UR - https://formative.jmir.org/2024/1/e50710 UR - http://dx.doi.org/10.2196/50710 ID - info:doi/10.2196/50710 ER - TY - JOUR AU - Drogt, Jojanneke AU - Milota, Megan AU - Veldhuis, Wouter AU - Vos, Shoko AU - Jongsma, Karin PY - 2024/11/21 TI - The Promise of AI for Image-Driven Medicine: Qualitative Interview Study of Radiologists? and Pathologists? Perspectives JO - JMIR Hum Factors SP - e52514 VL - 11 KW - digital medicine KW - computer vision KW - medical AI KW - image-driven specialisms KW - qualitative interview study KW - digital health ethics KW - artificial intelligence KW - AI KW - imaging KW - imaging informatics KW - radiology KW - pathology N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e52514 UR - http://dx.doi.org/10.2196/52514 ID - info:doi/10.2196/52514 ER - TY - JOUR AU - Schmollinger, Martin AU - Gerstner, Jessica AU - Stricker, Eric AU - Muench, Alexander AU - Breckwoldt, Benjamin AU - Sigle, Manuel AU - Rosenberger, Peter AU - Wunderlich, Robert PY - 2024/11/21 TI - Evaluation of an App-Based Mobile Triage System for Mass Casualty Incidents: Within-Subjects Experimental Study JO - J Med Internet Res SP - e65728 VL - 26 KW - disaster medicine KW - mass casualty incidents KW - digitalization KW - triage KW - Germany KW - mobile triage app N2 - 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) × 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. UR - https://www.jmir.org/2024/1/e65728 UR - http://dx.doi.org/10.2196/65728 UR - http://www.ncbi.nlm.nih.gov/pubmed/39474975 ID - info:doi/10.2196/65728 ER - TY - JOUR AU - Alnooh, Ghadah AU - AlTamimi, Z. Jozaa AU - Williams, A. Elizabeth AU - Hawley, S. Mark PY - 2024/11/19 TI - 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 JO - JMIR Form Res SP - e60037 VL - 8 KW - hypertension KW - blood pressure KW - Dietary Approaches to Stop Hypertension KW - DASH diet KW - self-efficacy KW - mobile health KW - mHealth KW - Saudi Arabia KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e60037 UR - http://dx.doi.org/10.2196/60037 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60037 ER - TY - JOUR AU - Ricci, Sofia Fabiana AU - Liguori, Lorenzo AU - Palermo, Eduardo AU - Rizzo, John-Ross AU - Porfiri, Maurizio PY - 2024/11/18 TI - Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study JO - JMIR Rehabil Assist Technol SP - e55776 VL - 11 KW - assistive technology KW - human-computer interaction KW - multisensory feedback KW - virtual reality KW - visual impairment KW - haptic N2 - 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. UR - https://rehab.jmir.org/2024/1/e55776 UR - http://dx.doi.org/10.2196/55776 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55776 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Bayuo, Jonathan AU - Su, Jing Jing AU - Wong, Yuet Frances Kam AU - Chow, Sum Karen Kit AU - Wong, Po Bonnie AU - Wong, Man Siu AU - Hui, Vivian PY - 2024/11/18 TI - 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 JO - J Med Internet Res SP - e52435 VL - 26 KW - wearable monitoring device KW - lay worker KW - smartwatch KW - older adult KW - nurse KW - engagement KW - attrition KW - wearable KW - user experience N2 - 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 (?=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 UR - https://www.jmir.org/2024/1/e52435 UR - http://dx.doi.org/10.2196/52435 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52435 ER - TY - JOUR AU - Essop, Hafsa AU - Kekana, Mable Ramadimetja AU - Brosens, Jacques AU - Smuts, Hanlie PY - 2024/11/15 TI - 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 JO - JMIR Form Res SP - e58608 VL - 8 KW - mobile app KW - design science research KW - usefulness KW - pregnant radiographers KW - fetal dosimetry KW - occupational health and safety KW - mobile phone KW - maternal and child health KW - PregiDose N2 - 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. UR - https://formative.jmir.org/2024/1/e58608 UR - http://dx.doi.org/10.2196/58608 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58608 ER - TY - JOUR AU - Rivera Rivera, Nathalie Jessica AU - AuBuchon, E. Katarina AU - Smith, Marjanna AU - Starling, Claire AU - Ganacias, G. Karen AU - Danielson, Aimee AU - Patchen, Loral AU - Rethy, A. Janine AU - Blumenthal, Joseph H. AU - Thomas, D. Angela AU - Arem, Hannah PY - 2024/11/14 TI - Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study JO - JMIR Pediatr Parent SP - e56807 VL - 7 KW - postpartum care KW - newborn care KW - health education KW - chatbot KW - mHealth KW - mobile health KW - feedback KW - health equity N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e56807 UR - http://dx.doi.org/10.2196/56807 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56807 ER - TY - JOUR AU - Shojaei, Fereshtehossadat AU - Shojaei, Fatemehalsadat AU - Desai, P. Archita AU - Long, Emily AU - Mehta, Jade AU - Fowler, R. Nicole AU - Holden, J. Richard AU - Orman, S. Eric AU - Boustani, Malaz PY - 2024/11/13 TI - The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design JO - JMIR Form Res SP - e57390 VL - 8 KW - AgileNudge+ KW - agile KW - nudge strategy KW - nudging interventions KW - agile implementation KW - human behavior KW - software design KW - human-computer interaction KW - user experience design KW - usability testing N2 - 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. UR - https://formative.jmir.org/2024/1/e57390 UR - http://dx.doi.org/10.2196/57390 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57390 ER - TY - JOUR AU - Reynolds, W. Christopher AU - Lee, HaEun AU - Sieka, Joseph AU - Perosky, Joseph AU - Lori, R. Jody PY - 2024/11/13 TI - Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia JO - JMIR Mhealth Uhealth SP - e58624 VL - 12 KW - mHealth KW - mobile triage KW - referral pathways KW - Liberia KW - LMIC KW - low- income country KW - obstetric triage KW - third delay KW - mobile health KW - mobile application KW - digital health KW - digital intervention KW - smartphone KW - middle-income country N2 - 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. UR - https://mhealth.jmir.org/2024/1/e58624 UR - http://dx.doi.org/10.2196/58624 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58624 ER - TY - JOUR AU - Merry, Kohle AU - MacPherson, M. Megan AU - Whittaker, L. Jackie AU - Napier, Christopher AU - Holsti, Liisa AU - Scott, Alex PY - 2024/11/13 TI - An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study JO - JMIR Hum Factors SP - e57873 VL - 11 KW - exercise therapy KW - physical therapy modalities KW - rehabilitation KW - tendons KW - tendinopathy KW - mobile health KW - mHealth KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e57873 UR - http://dx.doi.org/10.2196/57873 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57873 ER - TY - JOUR AU - Duran, T. Andrea AU - Cumella, M. Robin AU - Mendieta, Miguel AU - Keener-Denoia, Adrianna AU - López Veneros, David AU - Farris, G. Samantha AU - Moise, Nathalie AU - Kronish, M. Ian PY - 2024/11/12 TI - 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 JO - JMIR Form Res SP - e55137 VL - 8 KW - behavioral intervention development KW - implementation science KW - acute coronary syndrome KW - exercise sensitivity KW - interoceptive exposure KW - digital health KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e55137 UR - http://dx.doi.org/10.2196/55137 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55137 ER - TY - JOUR AU - Wang, Tzu AU - Huang, Yen-Ming AU - Chan, Hsun-Yu PY - 2024/11/8 TI - Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review JO - J Med Internet Res SP - e60787 VL - 26 KW - Asia KW - adherence KW - application KW - feature KW - medication KW - mobile N2 - 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. UR - https://www.jmir.org/2024/1/e60787 UR - http://dx.doi.org/10.2196/60787 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60787 ER - TY - JOUR AU - Straand, J. Ingjerd AU - Følstad, Asbjørn AU - Wünsche, C. Burkhard PY - 2024/11/8 TI - A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study JO - JMIR Form Res SP - e59158 VL - 8 KW - web-based intervention KW - positive psychology KW - mental health KW - user experience KW - persuasive design N2 - 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 RØST, 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. UR - https://formative.jmir.org/2024/1/e59158 UR - http://dx.doi.org/10.2196/59158 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59158 ER - TY - JOUR AU - Lange-Drenth, Lukas AU - Schulz, Holger AU - Suck, Isabell AU - Bleich, Christiane PY - 2024/11/8 TI - Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders JO - JMIR Form Res SP - e51865 VL - 8 KW - telerehabilitation KW - rehabilitation KW - eHealth development KW - value specification KW - stakeholder participation KW - occupational injuries KW - vocational rehabilitation KW - aftercare KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e51865 UR - http://dx.doi.org/10.2196/51865 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51865 ER - TY - JOUR AU - Berger, Mathilde AU - Deblock-Bellamy, Anne AU - Chèze, Laurence AU - Robert, Thomas AU - Desrosiers, J. Julie AU - Christe, Guillaume AU - Bertrand, Martine Anne PY - 2024/11/7 TI - 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 JO - JMIR Hum Factors SP - e59897 VL - 11 KW - chronic low back pain KW - needs KW - self-management KW - physical activity KW - mobile health KW - mHealth KW - user-centered design N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e59897 UR - http://dx.doi.org/10.2196/59897 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59897 ER - TY - JOUR AU - Larson, Elizabeth AU - Mattie, L. Rebecca AU - Riffkin, A. Sophia PY - 2024/10/31 TI - 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 JO - JMIR Hum Factors SP - e54171 VL - 11 KW - autism KW - caregiver KW - activities KW - mindfulness KW - mobile application KW - stress KW - wellness KW - app KW - application KW - usage KW - children KW - developmental disability KW - usability KW - acceptability KW - meditation KW - wellness application N2 - 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 UR - https://humanfactors.jmir.org/2024/1/e54171 UR - http://dx.doi.org/10.2196/54171 ID - info:doi/10.2196/54171 ER - TY - JOUR AU - Lopez-Olivo, A. Maria AU - Suarez-Almazor, E. Maria AU - Duhon, F. Gabrielle AU - Cherry, McKenna AU - Lu, Huifang AU - Calabrese, Cassandra AU - Altan, Mehmet AU - Tawbi, Hussain AU - Meara, Alexa AU - Bingham, O. Clifton AU - Diab, Adi AU - Leal, B. Viola AU - Volk, J. Robert PY - 2024/10/25 TI - Development of an Educational Website for Patients With Cancer and Preexisting Autoimmune Diseases Considering Immune Checkpoint Blockers: Usability and Acceptability Study JO - JMIR Cancer SP - e53443 VL - 10 KW - immune checkpoint inhibitors KW - patient education KW - usability testing KW - cancer KW - autoimmune diseases KW - mobile phones KW - user testing KW - usability KW - user experience KW - immunotherapy KW - websites KW - development KW - acceptability KW - autoimmune KW - immunology KW - oncology KW - architecture KW - iterative KW - vasculitis KW - Crohn disease KW - Sjogren syndrome KW - educational KW - web-based resource KW - health information KW - rheumatology KW - arthritis KW - web design KW - eHealth KW - adverse events KW - patient care KW - treatment N2 - 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. UR - https://cancer.jmir.org/2024/1/e53443 UR - http://dx.doi.org/10.2196/53443 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53443 ER - TY - JOUR AU - Manning, B. Julia AU - Blandford, Ann AU - Edbrooke-Childs, Julian PY - 2024/10/22 TI - Facilitators of and Barriers to Teachers? Engagement With Consumer Technologies for Stress Management: Qualitative Study JO - J Med Internet Res SP - e50457 VL - 26 KW - teachers KW - stress KW - workplace KW - self-management KW - digital health KW - technology KW - qualitative KW - context KW - high schools KW - wearables KW - apps KW - human-computer interaction KW - HCI KW - personal informatics N2 - 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. UR - https://www.jmir.org/2024/1/e50457 UR - http://dx.doi.org/10.2196/50457 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50457 ER - TY - JOUR AU - Kabukye, K. Johnblack AU - Nakku, Juliet AU - Niwemuhwezi, Jackline AU - Nsereko, James AU - Namagembe, Rosemary AU - Groen, Emilie Iris Dorothee AU - Neumbe, Ritah AU - Mubiru, Denis AU - Kisakye, Caroline AU - Nanyonga, Roseline AU - Sjölinder, Marie AU - Nilsson, Susanne AU - Wamala-Larsson, Caroline PY - 2024/10/21 TI - Assessing the Usage and Usability of a Mental Health Advice Telephone Service in Uganda: Mixed Methods Study JO - J Med Internet Res SP - e65692 VL - 26 KW - mHealth KW - mental health KW - telephone service KW - usability KW - satisfaction KW - evaluation KW - mixed method KW - Uganda KW - Africa N2 - 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. UR - https://www.jmir.org/2024/1/e65692 UR - http://dx.doi.org/10.2196/65692 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65692 ER - TY - JOUR AU - Fietta, Valentina AU - Rizzi, Silvia AU - De Luca, Chiara AU - Gios, Lorenzo AU - Pavesi, Chiara Maria AU - Gabrielli, Silvia AU - Monaro, Merylin AU - Forti, Stefano PY - 2024/10/18 TI - A Chatbot-Based Version of the World Health Organization?Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing JO - JMIR Hum Factors SP - e64614 VL - 11 KW - acceptance and commitment therapy KW - ACT KW - well-being KW - pregnancy KW - breast cancer KW - eHealth KW - mobile health KW - mHealth KW - development KW - usability KW - user-centered design N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e64614 UR - http://dx.doi.org/10.2196/64614 UR - http://www.ncbi.nlm.nih.gov/pubmed/39355954 ID - info:doi/10.2196/64614 ER - TY - JOUR AU - Ditmore, H. Melissa AU - Florez-Arango, Fernando Jose PY - 2024/10/9 TI - 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 JO - JMIR Hum Factors SP - e53557 VL - 11 KW - mobile health KW - sex worker KW - user-centered design methods KW - usability KW - heuristic analysis KW - cognitive walkthrough KW - aggression KW - abuse KW - occupational health KW - reporting KW - prototype KW - heuristics KW - human-centered design KW - implementation KW - barriers KW - enablers KW - data collection KW - digital health KW - underreporting N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e53557 UR - http://dx.doi.org/10.2196/53557 ID - info:doi/10.2196/53557 ER - TY - JOUR AU - Tarver, L. Willi AU - Savoy, April AU - Patel, Himalaya AU - Weiner, Michael AU - Holden, J. Richard PY - 2024/9/30 TI - Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis JO - JMIR Hum Factors SP - e49691 VL - 11 KW - health information technology KW - mobile devices KW - nursing and nursing systems KW - outpatient care KW - SEIPS 2.0 KW - work-system analysis N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e49691 UR - http://dx.doi.org/10.2196/49691 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49691 ER - TY - JOUR AU - Chen, David AU - Cao, Christian AU - Kloosterman, Robert AU - Parsa, Rod AU - Raman, Srinivas PY - 2024/9/23 TI - Trial Factors Associated With Completion of Clinical Trials Evaluating AI: Retrospective Case-Control Study JO - J Med Internet Res SP - e58578 VL - 26 KW - artificial intelligence KW - clinical trial KW - completion KW - AI KW - cross-sectional study KW - application KW - intervention KW - trial design KW - logistic regression KW - Europe KW - clinical KW - trials testing KW - health care KW - informatics KW - health information N2 - 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. UR - https://www.jmir.org/2024/1/e58578 UR - http://dx.doi.org/10.2196/58578 UR - http://www.ncbi.nlm.nih.gov/pubmed/39312296 ID - info:doi/10.2196/58578 ER - TY - JOUR AU - Anthony, J. Samantha AU - Pol, J. Sarah AU - Selkirk, K. Enid AU - Matthiesen, Amarens AU - Klaassen, J. Robert AU - Manase, Dorin AU - Silva, Amanda AU - Barwick, Melanie AU - Stinson, N. Jennifer AU - Damer, Alameen AU - Ayibiowu, Mowa AU - Dong, X. Selina AU - Oreskovich, Stephan AU - Brudno, Michael PY - 2024/9/19 TI - User-Centered Design and Usability of Voxe as a Pediatric Electronic Patient-Reported Outcome Measure Platform: Mixed Methods Evaluation Study JO - JMIR Hum Factors SP - e57984 VL - 11 KW - eHealth KW - end user engagement KW - mobile phone KW - patient-reported outcome KW - patient-reported outcome measures KW - pediatric KW - user-centered design N2 - 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 UR - https://humanfactors.jmir.org/2024/1/e57984 UR - http://dx.doi.org/10.2196/57984 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57984 ER - TY - JOUR AU - Staras, S. Stephanie A. AU - Tauscher, Justin AU - Vinson, Michelle AU - Thompson, A. Lindsay AU - Gerend, A. Mary AU - Shenkman, A. Elizabeth PY - 2024/9/19 TI - Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment JO - JMIR Form Res SP - e56559 VL - 8 KW - participatory design KW - think-aloud KW - implementation science KW - adolescent vaccination KW - human papillomavirus vaccine KW - usability KW - eHealth N2 - 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. UR - https://formative.jmir.org/2024/1/e56559 UR - http://dx.doi.org/10.2196/56559 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56559 ER - TY - JOUR AU - Johnsen, Mari Hege AU - Nes, Gonçalves Andréa Aparecida AU - Haddeland, Kristine PY - 2024/9/10 TI - 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 JO - JMIR Nursing SP - e48810 VL - 7 KW - application KW - assessment of clinical education KW - AssCE KW - clinical education assessment tool KW - electronic reports KW - feedback KW - guidance model KW - smartphone KW - Technology-Optimized Practice Process in Nursing KW - TOPP-N KW - information system success model KW - nurse KW - nursing KW - allied health KW - education KW - focus group KW - focus groups KW - technology enhanced learning KW - digital health KW - content analysis KW - student KW - students KW - nursing home KW - long-term care KW - learning management KW - mobile phone N2 - 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. UR - https://nursing.jmir.org/2024/1/e48810 UR - http://dx.doi.org/10.2196/48810 UR - http://www.ncbi.nlm.nih.gov/pubmed/39255477 ID - info:doi/10.2196/48810 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Solano, Luque Juan AU - Talbot, Charlotte AU - Giacco, Domenico PY - 2024/9/5 TI - Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience JO - JMIR Pediatr Parent SP - e53907 VL - 7 KW - digital microintervention KW - parenting app KW - product management KW - parent KW - parents KW - parenting KW - app KW - apps KW - usability KW - acceptability KW - family KW - families KW - interview KW - interviews KW - pediatric KW - pediatrics KW - child KW - children KW - youths KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - behavior KW - behaviors KW - disruptive behavior KW - thematic analysis N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e53907 UR - http://dx.doi.org/10.2196/53907 ID - info:doi/10.2196/53907 ER - TY - JOUR AU - Bressler, Michael AU - Merk, Joachim AU - Gohlke, Tanja AU - Kayali, Fares AU - Daigeler, Adrien AU - Kolbenschlag, Jonas AU - Prahm, Cosima PY - 2024/8/27 TI - A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study JO - JMIR Serious Games SP - e54193 VL - 12 KW - video games KW - virtual reality KW - exercise therapy KW - physical therapy KW - hand rehabilitation KW - finger rehabilitation N2 - 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. UR - https://games.jmir.org/2024/1/e54193 UR - http://dx.doi.org/10.2196/54193 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190432 ID - info:doi/10.2196/54193 ER - TY - JOUR AU - Lyles, Courtney AU - Berrean, Beth AU - Buenaventura, Ana AU - Milter, Svetlana AU - Hernandez, Daniel Dayana AU - Sarkar, Urmimala AU - Gutierrez, Christian AU - Palmer, Nynikka AU - Brown III, William PY - 2024/8/16 TI - Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study JO - JMIR Hum Factors SP - e53939 VL - 11 KW - mHealth KW - mobile health KW - eHealth KW - electronic health KW - application KW - digital health KW - digital ecosystem KW - informatics KW - community-based KW - community KW - co-design KW - human-centered design KW - community health KW - population health KW - technology KW - innovation KW - operations KW - social needs KW - health resources KW - qualitative analysis N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e53939 UR - http://dx.doi.org/10.2196/53939 ID - info:doi/10.2196/53939 ER - TY - JOUR AU - Burke, Meghan AU - Li, Chak AU - Cheung, Catherine Waifong AU - Terol, Kaori Adriana AU - Johnston, Amanda AU - Schueller, M. Stephen PY - 2024/8/14 TI - Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study JO - JMIR Form Res SP - e56043 VL - 8 KW - human-centered design KW - autism KW - service access KW - families KW - digital support KW - autistic children KW - autistic KW - children KW - child KW - app KW - apps KW - application KW - applications KW - digital tool KW - tool KW - tools N2 - 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. UR - https://formative.jmir.org/2024/1/e56043 UR - http://dx.doi.org/10.2196/56043 UR - http://www.ncbi.nlm.nih.gov/pubmed/39141412 ID - info:doi/10.2196/56043 ER - TY - JOUR AU - Gautam, Kamal AU - Shrestha, Roman AU - Dlamini, Sihlelelwe AU - Razali, Belle AU - Paudel, Kiran AU - Azwa, Iskandar AU - Saifi, Rumana AU - Toh, YuHang AU - Justin Lim, Hazriq AU - Sutherland, Ryan AU - Restar, Arjee AU - Phanuphak, Nittaya AU - Wickersham, A. Jeffrey PY - 2024/8/13 TI - Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study JO - JMIR Form Res SP - e56250 VL - 8 KW - HIV KW - AIDS KW - pre-exposure prophylaxis KW - PrEP KW - mobile health KW - mHealth KW - transgender women KW - Malaysia KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e56250 UR - http://dx.doi.org/10.2196/56250 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56250 ER - TY - JOUR AU - Reicherzer, Leah AU - Scheermesser, Mandy AU - Kläy, Adrian AU - Duarte, E. Jaime AU - Graf, S. Eveline PY - 2024/8/9 TI - Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists JO - JMIR Rehabil Assist Technol SP - e52676 VL - 11 KW - assistive device KW - barriers KW - facilitators KW - mobility KW - older adults KW - wearable robots N2 - 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. UR - https://rehab.jmir.org/2024/1/e52676 UR - http://dx.doi.org/10.2196/52676 ID - info:doi/10.2196/52676 ER - TY - JOUR AU - García de Alba-Chávez, Alberto Carlos AU - Espinosa-Curiel, Edrein Ismael AU - Michel-Nava, María Rosa PY - 2024/8/8 TI - Exploring the Impact of a Persuasive Serious Video Game (Farmily) on Promoting Home Gardening Among Novices: Design and Randomized Controlled Trial JO - JMIR Serious Games SP - e60771 VL - 12 KW - serious video game KW - persuasive game KW - home gardening KW - knowledge KW - attitude KW - self-efficacy KW - intention N2 - 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. UR - https://games.jmir.org/2024/1/e60771 UR - http://dx.doi.org/10.2196/60771 UR - http://www.ncbi.nlm.nih.gov/pubmed/39116437 ID - info:doi/10.2196/60771 ER - TY - JOUR AU - Wiegel, Patrick AU - Fotteler, Liselotte Marina AU - Kohn, Brigitte AU - Mayer, Sarah AU - Verri, Maria Filippo AU - Dallmeier, Dhayana AU - Denkinger, Michael PY - 2024/8/2 TI - Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study JO - JMIR Hum Factors SP - e53811 VL - 11 KW - assistive technology KW - older adults KW - caregiver KW - benefits KW - usability KW - gerontechnology N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e53811 UR - http://dx.doi.org/10.2196/53811 ID - info:doi/10.2196/53811 ER - TY - JOUR AU - LaVine, Danielle AU - Greer, Zara AU - Kim, Jiyun AU - Kumar, Santosh AU - Belin, Thomas AU - Shetty, Vivek PY - 2024/8/2 TI - A Remote Oral Self-Care Behaviors Assessment System in Vulnerable Populations: Usability and Feasibility Study JO - JMIR Form Res SP - e54999 VL - 8 KW - dental disease KW - underserved populations KW - mHealth KW - usability testing KW - feasibility testing, mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e54999 UR - http://dx.doi.org/10.2196/54999 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54999 ER - TY - JOUR AU - Lee, Audrey AU - Wyckoff, Elijah AU - Farcas, Emilia AU - Godino, Job AU - Patrick, Kevin AU - Spiegel, Spencer AU - Yu, Rose AU - Kumar, Arun AU - Loh, J. Kenneth AU - Gombatto, Sara PY - 2024/8/2 TI - Preliminary Validity and Acceptability of Motion Tape for Measuring Low Back Movement: Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e57953 VL - 11 KW - low back pain KW - fabric KW - nanocomposite KW - sensor acceptability KW - sensor validation KW - skin KW - strain KW - wearable N2 - 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. UR - https://rehab.jmir.org/2024/1/e57953 UR - http://dx.doi.org/10.2196/57953 UR - http://www.ncbi.nlm.nih.gov/pubmed/39093610 ID - info:doi/10.2196/57953 ER - TY - JOUR AU - Aljamaan, Fadi AU - Temsah, Mohamad-Hani AU - Altamimi, Ibraheem AU - Al-Eyadhy, Ayman AU - Jamal, Amr AU - Alhasan, Khalid AU - Mesallam, A. Tamer AU - Farahat, Mohamed AU - Malki, H. Khalid PY - 2024/7/31 TI - Reference Hallucination Score for Medical Artificial Intelligence Chatbots: Development and Usability Study JO - JMIR Med Inform SP - e54345 VL - 12 KW - artificial intelligence (AI) chatbots KW - reference hallucination KW - bibliographic verification KW - ChatGPT KW - Perplexity KW - SciSpace KW - Elicit KW - Bing N2 - 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 (? coefficient=?0.069; P=.32), while Perplexity had significantly lower RHS than ChatGPT (? coefficient=?0.345; P<.001). AI chatbots generally had significantly higher RHS when prompted with scenarios or complex format prompts (? 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. UR - https://medinform.jmir.org/2024/1/e54345 UR - http://dx.doi.org/10.2196/54345 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54345 ER - TY - JOUR AU - Engelsma, Thomas AU - Heijmink, Simone AU - Hendriksen, A. Heleen M. AU - Visser, C. Leonie N. AU - Lemstra, W. Afina AU - Jaspers, M. Monique W. AU - Peute, P. Linda W. PY - 2024/7/31 TI - Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study JO - JMIR Hum Factors SP - e54032 VL - 11 KW - dementia KW - design principles KW - digital health KW - memory clinic KW - usability evaluation KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e54032 UR - http://dx.doi.org/10.2196/54032 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54032 ER - TY - JOUR AU - Ferguson, IreLee AU - George, Grace AU - Narine, O. Kevin AU - Turner, Amari AU - McGhee, Zelda AU - Bajwa, Harris AU - Hart, G. Frances AU - Carter, Sierra AU - Beard, Courtney PY - 2024/7/31 TI - Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial JO - JMIR Ment Health SP - e56758 VL - 11 KW - interpretation bias KW - anxiety KW - depression KW - Black KW - Latinx KW - smartphone KW - mobile phone N2 - 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. UR - https://mental.jmir.org/2024/1/e56758 UR - http://dx.doi.org/10.2196/56758 UR - http://www.ncbi.nlm.nih.gov/pubmed/39083330 ID - info:doi/10.2196/56758 ER - TY - JOUR AU - Palmeirim, S. Marta AU - Houngbedji, A. Clarisse AU - Barth-Jaeggi, Tanja AU - Kouamé, Y. Jean-Pierre AU - Krouman, Aboubakar AU - Coulibaly, Daouda AU - Wyss, Kaspar PY - 2024/7/30 TI - Key Characteristics and Perception of Different Outbreak Surveillance Systems in Côte d?Ivoire: Cross-Sectional Survey Among Users JO - JMIR Public Health Surveill SP - e56275 VL - 10 KW - outbreak surveillance system KW - COVID-19 KW - Côte d?Ivoire KW - SORMAS KW - MAGPI KW - DHIS2 KW - outbreak surveillance KW - key characteristics KW - users? perception KW - infectious disease KW - infectious diseases KW - public health KW - disease surveillance KW - policy decision KW - cross-sectional study KW - descriptively analysis KW - Policymakers KW - health officials KW - healthcare system KW - Surveillance Outbreak Response Management and Analysis System KW - District Health Information Software 2 KW - policy makers KW - health care system N2 - 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 Côte 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 Côte 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 Côte d?Ivoire and potentially serving as a model for other countries facing similar decisions in their health care systems. UR - https://publichealth.jmir.org/2024/1/e56275 UR - http://dx.doi.org/10.2196/56275 ID - info:doi/10.2196/56275 ER - TY - JOUR AU - Shetty, B. Vinutha AU - Fried, Leanne AU - Roby, C. Heather AU - Soon, K. Wayne H. AU - Nguyen, Rebecca AU - Ong, Arthur AU - Jaimangal, Mohinder AU - Francis, Jacinta AU - Paramalingam, Nirubasini AU - Cross, Donna AU - Davis, Elizabeth PY - 2024/7/30 TI - Development of a Novel Mobile Health App to Empower Young People With Type 1 Diabetes to Exercise Safely: Co-Design Approach JO - JMIR Diabetes SP - e51491 VL - 9 KW - Mobile health application KW - Exercise KW - fitness KW - physical activity KW - design KW - co-design KW - focus group KW - focus groups KW - acT1ve KW - Type 1 diabetes KW - Young people KW - Blood glucose level KW - diabetic KW - diabetes KW - young KW - youth KW - type 1 KW - prototype KW - develop KW - development KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - user-centered design KW - mobile phone N2 - 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 UR - https://diabetes.jmir.org/2024/1/e51491 UR - http://dx.doi.org/10.2196/51491 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078700 ID - info:doi/10.2196/51491 ER - TY - JOUR AU - Sezgin, Emre AU - Kocaballi, Baki A. AU - Dolce, Millie AU - Skeens, Micah AU - Militello, Lisa AU - Huang, Yungui AU - Stevens, Jack AU - Kemper, R. Alex PY - 2024/7/19 TI - Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study JO - JMIR Hum Factors SP - e57114 VL - 11 KW - social determinants of health KW - social needs KW - chatbot KW - conversational agent KW - primary care KW - digital health KW - iterative design KW - implementation KW - evaluation KW - usability KW - feasibility N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e57114 UR - http://dx.doi.org/10.2196/57114 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57114 ER - TY - JOUR AU - Lin, Yulan AU - Xu, Xiaonan AU - Liu, Yiyang AU - Alias, Haridah AU - Hu, Zhijian AU - Wong, Ping Li PY - 2024/7/16 TI - Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey JO - J Med Internet Res SP - e53497 VL - 26 KW - telemedicine KW - acceptance KW - China KW - general public KW - COVID-19 KW - pandemic KW - health care KW - public health KW - health care delivery KW - health care services KW - survey KW - cross-sectional survey KW - consultation KW - teleconsultation KW - health care system N2 - 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 (?=0.322; P<.001) and perceived ease of use (?=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. UR - https://www.jmir.org/2024/1/e53497 UR - http://dx.doi.org/10.2196/53497 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012687 ID - info:doi/10.2196/53497 ER - TY - JOUR AU - Hasson, E. Rebecca AU - Xie, Michelle AU - Tadikamalla, Dhiraj AU - Beemer, R. Lexie PY - 2024/7/15 TI - 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 JO - JMIR Hum Factors SP - e52496 VL - 11 KW - web-based interventions KW - children KW - adolescents KW - child KW - adolescent KW - youth KW - user experience KW - website KW - websites KW - implementation science KW - human-centered design KW - human-centred design KW - HCD KW - web based KW - home based KW - interview KW - heuristics KW - interviews KW - heuristic KW - competitive analysis KW - video KW - videos KW - YouTube KW - physical activity KW - exercise KW - fitness N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e52496 UR - http://dx.doi.org/10.2196/52496 ID - info:doi/10.2196/52496 ER - TY - JOUR AU - Baik, H. Sharon AU - Clark, Karen AU - Sanchez, Marisol AU - Loscalzo, Matthew AU - Celis, Ashley AU - Razavi, Marianne AU - Yang, Dershung AU - Dale, William AU - Haas, Niina PY - 2024/7/10 TI - Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial JO - JMIR Cancer SP - e49703 VL - 10 KW - cancer KW - distress screening KW - eHealth KW - supportive care KW - mobile phone N2 - 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 UR - https://cancer.jmir.org/2024/1/e49703 UR - http://dx.doi.org/10.2196/49703 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49703 ER - TY - JOUR AU - Jo, Eunbeen AU - Song, Sanghoun AU - Kim, Jong-Ho AU - Lim, Subin AU - Kim, Hyeon Ju AU - Cha, Jung-Joon AU - Kim, Young-Min AU - Joo, Joon Hyung PY - 2024/7/8 TI - Assessing GPT-4?s Performance in Delivering Medical Advice: Comparative Analysis With Human Experts JO - JMIR Med Educ SP - e51282 VL - 10 KW - GPT-4 KW - medical advice KW - ChatGPT KW - cardiology KW - cardiologist KW - heart KW - advice KW - recommendation KW - recommendations KW - linguistic KW - linguistics KW - artificial intelligence KW - NLP KW - natural language processing KW - chatbot KW - chatbots KW - conversational agent KW - conversational agents KW - response KW - responses N2 - 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. UR - https://mededu.jmir.org/2024/1/e51282 UR - http://dx.doi.org/10.2196/51282 ID - info:doi/10.2196/51282 ER - TY - JOUR AU - Ansaldo, Inés Ana AU - Masson-Trottier, Michèle AU - Delacourt, Barbara AU - Dubuc, Jade AU - Dubé, Catherine PY - 2024/7/4 TI - 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 JO - JMIR Aging SP - e47565 VL - 7 KW - dementia KW - communication KW - caregivers KW - technology KW - burden KW - mixed methods design KW - quality of life KW - mobile phone KW - tablet N2 - 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. UR - https://aging.jmir.org/2024/1/e47565 UR - http://dx.doi.org/10.2196/47565 UR - http://www.ncbi.nlm.nih.gov/pubmed/38963691 ID - info:doi/10.2196/47565 ER - TY - JOUR AU - Chun, Minki AU - Yu, Ha-Jin AU - Jung, Hyunggu PY - 2024/7/3 TI - A Deep Learning?Based Rotten Food Recognition App for Older Adults: Development and Usability Study JO - JMIR Form Res SP - e55342 VL - 8 KW - digital health KW - mobile health KW - mHealth KW - app KW - apps KW - application KW - applications KW - smartphone KW - smartphones KW - classification KW - digital sensor KW - deep learning KW - artificial intelligence KW - machine learning KW - food KW - foods KW - fruit KW - fruits KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - usability KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - camera KW - image KW - imaging KW - photo KW - photos KW - photograph KW - photographs KW - recognition KW - picture KW - pictures KW - sensor KW - sensors KW - develop KW - development KW - design N2 - 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. UR - https://formative.jmir.org/2024/1/e55342 UR - http://dx.doi.org/10.2196/55342 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55342 ER - TY - JOUR AU - Chien, Shao-Yun AU - Zaslavsky, Oleg AU - Berridge, Clara PY - 2024/7/3 TI - Technology Usability for People Living With Dementia: Concept Analysis JO - JMIR Aging SP - e51987 VL - 7 KW - usability KW - dementia KW - older adults KW - technology KW - concept analysis KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2024/1/e51987 UR - http://dx.doi.org/10.2196/51987 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51987 ER - TY - JOUR AU - Soehnchen, Clarissa AU - Burmann, Anja AU - Henningsen, Maike AU - Meister, Sven PY - 2024/7/3 TI - A Digital Sexual Health Education Web Application for Resource-Poor Regions in Kenya: Implementation-Oriented Case Study Using the Intercultural Research Model JO - JMIR Form Res SP - e58549 VL - 8 KW - sexual health education KW - Intercultural Research Model KW - semistructured interview KW - SUS analysis KW - user-centered design N2 - 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 UR - https://formative.jmir.org/2024/1/e58549 UR - http://dx.doi.org/10.2196/58549 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58549 ER - TY - JOUR AU - Wodu, Obinuchi Chioma AU - Sweeney, Gillian AU - Slachetka, Milena AU - Kerr, Andrew PY - 2024/6/26 TI - Stroke Survivors? Interaction With Hand Rehabilitation Devices: Observational Study JO - JMIR Biomed Eng SP - e54159 VL - 9 KW - stroke KW - rehabilitation KW - hand rehabilitation devices KW - accessibility KW - stroke survivors KW - rehabilitation technologies N2 - 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. UR - https://biomedeng.jmir.org/2024/1/e54159 UR - http://dx.doi.org/10.2196/54159 UR - http://www.ncbi.nlm.nih.gov/pubmed/38922668 ID - info:doi/10.2196/54159 ER - TY - JOUR AU - Cho, Aram AU - Cha, Chiyoung AU - Baek, Gumhee PY - 2024/6/21 TI - Development of an Artificial Intelligence?Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial JO - J Med Internet Res SP - e54029 VL - 26 KW - artificial intelligence KW - burnout KW - mobile app KW - nurses KW - nurse KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - usability KW - satisfaction KW - effectiveness KW - tailored KW - mind-body KW - meditation KW - mindfulness KW - ACT KW - algorithm KW - algorithms KW - occupational health KW - digital health KW - recommender KW - optimization KW - acceptance and commitment therapy KW - job KW - worker KW - workers KW - stress KW - employee KW - employees N2 - 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. UR - https://www.jmir.org/2024/1/e54029 UR - http://dx.doi.org/10.2196/54029 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54029 ER - TY - JOUR AU - Miller, Morven AU - McCann, Lisa AU - Lewis, Liane AU - Miaskowski, Christine AU - Ream, Emma AU - Darley, Andrew AU - Harris, Jenny AU - Kotronoulas, Grigorios AU - V Berg, Geir AU - Lubowitzki, Simone AU - Armes, Jo AU - Patiraki, Elizabeth AU - Furlong, Eileen AU - Fox, Patricia AU - Gaiger, Alexander AU - Cardone, Antonella AU - Orr, Dawn AU - Flowerday, Adrian AU - Katsaragakis, Stylianos AU - Skene, Simon AU - Moore, Margaret AU - McCrone, Paul AU - De Souza, Nicosha AU - Donnan, T. Peter AU - Maguire, Roma PY - 2024/6/20 TI - Patients? and Clinicians? Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews JO - J Med Internet Res SP - e49309 VL - 26 KW - chemotherapy KW - digital health KW - education KW - predictive risk models KW - qualitative research methods KW - symptoms KW - symptom cluster KW - tailored information N2 - 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 UR - https://www.jmir.org/2024/1/e49309 UR - http://dx.doi.org/10.2196/49309 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49309 ER - TY - JOUR AU - Kunchay, Sahiti AU - Linden-Carmichael, N. Ashley AU - Abdullah, Saeed PY - 2024/6/20 TI - Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study JO - JMIR Hum Factors SP - e50795 VL - 11 KW - smartwatches KW - substance use KW - ecological momentary assessment KW - mobile health KW - mHealth KW - human-centered design KW - feasibility studies KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e50795 UR - http://dx.doi.org/10.2196/50795 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50795 ER - TY - JOUR AU - Mosch, Lina AU - Sümer, Meltem AU - Flint, Rike Anne AU - Feufel, Markus AU - Balzer, Felix AU - Mörike, Frauke AU - Poncette, Akira-Sebastian PY - 2024/6/18 TI - Alarm Management in Intensive Care: Qualitative Triangulation Study JO - JMIR Hum Factors SP - e55571 VL - 11 KW - digital health KW - transdisciplinary research KW - technological innovation KW - patient-centered care KW - qualitative KW - ethnographic KW - ethnography KW - intensive care unit KW - ICU KW - intensive care KW - German KW - Germany KW - Europe KW - European KW - interview KW - interviews KW - alarm KW - alarms KW - intelligent KW - artificial intelligence KW - grounded theory KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e55571 UR - http://dx.doi.org/10.2196/55571 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888941 ID - info:doi/10.2196/55571 ER - TY - JOUR AU - Porta, Xènia AU - Nieto, Rubén AU - Serrat, Mayte AU - Bourdin Kreitz, Pierre PY - 2024/6/18 TI - Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study JO - JMIR Form Res SP - e55751 VL - 8 KW - fibromyalgia KW - chronic pain KW - pain management KW - information and communication technologies KW - use KW - satisfaction N2 - 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. UR - https://formative.jmir.org/2024/1/e55751 UR - http://dx.doi.org/10.2196/55751 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55751 ER - TY - JOUR AU - Siste, Kristiana AU - Ophinni, Youdiil AU - Hanafi, Enjeline AU - Yamada, Chika AU - Novalino, Reza AU - Limawan, P. Albert AU - Beatrice, Evania AU - Rafelia, Vania AU - Alison, Peter AU - Matsumoto, Toshihiko AU - Sakamoto, Ryota PY - 2024/6/18 TI - Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study JO - JMIR Form Res SP - e50452 VL - 8 KW - substance use disorder KW - cognitive behavioral therapy KW - telemedicine KW - peer involvement KW - Indonesia KW - substance use disorders KW - digital intervention KW - COVID-19 KW - psychotherapy KW - drug KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e50452 UR - http://dx.doi.org/10.2196/50452 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50452 ER - TY - JOUR AU - Wekenborg, Katharina Magdalena AU - Förster, Katharina AU - Schweden, Florian AU - Weidemann, Robin AU - Bechtolsheim, von Felix AU - Kirschbaum, Clemens AU - Weitz, Jürgen AU - Ditzen, Beate PY - 2024/6/17 TI - Differences in Physicians? Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study JO - J Med Internet Res SP - e49581 VL - 26 KW - physicians KW - digital transformation KW - chronic stress KW - hair cortisol concentration KW - work stressors KW - work resources N2 - 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. UR - https://www.jmir.org/2024/1/e49581 UR - http://dx.doi.org/10.2196/49581 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885014 ID - info:doi/10.2196/49581 ER - TY - JOUR AU - Espinoza Chamorro, Roberto AU - Santos, O. Luciano H. AU - Mori, Yukiko AU - Liu, Chang AU - Yamamoto, Goshiro AU - Kuroda, Tomohiro PY - 2024/6/14 TI - Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study JO - JMIR Hum Factors SP - e50086 VL - 11 KW - blood donation KW - deferral experience KW - Theory of Planned Behavior KW - Self-Determination Theory KW - gamification KW - ICT design KW - motivation KW - patient education KW - prototype KW - feasibility N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e50086 UR - http://dx.doi.org/10.2196/50086 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875005 ID - info:doi/10.2196/50086 ER - TY - JOUR AU - Lancioni, E. Giulio AU - Singh, N. Nirbhay AU - O?Reilly, F. Mark AU - Sigafoos, Jeff AU - Alberti, Gloria AU - Orlando, Isabella AU - Chiariello, Valeria AU - Desideri, Lorenzo PY - 2024/6/12 TI - 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 JO - JMIR Rehabil Assist Technol SP - e59315 VL - 11 KW - technology KW - tablet KW - task KW - instructions KW - intellectual disability, visual impairment, hearing impairment N2 - 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. UR - https://rehab.jmir.org/2024/1/e59315 UR - http://dx.doi.org/10.2196/59315 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865701 ID - info:doi/10.2196/59315 ER - TY - JOUR AU - Landis-Lewis, Zach AU - Andrews, A. Chris AU - Gross, A. Colin AU - Friedman, P. Charles AU - Shah, J. Nirav PY - 2024/6/11 TI - Exploring Anesthesia Provider Preferences for Precision Feedback: Preference Elicitation Study JO - JMIR Med Educ SP - e54071 VL - 10 KW - audit and feedback KW - dashboard KW - motivation KW - visualization KW - anesthesia care KW - anesthesia KW - feedback KW - engagement KW - effectiveness KW - precision feedback KW - experimental design KW - design KW - clinical practice KW - motivational KW - performance KW - performance data N2 - 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 (?=.85) and display format (?=.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. UR - https://mededu.jmir.org/2024/1/e54071 UR - http://dx.doi.org/10.2196/54071 ID - info:doi/10.2196/54071 ER - TY - JOUR AU - Goerss, Doreen AU - Köhler, Stefanie AU - Rong, Eleonora AU - Temp, Gesine Anna AU - Kilimann, Ingo AU - Bieber, Gerald AU - Teipel, Stefan PY - 2024/6/7 TI - Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach JO - JMIR Aging SP - e50107 VL - 7 KW - assistive technology KW - user-centered design KW - usability KW - dementia KW - smartwatch KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2024/1/e50107 UR - http://dx.doi.org/10.2196/50107 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848116 ID - info:doi/10.2196/50107 ER - TY - JOUR AU - Narang, Gaurav AU - Chen, J. Yaozhu AU - Wedel, Nicole AU - Wu, Melody AU - Luo, Michelle AU - Atreja, Ashish PY - 2024/6/6 TI - Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study JO - JMIR Form Res SP - e52251 VL - 8 KW - cyclic vomiting syndrome KW - vomiting KW - vomit KW - emetic KW - emesis KW - gut KW - GI KW - gastrointestinal KW - internal medicine KW - prototype KW - prototypes KW - iterative KW - self-management KW - disease management KW - gut-brain interaction KW - gut-brain KW - artificial intelligence KW - digital patient assistant KW - assistant KW - assistants KW - design thinking KW - design KW - patient-centric KW - patient centred KW - patient centered KW - patient-centric approach KW - System Usability Scale KW - symptom tracking KW - digital health solution KW - user experience KW - usability KW - symptom KW - symptoms KW - tracking KW - monitoring KW - participatory KW - co-design digital health technology KW - patient assistance KW - patient experience KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e52251 UR - http://dx.doi.org/10.2196/52251 UR - http://www.ncbi.nlm.nih.gov/pubmed/38842924 ID - info:doi/10.2196/52251 ER - TY - JOUR AU - Heitkemper, Elizabeth AU - Hulse, Scott AU - Bekemeier, Betty AU - Schultz, Melinda AU - Whitman, Greg AU - Turner, M. Anne PY - 2024/6/5 TI - The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation JO - JMIR Hum Factors SP - e51666 VL - 11 KW - data dashboard KW - rural health KW - health equity KW - usability KW - nursing informatics KW - dashboard KW - rural KW - informatics KW - satisfaction KW - think aloud KW - content analysis KW - user experience KW - public health KW - visualization KW - information systems N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e51666 UR - http://dx.doi.org/10.2196/51666 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837192 ID - info:doi/10.2196/51666 ER - TY - JOUR AU - Burn, Anne-Marie AU - Hall, Poppy AU - Anderson, Joanna PY - 2024/6/4 TI - A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program JO - JMIR Form Res SP - e50024 VL - 8 KW - self-harm KW - schools KW - young people KW - youth KW - school staff KW - training KW - coproduction KW - qualitative N2 - 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. UR - https://formative.jmir.org/2024/1/e50024 UR - http://dx.doi.org/10.2196/50024 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833286 ID - info:doi/10.2196/50024 ER - TY - JOUR AU - Bunt, Lance AU - Greeff, Japie AU - Taylor, Estelle PY - 2024/5/31 TI - Enhancing Serious Game Design: Expert-Reviewed, Stakeholder-Centered Framework JO - JMIR Serious Games SP - e48099 VL - 12 KW - serious games KW - stakeholder theory KW - enterprise architecture KW - serious game development KW - design framework N2 - 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. UR - https://games.jmir.org/2024/1/e48099 UR - http://dx.doi.org/10.2196/48099 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820585 ID - info:doi/10.2196/48099 ER - TY - JOUR AU - Murabito, M. Joanne AU - Faro, M. Jamie AU - Zhang, Yuankai AU - DeMalia, Angelo AU - Hamel, Alexander AU - Agyapong, Nakesha AU - Liu, Hongshan AU - Schramm, Eric AU - McManus, D. David AU - Borrelli, Belinda PY - 2024/5/30 TI - Smartphone App Designed to Collect Health Information in Older Adults: Usability Study JO - JMIR Hum Factors SP - e56653 VL - 11 KW - mobile application surveys KW - mixed methods KW - electronic data collection KW - mHealth KW - mobile health KW - mobile application KW - mobile applications KW - app KW - apps KW - application KW - applications KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - health information N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e56653 UR - http://dx.doi.org/10.2196/56653 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815261 ID - info:doi/10.2196/56653 ER - TY - JOUR AU - Morita, Kentaro AU - Miura, Kenichiro AU - Toyomaki, Atsuhito AU - Makinodan, Manabu AU - Ohi, Kazutaka AU - Hashimoto, Naoki AU - Yasuda, Yuka AU - Mitsudo, Takako AU - Higuchi, Fumihiro AU - Numata, Shusuke AU - Yamada, Akiko AU - Aoki, Yohei AU - Honda, Hiromitsu AU - Mizui, Ryo AU - Honda, Masato AU - Fujikane, Daisuke AU - Matsumoto, Junya AU - Hasegawa, Naomi AU - Ito, Satsuki AU - Akiyama, Hisashi AU - Onitsuka, Toshiaki AU - Satomura, Yoshihiro AU - Kasai, Kiyoto AU - Hashimoto, Ryota PY - 2024/5/30 TI - Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study JO - JMIR Ment Health SP - e56668 VL - 11 KW - schizophrenia KW - cognitive function KW - eye movement KW - diagnostic biomarkers KW - digital health tools N2 - 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. UR - https://mental.jmir.org/2024/1/e56668 UR - http://dx.doi.org/10.2196/56668 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815257 ID - info:doi/10.2196/56668 ER - TY - JOUR AU - Greeley, Brian AU - Chung, Seohyeon Sally AU - Graves, Lorraine AU - Song, Xiaowei PY - 2024/5/28 TI - Combating Barriers to the Development of a Patient-Oriented Frailty Website JO - JMIR Aging SP - e53098 VL - 7 KW - frailty KW - frailty website KW - patient-oriented assessment KW - community-dwelling older adults KW - internet security KW - privacy KW - barrier KW - barriers KW - development KW - implementation KW - patient-oriented KW - internet KW - virtual health resource KW - community dwelling KW - older adult KW - older adults KW - health care professional KW - caregiver KW - caregivers KW - technology KW - real-time KW - monitoring KW - aging KW - ageing UR - https://aging.jmir.org/2024/1/e53098 UR - http://dx.doi.org/10.2196/53098 ID - info:doi/10.2196/53098 ER - TY - JOUR AU - Rony, Jahangir Rahat AU - Amir, Shajnush AU - Ahmed, Nova AU - Atiba, Samuelson AU - Verdezoto, Nervo AU - Sparkes, Valerie AU - Stawarz, Katarzyna PY - 2024/5/28 TI - Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e54699 VL - 11 KW - rehabilitation KW - wearables KW - upper-limb rehabilitation KW - user-centered design KW - qualitative KW - interviews KW - experiences KW - attitudes KW - perceptions KW - digital health KW - health technology KW - wearable KW - user centered design KW - design KW - home KW - stroke KW - recovery KW - affordable KW - low income KW - low resource KW - Bangladesh KW - physiotherapy N2 - 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. UR - https://rehab.jmir.org/2024/1/e54699 UR - http://dx.doi.org/10.2196/54699 ID - info:doi/10.2196/54699 ER - TY - JOUR AU - Collins-Pisano, Caroline AU - Leggett, N. Amanda AU - Gambee, David AU - Fortuna, L. Karen PY - 2024/5/27 TI - 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 JO - JMIR Hum Factors SP - e41202 VL - 11 KW - family caregivers KW - dementia KW - peer support KW - technology KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e41202 UR - http://dx.doi.org/10.2196/41202 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801660 ID - info:doi/10.2196/41202 ER - TY - JOUR AU - Bridges, Bronwyn AU - Taylor, Jake AU - Weber, Thomas John PY - 2024/5/24 TI - Evaluation of the Parkinson?s Remote Interactive Monitoring System in a Clinical Setting: Usability Study JO - JMIR Hum Factors SP - e54145 VL - 11 KW - Parkinson disease KW - usability KW - remote monitoring KW - motor examination KW - movement disorders KW - thematic analysis KW - System Usability Scale KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e54145 UR - http://dx.doi.org/10.2196/54145 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787603 ID - info:doi/10.2196/54145 ER - TY - JOUR AU - Prochaska, Eveline AU - Ammenwerth, Elske PY - 2024/5/23 TI - Clinical Utility and Usability of the Digital Box and Block Test: Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e54939 VL - 11 KW - assessment KW - clinical utility KW - digital Box and Block Test KW - dBBT KW - hand dexterity KW - dexterity KW - usability N2 - 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 UR - https://rehab.jmir.org/2024/1/e54939 UR - http://dx.doi.org/10.2196/54939 ID - info:doi/10.2196/54939 ER - TY - JOUR AU - Washington, T. Karla AU - Oliver, Parker Debra AU - Donehower, K. Allison AU - White, Patrick AU - Benson, J. Jacquelyn AU - Lyons, G. Patrick AU - Demiris, George PY - 2024/5/23 TI - Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment JO - JMIR Hum Factors SP - e51789 VL - 11 KW - caregivers KW - home care services KW - hospice care KW - signs and symptoms KW - technology KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e51789 UR - http://dx.doi.org/10.2196/51789 UR - http://www.ncbi.nlm.nih.gov/pubmed/38781581 ID - info:doi/10.2196/51789 ER - TY - JOUR AU - Teh, Pei-Lee AU - Kwok, J. Andrei O. AU - Cheong, Loong Wing AU - Lee, Shaun PY - 2024/5/21 TI - Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study JO - JMIR Form Res SP - e54101 VL - 8 KW - digital health KW - older adults KW - digital divide KW - aging KW - pilot KW - Malaysia KW - coach KW - digital access KW - social barrier KW - virtual KW - virtual coach KW - digital tool KW - tool KW - engagement KW - gamification KW - user experience KW - app KW - technology tool KW - digital literacy KW - user experience design KW - decision support KW - support N2 - 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. UR - https://formative.jmir.org/2024/1/e54101 UR - http://dx.doi.org/10.2196/54101 UR - http://www.ncbi.nlm.nih.gov/pubmed/38772022 ID - info:doi/10.2196/54101 ER - TY - JOUR AU - Amiot, Odile AU - Sauvaget, Anne AU - Alamome, Isabelle AU - Bulteau, Samuel AU - Charpeaud, Thomas AU - Clair, Anne-Hélène AU - Courtet, Philippe AU - Drapier, Dominique AU - Haffen, Emmanuel AU - Fakra, Eric AU - Gaudeau-Bosma, Christian AU - Gaillard, Adeline AU - Mouchabac, Stéphane AU - Pineau, Fanny AU - Narboni, Véronique AU - Duburcq, Anne AU - Lecardeur, Laurent PY - 2024/5/20 TI - Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study JO - JMIR Form Res SP - e53204 VL - 8 KW - prospective acceptability KW - digital health KW - depression KW - e-mental health KW - deprexis KW - psychotherapy N2 - 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. UR - https://formative.jmir.org/2024/1/e53204 UR - http://dx.doi.org/10.2196/53204 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568139 ID - info:doi/10.2196/53204 ER - TY - JOUR AU - Bozorgmehr, Arezoo AU - Thiem, Simon-Konstantin AU - Wild, Dorothea AU - Reinsdorff, Melanie AU - Vollmar, Christian Horst AU - Kappernagel, Annika AU - Schloessler, Kathrin AU - Weissbach, Sabine AU - Pentzek, Michael AU - Dehnen, Dorothea AU - Drexler, Julia AU - Mueller, Sigrid Beate AU - Pilic, Larisa AU - Lehmann, Lion AU - Loescher, Susanne AU - Hohmann, Darinka Elena AU - Frank, Friederike AU - Ates, Gülay AU - Kersten, Susanne AU - Mortsiefer, Achim AU - Aretz, Benjamin AU - Weltermann, Birgitta PY - 2024/5/20 TI - Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study JO - JMIR Form Res SP - e53206 VL - 8 KW - primary care KW - general practice research network KW - physicians KW - feasibility study KW - IT infrastructure KW - usability KW - FallAkte KW - FallAkte Plus system KW - mixed methods usability study KW - North Rhine-Westphalian general practice research network KW - NRW-GPRN KW - Germany KW - German KW - universities KW - survey KW - questionnaire KW - participants N2 - 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. UR - https://formative.jmir.org/2024/1/e53206 UR - http://dx.doi.org/10.2196/53206 UR - http://www.ncbi.nlm.nih.gov/pubmed/38767942 ID - info:doi/10.2196/53206 ER - TY - JOUR AU - Lemos, Marta AU - Henriques, Rita Ana AU - Lopes, Gil David AU - Mendonça, Nuno AU - Victorino, André AU - Costa, Andreia AU - Arriaga, Miguel AU - Gregório, João Maria AU - de Sousa, Rute AU - Canhão, Helena AU - Rodrigues, M. Ana PY - 2024/5/17 TI - Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study JO - JMIR Form Res SP - e46151 VL - 8 KW - DigiAdherence KW - mHealth KW - mobile app KW - technology KW - utility KW - usability KW - ICT KW - application KW - patient-centered KW - tool KW - prevention KW - falls KW - treatment KW - nutrition KW - physical activity KW - pilot study KW - older adults KW - adherence KW - engagement KW - compliance N2 - 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 Portimão, 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 UR - https://formative.jmir.org/2024/1/e46151 UR - http://dx.doi.org/10.2196/46151 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758585 ID - info:doi/10.2196/46151 ER - TY - JOUR AU - Szkodny, Dominika AU - Wróblewska-Czajka, Ewa AU - Stryja, Miko?aj AU - Gara, Filip AU - Wyl?ga?a, Edward PY - 2024/5/15 TI - Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study JO - JMIR Form Res SP - e50398 VL - 8 KW - eye donor KW - corneal transplant KW - donor shortage KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - application KW - tissue procurement KW - organ KW - procurement KW - donor KW - donors KW - donation KW - transplant KW - transplantation KW - transplants KW - usability KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - interview KW - interviews KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - reporting N2 - 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. UR - https://formative.jmir.org/2024/1/e50398 UR - http://dx.doi.org/10.2196/50398 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748474 ID - info:doi/10.2196/50398 ER - TY - JOUR AU - Aspelund, Anna AU - Valkonen, Paula AU - Viitanen, Johanna AU - Rauta, Virpi PY - 2024/5/14 TI - Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions JO - JMIR Hum Factors SP - e53691 VL - 11 KW - usability KW - UX KW - user experience KW - PX KW - patient experience KW - user-based evaluation KW - patients KW - eHealth KW - digital health solution KW - kidney disease KW - home dialysis N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e53691 UR - http://dx.doi.org/10.2196/53691 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743476 ID - info:doi/10.2196/53691 ER - TY - JOUR AU - Farah, Line AU - Borget, Isabelle AU - Martelli, Nicolas AU - Vallee, Alexandre PY - 2024/5/13 TI - Suitability of the Current Health Technology Assessment of Innovative Artificial Intelligence-Based Medical Devices: Scoping Literature Review JO - J Med Internet Res SP - e51514 VL - 26 KW - artificial intelligence KW - machine learning KW - health technology assessment KW - medical devices KW - evaluation N2 - 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. UR - https://www.jmir.org/2024/1/e51514 UR - http://dx.doi.org/10.2196/51514 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739911 ID - info:doi/10.2196/51514 ER - TY - JOUR AU - Sien, Sang-Wha AU - Kobekyaa, Kyerepagr Francis AU - Puts, Martine AU - Currie, Leanne AU - Tompson, Margaret AU - Hedges, Penelope AU - McGrenere, Joanna AU - Mariano, Caroline AU - Haase, R. Kristen PY - 2024/5/8 TI - Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing JO - JMIR Aging SP - e53163 VL - 7 KW - cancer KW - aging KW - self-management KW - usability testing KW - design thinking KW - design KW - oncology KW - develop KW - development KW - usability KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - symptom KW - symptoms KW - comorbidity KW - comorbidities KW - comorbid KW - multimorbidity KW - multimorbidities KW - co-design N2 - 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. UR - https://aging.jmir.org/2024/1/e53163 UR - http://dx.doi.org/10.2196/53163 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717806 ID - info:doi/10.2196/53163 ER - TY - JOUR AU - O?Donnell, A. Elizabeth AU - Van Citters, D. Aricca AU - Khayal, S. Inas AU - Wilson, M. Matthew AU - Gustafson, David AU - Barnato, E. Amber AU - Buccellato, C. Andrea AU - Young, Colleen AU - Holthoff, M. Megan AU - Korsunskiy, Eugene AU - Tomlin, C. Stephanie AU - Cullinan, M. Amelia AU - Steinbaugh, C. Alexandra AU - Hinson, J. Jennifer AU - Johnson, R. Kristen AU - Williams, Andrew AU - Thomson, M. Ruth AU - Haines, M. Janet AU - Holmes, B. Anne AU - Bradley, D. Ann AU - Nelson, C. Eugene AU - Kirkland, B. Kathryn PY - 2024/5/8 TI - A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study JO - JMIR Hum Factors SP - e53194 VL - 11 KW - human-centered design KW - caregivers KW - care partners KW - serious illness KW - peer support KW - online support network KW - virtual network KW - online network KW - caregiver KW - unmet need KW - unmet needs KW - active care KW - bereaved care KW - bereavement KW - clinician KW - clinicians KW - function KW - functions KW - specification KW - information KW - emotional support KW - technical support KW - privacy protection KW - rural KW - viability KW - impact KW - engineering design KW - care provider KW - care providers KW - mortality KW - quality of life KW - tertiary care KW - caregiving N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e53194 UR - http://dx.doi.org/10.2196/53194 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717809 ID - info:doi/10.2196/53194 ER - TY - JOUR AU - Branitsky, Alison AU - Longden, Eleanor AU - Bucci, Sandra AU - Morrison, P. Anthony AU - Varese, Filippo PY - 2024/5/3 TI - Group Cohesion and Necessary Adaptations in Online Hearing Voices Peer Support Groups: Qualitative Study With Group Facilitators JO - JMIR Form Res SP - e51694 VL - 8 KW - peer support KW - group cohesion KW - web-based delivery KW - hearing voices KW - Hearing Voices Movement KW - self-help groups N2 - 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. UR - https://formative.jmir.org/2024/1/e51694 UR - http://dx.doi.org/10.2196/51694 UR - http://www.ncbi.nlm.nih.gov/pubmed/38701439 ID - info:doi/10.2196/51694 ER - TY - JOUR AU - Doan, Xengie AU - Rossi, Arianna AU - Botes, Marietjie AU - Selzer, Annika PY - 2024/4/30 TI - Comparing Attitudes Toward Different Consent Mediums: Semistructured Qualitative Study JO - JMIR Hum Factors SP - e53113 VL - 11 KW - consent KW - transparency KW - data governance KW - visualization KW - health data sharing N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e53113 UR - http://dx.doi.org/10.2196/53113 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687983 ID - info:doi/10.2196/53113 ER - TY - JOUR AU - Mitchell, MH Ellen AU - Adejumo, Adedeji Olusola AU - Abdur-Razzaq, Hussein AU - Ogbudebe, Chidubem AU - Gidado, Mustapha PY - 2024/4/25 TI - The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria JO - JMIR Public Health Surveill SP - e52191 VL - 10 KW - surveillance KW - trust KW - Integrated Disease Surveillance and Response KW - IDSR KW - tuberculosis KW - notification KW - public-private mix KW - infectious disease KW - disease surveillance KW - surveillance behavior KW - health care worker KW - health professional KW - public health KW - Nigeria KW - survey KW - behavior KW - self-reported N2 - 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. UR - https://publichealth.jmir.org/2024/1/e52191 UR - http://dx.doi.org/10.2196/52191 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506095 ID - info:doi/10.2196/52191 ER - TY - JOUR AU - Tremoulet, D. Patrice AU - Lobo, F. Andrea AU - Simmons, A. Christina AU - Baliga, Ganesh AU - Brady, Matthew PY - 2024/4/25 TI - Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing JO - JMIR Hum Factors SP - e51612 VL - 11 KW - technology prototype KW - data collection KW - documentation KW - direct support professionals KW - intellectual and developmental disabilities KW - pilot test KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e51612 UR - http://dx.doi.org/10.2196/51612 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662420 ID - info:doi/10.2196/51612 ER - TY - JOUR AU - Lu, Yinn Si AU - Yoon, Sungwon AU - Yee, Qi Wan AU - Heng Wen Ngiam, Nerice AU - Ng, Yi Kennedy Yao AU - Low, Leng Lian PY - 2024/4/25 TI - Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study JO - JMIR Aging SP - e52292 VL - 7 KW - digital divide KW - digital learning KW - smartphones KW - social gerontology KW - older adults KW - COVID-19 pandemic KW - technology adoption N2 - 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. UR - https://aging.jmir.org/2024/1/e52292 UR - http://dx.doi.org/10.2196/52292 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662423 ID - info:doi/10.2196/52292 ER - TY - JOUR AU - Kwok, Ian AU - Lattie, Gardiner Emily AU - Yang, Dershung AU - Summers, Amanda AU - Cotten, Paul AU - Leong, Alina Caroline AU - Moskowitz, Tedlie Judith PY - 2024/4/25 TI - Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study JO - JMIR Form Res SP - e50234 VL - 8 KW - Alzheimer disease KW - dementia KW - caregiving KW - eHealth KW - web-based interventions KW - positive emotion KW - stress KW - coping N2 - 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. UR - https://formative.jmir.org/2024/1/e50234 UR - http://dx.doi.org/10.2196/50234 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662432 ID - info:doi/10.2196/50234 ER - TY - JOUR AU - Asano, Masaki AU - Imai, Shungo AU - Shimizu, Yuri AU - Kizaki, Hayato AU - Ito, Yukiko AU - Tsuchiya, Makoto AU - Kuriyama, Ryoko AU - Yoshida, Nao AU - Shimada, Masanori AU - Sando, Takanori AU - Ishijima, Tomo AU - Hori, Satoko PY - 2024/4/24 TI - 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 JO - J Med Internet Res SP - e54645 VL - 26 KW - tablet KW - tablets KW - capsules KW - capsule KW - size KW - personal health record KW - electronic medication notebook KW - patient preference KW - drug KW - drugs KW - pharmacy KW - pharmacies KW - pharmacology KW - pharmacotherapy KW - pharmaceutic KW - pharmaceutics KW - pharmaceuticals KW - pharmaceutical KW - medication KW - medications KW - preference KW - preferences KW - pill KW - pills KW - machine learning KW - decision tree KW - swallow KW - swallowing KW - throat KW - pharynx KW - risk KW - risks KW - dysphagia KW - speech KW - mobile phone N2 - 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. UR - https://www.jmir.org/2024/1/e54645 UR - http://dx.doi.org/10.2196/54645 UR - http://www.ncbi.nlm.nih.gov/pubmed/38657229 ID - info:doi/10.2196/54645 ER - TY - JOUR AU - Björling, A. Elin AU - Sonney, Jennifer AU - Zade, Himanshu AU - Rodriguez, Sofia AU - Pullmann, D. Michael AU - Moon, Hyun Soo PY - 2024/4/22 TI - Using Virtual Reality to Reduce Stress in Adolescents: Mixed Methods Usability Study JO - JMIR XR Spatial Comput SP - e49171 VL - 1 KW - virtual reality KW - adolescents KW - perceived stress KW - participatory design KW - depression N2 - 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. UR - https://xr.jmir.org/2024/1/e49171 UR - http://dx.doi.org/10.2196/49171 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49171 ER - TY - JOUR AU - Foster, Marva AU - Fix, M. Gemmae AU - Hyde, Justeen AU - Dunlap, Shawn AU - Byrne, H. Thomas AU - Sugie, F. Naomi AU - Kuhn, Randall AU - Gabrielian, Sonya AU - Roncarati, S. Jill AU - Zhao, Shibei AU - McInnes, Keith D. PY - 2024/4/22 TI - Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology?Supported Intervention JO - JMIR Res Protoc SP - e53022 VL - 13 KW - ethnography KW - homelessness KW - housing transitions KW - longitudinal data KW - military KW - mobile technology KW - smartphone KW - social support KW - veterans N2 - 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 UR - https://www.researchprotocols.org/2024/1/e53022 UR - http://dx.doi.org/10.2196/53022 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648101 ID - info:doi/10.2196/53022 ER - TY - JOUR AU - Bults, Marloes AU - van Leersum, Margaretha Catharina AU - Olthuis, Josef Theodorus Johannes AU - Siebrand, Egbert AU - Malik, Zohrah AU - Liu, Lili AU - Miguel-Cruz, Antonio AU - Jukema, Seerp Jan AU - den Ouden, Maria Marjolein Elisabeth PY - 2024/4/19 TI - Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study JO - JMIR Aging SP - e50219 VL - 7 KW - assistive technology KW - technology acceptance KW - immigrant KW - dementia KW - marginalized older adults N2 - 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. UR - https://aging.jmir.org/2024/1/e50219 UR - http://dx.doi.org/10.2196/50219 UR - http://www.ncbi.nlm.nih.gov/pubmed/38639994 ID - info:doi/10.2196/50219 ER - TY - JOUR AU - Blanchard, Marc AU - Koller, Nadana Cinja AU - Azevedo, Ming Pedro AU - Prétat, Tiffany AU - Hügle, Thomas PY - 2024/4/19 TI - Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach JO - JMIR Form Res SP - e50832 VL - 8 KW - digital health KW - patient preference KW - user experience KW - patient-centricity KW - platform KW - development KW - fibromyalgia KW - self-management KW - quality of life KW - patient outcome KW - musculoskeletal KW - usability testing KW - digital health solution N2 - 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 UR - https://formative.jmir.org/2024/1/e50832 UR - http://dx.doi.org/10.2196/50832 UR - http://www.ncbi.nlm.nih.gov/pubmed/38639986 ID - info:doi/10.2196/50832 ER - TY - JOUR AU - Fan, Qiping AU - Hoang, Minh-Nguyet AU - DuBose, Logan AU - Ory, G. Marcia AU - Vennatt, Jeswin AU - Salha, Diana AU - Lee, Shinduk AU - Falohun, Tokunbo PY - 2024/4/17 TI - The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study JO - JMIR Aging SP - e55132 VL - 7 KW - evaluation KW - usability KW - family caregiver KW - Alzheimer disease KW - dementia KW - digital health KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2024/1/e55132 UR - http://dx.doi.org/10.2196/55132 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630527 ID - info:doi/10.2196/55132 ER - TY - JOUR AU - McCallum, Claire AU - Campbell, Miglena AU - Vines, John AU - Rapley, Tim AU - Ellis, Jason AU - Deary, Vincent AU - Hackett, Katie PY - 2024/4/17 TI - A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops JO - JMIR Hum Factors SP - e54172 VL - 11 KW - self-management KW - mobile health KW - mHealth KW - eHealth KW - Sjögren's syndrome KW - patient participation KW - patient involvement KW - fatigue KW - chronic disease KW - focus groups KW - complex intervention development KW - mobile phone N2 - Background: Sjögren'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. UR - https://humanfactors.jmir.org/2024/1/e54172 UR - http://dx.doi.org/10.2196/54172 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630530 ID - info:doi/10.2196/54172 ER - TY - JOUR AU - Laidsaar-Powell, Rebekah AU - Giunta, Sarah AU - Butow, Phyllis AU - Keast, Rachael AU - Koczwara, Bogda AU - Kay, Judy AU - Jefford, Michael AU - Turner, Sandra AU - Saunders, Christobel AU - Schofield, Penelope AU - Boyle, Frances AU - Yates, Patsy AU - White, Kate AU - Miller, Annie AU - Butt, Zoe AU - Bonnaudet, Melanie AU - Juraskova, Ilona PY - 2024/4/17 TI - 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 JO - JMIR Med Educ SP - e50118 VL - 10 KW - family carers KW - patient education KW - health professional education KW - web-based intervention KW - mobile phone N2 - 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. UR - https://mededu.jmir.org/2024/1/e50118 UR - http://dx.doi.org/10.2196/50118 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630531 ID - info:doi/10.2196/50118 ER - TY - JOUR AU - Wahl, J. Kate AU - Brooks, Melissa AU - Trenaman, Logan AU - Desjardins-Lorimer, Kirsten AU - Bell, M. Carolyn AU - Chokmorova, Nazgul AU - Segall, Romy AU - Syring, Janelle AU - Williams, Aleyah AU - Li, C. Linda AU - Norman, V. Wendy AU - Munro, Sarah PY - 2024/4/16 TI - User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study JO - J Med Internet Res SP - e48793 VL - 26 KW - family planning KW - abortion KW - shared decision-making KW - patient decision aid KW - qualitative KW - evaluation KW - Canada KW - health equity N2 - 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. UR - https://www.jmir.org/2024/1/e48793 UR - http://dx.doi.org/10.2196/48793 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625731 ID - info:doi/10.2196/48793 ER - TY - JOUR AU - Opper, A. Claudia AU - Browne, A. Felicia AU - Howard, N. Brittni AU - Zule, A. William AU - Wechsberg, M. Wendee PY - 2024/4/16 TI - Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Hum Factors SP - e51518 VL - 11 KW - HIV KW - Black women KW - mobile apps KW - social determinants of health KW - prevention KW - substance use KW - usability N2 - 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 UR - https://humanfactors.jmir.org/2024/1/e51518 UR - http://dx.doi.org/10.2196/51518 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625721 ID - info:doi/10.2196/51518 ER - TY - JOUR AU - Sobrinho, Silva Andressa Crystine da AU - Gomes, Oliveira Grace Angelica de AU - Bueno Júnior, Roberto Carlos PY - 2024/4/15 TI - Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach JO - JMIR Form Res SP - e54214 VL - 8 KW - information and communications technologies KW - ICTs KW - health care KW - digital inclusion KW - focus groups KW - health promotion KW - user KW - usability KW - health literacy KW - digital competencies KW - digital skills KW - mobile phone N2 - 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 Ribeirão Prêto, São 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 São 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. UR - https://formative.jmir.org/2024/1/e54214 UR - http://dx.doi.org/10.2196/54214 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619865 ID - info:doi/10.2196/54214 ER - TY - JOUR AU - Louch, Gemma AU - Berzins, Kathryn AU - Walker, Lauren AU - Wormald, Gemma AU - Blackwell, Kirstin AU - Stephens, Michael AU - Brown, Mark AU - Baker, John PY - 2024/4/12 TI - 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 JO - JMIR Form Res SP - e53726 VL - 8 KW - patient safety KW - mental health KW - patient involvement KW - qualitative KW - digital innovation KW - real time KW - monitoring KW - safety KW - develop KW - development KW - design KW - perception KW - perceptions KW - prototype KW - evidence scan KW - interview KW - interviews KW - logic model KW - programme theory KW - dashboard KW - dashboards KW - interface N2 - 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. UR - https://formative.jmir.org/2024/1/e53726 UR - http://dx.doi.org/10.2196/53726 UR - http://www.ncbi.nlm.nih.gov/pubmed/38607663 ID - info:doi/10.2196/53726 ER - TY - JOUR AU - O'Brien, Niki AU - Fernandez Crespo, Roberto AU - O'Driscoll, Fiona AU - Prendergast, Mabel AU - Chana, Deeph AU - Darzi, Ara AU - Ghafur, Saira PY - 2024/4/11 TI - 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 JO - JMIR Form Res SP - e50968 VL - 8 KW - acceptability KW - cross sectional KW - cybersecurity KW - digital health KW - digital transformation KW - education KW - feasibility KW - framework KW - frameworks KW - global health KW - health systems KW - implementation KW - organization KW - organizational KW - organizations KW - patient safety KW - SWOT KW - TAM KW - usability N2 - 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. UR - https://formative.jmir.org/2024/1/e50968 UR - http://dx.doi.org/10.2196/50968 UR - http://www.ncbi.nlm.nih.gov/pubmed/38603777 ID - info:doi/10.2196/50968 ER - TY - JOUR AU - Hoffmann, Christin AU - Avery, Kerry AU - Macefield, Rhiannon AU - Dvo?ák, Tadeá? AU - Snelgrove, Val AU - Blazeby, Jane AU - Hopkins, Della AU - Hickey, Shireen AU - Gibbison, Ben AU - Rooshenas, Leila AU - Williams, Adam AU - Aning, Jonathan AU - Bekker, L. Hilary AU - McNair, GK Angus AU - PY - 2024/4/10 TI - Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation JO - JMIR Hum Factors SP - e46698 VL - 11 KW - surgery KW - shared decision-making KW - patient participation KW - mixed methods KW - real-time measurement KW - patient-reported measure KW - electronic data collection KW - usability KW - data collection KW - patient reported KW - satisfaction KW - mobile phone N2 - 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 UR - https://humanfactors.jmir.org/2024/1/e46698 UR - http://dx.doi.org/10.2196/46698 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598276 ID - info:doi/10.2196/46698 ER - TY - JOUR AU - Detsomboonrat, Palinee AU - Pisarnturakit, Pantuwadee Pagaporn PY - 2024/4/10 TI - Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e56143 VL - 8 KW - capability KW - health survey KW - oral health KW - mobile apps KW - personal health information KW - PHI KW - satisfaction KW - tooth KW - teeth KW - oral KW - dental KW - dentist KW - dentistry KW - data entry KW - data collection KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - periodontal KW - survey KW - questionnaire KW - questionnaires N2 - 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. UR - https://formative.jmir.org/2024/1/e56143 UR - http://dx.doi.org/10.2196/56143 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598287 ID - info:doi/10.2196/56143 ER - TY - JOUR AU - Krakowczyk, Barbara Julia AU - Truijens, Femke AU - Teufel, Martin AU - Lalgi, Tania AU - Heinen, Jana AU - Schug, Caterina AU - Erim, Yesim AU - Pantförder, Michael AU - Graf, Johanna AU - Bäuerle, Alexander PY - 2024/4/9 TI - Evaluation of the e?Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial JO - JMIR Cancer SP - e53117 VL - 10 KW - psycho-oncology KW - eHealth KW - digital health KW - cancer KW - Reduct trial KW - oncology N2 - 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. UR - https://cancer.jmir.org/2024/1/e53117 UR - http://dx.doi.org/10.2196/53117 UR - http://www.ncbi.nlm.nih.gov/pubmed/38592764 ID - info:doi/10.2196/53117 ER - TY - JOUR AU - Haslam-Larmer, Lynn AU - Grigorovich, Alisa AU - Shum, Leia AU - Bianchi, Andria AU - Newman, Kristine AU - Iaboni, Andrea AU - McMurray, Josephine PY - 2024/4/8 TI - Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study JO - JMIR Aging SP - e45978 VL - 7 KW - remote sensing technologies KW - dementia KW - real-time location systems KW - Fit between Individuals, Tasks, and Technology framework KW - FITT framework KW - technology implementation N2 - 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. UR - https://aging.jmir.org/2024/1/e45978 UR - http://dx.doi.org/10.2196/45978 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587884 ID - info:doi/10.2196/45978 ER - TY - JOUR AU - Moorthy, Preetha AU - Weinert, Lina AU - Schüttler, Christina AU - Svensson, Laura AU - Sedlmayr, Brita AU - Müller, Julia AU - Nagel, Till PY - 2024/4/5 TI - Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review JO - JMIR Mhealth Uhealth SP - e52179 VL - 12 KW - wearables KW - mobile health KW - mHealth KW - mobile phone KW - usability methods KW - usability attributes KW - evaluation frameworks KW - health care N2 - 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. UR - https://mhealth.jmir.org/2024/1/e52179 UR - http://dx.doi.org/10.2196/52179 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578671 ID - info:doi/10.2196/52179 ER - TY - JOUR AU - Medina-García, Rodrigo AU - López-Rodríguez, A. Juan AU - Lozano-Hernández, María Cristina AU - Ruiz Bejerano, Verónica AU - Criscio, Paride AU - Del Cura-González, Isabel AU - PY - 2024/4/5 TI - A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study JO - JMIR Hum Factors SP - e46811 VL - 11 KW - user-centered design KW - multimorbidity KW - comorbid KW - self-care KW - medical informatics KW - primary health care KW - chronic disease KW - chronic condition KW - chronic illness KW - primary care KW - usability KW - telemedicne KW - telehealth KW - information and communication technologies KW - ICT KW - digital health KW - eHealth KW - human-computer interaction N2 - 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 UR - https://humanfactors.jmir.org/2024/1/e46811 UR - http://dx.doi.org/10.2196/46811 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578675 ID - info:doi/10.2196/46811 ER - TY - JOUR AU - Dang, Ha Thu AU - Wickramasinghe, Nilmini AU - Forkan, Mohammad Abdur Rahim AU - Jayaraman, Prakash Prem AU - Burbury, Kate AU - O?Callaghan, Clare AU - Whitechurch, Ashley AU - Schofield, Penelope PY - 2024/4/3 TI - Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach JO - JMIR Cancer SP - e46979 VL - 10 KW - cancer KW - behavioral science KW - design science research KW - digital KW - medication adherence KW - mobile solution KW - Safety and Adherence to Medication and Self-Care Advice in Oncology KW - SAMSON KW - mobile phone N2 - 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. UR - https://cancer.jmir.org/2024/1/e46979 UR - http://dx.doi.org/10.2196/46979 UR - http://www.ncbi.nlm.nih.gov/pubmed/38569178 ID - info:doi/10.2196/46979 ER - TY - JOUR AU - Correia de Barros, Ana AU - Bergmans, Mariëtte AU - Hasanaj, Kreshnik AU - Krasniqi, Drianë AU - Nóbrega, Catarina AU - Carvalho Carneiro, Bruna AU - Vasconcelos, A. Priscila AU - Quinta-Gomes, Luísa Ana AU - Nobre, J. Pedro AU - Couto da Silva, Joana AU - Mendes-Santos, Cristina PY - 2024/4/3 TI - Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study JO - JMIR Hum Factors SP - e56206 VL - 11 KW - internet interventions KW - mobile health KW - mHealth KW - older adults KW - sexual health KW - smartphone KW - user experience KW - pilot study KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e56206 UR - http://dx.doi.org/10.2196/56206 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568726 ID - info:doi/10.2196/56206 ER - TY - JOUR AU - Adler, F. Rachel AU - Baez, Kevin AU - Morales, Paulina AU - Sotelo, Jocelyn AU - Victorson, David AU - Magasi, Susan PY - 2024/4/2 TI - Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing JO - JMIR Hum Factors SP - e51522 VL - 11 KW - mobile health KW - mHealth KW - apps KW - usability KW - cancer survivors KW - accessibility KW - disabilities KW - cancer KW - oncology KW - heuristics KW - empowerment KW - advocacy KW - mindfulness KW - problem-solving N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e51522 UR - http://dx.doi.org/10.2196/51522 UR - http://www.ncbi.nlm.nih.gov/pubmed/38564261 ID - info:doi/10.2196/51522 ER - TY - JOUR AU - Silva, Rui AU - Morouço, Pedro AU - Lains, Jorge AU - Amorim, Paula AU - Alves, Nuno AU - Veloso, Prieto António PY - 2024/4/2 TI - Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial JO - JMIR Res Protoc SP - e52365 VL - 13 KW - 3D printing KW - 3D scanner KW - ankle foot orthosis KW - biomechanical analysis KW - equinovarus foot N2 - 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 UR - https://www.researchprotocols.org/2024/1/e52365 UR - http://dx.doi.org/10.2196/52365 UR - http://www.ncbi.nlm.nih.gov/pubmed/38564249 ID - info:doi/10.2196/52365 ER - TY - JOUR AU - Choi, Hyeonkyeong AU - Kim, Seunghee AU - Jang, Wonseuk PY - 2024/4/1 TI - User Experience Evaluation of a Spinal Surgery Robot: Workload, Usability, and Satisfaction Study JO - JMIR Hum Factors SP - e54425 VL - 11 KW - robot spine surgery KW - usability KW - satisfaction KW - System Usability Scale KW - surgical navigation systems KW - robotics KW - surgery KW - neurosurgery N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e54425 UR - http://dx.doi.org/10.2196/54425 UR - http://www.ncbi.nlm.nih.gov/pubmed/38432688 ID - info:doi/10.2196/54425 ER - TY - JOUR AU - Acharya, Harshdeep AU - Sykes, J. Kevin AU - Neira, Mirás Ton AU - Scott, Angela AU - Pacheco, M. Christina AU - Sanner, Matthew AU - Ablah, Elizabeth AU - Oyowe, Kevin AU - Ellerbeck, F. Edward AU - Greiner, Allen K. AU - Corriveau, A. Erin AU - Finocchario-Kessler, Sarah PY - 2024/4/1 TI - A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study JO - JMIR Form Res SP - e52920 VL - 8 KW - public health KW - database KW - community health worker KW - social determinants of health KW - health worker KW - health workers KW - CHW KW - CHWs KW - community-based KW - data collection KW - functionality KW - develop KW - development KW - EHR KW - EHRs KW - EMR KW - EMRs KW - dashboard KW - dashboards KW - health record KW - health records KW - documentation KW - medical record KW - medical records KW - equity KW - inequity KW - inequities N2 - 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. UR - https://formative.jmir.org/2024/1/e52920 UR - http://dx.doi.org/10.2196/52920 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557671 ID - info:doi/10.2196/52920 ER - TY - JOUR AU - Thomas, Amy AU - Asnes, Andrea AU - Libby, Kyle AU - Hsiao, Allen AU - Tiyyagura, Gunjan PY - 2024/3/29 TI - Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study JO - J Med Internet Res SP - e51058 VL - 26 KW - child abuse KW - clinical decision support KW - CDS KW - pediatrics KW - child KW - children KW - natural language processing KW - usability KW - clinical decision support system KW - physical abuse N2 - 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. UR - https://www.jmir.org/2024/1/e51058 UR - http://dx.doi.org/10.2196/51058 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551639 ID - info:doi/10.2196/51058 ER - TY - JOUR AU - He, Yunfan AU - Zhu, Wei AU - Wang, Tong AU - Chen, Han AU - Xin, Junyi AU - Liu, Yongcheng AU - Lei, Jianbo AU - Liang, Jun PY - 2024/3/28 TI - Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study JO - JMIR Mhealth Uhealth SP - e55199 VL - 12 KW - hypertension management KW - mobile health KW - topic modeling KW - satisfaction KW - 2-factor model KW - comparative study N2 - 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 (?=.354, P<.001), while cost had the most significant impact on ND (?=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 (?=0.312, P<.001), while data synchronization had the most significant impact on ND (?=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. UR - https://mhealth.jmir.org/2024/1/e55199 UR - http://dx.doi.org/10.2196/55199 UR - http://www.ncbi.nlm.nih.gov/pubmed/38547475 ID - info:doi/10.2196/55199 ER - TY - JOUR AU - Liu, Y. Albert AU - Alleyne, Cat-Dancing AU - Doblecki-Lewis, Susanne AU - Koester, A. Kimberly AU - Gonzalez, Rafael AU - Vinson, Janie AU - Scott, Hyman AU - Buchbinder, Susan AU - Torres, S. Thiago PY - 2024/3/27 TI - 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 JO - JMIR Form Res SP - e54073 VL - 8 KW - preexposure prophylaxis KW - PrEP KW - Spanish-speaking KW - Latino KW - transgender KW - men who have sex with men KW - mobile health KW - mHealth KW - HIV prevention KW - HIV KW - technology KW - formative KW - development KW - mobile technology, mobile app KW - text-messaging KW - SMS KW - app KW - application KW - USA KW - United States KW - health equity KW - mHealth tool KW - tool KW - acceptability KW - self-management KW - pilot KW - support N2 - 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. UR - https://formative.jmir.org/2024/1/e54073 UR - http://dx.doi.org/10.2196/54073 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536232 ID - info:doi/10.2196/54073 ER - TY - JOUR AU - Irvine, Kathryn Mary AU - Zimba, Rebecca AU - Avoundjian, Tigran AU - Peterson, Meghan AU - Emmert, Connor AU - Kulkarni, G. Sarah AU - Philbin, M. Morgan AU - Kelvin, A. Elizabeth AU - Nash, Denis PY - 2024/3/27 TI - 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 JO - JMIR Res Protoc SP - e56892 VL - 13 KW - HIV KW - implementation science KW - long-acting injectables KW - LAI KW - patient decision aid KW - medical case management KW - MCM KW - antiretroviral therapy KW - ART N2 - 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 UR - https://www.researchprotocols.org/2024/1/e56892 UR - http://dx.doi.org/10.2196/56892 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536227 ID - info:doi/10.2196/56892 ER - TY - JOUR AU - Cyrkot, Samantha AU - Hartling, Lisa AU - Scott, D. Shannon AU - Elliott, A. Sarah PY - 2024/3/20 TI - Parents? User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study JO - JMIR Form Res SP - e53593 VL - 8 KW - awareness KW - COVID-19 KW - credibility KW - credible KW - descriptive KW - guidelines KW - health evidence KW - information behavior KW - information needs KW - information seeking KW - information-seeking behaviour KW - interface KW - internet KW - interview KW - knowledge mobilization KW - parent KW - parenting KW - public health KW - qualitative KW - recommendation KW - recommender KW - SARS-CoV-2 KW - think-aloud activity KW - think-aloud KW - trust KW - trustworthy KW - usability KW - user experience KW - web design KW - website N2 - 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. UR - https://formative.jmir.org/2024/1/e53593 UR - http://dx.doi.org/10.2196/53593 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506915 ID - info:doi/10.2196/53593 ER - TY - JOUR AU - Poudyal, Anubhuti AU - Lewis, Delta-Marie AU - Taha, Sarah AU - Martinez, J. Alyssa AU - Magoun, Lauren AU - Ho, Xian Y. AU - Carmio, Natali AU - Naslund, A. John AU - Sanchez, Katherine AU - Lesh, Neal AU - Patel, Vikram PY - 2024/3/11 TI - Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study JO - JMIR Form Res SP - e55205 VL - 8 KW - digital technology KW - mental health KW - depression KW - task sharing KW - nonspecialist providers KW - peer supervision KW - therapy quality N2 - 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. UR - https://formative.jmir.org/2024/1/e55205 UR - http://dx.doi.org/10.2196/55205 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466971 ID - info:doi/10.2196/55205 ER - TY - JOUR AU - Savolainen, Kaisa AU - Kujala, Sari PY - 2024/3/8 TI - Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services JO - JMIR Hum Factors SP - e45275 VL - 11 KW - eHealth KW - online symptom checkers KW - usability KW - cognitive accessibility KW - web accessibility KW - qualitative research N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e45275 UR - http://dx.doi.org/10.2196/45275 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457214 ID - info:doi/10.2196/45275 ER - TY - JOUR AU - Rettinger, Lena AU - Schönthaler, Erna AU - Kerschbaumer, Andrea AU - Hauser, Carina AU - Klupper, Carissa AU - Aichinger, Lea AU - Werner, Franz PY - 2024/3/7 TI - Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study JO - JMIR Rehabil Assist Technol SP - e51116 VL - 11 KW - handwriting KW - handwriting pressure KW - pen KW - children KW - occupational therapy KW - assistive technology KW - tablet KW - app N2 - 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. UR - https://rehab.jmir.org/2024/1/e51116 UR - http://dx.doi.org/10.2196/51116 UR - http://www.ncbi.nlm.nih.gov/pubmed/38451584 ID - info:doi/10.2196/51116 ER - TY - JOUR AU - Anders, Carolin AU - Moorthy, Preetha AU - Svensson, Laura AU - Müller, Julia AU - Heinze, Oliver AU - Knaup, Petra AU - Wallwiener, Markus AU - Deutsch, M. Thomas AU - Le, Thao-Vy AU - Weinert, Lina PY - 2024/3/5 TI - Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking JO - JMIR Hum Factors SP - e50926 VL - 11 KW - mobile health KW - mHealth KW - usability KW - breast cancer KW - eye tracking KW - user interface KW - mixed methods KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e50926 UR - http://dx.doi.org/10.2196/50926 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441959 ID - info:doi/10.2196/50926 ER - TY - JOUR AU - Keogh, Alison AU - Brennan, Carol AU - Johnston, William AU - Dickson, Jane AU - Leslie, J. Stephen AU - Burke, David AU - Megyesi, Peter AU - Caulfield, Brian PY - 2024/3/1 TI - Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study JO - JMIR Form Res SP - e52442 VL - 8 KW - digital health KW - heart failure KW - cardiology KW - self-care KW - behavior change KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - mobile phone KW - elderly KW - self-management KW - digital tools KW - digital tool KW - human-centered design KW - app KW - apps KW - applications KW - wearables KW - wearable KW - Fitbit KW - usability KW - adherence KW - feasibility KW - congestive heart failure KW - cardiac failure KW - myocardial failure KW - heart decompensation N2 - 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. UR - https://formative.jmir.org/2024/1/e52442 UR - http://dx.doi.org/10.2196/52442 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427410 ID - info:doi/10.2196/52442 ER - TY - JOUR AU - Ni, Chenxu AU - Wang, Yi-fu AU - Zhang, Yun-ting AU - Yuan, Min AU - Xu, Qing AU - Shen, Fu-ming AU - Li, Dong-Jie AU - Huang, Fang PY - 2024/2/29 TI - A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study JO - JMIR Form Res SP - e50528 VL - 8 KW - WeChat applet KW - usability testing KW - utility testing KW - cancer patients KW - patients KW - cancer KW - qualitative study N2 - 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. UR - https://formative.jmir.org/2024/1/e50528 UR - http://dx.doi.org/10.2196/50528 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421700 ID - info:doi/10.2196/50528 ER - TY - JOUR AU - Lee, Audrey AU - Dionicio, Patricia AU - Farcas, Emilia AU - Godino, Job AU - Patrick, Kevin AU - Wyckoff, Elijah AU - Loh, J. Kenneth AU - Gombatto, Sara PY - 2024/2/29 TI - Physical Therapists? Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study JO - JMIR Hum Factors SP - e55246 VL - 11 KW - low back pain KW - physical therapy KW - physical therapist KW - wearable sensor KW - technology acceptance model KW - motion tape KW - kinesiology tape N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e55246 UR - http://dx.doi.org/10.2196/55246 UR - http://www.ncbi.nlm.nih.gov/pubmed/38421708 ID - info:doi/10.2196/55246 ER - TY - JOUR AU - Schmitz, Boris AU - Wirtz, Svenja AU - Sestayo-Fernández, Manuela AU - Schäfer, Hendrik AU - Douma, R. Emma AU - Alonso Vazquez, Marta AU - González-Salvado, Violeta AU - Habibovic, Mirela AU - Gatsios, Dimitris AU - Kop, Johan Willem AU - Peña-Gil, Carlos AU - Mooren, Frank PY - 2024/2/22 TI - Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis JO - J Med Internet Res SP - e53991 VL - 26 KW - eHealth KW - coronary artery disease KW - rehabilitation KW - mHealth KW - mobile health KW - mobile phone KW - app KW - apps KW - applications KW - personalized medicine KW - patient empowerment KW - living lab KW - coronary KW - cardiac KW - cardiology KW - heart KW - telehealth KW - telemedicine KW - monitoring KW - survey KW - surveys KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - technology use KW - usage N2 - 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 UR - https://www.jmir.org/2024/1/e53991 UR - http://dx.doi.org/10.2196/53991 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386376 ID - info:doi/10.2196/53991 ER - TY - JOUR AU - Pease, Anna AU - Ingram, Jenny AU - Lambert, Becky AU - Patrick, Karen AU - Pitts, Kieren AU - Fleming, J. Peter AU - Blair, S. Peter AU - PY - 2024/2/22 TI - A Risk Assessment and Planning Tool to Prevent Sudden Unexpected Death in Infancy: Development and Evaluation of The Baby Sleep Planner JO - JMIR Pediatr Parent SP - e49952 VL - 7 KW - safer sleep KW - parent education KW - co-design KW - process evaluation KW - sudden infant death syndrome KW - SIDS KW - sleep KW - baby KW - babies KW - infant KW - infants KW - prototype KW - interface KW - develop KW - development KW - sleeping KW - pattern KW - tool KW - parent KW - infant mortality KW - risk KW - risks KW - assessment KW - death KW - mortality KW - parents KW - parenting KW - risk assessment KW - sudden unexpected death in infancy KW - SUDI KW - approach KW - antenatal KW - postnatal KW - user testing KW - user experience KW - web-based KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives N2 - 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. UR - https://pediatrics.jmir.org/2024/1/e49952 UR - http://dx.doi.org/10.2196/49952 UR - http://www.ncbi.nlm.nih.gov/pubmed/38386377 ID - info:doi/10.2196/49952 ER - TY - JOUR AU - Østervang, Christina AU - Jensen, Myhre Charlotte AU - Coyne, Elisabeth AU - Dieperink, B. Karin AU - Lassen, Annmarie PY - 2024/2/21 TI - Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study JO - JMIR Hum Factors SP - e48445 VL - 11 KW - consumer KW - eHealth KW - elderly KW - emergency department KW - emergency KW - family members KW - healthcare professionals KW - information system KW - mixed methods research: patients KW - qualitative interview KW - questionnaire KW - technology KW - usability KW - usable N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e48445 UR - http://dx.doi.org/10.2196/48445 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381502 ID - info:doi/10.2196/48445 ER - TY - JOUR AU - Hahn, Christine AU - Tilstra-Ferrell, Emily AU - Salim, Selime AU - Goodrum, Nada AU - Rheingold, Alyssa AU - Gilmore, K. Amanda AU - Barber, Sara AU - Moreland, Angela PY - 2024/2/15 TI - 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 JO - JMIR Form Res SP - e49557 VL - 8 KW - screening, brief intervention, and referral to treatment KW - brief intervention KW - intimate partner violence KW - sexual assault KW - substance use KW - alcohol use KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e49557 UR - http://dx.doi.org/10.2196/49557 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358791 ID - info:doi/10.2196/49557 ER - TY - JOUR AU - Ma, Yuanchao AU - Achiche, Sofiane AU - Pomey, Marie-Pascale AU - Paquette, Jesseca AU - Adjtoutah, Nesrine AU - Vicente, Serge AU - Engler, Kim AU - AU - Laymouna, Moustafa AU - Lessard, David AU - Lemire, Benoît AU - Asselah, Jamil AU - Therrien, Rachel AU - Osmanlliu, Esli AU - Zawati, H. Ma'n AU - Joly, Yann AU - Lebouché, Bertrand PY - 2024/2/13 TI - 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) JO - JMIR Res Protoc SP - e54668 VL - 13 KW - chatbot KW - master protocol KW - adaptive platform trial design KW - implementation science KW - telehealth KW - digital health KW - Canada KW - artificial intelligence KW - conversational agent KW - self-management KW - research ethics KW - patient and stakeholder engagement KW - co-construction KW - mobile phone N2 - 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?Université de Montréal (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 UR - https://www.researchprotocols.org/2024/1/e54668 UR - http://dx.doi.org/10.2196/54668 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349734 ID - info:doi/10.2196/54668 ER - TY - JOUR AU - Lai, Byron AU - Wadsworth, Danielle AU - Spring, Katherine AU - Jones, S. Chloe AU - Mintz, Madison AU - Malone, A. Laurie AU - Kim, Yumi AU - Wilroy, Jereme AU - Lee, Holim PY - 2024/2/12 TI - Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study JO - JMIR Rehabil Assist Technol SP - e50582 VL - 11 KW - cerebral palsy KW - telehealth KW - young adults KW - telemonitoring KW - exercise KW - therapy KW - therapeutic exercise KW - assessment KW - teleassessment KW - reliability KW - usability KW - disability KW - youth KW - physical fitness KW - videoconference N2 - 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. UR - https://rehab.jmir.org/2024/1/e50582 UR - http://dx.doi.org/10.2196/50582 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345838 ID - info:doi/10.2196/50582 ER - TY - JOUR AU - McElwain, L. Nancy AU - Fisher, C. Meghan AU - Nebeker, Camille AU - Bodway, M. Jordan AU - Islam, Bashima AU - Hasegawa-Johnson, Mark PY - 2024/2/8 TI - Evaluating Users? Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach JO - JMIR Hum Factors SP - e49316 VL - 11 KW - wearable devices KW - multimodal sensing KW - user experience KW - usability KW - privacy KW - children KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e49316 UR - http://dx.doi.org/10.2196/49316 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329785 ID - info:doi/10.2196/49316 ER - TY - JOUR AU - Bhattacharjee, Ananya AU - Chen, Pan AU - Mandal, Abhijoy AU - Hsu, Anne AU - O'Leary, Katie AU - Mariakakis, Alex AU - Williams, Jay Joseph PY - 2024/2/8 TI - Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study JO - JMIR Form Res SP - e47360 VL - 8 KW - reflection KW - mental health KW - stress KW - reflective questioning activity KW - RQA KW - brief intervention KW - computer-mediated communication KW - email KW - SMS text messaging KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e47360 UR - http://dx.doi.org/10.2196/47360 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329800 ID - info:doi/10.2196/47360 ER - TY - JOUR AU - Elavsky, Steriani AU - Knapova, Lenka AU - Jani?, Kamil AU - Cimler, Richard AU - Kuhnova, Jitka AU - Cernicky, Tomas PY - 2024/2/7 TI - Multiple Perspectives on the Adoption of SMART Technologies for Improving Care of Older People: Mixed Methods Study JO - J Med Internet Res SP - e45492 VL - 26 KW - adults KW - older KW - technologies KW - technological KW - caregivers KW - SMART KW - mobile phone N2 - 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. UR - https://www.jmir.org/2024/1/e45492 UR - http://dx.doi.org/10.2196/45492 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324345 ID - info:doi/10.2196/45492 ER - TY - JOUR AU - Dryden, M. Eileen AU - Anwar, Chitra AU - Conti, Jennifer AU - Boudreau, H. Jacqueline AU - Kennedy, A. Meaghan AU - Hung, W. William AU - Nearing, A. Kathryn AU - Pimentel, B. Camilla AU - Moo, Lauren PY - 2024/2/1 TI - The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults JO - JMIR Form Res SP - e52096 VL - 8 KW - qualitative interviews KW - visual recall aid KW - older adults KW - health services research KW - web-based methods KW - visual tool KW - recall KW - qualitative interview KW - experience KW - perspective KW - motivation KW - patient KW - recall capacity KW - medical information KW - visual appointment KW - geriatric KW - older people KW - telemedicine KW - videoconference KW - e-consultation KW - e-medicine KW - internet medicine KW - REVISIT KW - Remembering Healthcare Encounters Visually and Interactively KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e52096 UR - http://dx.doi.org/10.2196/52096 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300691 ID - info:doi/10.2196/52096 ER - TY - JOUR AU - van der Heijden, Zoë AU - de Gooijer, Femke AU - Camps, Guido AU - Lucassen, Desiree AU - Feskens, Edith AU - Lasschuijt, Marlou AU - Brouwer-Brolsma, Elske PY - 2024/2/1 TI - User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study JO - JMIR Form Res SP - e47850 VL - 8 KW - diet KW - children KW - dietary assessment KW - recall KW - technological innovation KW - mobile health KW - mHealth KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e47850 UR - http://dx.doi.org/10.2196/47850 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300689 ID - info:doi/10.2196/47850 ER - TY - JOUR AU - Moore, Richard AU - Al-Tamimi, Abdel-Karim AU - Freeman, Elizabeth PY - 2024/1/31 TI - Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study JO - JMIR Form Res SP - e51571 VL - 8 KW - physical activity KW - inactivity KW - conversational agent KW - CA KW - adolescent KW - public health KW - digital health interventions KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2024/1/e51571 UR - http://dx.doi.org/10.2196/51571 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294857 ID - info:doi/10.2196/51571 ER - TY - JOUR AU - Al-yaseen, Waraf AU - Raggio, Procida Daniela AU - Araujo, Mariana AU - Innes, Nicola PY - 2024/1/30 TI - ?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 JO - JMIR Form Res SP - e49561 VL - 8 KW - oral health promotion KW - mobile health KW - mHealth KW - children KW - oral health KW - behavior change KW - coproduction KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2024/1/e49561 UR - http://dx.doi.org/10.2196/49561 UR - http://www.ncbi.nlm.nih.gov/pubmed/38289667 ID - info:doi/10.2196/49561 ER - TY - JOUR AU - Fiorini, Laura AU - D'Onofrio, Grazia AU - Sorrentino, Alessandra AU - Cornacchia Loizzo, Gabriella Federica AU - Russo, Sergio AU - Ciccone, Filomena AU - Giuliani, Francesco AU - Sancarlo, Daniele AU - Cavallo, Filippo PY - 2024/1/26 TI - The Role of Coherent Robot Behavior and Embodiment in Emotion Perception and Recognition During Human-Robot Interaction: Experimental Study JO - JMIR Hum Factors SP - e45494 VL - 11 KW - social robot KW - emotion recognition KW - human emotion perception KW - human-robot interaction KW - robot cospeech gestures evaluation N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e45494 UR - http://dx.doi.org/10.2196/45494 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277201 ID - info:doi/10.2196/45494 ER - TY - JOUR AU - Cranston, D. Kaela AU - Grieve, J. Natalie AU - Dineen, E. Tineke AU - Jung, E. Mary PY - 2024/1/26 TI - Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study JO - JMIR Form Res SP - e50942 VL - 8 KW - program evaluation KW - prediabetic state KW - e-learning education KW - e-learning KW - platform KW - usability KW - diabetes KW - prevention KW - knowledge translation KW - end user KW - type 2 diabetes KW - framework N2 - 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. UR - https://formative.jmir.org/2024/1/e50942 UR - http://dx.doi.org/10.2196/50942 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277214 ID - info:doi/10.2196/50942 ER - TY - JOUR AU - Messina, Anna AU - Amati, Rebecca AU - Annoni, Maria Anna AU - Bano, Beatrice AU - Albanese, Emiliano AU - Fiordelli, Maddalena PY - 2024/1/24 TI - Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach JO - JMIR Form Res SP - e46941 VL - 8 KW - informal caregivers KW - iSupport KW - dementia KW - digital interventions KW - mHealth KW - community-based participatory research KW - community KW - caregiver KW - mental distress KW - physical distress KW - support KW - development N2 - 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. UR - https://formative.jmir.org/2024/1/e46941 UR - http://dx.doi.org/10.2196/46941 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265857 ID - info:doi/10.2196/46941 ER - TY - JOUR AU - Wang, Xin AU - Li, Juan AU - Liang, Tianyi AU - Hasan, Ul Wordh AU - Zaman, Tuz Kimia AU - Du, Yang AU - Xie, Bo AU - Tao, Cui PY - 2024/1/23 TI - Promoting Personalized Reminiscence Among Cognitively Intact Older Adults Through an AI-Driven Interactive Multimodal Photo Album: Development and Usability Study JO - JMIR Aging SP - e49415 VL - 7 KW - aging KW - knowledge graph KW - machine learning KW - reminiscence KW - voice assistant N2 - 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. UR - https://aging.jmir.org/2024/1/e49415 UR - http://dx.doi.org/10.2196/49415 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261365 ID - info:doi/10.2196/49415 ER - TY - JOUR AU - Straand, Jevnaker Ingjerd AU - Følstad, Asbjørn AU - Bjørnestad, Ravndal Jone PY - 2024/1/18 TI - Exploring a Gaming-Based Intervention for Unemployed Young Adults: Thematic Analysis JO - JMIR Hum Factors SP - e44423 VL - 11 KW - positive psychology intervention KW - digital mental health KW - serious gaming KW - intervention design KW - research through design KW - gaming-based intervention N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e44423 UR - http://dx.doi.org/10.2196/44423 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236624 ID - info:doi/10.2196/44423 ER - TY - JOUR AU - Zhu, Di AU - Al Mahmud, Abdullah AU - Liu, Wei PY - 2024/1/17 TI - Digital Storytelling Intervention for Enhancing the Social Participation of People With Mild Cognitive Impairment: Co-Design and Usability Study JO - JMIR Aging SP - e54138 VL - 7 KW - co-design KW - digital storytelling KW - people with mild cognitive impairment KW - MCI KW - technology-based intervention development KW - dementia KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2024/1/e54138 UR - http://dx.doi.org/10.2196/54138 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231541 ID - info:doi/10.2196/54138 ER - TY - JOUR AU - Kim, Sung-In AU - Jang, So-youn AU - Kim, Taewan AU - Kim, Bogoan AU - Jeong, Dayoung AU - Noh, Taehyung AU - Jeong, Mingon AU - Hall, Kaely AU - Kim, Meelim AU - Yoo, Jeong Hee AU - Han, Kyungsik AU - Hong, Hwajung AU - Kim, G. Jennifer PY - 2024/1/11 TI - Promoting Self-Efficacy of Individuals With Autism in Practicing Social Skills in the Workplace Using Virtual Reality and Physiological Sensors: Mixed Methods Study JO - JMIR Form Res SP - e52157 VL - 8 KW - autism KW - virtual reality KW - workplace KW - self-efficacy KW - social skills KW - data reflection N2 - 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. UR - https://formative.jmir.org/2024/1/e52157 UR - http://dx.doi.org/10.2196/52157 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206652 ID - info:doi/10.2196/52157 ER - TY - JOUR AU - Bérubé, Caterina AU - Lehmann, Franziska Vera AU - Maritsch, Martin AU - Kraus, Mathias AU - Feuerriegel, Stefan AU - Wortmann, Felix AU - Züger, Thomas AU - Stettler, Christoph AU - Fleisch, Elgar AU - Kocaballi, Baki A. AU - Kowatsch, Tobias PY - 2024/1/9 TI - Effectiveness and User Perception of an In-Vehicle Voice Warning for Hypoglycemia: Development and Feasibility Trial JO - JMIR Hum Factors SP - e42823 VL - 11 KW - hypoglycemia KW - type-1 diabetes mellitus KW - in-vehicle voice assistant KW - voice interface KW - voice warning KW - digital health intervention KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e42823 UR - http://dx.doi.org/10.2196/42823 UR - http://www.ncbi.nlm.nih.gov/pubmed/38194257 ID - info:doi/10.2196/42823 ER - TY - JOUR AU - Luu, Phuoc An AU - Nguyen, Thanh Truong AU - Cao, Cam Van Thi AU - Ha, Diem Trinh Hoang AU - Chung, Thu Lien Thi AU - Truong, Ngoc Trung AU - Nguyen Le Nhu, Tung AU - Dao, Bach Khoa AU - Nguyen, Van Hao AU - Khanh, Quoc Phan Nguyen AU - Le, Thuy Khanh Thuy AU - Tran, Bao Luu Hoai AU - Nhat, Huy Phung Tran AU - Tran, Minh Duc AU - Lam, Minh Yen AU - Thwaites, Louise Catherine AU - Mcknight, Jacob AU - Vinh Chau, Van Nguyen AU - Van Nuil, Ilo Jennifer AU - PY - 2024/1/5 TI - 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 JO - JMIR Hum Factors SP - e44619 VL - 11 KW - vital signs KW - wearable devices KW - action learning KW - technology acceptance model KW - TAM KW - COVID-19 KW - user-centered design KW - wearables KW - remote monitoring KW - technology acceptance KW - oximeter N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e44619 UR - http://dx.doi.org/10.2196/44619 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180799 ID - info:doi/10.2196/44619 ER - TY - JOUR AU - Fubini, Elias Pietro AU - Savoldelli, Louis Georges AU - Beckmann, Sara Tal AU - Samer, Flora Caroline AU - Suppan, Mélanie PY - 2024/1/3 TI - Impact of a Mobile App (LoAD Calc) on the Calculation of Maximum Safe Doses of Local Anesthetics: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53679 VL - 13 KW - dose calculation KW - drug safety KW - information systems research KW - local anesthetic systemic toxicity KW - local anesthetics KW - mobile health app KW - study protocol KW - toxicity N2 - 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 UR - https://www.researchprotocols.org/2024/1/e53679 UR - http://dx.doi.org/10.2196/53679 UR - http://www.ncbi.nlm.nih.gov/pubmed/38170571 ID - info:doi/10.2196/53679 ER - TY - JOUR AU - Choi, Soyoung AU - Sajib, Zaman Md Refat Uz AU - Manzano, Jenna AU - Chlebek, Joseph Christian PY - 2023/12/25 TI - mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study JO - JMIR Form Res SP - e52410 VL - 7 KW - aging KW - mobile health KW - older adults KW - technology KW - visual impairment KW - wearables KW - wearable KW - vision KW - visual KW - qualitative analysis KW - health behavior KW - mHealth KW - mHealth technology KW - digital technology KW - medical application KW - application KW - app KW - applications KW - usage KW - well-being KW - cross-section interview KW - interview KW - interviews KW - tracking KW - health data KW - symptom monitoring KW - monitor KW - monitoring KW - symptom KW - symptoms KW - physical activity KW - walking KW - routine KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e52410 UR - http://dx.doi.org/10.2196/52410 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145472 ID - info:doi/10.2196/52410 ER - TY - JOUR AU - Fridriksdottir, Nanna AU - Ingadottir, Brynja AU - Skuladottir, Kristin AU - Zoëga, Sigridur AU - Gunnarsdottir, Sigridur PY - 2023/12/22 TI - Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study JO - JMIR Form Res SP - e50550 VL - 7 KW - web portal for patients with cancer KW - supportive digital health service KW - symptom monitoring KW - self-management support KW - feasibility KW - usability KW - acceptability KW - patient education KW - health engagement KW - patient-reported outcomes KW - digital health service KW - patient portal KW - electronic health records KW - mobile phone N2 - 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 (?=?.45), ESASr engagement (?=.5), symptom interference (?=.4), and received knowledge (?=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (?=?.31), ESASr engagement (?=.37), symptom interference (?=.60), self-care self-efficacy (?=.37), and received knowledge (?=.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. UR - https://formative.jmir.org/2023/1/e50550 UR - http://dx.doi.org/10.2196/50550 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015268 ID - info:doi/10.2196/50550 ER - TY - JOUR AU - De Sutter, Evelien AU - Geerts, David AU - Yskout, Koen AU - Verreydt, Stef AU - Borry, Pascal AU - Barbier, Liese AU - Huys, Isabelle PY - 2023/12/19 TI - Testing and Practical Implementation of a User-Friendly Personalized and Long-Term Electronic Informed Consent Prototype in Clinical Research: Mixed Methods Study JO - J Med Internet Res SP - e46306 VL - 25 KW - human-centered design KW - digital health KW - qualitative research KW - informed consent KW - trial KW - stakeholders KW - implementation N2 - 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. UR - https://www.jmir.org/2023/1/e46306 UR - http://dx.doi.org/10.2196/46306 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113088 ID - info:doi/10.2196/46306 ER - TY - JOUR AU - Evans, Eric AU - Zengul, Ayse AU - Knight, Amy AU - Willig, Amanda AU - Cherrington, Andrea AU - Mehta, Tapan AU - Thirumalai, Mohanraj PY - 2023/12/18 TI - Stakeholders? Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study JO - JMIR Rehabil Assist Technol SP - e43309 VL - 10 KW - self-management KW - physical disabilities KW - physical disability KW - chronic condition KW - chronic illness KW - mental health KW - physical activity KW - barrier KW - disability KW - chronic KW - technology KW - interview KW - data KW - symptom KW - support KW - digital KW - development KW - need KW - perspective KW - qualitative KW - focus group KW - assistive technology KW - assistive technologies N2 - 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 UR - https://rehab.jmir.org/2023/1/e43309 UR - http://dx.doi.org/10.2196/43309 UR - http://www.ncbi.nlm.nih.gov/pubmed/38109170 ID - info:doi/10.2196/43309 ER - TY - JOUR AU - Islam, Riasat AU - Gooch, Daniel AU - Karlakki, Sudheer AU - Price, Blaine PY - 2023/12/18 TI - A Device for Prehabilitation of Total Knee Replacement Surgery (Slider): Usability Study JO - JMIR Form Res SP - e48055 VL - 7 KW - physiotherapy KW - rehabilitation KW - prehabilitation, knee replacement KW - community physiotherapy KW - outpatient KW - gamification KW - motivation KW - adherence KW - knee KW - exercise KW - preoperative KW - postoperative KW - usability KW - validation KW - software KW - exergames KW - geriatric rehabilitation KW - self-regulated exercise KW - assistive technology KW - telerehabilitation KW - digital health KW - healthcare delivery N2 - 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. UR - https://formative.jmir.org/2023/1/e48055 UR - http://dx.doi.org/10.2196/48055 UR - http://www.ncbi.nlm.nih.gov/pubmed/38109191 ID - info:doi/10.2196/48055 ER - TY - JOUR AU - Mohanraj, Sangeetha AU - Malone, A. Laurie AU - Mendonca, J. Christen AU - Thirumalai, Mohanraj PY - 2023/12/15 TI - Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study JO - JMIR Form Res SP - e49685 VL - 7 KW - web-based exercise KW - user experience KW - community health KW - fitness facility KW - tele-exercise KW - physical disability KW - physical activity KW - exercise KW - fitness KW - virtual KW - interface KW - disability KW - disabilities KW - accessibility KW - telehealth KW - telemedicine KW - eHealth KW - digital health KW - mixed methods study N2 - 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. UR - https://formative.jmir.org/2023/1/e49685 UR - http://dx.doi.org/10.2196/49685 UR - http://www.ncbi.nlm.nih.gov/pubmed/38100173 ID - info:doi/10.2196/49685 ER - TY - JOUR AU - Beesoon, Sanjay AU - Drobot, Ashley AU - Smokeyday, Melissa AU - Ali, Al-Bakir AU - Collins, Zoe AU - Reynolds, Colin AU - Berzins, Sandra AU - Gibson, Alison AU - Nelson, Gregg PY - 2023/12/15 TI - 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 JO - JMIR Form Res SP - e49277 VL - 7 KW - app KW - digital health KW - patient experience KW - provider satisfaction KW - application KW - recovery KW - cost-effective KW - evaluation KW - implementation KW - gynecologic oncology KW - colorectal surgery KW - surgery KW - care N2 - 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. UR - https://formative.jmir.org/2023/1/e49277/ UR - http://dx.doi.org/10.2196/49277 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49277 ER - TY - JOUR AU - Huguet, Anna AU - Rozario, Sharlene AU - Wozney, Lori AU - McGrath, J. Patrick PY - 2023/12/12 TI - An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing JO - JMIR Hum Factors SP - e48677 VL - 10 KW - adolescents KW - cognitive-behavioral intervention KW - design process KW - end users KW - headaches KW - internet KW - usability KW - young adult N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e48677 UR - http://dx.doi.org/10.2196/48677 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085567 ID - info:doi/10.2196/48677 ER - TY - JOUR AU - Nitschke, Marlies AU - Nwosu, Bertrand Obioma AU - Grube, Lara AU - Knitza, Johannes AU - Seifer, Ann-Kristin AU - Eskofier, M. Bjoern AU - Schett, Georg AU - Morf, Harriet PY - 2023/12/12 TI - Refinement and Usability Analysis of an eHealth App for Ankylosing Spondylitis as a Complementary Treatment to Physical Therapy: Development and Usability Study JO - JMIR Form Res SP - e47426 VL - 7 KW - ankylosing spondylitis KW - axial spondylarthritis KW - DHA KW - digital health application KW - eHealth KW - self-assessment KW - Usability KW - Yoga KW - YogiTherapy N2 - 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. UR - https://formative.jmir.org/2023/1/e47426 UR - http://dx.doi.org/10.2196/47426 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085558 ID - info:doi/10.2196/47426 ER - TY - JOUR AU - Jan, Michael AU - Coppin-Renz, Antonia AU - West, Robin AU - Gallo, Le Christophe AU - Cochran, M. Jeffrey AU - Heumen, van Emiel AU - Fahmy, Michael AU - Reuteman-Fowler, Corey J. PY - 2023/12/12 TI - Safety Evaluation in Iterative Development of Wearable Patches for Aripiprazole Tablets With Sensor: Pooled Analysis of Clinical Trials JO - JMIR Form Res SP - e44768 VL - 7 KW - wearable sensor KW - adhesive patch KW - adverse events KW - skin irritation KW - product iteration KW - mobile phone KW - biocompatibility KW - Abilify MyCite KW - development KW - sensors KW - skin KW - monitoring KW - treatment KW - schizophrenia KW - bipolar disorder KW - depressive disorder KW - abrasions KW - blisters KW - dermatitis KW - pain KW - rash N2 - 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 UR - https://formative.jmir.org/2023/1/e44768 UR - http://dx.doi.org/10.2196/44768 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085556 ID - info:doi/10.2196/44768 ER - TY - JOUR AU - Mahmoodi Kahriz, Bahram AU - Snuggs, Sarah AU - Sah, Anumeha AU - Clot, Sophie AU - Lamport, Daniel AU - Forrest, Joseph AU - Helme-Guizon, Agnes AU - Wilhelm, Marie-Claire AU - Caldara, Cindy AU - Anin, Valentine Camille AU - Vogt, Julia PY - 2023/12/11 TI - Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries JO - JMIR Hum Factors SP - e44993 VL - 10 KW - mobile apps KW - healthy eating and physical activity KW - attitude KW - BMI and self-efficacy N2 - 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 (?=.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. UR - https://humanfactors.jmir.org/2023/1/e44993 UR - http://dx.doi.org/10.2196/44993 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079197 ID - info:doi/10.2196/44993 ER - TY - JOUR AU - Struik, Laura AU - Christianson, Kyla AU - Khan, Shaheer AU - Sharma, H. Ramona PY - 2023/12/8 TI - Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study JO - JMIR Form Res SP - e43096 VL - 7 KW - qualitative research KW - tobacco use KW - smoking KW - vaping KW - cessation KW - eHealth KW - individuals who smoke KW - users KW - tobacco KW - e-cigarettes KW - cigarettes KW - web-based KW - support KW - behavioral KW - smartphone app KW - social media KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e43096 UR - http://dx.doi.org/10.2196/43096 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064266 ID - info:doi/10.2196/43096 ER - TY - JOUR AU - Faber, S. Jasper AU - Al-Dhahir, Isra AU - Kraal, J. Jos AU - Breeman, D. Linda AU - van den Berg-Emons, G. Rita J. AU - Reijnders, Thomas AU - van Dijk, Sandra AU - Janssen, R. Veronica AU - Kraaijenhagen, A. Roderik AU - Visch, T. Valentijn AU - Chavannes, H. Niels AU - Evers, M. Andrea W. PY - 2023/12/4 TI - Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach JO - J Med Internet Res SP - e48461 VL - 25 KW - eHealth KW - guide KW - guidelines professionals KW - intervention development KW - intervention evaluation KW - low socioeconomic position KW - low socioeconomic status KW - risk groups KW - tailored care N2 - 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. UR - https://www.jmir.org/2023/1/e48461 UR - http://dx.doi.org/10.2196/48461 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048148 ID - info:doi/10.2196/48461 ER - TY - JOUR AU - Richardson, X. Matt AU - Aytar, Osman AU - Hess-Wiktor, Katarzyna AU - Wamala-Andersson, Sarah PY - 2023/12/4 TI - Digital Microlearning for Training and Competency Development of Older Adult Care Personnel: Mixed Methods Intervention Study to Assess Needs, Effectiveness, and Areas of Application JO - JMIR Med Educ SP - e45177 VL - 9 KW - digital microlearning KW - elderly care KW - older adult care KW - competency development KW - implementation research KW - dementia KW - COVID-19 N2 - 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 ~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. UR - https://mededu.jmir.org/2023/1/e45177 UR - http://dx.doi.org/10.2196/45177 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048152 ID - info:doi/10.2196/45177 ER - TY - JOUR AU - Pozuelo, R. Julia AU - Moffett, D. Bianca AU - Davis, Meghan AU - Stein, Alan AU - Cohen, Halley AU - Craske, G. Michelle AU - Maritze, Meriam AU - Makhubela, Princess AU - Nabulumba, Christine AU - Sikoti, Doreen AU - Kahn, Kathleen AU - Sodi, Tholene AU - AU - van Heerden, Alastair AU - O?Mahen, A. Heather PY - 2023/11/30 TI - User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study JO - JMIR Form Res SP - e51423 VL - 7 KW - depression KW - adolescents KW - mental health app KW - behavioral activation KW - user-centered design KW - low- and middle-income countries KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e51423 UR - http://dx.doi.org/10.2196/51423 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032691 ID - info:doi/10.2196/51423 ER - TY - JOUR AU - Adams, W. Zachary AU - Marriott, R. Brigid AU - Karra, Swathi AU - Linhart-Musikant, Elizabeth AU - Raymond, L. Jodi AU - Fischer, J. Lydia AU - Bixler, A. Kristina AU - Bell, M. Teresa AU - Bryan, A. Eric AU - Hulvershorn, A. Leslie PY - 2023/11/30 TI - User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study JO - JMIR Form Res SP - e45128 VL - 7 KW - access-to-care KW - addiction KW - adolescent KW - behavior KW - health disorder KW - opioid use disorder KW - opioid KW - personalized care KW - telehealth KW - telemedicine KW - trauma KW - user KW - youth N2 - 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. UR - https://formative.jmir.org/2023/1/e45128 UR - http://dx.doi.org/10.2196/45128 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032728 ID - info:doi/10.2196/45128 ER - TY - JOUR AU - Ha, Sandeul AU - Ho, Hee Seung AU - Bae, Young-Hyeon AU - Lee, Minyoung AU - Kim, Hee Ju AU - Kim, Han Ju AU - Lee, Jisan PY - 2023/11/28 TI - Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study JO - J Med Internet Res SP - e50029 VL - 25 KW - digital health equity KW - digital health care service KW - COVID-19 KW - mobile health KW - mHealth KW - mobile apps KW - needs assessments KW - heuristic KW - people with disability KW - caregivers KW - health personnel KW - mobile phone N2 - 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. UR - https://www.jmir.org/2023/1/e50029 UR - http://dx.doi.org/10.2196/50029 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015589 ID - info:doi/10.2196/50029 ER - TY - JOUR AU - Ding, Y. Eric AU - Tran, Khanh-Van AU - Lessard, Darleen AU - Wang, Ziyue AU - Han, Dong AU - Mohagheghian, Fahimeh AU - Mensah Otabil, Edith AU - Noorishirazi, Kamran AU - Mehawej, Jordy AU - Filippaios, Andreas AU - Naeem, Syed AU - Gottbrecht, F. Matthew AU - Fitzgibbons, P. Timothy AU - Saczynski, S. Jane AU - Barton, Bruce AU - Chon, Ki AU - McManus, D. David PY - 2023/11/28 TI - Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial JO - JMIR Cardio SP - e45137 VL - 7 KW - accuracy KW - atrial fibrillation KW - cardiac arrhythmia KW - design KW - detection KW - diagnosis KW - electrocardiography KW - monitoring KW - older adults KW - photoplethysmography KW - prevention KW - remote monitoring KW - smartwatch KW - stroke KW - usability N2 - 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 UR - https://cardio.jmir.org/2023/1/e45137 UR - http://dx.doi.org/10.2196/45137 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015598 ID - info:doi/10.2196/45137 ER - TY - JOUR AU - Oakley-Girvan, Ingrid AU - Yunis, Reem AU - Fonda, J. Stephanie AU - Longmire, Michelle AU - Veuthey, L. Tess AU - Shieh, Jennifer AU - Aghaee, Sara AU - Kubo, Ai AU - Davis, W. Sharon AU - Liu, Raymond AU - Neeman, Elad PY - 2023/11/21 TI - Correlation Between Remote Symptom Reporting by Caregivers and Adverse Clinical Outcomes: Mixed Methods Study JO - J Med Internet Res SP - e49100 VL - 25 KW - adverse events KW - cancer KW - decentralized clinical trials KW - electronic patient-reported outcomes KW - ePROs KW - mobile health app KW - observer-reported outcomes KW - Patient-Reported Outcomes Measurement Information System Patient-Reported Outcome Common Terminology Criteria for Adverse Events KW - patient-reported outcomes KW - PRO-CTCAE KW - PROMIS KW - remote clinical trials KW - remote monitoring KW - smartphone N2 - 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. UR - https://www.jmir.org/2023/1/e49100 UR - http://dx.doi.org/10.2196/49100 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988151 ID - info:doi/10.2196/49100 ER - TY - JOUR AU - Weermeijer, Merlijn Jeroen Dennis AU - Wampers, Martien AU - de Thurah, Lena AU - Bonnier, Rafaël AU - Piot, Maarten AU - Kuppens, Peter AU - Myin-Germeys, Inez AU - Kiekens, Glenn PY - 2023/11/21 TI - Usability of the Experience Sampling Method in Specialized Mental Health Care: Pilot Evaluation Study JO - JMIR Form Res SP - e48821 VL - 7 KW - experience sampling KW - ecological momentary assessment KW - implementation KW - digital mental health KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e48821 UR - http://dx.doi.org/10.2196/48821 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988137 ID - info:doi/10.2196/48821 ER - TY - JOUR AU - Smayda, Elisabeth Kirsten AU - Cooper, Hodsdon Sarah AU - Leyden, Katie AU - Ulaszek, Jackie AU - Ferko, Nicole AU - Dobrin, Annamaria PY - 2023/11/20 TI - Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study JO - JMIR Rehabil Assist Technol SP - e50438 VL - 10 KW - chronic stroke KW - walking KW - InTandem KW - MR-001 KW - neurorehabilitation KW - human factors engineering KW - usability KW - rhythmic auditory stimulation KW - validation KW - neurotherapeutic N2 - 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. UR - https://rehab.jmir.org/2023/1/e50438 UR - http://dx.doi.org/10.2196/50438 UR - http://www.ncbi.nlm.nih.gov/pubmed/37983080 ID - info:doi/10.2196/50438 ER - TY - JOUR AU - Wood, D. Michael AU - West, C. Nicholas AU - Fokkens, Christina AU - Chen, Ying AU - Loftsgard, C. Kent AU - Cardinal, Krystal AU - Whyte, D. Simon AU - Portales-Casamar, Elodie AU - Görges, Matthias PY - 2023/11/17 TI - An Individualized Postoperative Pain Risk Communication Tool for Use in Pediatric Surgery: Co-Design and Usability Evaluation JO - JMIR Pediatr Parent SP - e46785 VL - 6 KW - eHealth KW - risk communication KW - decision aid KW - pain KW - individualized risk KW - surgery KW - anesthesia KW - postoperative KW - risk KW - co-design KW - focus group KW - requirement definition KW - prototyping KW - usability KW - prototype KW - child KW - pediatric KW - decision support KW - iterative N2 - 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. UR - https://pediatrics.jmir.org/2023/1/e46785 UR - http://dx.doi.org/10.2196/46785 UR - http://www.ncbi.nlm.nih.gov/pubmed/37976087 ID - info:doi/10.2196/46785 ER - TY - JOUR AU - Lunde, Pernille AU - Skoglund, Gyri AU - Olsen, Fromholt Cecilie AU - Hilde, Gunvor AU - Bong, Kiat Way AU - Nilsson, Blakstad Birgitta PY - 2023/11/15 TI - Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study JO - JMIR Hum Factors SP - e48950 VL - 10 KW - mHealth KW - mobile phone app KW - smartphone KW - lifestyle KW - usability KW - diabetes KW - diabetic KW - mobile health KW - app KW - apps KW - application KW - applications KW - think-aloud KW - think aloud KW - user experience KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e48950 UR - http://dx.doi.org/10.2196/48950 UR - http://www.ncbi.nlm.nih.gov/pubmed/37966894 ID - info:doi/10.2196/48950 ER - TY - JOUR AU - Tacchino, Andrea AU - Ponzio, Michela AU - Confalonieri, Paolo AU - Leocani, Letizia AU - Inglese, Matilde AU - Centonze, Diego AU - Cocco, Eleonora AU - Gallo, Paolo AU - Paolicelli, Damiano AU - Rovaris, Marco AU - Sabattini, Loredana AU - Tedeschi, Gioacchino AU - Prosperini, Luca AU - Patti, Francesco AU - Bramanti, Placido AU - Pedrazzoli, Elisabetta AU - Battaglia, Alberto Mario AU - Brichetto, Giampaolo PY - 2023/11/8 TI - An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study JO - JMIR Serious Games SP - e41371 VL - 11 KW - exergame KW - Multiple Sclerosis Fitness Intervention Training KW - MS-FIT KW - Pilates KW - Kinect KW - multiple sclerosis KW - exercise KW - serious games KW - balance KW - mobile phone N2 - 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. UR - https://games.jmir.org/2023/1/e41371 UR - http://dx.doi.org/10.2196/41371 UR - http://www.ncbi.nlm.nih.gov/pubmed/37938895 ID - info:doi/10.2196/41371 ER - TY - JOUR AU - Câmara Gradim, Carolina Luma AU - Santana, Maciel André Luiz AU - Archanjo José, Marcelo AU - Zuffo, Knörich Marcelo AU - Lopes, Deus Roseli de PY - 2023/11/8 TI - An Automated Electronic System in a Motorized Wheelchair for Telemonitoring: Mixed Methods Study Based on Internet of Things JO - JMIR Form Res SP - e49102 VL - 7 KW - eHealth systems KW - telemonitoring KW - inertial measurement unit KW - IMU KW - sensors KW - Internet of Things KW - IoT KW - pressure injury KW - wheelchair KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e49102 UR - http://dx.doi.org/10.2196/49102 UR - http://www.ncbi.nlm.nih.gov/pubmed/37776327 ID - info:doi/10.2196/49102 ER - TY - JOUR AU - Kluge, G. Murielle AU - Maltby, Steven AU - Kuhne, Caroline AU - Walker, Nicole AU - Bennett, Neanne AU - Aidman, Eugene AU - Nalivaiko, Eugene AU - Walker, Rohan Frederick PY - 2023/11/6 TI - Evaluation of a Virtual Reality Platform to Train Stress Management Skills for a Defense Workforce: Multisite, Mixed Methods Feasibility Study JO - J Med Internet Res SP - e46368 VL - 25 KW - virtual reality KW - workplace training KW - stress management KW - defense N2 - 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. UR - https://www.jmir.org/2023/1/e46368 UR - http://dx.doi.org/10.2196/46368 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930751 ID - info:doi/10.2196/46368 ER - TY - JOUR AU - Moldestad, Megan AU - Petrova, V. Valentina AU - Tirtanadi, Katie AU - Mishra, R. Sonali AU - Rajan, Suparna AU - Sayre, George AU - Fortney, C. John AU - Reisinger, Schacht Heather PY - 2023/11/6 TI - 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 JO - JMIR Form Res SP - e47189 VL - 7 KW - evidence-based psychosocial interventions KW - telehealth KW - qualitative KW - user-centered design KW - implementation science KW - Department of Veterans Affairs health care system N2 - 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. UR - https://formative.jmir.org/2023/1/e47189 UR - http://dx.doi.org/10.2196/47189 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930747 ID - info:doi/10.2196/47189 ER - TY - JOUR AU - Foley, Gillian AU - Ricciardelli, Rosemary PY - 2023/11/6 TI - Views on the Functionality and Use of the PeerConnect App Among Public Safety Personnel: Qualitative Analysis JO - JMIR Form Res SP - e46968 VL - 7 KW - peer support KW - apps KW - mobile health technology KW - mobile health KW - mHealth KW - public safety personnel KW - correctional workers KW - police officers KW - emergency workers KW - first responders KW - mental health KW - Canada KW - digital health KW - intervention KW - peers KW - mobile app KW - peer support apps KW - web-based KW - web-based communities N2 - 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. UR - https://formative.jmir.org/2023/1/e46968 UR - http://dx.doi.org/10.2196/46968 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930765 ID - info:doi/10.2196/46968 ER - TY - JOUR AU - Longacre, L. Margaret AU - Chwistek, Marcin AU - Keleher, Cynthia AU - Siemon, Mark AU - Egleston, L. Brian AU - Collins, Molly AU - Fang, Y. Carolyn PY - 2023/11/2 TI - Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit JO - JMIR Hum Factors SP - e47624 VL - 10 KW - caregiving KW - patient portal, health policy KW - palliative oncology KW - oncology KW - engagement KW - family caregiver KW - caregiver KW - communication KW - usage KW - usability KW - clinical care KW - cancer N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e47624 UR - http://dx.doi.org/10.2196/47624 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917129 ID - info:doi/10.2196/47624 ER - TY - JOUR AU - Yamada, Kazunosuke AU - Enokida, Yasuaki AU - Kato, Ryuji AU - Imaizumi, Jun AU - Takada, Takahiro AU - Ojima, Hitoshi PY - 2023/11/1 TI - The Feasibility and Reliability of Upper Arm?Worn Apple Watch Heart Rate Monitoring for Surgeons During Surgery: Observational Study JO - JMIR Hum Factors SP - e50891 VL - 10 KW - Apple Watch KW - heart rate KW - surgery KW - robot N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e50891 UR - http://dx.doi.org/10.2196/50891 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910162 ID - info:doi/10.2196/50891 ER - TY - JOUR AU - Moon, Hui-Woun AU - Park, Me Da Som AU - Jung, Young Se PY - 2023/10/30 TI - Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study JO - JMIR Form Res SP - e36324 VL - 7 KW - care KW - caregiving KW - instrument development KW - elderly KW - quality of life KW - ergonomics KW - focus groups KW - musculoskeletal KW - usability KW - feasibility KW - digital health intervention KW - digital health KW - health intervention KW - nursing KW - electronic medical record N2 - 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. UR - https://formative.jmir.org/2023/1/e36324 UR - http://dx.doi.org/10.2196/36324 UR - http://www.ncbi.nlm.nih.gov/pubmed/37902820 ID - info:doi/10.2196/36324 ER - TY - JOUR AU - Aclan, Roslyn AU - George, Stacey AU - Laver, Kate PY - 2023/10/26 TI - A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study JO - JMIR Aging SP - e49500 VL - 6 KW - age-friendliness KW - aging KW - home environment KW - self-assessment KW - digital KW - tool N2 - 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 ? 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, ?=0.10), bathrooms (64% agreement, ?=0.46), and backyards (55% agreement, ?=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. UR - https://aging.jmir.org/2023/1/e49500 UR - http://dx.doi.org/10.2196/49500 UR - http://www.ncbi.nlm.nih.gov/pubmed/37883134 ID - info:doi/10.2196/49500 ER - TY - JOUR AU - Sharma, Nikita AU - Braakman-Jansen, A. Louise M. AU - Oinas-Kukkonen, Harri AU - Croockewit, Hendrik Jan AU - Gemert-Pijnen, van JEWC PY - 2023/10/25 TI - Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study JO - JMIR Aging SP - e49319 VL - 6 KW - informal caregiving KW - cognitive impairment KW - unobtrusive sensing solutions KW - in-home care KW - aging in place KW - assistive technologies N2 - 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. UR - https://aging.jmir.org/2023/1/e49319 UR - http://dx.doi.org/10.2196/49319 UR - http://www.ncbi.nlm.nih.gov/pubmed/37878353 ID - info:doi/10.2196/49319 ER - TY - JOUR AU - Hægermark, Aale Emil AU - Kongshaug, Nina AU - Raj, Xavier Sunil AU - Hofsli, Eva AU - Faxvaag, Arild PY - 2023/10/19 TI - Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study JO - JMIR Form Res SP - e47374 VL - 7 KW - mobile health KW - mHealth KW - user-centered design KW - usability testing KW - cancer KW - side effects KW - cytostatic treatment KW - intervention KW - mobile app KW - usability KW - user interface KW - user KW - smartphone KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e47374 UR - http://dx.doi.org/10.2196/47374 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856183 ID - info:doi/10.2196/47374 ER - TY - JOUR AU - Dreesmann, J. Nathan AU - Buchanan, Diana AU - Tang, Jean Hsin-Yi AU - Furness III, Thomas AU - Thompson, Hilaire PY - 2023/10/17 TI - Virtual Reality Meditation for Fatigue in Persons With Rheumatoid Arthritis: Mixed Methods Pilot Study JO - JMIR Form Res SP - e46209 VL - 7 KW - anxiety KW - chronic pain KW - depression KW - fatigue KW - feasibility study KW - feasibility KW - head-mounted display KW - meditation KW - mixed method KW - mood KW - pain KW - rheumatoid arthritis KW - symptom KW - virtual reality KW - VR N2 - 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 UR - https://formative.jmir.org/2023/1/e46209 UR - http://dx.doi.org/10.2196/46209 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847542 ID - info:doi/10.2196/46209 ER - TY - JOUR AU - Metzler-Baddeley, Claudia AU - Busse, Monica AU - Drew, Cheney AU - Pallmann, Philip AU - Cantera, Jaime AU - Ioakeimidis, Vasileios AU - Rosser, Anne PY - 2023/10/6 TI - HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study JO - JMIR Form Res SP - e48395 VL - 7 KW - Huntington disease KW - electronic health KW - intervention KW - training application KW - rhythm KW - timing KW - drumming KW - movement KW - cognition KW - integrated knowledge translation KW - gamification KW - Template for Intervention Description and Replication (TIDieR) KW - TIDieR KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e48395 UR - http://dx.doi.org/10.2196/48395 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801351 ID - info:doi/10.2196/48395 ER - TY - JOUR AU - Hermsen, Sander AU - Van Abswoude, Femke AU - Steenbergen, Bert PY - 2023/10/5 TI - The Effect of Social Networks on Active Living in Adolescents: Qualitative Focus Group Study JO - JMIR Form Res SP - e46350 VL - 7 KW - active living KW - adolescents KW - physical activity KW - digital health KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e46350 UR - http://dx.doi.org/10.2196/46350 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796582 ID - info:doi/10.2196/46350 ER - TY - JOUR AU - Randall, Natasha AU - Kamino, Waki AU - Joshi, Swapna AU - Chen, Wei-Chu AU - Hsu, Long-Jing AU - Tsui, M. Katherine AU - ?abanovi?, Selma PY - 2023/10/4 TI - Understanding the Connection Among Ikigai, Well-Being, and Home Robot Acceptance in Japanese Older Adults: Mixed Methods Study JO - JMIR Aging SP - e45442 VL - 6 KW - ikigai KW - meaning in life KW - purpose KW - well-being KW - eudaimonic KW - hedonic KW - happiness KW - home robots KW - social robots KW - human-robot interaction KW - Japan N2 - 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. UR - https://aging.jmir.org/2023/1/e45442 UR - http://dx.doi.org/10.2196/45442 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792460 ID - info:doi/10.2196/45442 ER - TY - JOUR AU - Goueth, Rose AU - Darney, Blair AU - Hoffman, Aubri AU - Eden, B. Karen PY - 2023/10/3 TI - Evaluating the Acceptability and Feasibility of a Sexual Health?Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study JO - JMIR Form Res SP - e44170 VL - 7 KW - decision aid KW - contraception KW - decision-making KW - user-centered design KW - young adults KW - pilot study KW - feasibility KW - acceptability KW - development KW - support KW - tool KW - survey KW - sexual health N2 - 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. UR - https://formative.jmir.org/2023/1/e44170 UR - http://dx.doi.org/10.2196/44170 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788070 ID - info:doi/10.2196/44170 ER - TY - JOUR AU - Bui, T. Dung AU - Barnett, Tony AU - Hoang, Ha AU - Chinthammit, Winyu PY - 2023/10/2 TI - Usability of Augmented Reality Technology in Situational Telementorship for Managing Clinical Scenarios: Quasi-Experimental Study JO - JMIR Med Educ SP - e47228 VL - 9 KW - augmented reality KW - mentorship KW - patient simulation KW - patient care management KW - quasi-experimental study KW - telehealth N2 - 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. UR - https://mededu.jmir.org/2023/1/e47228 UR - http://dx.doi.org/10.2196/47228 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782533 ID - info:doi/10.2196/47228 ER - TY - JOUR AU - Fossouo Tagne, Joel AU - Yakob, Amin Reginald AU - Mcdonald, Rachael AU - Wickramasinghe, Nilmini PY - 2023/9/29 TI - A Web-Based Tool to Report Adverse Drug Reactions by Community Pharmacists in Australia: Usability Testing Study JO - JMIR Form Res SP - e48976 VL - 7 KW - ADR KW - adverse drug reaction KW - pharmacovigilance KW - community pharmacy KW - digital health evaluation KW - usability testing N2 - 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. UR - https://formative.jmir.org/2023/1/e48976 UR - http://dx.doi.org/10.2196/48976 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773620 ID - info:doi/10.2196/48976 ER - TY - JOUR AU - Palm, Klas AU - Kronlid, Carl AU - Brantnell, Anders AU - Elf, Marie AU - Borg, Johan PY - 2023/9/28 TI - Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study JO - JMIR Res Protoc SP - e44562 VL - 12 KW - barriers KW - digital health KW - facilitators KW - health care KW - implementation KW - internet of things KW - IoT solution KW - older people KW - person-centered care KW - technology N2 - 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 UR - https://www.researchprotocols.org/2023/1/e44562 UR - http://dx.doi.org/10.2196/44562 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768725 ID - info:doi/10.2196/44562 ER - TY - JOUR AU - Böttinger, J. Melissa AU - Litz, Elena AU - Gordt-Oesterwind, Katharina AU - Jansen, Carl-Philipp AU - Memmer, Nicole AU - Mychajliw, Christian AU - Radeck, Leon AU - Bauer, M. Jürgen AU - Becker, Clemens PY - 2023/9/26 TI - Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study JO - JMIR Aging SP - e46738 VL - 6 KW - aged KW - self-assessment KW - mobile apps KW - mobile health KW - mHealth KW - community-based participatory research KW - co-creation KW - comprehensive geriatric assessment KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2023/1/e46738 UR - http://dx.doi.org/10.2196/46738 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751274 ID - info:doi/10.2196/46738 ER - TY - JOUR AU - Oladele, Ayoola David AU - Iwelunmor, Juliet AU - Gbajabiamila, Titilola AU - Obiezu-Umeh, Chisom AU - Okwuzu, Ogoamaka Jane AU - Nwaozuru, Ucheoma AU - Musa, Zaidat Adesola AU - Tahlil, Kadija AU - Idigbe, Ifeoma AU - Ong, Jason AU - Tang, Weiming AU - Tucker, Joseph AU - Ezechi, Oliver PY - 2023/9/25 TI - An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility JO - JMIR Form Res SP - e44402 VL - 7 KW - adolescent KW - adolescents and young adults KW - Africa KW - AYA KW - development KW - feasibility KW - HIV self-testing KW - HIV KW - HIVST KW - information system KW - Nigeria KW - platform KW - testing KW - think aloud KW - unstructured supplementary service data KW - usability KW - user-centered KW - USSD KW - young adult KW - youth N2 - 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. UR - https://formative.jmir.org/2023/1/e44402 UR - http://dx.doi.org/10.2196/44402 UR - http://www.ncbi.nlm.nih.gov/pubmed/37747780 ID - info:doi/10.2196/44402 ER - TY - JOUR AU - Dale, Jeremy AU - Nanton, Veronica AU - Day, Theresa AU - Apenteng, Patricia AU - Bernstein, Janine Celia AU - Grason Smith, Gillian AU - Strong, Peter AU - Procter, Rob PY - 2023/9/21 TI - Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study JO - JMIR Aging SP - e41185 VL - 6 KW - informal carers KW - information technology KW - internet KW - information needs KW - mixed methods evaluation KW - Reach, Effectiveness, Adoption, Implementation, and Maintenance KW - RE-AIM KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2023/1/e41185 UR - http://dx.doi.org/10.2196/41185 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733406 ID - info:doi/10.2196/41185 ER - TY - JOUR AU - Chen, Nai-Jung AU - Huang, Chiu-Mieh AU - Fan, Ching-Chih AU - Lu, Li-Ting AU - Lin, Fen-He AU - Liao, Jung-Yu AU - Guo, Jong-Long PY - 2023/9/19 TI - User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study JO - JMIR Form Res SP - e45484 VL - 7 KW - chronic kidney disease KW - chatbot KW - health education KW - push notification KW - users? evaluation N2 - 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 UR - https://formative.jmir.org/2023/1/e45484 UR - http://dx.doi.org/10.2196/45484 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725429 ID - info:doi/10.2196/45484 ER - TY - JOUR AU - Verweij, Lynn AU - Metsemakers, M. Sanne J. J. P. AU - Ector, G. Geneviève I. C. AU - Rademaker, Peter AU - Bekker, L. Charlotte AU - van Vlijmen, Bas AU - van der Reijden, A. Bert AU - Blijlevens, A. Nicole M. AU - Hermens, G. Rosella P. M. PY - 2023/9/15 TI - Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach JO - J Med Internet Res SP - e45259 VL - 25 KW - eHealth KW - digital care platform KW - feasibility KW - patient experiences KW - usability KW - chronic myeloid leukemia KW - participatory action research KW - CMyLife N2 - 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. UR - https://www.jmir.org/2023/1/e45259 UR - http://dx.doi.org/10.2196/45259 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713242 ID - info:doi/10.2196/45259 ER - TY - JOUR AU - Wang, Jitao AU - Wu, Zhenke AU - Choi, Won Sung AU - Sen, Srijan AU - Yan, Xinghui AU - Miner, A. Jennifer AU - Sander, M. Angelle AU - Lyden, K. Angela AU - Troost, P. Jonathan AU - Carlozzi, E. Noelle PY - 2023/9/14 TI - The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study JO - JMIR Form Res SP - e43099 VL - 7 KW - caregiver KW - just-in-time adaptive intervention KW - JITAI KW - mobile health intervention KW - health-related quality of life KW - HRQOL KW - intervention KW - self-management KW - quality of life KW - psychological KW - effectiveness KW - acceptability KW - feasibility KW - design KW - anxiety KW - depression KW - QOL KW - affect KW - medication KW - pharma KW - rehab KW - wearable KW - ubiquitous KW - accelerometer KW - sleep KW - polysomnography KW - PROMIS Anxiety KW - PROMIS Depression KW - computer adaptive test KW - CAT KW - generalized estimating equations KW - GEE KW - weighted and centered least square KW - WCLS N2 - 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 UR - https://formative.jmir.org/2023/1/e43099 UR - http://dx.doi.org/10.2196/43099 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707948 ID - info:doi/10.2196/43099 ER - TY - JOUR AU - Kwok, Ian AU - Lattie, Gardiner Emily AU - Yang, Dershung AU - Summers, Amanda AU - Grote, Veronika AU - Cotten, Paul AU - Moskowitz, Tedlie Judith PY - 2023/9/6 TI - Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study JO - JMIR Aging SP - e46269 VL - 6 KW - dementia KW - caregiving KW - eHealth KW - digital interventions KW - positive emotion KW - stress KW - coping N2 - 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. UR - https://aging.jmir.org/2023/1/e46269 UR - http://dx.doi.org/10.2196/46269 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672311 ID - info:doi/10.2196/46269 ER - TY - JOUR AU - Torres-Robles, Andrea AU - Allison, Karen AU - Poon, K. Simon AU - Shaw, Miranda AU - Hutchings, Owen AU - Britton, J. Warwick AU - Wilson, Andrew AU - Baysari, Melissa PY - 2023/9/5 TI - Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study JO - J Med Internet Res SP - e44540 VL - 25 KW - remote monitoring KW - patient experience KW - user experience KW - COVID-19 KW - pulse oximetry KW - usability KW - acceptability KW - oximetry KW - wearable device N2 - 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. UR - https://www.jmir.org/2023/1/e44540 UR - http://dx.doi.org/10.2196/44540 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535831 ID - info:doi/10.2196/44540 ER - TY - JOUR AU - Cohen, Edwin AU - Byrom, Bill AU - Becher, Anja AU - Jörntén-Karlsson, Magnus AU - Mackenzie, K. Andrew PY - 2023/9/1 TI - Comparative Effectiveness of eConsent: Systematic Review JO - J Med Internet Res SP - e43883 VL - 25 KW - acceptability KW - clinical trial KW - comprehension KW - digital consent KW - eConsent KW - effectiveness KW - electronic consent KW - informed consent form KW - patient engagement KW - usability N2 - 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. UR - https://www.jmir.org/2023/1/e43883 UR - http://dx.doi.org/10.2196/43883 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656499 ID - info:doi/10.2196/43883 ER - TY - JOUR AU - Listiyandini, Arruum Ratih AU - Andriani, Annisa AU - Kusristanti, Chandradewi AU - Moulds, Michelle AU - Mahoney, Alison AU - Newby, M. Jill PY - 2023/8/31 TI - Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study JO - JMIR Form Res SP - e47126 VL - 7 KW - psychological distress KW - mindfulness KW - cultural adaptation KW - internet-delivered KW - students KW - Indonesia KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e47126 UR - http://dx.doi.org/10.2196/47126 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651168 ID - info:doi/10.2196/47126 ER - TY - JOUR AU - Vanderhout, Shelley AU - Goldbloom, B. Ellen AU - Li, Amy AU - Newhook, Dennis AU - Garcia, Meghan AU - Dulude, Catherine PY - 2023/8/30 TI - Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study JO - J Med Internet Res SP - e45287 VL - 25 KW - environmental scan KW - experience KW - interviews KW - pediatrics KW - telemedicine KW - virtual care N2 - 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. UR - https://www.jmir.org/2023/1/e45287 UR - http://dx.doi.org/10.2196/45287 UR - http://www.ncbi.nlm.nih.gov/pubmed/37647120 ID - info:doi/10.2196/45287 ER - TY - JOUR AU - Wong, Willis AU - Ming, David AU - Pateras, Sara AU - Fee, Holmes Casey AU - Coleman, Cara AU - Docktor, Michael AU - Shah, Nirmish AU - Antonelli, Richard PY - 2023/8/28 TI - Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study JO - JMIR Form Res SP - e43993 VL - 7 KW - mobile health KW - mHealth KW - complex care KW - care coordination KW - digital health tools KW - simulation KW - family-centered design KW - user-centered design KW - participatory design KW - co-design N2 - 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. UR - https://formative.jmir.org/2023/1/e43993 UR - http://dx.doi.org/10.2196/43993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639303 ID - info:doi/10.2196/43993 ER - TY - JOUR AU - McCrae, S. Christina AU - Curtis, F. Ashley AU - Stearns, A. Melanie AU - Nair, Neetu AU - Golzy, Mojgan AU - Shenker, I. Joel AU - Beversdorf, Q. David AU - Cottle, Amelia AU - Rowe, A. Meredeth PY - 2023/8/24 TI - Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study JO - JMIR Aging SP - e45859 VL - 6 KW - arousal KW - caregivers KW - cognitive behavioral therapy KW - CBT: cognitive behavioral therapy for insomnia KW - CBT-I KW - dementia KW - insomnia KW - internet N2 - 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 UR - https://aging.jmir.org/2023/1/e45859 UR - http://dx.doi.org/10.2196/45859 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616032 ID - info:doi/10.2196/45859 ER - TY - JOUR AU - Nair, Monika AU - Andersson, Jonas AU - Nygren, M. Jens AU - Lundgren, E. Lina PY - 2023/8/23 TI - 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 JO - JMIR Form Res SP - e47335 VL - 7 KW - implementation KW - AI systems KW - health care KW - interviews KW - artificial Intelligence KW - AI KW - decision support tool KW - readmission KW - prediction KW - heart failure KW - digital tool N2 - 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. UR - https://formative.jmir.org/2023/1/e47335 UR - http://dx.doi.org/10.2196/47335 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610799 ID - info:doi/10.2196/47335 ER - TY - JOUR AU - Kouri, Andrew AU - Gupta, Samir AU - Straus, E. Sharon AU - Sale, M. Joanna E. PY - 2023/8/22 TI - Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study JO - J Med Internet Res SP - e45955 VL - 25 KW - older adults KW - mHealth KW - asthma KW - chronic obstructive pulmonary disease KW - qualitative research KW - digital health KW - qualitative study KW - airway disease KW - barrier KW - health technology KW - interview KW - smartphone KW - airway KW - implementation KW - mobile phone N2 - 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. UR - https://www.jmir.org/2023/1/e45955 UR - http://dx.doi.org/10.2196/45955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606961 ID - info:doi/10.2196/45955 ER - TY - JOUR AU - Krafft, Jelena AU - Barisch-Fritz, Bettina AU - Krell-Roesch, Janina AU - Trautwein, Sandra AU - Scharpf, Andrea AU - Woll, Alexander PY - 2023/8/22 TI - 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 JO - JMIR Aging SP - e46480 VL - 6 KW - dementia KW - individualized physical exercise KW - tailored exercise KW - physical activity KW - older adults KW - app KW - mobile health KW - mHealth KW - usability KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2023/1/e46480 UR - http://dx.doi.org/10.2196/46480 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606974 ID - info:doi/10.2196/46480 ER - TY - JOUR AU - Nguyen, Hoang Thinh AU - Cunha, Pereira Priscila AU - Rowland, Friedman Annabelle AU - Orenstein, Evan AU - Lee, Tricia AU - Kandaswamy, Swaminathan PY - 2023/8/22 TI - User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study JO - JMIR Form Res SP - e47574 VL - 7 KW - clinical decision support KW - peanut KW - peanut introduction KW - early peanut introduction KW - allergy KW - electronic health records KW - simulation KW - user-centered design N2 - 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. UR - https://formative.jmir.org/2023/1/e47574 UR - http://dx.doi.org/10.2196/47574 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606983 ID - info:doi/10.2196/47574 ER - TY - JOUR AU - Vial, Stéphane AU - Boudhraâ, Sana AU - Dumont, Mathieu AU - Tremblay, Melanie AU - Riendeau, Sophie PY - 2023/8/22 TI - 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 JO - JMIR Res Protoc SP - e47220 VL - 12 KW - co-design KW - human-centered design KW - e-mental health KW - design expertise KW - user engagement KW - patient-centered design KW - imaginary prototype N2 - 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 Montréal (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 UR - https://www.researchprotocols.org/2023/1/e47220 UR - http://dx.doi.org/10.2196/47220 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606978 ID - info:doi/10.2196/47220 ER - TY - JOUR AU - Nakikj, Drashko AU - Kreda, David AU - Gehlenborg, Nils PY - 2023/8/21 TI - 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 JO - JMIR Hum Factors SP - e41552 VL - 10 KW - patients KW - electronic health records KW - sensemaking KW - pattern detection KW - data organization KW - alerts KW - reports KW - collections N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e41552 UR - http://dx.doi.org/10.2196/41552 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603400 ID - info:doi/10.2196/41552 ER - TY - JOUR AU - Broderick, Michelle AU - O'Shea, Robert AU - Burridge, Jane AU - Demain, Sara AU - Johnson, Louise AU - Bentley, Paul PY - 2023/8/21 TI - Examining Usability, Acceptability, and Adoption of a Self-Directed, Technology-Based Intervention for Upper Limb Rehabilitation After Stroke: Cohort Study JO - JMIR Rehabil Assist Technol SP - e45993 VL - 10 KW - stroke rehabilitation KW - interactive gaming KW - rehabilitation technology KW - technology usability KW - technology acceptability KW - self-management KW - usability KW - acceptability KW - stroke KW - rehabilitation KW - adoption KW - engagement KW - acceptance KW - limb KW - mobility KW - mobile phone N2 - 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) (?=0.55; 95% CI 0.23-0.75; P=.007) and acceptability as well as domains of perceived usefulness (?=0.42; 95% CI 0.09-0.68; P=.03) and perceived ease of use (?=0.46; 95% CI 0.10-0.74; P=.02). Technology acceptance decreased with increased global stroke severity (?=?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. UR - https://rehab.jmir.org/2023/1/e45993 UR - http://dx.doi.org/10.2196/45993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603405 ID - info:doi/10.2196/45993 ER - TY - JOUR AU - Alhasani, Rehab AU - George, Nicole AU - Radman, Dennis AU - Auger, Claudine AU - Ahmed, Sara PY - 2023/8/15 TI - Methodologies for Evaluating the Usability of Rehabilitation Technologies Aimed at Supporting Shared Decision-Making: Scoping Review JO - JMIR Rehabil Assist Technol SP - e41359 VL - 10 KW - usability KW - technology KW - rehabilitation KW - shared decision-making KW - mobile phone N2 - 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. UR - https://rehab.jmir.org/2023/1/e41359 UR - http://dx.doi.org/10.2196/41359 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581911 ID - info:doi/10.2196/41359 ER - TY - JOUR AU - Au, Jessica AU - Falloon, Caitlin AU - Ravi, Ayngaran AU - Ha, Phil AU - Le, Suong PY - 2023/8/15 TI - A Beta-Prototype Chatbot for Increasing Health Literacy of Patients With Decompensated Cirrhosis: Usability Study JO - JMIR Hum Factors SP - e42506 VL - 10 KW - chronic liver disease KW - chatbot KW - artificial intelligence KW - health literacy KW - acceptability N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42506 UR - http://dx.doi.org/10.2196/42506 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581920 ID - info:doi/10.2196/42506 ER - TY - JOUR AU - Madujibeya, Ifeanyi AU - Lennie, A. Terry AU - Pelzel, Jamie AU - Moser, K. Debra PY - 2023/8/15 TI - Patients? Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis JO - JMIR Form Res SP - e39525 VL - 7 KW - heart failure KW - patients? experiences KW - experience KW - satisfaction KW - facilitator KW - mobile health apps KW - mobile app KW - health app KW - app feature KW - mobile health KW - cardiology KW - cardiovascular KW - patient care KW - self-management KW - patient KW - heart KW - mHealth KW - self-care KW - medication KW - performance KW - feedback KW - personalized N2 - 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. UR - https://formative.jmir.org/2023/1/e39525 UR - http://dx.doi.org/10.2196/39525 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581912 ID - info:doi/10.2196/39525 ER - TY - JOUR AU - Avramovi?, Petra AU - Rietdijk, Rachael AU - Kenny, Belinda AU - Power, Emma AU - Togher, Leanne PY - 2023/8/9 TI - Developing a Digital Health Intervention for Conversation Skills After Brain Injury (convers-ABI-lity) Using a Collaborative Approach: Mixed Methods Study JO - J Med Internet Res SP - e45240 VL - 25 KW - brain injury KW - cognitive-communication KW - communication partner training KW - digital health KW - co-design N2 - 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. UR - https://www.jmir.org/2023/1/e45240 UR - http://dx.doi.org/10.2196/45240 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556179 ID - info:doi/10.2196/45240 ER - TY - JOUR AU - Mehra, Richa AU - Pulman, Andy AU - Dogan, Huseyin AU - Murphy, Jane AU - Bitters, Fiona PY - 2023/8/4 TI - A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study JO - JMIR Hum Factors SP - e42912 VL - 10 KW - nutrition KW - activity KW - behavior change KW - telemedicine KW - mobile health KW - police KW - lifestyle management KW - management KW - usability testing KW - design KW - build KW - prototype KW - testing KW - survey KW - interview KW - development KW - user center KW - officer KW - law enforcement KW - cop KW - detective KW - policeman KW - policing KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42912 UR - http://dx.doi.org/10.2196/42912 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540549 ID - info:doi/10.2196/42912 ER - TY - JOUR AU - Ketelhut, Sascha AU - Bodman, Alex AU - Ries, Thomas AU - Nigg, R. Claudio PY - 2023/8/3 TI - Challenging the Portrait of the Unhealthy Gamer?The Fitness and Health Status of Esports Players and Their Peers: Comparative Cross-Sectional Study JO - J Med Internet Res SP - e45063 VL - 25 KW - blood pressure KW - gamers KW - health status KW - physical activity behavior KW - physical fitness KW - esports KW - health burden KW - sedentary athlete KW - health KW - fitness N2 - 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. UR - https://www.jmir.org/2023/1/e45063 UR - http://dx.doi.org/10.2196/45063 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535408 ID - info:doi/10.2196/45063 ER - TY - JOUR AU - Mendonca, J. Christen AU - Malone, A. Laurie AU - Mohanraj, Sangeetha AU - Thirumalai, Mohanraj PY - 2023/8/3 TI - The Usability of a Touchpad Active Video Game Controller for Individuals With Impaired Mobility: Observational Study JO - JMIR Rehabil Assist Technol SP - e41993 VL - 10 KW - active video games KW - exergames KW - usability KW - enjoyment KW - disability KW - mobility limitation KW - mobility impairment N2 - 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. UR - https://rehab.jmir.org/2023/1/e41993 UR - http://dx.doi.org/10.2196/41993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535411 ID - info:doi/10.2196/41993 ER - TY - JOUR AU - Amiri, Maryam AU - Li, Juan AU - Hasan, Wordh PY - 2023/8/3 TI - Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study JO - JMIR Form Res SP - e46434 VL - 7 KW - diabetes KW - fuzzy logic KW - meal planning KW - multicriteria decision-making KW - optimization N2 - 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. UR - https://formative.jmir.org/2023/1/e46434 UR - http://dx.doi.org/10.2196/46434 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535413 ID - info:doi/10.2196/46434 ER - TY - JOUR AU - Labarta, I. José AU - Dimitri, Paul AU - Keiser, Matthew AU - Koledova, Ekaterina AU - Rivera-Romero, Octavio PY - 2023/8/2 TI - 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 JO - JMIR Hum Factors SP - e46893 VL - 10 KW - connected health KW - growth hormone deficiency KW - participatory health informatics KW - recombinant human growth hormone KW - technology acceptance KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e46893 UR - http://dx.doi.org/10.2196/46893 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531173 ID - info:doi/10.2196/46893 ER - TY - JOUR AU - Patel, S. Khushi AU - Corbett, F. Cynthia AU - Combs, M. Elizabeth AU - Donevant, B. Sara AU - Selph, J. Margaret AU - Gibson, M. Lynette AU - Dawson, M. Robin AU - Sheth, P. Amit AU - Hughes, G. Ronda PY - 2023/7/28 TI - Perceptions of COVID-19 and the Use of Health Information Technology Among People Who Are Uninsured: Multimethod Survey Study JO - JMIR Form Res SP - e45349 VL - 7 KW - COVID-19 KW - medically uninsured KW - medical informatics KW - telemedicine KW - mobile apps KW - health literacy KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e45349 UR - http://dx.doi.org/10.2196/45349 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505792 ID - info:doi/10.2196/45349 ER - TY - JOUR AU - McCue, Maggie AU - Khatib, Rasha AU - Kabir, Christopher AU - Blair, Chris AU - Fehnert, Ben AU - King, James AU - Spalding, Alexander AU - Zaki, Lara AU - Chrones, Lambros AU - Roy, Anit AU - Kemp, E. David PY - 2023/7/26 TI - User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study JO - JMIR Hum Factors SP - e42768 VL - 10 KW - depression KW - major depressive disorder KW - depression management KW - patient engagement KW - user-centered design KW - mobile app KW - digital platform KW - qualitative research KW - shared decision-making KW - measurement-based care KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42768 UR - http://dx.doi.org/10.2196/42768 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494099 ID - info:doi/10.2196/42768 ER - TY - JOUR AU - Singleton, C. Anna AU - Raeside, Rebecca AU - Hyun, K. Karice AU - Hayes, Molly AU - Sherman, A. Kerry AU - Elder, Elisabeth AU - Redfern, Julie AU - Partridge, R. Stephanie PY - 2023/7/25 TI - 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 JO - J Med Internet Res SP - e45164 VL - 25 KW - digital health KW - telemedicine KW - SMS text messaging KW - breast cancer KW - implementation science KW - cancer survivorship KW - supportive care KW - public health KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2023/1/e45164 UR - http://dx.doi.org/10.2196/45164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490319 ID - info:doi/10.2196/45164 ER - TY - JOUR AU - O'Connor, Antonia AU - Tai, Andrew AU - Brinn, Malcolm AU - Hoang, Hien Amy Nguyen Thuc AU - Cataldi, Daniele AU - Carson-Chahhoud, Kristin PY - 2023/7/25 TI - Co-design of an Augmented Reality Asthma Inhaler Educational Intervention for Children: Development and Usability Study JO - JMIR Pediatr Parent SP - e40219 VL - 6 KW - asthma KW - asthma education KW - pediatric KW - pediatric asthma KW - co-design KW - usability KW - development KW - smartphone KW - tablet KW - augmented reality KW - health education KW - mobile app KW - mobile phone N2 - 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 UR - https://pediatrics.jmir.org/2023/1/e40219 UR - http://dx.doi.org/10.2196/40219 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490325 ID - info:doi/10.2196/40219 ER - TY - JOUR AU - Wrightson-Hester, Aimee-Rose AU - Anderson, Georgia AU - Dunstan, Joel AU - McEvoy, M. Peter AU - Sutton, J. Christopher AU - Myers, Bronwyn AU - Egan, Sarah AU - Tai, Sara AU - Johnston-Hollitt, Melanie AU - Chen, Wai AU - Gedeon, Tom AU - Mansell, Warren PY - 2023/7/21 TI - An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series JO - JMIR Hum Factors SP - e46849 VL - 10 KW - mental health KW - conversational agents KW - chatbots KW - young people KW - acceptability KW - feasibility KW - co-design KW - artificial therapist KW - artificial intelligence KW - youth KW - child KW - adolescent KW - chatbot KW - Manage Your Life Online KW - MYLO KW - support KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e46849 UR - http://dx.doi.org/10.2196/46849 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477969 ID - info:doi/10.2196/46849 ER - TY - JOUR AU - Howell, Doris AU - Bryant Lukosius, Denise AU - Avery, Jonathan AU - Santaguida, Athina AU - Powis, Melanie AU - Papadakos, Tina AU - Addario, Vincenzo AU - Lovas, Mike AU - Kukreti, Vishal AU - Haase, Kristen AU - Mayo, J. Samantha AU - Papadakos, Janet AU - Moradian, Saeed AU - Krzyzanowska, K. Monika PY - 2023/7/21 TI - 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 JO - JMIR Cancer SP - e44914 VL - 9 KW - web-based program KW - self-management KW - cancer treatment KW - digital technology KW - co-design KW - usability N2 - 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. UR - https://cancer.jmir.org/2023/1/e44914 UR - http://dx.doi.org/10.2196/44914 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477968 ID - info:doi/10.2196/44914 ER - TY - JOUR AU - Andersson, Susanne AU - Scandurra, Isabella AU - Nyström, Ulrika AU - Varemo, Marika AU - Hellstrand Tang, Ulla PY - 2023/7/18 TI - Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals: Qualitative Study JO - JMIR Nursing SP - e45501 VL - 6 KW - diabetes KW - foot ulcer KW - prevention KW - primary health care KW - qualitative research KW - structured foot examination KW - validation KW - user experiences KW - participatory design N2 - 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 Västra Götaland 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 UR - https://nursing.jmir.org/2023/1/e45501 UR - http://dx.doi.org/10.2196/45501 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463012 ID - info:doi/10.2196/45501 ER - TY - JOUR AU - Pol, Margriet AU - Qadeer, Amarzish AU - van Hartingsveldt, Margo AU - Choukou, Mohamed-Amine PY - 2023/7/18 TI - Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study JO - JMIR Rehabil Assist Technol SP - e44498 VL - 10 KW - aging in place KW - aging well KW - digital technology KW - remote monitoring KW - activity KW - sensor KW - mobile phone N2 - 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. UR - https://rehab.jmir.org/2023/1/e44498 UR - http://dx.doi.org/10.2196/44498 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463040 ID - info:doi/10.2196/44498 ER - TY - JOUR AU - Idrisov, Bulat AU - Hallgren, A. Kevin AU - Michaels, Alyssa AU - Soth, Sean AU - Darnton, James AU - Grekin, Paul AU - Woolworth, Steve AU - Saxon, J. Andrew AU - Tsui, I. Judith PY - 2023/7/13 TI - Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study JO - JMIR Hum Factors SP - e42654 VL - 10 KW - addiction KW - direct observed therapy KW - health app KW - methadone KW - mHealth KW - mobile app KW - mobile health KW - opioid KW - smartphone app KW - substance use KW - usability KW - user engagement KW - user testing KW - workload N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42654 UR - http://dx.doi.org/10.2196/42654 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440298 ID - info:doi/10.2196/42654 ER - TY - JOUR AU - Simola, Saija AU - Hörhammer, Iiris AU - Xu, Yuhui AU - Bärkås, Annika AU - Fagerlund, Johansen Asbjørn AU - Hagström, Josefin AU - Holmroos, Mari AU - Hägglund, Maria AU - Johansen, Alise Monika AU - Kane, Bridget AU - Kharko, Anna AU - Scandurra, Isabella AU - Kujala, Sari PY - 2023/6/30 TI - Patients? Experiences of a National Patient Portal and Its Usability: Cross-Sectional Survey Study JO - J Med Internet Res SP - e45974 VL - 25 KW - patient portal KW - perceived usability KW - System Usability Scale KW - electronic health record KW - patient experiences KW - patient-accessible electronic health records KW - national survey N2 - 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 (?=.51; P<.001), whereas reporting a very negative experience was negatively associated with perceived usability (?=?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. UR - https://www.jmir.org/2023/1/e45974 UR - http://dx.doi.org/10.2196/45974 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389909 ID - info:doi/10.2196/45974 ER - TY - JOUR AU - Collier, Futterman Ann AU - Hagemann, Shelby AU - Trinidad, Brown Susan AU - Vigil-Hayes, Morgan PY - 2023/6/30 TI - Human-to-Computer Interactivity Features Incorporated Into Behavioral Health mHealth Apps: Systematic Search JO - JMIR Form Res SP - e44926 VL - 7 KW - app KW - behavioral app KW - behavioral health KW - consumers KW - engagement KW - health application KW - interactivity KW - mHealth KW - stickiness KW - support KW - therapeutic KW - user engagement KW - users N2 - 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. UR - https://formative.jmir.org/2023/1/e44926 UR - http://dx.doi.org/10.2196/44926 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389916 ID - info:doi/10.2196/44926 ER - TY - JOUR AU - Kekkonen, Markku AU - Korkiakangas, Eveliina AU - Laitinen, Jaana AU - Oinas-Kukkonen, Harri PY - 2023/6/26 TI - Factors Reducing the Use of a Persuasive mHealth App and How to Mitigate Them: Thematic Analysis JO - JMIR Hum Factors SP - e40579 VL - 10 KW - mobile phone KW - mobile health KW - mHealth KW - Persuasive Systems Design KW - behavior change KW - thematic analysis KW - microentrepreneurs KW - randomized controlled trial N2 - 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 UR - https://humanfactors.jmir.org/2023/1/e40579 UR - http://dx.doi.org/10.2196/40579 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358883 ID - info:doi/10.2196/40579 ER - TY - JOUR AU - Forcino, C. Rachel AU - Rotenberg, Sivan AU - Morrissette, J. Kali AU - Godzik, M. Cassandra AU - Lichtenstein, D. Jonathan AU - Schiffelbein, E. Jenna AU - Stevens, J. Courtney AU - Sundar, Vidya AU - Brucker, L. Debra AU - Connolly, Deirdre AU - Keysor, Julie AU - Lyons, Doyle Kathleen PY - 2023/6/26 TI - Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers JO - JMIR Form Res SP - e47263 VL - 7 KW - cancer KW - employment KW - intervention development KW - intervention KW - people living with cancer KW - cancer survivor KW - health care provider N2 - 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. UR - https://formative.jmir.org/2023/1/e47263 UR - http://dx.doi.org/10.2196/47263 UR - http://www.ncbi.nlm.nih.gov/pubmed/37358907 ID - info:doi/10.2196/47263 ER - TY - JOUR AU - Suzuki, Mai AU - Yamanaka, Kou AU - Fukushima, Shinichi AU - Ogawa, Mayu AU - Nagaiwa, Yuki AU - Naito, Toshio PY - 2023/6/22 TI - A Mobile Medication Support App and Its Impact on People Living With HIV: 12-Week User Experience and Medication Compliance Pilot Study JO - JMIR Form Res SP - e43527 VL - 7 KW - human immunodeficiency virus KW - HIV KW - acquired immunodeficiency syndrome KW - mobile health KW - mHealth KW - medication compliance KW - satisfaction survey N2 - 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. UR - https://formative.jmir.org/2023/1/e43527 UR - http://dx.doi.org/10.2196/43527 UR - http://www.ncbi.nlm.nih.gov/pubmed/37021843 ID - info:doi/10.2196/43527 ER - TY - JOUR AU - Diefenbach, A. Michael AU - Marziliano, Allison AU - Siembida, J. Elizabeth AU - Mistretta, Thomas AU - Pfister, Halie AU - Yacoub, Andrea AU - Aibel, Kelli AU - Patel, Priya AU - Lapitan, Emmanuel AU - Tagai, K. Erin AU - Smaldone, Marc AU - Miller, M. Suzanne PY - 2023/6/22 TI - Cancer Resource and Information Support (CRIS) for Bladder Cancer Survivors and Their Caregivers: Development and Usability Testing Study JO - JMIR Form Res SP - e41876 VL - 7 KW - muscle invasive bladder cancer KW - behavioral intervention development KW - ORBIT model KW - usability testing KW - web-based intervention N2 - 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. UR - https://formative.jmir.org/2023/1/e41876 UR - http://dx.doi.org/10.2196/41876 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347533 ID - info:doi/10.2196/41876 ER - TY - JOUR AU - Shah, Harsh AU - Patel, Jay AU - Yasobant, Sandul AU - Saxena, Deepak AU - Saha, Somen AU - Sinha, Anish AU - Bhavsar, Priya AU - Patel, Yogesh AU - Modi, Bhavesh AU - Nimavat, Pankaj AU - Kapadiya, Dixit AU - Fancy, Manish PY - 2023/6/19 TI - 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 JO - J Med Internet Res SP - e45400 VL - 25 KW - capacity building KW - Ni-kshay SETU KW - National Tuberculosis Elimination Program KW - digital health KW - India KW - tuberculosis N2 - 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. UR - https://www.jmir.org/2023/1/e45400 UR - http://dx.doi.org/10.2196/45400 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335610 ID - info:doi/10.2196/45400 ER - TY - JOUR AU - Ghorayeb, Abir AU - Comber, Rob AU - Gooberman-Hill, Rachael PY - 2023/6/16 TI - Development of a Smart Home Interface With Older Adults: Multi-Method Co-Design Study JO - JMIR Aging SP - e44439 VL - 6 KW - data visualization KW - digital health KW - smart homes KW - older people KW - technology acceptance KW - qualitative research KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2023/1/e44439 UR - http://dx.doi.org/10.2196/44439 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327037 ID - info:doi/10.2196/44439 ER - TY - JOUR AU - Trivedi, Ranak AU - Hirayama, Kawena Sierra AU - Risbud, Rashmi AU - Suresh, Madhuvanthi AU - Humber, Blair Marika AU - Butler, Kevin AU - Razze, Alex AU - Timko, Christine AU - Nelson, Karin AU - Zulman, M. Donna AU - Asch, M. Steven AU - Humphreys, Keith AU - Piette, D. John PY - 2023/6/16 TI - Adapting a Telephone-Based, Dyadic Self-management Program to Be Delivered Over the Web: Methodology and Usability Testing JO - JMIR Form Res SP - e43903 VL - 7 KW - dyadic KW - eHealth KW - behavioral interventions KW - self-management KW - caregiver KW - web-based KW - interventions KW - stress management KW - self-care N2 - 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. UR - https://formative.jmir.org/2023/1/e43903 UR - http://dx.doi.org/10.2196/43903 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327057 ID - info:doi/10.2196/43903 ER - TY - JOUR AU - van de Baan, Christian Frank AU - Lambregts, Stijn AU - Bergman, Esther AU - Most, Jasper AU - Westra, Daan PY - 2023/6/12 TI - Involving Health Professionals in the Development of Quality and Safety Dashboards: Qualitative Study JO - J Med Internet Res SP - e42649 VL - 25 KW - quality improvement KW - dashboard KW - user involvement KW - innovation KW - health care provider KW - health care professional KW - feedback KW - opinion KW - perspective KW - qualitative KW - constant comparative method N2 - 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. UR - https://www.jmir.org/2023/1/e42649 UR - http://dx.doi.org/10.2196/42649 UR - http://www.ncbi.nlm.nih.gov/pubmed/37307058 ID - info:doi/10.2196/42649 ER - TY - JOUR AU - Fleischer, Jennifer AU - Ayton, Jeff AU - Riley, Maree AU - Binsted, Kim AU - Cowan, R. Devin AU - Fellows, M. Abigail AU - Weiss, A. Jeff AU - Buckey, C. Jay PY - 2023/6/9 TI - Web-Based, Interactive, Interest-Based Negotiation Training for Managing Conflict in Isolated Environments: Opportunistic Study With an e-Survey JO - JMIR Form Res SP - e42214 VL - 7 KW - conflict management KW - bargaining KW - confined environments KW - COVID-19 KW - pandemic KW - development KW - environment KW - skill KW - training KW - users KW - essential KW - Australia KW - management N2 - 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. UR - https://formative.jmir.org/2023/1/e42214 UR - http://dx.doi.org/10.2196/42214 UR - http://www.ncbi.nlm.nih.gov/pubmed/37075233 ID - info:doi/10.2196/42214 ER - TY - JOUR AU - Islam, Ashraful AU - Chaudhry, Moalla Beenish PY - 2023/6/8 TI - Design Validation of a Relational Agent by COVID-19 Patients: Mixed Methods Study JO - JMIR Hum Factors SP - e42740 VL - 10 KW - COVID-19 KW - relational agent KW - mHealth KW - design validation KW - health care KW - chatbot KW - digital health intervention KW - health care professional KW - heuristic KW - health promotion KW - mental well-being KW - design validation survey KW - self-isolation N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42740 UR - http://dx.doi.org/10.2196/42740 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350760 ID - info:doi/10.2196/42740 ER - TY - JOUR AU - Martins, Isabel Ana AU - Santinha, Gonçalo AU - Almeida, Margarida Ana AU - Ribeiro, Óscar AU - Silva, Telmo AU - Rocha, Nelson AU - Silva, G. Anabela PY - 2023/6/6 TI - Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist JO - J Med Internet Res SP - e44326 VL - 25 KW - usability evaluation KW - Delphi study KW - user-centered design KW - design KW - usability KW - evaluation KW - process KW - development KW - user KW - digital KW - efficient KW - reporting KW - quality KW - applicability N2 - 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. UR - https://www.jmir.org/2023/1/e44326 UR - http://dx.doi.org/10.2196/44326 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279047 ID - info:doi/10.2196/44326 ER - TY - JOUR AU - Auton, Alice AU - Zaman, Sameer AU - Padayachee, Yorissa AU - Samways, W. Jack AU - Quaife, M. Nicholas AU - Sweeney, Mark AU - Tenorio, Indira AU - Linton, F. Nick W. AU - Cole, D. Graham AU - Peters, S. Nicholas AU - Mayet, Jamil AU - Barton, Carys AU - Plymen, Carla PY - 2023/6/6 TI - Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives JO - JMIR Nursing SP - e44630 VL - 6 KW - heart failure KW - health-related quality of life KW - mHealth KW - nurse specialist KW - patient engagement KW - self-management KW - self-care N2 - 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. UR - https://nursing.jmir.org/2023/1/e44630 UR - http://dx.doi.org/10.2196/44630 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279054 ID - info:doi/10.2196/44630 ER - TY - JOUR AU - Han, Jeong Hee AU - Mendu, Sanjana AU - Jaworski, K. Beth AU - Owen, E. Jason AU - Abdullah, Saeed PY - 2023/5/29 TI - Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts JO - JMIR Form Res SP - e45894 VL - 7 KW - conversational agent KW - PTSD KW - self-management KW - clinical experts KW - evaluation KW - support system KW - mental health KW - trauma N2 - 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. UR - https://formative.jmir.org/2023/1/e45894 UR - http://dx.doi.org/10.2196/45894 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247220 ID - info:doi/10.2196/45894 ER - TY - JOUR AU - Geerts, Jody AU - Pieterse, Marcel AU - Laverman, Goos AU - Waanders, Femke AU - Oosterom, Nicole AU - Slegten, Jacqueline AU - Salemink, Elske AU - Bode, Christina PY - 2023/5/29 TI - Cognitive Bias Modification Training Targeting Fatigue in Patients With Kidney Disease: Usability Study JO - JMIR Form Res SP - e43636 VL - 7 KW - cognitive bias KW - patient perspective KW - qualitative study KW - nephrology KW - fatigue KW - vitality KW - acceptability KW - applicability KW - usability KW - design N2 - 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. UR - https://formative.jmir.org/2023/1/e43636 UR - http://dx.doi.org/10.2196/43636 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247217 ID - info:doi/10.2196/43636 ER - TY - JOUR AU - Blazey, Meghan AU - Marinac, Catherine AU - Whiteley, Jessica AU - Peterson, Sarah AU - Burns White, Karen AU - Jacques, Cathyanah AU - Lam, Helen AU - Halpenny, Barbara AU - Patel, Shree AU - Lamothe, Raymond AU - Wright, Julie PY - 2023/5/24 TI - 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 JO - JMIR Form Res SP - e43592 VL - 7 KW - sedentary behavior KW - digital health KW - dyad-based intervention KW - breast cancer risk KW - breast cancer survivor KW - social support KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2023/1/e43592 UR - http://dx.doi.org/10.2196/43592 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223968 ID - info:doi/10.2196/43592 ER - TY - JOUR AU - Olesen, Linnet Mette AU - Rossen, Sine AU - Jørgensen, Rikke AU - Langballe Udbjørg, Line AU - Hansson, Helena PY - 2023/5/18 TI - Usefulness of a Digitally Assisted Person-Centered Care Intervention: Qualitative Study of Patients? and Nurses? Experiences in a Long-term Perspective JO - JMIR Nursing SP - e46673 VL - 6 KW - digital technology KW - digital nursing KW - digitally assisted guided self-determination KW - empowerment KW - self-management KW - person-centered care KW - qualitative KW - service design KW - patient care KW - nurse KW - quality of life KW - interview KW - web-based questionnaire KW - functionality KW - support KW - training KW - implementation KW - self-determination KW - autonomy KW - agency KW - person centered KW - patient centered KW - client focus KW - gynecology KW - oncology KW - health knowledge KW - health care professional KW - health care provider KW - HCP KW - mobile phone N2 - 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. UR - https://nursing.jmir.org/2023/1/e46673 UR - http://dx.doi.org/10.2196/46673 UR - http://www.ncbi.nlm.nih.gov/pubmed/37200076 ID - info:doi/10.2196/46673 ER - TY - JOUR AU - Fields, Beth AU - Still, Catherine AU - Medlin, Austin AU - Strayer, Andrea AU - Arbaje, I. Alicia AU - Gilmore-Bykovskyi, Andrea AU - Werner, Nicole PY - 2023/5/16 TI - 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 JO - JMIR Res Protoc SP - e45274 VL - 12 KW - caregiving KW - co-design KW - dementia KW - health care KW - systems KW - mixed methods N2 - 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 UR - https://www.researchprotocols.org/2023/1/e45274 UR - http://dx.doi.org/10.2196/45274 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191978 ID - info:doi/10.2196/45274 ER - TY - JOUR AU - Saly, Lauren AU - Provvidenza, Christine AU - Al-Hakeem, Hiba AU - Hickling, Andrea AU - Stevens, Sara AU - Kakonge, Lisa AU - Hunt, W. Anne AU - Bennett, Sheila AU - Martinussen, Rhonda AU - Scratch, E. Shannon PY - 2023/5/15 TI - The Teach-ABI Professional Development Module for Educators About Pediatric Acquired Brain Injury: Mixed Method Usability Study JO - JMIR Hum Factors SP - e43129 VL - 10 KW - acquired brain injury KW - educators KW - professional development KW - usability testing KW - satisfaction testing KW - knowledge translation KW - usability KW - death KW - disability KW - children KW - development KW - Ontario KW - research KW - online KW - school N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43129 UR - http://dx.doi.org/10.2196/43129 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184920 ID - info:doi/10.2196/43129 ER - TY - JOUR AU - Alami, Jawad AU - Hammonds, Clare AU - Hensien, Erin AU - Khraibani, Jenan AU - Borowitz, Stephen AU - Hellems, Martha AU - Riggs, Sara PY - 2023/5/10 TI - Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study JO - JMIR Med Educ SP - e38079 VL - 9 KW - EHR KW - pediatric KW - usability KW - prerounding KW - training KW - electronic health record KW - eHealth N2 - 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. UR - https://mededu.jmir.org/2023/1/e38079 UR - http://dx.doi.org/10.2196/38079 UR - http://www.ncbi.nlm.nih.gov/pubmed/37163346 ID - info:doi/10.2196/38079 ER - TY - JOUR AU - Jing, Xia AU - Patel, L. Vimla AU - Cimino, J. James AU - Shubrook, H. Jay AU - Zhou, Yuchun AU - Draghi, N. Brooke AU - Ernst, A. Mytchell AU - Liu, Chang AU - De Lacalle, Sonsoles PY - 2023/4/27 TI - A Visual Analytic Tool (VIADS) to Assist the Hypothesis Generation Process in Clinical Research: Mixed Methods Usability Study JO - JMIR Hum Factors SP - e44644 VL - 10 KW - usability KW - VIADS KW - data-driven hypothesis generation KW - visualization KW - clinical research KW - SUS KW - mixed methods study N2 - 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 UR - https://humanfactors.jmir.org/2023/1/e44644 UR - http://dx.doi.org/10.2196/44644 UR - http://www.ncbi.nlm.nih.gov/pubmed/37011112 ID - info:doi/10.2196/44644 ER - TY - JOUR AU - Sweeney, Megan AU - Barton, William AU - Nebeker, Camille PY - 2023/4/27 TI - Evaluating Mobile Apps Targeting Older Adults: Descriptive Study JO - JMIR Form Res SP - e37329 VL - 7 KW - older adults KW - mobile apps KW - privacy KW - data management, research ethics KW - app KW - aging KW - environment KW - safety KW - smartphone KW - personal information KW - user knowledge KW - user KW - data KW - data collection KW - storage N2 - 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. UR - https://formative.jmir.org/2023/1/e37329 UR - http://dx.doi.org/10.2196/37329 UR - http://www.ncbi.nlm.nih.gov/pubmed/37103995 ID - info:doi/10.2196/37329 ER - TY - JOUR AU - Tomas, Vanessa AU - Hsu, Shaelynn AU - Kingsnorth, Shauna AU - Anagnostou, Evdokia AU - Kirsh, Bonnie AU - Lindsay, Sally PY - 2023/4/27 TI - Development and Usability Testing of a Web-Based Workplace Disability Disclosure Decision Aid Tool for Autistic Youth and Young Adults: Qualitative Co-design Study JO - JMIR Form Res SP - e44354 VL - 7 KW - autism KW - decision aids KW - co-design KW - disability disclosure KW - employment KW - knowledge translation KW - patient-oriented research KW - qualitative KW - usability testing KW - youth and young adults N2 - 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. UR - https://formative.jmir.org/2023/1/e44354 UR - http://dx.doi.org/10.2196/44354 UR - http://www.ncbi.nlm.nih.gov/pubmed/37104002 ID - info:doi/10.2196/44354 ER - TY - JOUR AU - Schüttler, Christina AU - Zerlik, Maria AU - Gruendner, Julian AU - Köhler, Thomas AU - Rosenau, Lorenz AU - Prokosch, Hans-Ulrich AU - Sedlmayr, Brita PY - 2023/4/19 TI - Empowering Researchers to Query Medical Data and Biospecimens by Ensuring Appropriate Usability of a Feasibility Tool: Evaluation Study JO - JMIR Hum Factors SP - e43782 VL - 10 KW - usability evaluation KW - ontology KW - feasibility queries KW - user-centered design KW - clinical research informatics KW - user interface N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43782 UR - http://dx.doi.org/10.2196/43782 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074765 ID - info:doi/10.2196/43782 ER - TY - JOUR AU - Hollier, M. John AU - Strickland, A. Tiantá AU - Fordis, Michael C. AU - van Tilburg, AL Miranda AU - Shulman, J. Robert AU - Thompson, Debbe PY - 2023/4/19 TI - 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 JO - JMIR Form Res SP - e41321 VL - 7 KW - guided imagery therapy KW - guided imagery KW - psychotherapy KW - disorders of gut-brain interaction KW - functional abdominal pain disorders KW - pediatric KW - pain KW - mobile app KW - mobile health KW - mHealth KW - mixed methods research KW - usability KW - gamification KW - user-centered design KW - guided image therapy KW - app prototype KW - prototype KW - feedback KW - children KW - child KW - youths KW - caregiver KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e41321 UR - http://dx.doi.org/10.2196/41321 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074773 ID - info:doi/10.2196/41321 ER - TY - JOUR AU - Rui, Angela AU - Garabedian, M. Pamela AU - Marceau, Marlika AU - Syrowatka, Ania AU - Volk, A. Lynn AU - Edrees, H. Heba AU - Seger, L. Diane AU - Amato, G. Mary AU - Cambre, Jacob AU - Dulgarian, Sevan AU - Newmark, P. Lisa AU - Nanji, C. Karen AU - Schultz, Petra AU - Jackson, Purcell Gretchen AU - Rozenblum, Ronen AU - Bates, W. David PY - 2023/4/17 TI - Performance of a Web-Based Reference Database With Natural Language Searching Capabilities: Usability Evaluation of DynaMed and Micromedex With Watson JO - JMIR Hum Factors SP - e43960 VL - 10 KW - medication safety KW - patient safety KW - usability KW - searching behavior KW - efficiency KW - quality of care KW - web-based databases KW - point-of-care information KW - POCI KW - point-of-care tools KW - artificial intelligence KW - machine learning KW - clinical decision support KW - natural language processing N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43960 UR - http://dx.doi.org/10.2196/43960 UR - http://www.ncbi.nlm.nih.gov/pubmed/37067858 ID - info:doi/10.2196/43960 ER - TY - JOUR AU - Davoody, Nadia AU - Eghdam, Aboozar AU - Koch, Sabine AU - Hägglund, Maria PY - 2023/4/17 TI - Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study JO - JMIR Hum Factors SP - e43861 VL - 10 KW - usability testing KW - stroke KW - aphasia KW - eHealth KW - rehabilitation KW - co-design KW - evaluation KW - user-centered design KW - effectiveness KW - user satisfaction KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43861 UR - http://dx.doi.org/10.2196/43861 UR - http://www.ncbi.nlm.nih.gov/pubmed/37067848 ID - info:doi/10.2196/43861 ER - TY - JOUR AU - Chen-Sankey, Julia AU - Elhabashy, Maryam AU - Gratale, Stefanie AU - Geller, Jason AU - Mercincavage, Melissa AU - Strasser, A. Andrew AU - Delnevo, D. Cristine AU - Jeong, Michelle AU - Wackowski, A. Olivia PY - 2023/4/13 TI - Examining Visual Attention to Tobacco Marketing Materials Among Young Adult Smokers: Protocol for a Remote Webcam-Based Eye-Tracking Experiment JO - JMIR Res Protoc SP - e43512 VL - 12 KW - eye tracking KW - remote eye tracking KW - e-cigarette marketing KW - young adults KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2023/1/e43512 UR - http://dx.doi.org/10.2196/43512 UR - http://www.ncbi.nlm.nih.gov/pubmed/37052989 ID - info:doi/10.2196/43512 ER - TY - JOUR AU - Lundstedt, Rikard AU - Persson, Johanna AU - Håkansson, Carita AU - Frennert, Susanne AU - Wallergård, Mattias PY - 2023/4/7 TI - Designing Virtual Natural Environments for Older Adults: Think-Aloud Study JO - JMIR Hum Factors SP - e40932 VL - 10 KW - virtual natural environments KW - user-centered design KW - qualitative method KW - real-time 3D graphics KW - older adults N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e40932 UR - http://dx.doi.org/10.2196/40932 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027206 ID - info:doi/10.2196/40932 ER - TY - JOUR AU - Willms, Amanda AU - Rhodes, E. Ryan AU - Liu, Sam PY - 2023/4/5 TI - The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a ?No-Code? Mobile App Builder: Development and Usability Study JO - JMIR Form Res SP - e43823 VL - 7 KW - mobile health KW - mHealth KW - usability study KW - financial incentive KW - physical activity KW - mobile phone KW - smartphone N2 - 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. UR - https://formative.jmir.org/2023/1/e43823 UR - http://dx.doi.org/10.2196/43823 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018038 ID - info:doi/10.2196/43823 ER - TY - JOUR AU - Bally, S. Esmee L. AU - Cheng, Demi AU - van Grieken, Amy AU - Ferri Sanz, Mireia AU - Zanutto, Oscar AU - Carroll, Aine AU - Darley, Andrew AU - Roozenbeek, Bob AU - Dippel, J. Diederik W. AU - Raat, Hein PY - 2023/4/4 TI - Patients? Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study JO - J Med Internet Res SP - e42556 VL - 25 KW - stroke patients KW - digital health technology KW - self-management KW - co-design KW - user-requirements KW - user-centered design KW - qualitative research N2 - 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 UR - https://www.jmir.org/2023/1/e42556 UR - http://dx.doi.org/10.2196/42556 UR - http://www.ncbi.nlm.nih.gov/pubmed/37014677 ID - info:doi/10.2196/42556 ER - TY - JOUR AU - Chagas, Azevedo Bruno AU - Pagano, Silvina Adriana AU - Prates, Oliveira Raquel AU - Praes, Cordeiro Elisa AU - Ferreguetti, Kícila AU - Vaz, Helena AU - Reis, Nogueira Zilma Silveira AU - Ribeiro, Bonisson Leonardo AU - Ribeiro, Pinho Antonio Luiz AU - Pedroso, Marques Thais AU - Beleigoli, Alline AU - Oliveira, Alves Clara Rodrigues AU - Marcolino, Soriano Milena PY - 2023/4/3 TI - Evaluating User Experience With a Chatbot Designed as a Public Health Response to the COVID-19 Pandemic in Brazil: Mixed Methods Study JO - JMIR Hum Factors SP - e43135 VL - 10 KW - user experience KW - chatbots KW - telehealth KW - COVID-19 KW - human-computer interaction KW - HCI KW - empirical studies in human-computer interaction KW - empirical studies in HCI KW - health care information systems N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43135 UR - http://dx.doi.org/10.2196/43135 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634267 ID - info:doi/10.2196/43135 ER - TY - JOUR AU - Mehdizadeh, Hamed AU - Asadi, Farkhondeh AU - Nazemi, Eslam AU - Mehrvar, Azim AU - Yazdanian, Azade AU - Emami, Hassan PY - 2023/3/30 TI - A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study JO - JMIR Pediatr Parent SP - e43867 VL - 6 KW - Digital health KW - eHealth KW - Telehealth KW - mHealth KW - Mobile app KW - self-management KW - cancer KW - child KW - parent KW - caregiver KW - usability evaluation N2 - 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. UR - https://pediatrics.jmir.org/2023/1/e43867 UR - http://dx.doi.org/10.2196/43867 UR - http://www.ncbi.nlm.nih.gov/pubmed/36995746 ID - info:doi/10.2196/43867 ER - TY - JOUR AU - Day, Sarah AU - Ncube, Vuyolwethu AU - Maja, Lactricia AU - Wasunna, Beatrice AU - Pienaar, Jacqueline AU - Setswe, Geoffrey AU - Waweru, Evelyn AU - Feldacker, Caryl PY - 2023/3/22 TI - 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 JO - JMIR Form Res SP - e44122 VL - 7 KW - digital health innovation KW - usability KW - health care workers perspectives KW - low- and middle-income countries KW - two-way texting KW - postoperative telehealth KW - male circumcision KW - South Africa KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2023/1/e44122 UR - http://dx.doi.org/10.2196/44122 UR - http://www.ncbi.nlm.nih.gov/pubmed/36947127 ID - info:doi/10.2196/44122 ER - TY - JOUR AU - Barton, J. Hanna AU - Salwei, E. Megan AU - Rutkowski, A. Rachel AU - Wust, Kathryn AU - Krause, Sheryl AU - Hoonakker, LT Peter AU - Dail, vW Paula AU - Buckley, M. Denise AU - Eastman, Alexis AU - Ehlenfeldt, Brad AU - Patterson, W. Brian AU - Shah, N. Manish AU - King, J. Barbara AU - Werner, E. Nicole AU - Carayon, Pascale PY - 2023/3/9 TI - Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation JO - JMIR Hum Factors SP - e43729 VL - 10 KW - patient safety KW - heuristic evaluation KW - usability KW - emergency medicine KW - safety KW - emergency KW - human factors engineering KW - discharge summary KW - documentation KW - heuristic N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43729 UR - http://dx.doi.org/10.2196/43729 UR - http://www.ncbi.nlm.nih.gov/pubmed/36892941 ID - info:doi/10.2196/43729 ER - TY - JOUR AU - Kim, Chan Joo AU - Saguna, Saguna AU - Åhlund, Christer PY - 2023/3/8 TI - Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study JO - JMIR Hum Factors SP - e42145 VL - 10 KW - Internet of Things KW - health monitoring KW - older adults KW - augmented reality KW - user experience KW - independent living KW - design study KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42145 UR - http://dx.doi.org/10.2196/42145 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884275 ID - info:doi/10.2196/42145 ER - TY - JOUR AU - Harakeh, Zeena AU - de Hoogh, M. Iris AU - van Keulen, Hilde AU - Kalkman, Gino AU - van Someren, Eugene AU - van Empelen, Pepijn AU - Otten, Wilma PY - 2023/3/7 TI - 360° Diagnostic Tool to Personalize Lifestyle Advice in Primary Care for People With Type 2 Diabetes: Development and Usability Study JO - JMIR Form Res SP - e37305 VL - 7 KW - type 2 diabetes KW - diagnostic tool KW - holistic approach KW - personalized advice KW - shared decision-making KW - health professionals N2 - 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° 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° diagnostic tool. Methods: We defined the requirements for the web-based 360° 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° 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. UR - https://formative.jmir.org/2023/1/e37305 UR - http://dx.doi.org/10.2196/37305 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881463 ID - info:doi/10.2196/37305 ER - TY - JOUR AU - Spang, P. Robert AU - Haeger, Christine AU - Mümken, A. Sandra AU - Brauer, Max AU - Voigt-Antons, Jan-Niklas AU - Gellert, Paul PY - 2023/3/2 TI - Smartphone Global Positioning System?Based System to Assess Mobility in Health Research: Development, Accuracy, and Usability Study JO - JMIR Rehabil Assist Technol SP - e42258 VL - 10 KW - geographic information system KW - rehabilitation KW - prevention medicine KW - geoinformatics KW - out-of-home mobility N2 - 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 UR - https://rehab.jmir.org/2023/1/e42258 UR - http://dx.doi.org/10.2196/42258 UR - http://www.ncbi.nlm.nih.gov/pubmed/36862498 ID - info:doi/10.2196/42258 ER - TY - JOUR AU - Ayyoubzadeh, Mohammad Seyed AU - Baniasadi, Tayebeh AU - Shirkhoda, Mohammad AU - Rostam Niakan Kalhori, Sharareh AU - Mohammadzadeh, Niloofar AU - Roudini, Kamran AU - Ghalehtaki, Reza AU - Memari, Fereidoon AU - Jalaeefar, Amirmohsen PY - 2023/2/15 TI - Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things?Based Device: Development and Usability Study JO - JMIR Cancer SP - e42250 VL - 9 KW - eHealth KW - telemedicine KW - colorectal cancer KW - cancer survivor KW - IoT KW - mHealth KW - patient monitoring KW - remote monitoring KW - postdischarge care KW - cancer KW - patient care KW - cancer care KW - postoperative complications N2 - 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. UR - https://cancer.jmir.org/2023/1/e42250 UR - http://dx.doi.org/10.2196/42250 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790851 ID - info:doi/10.2196/42250 ER - TY - JOUR AU - Christensen, Rønn Oliver AU - Hedegaard, Leonora AU - Rask, Trøllund Mette AU - Clemensen, Jane AU - Frostholm, Lisbeth AU - Rosendal, Marianne PY - 2023/2/8 TI - Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study JO - JMIR Hum Factors SP - e42572 VL - 10 KW - eHealth KW - digital health KW - medically unexplained symptom KW - persistent physical symptom KW - self-management KW - usability KW - physical symptom KW - persistent symptom KW - unexplained symptom KW - symptom management KW - unguided KW - thinking aloud KW - think aloud N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e42572 UR - http://dx.doi.org/10.2196/42572 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753312 ID - info:doi/10.2196/42572 ER - TY - JOUR AU - Triplett, S. Noah AU - Johnson, Clara AU - Kiche, Sharon AU - Dastrup, Kara AU - Nguyen, Julie AU - Daniels, Alayna AU - Mbwayo, Anne AU - Amanya, Cyrilla AU - Munson, Sean AU - Collins, Y. Pamela AU - Weiner, J. Bryan AU - Dorsey, Shannon PY - 2023/2/2 TI - Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study JO - JMIR Form Res SP - e38822 VL - 7 KW - task shifting KW - human-centered design KW - supervision KW - global mental health KW - acceptability KW - feasibility KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2023/1/e38822 UR - http://dx.doi.org/10.2196/38822 UR - http://www.ncbi.nlm.nih.gov/pubmed/36729591 ID - info:doi/10.2196/38822 ER - TY - JOUR AU - Muñoz Esquivel, Karla AU - Gillespie, James AU - Kelly, Daniel AU - Condell, Joan AU - Davies, Richard AU - McHugh, Catherine AU - Duffy, William AU - Nevala, Elina AU - Alamäki, Antti AU - Jalovaara, Juha AU - Tedesco, Salvatore AU - Barton, John AU - Timmons, Suzanne AU - Nordström, Anna PY - 2023/1/19 TI - Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study JO - JMIR Aging SP - e36807 VL - 6 KW - usability KW - older adults KW - remote sensing KW - sensor systems KW - wearable device KW - mobile phone N2 - 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 (?=0.34) and whether the device was fit for purpose (?=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. UR - https://aging.jmir.org/2023/1/e36807 UR - http://dx.doi.org/10.2196/36807 UR - http://www.ncbi.nlm.nih.gov/pubmed/36656636 ID - info:doi/10.2196/36807 ER - TY - JOUR AU - Rouleau, Geneviève AU - Reis, Catherine AU - Ivers, Noah AU - Desveaux, Laura PY - 2023/1/6 TI - Characterizing the Gaps Between Best-Practice Implementation Strategies and Real-world Implementation: Qualitative Study Among Family Physicians Who Engaged With Audit and Feedback Reports JO - JMIR Hum Factors SP - e38736 VL - 10 KW - audit and feedback KW - family physicians KW - primary care KW - qualitative N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e38736 UR - http://dx.doi.org/10.2196/38736 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607715 ID - info:doi/10.2196/38736 ER - TY - JOUR AU - Schuetze, Leon AU - Srivastava, Siddharth AU - Missenye, Mtiba Abdallah AU - Rwezaula, Josephat Elizeus AU - Stoermer, Manfred AU - De Allegri, Manuela PY - 2023/1/6 TI - 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 JO - J Med Internet Res SP - e38818 VL - 25 KW - health financing KW - qualitative KW - digital health intervention KW - low-resource setting KW - strategic purchasing KW - scale KW - mobile phone N2 - 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. UR - https://www.jmir.org/2023/1/e38818 UR - http://dx.doi.org/10.2196/38818 UR - http://www.ncbi.nlm.nih.gov/pubmed/36607708 ID - info:doi/10.2196/38818 ER - TY - JOUR AU - Andreasen, Mari Eva AU - Høigaard, Rune AU - Berg, Helen AU - Steinsbekk, Aslak AU - Haraldstad, Kristin PY - 2022/12/29 TI - Usability Evaluation of the Preoperative ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Desktop Virtual Reality Application: Qualitative Observational Study JO - JMIR Hum Factors SP - e40400 VL - 9 IS - 4 KW - desktop virtual reality KW - handover KW - ISBAR KW - preoperative KW - undergraduate nursing students KW - usability evaluation KW - usability KW - nursing KW - health care education KW - student KW - medical education KW - medical training KW - VR KW - virtual reality KW - surgery KW - surgical KW - System Usability Scale KW - communication KW - self-instruction KW - self-guided KW - nurse KW - training KW - undergraduate KW - health care professional KW - health care provider N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e40400 UR - http://dx.doi.org/10.2196/40400 UR - http://www.ncbi.nlm.nih.gov/pubmed/36580357 ID - info:doi/10.2196/40400 ER - TY - JOUR AU - Schlett, Christian AU - Röttele, Nicole AU - van der Keylen, Piet AU - Schöpf-Lazzarino, Christina Andrea AU - Klimmek, Miriam AU - Körner, Mirjam AU - Schnitzius, Kathrin AU - Voigt-Radloff, Sebastian AU - Maun, Andy AU - Sofroniou, Mario AU - Farin-Glattacker, Erik PY - 2022/12/29 TI - The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients JO - JMIR Form Res SP - e38748 VL - 6 IS - 12 KW - general practice KW - primary care KW - lower back pain KW - digital health intervention KW - web-based health information KW - eHealth KW - patient education KW - adherence KW - qualitative research KW - framework analysis KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2022/12/e38748 UR - http://dx.doi.org/10.2196/38748 UR - http://www.ncbi.nlm.nih.gov/pubmed/36580365 ID - info:doi/10.2196/38748 ER - TY - JOUR AU - Psavko, Simon AU - Katz, Noam AU - Mirchi, Tina AU - Green, R. Courtney PY - 2022/12/15 TI - Usability and Teachability of Continuous Glucose Monitoring Devices in Older Adults and Diabetes Educators: Task Analysis and Ease-of-Use Survey JO - JMIR Hum Factors SP - e42057 VL - 9 IS - 4 KW - medical devices KW - wearable devices KW - older adults KW - task analysis KW - usability testing KW - continuous glucose monitoring KW - glucose monitoring KW - glucose levels KW - diabetes KW - usability N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e42057 UR - http://dx.doi.org/10.2196/42057 UR - http://www.ncbi.nlm.nih.gov/pubmed/36347498 ID - info:doi/10.2196/42057 ER - TY - JOUR AU - Henriksen, Berg Hege AU - Knudsen, Dines Markus AU - Carlsen, Hauger Monica AU - Hjartåker, Anette AU - Blomhoff, Rune PY - 2022/11/8 TI - 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 JO - JMIR Form Res SP - e35933 VL - 6 IS - 11 KW - digital assessment tool KW - assessment tool KW - food frequency questionnaire KW - food KW - diet KW - nutrition KW - questionnaire KW - focus group KW - interview KW - usability KW - physical activity KW - lifestyle factor KW - dietary intake KW - digital health KW - chronic disease KW - chronic condition KW - health promotion KW - cancer KW - survivor KW - thematic analysis KW - research tool KW - measurement tool N2 - 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. UR - https://formative.jmir.org/2022/11/e35933 UR - http://dx.doi.org/10.2196/35933 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346647 ID - info:doi/10.2196/35933 ER - TY - JOUR AU - Jarvis, Tamika AU - Mah, L. Allison M. AU - Wang, H. Rosalie AU - Wilson, G. Michael PY - 2022/11/3 TI - Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study JO - JMIR Form Res SP - e36949 VL - 6 IS - 11 KW - assistive technology KW - program funding KW - usability testing KW - internet KW - web-based database KW - health services N2 - 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. UR - https://formative.jmir.org/2022/11/e36949 UR - http://dx.doi.org/10.2196/36949 UR - http://www.ncbi.nlm.nih.gov/pubmed/36326813 ID - info:doi/10.2196/36949 ER - TY - JOUR AU - Isabet, Baptiste AU - Rigaud, Anne-Sophie AU - Li, Wanji AU - Pino, Maribel PY - 2022/10/31 TI - Telepresence Robot Intervention to Reduce Loneliness and Social Isolation in Older Adults Living at Home (Project DOMIROB): Protocol for a Clinical Nonrandomized Study JO - JMIR Res Protoc SP - e40528 VL - 11 IS - 10 KW - older adults KW - telepresence robot KW - feeling of loneliness KW - social isolation KW - home KW - acceptability KW - usability N2 - 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 UR - https://www.researchprotocols.org/2022/10/e40528 UR - http://dx.doi.org/10.2196/40528 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315231 ID - info:doi/10.2196/40528 ER - TY - JOUR AU - Bendig, Jonas AU - Spanz, Anja AU - Leidig, Jana AU - Frank, Anika AU - Stahr, Marcus AU - Reichmann, Heinz AU - Loewenbrück, F. Kai AU - Falkenburger, H. Björn PY - 2022/10/25 TI - Measuring the Usability of eHealth Solutions for Patients With Parkinson Disease: Observational Study JO - JMIR Form Res SP - e39954 VL - 6 IS - 10 KW - eHealth KW - usability KW - Parkinson disease KW - telehealth and telemonitoring KW - older adults KW - aging KW - older population KW - neurodegenerative disease KW - digital solution KW - wearable sensor KW - mobile health KW - system usability KW - eHealth solution N2 - 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. UR - https://formative.jmir.org/2022/10/e39954 UR - http://dx.doi.org/10.2196/39954 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282558 ID - info:doi/10.2196/39954 ER - TY - JOUR AU - Kenter, Francisca Robin Maria AU - Schønning, Adrian AU - Inal, Yavuz PY - 2022/10/21 TI - Internet-Delivered Self-help for Adults With ADHD (MyADHD): Usability Study JO - JMIR Form Res SP - e37137 VL - 6 IS - 10 KW - usability testing KW - user evaluation KW - attention-deficit/hyperactivity disorder KW - self-guided intervention KW - internet-delivered KW - self-help KW - adults with attention-deficit/hyperactivity disorder KW - intervention KW - usability study KW - care needs KW - usability N2 - 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 UR - https://formative.jmir.org/2022/10/e37137 UR - http://dx.doi.org/10.2196/37137 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269662 ID - info:doi/10.2196/37137 ER - TY - JOUR AU - Tran-Nguyen, Kevin AU - Berger, Caroline AU - Bennett, Roxanne AU - Wall, Michelle AU - Morin, N. Suzanne AU - Rajabiyazdi, Fateme PY - 2022/10/17 TI - Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach JO - JMIR Aging SP - e37772 VL - 5 IS - 4 KW - older adults KW - mobile app KW - skeletal fracture KW - usability KW - patient-centered KW - human-centered design KW - digital health KW - eHealth KW - mobile health KW - mHealth KW - acute pain self-management KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2022/4/e37772 UR - http://dx.doi.org/10.2196/37772 UR - http://www.ncbi.nlm.nih.gov/pubmed/36251348 ID - info:doi/10.2196/37772 ER - TY - JOUR AU - Villalobos, Paola Jennifer AU - Bull, Salyers Sheana AU - Portz, Dickman Jennifer PY - 2022/10/6 TI - Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study JO - JMIR Aging SP - e35592 VL - 5 IS - 4 KW - mHealth KW - older adult KW - symptom KW - heart failure KW - palliative care KW - app KW - digital health KW - cardiology KW - heart KW - Convoy-Pal KW - mobile KW - tablet KW - smartwatch KW - adult KW - aging N2 - 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. UR - https://aging.jmir.org/2022/4/e35592 UR - http://dx.doi.org/10.2196/35592 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201402 ID - info:doi/10.2196/35592 ER - TY - JOUR AU - Schmidt, Ekkehard Steffen Christian AU - Sell, Stefan AU - Woll, Alexander PY - 2022/9/29 TI - The Use of Compression Stockings to Reduce Water Retention in the Legs During Gaming and Esports: Randomized Controlled Field Study JO - Interact J Med Res SP - e25886 VL - 11 IS - 2 KW - esport KW - streaming KW - gaming KW - water retention KW - fluid balance KW - compression stockings KW - bioelectrical impedance KW - mobile phone N2 - 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°; P<.001) but not in the upper extremities (+0.09°; 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. UR - https://www.i-jmr.org/2022/2/e25886 UR - http://dx.doi.org/10.2196/25886 UR - http://www.ncbi.nlm.nih.gov/pubmed/36173666 ID - info:doi/10.2196/25886 ER - TY - JOUR AU - Tuot, S. Delphine AU - Crowley, T. Susan AU - Katz, A. Lois AU - Leung, Joseph AU - Alcantara-Cadillo, K. Delly AU - Ruser, Christopher AU - Talbot-Montgomery, Elizabeth AU - Vassalotti, A. Joseph PY - 2022/9/28 TI - Usability Testing of the Kidney Score Platform to Enhance Communication About Kidney Disease in Primary Care Settings: Qualitative Think-Aloud Study JO - JMIR Form Res SP - e40001 VL - 6 IS - 9 KW - chronic kidney disease KW - CKD KW - awareness KW - usability KW - kidney KW - renal KW - think aloud KW - self-management KW - patient education KW - health education N2 - 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. UR - https://formative.jmir.org/2022/9/e40001 UR - http://dx.doi.org/10.2196/40001 UR - http://www.ncbi.nlm.nih.gov/pubmed/36170008 ID - info:doi/10.2196/40001 ER - TY - JOUR AU - Winston, Luke AU - McCann, Michael AU - Onofrei, George PY - 2022/9/27 TI - 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 JO - JMIR Form Res SP - e35114 VL - 6 IS - 9 KW - COVID-19 KW - machine learning KW - data analysis KW - epidemiology KW - human development index N2 - 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. UR - https://formative.jmir.org/2022/9/e35114 UR - http://dx.doi.org/10.2196/35114 UR - http://www.ncbi.nlm.nih.gov/pubmed/36001798 ID - info:doi/10.2196/35114 ER - TY - JOUR AU - Lowe, Cabella AU - Browne, Mitchell AU - Marsh, William AU - Morrissey, Dylan PY - 2022/8/30 TI - Usability Testing of a Digital Assessment Routing Tool for Musculoskeletal Disorders: Iterative, Convergent Mixed Methods Study JO - J Med Internet Res SP - e38352 VL - 24 IS - 8 KW - mobile health KW - mHealth KW - eHealth KW - digital health KW - digital technology KW - musculoskeletal KW - triage KW - physiotherapy triage KW - usability KW - acceptability KW - mobile phone N2 - 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 UR - https://www.jmir.org/2022/8/e38352 UR - http://dx.doi.org/10.2196/38352 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040787 ID - info:doi/10.2196/38352 ER - TY - JOUR AU - Stapinski, Ann Lexine AU - Nepal, Smriti AU - Guckel, Tara AU - Grummitt, Rachel Lucinda AU - Chapman, Cath AU - Lynch, Jane Samantha AU - Lawler, Maree Siobhan AU - Teesson, Maree AU - Newton, Clare Nicola PY - 2022/8/26 TI - Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study JO - JMIR Pediatr Parent SP - e34721 VL - 5 IS - 3 KW - alcohol and other drugs KW - prevention KW - adolescence KW - schools KW - drug prevention KW - drug prevention website N2 - 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. UR - https://pediatrics.jmir.org/2022/3/e34721 UR - http://dx.doi.org/10.2196/34721 UR - http://www.ncbi.nlm.nih.gov/pubmed/36018617 ID - info:doi/10.2196/34721 ER - TY - JOUR AU - Bird, Marissa AU - Carter, Nancy AU - Lim, Audrey AU - Kazmie, Nadia AU - Fajardo, Cindy AU - Reaume, Shannon AU - McGillion, H. Michael PY - 2022/8/12 TI - A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study JO - JMIR Form Res SP - e34572 VL - 6 IS - 8 KW - usability testing KW - digital health KW - children with medical complexities KW - children KW - chronic disease KW - pediatrics KW - health care KW - parenting KW - virtual health KW - care provider KW - youth KW - family needs KW - home care KW - usability N2 - 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. UR - https://formative.jmir.org/2022/8/e34572 UR - http://dx.doi.org/10.2196/34572 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969456 ID - info:doi/10.2196/34572 ER - TY - JOUR AU - Lamaj, Ganimete AU - Pablo-Trinidad, Alberto AU - Butterworth, Ian AU - Bell, Nolan AU - Benasutti, Ryan AU - Bourquard, Aurelien AU - Sanchez-Ferro, Alvaro AU - Castro-Gonzalez, Carlos AU - Jiménez-Ubieto, Ana AU - Baumann, Tycho AU - Rodriguez-Izquierdo, Antonia AU - Pottier, Elizabeth AU - Shelton, Anthony AU - Martinez-Lopez, Joaquin AU - Sloan, Mark John PY - 2022/8/9 TI - Usability Evaluation of a Noninvasive Neutropenia Screening Device (PointCheck) for Patients Undergoing Cancer Chemotherapy: Mixed Methods Observational Study JO - J Med Internet Res SP - e37368 VL - 24 IS - 8 KW - digital health KW - usability KW - patient-centered care KW - remote monitoring KW - decision support systems KW - white blood cells KW - diagnosis KW - medical device KW - cancer KW - chemotherapy KW - infection KW - white blood cell KW - technology N2 - 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/?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) UR - https://www.jmir.org/2022/8/e37368 UR - http://dx.doi.org/10.2196/37368 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943786 ID - info:doi/10.2196/37368 ER - TY - JOUR AU - Mahmoudi Asl, Aysan AU - Molinari Ulate, Mauricio AU - Franco Martin, Manuel AU - van der Roest, Henriëtte PY - 2022/8/1 TI - Methodologies Used to Study the Feasibility, Usability, Efficacy, and Effectiveness of Social Robots For Elderly Adults: Scoping Review JO - J Med Internet Res SP - e37434 VL - 24 IS - 8 KW - aged KW - dementia KW - social robots KW - pet-bots KW - community settings KW - long-term care KW - methods KW - scoping review N2 - 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. UR - https://www.jmir.org/2022/8/e37434 UR - http://dx.doi.org/10.2196/37434 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916695 ID - info:doi/10.2196/37434 ER - TY - JOUR AU - Kiesewetter, Jan AU - Hege, Inga AU - Sailer, Michael AU - Bauer, Elisabeth AU - Schulz, Claudia AU - Platz, Manfred AU - Adler, Martin PY - 2022/7/28 TI - Implementing Remote Collaboration in a Virtual Patient Platform: Usability Study JO - JMIR Med Educ SP - e24306 VL - 8 IS - 3 KW - collaborative learning KW - clinical reasoning KW - webRTC KW - collaboration KW - collaborative KW - decision making N2 - 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, ?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. UR - https://mededu.jmir.org/2022/3/e24306 UR - http://dx.doi.org/10.2196/24306 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900827 ID - info:doi/10.2196/24306 ER - TY - JOUR AU - Ammann-Reiffer, Corinne AU - Kläy, Andrina AU - Keller, Urs PY - 2022/7/14 TI - Virtual Reality as a Therapy Tool for Walking Activities in Pediatric Neurorehabilitation: Usability and User Experience Evaluation JO - JMIR Serious Games SP - e38509 VL - 10 IS - 3 KW - rehabilitation KW - pediatric KW - child KW - adolescent KW - walking KW - feasibility study KW - virtual reality KW - head-mounted display KW - therapy KW - tool KW - user KW - usability KW - visual KW - auditory KW - feedback KW - youth N2 - 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. UR - https://games.jmir.org/2022/3/e38509 UR - http://dx.doi.org/10.2196/38509 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834316 ID - info:doi/10.2196/38509 ER - TY - JOUR AU - Chang, Chien-Hsiang AU - Yeh, Chung-Hsing AU - Chang, Chien-Cheng AU - Lin, Yang-Cheng PY - 2022/7/14 TI - Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study JO - JMIR Serious Games SP - e38465 VL - 10 IS - 3 KW - dementia KW - elderly KW - usability KW - gesture recognition KW - card recognition rehabilitation KW - interactive somatosensory game N2 - 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. UR - https://games.jmir.org/2022/3/e38465 UR - http://dx.doi.org/10.2196/38465 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834303 ID - info:doi/10.2196/38465 ER - TY - JOUR AU - Shan, Yi AU - Ji, Meng AU - Xie, Wenxiu AU - Li, Rongying AU - Qian, Xiaobo AU - Zhang, Xiaomin AU - Hao, Tianyong PY - 2022/7/6 TI - Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study JO - JMIR Form Res SP - e37933 VL - 6 IS - 7 KW - mHealth app KW - usability KW - Chinese version of MAUQ KW - improved translation KW - validity KW - stability KW - reliability KW - cross-cultural adaptability KW - mobile phone N2 - 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 ?=.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. UR - https://formative.jmir.org/2022/7/e37933 UR - http://dx.doi.org/10.2196/37933 UR - http://www.ncbi.nlm.nih.gov/pubmed/35793132 ID - info:doi/10.2196/37933 ER - TY - JOUR AU - Soussi, Daniella AU - Vedi, Jade Chiara PY - 2022/6/29 TI - 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? JO - JMIR Hum Factors SP - e36681 VL - 9 IS - 2 KW - telemedicine KW - user experience KW - satisfaction KW - technology acceptance KW - usability KW - perioperative KW - surgery KW - consultation KW - surgeons KW - performance KW - evaluation KW - tele-guidance KW - telehealth KW - telemedicine implementation KW - telementoring KW - surgical consultation KW - usefulness UR - https://humanfactors.jmir.org/2022/2/e36681 UR - http://dx.doi.org/10.2196/36681 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767326 ID - info:doi/10.2196/36681 ER - TY - JOUR AU - Johnson, Grødem Susanne AU - Potrebny, Thomas AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2022/6/29 TI - Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Scoping Review JO - JMIR Med Educ SP - e38259 VL - 8 IS - 2 KW - user-computer interface KW - mobile apps KW - online learning KW - health education KW - students N2 - 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 UR - https://mededu.jmir.org/2022/2/e38259 UR - http://dx.doi.org/10.2196/38259 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767323 ID - info:doi/10.2196/38259 ER - TY - JOUR AU - El Ayadi, M. Alison AU - Duggal, Mona AU - Bagga, Rashmi AU - Singh, Pushpendra AU - Kumar, Vijay AU - Ahuja, Alka AU - Kankaria, Ankita AU - Hosapatna Basavarajappa, Darshan AU - Kaur, Jasmeet AU - Sharma, Preetika AU - Gupta, Swati AU - Pendse, S. Ruchita AU - Weil, Laura AU - Swendeman, Dallas AU - Diamond-Smith, G. Nadia PY - 2022/6/29 TI - A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study JO - JMIR Form Res SP - e34087 VL - 6 IS - 6 KW - mHealth KW - group care KW - postpartum KW - postnatal KW - antenatal KW - India KW - pilot KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2022/6/e34087 UR - http://dx.doi.org/10.2196/34087 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767348 ID - info:doi/10.2196/34087 ER - TY - JOUR AU - Hägglund, Maria AU - Scandurra, Isabella PY - 2022/6/23 TI - Usability of the Swedish Accessible Electronic Health Record: Qualitative Survey Study JO - JMIR Hum Factors SP - e37192 VL - 9 IS - 2 KW - usability KW - evaluation KW - patient-accessible electronic health records KW - open notes KW - patient portals KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e37192 UR - http://dx.doi.org/10.2196/37192 UR - http://www.ncbi.nlm.nih.gov/pubmed/35737444 ID - info:doi/10.2196/37192 ER - TY - JOUR AU - Signorelli, Ruiz Gabriel AU - Monteiro-Guerra, Francisco AU - Rivera-Romero, Octavio AU - Núñez-Benjumea, J. Francisco AU - Fernández-Luque, Luis PY - 2022/6/22 TI - Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study JO - JMIR Form Res SP - e32354 VL - 6 IS - 6 KW - breast cancer KW - BC KW - mobile app KW - physical activity KW - mHealth KW - acceptability KW - user experience KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2022/6/e32354 UR - http://dx.doi.org/10.2196/32354 UR - http://www.ncbi.nlm.nih.gov/pubmed/35731554 ID - info:doi/10.2196/32354 ER - TY - JOUR AU - Munson, A. Sean AU - Friedman, C. Emily AU - Osterhage, Katie AU - Allred, Ryan AU - Pullmann, D. Michael AU - Areán, A. Patricia AU - Lyon, R. Aaron AU - PY - 2022/6/14 TI - Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis JO - J Med Internet Res SP - e37585 VL - 24 IS - 6 KW - evidence-based psychosocial interventions KW - usability KW - implementation strategies KW - mental health KW - human-centered design KW - implementation science N2 - 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 UR - https://www.jmir.org/2022/6/e37585 UR - http://dx.doi.org/10.2196/37585 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700016 ID - info:doi/10.2196/37585 ER - TY - JOUR AU - Petros, Gebrewold Nuhamin AU - Hadlaczky, Gergo AU - Carletto, Sara AU - Martinez, Gonzalez Sergio AU - Ostacoli, Luca AU - Ottaviano, Manuel AU - Meyer, Björn AU - Scilingo, Pasquale Enzo AU - Carli, Vladimir PY - 2022/6/8 TI - Sociodemographic Characteristics Associated With an eHealth System Designed to Reduce Depressive Symptoms Among Patients With Breast or Prostate Cancer: Prospective Study JO - JMIR Form Res SP - e33734 VL - 6 IS - 6 KW - mental health KW - depression KW - eHealth KW - usability KW - breast cancer KW - prostate cancer KW - System Usability Scale KW - SUS KW - the user version of the Mobile App Rating Scale KW - uMARS KW - Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases KW - NEVERMIND system N2 - 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 (?=.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 (?=?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 UR - https://formative.jmir.org/2022/6/e33734 UR - http://dx.doi.org/10.2196/33734 UR - http://www.ncbi.nlm.nih.gov/pubmed/35675116 ID - info:doi/10.2196/33734 ER - TY - JOUR AU - Knobel, Johannes Samuel Elia AU - Kaufmann, Charlotte Brigitte AU - Geiser, Nora AU - Gerber, Moreno Stephan AU - Müri, M. René AU - Nef, Tobias AU - Nyffeler, Thomas AU - Cazzoli, Dario PY - 2022/5/25 TI - Effects of Virtual Reality?Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study JO - JMIR Serious Games SP - e34884 VL - 10 IS - 2 KW - virtual reality KW - search task KW - stroke KW - neglect, multimodal cueing KW - bird search task N2 - 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. UR - https://games.jmir.org/2022/2/e34884 UR - http://dx.doi.org/10.2196/34884 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612894 ID - info:doi/10.2196/34884 ER - TY - JOUR AU - Kim, Sunyoung AU - Stanton, Kaitlyn AU - Park, Yunoh AU - Thomas, Stephen PY - 2022/5/23 TI - A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study JO - JMIR Form Res SP - e37118 VL - 6 IS - 5 KW - asthma KW - children KW - indoor air quality KW - mobile app KW - smartphone KW - mHealth N2 - 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. UR - https://formative.jmir.org/2022/5/e37118 UR - http://dx.doi.org/10.2196/37118 UR - http://www.ncbi.nlm.nih.gov/pubmed/35604753 ID - info:doi/10.2196/37118 ER - TY - JOUR AU - Patel, Tejal AU - Ivo, Jessica AU - Pitre, Teresa AU - Faisal, Sadaf AU - Antunes, Kristen AU - Oda, Kasumi PY - 2022/5/19 TI - An In-Home Medication Dispensing System to Support Medication Adherence for Patients With Chronic Conditions in the Community Setting: Prospective Observational Pilot Study JO - JMIR Form Res SP - e34906 VL - 6 IS - 5 KW - smart KW - medication adherence KW - usability KW - geriatric KW - in-home KW - community KW - chronic diseases KW - medication dispensing KW - eHealth KW - platform KW - self management KW - support tool KW - chronic disease KW - caregiver KW - satisfaction N2 - 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. UR - https://formative.jmir.org/2022/5/e34906 UR - http://dx.doi.org/10.2196/34906 UR - http://www.ncbi.nlm.nih.gov/pubmed/35587371 ID - info:doi/10.2196/34906 ER - TY - JOUR AU - Cho, Hwayoung AU - Keenan, Gail AU - Madandola, O. Olatunde AU - Dos Santos, Cristina Fabiana AU - Macieira, R. Tamara G. AU - Bjarnadottir, I. Ragnhildur AU - Priola, B. Karen J. AU - Dunn Lopez, Karen PY - 2022/5/10 TI - Assessing the Usability of a Clinical Decision Support System: Heuristic Evaluation JO - JMIR Hum Factors SP - e31758 VL - 9 IS - 2 KW - usability KW - heuristic KW - clinical decision support KW - electronic health record KW - expert review KW - evaluation KW - user interface KW - human-computer interaction N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e31758 UR - http://dx.doi.org/10.2196/31758 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536613 ID - info:doi/10.2196/31758 ER - TY - JOUR AU - Buss, Helen Vera AU - Varnfield, Marlien AU - Harris, Mark AU - Barr, Margo PY - 2022/5/10 TI - A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study JO - JMIR Hum Factors SP - e35065 VL - 9 IS - 2 KW - mobile health KW - behavior change intervention KW - primary prevention KW - health promotion KW - cardiovascular disease KW - diabetes mellitus, type 2 KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35065 UR - http://dx.doi.org/10.2196/35065 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536603 ID - info:doi/10.2196/35065 ER - TY - JOUR AU - Kumwichar, Ponlagrit AU - Chongsuvivatwong, Virasakdi AU - Prappre, Tagoon PY - 2022/5/6 TI - Video-Observed Therapy With a Notification System for Improving the Monitoring of Tuberculosis Treatment in Thailand: Usability Study JO - JMIR Form Res SP - e35994 VL - 6 IS - 5 KW - app KW - compliance KW - usability KW - remote monitoring KW - therapy KW - tuberculosis KW - lung KW - infectious disease KW - user experience KW - video directly observed therapy KW - video-enhanced therapy KW - video-observed therapy KW - digital health KW - health care system KW - disease monitoring KW - health monitoring KW - video consultation KW - online health KW - virtual therapy N2 - 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. UR - https://formative.jmir.org/2022/5/e35994 UR - http://dx.doi.org/10.2196/35994 UR - http://www.ncbi.nlm.nih.gov/pubmed/35522469 ID - info:doi/10.2196/35994 ER - TY - JOUR AU - Gelgoot, Noah Eden AU - Kruglova, Katya AU - Chan, Peter AU - Lo, Kirk AU - Rosberger, Zeev AU - Chown, Philippa AU - Kazdan, Jordana AU - O?Connell, Laura Siobhan Bernadette AU - Zelkowitz, Phyllis PY - 2022/5/4 TI - Evaluation of a Mobile Health App Offering Fertility Information to Male Patients With Cancer: Usability Study JO - JMIR Cancer SP - e33594 VL - 8 IS - 2 KW - mobile app KW - eHealth KW - male KW - cancer KW - infertility KW - fertility preservation KW - psycho-oncology N2 - 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. UR - https://cancer.jmir.org/2022/2/e33594 UR - http://dx.doi.org/10.2196/33594 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507408 ID - info:doi/10.2196/33594 ER - TY - JOUR AU - Pit, Sabrina AU - Ramsden, Robyn AU - Tan, JH Aaron AU - Payne, Kristy AU - Barr, James AU - Eames, Benjamin AU - Edwards, Mike AU - Colbran, Richard PY - 2022/5/2 TI - 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? JO - JMIR Hum Factors SP - e35094 VL - 9 IS - 2 KW - health KW - wellness KW - mobile apps KW - persuasive strategies KW - behavior change KW - review KW - health workforce KW - capability KW - career KW - employment KW - rural KW - workforce planning KW - mHealth KW - mobile health KW - digital health KW - health professional KW - user experience KW - health application KW - task support KW - social support KW - dialog support N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35094 UR - http://dx.doi.org/10.2196/35094 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499866 ID - info:doi/10.2196/35094 ER - TY - JOUR AU - Perales-Puchalt, Jaime AU - Acosta-Rullán, Mariola AU - Ramírez-Mantilla, Mariana AU - Espinoza-Kissell, Paul AU - Vidoni, Eric AU - Niedens, Michelle AU - Ellerbeck, Edward AU - Hinton, Ladson AU - Loera, Linda AU - Ramírez, Susana A. AU - Lara, Esther AU - Watts, Amber AU - Williams, Kristine AU - Resendez, Jason AU - Burns, Jeffrey PY - 2022/4/28 TI - A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study JO - JMIR Aging SP - e35625 VL - 5 IS - 2 KW - Latinx individuals KW - mHealth KW - dementia KW - caregiving N2 - 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. UR - https://aging.jmir.org/2022/2/e35625 UR - http://dx.doi.org/10.2196/35625 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482366 ID - info:doi/10.2196/35625 ER - TY - JOUR AU - Rian, Torbjørn AU - Sand, Kari AU - Skogvoll, Eirik AU - Klepstad, Pål AU - Wik, S. Tina PY - 2022/4/28 TI - A Web-Based Communication Tool for Postoperative Follow-up and Pain Assessment at Home After Primary Knee Arthroplasty: Feasibility and Usability Study JO - JMIR Form Res SP - e34543 VL - 6 IS - 4 KW - feasibility studies KW - postoperative follow-up KW - primary knee arthroplasty, pain assessment KW - mobile application KW - pain treatment KW - follow-up at home N2 - 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 UR - https://formative.jmir.org/2022/4/e34543 UR - http://dx.doi.org/10.2196/34543 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482392 ID - info:doi/10.2196/34543 ER - TY - JOUR AU - Gooch, Daniel AU - Mehta, Vikram AU - Stuart, Avelie AU - Katz, Dmitri AU - Bennasar, Mohamed AU - Levine, Mark AU - Bandara, Arosha AU - Nuseibeh, Bashar AU - Bennaceur, Amel AU - Price, Blaine PY - 2022/4/27 TI - Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study JO - JMIR Hum Factors SP - e34606 VL - 9 IS - 2 KW - older adults KW - health KW - emotion KW - affect KW - well-being KW - tangible interaction KW - TUI N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e34606 UR - http://dx.doi.org/10.2196/34606 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475781 ID - info:doi/10.2196/34606 ER - TY - JOUR AU - Dennett, M. Amy AU - Tang, Y. Clarice AU - Chiu, April AU - Osadnik, Christian AU - Granger, L. Catherine AU - Taylor, F. Nicholas AU - Campbell, L. Kristin AU - Barton, Christian PY - 2022/4/21 TI - A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study JO - JMIR Cancer SP - e34903 VL - 8 IS - 2 KW - cancer KW - website KW - online learning KW - professional development KW - physiotherapy KW - exercise KW - cancer survivorship KW - cancer survivor KW - digital health KW - online health KW - online toolkit N2 - 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. UR - https://cancer.jmir.org/2022/2/e34903 UR - http://dx.doi.org/10.2196/34903 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451966 ID - info:doi/10.2196/34903 ER - TY - JOUR AU - van Strien-Knippenberg, S. Inge AU - Altendorf, B. Maria AU - Hoving, Ciska AU - van Weert, M. Julia C. AU - Smit, S. Eline PY - 2022/4/21 TI - Message Frame?Tailoring in Digital Health Communication: Intervention Redesign and Usability Testing JO - JMIR Form Res SP - e33886 VL - 6 IS - 4 KW - digital health communication KW - web-based computer tailoring KW - smoking cessation intervention KW - message framing KW - usability testing N2 - 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 UR - https://formative.jmir.org/2022/4/e33886 UR - http://dx.doi.org/10.2196/33886 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451988 ID - info:doi/10.2196/33886 ER - TY - JOUR AU - Schöpfer, Céline AU - Ehrler, Frederic AU - Berger, Antoine AU - Bollondi Pauly, Catherine AU - Buytaert, Laurence AU - De La Serna, Camille AU - Hartheiser, Florence AU - Fassier, Thomas AU - Clavien, Christine PY - 2022/4/20 TI - A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study JO - JMIR Hum Factors SP - e34626 VL - 9 IS - 2 KW - usability KW - mobile apps KW - advance directives KW - advance care planning KW - mHealth KW - mobile health KW - palliative care KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e34626 UR - http://dx.doi.org/10.2196/34626 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442206 ID - info:doi/10.2196/34626 ER - TY - JOUR AU - Burda, Václav AU - Mráz, Milo? AU - Schneider, Jakub AU - Novák, Daniel PY - 2022/4/20 TI - Managing Diabetes Using Mobiab: Long-Term Case Study of the Impact of a Mobile App on Self-management JO - JMIR Diabetes SP - e36675 VL - 7 IS - 2 KW - diabetes mellitus KW - self-management KW - mobile app KW - case study KW - long-term data N2 - 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. UR - https://diabetes.jmir.org/2022/2/e36675 UR - http://dx.doi.org/10.2196/36675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442201 ID - info:doi/10.2196/36675 ER - TY - JOUR AU - Hollanda De Sa Neto, Herul AU - Habfast-Robertson, Ines AU - Hempel-Bruder, Christina AU - Durand, Marie-Anne AU - Jacot-Sadowski, Isabelle AU - Khazaal, Yasser AU - Berlin, Ivan AU - Selby, Kevin PY - 2022/4/20 TI - Formative Provider Testing of a New Encounter Decision Aid for Smoking Cessation: Questionnaire Study JO - JMIR Form Res SP - e32960 VL - 6 IS - 4 KW - decision aid KW - smoking cessation KW - electronic tool KW - shared decision-making N2 - 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. UR - https://formative.jmir.org/2022/4/e32960 UR - http://dx.doi.org/10.2196/32960 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442200 ID - info:doi/10.2196/32960 ER - TY - JOUR AU - Khowaja, Kamran AU - Syed, Waheeda Wafa AU - Singh, Meghna AU - Taheri, Shahrad AU - Chagoury, Odette AU - Al-Thani, Dena AU - Aupetit, Michaël PY - 2022/4/8 TI - A Participatory Design Approach to Develop Visualization of Wearable Actigraphy Data for Health Care Professionals: Case Study in Qatar JO - JMIR Hum Factors SP - e25880 VL - 9 IS - 2 KW - participatory design KW - user-centered design KW - visualization KW - health care professional KW - persona KW - brainwriting KW - heuristic walkthrough KW - use case KW - interface walkthrough N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e25880 UR - http://dx.doi.org/10.2196/25880 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394442 ID - info:doi/10.2196/25880 ER - TY - JOUR AU - Tanaka, Hiroki AU - Nakamura, Satoshi PY - 2022/3/29 TI - The Acceptability of Virtual Characters as Social Skills Trainers: Usability Study JO - JMIR Hum Factors SP - e35358 VL - 9 IS - 1 KW - social skills training KW - virtual agent design KW - virtual assistant KW - virtual trainer KW - chatbot KW - acceptability KW - realism KW - virtual agent KW - simulation KW - social skill KW - social interaction KW - design KW - training KW - crowdsourcing N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e35358 UR - http://dx.doi.org/10.2196/35358 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348468 ID - info:doi/10.2196/35358 ER - TY - JOUR AU - Stambler, Mollie Danielle AU - Feddema, Erin AU - Riggins, Olivia AU - Campeau, Kari AU - Breuch, Kastman Lee-Ann AU - Kessler, M. Molly AU - Misono, Stephanie PY - 2022/3/25 TI - REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study JO - JMIR Hum Factors SP - e26461 VL - 9 IS - 1 KW - web-based intervention KW - REDCap KW - voice disorders KW - usability study KW - heuristics KW - eHealth KW - online KW - health KW - web-based participation KW - patients KW - web-based platform N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e26461 UR - http://dx.doi.org/10.2196/26461 UR - http://www.ncbi.nlm.nih.gov/pubmed/35333191 ID - info:doi/10.2196/26461 ER - TY - JOUR AU - Strauss, T. Alexandra AU - Morgan, Cameron AU - El Khuri, Christopher AU - Slogeris, Becky AU - Smith, G. Aria AU - Klein, Eili AU - Toerper, Matt AU - DeAngelo, Anthony AU - Debraine, Arnaud AU - Peterson, Susan AU - Gurses, P. Ayse AU - Levin, Scott AU - Hinson, Jeremiah PY - 2022/3/23 TI - A Patient Outcomes?Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP) JO - JMIR Hum Factors SP - e30130 VL - 9 IS - 1 KW - emergency medicine KW - usability KW - human-centered design KW - health informatics KW - feedback KW - practice-based learning and improvement KW - emergency room KW - ER KW - platform KW - outcomes KW - closed-loop learning N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e30130 UR - http://dx.doi.org/10.2196/30130 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319469 ID - info:doi/10.2196/30130 ER - TY - JOUR AU - Duggan, M. Nicole AU - Hasdianda, Adrian M. AU - Baker, Olesya AU - Jambaulikar, Guruprasad AU - Goldsmith, J. Andrew AU - Condella, Anna AU - Azizoddin, Desiree AU - Landry, I. Adaira AU - Boyer, W. Edward AU - Eyre, J. Andrew PY - 2022/3/22 TI - The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study JO - JMIR Form Res SP - e28353 VL - 6 IS - 3 KW - shift work KW - sleep KW - sleep aid KW - alertness KW - earbud KW - SleepBuds KW - healthcare worker KW - physician KW - health care N2 - 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. UR - https://formative.jmir.org/2022/3/e28353 UR - http://dx.doi.org/10.2196/28353 UR - http://www.ncbi.nlm.nih.gov/pubmed/35315781 ID - info:doi/10.2196/28353 ER - TY - JOUR AU - Happe, Lisa AU - Sgraja, Marie AU - Hein, Andreas AU - Diekmann, Rebecca PY - 2022/3/16 TI - Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study JO - JMIR Hum Factors SP - e31823 VL - 9 IS - 1 KW - older adults KW - rehabilitation KW - physical activity KW - nutrition KW - e-coach KW - usability testing KW - tablet computers KW - health behavior KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e31823 UR - http://dx.doi.org/10.2196/31823 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293874 ID - info:doi/10.2196/31823 ER - TY - JOUR AU - Rochat, Jessica AU - Ehrler, Frédéric AU - Siebert, N. Johan AU - Ricci, Arnaud AU - Garretas Ruiz, Victor AU - Lovis, Christian PY - 2022/3/15 TI - Usability Testing of a Patient-Centered Mobile Health App for Supporting and Guiding the Pediatric Emergency Department Patient Journey: Mixed Methods Study JO - JMIR Pediatr Parent SP - e25540 VL - 5 IS - 1 KW - usability KW - user-centered design KW - information systems KW - mobile apps KW - emergency service KW - hospital KW - pediatrics KW - mobile phone N2 - 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. UR - https://pediatrics.jmir.org/2022/1/e25540 UR - http://dx.doi.org/10.2196/25540 UR - http://www.ncbi.nlm.nih.gov/pubmed/35289754 ID - info:doi/10.2196/25540 ER - TY - JOUR AU - Turesson, Christina AU - Liedberg, Gunilla AU - Björk, Mathilda PY - 2022/3/14 TI - 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 JO - JMIR Hum Factors SP - e33571 VL - 9 IS - 1 KW - agile design process KW - chronic pain KW - digital support KW - eHealth KW - return to work KW - self-management KW - smartphone apps KW - user-centered design KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e33571 UR - http://dx.doi.org/10.2196/33571 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285814 ID - info:doi/10.2196/33571 ER - TY - JOUR AU - Poncette, Akira-Sebastian AU - Mosch, Katharina Lina AU - Stablo, Lars AU - Spies, Claudia AU - Schieler, Monique AU - Weber-Carstens, Steffen AU - Feufel, A. Markus AU - Balzer, Felix PY - 2022/3/11 TI - A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation JO - JMIR Hum Factors SP - e30655 VL - 9 IS - 1 KW - digital health KW - patient monitoring KW - intensive care medicine KW - intensive care unit KW - technological innovation KW - user-centered design KW - usability KW - user experience KW - implementation science KW - qualitative research KW - interview KW - mixed methods KW - mobile phone N2 - 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 UR - https://humanfactors.jmir.org/2022/1/e30655 UR - http://dx.doi.org/10.2196/30655 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275071 ID - info:doi/10.2196/30655 ER - TY - JOUR AU - Hopstock, Arnesdatter Laila AU - Medin, Christine Anine AU - Skeie, Guri AU - Henriksen, André AU - Lundblad, Wasmuth Marie PY - 2022/3/11 TI - Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study JO - JMIR Form Res SP - e35092 VL - 6 IS - 3 KW - system usability score KW - older adults KW - measurements KW - nutrition KW - dietary intake KW - digital health KW - web tool N2 - 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. UR - https://formative.jmir.org/2022/3/e35092 UR - http://dx.doi.org/10.2196/35092 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275079 ID - info:doi/10.2196/35092 ER - TY - JOUR AU - Neale, Joanne AU - Bowen, May Alice PY - 2022/3/8 TI - 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 JO - JMIR Hum Factors SP - e33038 VL - 9 IS - 1 KW - apps KW - digital literacy KW - mHealth KW - substance use KW - recovery KW - qualitative KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e33038 UR - http://dx.doi.org/10.2196/33038 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258474 ID - info:doi/10.2196/33038 ER - TY - JOUR AU - Abdulai, Abdul-Fatawu AU - Howard, Fuchsia A. AU - Yong, J. Paul AU - Noga, Heather AU - Parmar, Gurkiran AU - Currie, M. Leanne PY - 2022/3/3 TI - Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis JO - JMIR Hum Factors SP - e31317 VL - 9 IS - 1 KW - endometriosis KW - sexual pain KW - dyspareunia KW - usability testing KW - think-aloud KW - stigma KW - web sites KW - digital health KW - informatics N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e31317 UR - http://dx.doi.org/10.2196/31317 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238789 ID - info:doi/10.2196/31317 ER - TY - JOUR AU - Siebert, N. Johan AU - Gosetto, Laëtitia AU - Sauvage, Manon AU - Bloudeau, Laurie AU - Suppan, Laurent AU - Rodieux, Frédérique AU - Haddad, Kevin AU - Hugon, Florence AU - Gervaix, Alain AU - Lovis, Christian AU - Combescure, Christophe AU - Manzano, Sergio AU - Ehrler, Frederic AU - PY - 2022/3/1 TI - 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 JO - JMIR Hum Factors SP - e35399 VL - 9 IS - 1 KW - cardiopulmonary resuscitation KW - drugs KW - emergency medical services KW - medication errors KW - mobile health KW - mobile apps KW - out-of-hospital cardiac arrest KW - paramedics KW - pediatrics KW - System Usability Scale KW - Unified Theory of Acceptance and Use of Technology KW - smartphone KW - mobile phone N2 - 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 UR - https://humanfactors.jmir.org/2022/1/e35399 UR - http://dx.doi.org/10.2196/35399 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230243 ID - info:doi/10.2196/35399 ER - TY - JOUR AU - van de Belt, H. Tom AU - de Croon, Aimee AU - Freriks, Faye AU - Blomseth Christiansen, Thomas AU - Eg Larsen, Jakob AU - de Groot, Martijn PY - 2022/3/1 TI - Barriers to and Facilitators of Using a One Button Tracker and Web-Based Data Analytics Tool for Personal Science: Exploratory Study JO - JMIR Form Res SP - e32704 VL - 6 IS - 3 KW - self-tracking KW - personal science KW - one-button-tracker KW - barriers KW - facilitators KW - quantified self KW - health promotion KW - button tracker KW - usability testing KW - One Button Tracker KW - health technology KW - system usability N2 - 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. UR - https://formative.jmir.org/2022/3/e32704 UR - http://dx.doi.org/10.2196/32704 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230247 ID - info:doi/10.2196/32704 ER - TY - JOUR AU - Chowdhary, Kuntal AU - Yu, Xie Daihua AU - Pramana, Gede AU - Mesoros, Matthew AU - Fairman, Andrea AU - Dicianno, Edward Brad AU - Parmanto, Bambang PY - 2022/2/24 TI - User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study JO - JMIR Hum Factors SP - e23794 VL - 9 IS - 1 KW - cellular phone KW - mobile apps KW - telemedicine KW - adaptive mHealth KW - rehabilitation KW - self-care KW - spinal cord injury KW - spina bifida KW - chronic disease KW - persons with disability KW - accessibility KW - dexterity impairments KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e23794 UR - http://dx.doi.org/10.2196/23794 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200144 ID - info:doi/10.2196/23794 ER - TY - JOUR AU - Blair, A. Rachel AU - Horn, E. Christine AU - Dias, M. Jennifer AU - McDonnell, E. Marie AU - Seely, W. Ellen PY - 2022/2/22 TI - Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study JO - JMIR Hum Factors SP - e32815 VL - 9 IS - 1 KW - gestational diabetes mellitus KW - SMS text messaging KW - mobile phone KW - mobile health KW - pregnancy KW - blood glucose self-monitoring N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e32815 UR - http://dx.doi.org/10.2196/32815 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191851 ID - info:doi/10.2196/32815 ER - TY - JOUR AU - Koh, Qi Wei AU - Whelan, Sally AU - Heins, Pascale AU - Casey, Dympna AU - Toomey, Elaine AU - Dröes, Rose-Marie PY - 2022/2/22 TI - 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 JO - JMIR Aging SP - e29224 VL - 5 IS - 1 KW - social robot KW - pet robots KW - low-cost robot KW - dementia KW - older adults KW - qualitative research KW - qualitative content analysis N2 - 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. UR - https://aging.jmir.org/2022/1/e29224 UR - http://dx.doi.org/10.2196/29224 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191844 ID - info:doi/10.2196/29224 ER - TY - JOUR AU - Sonney, Jennifer AU - Cho, E. Emily AU - Zheng, Qiming AU - Kientz, A. Julie PY - 2022/2/17 TI - Refinement of a Parent?Child Shared Asthma Management Mobile Health App: Human-Centered Design Study JO - JMIR Pediatr Parent SP - e34117 VL - 5 IS - 1 KW - parent?child shared management KW - school-age children KW - asthma KW - participatory design KW - mHealth KW - prototype KW - usability KW - family health informatics N2 - 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. UR - https://pediatrics.jmir.org/2022/1/e34117 UR - http://dx.doi.org/10.2196/34117 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175214 ID - info:doi/10.2196/34117 ER - TY - JOUR AU - Fyhr, AnnSofie AU - Persson, Johanna AU - Ek, Åsa PY - 2022/2/17 TI - Usage and Usability of a National e-Library for Chemotherapy Regimens: Mixed Methods Study JO - JMIR Hum Factors SP - e33651 VL - 9 IS - 1 KW - chemotherapy regimens KW - user evaluation KW - standardization KW - patient safety KW - chemotherapy KW - safety KW - usability KW - e-library KW - medication errors N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e33651 UR - http://dx.doi.org/10.2196/33651 UR - http://www.ncbi.nlm.nih.gov/pubmed/35175199 ID - info:doi/10.2196/33651 ER - TY - JOUR AU - Hawthorne, Grace AU - Greening, Neil AU - Esliger, Dale AU - Briggs-Price, Samuel AU - Richardson, Matthew AU - Chaplin, Emma AU - Clinch, Lisa AU - Steiner, C. Michael AU - Singh, J. Sally AU - Orme, W. Mark PY - 2022/2/16 TI - Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study JO - JMIR Hum Factors SP - e30091 VL - 9 IS - 1 KW - chronic obstructive pulmonary disease KW - digital health KW - physical activity KW - respiratory rate KW - wearable technology KW - wearable device KW - vital signs monitor N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e30091 UR - http://dx.doi.org/10.2196/30091 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171101 ID - info:doi/10.2196/30091 ER - TY - JOUR AU - Kohlbrenner, Dario AU - Clarenbach, F. Christian AU - Ivankay, Adam AU - Zimmerli, Lukas AU - Gross, S. Christoph AU - Kuhn, Manuel AU - Brunschwiler, Thomas PY - 2022/2/16 TI - Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk JO - JMIR Hum Factors SP - e31448 VL - 9 IS - 1 KW - home monitoring KW - digital health KW - respiratory disease KW - usability KW - feasibility KW - adherence KW - disease management KW - chronic disease KW - patient monitoring N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e31448 UR - http://dx.doi.org/10.2196/31448 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171107 ID - info:doi/10.2196/31448 ER - TY - JOUR AU - Mendes-Santos, Cristina AU - Nunes, Francisco AU - Weiderpass, Elisabete AU - Santana, Rui AU - Andersson, Gerhard PY - 2022/2/15 TI - Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study JO - JMIR Cancer SP - e33550 VL - 8 IS - 1 KW - acceptance and commitment therapy KW - anxiety KW - breast cancer survivors KW - cognitive behavioral therapy KW - depression KW - digital mental health KW - e-mental health KW - user-centered design KW - internet interventions KW - usability KW - mobile phone N2 - 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. UR - https://cancer.jmir.org/2022/1/e33550 UR - http://dx.doi.org/10.2196/33550 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166682 ID - info:doi/10.2196/33550 ER - TY - JOUR AU - Bangash, Hana AU - Makkawy, Ahmed AU - Gundelach, H. Justin AU - Miller, A. Alexandra AU - Jacobson, A. Kimberly AU - Kullo, J. Iftikhar PY - 2022/2/15 TI - Web-Based Tool (FH Family Share) to Increase Uptake of Cascade Testing for Familial Hypercholesterolemia: Development and Evaluation JO - JMIR Hum Factors SP - e32568 VL - 9 IS - 1 KW - familial hypercholesterolemia KW - cascade testing KW - communication KW - genetic counselors KW - digital tools KW - website KW - usability KW - user experience KW - public health N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e32568 UR - http://dx.doi.org/10.2196/32568 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166678 ID - info:doi/10.2196/32568 ER - TY - JOUR AU - Sheshadri, Ajay AU - Makhnoon, Sukh AU - Alousi, M. Amin AU - Bashoura, Lara AU - Andrade, Rene AU - Miller, J. Christopher AU - Stolar, R. Karen AU - Arain, Hasan Muhammad AU - Noor, Laila AU - Balagani, Amulya AU - Jain, Akash AU - Blanco, David AU - Ortiz, Abel AU - Taylor, S. Michael AU - Stenzler, Alex AU - Mehta, Rohtesh AU - Popat, R. Uday AU - Hosing, Chitra AU - Ost, E. David AU - Champlin, E. Richard AU - Dickey, F. Burton AU - Peterson, K. Susan PY - 2022/2/7 TI - Home-Based Spirometry Telemonitoring After Allogeneic Hematopoietic Cell Transplantation: Mixed Methods Evaluation of Acceptability and Usability JO - JMIR Form Res SP - e29393 VL - 6 IS - 2 KW - allogeneic hematopoietic cell transplantation KW - home-based spirometry KW - acceptability KW - usability KW - mixed methods evaluation KW - patient perspectives KW - spirometry KW - feasibility KW - mHealth KW - home-based KW - remote care KW - respirology KW - pulmonary medicine KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2022/2/e29393 UR - http://dx.doi.org/10.2196/29393 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129455 ID - info:doi/10.2196/29393 ER - TY - JOUR AU - Scheder-Bieschin, Justus AU - Blümke, Bibiana AU - de Buijzer, Erwin AU - Cotte, Fabienne AU - Echterdiek, Fabian AU - Nacsa, Júlia AU - Ondresik, Marta AU - Ott, Matthias AU - Paul, Gregor AU - Schilling, Tobias AU - Schmitt, Anne AU - Wicks, Paul AU - Gilbert, Stephen PY - 2022/2/7 TI - Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study JO - JMIR Form Res SP - e28199 VL - 6 IS - 2 KW - symptom assessment application KW - anamnesis KW - health care system KW - patient history taking KW - diagnosis KW - emergency department N2 - 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 UR - https://formative.jmir.org/2022/2/e28199 UR - http://dx.doi.org/10.2196/28199 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129452 ID - info:doi/10.2196/28199 ER - TY - JOUR AU - Jaffar, Aida AU - Mohd-Sidik, Sherina AU - Foo, Nien Chai AU - Admodisastro, Novia AU - Abdul Salam, Nur Sobihatun AU - Ismail, Diana Noor PY - 2022/2/3 TI - Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study JO - JMIR Hum Factors SP - e30989 VL - 9 IS - 1 KW - User-centered design KW - mHealth app KW - Digital intervention KW - mHealth Development and Evaluation Framework KW - Usability KW - Acceptability KW - Pelvic Floor Muscle Training KW - Urinary incontinence KW - Pregnancy N2 - Background: Mobile health apps, for example, the Tät, 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. UR - https://humanfactors.jmir.org/2022/1/e30989 UR - http://dx.doi.org/10.2196/30989 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113025 ID - info:doi/10.2196/30989 ER - TY - JOUR AU - Khanbhai, Mustafa AU - Symons, Joshua AU - Flott, Kelsey AU - Harrison-White, Stephanie AU - Spofforth, Jamie AU - Klaber, Robert AU - Manton, David AU - Darzi, Ara AU - Mayer, Erik PY - 2022/2/3 TI - Enriching the Value of Patient Experience Feedback: Web-Based Dashboard Development Using Co-design and Heuristic Evaluation JO - JMIR Hum Factors SP - e27887 VL - 9 IS - 1 KW - patient experience KW - friends and family test KW - quality dashboard KW - co-design KW - heuristic evaluation KW - usability N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e27887 UR - http://dx.doi.org/10.2196/27887 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113022 ID - info:doi/10.2196/27887 ER - TY - JOUR AU - Batchelor, Rachel AU - Gulshan, Sarah AU - Shritharan, Halpana AU - Williams, Elen AU - Henderson, Claire AU - Gillard, Steve AU - Woodham, A. Luke AU - Cornelius, Victoria AU - Elkes, Jack AU - Sin, Jacqueline PY - 2022/2/2 TI - Perceived Acceptability and Experiences of a Digital Psychoeducation and Peer Support Intervention (COPe-support): Interview Study With Carers Supporting Individuals With Psychosis JO - J Med Internet Res SP - e27781 VL - 24 IS - 2 KW - eHealth KW - family carers KW - qualitative research KW - psychosis KW - peer support KW - web-based psychoeducation KW - mobile phone N2 - 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 UR - https://www.jmir.org/2022/2/e27781 UR - http://dx.doi.org/10.2196/27781 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107439 ID - info:doi/10.2196/27781 ER - TY - JOUR AU - Agachi, Elena AU - Bijmolt, A. Tammo H. AU - Mierau, O. Jochen AU - van Ittersum, Koert PY - 2022/2/2 TI - Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study JO - JMIR Hum Factors SP - e32112 VL - 9 IS - 1 KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - internet KW - preventive health program KW - health disparities KW - NSES KW - program adoption KW - survival analysis N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e32112 UR - http://dx.doi.org/10.2196/32112 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107433 ID - info:doi/10.2196/32112 ER - TY - JOUR AU - Reifman, Jaques AU - Kumar, Kamal AU - Hartman, Luke AU - Frock, Andrew AU - Doty, J. Tracy AU - Balkin, J. Thomas AU - Ramakrishnan, Sridhar AU - Vital-Lopez, G. Francisco PY - 2022/1/27 TI - 2B-Alert Web 2.0, an Open-Access Tool for Predicting Alertness and Optimizing the Benefits of Caffeine: Utility Study JO - J Med Internet Res SP - e29595 VL - 24 IS - 1 KW - alertness-prediction model KW - caffeine intervention KW - neurobehavioral performance KW - psychomotor vigilance test KW - PVT KW - sleep loss N2 - 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. UR - https://www.jmir.org/2022/1/e29595 UR - http://dx.doi.org/10.2196/29595 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084336 ID - info:doi/10.2196/29595 ER - TY - JOUR AU - Passardi, Alessandro AU - Foca, Flavia AU - Caffo, Orazio AU - Tondini, Alberto Carlo AU - Zambelli, Alberto AU - Vespignani, Roberto AU - Bartolini, Giulia AU - Sullo, Giulio Francesco AU - Andreis, Daniele AU - Dianti, Marco AU - Eccher, Claudio AU - Piras, Maria Enrico AU - Forti, Stefano PY - 2022/1/26 TI - A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training?Validation Trial JO - J Med Internet Res SP - e27349 VL - 24 IS - 1 KW - adherence KW - oral anticancer drug KW - mHealth KW - ONCO-TreC KW - electronic diary N2 - 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 UR - https://www.jmir.org/2022/1/e27349 UR - http://dx.doi.org/10.2196/27349 UR - http://www.ncbi.nlm.nih.gov/pubmed/35080505 ID - info:doi/10.2196/27349 ER - TY - JOUR AU - Gagnon-Roy, Mireille AU - Pinard, Stéphanie AU - Bottari, Carolina AU - Le Morellec, Fanny AU - Laliberté, Catherine AU - Ben Lagha, Rym AU - Yaddaden, Amel AU - Pigot, Hélène AU - Giroux, Sylvain AU - Bier, Nathalie PY - 2022/1/26 TI - Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study JO - JMIR Rehabil Assist Technol SP - e28701 VL - 9 IS - 1 KW - usability testing and evaluation KW - user experience KW - qualitative methods KW - assistive technologies KW - rehabilitation KW - patient safety N2 - 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. UR - https://rehab.jmir.org/2022/1/e28701 UR - http://dx.doi.org/10.2196/28701 UR - http://www.ncbi.nlm.nih.gov/pubmed/35080496 ID - info:doi/10.2196/28701 ER - TY - JOUR AU - Svendsen, Jagd Malene AU - Sandal, Fleng Louise AU - Kjær, Per AU - Nicholl, I. Barbara AU - Cooper, Kay AU - Mair, Frances AU - Hartvigsen, Jan AU - Stochkendahl, Jensen Mette AU - Søgaard, Karen AU - Mork, Jarle Paul AU - Rasmussen, Charlotte PY - 2022/1/24 TI - 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 JO - J Med Internet Res SP - e26555 VL - 24 IS - 1 KW - intervention mapping KW - behavior change KW - low back pain KW - self-management KW - mHealth KW - app-based intervention KW - decision support system KW - digital health intervention KW - mobile phone N2 - 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. UR - https://www.jmir.org/2022/1/e26555 UR - http://dx.doi.org/10.2196/26555 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072645 ID - info:doi/10.2196/26555 ER - TY - JOUR AU - Hogan, P. Timothy AU - Etingen, Bella AU - McMahon, Nicholas AU - Bixler, R. Felicia AU - Am, Linda AU - Wacks, E. Rachel AU - Shimada, L. Stephanie AU - Reilly, D. Erin AU - Frisbee, L. Kathleen AU - Smith, M. Bridget PY - 2022/1/20 TI - Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation JO - JMIR Form Res SP - e33716 VL - 6 IS - 1 KW - mobile health applications KW - pain KW - veterans KW - usability N2 - 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. UR - https://formative.jmir.org/2022/1/e33716 UR - http://dx.doi.org/10.2196/33716 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049515 ID - info:doi/10.2196/33716 ER - TY - JOUR AU - Larsen, Kevin AU - Akindele, Bilikis AU - Head, Henry AU - Evans, Rick AU - Mehta, Purvi AU - Hlatky, Quinn AU - Krause, Brendan AU - Chen, Sydney AU - King, Dominic PY - 2022/1/18 TI - 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 JO - JMIR Hum Factors SP - e33470 VL - 9 IS - 1 KW - clinical decision support KW - user-centered design KW - user testing KW - type 2 diabetes mellitus KW - evidence-based guidelines KW - validation KW - workflows KW - electronic health record KW - decision support KW - design KW - diabetes N2 - 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 ? 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. UR - https://humanfactors.jmir.org/2022/1/e33470 UR - http://dx.doi.org/10.2196/33470 UR - http://www.ncbi.nlm.nih.gov/pubmed/34784293 ID - info:doi/10.2196/33470 ER - TY - JOUR AU - Doyle, Sarah AU - Pavlos, Rebecca AU - Carlson, J. Samantha AU - Barton, Katherine AU - Bhuiyan, Mejbah AU - Boeing, Bernadett AU - Borland, L. Meredith AU - Hoober, Steven AU - Blyth, C. Christopher PY - 2022/1/17 TI - Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians JO - JMIR Form Res SP - e29889 VL - 6 IS - 1 KW - usability testing KW - REDCap KW - discharge instructions KW - acute respiratory infection KW - digital health technology KW - mobile technology KW - semistructured interview KW - pediatric acute respiratory infection KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2022/1/e29889 UR - http://dx.doi.org/10.2196/29889 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037889 ID - info:doi/10.2196/29889 ER - TY - JOUR AU - Fox, Sarah AU - Brown, E. Laura J. AU - Antrobus, Steven AU - Brough, David AU - Drake, J. Richard AU - Jury, Francine AU - Leroi, Iracema AU - Parry-Jones, R. Adrian AU - Machin, Matthew PY - 2022/1/14 TI - Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e24483 VL - 10 IS - 1 KW - agile KW - dementia KW - co-design KW - cognition KW - mHealth KW - patient public involvement KW - software development KW - mobile phone N2 - 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. UR - https://mhealth.jmir.org/2022/1/e24483 UR - http://dx.doi.org/10.2196/24483 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029539 ID - info:doi/10.2196/24483 ER - TY - JOUR AU - Poduval, Shoba AU - Ross, Jamie AU - Pal, Kingshuk AU - Newhouse, Nikki AU - Hamilton, Fiona AU - Murray, Elizabeth PY - 2022/1/14 TI - Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach JO - JMIR Hum Factors SP - e31567 VL - 9 IS - 1 KW - type 2 diabetes KW - patient self-management KW - diabetes education KW - primary care KW - digital health N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e31567 UR - http://dx.doi.org/10.2196/31567 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029531 ID - info:doi/10.2196/31567 ER - TY - JOUR AU - Feldman, G. Amy AU - Moore, Susan AU - Bull, Sheana AU - Morris, A. Megan AU - Wilson, Kumanan AU - Bell, Cameron AU - Collins, M. Margaret AU - Denize, M. Kathryn AU - Kempe, Allison PY - 2022/1/13 TI - A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study JO - JMIR Form Res SP - e32273 VL - 6 IS - 1 KW - vaccinations KW - transplantation KW - mobile app KW - agile development KW - immunization KW - mHealth KW - mobile health KW - children KW - transplant recipients KW - pediatric transplant recipients KW - pediatrics N2 - 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. UR - https://formative.jmir.org/2022/1/e32273 UR - http://dx.doi.org/10.2196/32273 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023840 ID - info:doi/10.2196/32273 ER - TY - JOUR AU - Gunn, M. Kate AU - Skaczkowski, Gemma AU - Dollman, James AU - Vincent, D. Andrew AU - Short, E. Camille AU - Brumby, Susan AU - Barrett, Alison AU - Harrison, Nathan AU - Turnbull, Deborah PY - 2022/1/11 TI - Combining Farmers? Preferences With Evidence-Based Strategies to Prevent and Lower Farmers? Distress: Co-design and Acceptability Testing of ifarmwell JO - JMIR Hum Factors SP - e27631 VL - 9 IS - 1 KW - farm KW - agriculture KW - rural KW - drought KW - mental health KW - stress KW - coping KW - online intervention KW - acceptance and commitment therapy N2 - 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 UR - https://humanfactors.jmir.org/2022/1/e27631 UR - http://dx.doi.org/10.2196/27631 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014963 ID - info:doi/10.2196/27631 ER - TY - JOUR AU - Mattila, Elina AU - Hansen, Susanne AU - Bundgaard, Lise AU - Ramsey, Lauren AU - Dunning, Alice AU - Silva, N. Marlene AU - Harjumaa, Marja AU - Ermes, Miikka AU - Marques, M. Marta AU - Matos, Marcela AU - Larsen, C. Sofus AU - Encantado, Jorge AU - Santos, Inês AU - Horgan, Graham AU - O'Driscoll, Ruairi AU - Turicchi, Jake AU - Duarte, Cristiana AU - Palmeira, L. António AU - Stubbs, James R. AU - Heitmann, Lilienthal Berit AU - Lähteenmäki, Liisa PY - 2022/1/10 TI - Users? Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial JO - J Med Internet Res SP - e29302 VL - 24 IS - 1 KW - digital behavior change intervention KW - user experience KW - technology acceptance KW - weight-loss maintenance KW - focus groups KW - mixed methods KW - mobile phone N2 - 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, 2×2 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 UR - https://www.jmir.org/2022/1/e29302 UR - http://dx.doi.org/10.2196/29302 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006081 ID - info:doi/10.2196/29302 ER - TY - JOUR AU - Shaikh, Ahmed AU - Bhatia, Abhishek AU - Yadav, Ghanshyam AU - Hora, Shashwat AU - Won, Chung AU - Shankar, Mark AU - Heerboth, Aaron AU - Vemulapalli, Prakash AU - Navalkar, Paresh AU - Oswal, Kunal AU - Heaton, Clay AU - Saunik, Sujata AU - Khanna, Tarun AU - Balsari, Satchit PY - 2022/1/10 TI - Applying Human-Centered Design Principles to Digital Syndromic Surveillance at a Mass Gathering in India: Viewpoint JO - J Med Internet Res SP - e27952 VL - 24 IS - 1 KW - mHealth KW - design KW - human centered design KW - intervention KW - syndromic surveillance KW - digital health UR - https://www.jmir.org/2022/1/e27952 UR - http://dx.doi.org/10.2196/27952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006088 ID - info:doi/10.2196/27952 ER - TY - JOUR AU - Rao, Nema AU - Perdomo, Sophy AU - Jonassaint, Charles PY - 2022/1/7 TI - A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach JO - JMIR Hum Factors SP - e27689 VL - 9 IS - 1 KW - pain KW - pain measurement KW - chronic pain KW - animations KW - mobile apps KW - human-centered design N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e27689 UR - http://dx.doi.org/10.2196/27689 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994697 ID - info:doi/10.2196/27689 ER - TY - JOUR AU - Savoy, April AU - Saleem, J. Jason AU - Barker, C. Barry AU - Patel, Himalaya AU - Kara, Areeba PY - 2022/1/4 TI - Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists: Workflow Analysis Based on Semistructured Interviews JO - JMIR Hum Factors SP - e28783 VL - 9 IS - 1 KW - electronic health records KW - hospital medicine KW - user-computer interface KW - human-computer interaction KW - usability KW - mental workload KW - workflow analysis N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e28783 UR - http://dx.doi.org/10.2196/28783 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643530 ID - info:doi/10.2196/28783 ER - TY - JOUR AU - Thirumalai, Mohanraj AU - Brown, Nashira AU - Niranjan, Soumya AU - Townsend, Sh'Nese AU - Powell, Anne Mary AU - Neal, Whitney AU - Schleicher, Erica AU - Raparla, Venkatadri AU - Oster, Robert AU - Demark-Wahnefried, Wendy AU - Pekmezi, Dori PY - 2022/1/4 TI - An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study JO - JMIR Hum Factors SP - e29494 VL - 9 IS - 1 KW - interactive voice response systems KW - usability KW - exercise KW - physical activity KW - rural health KW - telehealth N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e29494 UR - http://dx.doi.org/10.2196/29494 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982714 ID - info:doi/10.2196/29494 ER - TY - JOUR AU - Ogundaini, Oluwamayowa AU - de la Harpe, Retha PY - 2022/1/4 TI - The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach JO - JMIR Form Res SP - e23236 VL - 6 IS - 1 KW - agency KW - health care professionals KW - technology performativity KW - sub-Saharan Africa KW - service design KW - work activities KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2022/1/e23236 UR - http://dx.doi.org/10.2196/23236 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982713 ID - info:doi/10.2196/23236 ER - TY - JOUR AU - Wang, Hua AU - Gupta, Sneha AU - Singhal, Arvind AU - Muttreja, Poonam AU - Singh, Sanghamitra AU - Sharma, Poorva AU - Piterova, Alice PY - 2022/1/3 TI - An Artificial Intelligence Chatbot for Young People?s Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study JO - J Med Internet Res SP - e29969 VL - 24 IS - 1 KW - artificial intelligence KW - chatbot KW - Facebook KW - affordance KW - sex education KW - sexual and reproductive health KW - contraception KW - case study KW - young people KW - India KW - transmedia KW - mobile apps KW - mobile health KW - technology design KW - user engagement KW - digital health KW - mobile phone N2 - 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. UR - https://www.jmir.org/2022/1/e29969 UR - http://dx.doi.org/10.2196/29969 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982034 ID - info:doi/10.2196/29969 ER - TY - JOUR AU - Mariakakis, Alex AU - Karkar, Ravi AU - Patel, N. Shwetak AU - Kientz, A. Julie AU - Fogarty, James AU - Munson, A. Sean PY - 2022/1/3 TI - Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology JO - JMIR Hum Factors SP - e30474 VL - 9 IS - 1 KW - mobile health KW - survey instrument KW - health screening KW - health belief model KW - path analysis KW - user design KW - health technology KW - health intervention technology KW - digital health KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2022/1/e30474 UR - http://dx.doi.org/10.2196/30474 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982038 ID - info:doi/10.2196/30474 ER - TY - JOUR AU - Gale, James Jonathan AU - Black, Collin Kameron AU - Calvano, David Joshua AU - Fundingsland Jr, Lauritz Edwin AU - Lai, Deborah AU - Silacci, Sara AU - He, Shuhan PY - 2021/12/21 TI - An Analysis of US Academic Medical Center Websites: Usability Study JO - J Med Internet Res SP - e27750 VL - 23 IS - 12 KW - website usability KW - digital health KW - health care website KW - academic medical center KW - usability testing KW - web crawler N2 - 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. UR - https://www.jmir.org/2021/12/e27750 UR - http://dx.doi.org/10.2196/27750 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932015 ID - info:doi/10.2196/27750 ER - TY - JOUR AU - O'Campo, Patricia AU - Velonis, Alisa AU - Buhariwala, Pearl AU - Kamalanathan, Janisha AU - Hassan, Awaiz Maha AU - Metheny, Nicholas PY - 2021/12/21 TI - Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach JO - J Med Internet Res SP - e24114 VL - 23 IS - 12 KW - intimate partner violence KW - web-based applications KW - women KW - user-centered design N2 - 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. UR - https://www.jmir.org/2021/12/e24114 UR - http://dx.doi.org/10.2196/24114 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931998 ID - info:doi/10.2196/24114 ER - TY - JOUR AU - Davies, Karen AU - Cheraghi-Sohi, Sudeh AU - Ong, Nio Bie AU - Perryman, Katherine AU - Sanders, Caroline PY - 2021/12/20 TI - 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 JO - JMIR Res Protoc SP - e19543 VL - 10 IS - 12 KW - design research KW - co-design KW - dementia KW - mobile app KW - communication KW - safety KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2021/12/e19543 UR - http://dx.doi.org/10.2196/19543 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932011 ID - info:doi/10.2196/19543 ER - TY - JOUR AU - Choemprayong, Songphan AU - Charoenlap, Chris AU - Piromsopa, Krerk PY - 2021/12/20 TI - Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study JO - JMIR Hum Factors SP - e31130 VL - 8 IS - 4 KW - teleconsultation KW - remote consultation KW - mobile applications KW - usability KW - orthopedics KW - physician-to-physician consultation KW - electronic medical records KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e31130 UR - http://dx.doi.org/10.2196/31130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931991 ID - info:doi/10.2196/31130 ER - TY - JOUR AU - Cooray, Nipuna AU - Sun, Louise Si AU - Ho, Catherine AU - Adams, Susan AU - Keay, Lisa AU - Nassar, Natasha AU - Brown, Julie PY - 2021/12/20 TI - Toward a Behavior Theory?Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study JO - JMIR Pediatr Parent SP - e29731 VL - 4 IS - 4 KW - child injury KW - Behaviour Change Wheel KW - mobile app KW - mobile phone N2 - 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. UR - https://pediatrics.jmir.org/2021/4/e29731 UR - http://dx.doi.org/10.2196/29731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932004 ID - info:doi/10.2196/29731 ER - TY - JOUR AU - Tossaint-Schoenmakers, Rosian AU - Kasteleyn, Marise AU - Goedhart, Annelijn AU - Versluis, Anke AU - Talboom-Kamp, Esther PY - 2021/12/17 TI - The Impact of Patient Characteristics on Their Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study JO - JMIR Form Res SP - e25498 VL - 5 IS - 12 KW - patient portal KW - eHealth impact questionnaire KW - laboratory test results KW - self-efficacy KW - usability KW - age KW - gender KW - chronic disease KW - education KW - patient characteristics N2 - 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. UR - https://formative.jmir.org/2021/12/e25498 UR - http://dx.doi.org/10.2196/25498 UR - http://www.ncbi.nlm.nih.gov/pubmed/34927593 ID - info:doi/10.2196/25498 ER - TY - JOUR AU - Chen, Yuling AU - Ji, Meihua AU - Wu, Ying AU - Wang, Qingyu AU - Deng, Ying AU - Liu, Yong AU - Wu, Fangqin AU - Liu, Mingxuan AU - Guo, Yiqiang AU - Fu, Ziyuan AU - Zheng, Xiaoying PY - 2021/12/13 TI - An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis JO - JMIR Mhealth Uhealth SP - e26439 VL - 9 IS - 12 KW - mobile health KW - health behavior KW - system KW - development KW - usability KW - coronary heart disease N2 - 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 UR - https://mhealth.jmir.org/2021/12/e26439 UR - http://dx.doi.org/10.2196/26439 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898449 ID - info:doi/10.2196/26439 ER - TY - JOUR AU - Massanelli, Jackson AU - Sexton, W. Kevin AU - Lesher, T. Chris AU - Jensen, K. Hanna AU - Kimbrough, K. Mary AU - Privratsky, Anna AU - Taylor, R. John AU - Bhavaraju, Avi PY - 2021/12/13 TI - Integration of Web Analytics Into Graduate Medical Education: Usability Study JO - JMIR Form Res SP - e29748 VL - 5 IS - 12 KW - graduate medical education KW - website analysis KW - residency recruitment KW - medical education KW - website KW - analytics KW - usage KW - usability KW - user engagement KW - user-centered design KW - website design N2 - 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. UR - https://formative.jmir.org/2021/12/e29748 UR - http://dx.doi.org/10.2196/29748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898459 ID - info:doi/10.2196/29748 ER - TY - JOUR AU - Lee, W. Austin AU - Kenfield, A. Stacey AU - Wang, Y. Elizabeth AU - Enriquez, Anthony AU - Oni-Orisan, Akinyemi AU - Steinman, A. Michael AU - Sim, Ida AU - Breyer, N. Benjamin AU - Bauer, R. Scott PY - 2021/12/10 TI - Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study JO - JMIR Form Res SP - e30762 VL - 5 IS - 12 KW - LUTS KW - tamsulosin KW - mobile KW - app KW - mobile phone N2 - Background: Continuous ?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. UR - https://formative.jmir.org/2021/12/e30762 UR - http://dx.doi.org/10.2196/30762 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889745 ID - info:doi/10.2196/30762 ER - TY - JOUR AU - Harrington, Katharine AU - Zenk, N. Shannon AU - Van Horn, Linda AU - Giurini, Lauren AU - Mahakala, Nithya AU - Kershaw, N. Kiarri PY - 2021/12/2 TI - The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study JO - JMIR Form Res SP - e27512 VL - 5 IS - 12 KW - ecological momentary assessment KW - eating behaviors KW - crowdsourcing KW - food consumption images KW - food image processing KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/12/e27512 UR - http://dx.doi.org/10.2196/27512 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860666 ID - info:doi/10.2196/27512 ER - TY - JOUR AU - Counson, Isabelle AU - Bartholomew, Alexandra AU - Crawford, Joanna AU - Petrie, Katherine AU - Basarkod, Geetanjali AU - Moynihan, Victoria AU - Pires, Josie AU - Cohen, Rachel AU - Glozier, Nicholas AU - Harvey, Samuel AU - Sanatkar, Samineh PY - 2021/12/2 TI - 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 JO - JMIR Form Res SP - e26370 VL - 5 IS - 12 KW - digital mental health KW - mHealth apps KW - help-seeking KW - junior physicians KW - co-design KW - user-centered design KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/12/e26370 UR - http://dx.doi.org/10.2196/26370 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860662 ID - info:doi/10.2196/26370 ER - TY - JOUR AU - Coumans, J. Juul M. AU - Oenema, Anke AU - Bolman, W. Catherine A. AU - Lechner, Lilian PY - 2021/12/2 TI - 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 JO - JMIR Form Res SP - e22390 VL - 5 IS - 12 KW - diet KW - physical activity KW - eHealth KW - self-determination theory KW - motivational interviewing KW - process evaluation KW - nonusage attrition N2 - 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. UR - https://formative.jmir.org/2021/12/e22390 UR - http://dx.doi.org/10.2196/22390 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860670 ID - info:doi/10.2196/22390 ER - TY - JOUR AU - Petracca, Francesco AU - Tempre, Rosaria AU - Cucciniello, Maria AU - Ciani, Oriana AU - Pompeo, Elena AU - Sannino, Luigi AU - Lovato, Valeria AU - Castaman, Giancarlo AU - Ghirardini, Alessandra AU - Tarricone, Rosanna PY - 2021/12/1 TI - An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study JO - JMIR Form Res SP - e25071 VL - 5 IS - 12 KW - mobile apps KW - mHealth KW - hemophilia A KW - rare diseases KW - usability KW - user-centered design KW - design science KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2021/12/e25071 UR - http://dx.doi.org/10.2196/25071 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855619 ID - info:doi/10.2196/25071 ER - TY - JOUR AU - Aminoff, Hedvig AU - Meijer, Sebastiaan AU - Groth, Kristina AU - Arnelo, Urban PY - 2021/11/30 TI - User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service JO - JMIR Hum Factors SP - e30867 VL - 8 IS - 4 KW - telemedicine KW - user experience KW - satisfaction KW - technology acceptance KW - usability KW - perioperative KW - surgery KW - consultation KW - surgeons KW - performance KW - evaluation KW - teleguidance KW - telehealth KW - telemedicine implementation N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e30867 UR - http://dx.doi.org/10.2196/30867 UR - http://www.ncbi.nlm.nih.gov/pubmed/34851302 ID - info:doi/10.2196/30867 ER - TY - JOUR AU - Stöhr, R. Mark AU - Günther, Andreas AU - Majeed, W. Raphael PY - 2021/11/29 TI - The Collaborative Metadata Repository (CoMetaR) Web App: Quantitative and Qualitative Usability Evaluation JO - JMIR Med Inform SP - e30308 VL - 9 IS - 11 KW - usability KW - metadata KW - data visualization KW - semantic web KW - data management KW - data warehousing KW - communication barriers KW - quality improvement KW - biological ontologies KW - data curation N2 - 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. UR - https://medinform.jmir.org/2021/11/e30308 UR - http://dx.doi.org/10.2196/30308 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847059 ID - info:doi/10.2196/30308 ER - TY - JOUR AU - To, G. Quyen AU - Green, Chelsea AU - Vandelanotte, Corneel PY - 2021/11/26 TI - Feasibility, Usability, and Effectiveness of a Machine Learning?Based Physical Activity Chatbot: Quasi-Experimental Study JO - JMIR Mhealth Uhealth SP - e28577 VL - 9 IS - 11 KW - conversational agent KW - virtual coach KW - intervention KW - exercise KW - acceptability KW - mobile phone N2 - 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. UR - https://mhealth.jmir.org/2021/11/e28577 UR - http://dx.doi.org/10.2196/28577 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842552 ID - info:doi/10.2196/28577 ER - TY - JOUR AU - Shewchuk, Brittany AU - Green, A. Lee AU - Barber, Tanya AU - Miller, Jean AU - Teare, Sylvia AU - Campbell-Scherer, Denise AU - Mrklas, J. Kelly AU - Li, C. Linda AU - Marlett, Nancy AU - Wasylak, Tracy AU - Lopatina, Elena AU - McCaughey, Deirdre AU - Marshall, A. Deborah PY - 2021/11/25 TI - Patients? Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study JO - JMIR Form Res SP - e30495 VL - 5 IS - 11 KW - mobile health KW - mHealth KW - app KW - self-management KW - osteoarthritis N2 - 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. UR - https://formative.jmir.org/2021/11/e30495 UR - http://dx.doi.org/10.2196/30495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842526 ID - info:doi/10.2196/30495 ER - TY - JOUR AU - Wilroy, Jereme AU - Lai, Byron AU - Currie, Madison AU - Young, Hui-Ju AU - Thirumalai, Mohanraj AU - Mehta, Tapan AU - Giannone, John AU - Rimmer, James PY - 2021/11/18 TI - Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study JO - JMIR Form Res SP - e29799 VL - 5 IS - 11 KW - telehealth KW - disability KW - COVID-19 KW - exercise KW - assessments KW - feasibility KW - mHealth KW - teleassessment KW - mobility impairment KW - home exercise KW - participation KW - physical disabilities N2 - 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 UR - https://formative.jmir.org/2021/11/e29799 UR - http://dx.doi.org/10.2196/29799 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792477 ID - info:doi/10.2196/29799 ER - TY - JOUR AU - Burmann, Anja AU - Tischler, Max AU - Faßbach, Mira AU - Schneitler, Sophie AU - Meister, Sven PY - 2021/11/11 TI - The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study JO - JMIR Med Inform SP - e31527 VL - 9 IS - 11 KW - digitalization KW - digital transformation KW - health care KW - human factor KW - physicians KW - digital natives KW - web-based survey KW - digital health N2 - 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 (?=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. UR - https://medinform.jmir.org/2021/11/e31527 UR - http://dx.doi.org/10.2196/31527 UR - http://www.ncbi.nlm.nih.gov/pubmed/34545813 ID - info:doi/10.2196/31527 ER - TY - JOUR AU - Baumgartner, L. Susan AU - Buffkin Jr, Eric D. AU - Rukavina, Elise AU - Jones, Jason AU - Weiler, Elizabeth AU - Carnes, C. Tony PY - 2021/11/8 TI - A Novel Digital Pill System for Medication Adherence Measurement and Reporting: Usability Validation Study JO - JMIR Hum Factors SP - e30786 VL - 8 IS - 4 KW - digital pills KW - digital medication KW - ingestible event marker KW - ingestible sensor KW - human factors KW - usability KW - validation study KW - medication adherence KW - medication nonadherence KW - remote patient monitoring KW - mobile phone N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e30786 UR - http://dx.doi.org/10.2196/30786 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747709 ID - info:doi/10.2196/30786 ER - TY - JOUR AU - Lazard, J. Allison AU - Babwah Brennen, Scott J. AU - Belina, P. Stephanie PY - 2021/11/4 TI - App Designs and Interactive Features to Increase mHealth Adoption: User Expectation Survey and Experiment JO - JMIR Mhealth Uhealth SP - e29815 VL - 9 IS - 11 KW - smartphone KW - interactive design KW - mobile apps KW - preventive health KW - mental models KW - prototypicality KW - attention KW - affordances N2 - 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. UR - https://mhealth.jmir.org/2021/11/e29815 UR - http://dx.doi.org/10.2196/29815 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734829 ID - info:doi/10.2196/29815 ER - TY - JOUR AU - Reichold, Michael AU - Heß, Miriam AU - Kolominsky-Rabas, Peter AU - Gräßel, Elmar AU - Prokosch, Hans-Ulrich PY - 2021/11/3 TI - Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study JO - JMIR Form Res SP - e31649 VL - 5 IS - 11 KW - dementia KW - usability KW - evaluation KW - mobile device KW - registry KW - electronic data collection KW - offline KW - mobile app KW - digital health KW - usability testing N2 - 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. UR - https://formative.jmir.org/2021/11/e31649 UR - http://dx.doi.org/10.2196/31649 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730543 ID - info:doi/10.2196/31649 ER - TY - JOUR AU - Hill, R. Jordan AU - Brown, C. Janetta AU - Campbell, L. Noll AU - Holden, J. Richard PY - 2021/11/2 TI - Usability-In-Place?Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review JO - JMIR Form Res SP - e26181 VL - 5 IS - 11 KW - mobile usability testing KW - usability inspection KW - methods KW - aging KW - literature synthesis KW - usability study KW - mobile usability KW - elderly KW - older adults KW - remote usability KW - mobility restriction N2 - 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. UR - https://formative.jmir.org/2021/11/e26181 UR - http://dx.doi.org/10.2196/26181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726604 ID - info:doi/10.2196/26181 ER - TY - JOUR AU - Bradwell, Louise Hannah AU - Edwards, Katie AU - Shenton, Deborah AU - Winnington, Rhona AU - Thill, Serge AU - Jones, B. Ray PY - 2021/11/1 TI - User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e30337 VL - 8 IS - 4 KW - companion robots KW - social robots KW - Paro KW - older adults KW - dementia KW - care homes KW - engagement KW - acceptability KW - gerontology KW - Joy for All KW - social care KW - user-centered design N2 - 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. UR - https://rehab.jmir.org/2021/4/e30337 UR - http://dx.doi.org/10.2196/30337 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723825 ID - info:doi/10.2196/30337 ER - TY - JOUR AU - Chin, Yun Winnie Szu AU - Kurowski, Alicia AU - Gore, Rebecca AU - Chen, Guanling AU - Punnett, Laura AU - PY - 2021/10/28 TI - Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study JO - JMIR Form Res SP - e20739 VL - 5 IS - 10 KW - mobile apps KW - usability testing KW - user experience design KW - mobile phone KW - mhealth KW - iterative testing KW - participatory research KW - user demographics KW - worker participation N2 - 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. UR - https://formative.jmir.org/2021/10/e20739 UR - http://dx.doi.org/10.2196/20739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709186 ID - info:doi/10.2196/20739 ER - TY - JOUR AU - Luo, Yan AU - Dozier, Krystal AU - Ikenberg, Carin PY - 2021/10/26 TI - Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis JO - J Med Internet Res SP - e27966 VL - 23 IS - 10 KW - electronic personal health records KW - human-technology interaction factors KW - clinical notes KW - smartphone app KW - ease of understanding N2 - 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 (?=.28, P=.005), 55 years old and older (?=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults (?=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults (?=.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. UR - https://www.jmir.org/2021/10/e27966 UR - http://dx.doi.org/10.2196/27966 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698646 ID - info:doi/10.2196/27966 ER - TY - JOUR AU - Wong, Jill AU - Foussat, C. Agathe AU - Ting, Steven AU - Acerbi, Enzo AU - van Elburg, M. Ruurd AU - Mei Chien, Chua PY - 2021/10/26 TI - A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study JO - JMIR Pediatr Parent SP - e30169 VL - 4 IS - 4 KW - chatbot KW - parental stress KW - parental sleep KW - infant feeding KW - preterm infants KW - term infants KW - sleep KW - stress KW - eHealth KW - support KW - anxiety KW - usability N2 - 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 UR - https://pediatrics.jmir.org/2021/4/e30169 UR - http://dx.doi.org/10.2196/30169 UR - http://www.ncbi.nlm.nih.gov/pubmed/34544679 ID - info:doi/10.2196/30169 ER - TY - JOUR AU - Reese, J. Thomas AU - Del Fiol, Guilherme AU - Morgan, Keaton AU - Hurwitz, T. Jason AU - Kawamoto, Kensaku AU - Gomez-Lumbreras, Ainhoa AU - Brown, L. Mary AU - Thiess, Henrik AU - Vazquez, R. Sara AU - Nelson, D. Scott AU - Boyce, Richard AU - Malone, Daniel PY - 2021/10/26 TI - A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study JO - JMIR Hum Factors SP - e28618 VL - 8 IS - 4 KW - shared decision-making KW - user-centered design KW - drug interaction KW - clinical decision support N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e28618 UR - http://dx.doi.org/10.2196/28618 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698649 ID - info:doi/10.2196/28618 ER - TY - JOUR AU - Giang, W. Wayne C. AU - Bland, Emma AU - Chen, Jeffrey AU - Colón-Morales, M. Coralys AU - Alvarado, M. Michelle PY - 2021/10/26 TI - User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews JO - JMIR Hum Factors SP - e27628 VL - 8 IS - 4 KW - insurance, health KW - health benefits plans KW - employee KW - decision aids KW - cognitive ergonomics KW - human factors engineering N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e27628 UR - http://dx.doi.org/10.2196/27628 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698647 ID - info:doi/10.2196/27628 ER - TY - JOUR AU - Doumas, M. Diana AU - Midgett, Aida AU - Myers, Valerie AU - Buller, Klein Mary PY - 2021/10/26 TI - Usability of a Technology-Based Bystander Bullying Intervention for Middle School Students in Rural, Low-Income Communities: Mixed Methods Study JO - JMIR Form Res SP - e32382 VL - 5 IS - 10 KW - technology-based bullying intervention KW - STAC-T KW - usability testing KW - middle school KW - rural KW - low-income KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2021/10/e32382 UR - http://dx.doi.org/10.2196/32382 UR - http://www.ncbi.nlm.nih.gov/pubmed/34582355 ID - info:doi/10.2196/32382 ER - TY - JOUR AU - Barr, J. Paul AU - Haslett, William AU - Dannenberg, D. Michelle AU - Oh, Lisa AU - Elwyn, Glyn AU - Hassanpour, Saeed AU - Bonasia, L. Kyra AU - Finora, C. James AU - Schoonmaker, A. Jesse AU - Onsando, Moraa W. AU - Ryan, James AU - Bruce, L. Martha AU - Das, K. Amar AU - Arend, Roger AU - Piper, Sheryl AU - Ganoe, H. Craig PY - 2021/10/22 TI - An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach JO - J Med Internet Res SP - e25512 VL - 23 IS - 10 KW - patient-centered care KW - health communication KW - audiovisual aids KW - user-centered design KW - software KW - natural language processing KW - patients KW - caregivers N2 - 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. UR - https://www.jmir.org/2021/10/e25512 UR - http://dx.doi.org/10.2196/25512 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677131 ID - info:doi/10.2196/25512 ER - TY - JOUR AU - Bente, E. Britt AU - Wentzel, Jobke AU - Groeneveld, GH Rik AU - IJzerman, VH Renée AU - de Buisonjé, R. David AU - Breeman, D. Linda AU - Janssen, R. Veronica AU - Kraaijenhagen, Roderik AU - Pieterse, E. Marcel AU - Evers, WM Andrea AU - van Gemert-Pijnen, EWC Julia PY - 2021/10/22 TI - Values of Importance to Patients With Cardiovascular Disease as a Foundation for eHealth Design and Evaluation: Mixed Methods Study JO - JMIR Cardio SP - e33252 VL - 5 IS - 2 KW - patient values KW - health behavior KW - lifestyle KW - mobile app KW - user-centered design KW - eHealth KW - cardiovascular disease KW - behavior KW - app KW - design KW - cardiovascular KW - evaluation KW - platform KW - support KW - intervention N2 - 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. UR - https://cardio.jmir.org/2021/2/e33252 UR - http://dx.doi.org/10.2196/33252 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677130 ID - info:doi/10.2196/33252 ER - TY - JOUR AU - Xiao, Jin AU - Luo, Jiebo AU - Ly-Mapes, Oriana AU - Wu, Tong Tong AU - Dye, Timothy AU - Al Jallad, Nisreen AU - Hao, Peirong AU - Ruan, Jinlong AU - Bullock, Sherita AU - Fiscella, Kevin PY - 2021/10/22 TI - 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 JO - JMIR Res Protoc SP - e32921 VL - 10 IS - 10 KW - artificial intelligence KW - smartphone app KW - mDentistry KW - dental caries KW - underserved population KW - mobile dentistry N2 - 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 UR - https://www.researchprotocols.org/2021/10/e32921 UR - http://dx.doi.org/10.2196/32921 UR - http://www.ncbi.nlm.nih.gov/pubmed/34529582 ID - info:doi/10.2196/32921 ER - TY - JOUR AU - Abujarad, Fuad AU - Peduzzi, Peter AU - Mun, Sophia AU - Carlson, Kristina AU - Edwards, Chelsea AU - Dziura, James AU - Brandt, Cynthia AU - Alfano, Sandra AU - Chupp, Geoffrey PY - 2021/10/19 TI - Comparing a Multimedia Digital Informed Consent Tool With Traditional Paper-Based Methods: Randomized Controlled Trial JO - JMIR Form Res SP - e20458 VL - 5 IS - 10 KW - digital consent KW - digital health KW - e-consent KW - informed consent KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2021/10/e20458 UR - http://dx.doi.org/10.2196/20458 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665142 ID - info:doi/10.2196/20458 ER - TY - JOUR AU - Cohen Rodrigues, R. Talia AU - de Buisonjé, R. David AU - Keesman, Mike AU - Reijnders, Thomas AU - van der Geer, E. Jessica AU - Janssen, R. Veronica AU - Kraaijenhagen, A. Roderik AU - Atsma, E. Douwe AU - Evers, M. Andrea W. PY - 2021/10/15 TI - Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care JO - J Med Internet Res SP - e25646 VL - 23 IS - 10 KW - eHealth KW - digital health KW - cardiovascular disease KW - cardiac care KW - lifestyle change KW - lifestyle support KW - intervention KW - health care professionals KW - implementation KW - interview KW - facilitators KW - barriers N2 - 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. UR - https://www.jmir.org/2021/10/e25646 UR - http://dx.doi.org/10.2196/25646 UR - http://www.ncbi.nlm.nih.gov/pubmed/34652280 ID - info:doi/10.2196/25646 ER - TY - JOUR AU - Suffoletto, Brian AU - Goldstein, Tina AU - Gotkiewicz, Dawn AU - Gotkiewicz, Emily AU - George, Brandie AU - Brent, David PY - 2021/10/14 TI - Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e32271 VL - 5 IS - 10 KW - college KW - mental health KW - self-management KW - digital intervention KW - mHealth N2 - 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 UR - https://formative.jmir.org/2021/10/e32271 UR - http://dx.doi.org/10.2196/32271 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647893 ID - info:doi/10.2196/32271 ER - TY - JOUR AU - Halttu, Kirsi AU - Oinas-Kukkonen, Harri PY - 2021/10/14 TI - Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study JO - JMIR Form Res SP - e23968 VL - 5 IS - 10 KW - self-monitoring KW - wearables KW - physical activity tracking KW - mHealth KW - need for cognition KW - persuasive design KW - tailoring KW - user research KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/10/e23968 UR - http://dx.doi.org/10.2196/23968 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647894 ID - info:doi/10.2196/23968 ER - TY - JOUR AU - Cruz, da Flávia Oliveira de Almeida Marques AU - Faria, Tostes Edison AU - Ghobad, Cardelino Pabblo AU - Alves, Mano Leandro Yukio AU - Reis, dos Paula Elaine Diniz PY - 2021/10/13 TI - A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study JO - J Med Internet Res SP - e24865 VL - 23 IS - 10 KW - mobile applications KW - health education KW - nursing care KW - oncology nursing KW - educational technology KW - breast neoplasms KW - radiation therapy N2 - 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. UR - https://www.jmir.org/2021/10/e24865 UR - http://dx.doi.org/10.2196/24865 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643531 ID - info:doi/10.2196/24865 ER - TY - JOUR AU - Bos, C. Véronique L. L. AU - Jansen, Tessa AU - Klazinga, S. Niek AU - Kringos, S. Dionne PY - 2021/10/12 TI - Development and Actionability of the Dutch COVID-19 Dashboard: Descriptive Assessment and Expert Appraisal Study JO - JMIR Public Health Surveill SP - e31161 VL - 7 IS - 10 KW - COVID-19 KW - dashboard KW - performance intelligence KW - Netherlands KW - actionability KW - communication KW - government KW - pandemic KW - public health N2 - 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. UR - https://publichealth.jmir.org/2021/10/e31161 UR - http://dx.doi.org/10.2196/31161 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543229 ID - info:doi/10.2196/31161 ER - TY - JOUR AU - Kruglova, Katya AU - O'Connell, Laura Siobhan Bernadette AU - Dawadi, Shrinkhala AU - Gelgoot, Noah Eden AU - Miner, A. Skye AU - Robins, Stephanie AU - Schinazi, Joy AU - Zelkowitz, Phyllis PY - 2021/10/12 TI - An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study JO - JMIR Form Res SP - e28136 VL - 5 IS - 10 KW - mHealth app KW - mHealth development process KW - infertility KW - intervention design KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/10/e28136 UR - http://dx.doi.org/10.2196/28136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636741 ID - info:doi/10.2196/28136 ER - TY - JOUR AU - Payne, H. Thomas AU - Keller, Carolyn AU - Arora, Pallavi AU - Brusati, Allison AU - Levin, Jesse AU - Salgaonkar, Monica AU - Li, Xi AU - Zech, Jennifer AU - Lees, Fischer A. PY - 2021/10/6 TI - Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study JO - J Med Internet Res SP - e30165 VL - 23 IS - 10 KW - electronic documentation KW - electronic health records KW - hospital progress notes KW - copy-paste KW - EHR KW - patient records KW - workflow KW - human factors KW - clinical communication KW - physician communication KW - hospital N2 - 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. UR - https://www.jmir.org/2021/10/e30165 UR - http://dx.doi.org/10.2196/30165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612825 ID - info:doi/10.2196/30165 ER - TY - JOUR AU - Ziemssen, Tjalf AU - Giovannoni, Gavin AU - Alvarez, Enrique AU - Bhan, Virender AU - Hersh, Carrie AU - Hoffmann, Olaf AU - Oreja-Guevara, Celia AU - Robles-Cedeño, R. Rene AU - Trojano, Maria AU - Vermersch, Patrick AU - Dobay, Pamela AU - Khwaja, Mudeer AU - Stadler, Bianca AU - Rauser, Benedict AU - Hach, Thomas AU - Piani-Meier, Daniela AU - Burton, Jason PY - 2021/10/6 TI - Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey JO - J Med Internet Res SP - e29558 VL - 23 IS - 10 KW - multiple sclerosis KW - relapsing remitting multiple sclerosis KW - secondary progressive multiple sclerosis KW - transition KW - progression KW - digital KW - usability N2 - 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. UR - https://www.jmir.org/2021/10/e29558 UR - http://dx.doi.org/10.2196/29558 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612826 ID - info:doi/10.2196/29558 ER - TY - JOUR AU - Rigamonti, Lia AU - Secchi, Matteo AU - Lawrence, B. Jimmy AU - Labianca, Luca AU - Wolfarth, Bernd AU - Peters, Harm AU - Bonaventura, Klaus AU - Back, Alexander David PY - 2021/10/5 TI - An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study JO - J Med Internet Res SP - e28767 VL - 23 IS - 10 KW - augmented reality KW - ultrasound KW - social media KW - remote KW - exercise science N2 - 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. UR - https://www.jmir.org/2021/10/e28767 UR - http://dx.doi.org/10.2196/28767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609312 ID - info:doi/10.2196/28767 ER - TY - JOUR AU - Snow-Hill, L. Nyssa AU - Donenberg, Geri AU - Feil, G. Edward AU - Smith, R. David AU - Floyd, R. Brenikki AU - Leve, Craig PY - 2021/9/30 TI - A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study JO - JMIR Form Res SP - e31185 VL - 5 IS - 9 KW - health education KW - sexual behavior KW - juvenile delinquency KW - feasibility studies KW - evidence-based practice KW - adolescent health services KW - inservice training KW - implementation science KW - organizational innovation KW - technology KW - risk reduction behavior KW - mobile phone KW - health technology KW - health promotion KW - sexual health N2 - 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. UR - https://formative.jmir.org/2021/9/e31185 UR - http://dx.doi.org/10.2196/31185 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591028 ID - info:doi/10.2196/31185 ER - TY - JOUR AU - Toonders, Johanna Suze Adriana AU - van Westrienen, Elisabeth Paula AU - Konings, Sophie AU - Nieboer, E. Marianne AU - Veenhof, Cindy AU - Pisters, F. Martijn PY - 2021/9/28 TI - Patients? Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study JO - J Med Internet Res SP - e19794 VL - 23 IS - 9 KW - usability KW - medically unexplained physical symptoms KW - blended care N2 - 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. UR - https://www.jmir.org/2021/9/e19794 UR - http://dx.doi.org/10.2196/19794 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581674 ID - info:doi/10.2196/19794 ER - TY - JOUR AU - Myhre, Leren Enid AU - Garnweidner-Holme, Lisa AU - Dahl, Bente AU - Reigstad, Myhre Marte AU - Lukasse, Mirjam PY - 2021/9/27 TI - Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study JO - JMIR Form Res SP - e28698 VL - 5 IS - 9 KW - early labor KW - latent phase KW - think aloud KW - usability KW - website KW - labor KW - pregnancy KW - user-friendliness KW - eHealth KW - user satisfaction N2 - 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. UR - https://formative.jmir.org/2021/9/e28698 UR - http://dx.doi.org/10.2196/28698 UR - http://www.ncbi.nlm.nih.gov/pubmed/34569940 ID - info:doi/10.2196/28698 ER - TY - JOUR AU - Smith-Turchyn, Jenna AU - Adams, C. Scott AU - Sabiston, M. Catherine PY - 2021/9/23 TI - Testing of a Self-administered 6-Minute Walk Test Using Technology: Usability, Reliability and Validity Study JO - JMIR Rehabil Assist Technol SP - e22818 VL - 8 IS - 3 KW - exercise KW - physical activity KW - usability testing KW - applications KW - mobile phone N2 - 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. UR - https://rehab.jmir.org/2021/3/e22818 UR - http://dx.doi.org/10.2196/22818 UR - http://www.ncbi.nlm.nih.gov/pubmed/34554105 ID - info:doi/10.2196/22818 ER - TY - JOUR AU - Hörhammer, Iiris AU - Kujala, Sari AU - Hilama, Pirjo AU - Heponiemi, Tarja PY - 2021/9/22 TI - Building Primary Health Care Personnel?s Support for a Patient Portal While Alleviating eHealth-Related Stress: Survey Study JO - J Med Internet Res SP - e28976 VL - 23 IS - 9 KW - patient portal KW - implementation KW - adoption KW - health care personnel KW - eHealth-related stress N2 - 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 (?=.15, P<.001), usability (?=.11, P<.001), and implementation practices (?=.07, P<.001) were positively associated with professionals? support and negatively associated with professionals eHealth-related stress (?=?.07, P=.010; ?=?.27, P<.001; and ?=?.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. UR - https://www.jmir.org/2021/9/e28976 UR - http://dx.doi.org/10.2196/28976 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550087 ID - info:doi/10.2196/28976 ER - TY - JOUR AU - Stunden, Chelsea AU - Stratton, Kirsten AU - Zakani, Sima AU - Jacob, John PY - 2021/9/22 TI - 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 JO - J Med Internet Res SP - e22942 VL - 23 IS - 9 KW - virtual reality KW - magnetic resonance imaging simulation KW - certified child life specialists KW - pediatrics KW - magnetic resonance imaging procedures KW - alternatives to sedation KW - preparing children for MRI N2 - 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 UR - https://www.jmir.org/2021/9/e22942 UR - http://dx.doi.org/10.2196/22942 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550072 ID - info:doi/10.2196/22942 ER - TY - JOUR AU - Kim, Sunyoung AU - Park, Yunoh AU - Ackerman, K. Matthew PY - 2021/9/22 TI - Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach JO - JMIR Form Res SP - e27447 VL - 5 IS - 9 KW - asthma KW - children KW - indoor air quality KW - mobile app KW - smartphone KW - user-centered design N2 - 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. UR - https://formative.jmir.org/2021/9/e27447 UR - http://dx.doi.org/10.2196/27447 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550080 ID - info:doi/10.2196/27447 ER - TY - JOUR AU - Shikako, Keiko AU - Mogo, I. Ebele R. AU - Grand-Maison, Valerie AU - Simpson, Robert AU - Pritchard-Wiart, Lesley AU - Majnemer, Annette AU - PY - 2021/9/16 TI - Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study JO - JMIR Form Res SP - e23877 VL - 5 IS - 9 KW - implementation research KW - mobile health KW - children with disabilities KW - physical activity promotion KW - digital health KW - inclusive leisure participation KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/9/e23877 UR - http://dx.doi.org/10.2196/23877 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528886 ID - info:doi/10.2196/23877 ER - TY - JOUR AU - Keyworth, Chris AU - O'Connor, Rory AU - Quinlivan, Leah AU - Armitage, J. Christopher PY - 2021/9/14 TI - Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation JO - J Med Internet Res SP - e28349 VL - 23 IS - 9 KW - self-harm KW - implementation intentions KW - acceptability KW - online KW - volitional help sheet KW - digital health KW - mental health N2 - 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. UR - https://www.jmir.org/2021/9/e28349 UR - http://dx.doi.org/10.2196/28349 UR - http://www.ncbi.nlm.nih.gov/pubmed/34518153 ID - info:doi/10.2196/28349 ER - TY - JOUR AU - Crawford, D. Natalie AU - Josma, Dorie AU - Harrington, V. Kristin R. AU - Morris, Joseph AU - Quamina, Alvan AU - Birkett, Michelle AU - Phillips II, Gregory PY - 2021/9/9 TI - 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 JO - JMIR Form Res SP - e30237 VL - 5 IS - 9 KW - think-aloud KW - egocentric networks KW - sociogram KW - social networks KW - MSM KW - transgender KW - network canvas KW - black MSM KW - infectious disease transmission KW - stigma N2 - 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. UR - https://formative.jmir.org/2021/9/e30237 UR - http://dx.doi.org/10.2196/30237 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499040 ID - info:doi/10.2196/30237 ER - TY - JOUR AU - Cheung, Ting Yin AU - Lam, Hong Pok AU - Lam, Tai-Ning Teddy AU - Lam, Wai Henry Hon AU - Li, Kong Chi PY - 2021/9/9 TI - Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study JO - JMIR Form Res SP - e27985 VL - 5 IS - 9 KW - mobile health KW - mHealth KW - patients KW - expectations KW - hemophilia KW - chronic diseases KW - rare diseases KW - self-management N2 - 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. UR - https://formative.jmir.org/2021/9/e27985 UR - http://dx.doi.org/10.2196/27985 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499034 ID - info:doi/10.2196/27985 ER - TY - JOUR AU - Murphy, Jane AU - McSharry, Jenny AU - Hynes, Lisa AU - Molloy, J. Gerard PY - 2021/9/1 TI - A Smartphone App to Support Adherence to Inhaled Corticosteroids in Young Adults With Asthma: Multi-Methods Feasibility Study JO - JMIR Form Res SP - e28784 VL - 5 IS - 9 KW - asthma KW - young adult KW - medication adherence KW - self-management KW - mobile applications KW - mHealth KW - intervention KW - usability KW - acceptability KW - feasibility KW - multi-methods KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2021/9/e28784 UR - http://dx.doi.org/10.2196/28784 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468325 ID - info:doi/10.2196/28784 ER - TY - JOUR AU - Coleone, Diomara Joane AU - Bellei, Andrei Ericles AU - Roman, Klein Mateus AU - Kirsten, Ramos Vanessa AU - De Marchi, Bertoletti Ana Carolina PY - 2021/8/27 TI - Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care JO - JMIR Form Res SP - e27454 VL - 5 IS - 8 KW - eating KW - mobile applications KW - primary health care KW - aged KW - type 2 diabetes mellitus N2 - 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. UR - https://formative.jmir.org/2021/8/e27454 UR - http://dx.doi.org/10.2196/27454 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448711 ID - info:doi/10.2196/27454 ER - TY - JOUR AU - Ranney, L. Megan AU - Pittman, K. Sarah AU - Moseley, Isabelle AU - Morgan, E. Kristen AU - Riese, Alison AU - Ybarra, Michele AU - Cunningham, Rebecca AU - Rosen, Rochelle PY - 2021/8/27 TI - Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design JO - JMIR Form Res SP - e25900 VL - 5 IS - 8 KW - adolescent KW - mobile health KW - digital health KW - cyberbullying KW - user-centered design KW - qualitative KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/8/e25900 UR - http://dx.doi.org/10.2196/25900 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448702 ID - info:doi/10.2196/25900 ER - TY - JOUR AU - Ribanszki, Robert AU - Saez Fonseca, Andres Jose AU - Barnby, Matthew Joseph AU - Jano, Kimberly AU - Osmani, Fatima AU - Almasi, Soma AU - Tsakanikos, Elias PY - 2021/8/27 TI - Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study JO - JMIR Form Res SP - e14004 VL - 5 IS - 8 KW - qualitative KW - adolescents KW - mental health KW - digital smartphone app KW - digital mental health KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/8/e14004 UR - http://dx.doi.org/10.2196/14004 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128814 ID - info:doi/10.2196/14004 ER - TY - JOUR AU - Wong, Cheong Kam AU - Thiagalingam, Aravinda AU - Kumar, Saurabh AU - Marschner, Simone AU - Kunwar, Ritu AU - Bailey, Jannine AU - Kok, Cindy AU - Usherwood, Tim AU - Chow, K. Clara PY - 2021/8/26 TI - User Perceptions and Experiences of a Handheld 12-Lead Electrocardiographic Device in a Clinical Setting: Usability Evaluation JO - JMIR Cardio SP - e21186 VL - 5 IS - 2 KW - handheld KW - electrocardiogram KW - ECG KW - acceptability KW - usability KW - user perception KW - user experience KW - atrial fibrillation KW - long QT KW - screening N2 - 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 ±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 ±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 (?=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. UR - https://cardio.jmir.org/2021/2/e21186 UR - http://dx.doi.org/10.2196/21186 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435958 ID - info:doi/10.2196/21186 ER - TY - JOUR AU - Bae, Seul Ye AU - Kim, Hwan Kyung AU - Choi, Won Sae AU - Ko, Taehoon AU - Lim, Seo Jun AU - Piao, Meihua PY - 2021/8/26 TI - 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 JO - JMIR Form Res SP - e26227 VL - 5 IS - 8 KW - COVID-19 KW - mobile app KW - telemedicine KW - wearable device KW - vital sign KW - satisfaction KW - usability N2 - 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. UR - https://formative.jmir.org/2021/8/e26227 UR - http://dx.doi.org/10.2196/26227 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254946 ID - info:doi/10.2196/26227 ER - TY - JOUR AU - McCall, Terika AU - Ali, Osama Muhammad AU - Yu, Fei AU - Fontelo, Paul AU - Khairat, Saif PY - 2021/8/17 TI - Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study JO - JMIR Form Res SP - e24393 VL - 5 IS - 8 KW - African Americans KW - women KW - mental health KW - anxiety KW - depression KW - telemedicine KW - mHealth KW - mobile applications KW - digital health KW - user-centered design KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/8/e24393 UR - http://dx.doi.org/10.2196/24393 UR - http://www.ncbi.nlm.nih.gov/pubmed/34133313 ID - info:doi/10.2196/24393 ER - TY - JOUR AU - Schoenmakers, Birgitte AU - Wens, Johan PY - 2021/8/16 TI - Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study JO - JMIR Form Res SP - e23834 VL - 5 IS - 8 KW - primary care KW - education KW - graduate KW - medical education KW - testing KW - assessment KW - app KW - COVID-19 KW - efficiency KW - accuracy N2 - 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. UR - https://formative.jmir.org/2021/8/e23834 UR - http://dx.doi.org/10.2196/23834 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398786 ID - info:doi/10.2196/23834 ER - TY - JOUR AU - Araújo, Fátima AU - Nogueira, Nilza Maria AU - Silva, Joana AU - Rego, Sílvia PY - 2021/8/12 TI - A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e25781 VL - 10 IS - 8 KW - fall prevention KW - technological platform KW - elderly KW - Otago Exercise Program N2 - 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 UR - https://www.researchprotocols.org/2021/8/e25781 UR - http://dx.doi.org/10.2196/25781 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387557 ID - info:doi/10.2196/25781 ER - TY - JOUR AU - Rankine, Jacquelin AU - Yeramosu, Deepika AU - Matheo, Loreta AU - Sequeira, M. Gina AU - Miller, Elizabeth AU - Ray, N. Kristin PY - 2021/8/5 TI - Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design JO - JMIR Hum Factors SP - e25568 VL - 8 IS - 3 KW - referral KW - consultation KW - telemedicine KW - telehealth KW - adolescents KW - child health KW - child health services KW - confidentiality KW - access to health care N2 - 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. UR - https://humanfactors.jmir.org/2021/3/e25568 UR - http://dx.doi.org/10.2196/25568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383665 ID - info:doi/10.2196/25568 ER - TY - JOUR AU - Park, Sang Hyun AU - Kim, Il Kwang AU - Chung, Ho-Young AU - Jeong, Sungmoon AU - Soh, Young Jae AU - Hyun, Ho Young AU - Kim, Sun Hwa PY - 2021/8/4 TI - A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study JO - JMIR Med Inform SP - e29184 VL - 9 IS - 8 KW - personal health record app KW - workplace health promotion KW - Fast Healthcare Interoperability Resources KW - national health care data set KW - human-centered design N2 - 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. UR - https://medinform.jmir.org/2021/8/e29184 UR - http://dx.doi.org/10.2196/29184 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346894 ID - info:doi/10.2196/29184 ER - TY - JOUR AU - Derksen, E. Marloes AU - Jaspers, WM Monique AU - van Strijp, Sander AU - Fransen, P. Mirjam PY - 2021/8/4 TI - Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study JO - JMIR Form Res SP - e24112 VL - 5 IS - 8 KW - think aloud KW - heuristic evaluation KW - usability KW - mHealth KW - game elements KW - smoking prevention KW - user-centered design KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/8/e24112 UR - http://dx.doi.org/10.2196/24112 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346895 ID - info:doi/10.2196/24112 ER - TY - JOUR AU - Abdulaal, Ahmed AU - Patel, Aatish AU - Al-Hindawi, Ahmed AU - Charani, Esmita AU - Alqahtani, A. Saleh AU - Davies, W. Gary AU - Mughal, Nabeela AU - Moore, Prockter Luke Stephen PY - 2021/7/28 TI - Clinical Utility and Functionality of an Artificial Intelligence?Based App to Predict Mortality in COVID-19: Mixed Methods Analysis JO - JMIR Form Res SP - e27992 VL - 5 IS - 7 KW - app KW - artificial intelligence KW - coronavirus KW - COVID-19 KW - development KW - function KW - graphical user interface KW - machine learning KW - model KW - mortality KW - neural network KW - prediction KW - usability KW - utility N2 - 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. UR - https://formative.jmir.org/2021/7/e27992 UR - http://dx.doi.org/10.2196/27992 UR - http://www.ncbi.nlm.nih.gov/pubmed/34115603 ID - info:doi/10.2196/27992 ER - TY - JOUR AU - Ingvaldsen, Hegna Sigrid AU - Tronvik, Erling AU - Brenner, Eiliv AU - Winnberg, Ingunn AU - Olsen, Alexander AU - Gravdahl, Bruvik Gøril AU - Stubberud, Anker PY - 2021/7/28 TI - A Biofeedback App for Migraine: Development and Usability Study JO - JMIR Form Res SP - e23229 VL - 5 IS - 7 KW - mHealth KW - headache KW - wearables KW - smartphone N2 - 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. UR - https://formative.jmir.org/2021/7/e23229 UR - http://dx.doi.org/10.2196/23229 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319243 ID - info:doi/10.2196/23229 ER - TY - JOUR AU - Hägglund, Maria AU - Scandurra, Isabella PY - 2021/7/27 TI - User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale JO - JMIR Hum Factors SP - e24927 VL - 8 IS - 3 KW - usability KW - system usability scale KW - evaluation KW - patient accessible electronic health records KW - open notes KW - patient portals N2 - 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 Skåne (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 Skåne, whereas 331 participants had received care in Region Uppsala. Uppsala?s mean SUS score was 80.71 (SD 13.41), compared with Skåne?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. UR - https://humanfactors.jmir.org/2021/3/e24927 UR - http://dx.doi.org/10.2196/24927 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313596 ID - info:doi/10.2196/24927 ER - TY - JOUR AU - Broekhuis, Marijke AU - van Velsen, Lex AU - Peute, Linda AU - Halim, Meilani AU - Hermens, Hermie PY - 2021/7/27 TI - Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications JO - JMIR Form Res SP - e18198 VL - 5 IS - 7 KW - usability benchmarking KW - eHealth systems KW - content analysis KW - usability framework KW - summative evaluation KW - mobile phone N2 - 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 ? was calculated for 2 data sets on both the category and factor levels, and all Cohen ? 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. UR - https://formative.jmir.org/2021/7/e18198 UR - http://dx.doi.org/10.2196/18198 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313594 ID - info:doi/10.2196/18198 ER - TY - JOUR AU - Duffy, Anthony AU - Christie, Greg AU - Moreno, Sylvain PY - 2021/7/26 TI - Examining Challenges to the Incorporation of End Users in the Design of Digital Health Interventions: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e28083 VL - 10 IS - 7 KW - digital health KW - end user(s) KW - user experience KW - UX KW - health behavior KW - intervention KW - co-design KW - mobile health KW - mHealth N2 - 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 UR - https://www.researchprotocols.org/2021/7/e28083 UR - http://dx.doi.org/10.2196/28083 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309578 ID - info:doi/10.2196/28083 ER - TY - JOUR AU - Schüttler, Christina AU - Prokosch, Hans-Ulrich AU - Sedlmayr, Martin AU - Sedlmayr, Brita PY - 2021/7/21 TI - Evaluation of Three Feasibility Tools for Identifying Patient Data and Biospecimen Availability: Comparative Usability Study JO - JMIR Med Inform SP - e25531 VL - 9 IS - 7 KW - software tools KW - user interface KW - feasibility KW - evaluation KW - research N2 - 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. UR - https://medinform.jmir.org/2021/7/e25531 UR - http://dx.doi.org/10.2196/25531 UR - http://www.ncbi.nlm.nih.gov/pubmed/34287211 ID - info:doi/10.2196/25531 ER - TY - JOUR AU - Sääskilahti, Maria AU - Ahonen, Riitta AU - Timonen, Johanna PY - 2021/7/16 TI - Pharmacy Customers? Experiences of Use, Usability, and Satisfaction of a Nationwide Patient Portal: Survey Study JO - J Med Internet Res SP - e25368 VL - 23 IS - 7 KW - patient portal KW - electronic prescription KW - electronic health records KW - usability KW - pharmacy customer KW - perception KW - experience KW - survey N2 - 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. UR - https://www.jmir.org/2021/7/e25368 UR - http://dx.doi.org/10.2196/25368 UR - http://www.ncbi.nlm.nih.gov/pubmed/34269687 ID - info:doi/10.2196/25368 ER - TY - JOUR AU - Rouzaud Laborde, Charlotte AU - Cenko, Erta AU - Mardini, T. Mamoun AU - Nerella, Subhash AU - Kheirkhahan, Matin AU - Ranka, Sanjay AU - Fillingim, B. Roger AU - Corbett, B. Duane AU - Weber, Eric AU - Rashidi, Parisa AU - Manini, Todd PY - 2021/7/14 TI - Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study JO - JMIR Aging SP - e24553 VL - 4 IS - 3 KW - ehealth KW - mobile health KW - ecological momentary assessment KW - real-time online assessment and mobility monitor KW - ROAMM KW - older adults KW - compliance KW - personal satisfaction KW - usability KW - smartwatch KW - knee osteoarthritis KW - pain KW - fatigue KW - wearable electronic device KW - mobile application N2 - 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. UR - https://aging.jmir.org/2021/3/e24553 UR - http://dx.doi.org/10.2196/24553 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259638 ID - info:doi/10.2196/24553 ER - TY - JOUR AU - Resnick, Daniel AU - Schapira, M. Marilyn AU - Smith, M. Jazmine AU - Bautista, Allison AU - Xu, Chang AU - Jones, Liz AU - Aysola, Jaya PY - 2021/7/14 TI - Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App JO - JMIR Form Res SP - e22510 VL - 5 IS - 7 KW - mHealth KW - cancer prevention KW - goal setting KW - social networks KW - health disparities KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/7/e22510 UR - http://dx.doi.org/10.2196/22510 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259162 ID - info:doi/10.2196/22510 ER - TY - JOUR AU - Valaitis, Ruta AU - Cleghorn, Laura AU - Vassilev, Ivaylo AU - Rogers, Anne AU - Ploeg, Jenny AU - Kothari, Anita AU - Risdon, Cathy AU - Gillett, James AU - Guenter, Dale AU - Dolovich, Lisa PY - 2021/7/12 TI - A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study JO - JMIR Form Res SP - e25285 VL - 5 IS - 7 KW - web-based tool KW - usability KW - feasibility KW - self-management KW - social network KW - primary care KW - health and social services KW - linkages KW - high systems users KW - volunteers N2 - 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. UR - https://formative.jmir.org/2021/7/e25285 UR - http://dx.doi.org/10.2196/25285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255654 ID - info:doi/10.2196/25285 ER - TY - JOUR AU - Gowarty, A. Minda AU - Longacre, R. Meghan AU - Vilardaga, Roger AU - Kung, J. Nathan AU - Gaughan-Maher, E. Ashley AU - Brunette, F. Mary PY - 2021/7/7 TI - Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study JO - JMIR Ment Health SP - e26873 VL - 8 IS - 7 KW - smoking cessation KW - mHealth KW - serious mental illness KW - smartphone application KW - digital health KW - psychiatric illness KW - tobacco treatment KW - mobile phone N2 - 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. UR - https://mental.jmir.org/2021/7/e26873 UR - http://dx.doi.org/10.2196/26873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255699 ID - info:doi/10.2196/26873 ER - TY - JOUR AU - Tawfik, S. Daniel AU - Sinha, Amrita AU - Bayati, Mohsen AU - Adair, C. Kathryn AU - Shanafelt, D. Tait AU - Sexton, Bryan J. AU - Profit, Jochen PY - 2021/7/6 TI - Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study JO - J Med Internet Res SP - e26817 VL - 23 IS - 7 KW - frustration with technology KW - emotional exhaustion KW - professional burnout KW - work-life integration KW - biomedical technology KW - work-life balance KW - user-centered design KW - electronic health records KW - medical informatics applications KW - health information systems N2 - 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. UR - https://www.jmir.org/2021/7/e26817 UR - http://dx.doi.org/10.2196/26817 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255674 ID - info:doi/10.2196/26817 ER - TY - JOUR AU - Heponiemi, Tarja AU - Kaihlanen, Anu-Marja AU - Gluschkoff, Kia AU - Saranto, Kaija AU - Nissinen, Sari AU - Laukka, Elina AU - Vehko, Tuulikki PY - 2021/7/6 TI - The Association Between Using a Mobile Version of an Electronic Health Record and the Well-Being of Nurses: Cross-sectional Survey Study JO - JMIR Med Inform SP - e28729 VL - 9 IS - 7 KW - stress related to information systems KW - time pressure KW - usability KW - stress KW - health and social care N2 - 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. UR - https://medinform.jmir.org/2021/7/e28729 UR - http://dx.doi.org/10.2196/28729 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255704 ID - info:doi/10.2196/28729 ER - TY - JOUR AU - Piau, Antoine AU - Steinmeyer, Zara AU - Charlon, Yoann AU - Courbet, Laetitia AU - Rialle, Vincent AU - Lepage, Benoit AU - Campo, Eric AU - Nourhashemi, Fati PY - 2021/7/5 TI - 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 JO - JMIR Mhealth Uhealth SP - e15641 VL - 9 IS - 7 KW - frail older adults KW - walking speed KW - outpatient monitoring KW - activity tracker KW - shoe insert N2 - 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 UR - https://mhealth.jmir.org/2021/7/e15641 UR - http://dx.doi.org/10.2196/15641 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260404 ID - info:doi/10.2196/15641 ER - TY - JOUR AU - Herbst, Rachel AU - Rybak, Tiffany AU - Meisman, Andrea AU - Whitehead, Monica AU - Rosen, Brittany AU - Crosby, E. Lori AU - Klein, D. Melissa AU - Real, J. Francis PY - 2021/6/29 TI - A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study JO - JMIR Pediatr Parent SP - e29518 VL - 4 IS - 2 KW - resident education KW - virtual reality KW - behavioral health promotion KW - COVID-19 N2 - 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. UR - https://pediatrics.jmir.org/2021/2/e29518 UR - http://dx.doi.org/10.2196/29518 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081601 ID - info:doi/10.2196/29518 ER - TY - JOUR AU - Jamal, Amr AU - Tharkar, Shabana AU - Alenazi, Hanan AU - Julaidan, Saud Bedoor AU - Al Hindawi, Ali Dania AU - AlAkeel, Suleman Norah AU - AlNuhayer, Mohammed Ola AU - AlDubaikhi, Hamoud Raneem PY - 2021/6/24 TI - Usability Analysis of a Health Sciences Digital Library by Medical Residents: Cross-sectional Survey JO - JMIR Form Res SP - e23293 VL - 5 IS - 6 KW - digital library usability KW - medical education KW - system usability scale KW - medical residents KW - Saudi Arabia N2 - 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. UR - https://formative.jmir.org/2021/6/e23293/ UR - http://dx.doi.org/10.2196/23293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34184992 ID - info:doi/10.2196/23293 ER - TY - JOUR AU - Persson, Johanna AU - Rydenfält, Christofer PY - 2021/6/22 TI - 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 JO - J Med Internet Res SP - e26694 VL - 23 IS - 6 KW - digital systems KW - electronic health records KW - digital work environment KW - ergonomics KW - usability KW - human-centered design UR - https://www.jmir.org/2021/6/e26694 UR - http://dx.doi.org/10.2196/26694 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156336 ID - info:doi/10.2196/26694 ER - TY - JOUR AU - Willis, Matthew AU - Brand Hein, Leah AU - Hu, Zhaoxian AU - Saran, Rajiv AU - Argentina, Marissa AU - Bragg-Gresham, Jennifer AU - Krein, L. Sarah AU - Gillespie, Brenda AU - Zheng, Kai AU - Veinot, C. Tiffany PY - 2021/6/14 TI - Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study JO - JMIR Hum Factors SP - e26012 VL - 8 IS - 2 KW - user interaction KW - dialysis KW - usability KW - informatics intervention N2 - 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. UR - https://humanfactors.jmir.org/2021/2/e26012 UR - http://dx.doi.org/10.2196/26012 UR - http://www.ncbi.nlm.nih.gov/pubmed/34121664 ID - info:doi/10.2196/26012 ER - TY - JOUR AU - Madar, Ronni AU - Ugon, Adrien AU - Ivankovi?, Damir AU - Tsopra, Rosy PY - 2021/6/11 TI - A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach JO - J Med Internet Res SP - e25741 VL - 23 IS - 6 KW - clinical decision support system KW - visualization KW - usability KW - clinical practice guidelines KW - antibiotic KW - primary care N2 - 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. UR - https://www.jmir.org/2021/6/e25741 UR - http://dx.doi.org/10.2196/25741 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114958 ID - info:doi/10.2196/25741 ER - TY - JOUR AU - Mascheroni, Alessandro AU - Choe, Kyoung Eun AU - Luo, Yuhan AU - Marazza, Michele AU - Ferlito, Clara AU - Caverzasio, Serena AU - Mezzanotte, Francesco AU - Kaelin-Lang, Alain AU - Faraci, Francesca AU - Puiatti, Alessandro AU - Ratti, Luca Pietro PY - 2021/6/8 TI - The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16304 VL - 9 IS - 6 KW - Parkinson disease KW - ecological momentary assessment KW - finger-tapping test KW - subjective scales KW - sleep diaries KW - tablet application KW - home-based system N2 - 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 UR - https://mhealth.jmir.org/2021/6/e16304 UR - http://dx.doi.org/10.2196/16304 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100767 ID - info:doi/10.2196/16304 ER - TY - JOUR AU - Salari, Raheleh AU - R Niakan Kalhori, Sharareh AU - GhaziSaeedi, Marjan AU - Jeddi, Marjan AU - Nazari, Mahin AU - Fatehi, Farhad PY - 2021/6/2 TI - Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation JO - J Med Internet Res SP - e18167 VL - 23 IS - 6 KW - type 2 diabetes KW - mobile health KW - mHealth KW - mobile app, self-management KW - behavior change N2 - 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. UR - https://www.jmir.org/2021/6/e18167 UR - http://dx.doi.org/10.2196/18167 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076579 ID - info:doi/10.2196/18167 ER - TY - JOUR AU - Norris, E. Anne AU - Thalasinos, Delcampo Roxana AU - Hecht, L. Michael PY - 2021/6/2 TI - Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups JO - JMIR Form Res SP - e24937 VL - 5 IS - 6 KW - implementation science KW - mobile apps KW - peer influence KW - early intervention KW - adolescent health N2 - 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. UR - https://formative.jmir.org/2021/6/e24937 UR - http://dx.doi.org/10.2196/24937 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076578 ID - info:doi/10.2196/24937 ER - TY - JOUR AU - Ormel, Ilja AU - Onu, C. Charles AU - Magalhaes, Mona AU - Tang, Terence AU - Hughes, B. John AU - Law, Susan PY - 2021/6/2 TI - 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 JO - JMIR Form Res SP - e22970 VL - 5 IS - 6 KW - qualitative research KW - illness narratives KW - experiential information KW - breast cancer KW - surgery KW - tailored information KW - recommender system KW - patient information and communication KW - mobile app KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/6/e22970 UR - http://dx.doi.org/10.2196/22970 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076582 ID - info:doi/10.2196/22970 ER - TY - JOUR AU - Iftikhar, Aleeha AU - Bond, R. Raymond AU - McGilligan, Victoria AU - Leslie, J. Stephen AU - Rjoob, Khaled AU - Knoery, Charles AU - Quigg, Ciara AU - Campbell, Ryan AU - Boyd, Kyle AU - McShane, Anne AU - Peace, Aaron PY - 2021/5/26 TI - Comparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study JO - JMIR Hum Factors SP - e25787 VL - 8 IS - 2 KW - digital forms KW - health care KW - usability evaluation KW - single-page form KW - multipage form KW - conversational forms N2 - 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×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. UR - https://humanfactors.jmir.org/2021/2/e25787 UR - http://dx.doi.org/10.2196/25787 UR - http://www.ncbi.nlm.nih.gov/pubmed/34037531 ID - info:doi/10.2196/25787 ER - TY - JOUR AU - Lwin, O. May AU - Sheldenkar, Anita AU - Panchapakesan, Chitra PY - 2021/5/26 TI - A Digital Mobile Community App for Caregivers in Singapore: Predevelopment and Usability Study JO - JMIR Nursing SP - e25679 VL - 4 IS - 2 KW - caregiving KW - technological solution KW - mobile application KW - easy communication KW - caregiver KW - mobile app KW - communication KW - elderly KW - aging population KW - internet technology KW - community network KW - network N2 - 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. UR - https://nursing.jmir.org/2021/2/e25679 UR - http://dx.doi.org/10.2196/25679 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345796 ID - info:doi/10.2196/25679 ER - TY - JOUR AU - Won, Stevenson Andrea AU - Barreau, C. Ariana AU - Gaertner, Mark AU - Stone, Tristan AU - Zhu, Joshua AU - Wang, Yao Cheng AU - Mackey, Sean PY - 2021/5/26 TI - Assessing the Feasibility of an Open-Source Virtual Reality Mirror Visual Feedback Module for Complex Regional Pain Syndrome: Pilot Usability Study JO - J Med Internet Res SP - e16536 VL - 23 IS - 5 KW - virtual reality KW - pain KW - complex regional pain syndrome KW - CRPS KW - open source KW - mirror visual feedback N2 - 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. UR - https://www.jmir.org/2021/5/e16536 UR - http://dx.doi.org/10.2196/16536 UR - http://www.ncbi.nlm.nih.gov/pubmed/34037530 ID - info:doi/10.2196/16536 ER - TY - JOUR AU - Andrade, Evismar AU - Quinlan, Leo AU - Harte, Richard AU - Byrne, Dara AU - Fallon, Enda AU - Kelly, Martina AU - Casey, Siobhan AU - Kirrane, Frank AU - O'Connor, Paul AU - O'Hora, Denis AU - Scully, Michael AU - Laffey, John AU - Pladys, Patrick AU - Beuchée, Alain AU - ÓLaighin, Gearoid PY - 2021/5/25 TI - Augmenting Critical Care Patient Monitoring Using Wearable Technology: Review of Usability and Human Factors JO - JMIR Hum Factors SP - e16491 VL - 8 IS - 2 KW - patient monitor KW - physiologic monitor KW - human factors KW - ergonomics KW - usability KW - user experience KW - wearable KW - mobile phone KW - critical care N2 - 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. UR - https://humanfactors.jmir.org/2021/2/e16491 UR - http://dx.doi.org/10.2196/16491 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032574 ID - info:doi/10.2196/16491 ER - TY - JOUR AU - McMaughan, Jones Darcy AU - Lin, Sherry AU - Ozmetin, Jennifer AU - Beverly, Gayle Judith AU - Brog, Joshua AU - Naiser, Emily PY - 2021/5/25 TI - A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study JO - JMIR Form Res SP - e22915 VL - 5 IS - 5 KW - youth with special health care needs KW - health care transitions KW - eHealth KW - usability KW - concurrent think aloud method N2 - 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. UR - https://formative.jmir.org/2021/5/e22915 UR - http://dx.doi.org/10.2196/22915 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032579 ID - info:doi/10.2196/22915 ER - TY - JOUR AU - Lowe, Cabella AU - Hanuman Sing, Harry AU - Browne, Mitchell AU - Alwashmi, F. Meshari AU - Marsh, William AU - Morrissey, Dylan PY - 2021/5/18 TI - Usability Testing of a Digital Assessment Routing Tool: Protocol for an Iterative Convergent Mixed Methods Study JO - JMIR Res Protoc SP - e27205 VL - 10 IS - 5 KW - mHealth KW - mobile health KW - eHealth KW - digital health KW - digital technology KW - musculoskeletal injury KW - musculoskeletal conditions KW - triage KW - physiotherapy triage KW - usability KW - acceptability N2 - 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 UR - https://www.researchprotocols.org/2021/5/e27205 UR - http://dx.doi.org/10.2196/27205 UR - http://www.ncbi.nlm.nih.gov/pubmed/34003135 ID - info:doi/10.2196/27205 ER - TY - JOUR AU - Lopes, Filipa AU - Rodrigues, Mário AU - Silva, G. Anabela PY - 2021/5/14 TI - User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study JO - JMIR Mhealth Uhealth SP - e25316 VL - 9 IS - 5 KW - pain assessment KW - mobile app KW - validity KW - reliability KW - usability KW - mHealth KW - pain KW - user-centered design N2 - 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. UR - https://mhealth.jmir.org/2021/5/e25316 UR - http://dx.doi.org/10.2196/25316 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988515 ID - info:doi/10.2196/25316 ER - TY - JOUR AU - Jones, Chelsea AU - Miguel-Cruz, Antonio AU - Brémault-Phillips, Suzette PY - 2021/5/13 TI - 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 JO - JMIR Rehabil Assist Technol SP - e26078 VL - 8 IS - 2 KW - NCAT KW - PTSD KW - cognitive assessment KW - cognition KW - executive function KW - technology acceptance KW - UTAUT KW - Canadian Armed Forces KW - mTBI KW - concussion KW - digital health KW - neuropsychology KW - neurology KW - post concussive symptoms KW - military N2 - 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. UR - https://rehab.jmir.org/2021/2/e26078 UR - http://dx.doi.org/10.2196/26078 UR - http://www.ncbi.nlm.nih.gov/pubmed/33983125 ID - info:doi/10.2196/26078 ER - TY - JOUR AU - Rager, L. Theresa AU - Koepfli, Cristian AU - Khan, A. Wasif AU - Ahmed, Sabeena AU - Mahmud, Hayat Zahid AU - Clayton, N. Katherine PY - 2021/5/12 TI - Usability of Rapid Cholera Detection Device (OmniVis) for Water Quality Workers in Bangladesh: Iterative Convergent Mixed Methods Study JO - J Med Internet Res SP - e22973 VL - 23 IS - 5 KW - cholera KW - environmental surveillance KW - mHealth KW - usability N2 - 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. UR - https://www.jmir.org/2021/5/e22973 UR - http://dx.doi.org/10.2196/22973 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978590 ID - info:doi/10.2196/22973 ER - TY - JOUR AU - Guay, Manon AU - Labbé, Mathieu AU - Séguin-Tremblay, Noémie AU - Auger, Claudine AU - Goyer, Geneviève AU - Veloza, Emily AU - Chevalier, Natalie AU - Polgar, Jan AU - Michaud, François PY - 2021/5/11 TI - Adapting a Person?s Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App?s Acceptability JO - JMIR Rehabil Assist Technol SP - e24669 VL - 8 IS - 2 KW - occupational therapy KW - mobile phone KW - aging KW - disability KW - telehealth KW - 3D visualization KW - universal design KW - built environment KW - camera KW - remote assessment KW - assistive technology N2 - 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. UR - https://rehab.jmir.org/2021/2/e24669 UR - http://dx.doi.org/10.2196/24669 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973867 ID - info:doi/10.2196/24669 ER - TY - JOUR AU - Helou, Samar AU - Abou-Khalil, Victoria AU - Iacobucci, Riccardo AU - El Helou, Elie AU - Kiyono, Ken PY - 2021/5/10 TI - Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation JO - J Med Internet Res SP - e25218 VL - 23 IS - 5 KW - computational ethnography KW - patient-physician communication KW - doctor-patient-computer interaction KW - electronic medical records KW - pose estimation KW - gaze KW - voice activity KW - dialogue KW - clinic layout N2 - 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. UR - https://www.jmir.org/2021/5/e25218 UR - http://dx.doi.org/10.2196/25218 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970117 ID - info:doi/10.2196/25218 ER - TY - JOUR AU - Petrocchi, Serena AU - Filipponi, Chiara AU - Montagna, Giacomo AU - Bonollo, Marta AU - Pagani, Olivia AU - Meani, Francesco PY - 2021/5/10 TI - A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study JO - JMIR Form Res SP - e28668 VL - 5 IS - 5 KW - breast cancer KW - decision-making process KW - breast cancer patient KW - smartphone app KW - empowerment KW - breast cancer journey KW - mobile app N2 - 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. UR - https://formative.jmir.org/2021/5/e28668 UR - http://dx.doi.org/10.2196/28668 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970120 ID - info:doi/10.2196/28668 ER - TY - JOUR AU - de Looff, Christiaan Pieter AU - Nijman, Henk AU - Didden, Robert AU - Noordzij, L. Matthijs PY - 2021/5/10 TI - Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study JO - JMIR Form Res SP - e18096 VL - 5 IS - 5 KW - forensic psychiatry KW - wearable biosensors KW - intellectual disabilities KW - usability KW - acceptance KW - continuous use KW - emotion regulation KW - behavior regulation N2 - 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. UR - https://formative.jmir.org/2021/5/e18096 UR - http://dx.doi.org/10.2196/18096 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970115 ID - info:doi/10.2196/18096 ER - TY - JOUR AU - Schättin, Alexandra AU - Häfliger, Stephan AU - Meyer, Alain AU - Früh, Barbara AU - Böckler, Sonja AU - Hungerbühler, Yannic AU - de Bruin, D. Eling AU - Frese, Sebastian AU - Steinlin Egli, Regula AU - Götz, Ulrich AU - Bauer, René AU - Martin-Niedecken, Lisa Anna PY - 2021/5/7 TI - Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies JO - JMIR Serious Games SP - e22826 VL - 9 IS - 2 KW - multiple sclerosis KW - exergame KW - motor KW - physical KW - cognition KW - usability KW - feasibility N2 - 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. UR - https://games.jmir.org/2021/2/e22826 UR - http://dx.doi.org/10.2196/22826 UR - http://www.ncbi.nlm.nih.gov/pubmed/33960956 ID - info:doi/10.2196/22826 ER - TY - JOUR AU - Akbar, Fatema AU - Mark, Gloria AU - Prausnitz, Stephanie AU - Warton, Margaret E. AU - East, A. Jeffrey AU - Moeller, F. Mark AU - Reed, E. Mary AU - Lieu, A. Tracy PY - 2021/4/28 TI - Physician Stress During Electronic Health Record Inbox Work: In Situ Measurement With Wearable Sensors JO - JMIR Med Inform SP - e24014 VL - 9 IS - 4 KW - electronic health records KW - stress KW - wearables KW - HRV KW - inbox KW - EHR alerts KW - after-hours work KW - electronic mail KW - physician well-being KW - Inbasket N2 - 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. UR - https://medinform.jmir.org/2021/4/e24014 UR - http://dx.doi.org/10.2196/24014 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908888 ID - info:doi/10.2196/24014 ER - TY - JOUR AU - Joshi, Meera AU - Archer, Stephanie AU - Morbi, Abigail AU - Arora, Sonal AU - Kwasnicki, Richard AU - Ashrafian, Hutan AU - Khan, Sadia AU - Cooke, Graham AU - Darzi, Ara PY - 2021/4/22 TI - Short-Term Wearable Sensors for In-Hospital Medical and Surgical Patients: Mixed Methods Analysis of Patient Perspectives JO - JMIR Perioper Med SP - e18836 VL - 4 IS - 1 KW - patient feedback KW - patient evaluation KW - questionnaire KW - interview KW - qualitative N2 - 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. UR - https://periop.jmir.org/2021/1/e18836 UR - http://dx.doi.org/10.2196/18836 UR - http://www.ncbi.nlm.nih.gov/pubmed/33885367 ID - info:doi/10.2196/18836 ER - TY - JOUR AU - LaMonica, M. Haley AU - Roberts, E. Anna AU - Davenport, A. Tracey AU - Hickie, B. Ian PY - 2021/4/21 TI - Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study JO - JMIR Aging SP - e25928 VL - 4 IS - 2 KW - older adults KW - mental health KW - technology KW - community-based participatory research KW - stakeholder participation KW - smartphone KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2021/2/e25928 UR - http://dx.doi.org/10.2196/25928 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881410 ID - info:doi/10.2196/25928 ER - TY - JOUR AU - Palotai, Miklos AU - Wallack, Max AU - Kujbus, Gergo AU - Dalnoki, Adam AU - Guttmann, Charles PY - 2021/4/16 TI - Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study JO - JMIR Mhealth Uhealth SP - e19564 VL - 9 IS - 4 KW - multiple sclerosis KW - fatigue KW - depression KW - mobile application KW - mobile phone KW - real-time assessment N2 - 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. UR - https://mhealth.jmir.org/2021/4/e19564 UR - http://dx.doi.org/10.2196/19564 UR - http://www.ncbi.nlm.nih.gov/pubmed/33861208 ID - info:doi/10.2196/19564 ER - TY - JOUR AU - Tremoulet, D. Patrice AU - Shah, D. Priyanka AU - Acosta, A. Alisha AU - Grant, W. Christian AU - Kurtz, T. Jon AU - Mounas, Peter AU - Kirchhoff, Michael AU - Wade, Elizabeth PY - 2021/4/15 TI - Usability of Electronic Health Record?Generated Discharge Summaries: Heuristic Evaluation JO - J Med Internet Res SP - e25657 VL - 23 IS - 4 KW - discharge summary KW - usability KW - electronic health record (EHR) KW - care coordination KW - elderly patients KW - patient safety KW - heuristic evaluation KW - human factors N2 - 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. UR - https://www.jmir.org/2021/4/e25657 UR - http://dx.doi.org/10.2196/25657 UR - http://www.ncbi.nlm.nih.gov/pubmed/33856353 ID - info:doi/10.2196/25657 ER - TY - JOUR AU - Dauber-Decker, L. Katherine AU - Basile, Melissa AU - King, D'Arcy AU - Polo, Jennifer AU - Calise, Karina AU - Khan, Sundas AU - Solomon, Jeffrey AU - Dunne, Daniel AU - Hajizadeh, Negin PY - 2021/4/14 TI - Developing a Decision Aid to Facilitate Informed Decision Making About Invasive Mechanical Ventilation and Lung Transplantation Among Adults With Cystic Fibrosis: Usability Testing JO - JMIR Hum Factors SP - e21270 VL - 8 IS - 2 KW - usability KW - medical informatics KW - clinical decision support KW - cystic fibrosis KW - advance care planning N2 - 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. UR - https://humanfactors.jmir.org/2021/2/e21270 UR - http://dx.doi.org/10.2196/21270 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851921 ID - info:doi/10.2196/21270 ER - TY - JOUR AU - Langlet, Sundström Billy AU - Odegi, Dorothy AU - Zandian, Modjtaba AU - Nolstam, Jenny AU - Södersten, Per AU - Bergh, Cecilia PY - 2021/4/13 TI - Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study JO - JMIR Serious Games SP - e24998 VL - 9 IS - 2 KW - feeding and eating disorders KW - anorexia nervosa KW - bulimia nervosa KW - binge eating disorder KW - immersive virtual reality KW - eating disorders KW - virtual reality N2 - 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. UR - https://games.jmir.org/2021/2/e24998 UR - http://dx.doi.org/10.2196/24998 UR - http://www.ncbi.nlm.nih.gov/pubmed/33847593 ID - info:doi/10.2196/24998 ER - TY - JOUR AU - Cerbas, Shannon AU - Kelemen, Arpad AU - Liang, Yulan AU - Sik-Lanyi, Cecilia AU - Van de Castle, Barbara PY - 2021/4/13 TI - A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation JO - JMIRx Med SP - e20461 VL - 2 IS - 2 KW - cancer KW - mobile app KW - gamification KW - bone marrow transplant KW - alpha testing KW - physical activity N2 - 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 ?=.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. UR - https://xmed.jmir.org/2021/2/e20461 UR - http://dx.doi.org/10.2196/20461 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725560 ID - info:doi/10.2196/20461 ER - TY - JOUR AU - Zhang, Tianyi AU - Mosier, Jarrod AU - Subbian, Vignesh PY - 2021/4/9 TI - 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? JO - JMIR Hum Factors SP - e24860 VL - 8 IS - 2 KW - telehealth KW - healthcare system KW - COVID-19 KW - human factors KW - implementation KW - SEIPS UR - https://humanfactors.jmir.org/2021/2/e24860 UR - http://dx.doi.org/10.2196/24860 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779566 ID - info:doi/10.2196/24860 ER - TY - JOUR AU - Kuhns, M. Lisa AU - Hereth, Jane AU - Garofalo, Robert AU - Hidalgo, Marco AU - Johnson, K. Amy AU - Schnall, Rebecca AU - Reisner, L. Sari AU - Belzer, Marvin AU - Mimiaga, J. Matthew PY - 2021/3/31 TI - A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study JO - J Med Internet Res SP - e21839 VL - 23 IS - 3 KW - transgender persons KW - HIV KW - mobile app KW - mHealth KW - mobile phone N2 - 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. UR - https://www.jmir.org/2021/3/e21839 UR - http://dx.doi.org/10.2196/21839 UR - http://www.ncbi.nlm.nih.gov/pubmed/33787503 ID - info:doi/10.2196/21839 ER - TY - JOUR AU - Hwang, Youjin AU - Shin, Donghoon AU - Eun, Jinsu AU - Suh, Bongwon AU - Lee, Joonhwan PY - 2021/3/29 TI - Design Guidelines of a Computer-Based Intervention for Computer Vision Syndrome: Focus Group Study and Real-World Deployment JO - J Med Internet Res SP - e22099 VL - 23 IS - 3 KW - computer-based intervention KW - computer vision syndrome KW - system interface KW - deployment study N2 - 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. UR - https://www.jmir.org/2021/3/e22099 UR - http://dx.doi.org/10.2196/22099 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779568 ID - info:doi/10.2196/22099 ER - TY - JOUR AU - Calvano, David Joshua AU - Fundingsland Jr, Lauritz Edwin AU - Lai, Deborah AU - Silacci, Sara AU - Raja, S. Ali AU - He, Shuhan PY - 2021/3/29 TI - Applying Website Rankings to Digital Health Centers in the United States to Assess Public Engagement: Website Usability Study JO - JMIR Hum Factors SP - e20721 VL - 8 IS - 1 KW - website usability KW - digital health KW - health care website KW - usability testing KW - web interventions KW - digital health care KW - web crawler N2 - 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. UR - https://humanfactors.jmir.org/2021/1/e20721 UR - http://dx.doi.org/10.2196/20721 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779564 ID - info:doi/10.2196/20721 ER - TY - JOUR AU - Bente, Elise Britt AU - van 't Klooster, Roderick Jan Willem Jaap AU - Schreijer, Annemarie Maud AU - Berkemeier, Lea AU - van Gend, Elmar Joris AU - Slijkhuis, Hendrik Peter Jan AU - Kelders, Marion Saskia AU - van Gemert-Pijnen, Cornelia Julia Elisabeth Wilhelmina PY - 2021/3/26 TI - The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study JO - JMIR Form Res SP - e27882 VL - 5 IS - 3 KW - usability testing KW - user evaluation KW - user experience KW - contact tracing apps KW - CoronaMelder KW - COVID-19 KW - pandemic KW - mobile apps KW - mHealth KW - public health N2 - 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. UR - https://formative.jmir.org/2021/3/e27882 UR - http://dx.doi.org/10.2196/27882 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724198 ID - info:doi/10.2196/27882 ER - TY - JOUR AU - Rotondi, J. Armando AU - Grady, Jonathan AU - Hanusa, H. Barbara AU - Haas, L. Gretchen AU - Spring, R. Michael AU - Abebe, Z. Kaleab AU - Luther, James AU - Gurklis, John PY - 2021/3/24 TI - Key Variables for Effective eHealth Designs for Individuals With and Without Mental Health Disorders: 2^12-4 Fractional Factorial Experiment JO - J Med Internet Res SP - e23137 VL - 23 IS - 3 KW - schizophrenia KW - severe mental illness KW - eHealth KW - eHealth design KW - website KW - usability KW - website design KW - website usability KW - fractional factorial design N2 - 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. UR - https://www.jmir.org/2021/3/e23137 UR - http://dx.doi.org/10.2196/23137 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759796 ID - info:doi/10.2196/23137 ER - TY - JOUR AU - Morse, S. Robert AU - Lambden, Kaley AU - Quinn, Erin AU - Ngoma, Twalib AU - Mushi, Beatrice AU - Ho, Xian Yun AU - Ngoma, Mamsau AU - Mahuna, Habiba AU - Sagan, B. Sarah AU - Mmari, Joshua AU - Miesfeldt, Susan PY - 2021/3/23 TI - A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach JO - JMIR Cancer SP - e24062 VL - 7 IS - 1 KW - mobile health KW - mHealth KW - user-centered design KW - palliative care KW - pain KW - cancer KW - sub-Saharan Africa KW - mobile phone N2 - 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. UR - https://cancer.jmir.org/2021/1/e24062 UR - http://dx.doi.org/10.2196/24062 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755022 ID - info:doi/10.2196/24062 ER - TY - JOUR AU - Bhattacharjya, Sutanuka AU - Cavuoto, Anne Lora AU - Reilly, Brandon AU - Xu, Wenyao AU - Subryan, Heamchand AU - Langan, Jeanne PY - 2021/3/22 TI - Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study JO - JMIR Hum Factors SP - e21312 VL - 8 IS - 1 KW - stroke KW - rehabilitation KW - smart technology KW - 3-dimensional printing KW - usability N2 - 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 UR - https://humanfactors.jmir.org/2021/1/e21312 UR - http://dx.doi.org/10.2196/21312 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749608 ID - info:doi/10.2196/21312 ER - TY - JOUR AU - Richardson, Julie AU - Letts, Lori AU - Sinclair, Susanne AU - Chan, David AU - Miller, Jordan AU - Donnelly, Catherine AU - Smith-Turchyn, Jenna AU - Wojkowski, Sarah AU - Gravesande, Janelle AU - Loyola Sánchez, Adalberto PY - 2021/3/18 TI - Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study JO - JMIR Rehabil Assist Technol SP - e19519 VL - 8 IS - 1 KW - rehabilitation KW - physiotherapy KW - occupational therapy KW - self-management KW - function KW - web-based application KW - usability KW - user-centered design N2 - 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. UR - https://rehab.jmir.org/2021/1/e19519 UR - http://dx.doi.org/10.2196/19519 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734090 ID - info:doi/10.2196/19519 ER - TY - JOUR AU - Chaniaud, Noémie AU - Megalakaki, Olga AU - Capo, Sophie AU - Loup-Escande, Emilie PY - 2021/3/17 TI - Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study JO - JMIR Hum Factors SP - e24846 VL - 8 IS - 1 KW - user characteristics KW - health literacy KW - home medical devices KW - usability study KW - remote health KW - home health N2 - 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. UR - https://humanfactors.jmir.org/2021/1/e24846 UR - http://dx.doi.org/10.2196/24846 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729161 ID - info:doi/10.2196/24846 ER - TY - JOUR AU - Witteman, O. Holly AU - Vaisson, Gratianne AU - Provencher, Thierry AU - Chipenda Dansokho, Selma AU - Colquhoun, Heather AU - Dugas, Michele AU - Fagerlin, Angela AU - Giguere, MC Anik AU - Haslett, Lynne AU - Hoffman, Aubri AU - Ivers, M. Noah AU - Légaré, France AU - Trottier, Marie-Eve AU - Stacey, Dawn AU - Volk, J. Robert AU - Renaud, Jean-Sébastien PY - 2021/3/16 TI - An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation JO - J Med Internet Res SP - e15032 VL - 23 IS - 3 KW - patient-centered care KW - patient participation KW - health services research KW - validation studies as topic KW - surveys and questionnaires KW - humans KW - user-centred design, human-centred design KW - user-centered design KW - human-centered design KW - co-design KW - instrument KW - scale KW - index KW - patient and public involvement N2 - 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. UR - https://www.jmir.org/2021/3/e15032 UR - http://dx.doi.org/10.2196/15032 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724194 ID - info:doi/10.2196/15032 ER - TY - JOUR AU - Otokiti, Umar Ahmed AU - Craven, K. Catherine AU - Shetreat-Klein, Avniel AU - Cohen, Stacey AU - Darrow, Bruce PY - 2021/3/16 TI - 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 JO - JMIR Res Protoc SP - e25148 VL - 10 IS - 3 KW - electronic health records KW - burnout, psychological KW - user-centered design KW - usability KW - EHR optimization N2 - 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 UR - https://www.researchprotocols.org/2021/3/e25148 UR - http://dx.doi.org/10.2196/25148 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724202 ID - info:doi/10.2196/25148 ER - TY - JOUR AU - Ratnanather, Tilak J. AU - Bhattacharya, Rohit AU - Heston, B. Margo AU - Song, Joanne AU - Fernandez, R. Lindsey AU - Lim, Seo Hong AU - Lee, Seung-Wook AU - Tam, Edric AU - Yoo, Sungho AU - Bae, Seung-Ho AU - Lam, Inez AU - Jeon, Won Hyoung AU - Chang, A. Son AU - Koo, Ja-Won PY - 2021/3/15 TI - An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study JO - JMIR Mhealth Uhealth SP - e20890 VL - 9 IS - 3 KW - speech therapy KW - mobile phone KW - computers, handheld KW - cochlear implants KW - hearing aids N2 - 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. UR - https://mhealth.jmir.org/2021/3/e20890 UR - http://dx.doi.org/10.2196/20890 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720025 ID - info:doi/10.2196/20890 ER - TY - JOUR AU - Rizvi, Rubina AU - VanHouten, Courtney AU - Bright, J. Tiffani AU - McKillop, M. Mollie AU - Alevy, Shira AU - Brotman, David AU - Sands-Lincoln, Megan AU - Snowdon, Jane AU - Robinson, J. Barbie AU - Staats, Carolyn AU - Jackson, P. Gretchen AU - Kassler, J. William PY - 2021/3/12 TI - The Perceived Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study JO - J Med Internet Res SP - e24122 VL - 23 IS - 3 KW - vulnerable population KW - managed care KW - data integration KW - advanced technologies KW - usability KW - mixed methods study N2 - 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. UR - https://www.jmir.org/2021/3/e24122 UR - http://dx.doi.org/10.2196/24122 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709928 ID - info:doi/10.2196/24122 ER - TY - JOUR AU - Lu?trek, Mitja AU - Bohanec, Marko AU - Cavero Barca, Carlos AU - Ciancarelli, Costanza Maria AU - Clays, Els AU - Dawodu, Adeyemo Amos AU - Derboven, Jan AU - De Smedt, Delphine AU - Dovgan, Erik AU - Lampe, Jure AU - Marino, Flavia AU - Mlakar, Miha AU - Pioggia, Giovanni AU - Puddu, Emilio Paolo AU - Rodríguez, Mario Juan AU - Schiariti, Michele AU - Slapni?ar, Ga?per AU - Slegers, Karin AU - Tartarisco, Gennaro AU - Vali?, Jakob AU - Vodopija, Aljo?a PY - 2021/3/5 TI - A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial JO - JMIR Med Inform SP - e24501 VL - 9 IS - 3 KW - congestive heart failure KW - personal health system KW - mobile application KW - mobile phone KW - wearable electronic devices KW - decision support techniques KW - psychological support KW - human centered design N2 - 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 UR - https://medinform.jmir.org/2021/3/e24501 UR - http://dx.doi.org/10.2196/24501 UR - http://www.ncbi.nlm.nih.gov/pubmed/33666562 ID - info:doi/10.2196/24501 ER - TY - JOUR AU - Hill, R. Jordan AU - Harrington, B. Addison AU - Adeoye, Philip AU - Campbell, L. Noll AU - Holden, J. Richard PY - 2021/3/4 TI - Going Remote?Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study JO - JMIR Mhealth Uhealth SP - e26702 VL - 9 IS - 3 KW - COVID-19 KW - mobile usability testing KW - usability inspection KW - methods KW - aging KW - agile KW - mobile phone N2 - 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 UR - https://mhealth.jmir.org/2021/3/e26702 UR - http://dx.doi.org/10.2196/26702 UR - http://www.ncbi.nlm.nih.gov/pubmed/33606655 ID - info:doi/10.2196/26702 ER - TY - JOUR AU - Chung, Kyungmi AU - Cho, Young Hee AU - Park, Young Jin PY - 2021/3/3 TI - A Chatbot for Perinatal Women?s and Partners? Obstetric and Mental Health Care: Development and Usability Evaluation Study JO - JMIR Med Inform SP - e18607 VL - 9 IS - 3 KW - chatbot KW - mobile phone KW - instant messaging KW - mobile health KW - perinatal care KW - usability KW - user experience KW - usability testing N2 - 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 (?=0.26; P=.36), ease of use (?=0.19; P=.51), satisfaction (?=0.21; P=.46), or total usability scores (?=0.32; P=.24). Unlike EOL, all 3 subfactors and the total usability had significant positive associations with each other (all ?>0.80; P<.001). Furthermore, perceived risks exhibited no significant negative associations with perceived benefits (?=?0.29; P=.30) or intention to seek (SEE; ?=?0.28; P=.32) or share (SHA; ?=?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 (?=0.94; P<.001) than with SHA (?=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. UR - https://medinform.jmir.org/2021/3/e18607 UR - http://dx.doi.org/10.2196/18607 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656442 ID - info:doi/10.2196/18607 ER - TY - JOUR AU - Dekkers, Tessa AU - Melles, Marijke AU - Vehmeijer, W. Stephan B. AU - de Ridder, Huib PY - 2021/3/3 TI - Effects of Information Architecture on the Effectiveness and User Experience of Web-Based Patient Education in Middle-Aged and Older Adults: Online Randomized Experiment JO - J Med Internet Res SP - e15846 VL - 23 IS - 3 KW - user-computer interface KW - total joint replacement KW - user-centered design KW - health education KW - mobile phone KW - computer-assisted instruction KW - patient education as topic KW - models, theoretical KW - middle aged KW - aged KW - humans KW - internet N2 - 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 (?=.18) were found to improve satisfaction (?=.17) indirectly. Increased perceptions of active control in the matrix IA (?=.11) also improved satisfaction (?=.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 (?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. UR - https://www.jmir.org/2021/3/e15846 UR - http://dx.doi.org/10.2196/15846 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656446 ID - info:doi/10.2196/15846 ER - TY - JOUR AU - Abrantes, Diogo AU - Teles, Soraia AU - Tavares de Sousa, Rita AU - Freitas, Alberto AU - Vieira-Marques, Pedro AU - Ferreira, Ana PY - 2021/3/1 TI - A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study JO - JMIR Aging SP - e18164 VL - 4 IS - 1 KW - aging KW - ambient assisted living KW - elderly KW - usability testing KW - user-centered design N2 - 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. UR - https://aging.jmir.org/2021/1/e18164 UR - http://dx.doi.org/10.2196/18164 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646134 ID - info:doi/10.2196/18164 ER - TY - JOUR AU - Kapoor, Alok AU - Andrade, Andreza AU - Hayes, Anna AU - Mazor, Kathleen AU - Possidente, Carl AU - Nolen, Kim AU - Hegeman-Dingle, Rozelle AU - McManus, David PY - 2021/2/24 TI - Usability, Perceived Usefulness, and Shared Decision-Making Features of the AFib 2gether Mobile App: Protocol for a Single-Arm Intervention Study JO - JMIR Res Protoc SP - e21986 VL - 10 IS - 2 KW - shared decision making KW - mobile health KW - stroke risk KW - anticoagulation risk KW - anticoagulation education KW - atrial fibrillation KW - anticoagulation therapy KW - anticoagulation KW - atrial flutter KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2021/2/e21986 UR - http://dx.doi.org/10.2196/21986 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625361 ID - info:doi/10.2196/21986 ER - TY - JOUR AU - Waselewski, Elise Marika AU - Flickinger, Elisabeth Tabor AU - Canan, Chelsea AU - Harrington, William AU - Franklin, Taylor AU - Otero, Nicole Kori AU - Huynh, Jacqueline AU - Waldman, Davila Ava Lena AU - Hilgart, Michelle AU - Ingersoll, Karen AU - Ait-Daoud Tiouririne, Nassima AU - Dillingham, Anne Rebecca PY - 2021/2/23 TI - A Mobile Health App to Support Patients Receiving Medication-Assisted Treatment for Opioid Use Disorder: Development and Feasibility Study JO - JMIR Form Res SP - e24561 VL - 5 IS - 2 KW - opioid use disorder KW - mHealth KW - retention in care KW - self-management KW - opioids KW - public health KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/2/e24561 UR - http://dx.doi.org/10.2196/24561 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620324 ID - info:doi/10.2196/24561 ER - TY - JOUR AU - Jung, Hyunggu AU - Demiris, George AU - Tarczy-Hornoch, Peter AU - Zachry, Mark PY - 2021/2/17 TI - A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study JO - JMIR Form Res SP - e14760 VL - 5 IS - 2 KW - mobile health KW - older adults KW - diabetes KW - dietary assessment KW - smartphone app KW - usability test N2 - 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. UR - http://formative.jmir.org/2021/2/e14760/ UR - http://dx.doi.org/10.2196/14760 UR - http://www.ncbi.nlm.nih.gov/pubmed/33493129 ID - info:doi/10.2196/14760 ER - TY - JOUR AU - Bierbooms, A. Joyce J. P. AU - Sluis-Thiescheffer, W. Wouter R. J. AU - Feijt, A. Milou AU - IJsselsteijn, A. Wijnand AU - Bongers, B. Inge M. PY - 2021/2/17 TI - Design of a Game-Based Training Environment to Enhance Health Care Professionals? E?Mental Health Skills: Protocol for a User Requirements Analysis JO - JMIR Res Protoc SP - e18815 VL - 10 IS - 2 KW - mental health KW - skill development KW - eHealth KW - games KW - user-centered design N2 - 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 UR - http://www.researchprotocols.org/2021/2/e18815/ UR - http://dx.doi.org/10.2196/18815 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595453 ID - info:doi/10.2196/18815 ER - TY - JOUR AU - Furlong, Lisa AU - Serry, Tanya AU - Erickson, Shane AU - Morris, E. Meg PY - 2021/2/11 TI - Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability JO - JMIR Res Protoc SP - e23921 VL - 10 IS - 2 KW - app KW - appraisal KW - characteristics KW - COVID-19 KW - health management KW - mHealth KW - mobile apps KW - phonics KW - phonological awareness KW - quality KW - reading KW - usability N2 - 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 UR - http://www.researchprotocols.org/2021/2/e23921/ UR - http://dx.doi.org/10.2196/23921 UR - http://www.ncbi.nlm.nih.gov/pubmed/33523827 ID - info:doi/10.2196/23921 ER - TY - JOUR AU - Bhalodiya, Maganbhai Jayendra AU - Palit, Arnab AU - Giblin, Gerard AU - Tiwari, Kumar Manoj AU - Prasad, K. Sanjay AU - Bhudia, K. Sunil AU - Arvanitis, N. Theodoros AU - Williams, A. Mark PY - 2021/2/10 TI - Identifying Myocardial Infarction Using Hierarchical Template Matching?Based Myocardial Strain: Algorithm Development and Usability Study JO - JMIR Med Inform SP - e22164 VL - 9 IS - 2 KW - left ventricle KW - myocardial infarction KW - myocardium KW - strain N2 - 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. UR - https://medinform.jmir.org/2021/2/e22164 UR - http://dx.doi.org/10.2196/22164 UR - http://www.ncbi.nlm.nih.gov/pubmed/33565992 ID - info:doi/10.2196/22164 ER - TY - JOUR AU - Hemmings, R. Nicola AU - Kawadler, M. Jamie AU - Whatmough, Rachel AU - Ponzo, Sonia AU - Rossi, Alessio AU - Morelli, Davide AU - Bird, Geoffrey AU - Plans, David PY - 2021/2/9 TI - Development and Feasibility of a Digital Acceptance and Commitment Therapy?Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study JO - JMIR Form Res SP - e21737 VL - 5 IS - 2 KW - anxiety KW - depression KW - acceptance and commitment therapy KW - person-based approach KW - mHealth KW - mental health KW - digital KW - remote KW - smartphone KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/2/e21737 UR - http://dx.doi.org/10.2196/21737 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560232 ID - info:doi/10.2196/21737 ER - TY - JOUR AU - Ndabu, Theophile AU - Mulgund, Pavankumar AU - Sharman, Raj AU - Singh, Ranjit PY - 2021/2/5 TI - Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study JO - JMIR Hum Factors SP - e21884 VL - 8 IS - 1 KW - patient safety KW - medical errors KW - health information technology KW - sociotechnical framework KW - patient harm N2 - 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. UR - http://humanfactors.jmir.org/2021/1/e21884/ UR - http://dx.doi.org/10.2196/21884 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544089 ID - info:doi/10.2196/21884 ER - TY - JOUR AU - Weaver, E. Kathryn AU - Klepin, D. Heidi AU - Wells, J. Brian AU - Dressler, V. Emily AU - Winkfield, M. Karen AU - Lamar, S. Zanetta AU - Avery, P. Tiffany AU - Pajewski, M. Nicholas AU - Hundley, Gregory W. AU - Johnson, Aimee AU - Davidson, C. Eleanor AU - Lopetegui, Marcelo AU - Foraker, E. Randi PY - 2021/1/21 TI - Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study JO - JMIR Cancer SP - e18396 VL - 7 IS - 1 KW - electronic health records KW - clinical decision support KW - usability testing KW - cardiovascular diseases KW - cancer survivors KW - breast cancer N2 - 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. UR - http://cancer.jmir.org/2021/1/e18396/ UR - http://dx.doi.org/10.2196/18396 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475511 ID - info:doi/10.2196/18396 ER - TY - JOUR AU - Yeong, Lee Jian AU - Thomas, Peter AU - Buller, James AU - Moosajee, Mariya PY - 2021/1/20 TI - A Newly Developed Web-Based Resource on Genetic Eye Disorders for Users With Visual Impairment (Gene.Vision): Usability Study JO - J Med Internet Res SP - e19151 VL - 23 IS - 1 KW - internet access KW - blindness KW - eye disease KW - genetic diseases KW - usability testing KW - qualitative research KW - internet-based intervention KW - consumer health information KW - mobile phone N2 - 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. UR - http://www.jmir.org/2021/1/e19151/ UR - http://dx.doi.org/10.2196/19151 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470932 ID - info:doi/10.2196/19151 ER - TY - JOUR AU - Coughlin, N. Lara AU - Nahum-Shani, Inbal AU - Philyaw-Kotov, L. Meredith AU - Bonar, E. Erin AU - Rabbi, Mashfiqui AU - Klasnja, Predrag AU - Murphy, Susan AU - Walton, A. Maureen PY - 2021/1/15 TI - Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study JO - JMIR Mhealth Uhealth SP - e24424 VL - 9 IS - 1 KW - mHealth KW - adolescents KW - young adults KW - just-in-time adaptive intervention KW - alcohol misuse KW - cannabis KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2021/1/e24424/ UR - http://dx.doi.org/10.2196/24424 UR - http://www.ncbi.nlm.nih.gov/pubmed/33448931 ID - info:doi/10.2196/24424 ER - TY - JOUR AU - Hawley-Hague, Helen AU - Tacconi, Carlo AU - Mellone, Sabato AU - Martinez, Ellen AU - Chiari, Lorenzo AU - Helbostad, Jorunn AU - Todd, Chris PY - 2021/1/12 TI - One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study JO - JMIR Rehabil Assist Technol SP - e19690 VL - 8 IS - 1 KW - aged KW - postural balance KW - telerehabilitation KW - patient compliance KW - accidental falls KW - mobile phone N2 - 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. UR - http://rehab.jmir.org/2021/1/e19690/ UR - http://dx.doi.org/10.2196/19690 UR - http://www.ncbi.nlm.nih.gov/pubmed/33433398 ID - info:doi/10.2196/19690 ER - TY - JOUR AU - van der Velde, Miriam AU - Valkenet, Karin AU - Geleijn, Edwin AU - Kruisselbrink, Marjoke AU - Marsman, Marije AU - Janssen, MJ Liedewij AU - Ruurda, P. Jelle AU - van der Peet, L. Donald AU - Aarden, J. Jesse AU - Veenhof, Cindy AU - van der Leeden, Marike PY - 2021/1/7 TI - Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e23402 VL - 9 IS - 1 KW - preoperative care KW - smartphone KW - mhealth KW - risk behavior KW - prehabilitation KW - usability N2 - 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 (?=?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 UR - http://mhealth.jmir.org/2021/1/e23402/ UR - http://dx.doi.org/10.2196/23402 UR - http://www.ncbi.nlm.nih.gov/pubmed/33410758 ID - info:doi/10.2196/23402 ER - TY - JOUR AU - Melnick, R. Edward AU - Harry, Elizabeth AU - Sinsky, A. Christine AU - Dyrbye, N. Liselotte AU - Wang, Hanhan AU - Trockel, Todd Mickey AU - West, P. Colin AU - Shanafelt, Tait PY - 2020/12/22 TI - Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis JO - J Med Internet Res SP - e23382 VL - 22 IS - 12 KW - electronic health record KW - EHR KW - usability KW - cognitive load KW - System Usability Scale KW - physician task load KW - NASA Task Load Index KW - physician KW - burnout KW - stress N2 - 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. UR - http://www.jmir.org/2020/12/e23382/ UR - http://dx.doi.org/10.2196/23382 UR - http://www.ncbi.nlm.nih.gov/pubmed/33289493 ID - info:doi/10.2196/23382 ER - TY - JOUR AU - Kim, Byeol AU - Loke, Yue-Hin AU - Mass, Paige AU - Irwin, R. Matthew AU - Capeland, Conrad AU - Olivieri, Laura AU - Krieger, Axel PY - 2020/12/8 TI - A Novel Virtual Reality Medical Image Display System for Group Discussions of Congenital Heart Disease: Development and Usability Testing JO - JMIR Cardio SP - e20633 VL - 4 IS - 1 KW - virtual reality KW - cardiac diagnostics KW - usability study KW - congenital heart disease KW - group collaboration N2 - 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 (?22=9.0, P=.01) displays. Differences between the display systems were more prominent with increasing case complexity (?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. UR - http://cardio.jmir.org/2020/1/e20633/ UR - http://dx.doi.org/10.2196/20633 UR - http://www.ncbi.nlm.nih.gov/pubmed/33289675 ID - info:doi/10.2196/20633 ER - TY - JOUR AU - Levinson, J. Anthony AU - Bousfield, John AU - Douglas, William AU - Ayers, Stephanie AU - Sztramko, Richard PY - 2020/12/4 TI - A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians JO - JMIR Hum Factors SP - e23904 VL - 7 IS - 4 KW - dementia KW - caregiver KW - education prescription KW - online education KW - internet KW - eHealth KW - knowledge translation KW - implementation science KW - scale and spread N2 - 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. UR - http://humanfactors.jmir.org/2020/4/e23904/ UR - http://dx.doi.org/10.2196/23904 UR - http://www.ncbi.nlm.nih.gov/pubmed/33275103 ID - info:doi/10.2196/23904 ER - TY - JOUR AU - Butler, Sonia AU - Sculley, Dean AU - Santos, Santos Derek AU - Fellas, Antoni AU - Gironès, Xavier AU - Singh-Grewal, Davinder AU - Coda, Andrea PY - 2020/12/1 TI - Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review JO - JMIR Pediatr Parent SP - e15833 VL - 3 IS - 2 KW - juvenile idiopathic arthritis KW - child KW - adolescence KW - eHealth KW - mHealth KW - systematic review KW - mobile phone KW - pain KW - physical activity KW - self-management KW - quality of life N2 - 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. UR - http://pediatrics.jmir.org/2020/2/e15833/ UR - http://dx.doi.org/10.2196/15833 UR - http://www.ncbi.nlm.nih.gov/pubmed/33258786 ID - info:doi/10.2196/15833 ER - TY - JOUR AU - Asbjørnsen, Aune Rikke AU - Wentzel, Jobke AU - Smedsrød, Lien Mirjam AU - Hjelmesæth, Jøran AU - Clark, M. Matthew AU - Solberg Nes, Lise AU - Van Gemert-Pijnen, C. Julia E. W. PY - 2020/11/30 TI - 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 JO - J Med Internet Res SP - e22598 VL - 22 IS - 11 KW - eHealth KW - weight loss maintenance KW - behavior change KW - design thinking KW - digital health interventions KW - persuasive technology KW - human-centered design N2 - 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 UR - http://www.jmir.org/2020/11/e22598/ UR - http://dx.doi.org/10.2196/22598 UR - http://www.ncbi.nlm.nih.gov/pubmed/33252347 ID - info:doi/10.2196/22598 ER - TY - JOUR AU - Kaihlanen, Anu-Marja AU - Gluschkoff, Kia AU - Hyppönen, Hannele AU - Kaipio, Johanna AU - Puttonen, Sampsa AU - Vehko, Tuulikki AU - Saranto, Kaija AU - Karhe, Liisa AU - Heponiemi, Tarja PY - 2020/11/18 TI - The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study JO - JMIR Med Inform SP - e23623 VL - 8 IS - 11 KW - electronic health records KW - usability KW - stress KW - cognitive failure KW - nurse N2 - 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 (?=.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 (?=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures (?=.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. UR - http://medinform.jmir.org/2020/11/e23623/ UR - http://dx.doi.org/10.2196/23623 UR - http://www.ncbi.nlm.nih.gov/pubmed/33206050 ID - info:doi/10.2196/23623 ER - TY - JOUR AU - Roosan, Don AU - Chok, Jay AU - Karim, Mazharul AU - Law, V. Anandi AU - Baskys, Andrius AU - Hwang, Angela AU - Roosan, R. Moom PY - 2020/11/9 TI - Artificial Intelligence?Powered Smartphone App to Facilitate Medication Adherence: Protocol for a Human Factors Design Study JO - JMIR Res Protoc SP - e21659 VL - 9 IS - 11 KW - artificial intelligence KW - smartphone app KW - patient cognition KW - complex medication information KW - medication adherence KW - machine learning KW - mobile phone N2 - 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 UR - http://www.researchprotocols.org/2020/11/e21659/ UR - http://dx.doi.org/10.2196/21659 UR - http://www.ncbi.nlm.nih.gov/pubmed/33164898 ID - info:doi/10.2196/21659 ER - TY - JOUR AU - Bonet, Lucia AU - Torous, John AU - Arce, David AU - Blanquer, Ignacio AU - Sanjuan, Julio PY - 2020/11/6 TI - ReMindCare App for Early Psychosis: Pragmatic Real World Intervention and Usability Study JO - JMIR Mhealth Uhealth SP - e22997 VL - 8 IS - 11 KW - app KW - clinical practice KW - mental health KW - psychosis KW - real-world intervention KW - telemedicine N2 - 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 (?2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (?2=7.4, P=.006) and fewer hospitalizations than TAU patients (?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 UR - https://mhealth.jmir.org/2020/11/e22997 UR - http://dx.doi.org/10.2196/22997 UR - http://www.ncbi.nlm.nih.gov/pubmed/33155986 ID - info:doi/10.2196/22997 ER - TY - JOUR AU - Bennett, Michael Kyle AU - Clary, Lynn Kelly AU - Smith, Cary Douglas AU - Lee, Ann Carol PY - 2020/11/5 TI - Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study JO - J Med Internet Res SP - e16632 VL - 22 IS - 11 KW - young adults KW - substance abuse KW - peer influence KW - mobile applications KW - mobile phone KW - community-based participatory research KW - crowdsourcing N2 - 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. UR - https://www.jmir.org/2020/11/e16632 UR - http://dx.doi.org/10.2196/16632 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151158 ID - info:doi/10.2196/16632 ER - TY - JOUR AU - Müssener, Ulrika AU - Thomas, Kristin AU - Linderoth, Catharina AU - Löf, Marie AU - Åsberg, Katarina AU - Henriksson, Pontus AU - Bendtsen, Marcus PY - 2020/10/29 TI - Development of an Intervention Targeting Multiple Health Behaviors Among High School Students: Participatory Design Study Using Heuristic Evaluation and Usability Testing JO - JMIR Mhealth Uhealth SP - e17999 VL - 8 IS - 10 KW - mHealth intervention KW - health behavior KW - high school students KW - participatory design KW - heuristic evaluation KW - usability testing KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2020/10/e17999/ UR - http://dx.doi.org/10.2196/17999 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118942 ID - info:doi/10.2196/17999 ER - TY - JOUR AU - Khowaja, Kamran AU - Al-Thani, Dena PY - 2020/10/28 TI - New Checklist for the Heuristic Evaluation of mHealth Apps (HE4EH): Development and Usability Study JO - JMIR Mhealth Uhealth SP - e20353 VL - 8 IS - 10 KW - mHealth KW - eHealth KW - heuristic evaluation KW - expert evaluation KW - self-monitoring KW - behavior change KW - design guidelines KW - framework N2 - 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. UR - http://mhealth.jmir.org/2020/10/e20353/ UR - http://dx.doi.org/10.2196/20353 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112252 ID - info:doi/10.2196/20353 ER - TY - JOUR AU - Alfonsi, E. Jeffrey AU - Choi, Y. Elizabeth E. AU - Arshad, Taha AU - Sammott, S. Stacie-Ann AU - Pais, Vanita AU - Nguyen, Cynthia AU - Maguire, R. Bryan AU - Stinson, N. Jennifer AU - Palmert, R. Mark PY - 2020/10/28 TI - Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial JO - JMIR Mhealth Uhealth SP - e22074 VL - 8 IS - 10 KW - carbohydrate counting KW - type 1 diabetes KW - image recognition KW - youth KW - digital health applications (apps) KW - mHealth N2 - 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 UR - http://mhealth.jmir.org/2020/10/e22074/ UR - http://dx.doi.org/10.2196/22074 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112249 ID - info:doi/10.2196/22074 ER - TY - JOUR AU - Bostrøm, Katrine AU - Børøsund, Elin AU - Varsi, Cecilie AU - Eide, Hilde AU - Flakk Nordang, Elise AU - Schreurs, MG Karlein AU - Waxenberg, B. Lori AU - Weiss, E. Karen AU - Morrison, J. Eleshia AU - Cvancarova Småstuen, Milada AU - Stubhaug, Audun AU - Solberg Nes, Lise PY - 2020/10/23 TI - Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study JO - JMIR Form Res SP - e23893 VL - 4 IS - 10 KW - chronic pain KW - feasibility KW - acceptability KW - self-management KW - eHealth KW - digital KW - cognitive-behavioral pain KW - usability KW - user centered N2 - 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 UR - http://formative.jmir.org/2020/10/e23893/ UR - http://dx.doi.org/10.2196/23893 UR - http://www.ncbi.nlm.nih.gov/pubmed/33094734 ID - info:doi/10.2196/23893 ER - TY - JOUR AU - Senathirajah, Yalini AU - Kaufman, R. David AU - Cato, D. Kenrick AU - Borycki, M. Elizabeth AU - Fawcett, Allen Jaime AU - Kushniruk, W. Andre PY - 2020/10/21 TI - Characterizing and Visualizing Display and Task Fragmentation in the Electronic Health Record: Mixed Methods Design JO - JMIR Hum Factors SP - e18484 VL - 7 IS - 4 KW - electronic health record KW - electronic medical record KW - medical informatics KW - information technology KW - data visualization KW - user computer interface N2 - 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. UR - https://humanfactors.jmir.org/2020/4/e18484 UR - http://dx.doi.org/10.2196/18484 UR - http://www.ncbi.nlm.nih.gov/pubmed/33084580 ID - info:doi/10.2196/18484 ER - TY - JOUR AU - Lattie, Emily AU - Cohen, A. Katherine AU - Winquist, Nathan AU - Mohr, C. David PY - 2020/10/10 TI - Examining an App-Based Mental Health Self-Care Program, IntelliCare for College Students: Single-Arm Pilot Study JO - JMIR Ment Health SP - e21075 VL - 7 IS - 10 KW - mHealth KW - college students KW - depression KW - anxiety KW - mobile phone N2 - 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 UR - http://mental.jmir.org/2020/10/e21075/ UR - http://dx.doi.org/10.2196/21075 UR - http://www.ncbi.nlm.nih.gov/pubmed/33037874 ID - info:doi/10.2196/21075 ER - TY - JOUR AU - Widnall, Emily AU - Grant, Ellen Claire AU - Wang, Tao AU - Cross, Lauren AU - Velupillai, Sumithra AU - Roberts, Angus AU - Stewart, Robert AU - Simonoff, Emily AU - Downs, Johnny PY - 2020/10/10 TI - User Perspectives of Mood-Monitoring Apps Available to Young People: Qualitative Content Analysis JO - JMIR Mhealth Uhealth SP - e18140 VL - 8 IS - 10 KW - mood monitoring KW - engagement KW - mobile applications KW - mHealth KW - mental health KW - smartphone KW - qualitative research KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2020/10/e18140/ UR - http://dx.doi.org/10.2196/18140 UR - http://www.ncbi.nlm.nih.gov/pubmed/33037875 ID - info:doi/10.2196/18140 ER - TY - JOUR AU - Green, P. Eric AU - Lai, Yihuan AU - Pearson, Nicholas AU - Rajasekharan, Sathyanath AU - Rauws, Michiel AU - Joerin, Angela AU - Kwobah, Edith AU - Musyimi, Christine AU - Jones, M. Rachel AU - Bhat, Chaya AU - Mulinge, Antonia AU - Puffer, S. Eve PY - 2020/10/5 TI - Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study JO - JMIR Form Res SP - e17895 VL - 4 IS - 10 KW - telemedicine KW - mental health KW - depression KW - artificial intelligence KW - Kenya KW - text messaging KW - mobile phone N2 - 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 UR - https://formative.jmir.org/2020/10/e17895 UR - http://dx.doi.org/10.2196/17895 UR - http://www.ncbi.nlm.nih.gov/pubmed/33016883 ID - info:doi/10.2196/17895 ER - TY - JOUR AU - Liu, Boxiang AU - Liu, Kaibo AU - Zhang, He AU - Zhang, Liang AU - Bian, Yuchen AU - Huang, Liang PY - 2020/10/2 TI - CoV-Seq, a New Tool for SARS-CoV-2 Genome Analysis and Visualization: Development and Usability Study JO - J Med Internet Res SP - e22299 VL - 22 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - bioinformatics KW - genetics KW - genome KW - virus KW - sequence KW - data sets KW - programming KW - web server N2 - 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. UR - https://www.jmir.org/2020/10/e22299 UR - http://dx.doi.org/10.2196/22299 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931441 ID - info:doi/10.2196/22299 ER - TY - JOUR AU - Liu, Ying-Chieh AU - Chen, Chien-Hung AU - Lin, Yu-Sheng AU - Chen, Hsin-Yun AU - Irianti, Denisa AU - Jen, Ting-Ni AU - Yeh, Jou-Yin AU - Chiu, Yueh-Hsia Sherry PY - 2020/9/28 TI - Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e20317 VL - 8 IS - 9 KW - voice-added design KW - food report KW - elderly KW - usability evaluation KW - automatic speech recognition KW - mHealth KW - randomized trial N2 - 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. UR - http://mhealth.jmir.org/2020/9/e20317/ UR - http://dx.doi.org/10.2196/20317 UR - http://www.ncbi.nlm.nih.gov/pubmed/32985999 ID - info:doi/10.2196/20317 ER - TY - JOUR AU - Bruen, Jane Ashley AU - Wall, Abbie AU - Haines-Delmont, Alina AU - Perkins, Elizabeth PY - 2020/9/28 TI - 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 JO - JMIR Ment Health SP - e18407 VL - 7 IS - 9 KW - mobile applications KW - smartphone KW - mobile phone KW - mHealth KW - mental health KW - suicide KW - social media N2 - 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. UR - http://mental.jmir.org/2020/9/e18407/ UR - http://dx.doi.org/10.2196/18407 UR - http://www.ncbi.nlm.nih.gov/pubmed/32985995 ID - info:doi/10.2196/18407 ER - TY - JOUR AU - Novak, Lovett Laurie AU - Simpson, L. Christopher AU - Coco, Joseph AU - McNaughton, D. Candace AU - Ehrenfeld, M. Jesse AU - Bloos, M. Sean AU - Fabbri, Daniel PY - 2020/9/25 TI - 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 JO - J Med Internet Res SP - e17978 VL - 22 IS - 9 KW - trauma handoffs KW - military field medicine KW - documentation KW - trauma KW - health records KW - hospital KW - emergency N2 - 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. UR - http://www.jmir.org/2020/9/e17978/ UR - http://dx.doi.org/10.2196/17978 UR - http://www.ncbi.nlm.nih.gov/pubmed/32975522 ID - info:doi/10.2196/17978 ER - TY - JOUR AU - Siedlikowski, Maia AU - Rauch, Frank AU - Tsimicalis, Argerie PY - 2020/9/22 TI - Giving Children With Osteogenesis Imperfecta a Voice: Participatory Approach for the Development of the Interactive Assessment and Communication Tool Sisom OI JO - J Med Internet Res SP - e17947 VL - 22 IS - 9 KW - child health KW - symptom assessment, communication, mobile apps, software N2 - 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. UR - http://www.jmir.org/2020/9/e17947/ UR - http://dx.doi.org/10.2196/17947 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960176 ID - info:doi/10.2196/17947 ER - TY - JOUR AU - Ryan, Ann Kelly AU - Babu, Pallavi AU - Easter, Rebecca AU - Saunders, Erika AU - Lee, Jinseok Andy AU - Klasnja, Predrag AU - Verchinina, Lilia AU - Micol, Valerie AU - Doil, Brent AU - McInnis, G. Melvin AU - Kilbourne, M. Amy PY - 2020/9/22 TI - A Smartphone App to Monitor Mood Symptoms in Bipolar Disorder: Development and Usability Study JO - JMIR Ment Health SP - e19476 VL - 7 IS - 9 KW - bipolar disorder KW - momentary assessment KW - mood KW - mobile phone KW - mobile app N2 - 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 (?=?.02; P=.04), and an increase in impulsivity self-ratings was related to a decrease in total call duration (?=?.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. UR - http://mental.jmir.org/2020/9/e19476/ UR - http://dx.doi.org/10.2196/19476 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960185 ID - info:doi/10.2196/19476 ER - TY - JOUR AU - Chaniaud, Noémie AU - Métayer, Natacha AU - Megalakaki, Olga AU - Loup-Escande, Emilie PY - 2020/9/21 TI - Effect of Prior Health Knowledge on the Usability of Two Home Medical Devices: Usability Study JO - JMIR Mhealth Uhealth SP - e17983 VL - 8 IS - 9 KW - usability KW - prior health knowledge KW - mHealth KW - home medical devices KW - blood pressure monitor KW - pulse oximeter N2 - 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 (?²2,146=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. UR - http://mhealth.jmir.org/2020/9/e17983/ UR - http://dx.doi.org/10.2196/17983 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955454 ID - info:doi/10.2196/17983 ER - TY - JOUR AU - Seppen, F. Bart AU - Wiegel, Jimmy AU - L'ami, J. Merel AU - Duarte dos Santos Rico, Sharon AU - Catarinella, S. Fabio AU - Turkstra, Franktien AU - Boers, Maarten AU - Bos, H. Wouter PY - 2020/9/21 TI - Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies JO - JMIR Form Res SP - e20165 VL - 4 IS - 9 KW - mHealth KW - eHealth KW - patient-reported outcome, smartphone app KW - rheumatoid arthritis KW - self-monitoring KW - telemonitoring KW - mobile phone N2 - 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. UR - http://formative.jmir.org/2020/9/e20165/ UR - http://dx.doi.org/10.2196/20165 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955447 ID - info:doi/10.2196/20165 ER - TY - JOUR AU - Lattie, G. Emily AU - Bass, Michael AU - Garcia, F. Sofia AU - Phillips, M. Siobhan AU - Moreno, I. Patricia AU - Flores, Marie Ann AU - Smith, JD AU - Scholtens, Denise AU - Barnard, Cynthia AU - Penedo, J. Frank AU - Cella, David AU - Yanez, Betina PY - 2020/9/21 TI - Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation JO - JMIR Form Res SP - e18412 VL - 4 IS - 9 KW - cancer survivorship KW - eHealth KW - patient-reported outcomes KW - digital health KW - symptom management KW - supportive care N2 - 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. UR - http://formative.jmir.org/2020/9/e18412/ UR - http://dx.doi.org/10.2196/18412 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955450 ID - info:doi/10.2196/18412 ER - TY - JOUR AU - Geerds, J. Merle A. AU - Nijmeijer, S. Wieke AU - Hegeman, H. J. AU - Vollenbroek-Hutten, R. Miriam M. PY - 2020/9/14 TI - Mobile App for Monitoring 3-Month Postoperative Functional Outcome After Hip Fracture: Usability Study JO - JMIR Hum Factors SP - e16989 VL - 7 IS - 3 KW - hip fracture KW - remote monitoring KW - elderly KW - telemedicine KW - orthogeriatric KW - mHealth KW - app N2 - 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. UR - https://humanfactors.jmir.org/2020/3/e16989 UR - http://dx.doi.org/10.2196/16989 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924949 ID - info:doi/10.2196/16989 ER - TY - JOUR AU - Prinsenberg, Tamara AU - Zantkuijl, Paul AU - Zuilhof, Wim AU - Davidovich, Udi AU - Schinkel, Janke AU - Prins, Maria AU - van der Valk, Marc PY - 2020/9/11 TI - 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 JO - JMIR Form Res SP - e19100 VL - 4 IS - 9 KW - co-creation KW - mHealth KW - intervention KW - hepatitis C KW - prevention KW - risk reduction KW - MSM KW - HCV N2 - 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. UR - http://formative.jmir.org/2020/9/e19100/ UR - http://dx.doi.org/10.2196/19100 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915157 ID - info:doi/10.2196/19100 ER - TY - JOUR AU - Moon, Youngjin AU - Oh, Jeongmin AU - Hyun, Jaeho AU - Kim, Youngkyu AU - Choi, Jaesoon AU - Namgoong, Jeongman AU - Kim, Ki Jun PY - 2020/9/10 TI - Cost-Effective Smartphone-Based Articulable Endoscope Systems for Developing Countries: Instrument Validation Study JO - JMIR Mhealth Uhealth SP - e17057 VL - 8 IS - 9 KW - smartphone-based endoscope KW - mobile health KW - low-resource settings KW - continuum body KW - articulable endoscope KW - low-cost medical device KW - point of care diagnostics N2 - 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 × 720 pixels) of the device was found to be acceptable for medical diagnosis. The maximum bending angle of 110° 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°, for a curvature of 0.013. The finest articulation resolution was 8.9°. 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 × 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. UR - http://mhealth.jmir.org/2020/9/e17057/ UR - http://dx.doi.org/10.2196/17057 UR - http://www.ncbi.nlm.nih.gov/pubmed/32909951 ID - info:doi/10.2196/17057 ER - TY - JOUR AU - Nordstoga, Lovise Anne AU - Bach, Kerstin AU - Sani, Sadiq AU - Wiratunga, Nirmalie AU - Mork, Jarle Paul AU - Villumsen, Morten AU - Cooper, Kay PY - 2020/9/9 TI - Usability and Acceptability of an App (SELFBACK) to Support Self-Management of Low Back Pain: Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e18729 VL - 7 IS - 2 KW - low back pain KW - self-management KW - physical activity KW - exercise KW - patient education KW - smartphone KW - mHealth KW - eHealth KW - digital health KW - case-based reasoning N2 - 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. UR - http://rehab.jmir.org/2020/2/e18729/ UR - http://dx.doi.org/10.2196/18729 UR - http://www.ncbi.nlm.nih.gov/pubmed/32902393 ID - info:doi/10.2196/18729 ER - TY - JOUR AU - Said, Sadiq AU - Gozdzik, Malgorzata AU - Roche, Raoul Tadzio AU - Braun, Julia AU - Rössler, Julian AU - Kaserer, Alexander AU - Spahn, R. Donat AU - Nöthiger, B. Christoph AU - Tscholl, Werner David PY - 2020/9/7 TI - 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 JO - J Med Internet Res SP - e19472 VL - 22 IS - 9 KW - workload KW - questionnaires KW - National Aeronautics and Space Administration Task Load Index KW - awareness KW - situation awareness KW - patient monitoring KW - thromboelastometry N2 - 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. UR - http://www.jmir.org/2020/9/e19472/ UR - http://dx.doi.org/10.2196/19472 UR - http://www.ncbi.nlm.nih.gov/pubmed/32780712 ID - info:doi/10.2196/19472 ER - TY - JOUR AU - Guhl, Emily AU - Althouse, D. Andrew AU - Pusateri, M. Alexandra AU - Kimani, Everlyne AU - Paasche-Orlow, K. Michael AU - Bickmore, W. Timothy AU - Magnani, W. Jared PY - 2020/9/4 TI - The Atrial Fibrillation Health Literacy Information Technology Trial: Pilot Trial of a Mobile Health App for Atrial Fibrillation JO - JMIR Cardio SP - e17162 VL - 4 IS - 1 KW - atrial fibrillation KW - health-related quality of life KW - medication adherence KW - health literacy KW - mobile phone N2 - 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. UR - http://cardio.jmir.org/2020/1/e17162/ UR - http://dx.doi.org/10.2196/17162 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886070 ID - info:doi/10.2196/17162 ER - TY - JOUR AU - Vila-Blanco, Nicolás AU - Freire, Vicente AU - Balsa-Castro, Carlos AU - Tomás, Inmaculada AU - Carreira, J. María PY - 2020/9/3 TI - DenTiUS Plaque, a Web-Based Application for the Quantification of Bacterial Plaque: Development and Usability Study JO - J Med Internet Res SP - e18570 VL - 22 IS - 9 KW - computer-aided diagnoses KW - computer-based biomedical applications KW - dental health KW - dental plaque quantification KW - web-based tools KW - medical informatics N2 - 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. UR - https://www.jmir.org/2020/9/e18570 UR - http://dx.doi.org/10.2196/18570 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663148 ID - info:doi/10.2196/18570 ER - TY - JOUR AU - Liao, Chien-Hung AU - Wu, Yu-Tung AU - Cheng, Chi-Tung AU - Ooyang, Chun-Hsiang AU - Kang, Shih-Ching AU - Fu, Chih-Yuan AU - Hsu, Yu-Pao AU - Hsieh, Chi-Hsun AU - Chen, Chih-Chi PY - 2020/8/28 TI - An Image-Based Mobile Health App for Postdrainage Monitoring: Usability Study JO - J Med Internet Res SP - e17686 VL - 22 IS - 8 KW - telemedicine KW - smartphone KW - surgical drainage KW - postdrainage care, mHealth N2 - 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. UR - http://www.jmir.org/2020/8/e17686/ UR - http://dx.doi.org/10.2196/17686 UR - http://www.ncbi.nlm.nih.gov/pubmed/32857060 ID - info:doi/10.2196/17686 ER - TY - JOUR AU - Patel, Devika AU - Sarlati, Siavash AU - Martin-Tuite, Patrick AU - Feler, Joshua AU - Chehab, Lara AU - Texada, Michael AU - Marquez, Ruben AU - Orellana, Julia F. AU - Henderson, L. Terrell AU - Nwabuo, Adaobi AU - Plevin, Rebecca AU - Dicker, Ami Rochelle AU - Juillard, Catherine AU - Sammann, Amanda PY - 2020/8/24 TI - Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study JO - JMIR Mhealth Uhealth SP - e15866 VL - 8 IS - 8 KW - human-centered design KW - violence intervention KW - information and communications technology N2 - 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. UR - http://mhealth.jmir.org/2020/8/e15866/ UR - http://dx.doi.org/10.2196/15866 UR - http://www.ncbi.nlm.nih.gov/pubmed/32831179 ID - info:doi/10.2196/15866 ER - TY - JOUR AU - Schüttler, Christina AU - Huth, Verena AU - von Jagwitz-Biegnitz, Magdaléna AU - Lablans, Martin AU - Prokosch, Hans-Ulrich AU - Griebel, Lena PY - 2020/8/18 TI - A Federated Online Search Tool for Biospecimens (Sample Locator): Usability Study JO - J Med Internet Res SP - e17739 VL - 22 IS - 8 KW - software tools KW - biological specimen banks KW - user interface KW - evaluation KW - research N2 - 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. UR - http://www.jmir.org/2020/8/e17739/ UR - http://dx.doi.org/10.2196/17739 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663150 ID - info:doi/10.2196/17739 ER - TY - JOUR AU - Lopez, Cristina AU - Gilmore, K. Amanda AU - Moreland, Angela AU - Danielson, Kmett Carla AU - Acierno, Ron PY - 2020/8/11 TI - Meeting Kids Where They Are At?A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study JO - J Med Internet Res SP - e16725 VL - 22 IS - 8 KW - adolescents KW - substance use KW - sexual risk reduction KW - telehealth KW - prevention programs KW - mobile phone N2 - 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. UR - http://www.jmir.org/2020/8/e16725/ UR - http://dx.doi.org/10.2196/16725 UR - http://www.ncbi.nlm.nih.gov/pubmed/32780022 ID - info:doi/10.2196/16725 ER - TY - JOUR AU - Guay, Manon AU - Latulippe, Karine AU - Auger, Claudine AU - Giroux, Dominique AU - Séguin-Tremblay, Noémie AU - Gauthier, Josée AU - Genest, Catherine AU - Morales, Ernesto AU - Vincent, Claude PY - 2020/8/10 TI - Self-Selection of Bathroom-Assistive Technology: Development of an Electronic Decision Support System (Hygiene 2.0) JO - J Med Internet Res SP - e16175 VL - 22 IS - 8 KW - hygiene KW - activities of daily living KW - decision aids KW - occupational therapy KW - aging KW - self-help devices KW - universal design KW - accidental falls KW - mobile phone N2 - 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. UR - https://www.jmir.org/2020/8/e16175 UR - http://dx.doi.org/10.2196/16175 UR - http://www.ncbi.nlm.nih.gov/pubmed/32773380 ID - info:doi/10.2196/16175 ER - TY - JOUR AU - Petersen, Lee Curtis AU - Halter, Ryan AU - Kotz, David AU - Loeb, Lorie AU - Cook, Summer AU - Pidgeon, Dawna AU - Christensen, C. Brock AU - Batsis, A. John PY - 2020/8/7 TI - Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16862 VL - 8 IS - 8 KW - aged adults KW - sarcopenia KW - remote sensing technology KW - telemedicine KW - mobile phone N2 - 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. UR - https://mhealth.jmir.org/2020/8/e16862 UR - http://dx.doi.org/10.2196/16862 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540843 ID - info:doi/10.2196/16862 ER - TY - JOUR AU - Krzyzanowski, C. Michelle AU - Kizakevich, N. Paul AU - Duren-Winfield, Vanessa AU - Eckhoff, Randall AU - Hampton, Joel AU - Blackman Carr, T. Loneke AU - McCauley, Georgia AU - Roberson, B. Kristina AU - Onsomu, O. Elijah AU - Williams, John AU - Price, Alise Amanda PY - 2020/8/5 TI - 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 JO - JMIR Mhealth Uhealth SP - e15156 VL - 8 IS - 8 KW - exercise KW - cardiovascular disease KW - diary KW - diet KW - mHealth KW - mobile phone N2 - 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. UR - https://mhealth.jmir.org/2020/8/e15156 UR - http://dx.doi.org/10.2196/15156 UR - http://www.ncbi.nlm.nih.gov/pubmed/32755883 ID - info:doi/10.2196/15156 ER - TY - JOUR AU - King, D'Arcy AU - Khan, Sundas AU - Polo, Jennifer AU - Solomon, Jeffrey AU - Pekmezaris, Renee AU - Hajizadeh, Negin PY - 2020/8/4 TI - Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study JO - JMIR Rehabil Assist Technol SP - e16004 VL - 7 IS - 2 KW - chronic obstructive pulmonary disease KW - usability testing KW - telehealth KW - telerehabilitation KW - vulnerable populations N2 - 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. UR - http://rehab.jmir.org/2020/2/e16004/ UR - http://dx.doi.org/10.2196/16004 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749229 ID - info:doi/10.2196/16004 ER - TY - JOUR AU - Johnson, Grødem Susanne AU - Potrebny, Thomas AU - Larun, Lillebeth AU - Ciliska, Donna AU - Olsen, Rydland Nina PY - 2020/8/4 TI - Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e19072 VL - 9 IS - 8 KW - user-computer interface KW - mobile app KW - online learning KW - health education KW - students N2 - 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 UR - https://www.researchprotocols.org/2020/8/e19072 UR - http://dx.doi.org/10.2196/19072 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750011 ID - info:doi/10.2196/19072 ER - TY - JOUR AU - Giunti, Guido AU - Rivera-Romero, Octavio AU - Kool, Jan AU - Bansi, Jens AU - Sevillano, Luis Jose AU - Granja-Dominguez, Anabel AU - Izquierdo-Ayuso, Guillermo AU - Giunta, Diego PY - 2020/8/4 TI - Evaluation of More Stamina, a Mobile App for Fatigue Management in Persons with Multiple Sclerosis: Protocol for a Feasibility, Acceptability, and Usability Study JO - JMIR Res Protoc SP - e18196 VL - 9 IS - 8 KW - multiple sclerosis KW - mHealth KW - fatigue KW - fatigue management KW - apps KW - gamification KW - user-centered design KW - usability, physical activity KW - eHealth KW - chronic conditions N2 - 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 UR - https://www.researchprotocols.org/2020/8/e18196 UR - http://dx.doi.org/10.2196/18196 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749995 ID - info:doi/10.2196/18196 ER - TY - JOUR AU - Guo, Xujun AU - Yang, Yarui AU - Takiff, E. Howard AU - Zhu, Minmin AU - Ma, Jianping AU - Zhong, Tao AU - Fan, Yuzheng AU - Wang, Jian AU - Liu, Shengyuan PY - 2020/7/31 TI - A Comprehensive App That Improves Tuberculosis Treatment Management Through Video-Observed Therapy: Usability Study JO - JMIR Mhealth Uhealth SP - e17658 VL - 8 IS - 7 KW - tuberculosis KW - management KW - video-observed therapy KW - directly observed therapy KW - mobile phone N2 - 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 (¥53 [US $7.57] vs ¥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. UR - https://mhealth.jmir.org/2020/7/e17658 UR - http://dx.doi.org/10.2196/17658 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735222 ID - info:doi/10.2196/17658 ER - TY - JOUR AU - O'Grady, Conor AU - Melia, Ruth AU - Bogue, John AU - O'Sullivan, Mary AU - Young, Karen AU - Duggan, Jim PY - 2020/7/30 TI - A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) JO - J Med Internet Res SP - e17481 VL - 22 IS - 7 KW - mobile apps KW - suicide KW - mHealth N2 - 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. UR - http://www.jmir.org/2020/7/e17481/ UR - http://dx.doi.org/10.2196/17481 UR - http://www.ncbi.nlm.nih.gov/pubmed/32729845 ID - info:doi/10.2196/17481 ER - TY - JOUR AU - Arevian, C. Armen AU - O'Hora, Jennifer AU - Rosser, James AU - Mango, D. Joseph AU - Miklowitz, J. David AU - Wells, B. Kenneth PY - 2020/7/29 TI - Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study JO - JMIR Mhealth Uhealth SP - e12655 VL - 8 IS - 7 KW - mobile health KW - community-based participatory research KW - app development KW - technology platforms KW - personalized medicine KW - behavioral health KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2020/7/e12655/ UR - http://dx.doi.org/10.2196/12655 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723714 ID - info:doi/10.2196/12655 ER - TY - JOUR AU - Dimaguila, Luis Gerardo AU - Gray, Kathleen AU - Merolli, Mark PY - 2020/7/28 TI - Enabling Better Use of Person-Generated Health Data in Stroke Rehabilitation Systems: Systematic Development of Design Heuristics JO - J Med Internet Res SP - e17132 VL - 22 IS - 7 KW - person-generated health data KW - patient-reported outcome measures KW - heuristics KW - stroke rehabilitation KW - consumer health informatics KW - evidence-based practice KW - information technology N2 - 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. UR - http://www.jmir.org/2020/7/e17132/ UR - http://dx.doi.org/10.2196/17132 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720901 ID - info:doi/10.2196/17132 ER - TY - JOUR AU - Park, Kyung Bu AU - Kim, Yoon Ji AU - Rogers, E. Valerie PY - 2020/7/28 TI - Development and Usability Evaluation of a Facebook-Based Intervention Program for Childhood Cancer Patients: Mixed Methods Study JO - J Med Internet Res SP - e18779 VL - 22 IS - 7 KW - pediatric cancer patients KW - childhood cancer KW - social network site KW - Facebook KW - usability N2 - 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. UR - http://www.jmir.org/2020/7/e18779/ UR - http://dx.doi.org/10.2196/18779 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720897 ID - info:doi/10.2196/18779 ER - TY - JOUR AU - Rael, Tagliaferri Christine AU - Lentz, Cody AU - Carballo-Diéguez, Alex AU - Giguere, Rebecca AU - Dolezal, Curtis AU - Feller, Daniel AU - D'Aquila, T. Richard AU - Hope, J. Thomas PY - 2020/7/27 TI - Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study JO - J Med Internet Res SP - e16904 VL - 22 IS - 7 KW - PrEP implant KW - YouTube KW - acceptability KW - long-acting PrEP KW - systemic PrEP KW - human-centered design KW - HIV prevention KW - removable implant KW - long-acting HIV prevention KW - gay and bisexual men N2 - 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. UR - https://www.jmir.org/2020/7/e16904 UR - http://dx.doi.org/10.2196/16904 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348277 ID - info:doi/10.2196/16904 ER - TY - JOUR AU - Kim, HyangHee AU - Lee, Sang-Ho AU - Cho, Nam-Bin AU - You, Heecheon AU - Choi, Teukgyu AU - Kim, Jinwon PY - 2020/7/27 TI - User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study JO - JMIR Mhealth Uhealth SP - e19585 VL - 8 IS - 7 KW - older adults KW - dysphagia KW - swallowing KW - mHealth KW - thematic analysis KW - usability KW - apps KW - education KW - experience KW - sociodemographic N2 - 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. UR - http://mhealth.jmir.org/2020/7/e19585/ UR - http://dx.doi.org/10.2196/19585 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663161 ID - info:doi/10.2196/19585 ER - TY - JOUR AU - Doma?ska, Barbara AU - Vansant, Stijn AU - Mountian, Irina PY - 2020/7/27 TI - A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study JO - JMIR Form Res SP - e17373 VL - 4 IS - 7 KW - rheumatology KW - internet KW - digital health KW - mobile health KW - mHealth KW - smartphone KW - mobile phone KW - validation human factors study N2 - 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. UR - http://formative.jmir.org/2020/7/e17373/ UR - http://dx.doi.org/10.2196/17373 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716310 ID - info:doi/10.2196/17373 ER - TY - JOUR AU - Mehra, Sumit AU - van den Helder, Jantine AU - Visser, Bart AU - Engelbert, H. Raoul H. AU - Weijs, M. Peter J. AU - Kröse, A. Ben J. PY - 2020/7/23 TI - Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study JO - J Med Internet Res SP - e16380 VL - 22 IS - 7 KW - frail elderly KW - aged KW - activities of daily living KW - exercise KW - health behavior KW - telemedicine KW - mobile devices KW - tablet computers KW - usability testing KW - evaluation N2 - 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. UR - http://www.jmir.org/2020/7/e16380/ UR - http://dx.doi.org/10.2196/16380 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459652 ID - info:doi/10.2196/16380 ER - TY - JOUR AU - Langan, Jeanne AU - Bhattacharjya, Sutanuka AU - Subryan, Heamchand AU - Xu, Wenyao AU - Chen, Baicheng AU - Li, Zhengxiong AU - Cavuoto, Lora PY - 2020/7/22 TI - In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study JO - JMIR Mhealth Uhealth SP - e19582 VL - 8 IS - 7 KW - stroke KW - rehabilitation KW - smart technology KW - 3D printing KW - usability N2 - 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 UR - http://mhealth.jmir.org/2020/7/e19582/ UR - http://dx.doi.org/10.2196/19582 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706702 ID - info:doi/10.2196/19582 ER - TY - JOUR AU - Garvelink, Marjolein Mirjam AU - Agbadjé, Tatiana Titilayo AU - Freitas, Adriana AU - Bergeron, Lysa AU - Petitjean, Thomas AU - Dugas, Michèle AU - Blair, Louisa AU - Archambault, Patrick AU - Roy, Noémie AU - Jones, Allyson AU - Légaré, France PY - 2020/7/22 TI - Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study JO - JMIR Mhealth Uhealth SP - e16979 VL - 8 IS - 7 KW - internet-based intervention KW - frail elderly KW - caregivers KW - decision making KW - personal autonomy KW - housing for the elderly N2 - 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. UR - https://mhealth.jmir.org/2020/7/e16979 UR - http://dx.doi.org/10.2196/16979 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412908 ID - info:doi/10.2196/16979 ER - TY - JOUR AU - Meinert, Edward AU - Rahman, Em AU - Potter, Alison AU - Lawrence, Wendy AU - Van Velthoven, Michelle PY - 2020/7/22 TI - Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e18068 VL - 9 IS - 7 KW - mHealth KW - mobile health KW - digital health KW - digital technology KW - weight loss KW - obesity KW - overweight KW - child health KW - cell phone KW - telecommunication N2 - 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 UR - http://www.researchprotocols.org/2020/7/e18068/ UR - http://dx.doi.org/10.2196/18068 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706703 ID - info:doi/10.2196/18068 ER - TY - JOUR AU - Cornet, Philip Victor AU - Toscos, Tammy AU - Bolchini, Davide AU - Rohani Ghahari, Romisa AU - Ahmed, Ryan AU - Daley, Carly AU - Mirro, J. Michael AU - Holden, J. Richard PY - 2020/7/21 TI - 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 JO - JMIR Mhealth Uhealth SP - e17703 VL - 8 IS - 7 KW - user-centered design KW - research methods KW - mobile health KW - digital health KW - mobile apps KW - usability KW - technology KW - evaluation KW - human-computer interaction KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2020/7/e17703/ UR - http://dx.doi.org/10.2196/17703 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706745 ID - info:doi/10.2196/17703 ER - TY - JOUR AU - Hsiao, Po-Jen AU - Chiu, Chih-Chien AU - Lin, Ke-Hsin AU - Hu, Fu-Kang AU - Tsai, Pei-Jan AU - Wu, Chun-Ting AU - Pang, Yuan-Kai AU - Lin, Yu AU - Kuo, Ming-Hao AU - Chen, Kang-Hua AU - Wu, Yi-Syuan AU - Wu, Hao-Yi AU - Chang, Ya-Ting AU - Chang, Yu-Tien AU - Cheng, Chia-Shiang AU - Chuu, Chih-Pin AU - Lin, Fu-Huang AU - Chang, Chi-Wen AU - Li, Yuan-Kuei AU - Chan, Jenq-Shyong AU - Chu, Chi-Ming PY - 2020/7/21 TI - Usability of Wearable Devices With a Novel Cardiac Force Index for Estimating the Dynamic Cardiac Function: Observational Study JO - JMIR Mhealth Uhealth SP - e15331 VL - 8 IS - 7 KW - cardiac force KW - running KW - acceleration KW - physical activity KW - heart rate N2 - 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 × [waist circumference] ? 1.827 × [smoke] + 0.020 × [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. UR - https://mhealth.jmir.org/2020/7/e15331 UR - http://dx.doi.org/10.2196/15331 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706725 ID - info:doi/10.2196/15331 ER - TY - JOUR AU - van Haasteren, Afua AU - Vayena, Effy AU - Powell, John PY - 2020/7/21 TI - The Mobile Health App Trustworthiness Checklist: Usability Assessment JO - JMIR Mhealth Uhealth SP - e16844 VL - 8 IS - 7 KW - checklist KW - trustworthiness KW - trust KW - mobile health apps KW - validation KW - survey N2 - 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. UR - http://mhealth.jmir.org/2020/7/e16844/ UR - http://dx.doi.org/10.2196/16844 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706733 ID - info:doi/10.2196/16844 ER - TY - JOUR AU - Langlet, Billy AU - Maramis, Christos AU - Diou, Christos AU - Maglaveras, Nikolaos AU - Fagerberg, Petter AU - Heimeier, Rachel AU - Lekka, Irini AU - Delopoulos, Anastasios AU - Ioakimidis, Ioannis PY - 2020/7/21 TI - Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study JO - JMIR Mhealth Uhealth SP - e14778 VL - 8 IS - 7 KW - mHealth KW - eHealth KW - dietary behavior KW - lifestyle behavioral monitoring KW - lifestyle interventions KW - obesity KW - mobile phone KW - smartphone KW - weight management KW - overweight N2 - 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. UR - http://mhealth.jmir.org/2020/7/e14778/ UR - http://dx.doi.org/10.2196/14778 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706684 ID - info:doi/10.2196/14778 ER - TY - JOUR AU - Mena, J. Luis AU - Félix, G. Vanessa AU - Ostos, Rodolfo AU - González, J. Armando AU - Martínez-Peláez, Rafael AU - Melgarejo, D. Jesus AU - Maestre, E. Gladys PY - 2020/7/20 TI - Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e18012 VL - 8 IS - 7 KW - mHealth KW - photoplethysmography KW - blood pressure monitoring KW - hypertension N2 - 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. UR - https://mhealth.jmir.org/2020/7/e18012 UR - http://dx.doi.org/10.2196/18012 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459642 ID - info:doi/10.2196/18012 ER - TY - JOUR AU - Patel, Ben AU - Thind, Arron PY - 2020/7/20 TI - Usability of Mobile Health Apps for Postoperative Care: Systematic Review JO - JMIR Perioper Med SP - e19099 VL - 3 IS - 2 KW - postoperative monitoring KW - postoperative care KW - mobile health app KW - telemedicine KW - smartphone KW - mobile phone N2 - 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. UR - https://periop.jmir.org/2020/2/e19099 UR - http://dx.doi.org/10.2196/19099 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393925 ID - info:doi/10.2196/19099 ER - TY - JOUR AU - Adrian, Molly AU - Coifman, Jessica AU - Pullmann, D. Michael AU - Blossom, B. Jennifer AU - Chandler, Casey AU - Coppersmith, Glen AU - Thompson, Paul AU - Lyon, R. Aaron PY - 2020/7/20 TI - Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study JO - JMIR Ment Health SP - e16338 VL - 7 IS - 7 KW - technology-enabled services KW - suicide prevention KW - school-based mental health KW - user-centered design KW - mobile phone N2 - 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. UR - https://mental.jmir.org/2020/7/e16338 UR - http://dx.doi.org/10.2196/16338 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706691 ID - info:doi/10.2196/16338 ER - TY - JOUR AU - Tajirian, Tania AU - Stergiopoulos, Vicky AU - Strudwick, Gillian AU - Sequeira, Lydia AU - Sanches, Marcos AU - Kemp, Jessica AU - Ramamoorthi, Karishini AU - Zhang, Timothy AU - Jankowicz, Damian PY - 2020/7/15 TI - The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey JO - J Med Internet Res SP - e19274 VL - 22 IS - 7 KW - electronic health record KW - physician KW - burnout KW - psychiatry KW - medical informatics N2 - 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. UR - https://www.jmir.org/2020/7/e19274 UR - http://dx.doi.org/10.2196/19274 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673234 ID - info:doi/10.2196/19274 ER - TY - JOUR AU - Miller, Stephen AU - Gilbert, Stephen AU - Virani, Vishaal AU - Wicks, Paul PY - 2020/7/10 TI - Patients? Utilization and Perception of an Artificial Intelligence?Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study JO - JMIR Hum Factors SP - e19713 VL - 7 IS - 3 KW - human-centered design KW - innovative KW - health care apps KW - eHealth KW - symptom checker KW - primary care KW - general practice KW - app KW - usability KW - acceptability KW - utility N2 - 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. UR - https://humanfactors.jmir.org/2020/3/e19713 UR - http://dx.doi.org/10.2196/19713 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540836 ID - info:doi/10.2196/19713 ER - TY - JOUR AU - Taylor Jr, A. Herman AU - Francis, Sherilyn AU - Evans, Ray Chad AU - Harvey, Marques AU - Newton, A. Brittney AU - Jones, P. Camara AU - Akintobi, Henry Tabia AU - Clifford, Gari PY - 2020/7/9 TI - Preventing Cardiovascular Disease Among Urban African Americans With a Mobile Health App (the MOYO App): Protocol for a Usability Study JO - JMIR Res Protoc SP - e16699 VL - 9 IS - 7 KW - African Americans KW - mHealth KW - community-based participatory research KW - agile design KW - cardiovascular N2 - 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 UR - https://www.researchprotocols.org/2020/7/e16699 UR - http://dx.doi.org/10.2196/16699 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673258 ID - info:doi/10.2196/16699 ER - TY - JOUR AU - Schleimer, Erica AU - Pearce, Jennifer AU - Barnecut, Andrew AU - Rowles, William AU - Lizee, Antoine AU - Klein, Arno AU - Block, J. Valerie AU - Santaniello, Adam AU - Renschen, Adam AU - Gomez, Refujia AU - Keshavan, Anisha AU - Gelfand, M. Jeffrey AU - Henry, G. Roland AU - Hauser, L. Stephen AU - Bove, Riley PY - 2020/7/6 TI - A Precision Medicine Tool for Patients With Multiple Sclerosis (the Open MS BioScreen): Human-Centered Design and Development JO - J Med Internet Res SP - e15605 VL - 22 IS - 7 KW - human-centered design KW - mobile phone KW - personal health record KW - participatory medicine KW - visualization in eHealth KW - human factors N2 - 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. UR - https://www.jmir.org/2020/7/e15605 UR - http://dx.doi.org/10.2196/15605 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628124 ID - info:doi/10.2196/15605 ER - TY - JOUR AU - Langer, L. Shelby AU - Ghosh, Neeta AU - Todd, Michael AU - Randall, K. Ashley AU - Romano, M. Joan AU - Bricker, B. Jonathan AU - Bolger, Niall AU - Burns, W. John AU - Hagan, C. Rachel AU - Porter, S. Laura PY - 2020/7/6 TI - Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study JO - JMIR Form Res SP - e14161 VL - 4 IS - 7 KW - ecological momentary assessment KW - smartphone KW - mobile phone KW - communication KW - disclosure KW - affect N2 - 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. UR - https://formative.jmir.org/2020/7/e14161 UR - http://dx.doi.org/10.2196/14161 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628614 ID - info:doi/10.2196/14161 ER - TY - JOUR AU - Andrade, Evismar AU - Quinlan, Leo AU - Harte, Richard AU - Byrne, Dara AU - Fallon, Enda AU - Kelly, Martina AU - Casey, Siobhan AU - Kirrane, Frank AU - O'Connor, Paul AU - O'Hora, Denis AU - Scully, Michael AU - Laffey, John AU - Pladys, Patrick AU - Beuchée, Alain AU - ÓLaighin, Gearóid PY - 2020/7/3 TI - Novel Interface Designs for Patient Monitoring Applications in Critical Care Medicine: Human Factors Review JO - JMIR Hum Factors SP - e15052 VL - 7 IS - 3 KW - interface design KW - usability KW - situation awareness KW - graphical display KW - satisfaction KW - response time KW - accuracy KW - anesthesiology KW - critical care KW - performance KW - ecological display N2 - 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. UR - https://humanfactors.jmir.org/2020/3/e15052 UR - http://dx.doi.org/10.2196/15052 UR - http://www.ncbi.nlm.nih.gov/pubmed/32618574 ID - info:doi/10.2196/15052 ER - TY - JOUR AU - LeRouge, M. Cynthia AU - Hah, Hyeyoung AU - Deckard, J. Gloria AU - Jiang, Haoqiang PY - 2020/6/29 TI - Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study JO - JMIR Mhealth Uhealth SP - e18391 VL - 8 IS - 6 KW - consumer health technologies KW - obesity care model KW - chronic care model KW - UTAUT KW - qualitative research KW - overweight KW - mobile phone KW - adolescent KW - couse KW - social support KW - obesity KW - social influence KW - consumer health informatics N2 - 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. UR - http://mhealth.jmir.org/2020/6/e18391/ UR - http://dx.doi.org/10.2196/18391 UR - http://www.ncbi.nlm.nih.gov/pubmed/32597788 ID - info:doi/10.2196/18391 ER - TY - JOUR AU - Peterson, M. Colleen AU - Mikal, P. Jude AU - McCarron, R. Hayley AU - Finlay, M. Jessica AU - Mitchell, L. Lauren AU - Gaugler, E. Joseph PY - 2020/6/26 TI - 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 JO - JMIR Aging SP - e17769 VL - 3 IS - 1 KW - Alzheimer disease KW - technology KW - disease management KW - personal health record KW - family caregiving KW - informal caregiving KW - caregiver burnout KW - web-based intervention KW - assistive technology N2 - 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. UR - http://aging.jmir.org/2020/1/e17769/ UR - http://dx.doi.org/10.2196/17769 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589158 ID - info:doi/10.2196/17769 ER - TY - JOUR AU - Vandekerckhove, Pieter AU - Vandekerckhove, Yves AU - Tavernier, Rene AU - De Jaegher, Kelly AU - de Mul, Marleen PY - 2020/6/25 TI - Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights JO - J Med Internet Res SP - e19771 VL - 22 IS - 6 KW - telemedicine KW - design thinking KW - cardiology KW - patient KW - COVID-19 KW - user experience UR - http://www.jmir.org/2020/6/e19771/ UR - http://dx.doi.org/10.2196/19771 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519964 ID - info:doi/10.2196/19771 ER - TY - JOUR AU - Parush, Avi AU - Wacht, Oren AU - Gomes, Ricardo AU - Frenkel, Amit PY - 2020/6/17 TI - Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study JO - J Med Internet Res SP - e19947 VL - 22 IS - 6 KW - COVID-19 KW - personal protective equipment KW - PPE KW - human factors KW - cognitive functioning KW - multinational survey KW - pandemic KW - protection KW - infectious disease KW - infection KW - survey N2 - 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 ? 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. UR - http://www.jmir.org/2020/6/e19947/ UR - http://dx.doi.org/10.2196/19947 UR - http://www.ncbi.nlm.nih.gov/pubmed/32511099 ID - info:doi/10.2196/19947 ER - TY - JOUR AU - Brick, R. Timothy AU - Mundie, James AU - Weaver, Jonathan AU - Fraleigh, Robert AU - Oravecz, Zita PY - 2020/6/17 TI - Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study JO - JMIR Form Res SP - e16072 VL - 4 IS - 6 KW - smartphone apps KW - ecological momentary assessment KW - real-time analysis KW - behavior change N2 - 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. UR - https://formative.jmir.org/2020/6/e16072 UR - http://dx.doi.org/10.2196/16072 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554373 ID - info:doi/10.2196/16072 ER - TY - JOUR AU - Cho, Hwayoung AU - Porras, Tiffany AU - Flynn, Gabriella AU - Schnall, Rebecca PY - 2020/6/15 TI - Usability of a Consumer Health Informatics Tool Following Completion of a Clinical Trial: Focus Group Study JO - J Med Internet Res SP - e17708 VL - 22 IS - 6 KW - consumer health informatics tool KW - mobile Health KW - mobile apps KW - clinical trial KW - symptom care KW - self-management KW - HIV-associated nonAIDS (HANA) KW - HANA conditions KW - HIV/AIDS N2 - 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. UR - http://www.jmir.org/2020/6/e17708/ UR - http://dx.doi.org/10.2196/17708 UR - http://www.ncbi.nlm.nih.gov/pubmed/32538796 ID - info:doi/10.2196/17708 ER - TY - JOUR AU - Korpershoek, G. Yvonne J. AU - Hermsen, Sander AU - Schoonhoven, Lisette AU - Schuurmans, J. Marieke AU - Trappenburg, A. Jaap C. PY - 2020/6/15 TI - 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 JO - J Med Internet Res SP - e15449 VL - 22 IS - 6 KW - mobile health KW - mHealth KW - user-centered design KW - behavior change KW - COPD KW - exacerbation KW - self-management KW - self-care KW - mobile phone N2 - 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. UR - https://www.jmir.org/2020/6/e15449 UR - http://dx.doi.org/10.2196/15449 UR - http://www.ncbi.nlm.nih.gov/pubmed/32538793 ID - info:doi/10.2196/15449 ER - TY - JOUR AU - Heapy, Connor AU - Montgomery, Kerry AU - Ersser, Steven AU - Gass, Matt AU - Goad, Nina AU - Thompson, R. Andrew PY - 2020/6/15 TI - A Psychosocial Support Website From the British Association of Dermatologists for People Living With a Skin Condition: Mixed Methods Evaluation JO - JMIR Dermatol SP - e17052 VL - 3 IS - 1 KW - dermatology KW - psychology KW - surveys and questionnaires KW - interview KW - mobile phone N2 - 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. UR - http://derma.jmir.org/2020/1/e17052/ UR - http://dx.doi.org/10.2196/17052 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/17052 ER - TY - JOUR AU - Wessels, J. Nienke AU - Hulshof, Lisa AU - Loohuis, M. Anne M. AU - van Gemert-Pijnen, Lisette AU - Jellema, Petra AU - van der Worp, Henk AU - Blanker, H. Marco PY - 2020/6/12 TI - User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study JO - JMIR Mhealth Uhealth SP - e17114 VL - 8 IS - 6 KW - ehealth KW - mobile applications KW - self-management KW - qualitative research N2 - 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. UR - http://mhealth.jmir.org/2020/6/e17114/ UR - http://dx.doi.org/10.2196/17114 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530431 ID - info:doi/10.2196/17114 ER - TY - JOUR AU - van Beek, Willemijn Judith Jantine AU - van Wegen, Henri Erwin Everardus AU - Rietberg, Berend Marc AU - Nyffeler, Thomas AU - Bohlhalter, Stephan AU - Kamm, Philipp Christian AU - Nef, Tobias AU - Vanbellingen, Tim PY - 2020/6/9 TI - Feasibility of a Home-Based Tablet App for Dexterity Training in Multiple Sclerosis: Usability Study JO - JMIR Mhealth Uhealth SP - e18204 VL - 8 IS - 6 KW - dexterity KW - feasibility KW - multiple sclerosis KW - rehabilitation KW - app KW - home-based training N2 - 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. UR - http://mhealth.jmir.org/2020/6/e18204/ UR - http://dx.doi.org/10.2196/18204 UR - http://www.ncbi.nlm.nih.gov/pubmed/32515747 ID - info:doi/10.2196/18204 ER - TY - JOUR AU - Siemer, Lutz AU - Ben Allouch, Somaya AU - Pieterse, E. Marcel AU - Brusse-Keizer, Marjolein AU - Sanderman, Robbert AU - Postel, G. Marloes PY - 2020/6/3 TI - Patients? User Experience of a Blended Face-to-Face and Web-Based Smoking Cessation Treatment: Qualitative Study JO - JMIR Form Res SP - e14550 VL - 4 IS - 6 KW - smoking cessation KW - cognitive therapy KW - blended treatment KW - smoking KW - user experience KW - tobacco KW - patient perspective N2 - 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. UR - https://formative.jmir.org/2020/6/e14550 UR - http://dx.doi.org/10.2196/14550 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343245 ID - info:doi/10.2196/14550 ER - TY - JOUR AU - Sengupta, Avijit AU - Beckie, Theresa AU - Dutta, Kaushik AU - Dey, Arup AU - Chellappan, Sriram PY - 2020/6/3 TI - A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study JO - JMIR Form Res SP - e16420 VL - 4 IS - 6 KW - coronary heart disease KW - mobile health technology KW - behavior change interventions KW - women KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2020/6/e16420 UR - http://dx.doi.org/10.2196/16420 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348270 ID - info:doi/10.2196/16420 ER - TY - JOUR AU - Wegner, Stephan AU - Lohmeyer, Quentin AU - Wahlen, Dimitri AU - Neumann, Sandra AU - Groebli, Jean-Claude AU - Meboldt, Mirko PY - 2020/6/3 TI - Value of Eye-Tracking Data for Classification of Information Processing?Intensive Handling Tasks: Quasi-Experimental Study on Cognition and User Interface Design JO - JMIR Hum Factors SP - e15581 VL - 7 IS - 2 KW - human factors engineering KW - mobile eye tracking KW - benchmarking KW - home care KW - usability KW - self-management KW - quantitative research KW - quantitative evaluation N2 - 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. UR - http://humanfactors.jmir.org/2020/2/e15581/ UR - http://dx.doi.org/10.2196/15581 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490840 ID - info:doi/10.2196/15581 ER - TY - JOUR AU - Hafiz, Pegah AU - Bardram, Eyvind Jakob PY - 2020/6/1 TI - The Ubiquitous Cognitive Assessment Tool for Smartwatches: Design, Implementation, and Evaluation Study JO - JMIR Mhealth Uhealth SP - e17506 VL - 8 IS - 6 KW - cognition KW - memory KW - response time KW - attention KW - Stroop task KW - wearable devices KW - mobile phone N2 - 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. UR - https://mhealth.jmir.org/2020/6/e17506 UR - http://dx.doi.org/10.2196/17506 UR - http://www.ncbi.nlm.nih.gov/pubmed/32478664 ID - info:doi/10.2196/17506 ER - TY - JOUR AU - Bowman, Cassandra AU - Lunyera, Joseph AU - Alkon, Aviel AU - Boulware, Ebony L. AU - St Clair Russell, Jennifer AU - Riley, Jennie AU - Fink, C. Jeffrey AU - Diamantidis, Clarissa PY - 2020/5/28 TI - A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study JO - JMIR Form Res SP - e16137 VL - 4 IS - 5 KW - patient safety KW - chronic kidney disease KW - patient education KW - mhealth N2 - 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. UR - http://formative.jmir.org/2020/5/e16137/ UR - http://dx.doi.org/10.2196/16137 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463366 ID - info:doi/10.2196/16137 ER - TY - JOUR AU - Ma, Shu-Ching AU - Chou, Willy AU - Chien, Tsair-Wei AU - Chow, Chi Julie AU - Yeh, Yu-Tsen AU - Chou, Po-Hsin AU - Lee, Huan-Fang PY - 2020/5/20 TI - An App for Detecting Bullying of Nurses Using Convolutional Neural Networks and Web-Based Computerized Adaptive Testing: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16747 VL - 8 IS - 5 KW - nurse bullying KW - NAQ-R assessment KW - receiver operating characteristic curve KW - convolutional neural network KW - computerized adaptive testing N2 - 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. UR - https://mhealth.jmir.org/2020/5/e16747 UR - http://dx.doi.org/10.2196/16747 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432557 ID - info:doi/10.2196/16747 ER - TY - JOUR AU - Downie, Simon Aron AU - Hancock, Mark AU - Abdel Shaheed, Christina AU - McLachlan, J. Andrew AU - Kocaballi, Baki Ahmet AU - Williams, M. Christopher AU - Michaleff, A. Zoe AU - Maher, G. Chris PY - 2020/5/11 TI - An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study JO - JMIR Med Inform SP - e17203 VL - 8 IS - 5 KW - low back pain KW - community pharmacy KW - decision support systems, clinical N2 - 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. UR - https://medinform.jmir.org/2020/5/e17203 UR - http://dx.doi.org/10.2196/17203 UR - http://www.ncbi.nlm.nih.gov/pubmed/32390593 ID - info:doi/10.2196/17203 ER - TY - JOUR AU - Polhemus, Marie Ashley AU - Novák, Jan AU - Ferrao, Jose AU - Simblett, Sara AU - Radaelli, Marta AU - Locatelli, Patrick AU - Matcham, Faith AU - Kerz, Maximilian AU - Weyer, Janice AU - Burke, Patrick AU - Huang, Vincy AU - Dockendorf, Fallon Marissa AU - Temesi, Gergely AU - Wykes, Til AU - Comi, Giancarlo AU - Myin-Germeys, Inez AU - Folarin, Amos AU - Dobson, Richard AU - Manyakov, V. Nikolay AU - Narayan, A. Vaibhav AU - Hotopf, Matthew PY - 2020/5/7 TI - Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study JO - JMIR Mhealth Uhealth SP - e16043 VL - 8 IS - 5 KW - human-centric design KW - design thinking KW - patient centricity KW - device selection KW - technology selection KW - remote patient monitoring KW - remote measurement technologies N2 - 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. UR - https://mhealth.jmir.org/2020/5/e16043 UR - http://dx.doi.org/10.2196/16043 UR - http://www.ncbi.nlm.nih.gov/pubmed/32379055 ID - info:doi/10.2196/16043 ER - TY - JOUR AU - Keogh, Alison AU - Dorn, F. Jonas AU - Walsh, Lorcan AU - Calvo, Francesc AU - Caulfield, Brian PY - 2020/4/20 TI - Comparing the Usability and Acceptability of Wearable Sensors Among Older Irish Adults in a Real-World Context: Observational Study JO - JMIR Mhealth Uhealth SP - e15704 VL - 8 IS - 4 KW - wearable technology KW - usability KW - mixed methods KW - user satisfaction N2 - 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. UR - http://mhealth.jmir.org/2020/4/e15704/ UR - http://dx.doi.org/10.2196/15704 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310149 ID - info:doi/10.2196/15704 ER - TY - JOUR AU - Chow, I. Philip AU - Showalter, L. Shayna AU - Gerber, Matthew AU - Kennedy, M. Erin AU - Brenin, David AU - Mohr, C. David AU - Lattie, G. Emily AU - Gupta, Alisha AU - Ocker, Gabrielle AU - Cohn, F. Wendy PY - 2020/4/15 TI - Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study JO - JMIR Cancer SP - e16476 VL - 6 IS - 1 KW - breast cancer KW - mental health KW - mHealth N2 - 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 UR - http://cancer.jmir.org/2020/1/e16476/ UR - http://dx.doi.org/10.2196/16476 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293570 ID - info:doi/10.2196/16476 ER - TY - JOUR AU - Gannon, Brittany AU - Davis, Rindcy AU - Kuhns, M. Lisa AU - Rodriguez, Garibay Rafael AU - Garofalo, Robert AU - Schnall, Rebecca PY - 2020/4/7 TI - A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation JO - JMIR Form Res SP - e17901 VL - 4 IS - 4 KW - young adults KW - usability KW - HIV KW - mHealth KW - young men KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2020/4/e17901 UR - http://dx.doi.org/10.2196/17901 UR - http://www.ncbi.nlm.nih.gov/pubmed/32254043 ID - info:doi/10.2196/17901 ER - TY - JOUR AU - Fortunato, Michael AU - Adusumalli, Srinath AU - Chokshi, Neel AU - Harrison, Joseph AU - Rareshide, Charles AU - Patel, Mitesh PY - 2020/4/7 TI - Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study JO - JMIR Form Res SP - e14508 VL - 4 IS - 4 KW - sleep KW - wearable devices KW - ischemic heart disease N2 - 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 UR - https://formative.jmir.org/2020/4/e14508 UR - http://dx.doi.org/10.2196/14508 UR - http://www.ncbi.nlm.nih.gov/pubmed/32254044 ID - info:doi/10.2196/14508 ER - TY - JOUR AU - Heiney, P. Sue AU - Donevant, B. Sara AU - Arp Adams, Swann AU - Parker, D. Pearman AU - Chen, Hongtu AU - Levkoff, Sue PY - 2020/4/3 TI - A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study JO - JMIR Aging SP - e17142 VL - 3 IS - 1 KW - heart failure KW - mobile health app KW - self-management N2 - 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. UR - http://aging.jmir.org/2020/1/e17142/ UR - http://dx.doi.org/10.2196/17142 UR - http://www.ncbi.nlm.nih.gov/pubmed/32242822 ID - info:doi/10.2196/17142 ER - TY - JOUR AU - Baker, Kevin AU - Maurel, Alice AU - Ward, Charlotte AU - Getachew, Dawit AU - Habte, Tedila AU - McWhorter, Cindy AU - LaBarre, Paul AU - Karlström, Jonas AU - Petzold, Max AU - Källander, Karin PY - 2020/3/30 TI - Automated Respiratory Rate Counter to Assess Children for Symptoms of Pneumonia: Protocol for Cross-Sectional Usability and Acceptability Studies in Ethiopia and Nepal JO - JMIR Res Protoc SP - e14405 VL - 9 IS - 3 KW - community health worker KW - pneumonia KW - child KW - respiratory rate KW - Nepal KW - Ethiopia N2 - 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 UR - http://www.researchprotocols.org/2007/3/e14405/ UR - http://dx.doi.org/10.2196/14405 UR - http://www.ncbi.nlm.nih.gov/pubmed/32224491 ID - info:doi/10.2196/14405 ER - TY - JOUR AU - Ali, Haneen AU - Li, Huiyang PY - 2020/3/27 TI - Use of Notification and Communication Technology (Call Light Systems) in Nursing Homes: Observational Study JO - J Med Internet Res SP - e16252 VL - 22 IS - 3 KW - communication systems KW - nursing home KW - response time KW - safety KW - quality of health care KW - observational study N2 - 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. UR - http://www.jmir.org/2020/3/e16252/ UR - http://dx.doi.org/10.2196/16252 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217497 ID - info:doi/10.2196/16252 ER - TY - JOUR AU - McGillion, Michael AU - Ouellette, Carley AU - Good, Amber AU - Bird, Marissa AU - Henry, Shaunattonie AU - Clyne, Wendy AU - Turner, Andrew AU - Ritvo, Paul AU - Ritvo, Sarah AU - Dvirnik, Nazari AU - Lamy, Andre AU - Whitlock, Richard AU - Lawton, Christopher AU - Walsh, Jake AU - Paterson, Ken AU - Duquette, Janine AU - Sanchez Medeiros, Karla AU - Elias, Fadi AU - Scott, Ted AU - Mills, Joseph AU - Harrington, Deborah AU - Field, Mark AU - Harsha, Prathiba AU - Yang, Stephen AU - Peter, Elizabeth AU - Bhavnani, Sanjeev AU - Devereaux, PJ PY - 2020/3/18 TI - Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study JO - J Med Internet Res SP - e15548 VL - 22 IS - 3 KW - monitoring, physiologic KW - postoperative care KW - user testing N2 - 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. UR - https://www.jmir.org/2020/3/e15548 UR - http://dx.doi.org/10.2196/15548 UR - http://www.ncbi.nlm.nih.gov/pubmed/32186521 ID - info:doi/10.2196/15548 ER - TY - JOUR AU - De Ramón Fernández, Alberto AU - Ruiz Fernández, Daniel AU - Marcos-Jorquera, Diego AU - Gilart Iglesias, Virgilio PY - 2020/3/17 TI - 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 JO - J Med Internet Res SP - e17161 VL - 22 IS - 3 KW - COPD KW - misdiagnosis KW - business process management strategy, support system KW - service-oriented architecture KW - hospital information system KW - early diagnosis N2 - 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. UR - https://www.jmir.org/2020/3/e17161 UR - http://dx.doi.org/10.2196/17161 UR - http://www.ncbi.nlm.nih.gov/pubmed/32181744 ID - info:doi/10.2196/17161 ER - TY - JOUR AU - Tscholl, Werner David AU - Rössler, Julian AU - Handschin, Lucas AU - Seifert, Burkhardt AU - Spahn, R. Donat AU - Nöthiger, B. Christoph PY - 2020/3/16 TI - The Mechanisms Responsible for Improved Information Transfer in Avatar-Based Patient Monitoring: Multicenter Comparative Eye-Tracking Study JO - J Med Internet Res SP - e15070 VL - 22 IS - 3 KW - computers KW - diagnosis KW - visual perception KW - awareness KW - patient safety N2 - 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. UR - http://www.jmir.org/2020/3/e15070/ UR - http://dx.doi.org/10.2196/15070 UR - http://www.ncbi.nlm.nih.gov/pubmed/32175913 ID - info:doi/10.2196/15070 ER - TY - JOUR AU - Ta, Vivian AU - Griffith, Caroline AU - Boatfield, Carolynn AU - Wang, Xinyu AU - Civitello, Maria AU - Bader, Haley AU - DeCero, Esther AU - Loggarakis, Alexia PY - 2020/3/6 TI - User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis JO - J Med Internet Res SP - e16235 VL - 22 IS - 3 KW - artificial intelligence KW - social support KW - artificial agents KW - chatbots KW - interpersonal relations N2 - 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. UR - http://www.jmir.org/2020/3/e16235/ UR - http://dx.doi.org/10.2196/16235 UR - http://www.ncbi.nlm.nih.gov/pubmed/32141837 ID - info:doi/10.2196/16235 ER - TY - JOUR AU - Drehlich, Mark AU - Naraine, Michael AU - Rowe, Katie AU - Lai, K. Samuel AU - Salmon, Jo AU - Brown, Helen AU - Koorts, Harriet AU - Macfarlane, Susie AU - Ridgers, D. Nicola PY - 2020/3/6 TI - Using the Technology Acceptance Model to Explore Adolescents? Perspectives on Combining Technologies for Physical Activity Promotion Within an Intervention: Usability Study JO - J Med Internet Res SP - e15552 VL - 22 IS - 3 KW - fitness trackers KW - social media KW - physical activity KW - youth N2 - 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 UR - https://www.jmir.org/2020/3/e15552 UR - http://dx.doi.org/10.2196/15552 UR - http://www.ncbi.nlm.nih.gov/pubmed/32141834 ID - info:doi/10.2196/15552 ER - TY - JOUR AU - Kristjansdottir, Birna Olöf AU - Børøsund, Elin AU - Westeng, Marianne AU - Ruland, Cornelia AU - Stenberg, Una AU - Zangi, A. Heidi AU - Stange, Kurt AU - Mirkovic, Jelena PY - 2020/3/4 TI - Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing JO - JMIR Form Res SP - e16831 VL - 4 IS - 3 KW - mobile app KW - self-management KW - strengths KW - chronic illness KW - rheumatology KW - usability KW - formative evaluation N2 - 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. UR - https://formative.jmir.org/2020/3/e16831 UR - http://dx.doi.org/10.2196/16831 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130126 ID - info:doi/10.2196/16831 ER - TY - JOUR AU - Joseph, P. Rodney AU - Keller, Colleen AU - Vega-López, Sonia AU - Adams, A. Marc AU - English, Rebekah AU - Hollingshead, Kevin AU - Hooker, P. Steven AU - Todd, Michael AU - Gaesser, A. Glenn AU - Ainsworth, E. Barbara PY - 2020/3/2 TI - A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk JO - JMIR Mhealth Uhealth SP - e15346 VL - 8 IS - 3 KW - eHealth KW - mHealth KW - exercise KW - minority health KW - primary prevention KW - heart diseases KW - African-American N2 - 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. UR - https://mhealth.jmir.org/2020/3/e15346 UR - http://dx.doi.org/10.2196/15346 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130198 ID - info:doi/10.2196/15346 ER - TY - JOUR AU - Milios, Athena AU - McGrath, Patrick AU - Baillie, Hannah PY - 2020/2/12 TI - A Weekly, Evidence-Based Health Letter for Caregivers (90Second Caregiver): Usability Study JO - JMIR Form Res SP - e14496 VL - 4 IS - 2 KW - caregivers KW - mental health KW - usability KW - depression KW - anxiety KW - stigma KW - hope KW - health information KW - persuasive design N2 - 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). UR - https://formative.jmir.org/2020/2/e14496 UR - http://dx.doi.org/10.2196/14496 UR - http://www.ncbi.nlm.nih.gov/pubmed/32049064 ID - info:doi/10.2196/14496 ER - TY - JOUR AU - Arsenijevic, Jelena AU - Tummers, Lars AU - Bosma, Niels PY - 2020/2/6 TI - Adherence to Electronic Health Tools Among Vulnerable Groups: Systematic Literature Review and Meta-Analysis JO - J Med Internet Res SP - e11613 VL - 22 IS - 2 KW - eHealth KW - digital health KW - disparities in health care KW - meta-analysis N2 - 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. UR - https://www.jmir.org/2020/2/e11613 UR - http://dx.doi.org/10.2196/11613 UR - http://www.ncbi.nlm.nih.gov/pubmed/32027311 ID - info:doi/10.2196/11613 ER - TY - JOUR AU - Purkayastha, Saptarshi AU - Addepally, Abhishek Siva AU - Bucher, Sherri PY - 2020/2/3 TI - Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial JO - JMIR Hum Factors SP - e14146 VL - 7 IS - 1 KW - cognitive behavioral therapy KW - mHealth KW - mental health KW - heuristics KW - usability N2 - 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. UR - http://humanfactors.jmir.org/2020/1/e14146/ UR - http://dx.doi.org/10.2196/14146 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012043 ID - info:doi/10.2196/14146 ER - TY - JOUR AU - Chew, Sara AU - Lai, Mei Pauline Siew AU - Ng, Jenn Chirk PY - 2020/1/31 TI - Usability and Utility of a Mobile App to Improve Medication Adherence Among Ambulatory Care Patients in Malaysia: Qualitative Study JO - JMIR Mhealth Uhealth SP - e15146 VL - 8 IS - 1 KW - medication adherence app KW - usability testing KW - utility testing N2 - 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. UR - http://mhealth.jmir.org/2020/1/e15146/ UR - http://dx.doi.org/10.2196/15146 UR - http://www.ncbi.nlm.nih.gov/pubmed/32003748 ID - info:doi/10.2196/15146 ER - TY - JOUR AU - Quan, Linh Amanda My AU - Stiell, Ian AU - Perry, J. Jeffrey AU - Paradis, Michelle AU - Brown, Erica AU - Gignac, Jordan AU - Wilson, Lindsay AU - Wilson, Kumanan PY - 2020/1/29 TI - Mobile Clinical Decision Tools Among Emergency Department Clinicians: Web-Based Survey and Analytic Data for Evaluation of The Ottawa Rules App JO - JMIR Mhealth Uhealth SP - e15503 VL - 8 IS - 1 KW - emergency departments KW - mHealth KW - clinical prediction rule KW - decision aids N2 - 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. UR - https://mhealth.jmir.org/2020/1/e15503 UR - http://dx.doi.org/10.2196/15503 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012095 ID - info:doi/10.2196/15503 ER - TY - JOUR AU - Cao, Jian AU - Truong, Lan Anh AU - Banu, Sophia AU - Shah, A. Asim AU - Sabharwal, Ashutosh AU - Moukaddam, Nidal PY - 2020/1/24 TI - Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study JO - JMIR Ment Health SP - e14045 VL - 7 IS - 1 KW - SOLVD-Teen and SOLVD-Parent App KW - adolescent depression KW - smartphone monitoring KW - self-evaluation KW - parental input KW - sensory data N2 - 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. UR - http://mental.jmir.org/2020/1/e14045/ UR - http://dx.doi.org/10.2196/14045 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012072 ID - info:doi/10.2196/14045 ER - TY - JOUR AU - Farias, Nathan AU - Rose-Davis, Benjamin AU - Hong, Paul AU - Wozney, Lori PY - 2020/1/15 TI - An Automated Text Messaging System (Tonsil-Text-To-Me) to Improve Tonsillectomy Perioperative Experience: Exploratory Qualitative Usability and Feasibility Study JO - JMIR Perioper Med SP - e14601 VL - 3 IS - 1 KW - short message service KW - tonsillectomy KW - pediatric otolaryngology KW - perioperative care N2 - 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. UR - https://periop.jmir.org/2020/1/e14601 UR - http://dx.doi.org/10.2196/14601 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393931 ID - info:doi/10.2196/14601 ER - TY - JOUR AU - Inal, Yavuz AU - Wake, Dugstad Jo AU - Guribye, Frode AU - Nordgreen, Tine PY - 2020/1/6 TI - Usability Evaluations of Mobile Mental Health Technologies: Systematic Review JO - J Med Internet Res SP - e15337 VL - 22 IS - 1 KW - systematic review KW - mobile KW - mHealth KW - mental health KW - usability evaluation N2 - 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. UR - https://www.jmir.org/2020/1/e15337 UR - http://dx.doi.org/10.2196/15337 UR - http://www.ncbi.nlm.nih.gov/pubmed/31904579 ID - info:doi/10.2196/15337 ER - TY - JOUR AU - Zhou, Leming AU - Saptono, Andi AU - Setiawan, Agus I. Made AU - Parmanto, Bambang PY - 2020/1/3 TI - Making Self-Management Mobile Health Apps Accessible to People With Disabilities: Qualitative Single-Subject Study JO - JMIR Mhealth Uhealth SP - e15060 VL - 8 IS - 1 KW - mobile app KW - self-management KW - accessibility KW - personalization N2 - 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. UR - https://mhealth.jmir.org/2020/1/e15060 UR - http://dx.doi.org/10.2196/15060 UR - http://www.ncbi.nlm.nih.gov/pubmed/31899453 ID - info:doi/10.2196/15060 ER - TY - JOUR AU - Hughes, Charmayne AU - Musselman, A. Elaine AU - Walsh, Lilia AU - Mariscal, Tatiana AU - Warner, Sam AU - Hintze, Amy AU - Rashidi, Neela AU - Gordon-Murer, Chloe AU - Tanha, Tiana AU - Licudo, Fahrial AU - Ng, Rachel AU - Tran, Jenna PY - 2020/1/3 TI - The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study JO - JMIR Nursing SP - e15828 VL - 3 IS - 1 KW - intimate partner violence KW - domestic violence KW - nursing education KW - learning N2 - 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. UR - https://nursing.jmir.org/2020/1/e15828 UR - http://dx.doi.org/10.2196/15828 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345778 ID - info:doi/10.2196/15828 ER - TY - JOUR AU - Hanghøj, Signe AU - Boisen, A. Kirsten AU - Hjerming, Maiken AU - Elsbernd, Abbey AU - Pappot, Helle PY - 2020/1/2 TI - Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study JO - JMIR Cancer SP - e15008 VL - 6 IS - 1 KW - AYA KW - adolescent and young adult KW - app KW - cancer KW - co-creation KW - mHealth KW - mobile phone KW - think-aloud test KW - usability N2 - 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 Kræftværket, 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 Kræftværket 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 Kræftværket 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 Kræftværket app with the input of more AYAs. UR - https://cancer.jmir.org/2020/1/e15008 UR - http://dx.doi.org/10.2196/15008 UR - http://www.ncbi.nlm.nih.gov/pubmed/31895046 ID - info:doi/10.2196/15008 ER - TY - JOUR AU - Lelong, Romain AU - Soualmia, F. Lina AU - Grosjean, Julien AU - Taalba, Mehdi AU - Darmoni, J. Stéfan PY - 2019/12/20 TI - Building a Semantic Health Data Warehouse in the Context of Clinical Trials: Development and Usability Study JO - JMIR Med Inform SP - e13917 VL - 7 IS - 4 KW - data warehousing KW - search engine KW - semantics KW - clinical trial KW - patient selection N2 - 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. UR - http://medinform.jmir.org/2019/4/e13917/ UR - http://dx.doi.org/10.2196/13917 UR - http://www.ncbi.nlm.nih.gov/pubmed/31859675 ID - info:doi/10.2196/13917 ER - TY - JOUR AU - Masi, Domitilla AU - Gomez-Rexrode, Elvira Amalia AU - Bardin, Rina AU - Seidman, Joshua PY - 2019/12/20 TI - The ?Preparation for Shared Decision-Making? Tool for Women With Advanced Breast Cancer: Qualitative Validation Study JO - J Participat Med SP - e16511 VL - 11 IS - 4 KW - shared decision making KW - clinical decision making KW - patient preferences KW - cancer KW - breast cancer KW - human-centered design KW - patient care planning N2 - 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. UR - http://jopm.jmir.org/2019/4/e16511/ UR - http://dx.doi.org/10.2196/16511 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/16511 ER - TY - JOUR AU - van der Vaart, Rosalie AU - van Driel, Dorine AU - Pronk, Kristel AU - Paulussen, Suzan AU - te Boekhorst, Selma AU - Rosmalen, M. Judith G. AU - Evers, M. Andrea W. PY - 2019/11/21 TI - The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study JO - JMIR Form Res SP - e12883 VL - 3 IS - 4 KW - internet-based cognitive behavior therapy KW - chronic pain KW - usability KW - digital health literacy skills KW - eHealth literacy N2 - 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). UR - http://formative.jmir.org/2019/4/e12883/ UR - http://dx.doi.org/10.2196/12883 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750839 ID - info:doi/10.2196/12883 ER - TY - JOUR AU - Silva, G. Anabela AU - Simões, Patrícia AU - Santos, Rita AU - Queirós, Alexandra AU - Rocha, P. Nelson AU - Rodrigues, Mário PY - 2019/11/15 TI - 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 JO - J Med Internet Res SP - e14829 VL - 21 IS - 11 KW - quality of health care KW - eHealth KW - mHealth KW - efficiency N2 - 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. UR - http://www.jmir.org/2019/11/e14829/ UR - http://dx.doi.org/10.2196/14829 UR - http://www.ncbi.nlm.nih.gov/pubmed/31730036 ID - info:doi/10.2196/14829 ER - TY - JOUR AU - Van de Ven, Pepijn AU - Araya, Ricardo AU - P de Paula Couto, Clara Maria AU - Henrique, Garcia Maiara AU - Meere, Damien AU - Vilela Mendes, Ana AU - Peters, J. Tim AU - Seabra, Antônio AU - Franzin, M. Renato AU - Carvalho Pereda, Paula AU - Scazufca, Marcia PY - 2019/11/12 TI - Investigating Software Requirements for Systems Supporting Task-Shifted Interventions: Usability Study JO - J Med Internet Res SP - e11346 VL - 21 IS - 11 KW - task-shifting KW - community health workers KW - depression KW - medical informatics N2 - 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 São 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. UR - https://www.jmir.org/2019/11/e11346 UR - http://dx.doi.org/10.2196/11346 UR - http://www.ncbi.nlm.nih.gov/pubmed/31714246 ID - info:doi/10.2196/11346 ER - TY - JOUR AU - Appleton, Marie Katherine AU - Bray, Jeff AU - Price, Sarah AU - Liebchen, Gernot AU - Jiang, Nan AU - Mavridis, Ioannis AU - Saulais, Laure AU - Giboreau, Agnès AU - Perez-Cueto, A. Federico J. AU - Coolen, Rebecca AU - Ronge, Manfred AU - Hartwell, Heather PY - 2019/11/4 TI - A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation JO - JMIR Form Res SP - e12966 VL - 3 IS - 4 KW - eating KW - eating behavior KW - food KW - diet KW - mhealth KW - mobile app KW - digitalhealth KW - smartphone N2 - 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. UR - http://formative.jmir.org/2019/4/e12966/ UR - http://dx.doi.org/10.2196/12966 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682575 ID - info:doi/10.2196/12966 ER - TY - JOUR AU - Bernard, Renaldo AU - Sabariego, Carla AU - Cieza, Alarcos PY - 2019/10/31 TI - Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey JO - J Med Internet Res SP - e12514 VL - 21 IS - 10 KW - World Wide Web KW - depression KW - anxiety KW - accessibility KW - interview KW - persona KW - expert study KW - eHealth KW - usability KW - user experience KW - facilitators KW - barriers KW - mental disorders N2 - 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 UR - http://www.jmir.org/2019/10/e12514/ UR - http://dx.doi.org/10.2196/12514 UR - http://www.ncbi.nlm.nih.gov/pubmed/31674915 ID - info:doi/10.2196/12514 ER - TY - JOUR AU - Vandenberk, Thijs AU - Storms, Valerie AU - Lanssens, Dorien AU - De Cannière, Hélène AU - Smeets, JP Christophe AU - Thijs, M. Inge AU - Batool, Tooba AU - Vanrompay, Yves AU - Vandervoort, M. Pieter AU - Grieten, Lars PY - 2019/10/29 TI - A Vendor-Independent Mobile Health Monitoring Platform for Digital Health Studies: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e12586 VL - 7 IS - 10 KW - information science KW - patient care management KW - mobile health KW - telemonitoring KW - monitoring, ambulatory N2 - 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. UR - https://mhealth.jmir.org/2019/10/e12586 UR - http://dx.doi.org/10.2196/12586 UR - http://www.ncbi.nlm.nih.gov/pubmed/31663862 ID - info:doi/10.2196/12586 ER - TY - JOUR AU - Fernandez, P. Maria AU - Bron, M. Gebbiena AU - Kache, A. Pallavi AU - Larson, R. Scott AU - Maus, Adam AU - Gustafson Jr, David AU - Tsao, I. Jean AU - Bartholomay, C. Lyric AU - Paskewitz, M. Susan AU - Diuk-Wasser, A. Maria PY - 2019/10/24 TI - Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study JO - JMIR Mhealth Uhealth SP - e14769 VL - 7 IS - 10 KW - Lyme disease KW - ticks KW - ecological momentary assessment KW - citizen science N2 - 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. UR - http://mhealth.jmir.org/2019/10/e14769/ UR - http://dx.doi.org/10.2196/14769 UR - http://www.ncbi.nlm.nih.gov/pubmed/31651409 ID - info:doi/10.2196/14769 ER - TY - JOUR AU - Stiles-Shields, Colleen AU - Garcia, Brittney AU - Villota, Kimberly AU - Wartman, Elicia AU - Winning, M. Adrien AU - Holmbeck, N. Grayson PY - 2019/10/10 TI - Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study JO - JMIR Pediatr Parent SP - e15153 VL - 2 IS - 2 KW - spina bifida occulta KW - mHealth KW - mobile apps KW - usability testing KW - adolescent KW - young adult KW - weight reduction programs KW - body weight maintenance N2 - 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. UR - https://pediatrics.jmir.org/2019/2/e15153 UR - http://dx.doi.org/10.2196/15153 UR - http://www.ncbi.nlm.nih.gov/pubmed/31603432 ID - info:doi/10.2196/15153 ER - TY - JOUR AU - Lyon, R. Aaron AU - Munson, A. Sean AU - Renn, N. Brenna AU - Atkins, C. David AU - Pullmann, D. Michael AU - Friedman, Emily AU - Areán, A. Patricia PY - 2019/10/9 TI - 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? JO - JMIR Res Protoc SP - e14990 VL - 8 IS - 10 KW - implementation science KW - human-centered design KW - evidence-based psychosocial interventions N2 - 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 UR - https://www.researchprotocols.org/2019/10/e14990 UR - http://dx.doi.org/10.2196/14990 UR - http://www.ncbi.nlm.nih.gov/pubmed/31599736 ID - info:doi/10.2196/14990 ER - TY - JOUR AU - Sezgin, Emre AU - Militello, Lisa AU - Huang, Yungui AU - Lin, Simon PY - 2019/10/2 TI - Look to the Future and SMILE: Feasibility of Interactive Voice Assistant Technology to Support Maternal Infant Health JO - iproc SP - e15231 VL - 5 IS - 1 KW - behavioral health KW - interactive voice response KW - mobile health KW - mothers KW - pregnancy KW - self care KW - self-management N2 - 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. UR - https://www.iproc.org/2019/1/e15231 UR - http://dx.doi.org/10.2196/15231 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/15231 ER - TY - JOUR AU - Ravindran, Vijay AU - Osgood, Monica AU - Sazawal, Vibha AU - Solorzano, Rita AU - Turnacioglu, Sinan PY - 2019/9/30 TI - Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study JO - JMIR Pediatr Parent SP - e14429 VL - 2 IS - 2 KW - autism spectrum disorder KW - interpersonal skills KW - virtual reality, instructional N2 - 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. UR - http://pediatrics.jmir.org/2019/2/e14429/ UR - http://dx.doi.org/10.2196/14429 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573921 ID - info:doi/10.2196/14429 ER - TY - JOUR AU - Welbie, Marlies AU - Wittink, Harriet AU - Westerman, J. Marjan AU - Topper, Ilse AU - Snoei, Josca AU - Devillé, M. Walter L. J. PY - 2019/9/27 TI - A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment JO - JMIR Form Res SP - e11617 VL - 3 IS - 3 KW - mHealth KW - eHealth KW - surveys and questionnaires KW - physical therapy specialty KW - qualitative research N2 - 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. UR - https://formative.jmir.org/2019/3/e11617 UR - http://dx.doi.org/10.2196/11617 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573909 ID - info:doi/10.2196/11617 ER - TY - JOUR AU - Ijaz, Kiran AU - Ahmadpour, Naseem AU - Naismith, L. Sharon AU - Calvo, A. Rafael PY - 2019/09/03 TI - An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study JO - JMIR Ment Health SP - e13887 VL - 6 IS - 9 KW - virtual reality KW - healthy aging KW - memory KW - cognition KW - dementia N2 - 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. UR - https://mental.jmir.org/2019/9/e13887/ UR - http://dx.doi.org/10.2196/13887 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482851 ID - info:doi/10.2196/13887 ER - TY - JOUR AU - Turk, Amadea AU - Fairclough, Emma AU - Grason Smith, Gillian AU - Lond, Benjamin AU - Nanton, Veronica AU - Dale, Jeremy PY - 2019/8/20 TI - Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive Study JO - JMIR Aging SP - e13875 VL - 2 IS - 2 KW - caregivers KW - information technology KW - internet N2 - 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. UR - https://aging.jmir.org/2019/2/e13875 UR - http://dx.doi.org/10.2196/13875 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518272 ID - info:doi/10.2196/13875 ER - TY - JOUR AU - Davis, C. Angela AU - Wright, C. Cassandra J. AU - Temple-Smith, J. Meredith AU - Hellard, E. Margaret AU - Lim, C. Megan S. PY - 2019/08/13 TI - 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 JO - JMIR Form Res SP - e12824 VL - 3 IS - 3 KW - adolescent KW - pornography KW - health promotion KW - internet KW - sex education N2 - 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. UR - http://formative.jmir.org/2019/3/e12824/ UR - http://dx.doi.org/10.2196/12824 UR - http://www.ncbi.nlm.nih.gov/pubmed/31411140 ID - info:doi/10.2196/12824 ER - TY - JOUR AU - Görges, Matthias AU - West, C. Nicholas AU - Petersen, L. Christian AU - Ansermino, Mark J. PY - 2019/08/05 TI - Development and Implementation of the Portable Operating Room Tracker App With Vital Signs Streaming Infrastructure: Operational Feasibility Study JO - JMIR Perioper Med SP - e13559 VL - 2 IS - 2 KW - communication systems KW - patient monitoring KW - user-centered design KW - human factors KW - anesthesia N2 - 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. UR - http://periop.jmir.org/2019/2/e13559/ UR - http://dx.doi.org/10.2196/13559 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393912 ID - info:doi/10.2196/13559 ER - TY - JOUR AU - Weichelt, Bryan AU - Heimonen, Tomi AU - Gorucu, Serap AU - Redmond, Emily AU - Vechinski, Josef AU - Pflughoeft, Kurt AU - Bendixsen, Casper AU - Salzwedel, Marsha AU - Scott, Erika AU - Namkoong, Kang AU - Purschwitz, Mark AU - Rautiainen, Risto AU - Murphy, J. Dennis PY - 2019/08/02 TI - Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study JO - JMIR Form Res SP - e13621 VL - 3 IS - 3 KW - agriculture KW - risk KW - wounds and injuries KW - safety KW - farms KW - news KW - newspaper article N2 - 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.? UR - http://formative.jmir.org/2019/3/e13621/ UR - http://dx.doi.org/10.2196/13621 UR - http://www.ncbi.nlm.nih.gov/pubmed/31376278 ID - info:doi/10.2196/13621 ER - TY - JOUR AU - Pfarr, Juliane AU - Ganter, T. Michael AU - Spahn, R. Donat AU - Noethiger, B. Christoph AU - Tscholl, W. David PY - 2019/07/17 TI - Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study JO - J Med Internet Res SP - e13041 VL - 21 IS - 7 KW - anesthesia KW - critical care KW - computers KW - diagnosis KW - patient monitoring KW - situation awareness KW - perception KW - vision N2 - 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. UR - http://www.jmir.org/2019/7/e13041/ UR - http://dx.doi.org/10.2196/13041 UR - http://www.ncbi.nlm.nih.gov/pubmed/31317870 ID - info:doi/10.2196/13041 ER - TY - JOUR AU - Dunsmuir, Dustin AU - Wu, Helen AU - Sun, Terri AU - West, C. Nicholas AU - Lauder, R. Gillian AU - Görges, Matthias AU - Ansermino, Mark J. PY - 2019/07/04 TI - A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility JO - JMIR Perioper Med SP - e12305 VL - 2 IS - 2 KW - pain management KW - pain, postoperative period KW - outpatients KW - mobile apps KW - child KW - parents N2 - 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. UR - https://periop.jmir.org/2019/2/e12305/ UR - http://dx.doi.org/10.2196/12305 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393928 ID - info:doi/10.2196/12305 ER - TY - JOUR AU - Kersting, Christine AU - Weltermann, Birgitta PY - 2019/07/04 TI - Evaluating the Feasibility of a Software Prototype Supporting the Management of Multimorbid Seniors: Mixed Methods Study in General Practices JO - JMIR Hum Factors SP - e12695 VL - 6 IS - 3 KW - patient care management KW - primary health care KW - clinical decision support systems KW - electronic health record KW - reminder system KW - health information technology N2 - 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 UR - https://humanfactors.jmir.org/2019/3/e12695/ UR - http://dx.doi.org/10.2196/12695 UR - http://www.ncbi.nlm.nih.gov/pubmed/31274115 ID - info:doi/10.2196/12695 ER - TY - JOUR AU - Garvin, Hornung Jennifer AU - Ducom, Julie AU - Matheny, Michael AU - Miller, Anne AU - Westerman, Dax AU - Reale, Carrie AU - Slagle, Jason AU - Kelly, Natalie AU - Beebe, Russ AU - Koola, Jejo AU - Groessl, J. Erik AU - Patterson, S. Emily AU - Weinger, Matthew AU - Perkins, M. Amy AU - Ho, B. Samuel PY - 2019/07/03 TI - Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis JO - JMIR Med Inform SP - e13627 VL - 7 IS - 3 KW - clinical decision support KW - human factors engineering KW - liver cirrhosis KW - interview N2 - 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. UR - https://medinform.jmir.org/2019/3/e13627/ UR - http://dx.doi.org/10.2196/13627 UR - http://www.ncbi.nlm.nih.gov/pubmed/31271153 ID - info:doi/10.2196/13627 ER - TY - JOUR AU - Araujo Almeida, Vanessa AU - Littlejohn, Paula AU - Cop, Irene AU - Brown, Erin AU - Afroze, Rimi AU - Davison, M. Karen PY - 2019/06/28 TI - Comparison of Nutrigenomics Technology Interface Tools for Consumers and Health Professionals: A Sequential Explanatory Mixed Methods Investigation JO - J Med Internet Res SP - e12580 VL - 21 IS - 6 KW - nutrigenomics KW - nutrigenetics KW - genomics KW - epigenomics KW - interface, user-computer N2 - 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 (?)=0.817, F1,53=11.68; P=.001; eta-squared [?²]=0.183) and saturated fat (MD=?1.7%; ?=0.816; F1,53=11.71; P=.001; ?²=0.18) as well as HRQoL scores (MD=8.1 points; ?=0.914; F1,53=4.92; P=.03; ?²=0.086) compared with week 9 postintervention measures. Interactions of time-by-group assignment were found for sodium intakes (?=0.846; F1,53=9.47; P=.003; ?²=0.15) and HEI-C scores (?=0.660; F1,53=27.43; P<.001; ?²=0.35). An analysis of phenotypic and genotypic information by group assignment found improved total fat (MD=?5%; ?=0.815; F1,51=11.36; P=.001; ?²=0.19) and saturated fat (MD=?1.3%; ?=0.822; F1,51=10.86; P=.002; ?²=0.18) intakes. Time-by-group interactions were found for sodium (?=0.844; F3,51=3.09; P=.04; ?²=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 UR - http://www.jmir.org/2019/6/e12580/ UR - http://dx.doi.org/10.2196/12580 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254340 ID - info:doi/10.2196/12580 ER - TY - JOUR AU - Jalil, Sakib AU - Myers, Trina AU - Atkinson, Ian AU - Soden, Muriel PY - 2019/06/06 TI - Complementing a Clinical Trial With Human-Computer Interaction: Patients? User Experience With Telehealth JO - JMIR Hum Factors SP - e9481 VL - 6 IS - 2 KW - clinical user-experience evaluation KW - telehealth KW - type 2 diabetes KW - user experience KW - human-computer interaction KW - patient-centered KW - patient-technology interaction KW - eHealth N2 - 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. UR - http://humanfactors.jmir.org/2019/2/e9481/ UR - http://dx.doi.org/10.2196/humanfactors.9481 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172958 ID - info:doi/10.2196/humanfactors.9481 ER - TY - JOUR AU - Grasaas, Erik AU - Fegran, Liv AU - Helseth, Sølvi AU - Stinson, Jennifer AU - Martinez, Santiago AU - Lalloo, Chitra AU - Haraldstad, Kristin PY - 2019/06/03 TI - iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway JO - JMIR Res Protoc SP - e12940 VL - 8 IS - 6 KW - health KW - self-management KW - adolescent KW - chronic pain KW - translating KW - mobile app N2 - 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. UR - https://www.researchprotocols.org/2019/6/e12940/ UR - http://dx.doi.org/10.2196/12940 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162132 ID - info:doi/10.2196/12940 ER - TY - JOUR AU - Rodriguez, Sarah AU - Hwang, Kevin AU - Wang, Jing PY - 2019/05/23 TI - Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers JO - JMIR Form Res SP - e10388 VL - 3 IS - 2 KW - patient-generated health data KW - connected health KW - remote monitoring KW - electronic health record KW - hypertension KW - patient reported outcome KW - self-measured blood pressure KW - self-monitoring of blood pressure N2 - 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. UR - http://formative.jmir.org/2019/2/e10388/ UR - http://dx.doi.org/10.2196/10388 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124468 ID - info:doi/10.2196/10388 ER - TY - JOUR AU - Zhang, Lingling AU - Babu, V. Sabarish AU - Jindal, Meenu AU - Williams, E. Joel AU - Gimbel, W. Ronald PY - 2019/05/23 TI - A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study JO - JMIR Res Protoc SP - e13502 VL - 8 IS - 5 KW - heart failure KW - mobile health KW - self-management KW - patient engagement KW - virtual human N2 - 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 UR - http://www.researchprotocols.org/2019/5/e13502/ UR - http://dx.doi.org/10.2196/13502 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124472 ID - info:doi/10.2196/13502 ER - TY - JOUR AU - Ferrara, Giannina AU - Kim, Jenna AU - Lin, Shuhao AU - Hua, Jenna AU - Seto, Edmund PY - 2019/05/17 TI - A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates JO - JMIR Mhealth Uhealth SP - e9232 VL - 7 IS - 5 KW - diet KW - nutrition assessment KW - behavior and behavior mechanisms N2 - 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. UR - http://mhealth.jmir.org/2019/5/e9232/ UR - http://dx.doi.org/10.2196/mhealth.9232 UR - http://www.ncbi.nlm.nih.gov/pubmed/31102369 ID - info:doi/10.2196/mhealth.9232 ER - TY - JOUR AU - Hyppönen, Hannele AU - Kaipio, Johanna AU - Heponiemi, Tarja AU - Lääveri, Tinja AU - Aalto, Anna-Mari AU - Vänskä, Jukka AU - Elovainio, Marko PY - 2019/05/16 TI - Developing the National Usability-Focused Health Information System Scale for Physicians: Validation Study JO - J Med Internet Res SP - e12875 VL - 21 IS - 5 KW - physicians KW - health information systems KW - questionnaire KW - validation studies N2 - 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. UR - https://www.jmir.org/2019/5/e12875/ UR - http://dx.doi.org/10.2196/12875 UR - http://www.ncbi.nlm.nih.gov/pubmed/31099336 ID - info:doi/10.2196/12875 ER - TY - JOUR AU - Ponum, Mahvish AU - Hasan, Osman AU - Khan, Saadia PY - 2019/05/14 TI - EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases JO - Interact J Med Res SP - e12664 VL - 8 IS - 2 KW - infectious diseases KW - mHealth KW - causes of death N2 - 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. UR - http://www.i-jmr.org/2019/2/e12664/ UR - http://dx.doi.org/10.2196/12664 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094329 ID - info:doi/10.2196/12664 ER - TY - JOUR AU - Kawakyu, Nami AU - Nduati, Ruth AU - Munguambe, Khátia AU - Coutinho, Joana AU - Mburu, Nancy AU - DeCastro, Georgina AU - Inguane, Celso AU - Zunt, Andrew AU - Abburi, Neil AU - Sherr, Kenneth AU - Gimbel, Sarah PY - 2019/05/13 TI - 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 JO - JMIR Mhealth Uhealth SP - e13963 VL - 7 IS - 5 KW - mHealth KW - quality improvement KW - engineering KW - HIV KW - mother to child transmission KW - implementation science N2 - 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. UR - http://mhealth.jmir.org/2019/5/e13963/ UR - http://dx.doi.org/10.2196/13963 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094351 ID - info:doi/10.2196/13963 ER - TY - JOUR AU - Bhattacharyya, Onil AU - Mossman, Kathryn AU - Gustafsson, Lovisa AU - Schneider, C. Eric PY - 2019/05/09 TI - Using Human-Centered Design to Build a Digital Health Advisor for Patients With Complex Needs: Persona and Prototype Development JO - J Med Internet Res SP - e10318 VL - 21 IS - 5 KW - chronic disease KW - user-centered design KW - medical applications N2 - 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. UR - https://www.jmir.org/2019/5/e10318/ UR - http://dx.doi.org/10.2196/10318 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094334 ID - info:doi/10.2196/10318 ER - TY - JOUR AU - Ohligs, Marian AU - Pereira, Carina AU - Voigt, Verena AU - Koeny, Marcus AU - Janß, Armin AU - Rossaint, Rolf AU - Czaplik, Michael PY - 2019/05/01 TI - Evaluation of an Anesthesia Dashboard Functional Model Based on a Manufacturer-Independent Communication Standard: Comparative Feasibility Study JO - JMIR Hum Factors SP - e12553 VL - 6 IS - 2 KW - operating room KW - anesthesia KW - interconnection KW - networking KW - human-computer interaction KW - process optimization KW - intelligent alarms KW - decision-support systems KW - 11073 SDC KW - service-oriented device connectivity N2 - 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. UR - http://humanfactors.jmir.org/2019/2/e12553/ UR - http://dx.doi.org/10.2196/12553 UR - http://www.ncbi.nlm.nih.gov/pubmed/31042150 ID - info:doi/10.2196/12553 ER - TY - JOUR AU - Fu, NC Helen AU - Adam, J. Terrence AU - Konstan, A. Joseph AU - Wolfson, A. Julian AU - Clancy, R. Thomas AU - Wyman, F. Jean PY - 2019/04/30 TI - Influence of Patient Characteristics and Psychological Needs on Diabetes Mobile App Usability in Adults With Type 1 or Type 2 Diabetes: Crossover Randomized Trial JO - JMIR Diabetes SP - e11462 VL - 4 IS - 2 KW - mHealth KW - diabetes KW - self-management KW - usability KW - Self-Determination Theory KW - mobile apps KW - user satisfaction N2 - 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. UR - https://diabetes.jmir.org/2019/2/e11462/ UR - http://dx.doi.org/10.2196/11462 UR - http://www.ncbi.nlm.nih.gov/pubmed/31038468 ID - info:doi/10.2196/11462 ER - TY - JOUR AU - Gerber, Moreno Stephan AU - Schütz, Narayan AU - Uslu, Sinan Arif AU - Schmidt, Nadine AU - Röthlisberger, Carina AU - Wyss, Patric AU - Perny, Sandra AU - Wyss, Corina AU - Koenig-Bruhin, Monica AU - Urwyler, Prabitha AU - Nyffeler, Thomas AU - Marchal-Crespo, Laura AU - Mosimann, Peter Urs AU - Müri, Martin René AU - Nef, Tobias PY - 2019/04/26 TI - Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study JO - JMIR Rehabil Assist Technol SP - e13163 VL - 6 IS - 1 KW - aphasia KW - high-intensity training KW - telerehabilitation KW - multiplatform system N2 - 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. UR - http://rehab.jmir.org/2019/1/e13163/ UR - http://dx.doi.org/10.2196/13163 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025946 ID - info:doi/10.2196/13163 ER - TY - JOUR AU - Setiawan, Agus I. Made AU - Zhou, Leming AU - Alfikri, Zakiy AU - Saptono, Andi AU - Fairman, D. Andrea AU - Dicianno, Edward Brad AU - Parmanto, Bambang PY - 2019/04/25 TI - An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies JO - JMIR Form Res SP - e12982 VL - 3 IS - 2 KW - mHealth KW - adaptive mHealth KW - mobile apps KW - telemedicine KW - personalized medicine KW - self-management KW - self-care KW - caregivers KW - chronic disease KW - persons with disabilities N2 - 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. UR - http://formative.jmir.org/2019/2/e12982/ UR - http://dx.doi.org/10.2196/12982 UR - http://www.ncbi.nlm.nih.gov/pubmed/31021324 ID - info:doi/10.2196/12982 ER - TY - JOUR AU - Tarver, L. Will AU - Haggstrom, A. David PY - 2019/04/23 TI - The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review JO - J Med Internet Res SP - e10256 VL - 21 IS - 4 KW - underserved populations KW - medical informatics KW - cancer N2 - 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. UR - http://www.jmir.org/2019/4/e10256/ UR - http://dx.doi.org/10.2196/10256 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012855 ID - info:doi/10.2196/10256 ER - TY - JOUR AU - Richardson, Safiya AU - Feldstein, David AU - McGinn, Thomas AU - Park, S. Linda AU - Khan, Sundas AU - Hess, Rachel AU - Smith, D. Paul AU - Mishuris, Grochow Rebecca AU - McCullagh, Lauren AU - Mann, Devin PY - 2019/04/15 TI - Live Usability Testing of Two Complex Clinical Decision Support Tools: Observational Study JO - JMIR Hum Factors SP - e12471 VL - 6 IS - 2 KW - usability KW - usability testing KW - user experience KW - clinical decision support KW - health informatics KW - provider adoption KW - workflow KW - live usability KW - clinical prediction rules N2 - 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. UR - http://humanfactors.jmir.org/2019/2/e12471/ UR - http://dx.doi.org/10.2196/12471 UR - http://www.ncbi.nlm.nih.gov/pubmed/30985283 ID - info:doi/10.2196/12471 ER - TY - JOUR AU - Boceta, Jaime AU - Samper, Daniel AU - de la Torre, Alejandro AU - Sánchez-de la Rosa, Rainel AU - González, Gloria PY - 2019/04/01 TI - Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain JO - JMIR Cancer SP - e10187 VL - 5 IS - 1 KW - breakthrough cancer pain KW - mHealth KW - mobile app KW - App INES·DIO N2 - 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·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·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·DIO. Conclusions: Our study showed that App INES·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. UR - https://cancer.jmir.org/2019/1/e10187/ UR - http://dx.doi.org/10.2196/10187 UR - http://www.ncbi.nlm.nih.gov/pubmed/30932862 ID - info:doi/10.2196/10187 ER - TY - JOUR AU - Buitenweg, C. David AU - Bongers, L. Ilja AU - van de Mheen, Dike AU - van Oers, AM Hans AU - van Nieuwenhuizen, Chijs PY - 2019/03/28 TI - Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems JO - JMIR Ment Health SP - e12378 VL - 6 IS - 3 KW - mobile app KW - quality of life KW - mental health KW - homeless persons KW - medical informatics N2 - 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. UR - http://mental.jmir.org/2019/3/e12378/ UR - http://dx.doi.org/10.2196/12378 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920381 ID - info:doi/10.2196/12378 ER - TY - JOUR AU - Prince, M. Rebecca AU - Soung Yee, Anthony AU - Parente, Laura AU - Enright, A. Katherine AU - Grunfeld, Eva AU - Powis, Melanie AU - Husain, Amna AU - Gandhi, Sonal AU - Krzyzanowska, K. Monika PY - 2019/03/28 TI - User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients JO - J Med Internet Res SP - e9958 VL - 21 IS - 3 KW - prototype KW - Web-based tool KW - toxicity management KW - chemotherapy KW - self-management N2 - 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. UR - http://www.jmir.org/2019/3/e9958/ UR - http://dx.doi.org/10.2196/jmir.9958 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920373 ID - info:doi/10.2196/jmir.9958 ER - TY - JOUR AU - Moraes Carrilho, Juliana AU - Oliveira, Ramos Isaias José AU - Santos, Dimitri AU - Osanan, Costa Gabriel AU - Cruz-Correia, João Ricardo AU - Reis, Nogueira Zilma Silveira PY - 2019/03/28 TI - Pregnant Users? Perceptions of the Birth Plan Interface in the ?My Prenatal Care? App: Observational Validation Study JO - JMIR Form Res SP - e11374 VL - 3 IS - 1 KW - birth plan KW - perinatal care KW - usability, mobile health KW - mobile app KW - pregnancy KW - prenatal care KW - mobile phone N2 - 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. UR - http://formative.jmir.org/2019/1/e11374/ UR - http://dx.doi.org/10.2196/11374 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920372 ID - info:doi/10.2196/11374 ER - TY - JOUR AU - Mugisha, Alice AU - Babic, Ankica AU - Wakholi, Peter AU - Tylleskär, Thorkild PY - 2019/03/22 TI - High-Fidelity Prototyping for Mobile Electronic Data Collection Forms Through Design and User Evaluation JO - JMIR Hum Factors SP - e11852 VL - 6 IS - 1 KW - high-fidelity prototype KW - group user testing KW - mobile electronic data collection forms KW - usability evaluation N2 - 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. UR - http://humanfactors.jmir.org/2019/1/e11852/ UR - http://dx.doi.org/10.2196/11852 UR - http://www.ncbi.nlm.nih.gov/pubmed/30900995 ID - info:doi/10.2196/11852 ER - TY - JOUR AU - Lang, Alexandra AU - Simmonds, Mark AU - Pinchin, James AU - Sharples, Sarah AU - Dunn, Lorrayne AU - Clarke, Susan AU - Bennett, Owen AU - Wood, Sally AU - Swinscoe, Caron PY - 2019/03/06 TI - The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation JO - JMIR Med Inform SP - e11678 VL - 7 IS - 1 KW - health information technology KW - early warning score KW - mobile health KW - staff workload KW - clinical deterioration KW - patient safety KW - mixed methods N2 - 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. UR - http://medinform.jmir.org/2019/1/e11678/ UR - http://dx.doi.org/10.2196/11678 UR - http://www.ncbi.nlm.nih.gov/pubmed/30839278 ID - info:doi/10.2196/11678 ER - TY - JOUR AU - Kavuma, Michael PY - 2019/02/25 TI - The Usability of Electronic Medical Record Systems Implemented in Sub-Saharan Africa: A Literature Review of the Evidence JO - JMIR Hum Factors SP - e9317 VL - 6 IS - 1 KW - review KW - computer systems KW - delivery of health care KW - sub-Saharan Africa N2 - 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. UR - http://humanfactors.jmir.org/2019/1/e9317/ UR - http://dx.doi.org/10.2196/humanfactors.9317 UR - http://www.ncbi.nlm.nih.gov/pubmed/30801251 ID - info:doi/10.2196/humanfactors.9317 ER - TY - JOUR AU - Mehra, Sumit AU - Visser, Bart AU - Cila, Nazli AU - van den Helder, Jantine AU - Engelbert, HH Raoul AU - Weijs, JM Peter AU - Kröse, JA Ben PY - 2019/02/01 TI - Supporting Older Adults in Exercising With a Tablet: A Usability Study JO - JMIR Hum Factors SP - e11598 VL - 6 IS - 1 KW - frail elderly KW - aged KW - activities of daily living KW - exercise KW - health behavior KW - telemedicine KW - mobile devices KW - tablet computers KW - usability testing KW - mobile phone N2 - 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. UR - http://humanfactors.jmir.org/2019/1/e11598/ UR - http://dx.doi.org/10.2196/11598 UR - http://www.ncbi.nlm.nih.gov/pubmed/30707106 ID - info:doi/10.2196/11598 ER - TY - JOUR AU - Heynsbergh, Natalie AU - Heckel, Leila AU - Botti, Mari AU - Livingston, M. Patricia PY - 2019/01/31 TI - A Smartphone App to Support Carers of People Living With Cancer: A Feasibility and Usability Study JO - JMIR Cancer SP - e11779 VL - 5 IS - 1 KW - cancer KW - carer KW - mobile app KW - smartphone KW - technology KW - mobile phone N2 - 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. UR - http://cancer.jmir.org/2019/1/e11779/ UR - http://dx.doi.org/10.2196/11779 UR - http://www.ncbi.nlm.nih.gov/pubmed/30702432 ID - info:doi/10.2196/11779 ER - TY - JOUR AU - Adam, Maya AU - McMahon, A. Shannon AU - Prober, Charles AU - Bärnighausen, Till PY - 2019/01/30 TI - Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach JO - J Med Internet Res SP - e12128 VL - 21 IS - 1 KW - human-centered design KW - health promotion KW - health behavior KW - health knowledge, attitudes, practice KW - community health workers KW - telemedicine KW - eHealth KW - mHealth UR - http://www.jmir.org/2019/1/e12128/ UR - http://dx.doi.org/10.2196/12128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698531 ID - info:doi/10.2196/12128 ER - TY - JOUR AU - Weichelt, Bryan AU - Bendixsen, Casper AU - Keifer, Matthew PY - 2019/01/29 TI - Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project JO - J Med Internet Res SP - e9711 VL - 21 IS - 1 KW - agriculture KW - farmworkers KW - injuries KW - occupational medicine KW - return to work KW - software application N2 - 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. UR - https://www.jmir.org/2019/1/e9711/ UR - http://dx.doi.org/10.2196/jmir.9711 UR - http://www.ncbi.nlm.nih.gov/pubmed/30694202 ID - info:doi/10.2196/jmir.9711 ER - TY - JOUR AU - Allman-Farinelli, Margaret AU - Ijaz, Kiran AU - Tran, Helen AU - Pallotta, Hermes AU - Ramos, Sidney AU - Liu, Junya AU - Wellard-Cole, Lyndal AU - Calvo, A. Rafael PY - 2019/01/09 TI - A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability JO - JMIR Formativ Res SP - e12456 VL - 3 IS - 1 KW - virtual reality KW - nutrition promotion KW - food policy KW - take-out food KW - obesity KW - young adults N2 - 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. UR - http://formative.jmir.org/2019/1/e12456/ UR - http://dx.doi.org/10.2196/12456 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684440 ID - info:doi/10.2196/12456 ER - TY - JOUR AU - Kakarmath, S. Sujay AU - de Redon, Emily AU - Centi, Jayne Amanda AU - Palacholla, Ramya AU - Kvedar, Joseph AU - Jethwani, Kamal AU - Agboola, Stephen PY - 2018/12/21 TI - Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study JO - JMIR Pediatr Parent SP - e10804 VL - 1 IS - 2 KW - connected health KW - continuous monitoring KW - mobile phone KW - pediatric KW - temperature N2 - 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) UR - http://pediatrics.jmir.org/2018/2/e10804/ UR - http://dx.doi.org/10.2196/10804 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518304 ID - info:doi/10.2196/10804 ER - TY - JOUR AU - Moradian, Saeed AU - Krzyzanowska, K. Monika AU - Maguire, Roma AU - Morita, P. Plinio AU - Kukreti, Vishal AU - Avery, Jonathan AU - Liu, Geoffrey AU - Cafazzo, Joseph AU - Howell, Doris PY - 2018/12/21 TI - Usability Evaluation of a Mobile Phone?Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study JO - JMIR Cancer SP - e10932 VL - 4 IS - 2 KW - mobile apps KW - mobile health KW - mobile phone KW - patient-centered care KW - patient remote monitoring KW - self-care KW - symptom management KW - usability testing N2 - 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. UR - http://cancer.jmir.org/2018/2/e10932/ UR - http://dx.doi.org/10.2196/10932 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578238 ID - info:doi/10.2196/10932 ER - TY - JOUR AU - Chokshi, Kuppin Sara AU - Mann, M. Devin PY - 2018/12/19 TI - Innovating From Within: A Process Model for User-Centered Digital Development in Academic Medical Centers JO - JMIR Hum Factors SP - e11048 VL - 5 IS - 4 KW - academic medical centers KW - digital health KW - heath information technology KW - innovation KW - process model KW - user-centered design N2 - 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. UR - http://humanfactors.jmir.org/2018/4/e11048/ UR - http://dx.doi.org/10.2196/11048 UR - http://www.ncbi.nlm.nih.gov/pubmed/30567688 ID - info:doi/10.2196/11048 ER - TY - JOUR AU - Deady, Mark AU - Johnston, David AU - Milne, David AU - Glozier, Nick AU - Peters, Dorian AU - Calvo, Rafael AU - Harvey, Samuel PY - 2018/12/04 TI - Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study JO - JMIR Mhealth Uhealth SP - e11661 VL - 6 IS - 12 KW - depression KW - workplace KW - mHealth KW - smartphone KW - eHealth KW - pilot N2 - 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. UR - https://mhealth.jmir.org/2018/12/e11661/ UR - http://dx.doi.org/10.2196/11661 UR - http://www.ncbi.nlm.nih.gov/pubmed/30514694 ID - info:doi/10.2196/11661 ER - TY - JOUR AU - Shtrichman, Ronit AU - Conrad, Stefan AU - Schimo, Kai AU - Shachar, Ran AU - Machluf, Ehud AU - Mindal, Enrique AU - Epstein, Howard AU - Epstein, Shirli AU - Paz, Alan PY - 2018/11/26 TI - Use of a Digital Medication Management System for Effective Assessment and Enhancement of Patient Adherence to Therapy (ReX): Feasibility Study JO - JMIR Hum Factors SP - e10128 VL - 5 IS - 4 KW - medication adherence KW - medication nonadherence KW - personalized medicine KW - therapy management N2 - 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. UR - http://humanfactors.jmir.org/2018/4/e10128/ UR - http://dx.doi.org/10.2196/10128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30478020 ID - info:doi/10.2196/10128 ER - TY - JOUR AU - Asfaw, Ayele Alemseged AU - Yan, H. Connie AU - Sweiss, Karen AU - Wirth, Scott AU - Ramirez, H. Victor AU - Patel, R. Pritesh AU - Sharp, K. Lisa PY - 2018/11/12 TI - Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study JO - JMIR Cancer SP - e12 VL - 4 IS - 2 KW - antineoplastic therapy KW - challenges KW - race/ethnicity KW - medication adherence KW - multiple myeloma N2 - 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. UR - http://cancer.jmir.org/2018/2/e12/ UR - http://dx.doi.org/10.2196/cancer.9918 UR - http://www.ncbi.nlm.nih.gov/pubmed/30425032 ID - info:doi/10.2196/cancer.9918 ER - TY - JOUR AU - Liang, Jun AU - Xian, Deqiang AU - Liu, Xingyu AU - Fu, Jing AU - Zhang, Xingting AU - Tang, Buzhou AU - Lei, Jianbo PY - 2018/11/08 TI - Usability Study of Mainstream Wearable Fitness Devices: Feature Analysis and System Usability Scale Evaluation JO - JMIR Mhealth Uhealth SP - e11066 VL - 6 IS - 11 KW - wearable devices KW - usability KW - System Usability Scale KW - function comparison KW - fitness N2 - 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. UR - http://mhealth.jmir.org/2018/11/e11066/ UR - http://dx.doi.org/10.2196/11066 UR - http://www.ncbi.nlm.nih.gov/pubmed/30409767 ID - info:doi/10.2196/11066 ER - TY - JOUR AU - Wellard-Cole, Lyndal AU - Potter, Melisa AU - Jung, (Joseph) Jisu AU - Chen, Juliana AU - Kay, Judy AU - Allman-Farinelli, Margaret PY - 2018/11/07 TI - A Tool to Measure Young Adults? Food Intake: Design and Development of an Australian Database of Foods for the Eat and Track Smartphone App JO - JMIR Mhealth Uhealth SP - e12136 VL - 6 IS - 11 KW - diet surveys KW - smartphone KW - mobile phone KW - young adult N2 - 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. UR - http://mhealth.jmir.org/2018/11/e12136/ UR - http://dx.doi.org/10.2196/12136 UR - http://www.ncbi.nlm.nih.gov/pubmed/30404768 ID - info:doi/10.2196/12136 ER - TY - JOUR AU - Lo, L. Louisa AU - Collins, M. Ian AU - Bressel, Mathias AU - Butow, Phyllis AU - Emery, Jon AU - Keogh, Louise AU - Weideman, Prue AU - Steel, Emma AU - Hopper, L. John AU - Trainer, H. Alison AU - Mann, B. Gregory AU - Bickerstaffe, Adrian AU - Antoniou, C. Antonis AU - Cuzick, Jack AU - Phillips, Kelly-Anne PY - 2018/11/07 TI - The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing JO - JMIR Formativ Res SP - e24 VL - 2 IS - 2 KW - clinical decision support KW - breast cancer KW - BRCA1 gene KW - BRCA2 gene KW - risk KW - preventive health KW - screening N2 - 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. UR - http://formative.jmir.org/2018/2/e24/ UR - http://dx.doi.org/10.2196/formative.9935 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684421 ID - info:doi/10.2196/formative.9935 ER - TY - JOUR AU - Verdaguer, Sandra AU - Mateo, F. Katrina AU - Wyka, Katarzyna AU - Dennis-Tiwary, A. Tracy AU - Leung, May May PY - 2018/11/01 TI - A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study JO - JMIR Formativ Res SP - e21 VL - 2 IS - 2 KW - usability testing KW - interactive technology KW - mHealth, childhood obesity KW - minority KW - health nutrition KW - health education N2 - 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. UR - http://formative.jmir.org/2018/2/e21/ UR - http://dx.doi.org/10.2196/formative.9747 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684417 ID - info:doi/10.2196/formative.9747 ER - TY - JOUR AU - Bromley, Sally AU - Drew, Michael AU - Talpey, Scott AU - McIntosh, Andrew AU - Finch, Caroline PY - 2018/10/09 TI - Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System JO - JMIR Hum Factors SP - e27 VL - 5 IS - 4 KW - online KW - health KW - injury & prevention KW - athletic performance KW - internet KW - mobile phone N2 - 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. UR - http://humanfactors.jmir.org/2018/4/e27/ UR - http://dx.doi.org/10.2196/humanfactors.9541 UR - http://www.ncbi.nlm.nih.gov/pubmed/30305257 ID - info:doi/10.2196/humanfactors.9541 ER - TY - JOUR AU - Martinez, William AU - Threatt, L. Anthony AU - Rosenbloom, Trent S. AU - Wallston, A. Kenneth AU - Hickson, B. Gerald AU - Elasy, A. Tom PY - 2018/9/24 TI - A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing JO - JMIR Hum Factors SP - e26 VL - 5 IS - 3 KW - diabetes mellitus, type 2 KW - patient portals KW - qualitative research KW - consumer health informatics N2 - 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. UR - http://humanfactors.jmir.org/2018/3/e26/ UR - http://dx.doi.org/10.2196/humanfactors.9569 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249579 ID - info:doi/10.2196/humanfactors.9569 ER - TY - JOUR AU - Piegari, Giuseppe AU - Iovane, Valentina AU - Carletti, Vincenzo AU - Fico, Rosario AU - Costagliola, Alessandro AU - De Biase, Davide AU - Prisco, Francesco AU - Paciello, Orlando PY - 2018/9/21 TI - Assessment of Google Glass for Photographic Documentation in Veterinary Forensic Pathology: Usability Study JO - JMIR Mhealth Uhealth SP - e180 VL - 6 IS - 9 KW - Google Glass KW - necropsy KW - pictures KW - documentation KW - veterinary forensic pathology KW - mobile phone N2 - 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. UR - http://mhealth.jmir.org/2018/9/e180/ UR - http://dx.doi.org/10.2196/mhealth.9975 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249586 ID - info:doi/10.2196/mhealth.9975 ER - TY - JOUR AU - Cho, Hwayoung AU - Powell, Dakota AU - Pichon, Adrienne AU - Thai, Jennie AU - Bruce, Josh AU - Kuhns, M. Lisa AU - Garofalo, Robert AU - Schnall, Rebecca PY - 2018/09/07 TI - A Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation JO - JMIR Mhealth Uhealth SP - e11450 VL - 6 IS - 9 KW - mobile apps KW - mobile health KW - information technology KW - health information technology KW - usability evaluation KW - adolescents KW - HIV prevention KW - men who have sex with men N2 - 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. UR - http://mhealth.jmir.org/2018/9/e11450/ UR - http://dx.doi.org/10.2196/11450 UR - http://www.ncbi.nlm.nih.gov/pubmed/30194060 ID - info:doi/10.2196/11450 ER - TY - JOUR AU - Børøsund, Elin AU - Mirkovic, Jelena AU - Clark, M. Matthew AU - Ehlers, L. Shawna AU - Andrykowski, A. Michael AU - Bergland, Anne AU - Westeng, Marianne AU - Solberg Nes, Lise PY - 2018/09/06 TI - A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing JO - JMIR Formativ Res SP - e19 VL - 2 IS - 2 KW - stress management KW - mindfulness KW - cancer KW - eHealth KW - mHealth KW - mobile apps KW - development KW - usability KW - user-centered design KW - mobile phones N2 - 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) UR - http://formative.jmir.org/2018/2/e19/ UR - http://dx.doi.org/10.2196/formative.9954 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684438 ID - info:doi/10.2196/formative.9954 ER - TY - JOUR AU - Fuller-Tyszkiewicz, Matthew AU - Richardson, Ben AU - Klein, Britt AU - Skouteris, Helen AU - Christensen, Helen AU - Austin, David AU - Castle, David AU - Mihalopoulos, Cathrine AU - O'Donnell, Renee AU - Arulkadacham, Lilani AU - Shatte, Adrian AU - Ware, Anna PY - 2018/08/23 TI - A Mobile App?Based Intervention for Depression: End-User and Expert Usability Testing Study JO - JMIR Ment Health SP - e54 VL - 5 IS - 3 KW - depression KW - eHealth KW - mHealth KW - young adult N2 - 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. UR - http://mental.jmir.org/2018/3/e54/ UR - http://dx.doi.org/10.2196/mental.9445 UR - http://www.ncbi.nlm.nih.gov/pubmed/30139722 ID - info:doi/10.2196/mental.9445 ER - TY - JOUR AU - Sharma, Kumar Deepak AU - Peterson, Jerrold Kevin AU - Hong, Na AU - Jiang, Guoqian PY - 2018/07/25 TI - The D2Refine Platform for the Standardization of Clinical Research Study Data Dictionaries: Usability Study JO - JMIR Hum Factors SP - e10205 VL - 5 IS - 3 KW - usability study KW - data dictionary KW - interoperability KW - electronic health records KW - usability framework KW - metadata KW - standardization N2 - 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. UR - http://humanfactors.jmir.org/2018/3/e10205/ UR - http://dx.doi.org/10.2196/10205 UR - http://www.ncbi.nlm.nih.gov/pubmed/30045832 ID - info:doi/10.2196/10205 ER - TY - JOUR AU - Schoen, W. Martin AU - Basch, Ethan AU - Hudson, L. Lori AU - Chung, E. Arlene AU - Mendoza, R. Tito AU - Mitchell, A. Sandra AU - St. Germain, Diane AU - Baumgartner, Paul AU - Sit, Laura AU - Rogak, J. Lauren AU - Shouery, Marwan AU - Shalley, Eve AU - Reeve, B. Bryce AU - Fawzy, R. Maria AU - Bhavsar, A. Nrupen AU - Cleeland, Charles AU - Schrag, Deborah AU - Dueck, C. Amylou AU - Abernethy, P. Amy PY - 2018/07/16 TI - Software for Administering the National Cancer Institute?s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study JO - JMIR Hum Factors SP - e10070 VL - 5 IS - 3 KW - usability KW - patient-reported outcomes KW - symptoms KW - adverse events KW - PRO-CTCAE KW - cancer clinical trials N2 - 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) UR - http://humanfactors.jmir.org/2018/3/e10070/ UR - http://dx.doi.org/10.2196/10070 UR - http://www.ncbi.nlm.nih.gov/pubmed/30012546 ID - info:doi/10.2196/10070 ER - TY - JOUR AU - Nazi, M. Kim AU - Turvey, L. Carolyn AU - Klein, M. Dawn AU - Hogan, P. Timothy PY - 2018/07/10 TI - A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design JO - J Med Internet Res SP - e10413 VL - 20 IS - 7 KW - patient portal KW - user-centered design KW - eHealth KW - veteran N2 - 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. UR - http://www.jmir.org/2018/7/e10413/ UR - http://dx.doi.org/10.2196/10413 UR - http://www.ncbi.nlm.nih.gov/pubmed/29991468 ID - info:doi/10.2196/10413 ER - TY - JOUR AU - Gayed, Aimée AU - LaMontagne, D. Anthony AU - Milner, Allison AU - Deady, Mark AU - Calvo, A. Rafael AU - Christensen, Helen AU - Mykletun, Arnstein AU - Glozier, Nick AU - Harvey, B. Samuel PY - 2018/07/03 TI - A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness JO - JMIR Ment Health SP - e10517 VL - 5 IS - 3 KW - manager; supervisor training; workplace mental health; mental health education; online intervention; knowledge; attitudes; behaviour; eHealth N2 - 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. UR - http://mental.jmir.org/2018/3/e10517/ UR - http://dx.doi.org/10.2196/10517 UR - http://www.ncbi.nlm.nih.gov/pubmed/29970359 ID - info:doi/10.2196/10517 ER - TY - JOUR AU - Schobel, Johannes AU - Pryss, Rüdiger AU - Probst, Thomas AU - Schlee, Winfried AU - Schickler, Marc AU - Reichert, Manfred PY - 2018/06/29 TI - Learnability of a Configurator Empowering End Users to Create Mobile Data Collection Instruments: Usability Study JO - JMIR Mhealth Uhealth SP - e148 VL - 6 IS - 6 KW - mHealth KW - data collection KW - mobile apps N2 - 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. UR - http://mhealth.jmir.org/2018/6/e148/ UR - http://dx.doi.org/10.2196/mhealth.9826 UR - http://www.ncbi.nlm.nih.gov/pubmed/29959107 ID - info:doi/10.2196/mhealth.9826 ER - TY - JOUR AU - Srikesavan, Cynthia AU - Williamson, Esther AU - Cranston, Tim AU - Hunter, John AU - Adams, Jo AU - Lamb, E. Sarah PY - 2018/06/27 TI - An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing JO - J Med Internet Res SP - e10457 VL - 20 IS - 6 KW - rheumatoid arthritis KW - hand joints KW - exercise training KW - web-based N2 - 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. UR - http://www.jmir.org/2018/6/e10457/ UR - http://dx.doi.org/10.2196/10457 UR - http://www.ncbi.nlm.nih.gov/pubmed/29950288 ID - info:doi/10.2196/10457 ER - TY - JOUR AU - Bernier, Angelina AU - Fedele, David AU - Guo, Yi AU - Chavez, Sarah AU - Smith, D. Megan AU - Warnick, Jennifer AU - Lieberman, Leora AU - Modave, François PY - 2018/06/06 TI - New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study JO - JMIR Diabetes SP - e10 VL - 3 IS - 2 KW - mHealth KW - information technology KW - diabetes education KW - pediatrics N2 - 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 (?=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. UR - http://diabetes.jmir.org/2018/2/e10/ UR - http://dx.doi.org/10.2196/diabetes.9202 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291069 ID - info:doi/10.2196/diabetes.9202 ER - TY - JOUR AU - Katapodi, C. Maria AU - Jung, Miyeon AU - Schafenacker, M. Ann AU - Milliron, J. Kara AU - Mendelsohn-Victor, E. Kari AU - Merajver, D. Sofia AU - Northouse, L. Laurel PY - 2018/04/13 TI - Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study JO - JMIR Cancer SP - e7 VL - 4 IS - 1 KW - BRCA families KW - family-based intervention study KW - Web-based intervention study KW - psycho-educational and skills-building intervention study KW - communication and coping KW - patient decision-aid KW - genetic testing N2 - 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) UR - http://cancer.jmir.org/2018/1/e7/ UR - http://dx.doi.org/10.2196/cancer.9210 UR - http://www.ncbi.nlm.nih.gov/pubmed/29653920 ID - info:doi/10.2196/cancer.9210 ER - TY - JOUR AU - Bernhard, Gerda AU - Mahler, Cornelia AU - Seidling, Marita Hanna AU - Stützle, Marion AU - Ose, Dominik AU - Baudendistel, Ines AU - Wensing, Michel AU - Szecsenyi, Joachim PY - 2018/03/27 TI - Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements JO - J Med Internet Res SP - e105 VL - 20 IS - 3 KW - medication KW - self-management KW - patient portal KW - patient participation KW - type 2 diabetes mellitus KW - focus groups KW - primary care N2 - 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. UR - http://www.jmir.org/2018/3/e105/ UR - http://dx.doi.org/10.2196/jmir.8666 UR - http://www.ncbi.nlm.nih.gov/pubmed/29588269 ID - info:doi/10.2196/jmir.8666 ER - TY - JOUR AU - Zikmund-Fisher, J. Brian AU - Scherer, M. Aaron AU - Witteman, O. Holly AU - Solomon, B. Jacob AU - Exe, L. Nicole AU - Fagerlin, Angela PY - 2018/03/26 TI - Effect of Harm Anchors in Visual Displays of Test Results on Patient Perceptions of Urgency About Near-Normal Values: Experimental Study JO - J Med Internet Res SP - e98 VL - 20 IS - 3 KW - decision making KW - education of patients KW - electronic health record KW - computer graphics KW - clinical laboratory information systems N2 - 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. UR - http://www.jmir.org/2018/3/e98/ UR - http://dx.doi.org/10.2196/jmir.8889 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581088 ID - info:doi/10.2196/jmir.8889 ER - TY - JOUR AU - Wallin, Emma AU - Norlund, Fredrika AU - Olsson, Gustaf Erik Martin AU - Burell, Gunilla AU - Held, Claes AU - Carlsson, Tommy PY - 2018/03/16 TI - 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 JO - J Med Internet Res SP - e87 VL - 20 IS - 3 KW - mental health KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - myocardial infarction KW - attrition KW - adherence N2 - 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. UR - http://www.jmir.org/2018/3/e87/ UR - http://dx.doi.org/10.2196/jmir.9690 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549067 ID - info:doi/10.2196/jmir.9690 ER - TY - JOUR AU - Zafeiridi, Paraskevi AU - Paulson, Kevin AU - Dunn, Rosie AU - Wolverson, Emma AU - White, Caroline AU - Thorpe, Adrian Jonathan AU - Antomarini, Marco AU - Cesaroni, Francesca AU - Scocchera, Francesca AU - Landrin-Dutot, Isabelle AU - Malherbe, Laëtitia AU - Lingiah, Hendi AU - Bérard, Marie AU - Gironès, Xavier AU - Quintana, Maria AU - Cortés, Ulises AU - Barrué, Cristian AU - Cortés, Atia AU - Paliokas, Ioannis AU - Votis, Konstantinos AU - Tzovaras, Dimitrios PY - 2018/03/12 TI - A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability JO - JMIR Formativ Res SP - e4 VL - 2 IS - 1 KW - dementia KW - technology KW - social support KW - caregivers N2 - 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. UR - http://formative.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/formative.9083 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684403 ID - info:doi/10.2196/formative.9083 ER - TY - JOUR AU - Dijkstra, Elske Nienke AU - Sino, Maria Carolina Geertruida AU - Heerdink, Rob Eibert AU - Schuurmans, Joanna Marieke PY - 2018/03/07 TI - Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study JO - JMIR Hum Factors SP - e10 VL - 5 IS - 1 KW - primary care KW - home care KW - eHealth KW - mHealth N2 - 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. UR - http://humanfactors.jmir.org/2018/1/e10/ UR - http://dx.doi.org/10.2196/humanfactors.8319 UR - http://www.ncbi.nlm.nih.gov/pubmed/29514771 ID - info:doi/10.2196/humanfactors.8319 ER - TY - JOUR AU - Thirumalai, Mohanraj AU - Kirkland, B. William AU - Misko, R. Samuel AU - Padalabalanarayanan, Sangeetha AU - Malone, A. Laurie PY - 2018/03/06 TI - Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation JO - JMIR Rehabil Assist Technol SP - e2 VL - 5 IS - 1 KW - sedentary lifestyle KW - video games KW - active video gaming KW - Wii Fit KW - equipment design KW - physical activity KW - exercise KW - wheelchairs KW - physical disability KW - rehabilitation KW - usability N2 - 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) UR - http://rehab.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/rehab.8003 UR - http://www.ncbi.nlm.nih.gov/pubmed/29510972 ID - info:doi/10.2196/rehab.8003 ER - TY - JOUR AU - Radovic, Ana AU - Gmelin, Theresa AU - Hua, Jing AU - Long, Cassandra AU - Stein, D. Bradley AU - Miller, Elizabeth PY - 2018/02/26 TI - Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study JO - JMIR Ment Health SP - e17 VL - 5 IS - 1 KW - adolescent KW - adolescent health services KW - technology KW - depression KW - anxiety N2 - 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. UR - http://mental.jmir.org/2018/1/e17/ UR - http://dx.doi.org/10.2196/mental.9441 UR - http://www.ncbi.nlm.nih.gov/pubmed/29483067 ID - info:doi/10.2196/mental.9441 ER - TY - JOUR AU - Schmocker, S. Kaspar AU - Zwahlen, S. Fabian AU - Denecke, Kerstin PY - 2018/02/26 TI - Mobile App for Simplifying Life With Diabetes: Technical Description and Usability Study of GlucoMan JO - JMIR Diabetes SP - e6 VL - 3 IS - 1 KW - diabetes management KW - patient empowerment KW - mobile health KW - self-care KW - chronic disease management KW - diabetes mellitus KW - mobile apps N2 - 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. UR - http://diabetes.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/diabetes.8160 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291070 ID - info:doi/10.2196/diabetes.8160 ER - TY - JOUR AU - Thomson, Karen AU - Brouwers, Corline AU - Damman, C. Olga AU - de Bruijne, C. Martine AU - Timmermans, RM Danielle AU - Melles, Marijke PY - 2018/02/20 TI - How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study JO - JMIR Hum Factors SP - e7 VL - 5 IS - 1 KW - medication adherence KW - eHealth KW - shared decision making KW - self-management KW - patient engagement N2 - 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. UR - http://humanfactors.jmir.org/2018/1/e7/ UR - http://dx.doi.org/10.2196/humanfactors.8948 UR - http://www.ncbi.nlm.nih.gov/pubmed/29463494 ID - info:doi/10.2196/humanfactors.8948 ER - TY - JOUR AU - Ratanawongsa, Neda AU - Matta, Y. George AU - Bohsali, B. Fuad AU - Chisolm, S. Margaret PY - 2018/02/06 TI - Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis JO - JMIR Hum Factors SP - e4 VL - 5 IS - 1 KW - electronic health records KW - physician-patient relations KW - patient safety N2 - 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. UR - http://humanfactors.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/humanfactors.9371 UR - http://www.ncbi.nlm.nih.gov/pubmed/29410388 ID - info:doi/10.2196/humanfactors.9371 ER - TY - JOUR AU - O'Reilly, Aidan Martin AU - Slevin, Patrick AU - Ward, Tomas AU - Caulfield, Brian PY - 2018/01/31 TI - A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift JO - JMIR Mhealth Uhealth SP - e33 VL - 6 IS - 1 KW - mHealth KW - feedback KW - posture KW - exercise therapy KW - biomedical technology KW - lower extremity KW - physical therapy specialty N2 - 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. UR - http://mhealth.jmir.org/2018/1/e33/ UR - http://dx.doi.org/10.2196/mhealth.8115 UR - http://www.ncbi.nlm.nih.gov/pubmed/29386171 ID - info:doi/10.2196/mhealth.8115 ER - TY - JOUR AU - Wang, Chih-Jau AU - Chaovalit, Pimwadee AU - Pongnumkul, Suporn PY - 2018/01/26 TI - A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study JO - JMIR Mhealth Uhealth SP - e27 VL - 6 IS - 1 KW - mobile health KW - breast feeding KW - mobile applications KW - health promotion KW - usability KW - usefulness N2 - 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. UR - http://mhealth.jmir.org/2018/1/e27/ UR - http://dx.doi.org/10.2196/mhealth.8337 UR - http://www.ncbi.nlm.nih.gov/pubmed/29374000 ID - info:doi/10.2196/mhealth.8337 ER - TY - JOUR AU - Kinner, M. Ellen AU - Armer, S. Jessica AU - McGregor, A. Bonnie AU - Duffecy, Jennifer AU - Leighton, Susan AU - Corden, E. Marya AU - Gauthier Mullady, Janine AU - Penedo, J. Frank AU - Lutgendorf, K. Susan PY - 2018/01/15 TI - Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results JO - JMIR Cancer SP - e1 VL - 4 IS - 1 KW - ovarian cancer KW - quality of life KW - feasibility studies KW - eHealth KW - psychological stress N2 - 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. UR - http://cancer.jmir.org/2018/1/e1/ UR - http://dx.doi.org/10.2196/cancer.8430 UR - http://www.ncbi.nlm.nih.gov/pubmed/29335233 ID - info:doi/10.2196/cancer.8430 ER - TY - JOUR AU - Kurahashi, M. Allison AU - Stinson, N. Jennifer AU - van Wyk, Margaret AU - Luca, Stephanie AU - Jamieson, Trevor AU - Weinstein, Peter AU - Cafazzo, A. Joseph AU - Lokuge, Bhadra AU - Cohen, Eyal AU - Rapoport, Adam AU - Husain, Amna PY - 2018/01/09 TI - The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System JO - JMIR Hum Factors SP - e2 VL - 5 IS - 1 KW - patient-centered care KW - patient participation KW - chronic disease KW - communication KW - internet communication tools KW - usability testing KW - interdisciplinary communication KW - health communication KW - continuity of patient care KW - patient care team KW - inventions N2 - 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. UR - http://humanfactors.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.7882 UR - http://www.ncbi.nlm.nih.gov/pubmed/29317386 ID - info:doi/10.2196/humanfactors.7882 ER - TY - JOUR AU - Schnall, Rebecca AU - Cho, Hwayoung AU - Liu, Jianfang PY - 2018/01/05 TI - Health Information Technology Usability Evaluation Scale (Health-ITUES) for Usability Assessment of Mobile Health Technology: Validation Study JO - JMIR Mhealth Uhealth SP - e4 VL - 6 IS - 1 KW - mobile technology KW - usability KW - mobile health apps KW - psychometric evaluation N2 - 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. UR - http://mhealth.jmir.org/2018/1/e4/ UR - http://dx.doi.org/10.2196/mhealth.8851 UR - http://www.ncbi.nlm.nih.gov/pubmed/29305343 ID - info:doi/10.2196/mhealth.8851 ER - TY - JOUR AU - Reid, Kathy AU - Hartling, Lisa AU - Ali, Samina AU - Le, Anne AU - Norris, Allison AU - Scott, D. Shannon PY - 2017/12/14 TI - 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 JO - J Med Internet Res SP - e412 VL - 19 IS - 12 KW - pain KW - child health KW - parents KW - art N2 - 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. UR - http://www.jmir.org/2017/12/e412/ UR - http://dx.doi.org/10.2196/jmir.8877 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242180 ID - info:doi/10.2196/jmir.8877 ER - TY - JOUR AU - Srikesavan, Swarnalatha Cynthia AU - Williamson, Esther AU - Eldridge, Lucy AU - Heine, Peter AU - Adams, Jo AU - Cranston, Tim AU - Lamb, E. Sarah PY - 2017/12/13 TI - 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 JO - J Med Internet Res SP - e411 VL - 19 IS - 12 KW - hand function KW - hand exercises KW - rheumatoid arthritis KW - online training KW - implementation N2 - 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. UR - http://www.jmir.org/2017/12/e411/ UR - http://dx.doi.org/10.2196/jmir.8424 UR - http://www.ncbi.nlm.nih.gov/pubmed/29237581 ID - info:doi/10.2196/jmir.8424 ER - TY - JOUR AU - Gray, Justin AU - Beatty, R. Jessica AU - Svikis, S. Dace AU - Puder, S. Karoline AU - Resnicow, Ken AU - Konkel, Janine AU - Rice, Shetoya AU - McGoron, Lucy AU - Ondersma, J. Steven PY - 2017/11/08 TI - Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers JO - JMIR Mhealth Uhealth SP - e172 VL - 5 IS - 11 KW - pregnancy KW - marijuana KW - intervention study KW - text messaging N2 - 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. UR - http://mhealth.jmir.org/2017/11/e172/ UR - http://dx.doi.org/10.2196/mhealth.7927 UR - http://www.ncbi.nlm.nih.gov/pubmed/29117931 ID - info:doi/10.2196/mhealth.7927 ER - TY - JOUR AU - Hege, Inga AU - Kononowicz, A. Andrzej AU - Adler, Martin PY - 2017/11/02 TI - A Clinical Reasoning Tool for Virtual Patients: Design-Based Research Study JO - JMIR Med Educ SP - e21 VL - 3 IS - 2 KW - learning KW - educational technology KW - computer-assisted instruction KW - clinical decision-making N2 - 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. UR - http://mededu.jmir.org/2017/2/e21/ UR - http://dx.doi.org/10.2196/mededu.8100 UR - http://www.ncbi.nlm.nih.gov/pubmed/29097355 ID - info:doi/10.2196/mededu.8100 ER - TY - JOUR AU - Himes, Park Katherine AU - Donovan, Heidi AU - Wang, Stephanie AU - Weaver, Carrie AU - Grove, Rae Jillian AU - Facco, Lucia Francesca PY - 2017/10/10 TI - Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial JO - JMIR Hum Factors SP - e26 VL - 4 IS - 4 KW - postpartum visit KW - behavioral economics KW - Medicaid KW - intervention KW - usability N2 - 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) UR - http://humanfactors.jmir.org/2017/4/e26/ UR - http://dx.doi.org/10.2196/humanfactors.7964 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017990 ID - info:doi/10.2196/humanfactors.7964 ER - TY - JOUR AU - Thies, Kathleen AU - Anderson, Daren AU - Cramer, Benjamin PY - 2017/10/03 TI - 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 JO - JMIR Hum Factors SP - e24 VL - 4 IS - 4 KW - telehealth KW - mobile health KW - mHealth KW - underserved patients KW - HIT KW - usability N2 - 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. UR - https://humanfactors.jmir.org/2017/4/e24/ UR - http://dx.doi.org/10.2196/humanfactors.7709 UR - http://www.ncbi.nlm.nih.gov/pubmed/28974481 ID - info:doi/10.2196/humanfactors.7709 ER - TY - JOUR AU - Milward, Joanna AU - Deluca, Paolo AU - Drummond, Colin AU - Watson, Rod AU - Dunne, Jacklyn AU - Kimergård, Andreas PY - 2017/08/08 TI - Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults JO - JMIR Mhealth Uhealth SP - e109 VL - 5 IS - 8 KW - alcohol KW - drinking KW - young adults KW - mHealth KW - brief intervention KW - apps KW - usability testing KW - user experience KW - focus group N2 - 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. UR - http://mhealth.jmir.org/2017/8/e109/ UR - http://dx.doi.org/10.2196/mhealth.7836 UR - http://www.ncbi.nlm.nih.gov/pubmed/28790022 ID - info:doi/10.2196/mhealth.7836 ER - TY - JOUR AU - Groen, G. Wim AU - Kuijpers, Wilma AU - Oldenburg, SA Hester AU - Wouters, WJM Michel AU - Aaronson, K. Neil AU - van Harten, H. Wim PY - 2017/08/08 TI - Supporting Lung Cancer Patients With an Interactive Patient Portal: Feasibility Study JO - JMIR Cancer SP - e10 VL - 3 IS - 2 KW - non-small cell lung cancer KW - patient empowerment KW - patient portal KW - supportive care KW - eHealth KW - feasibility N2 - 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. UR - http://cancer.jmir.org/2017/2/e10/ UR - http://dx.doi.org/10.2196/cancer.7443 UR - http://www.ncbi.nlm.nih.gov/pubmed/28790025 ID - info:doi/10.2196/cancer.7443 ER - TY - JOUR AU - Zhou, Leming AU - Bao, Jie AU - Parmanto, Bambang PY - 2017/08/01 TI - Systematic Review Protocol to Assess the Effectiveness of Usability Questionnaires in mHealth App Studies JO - JMIR Res Protoc SP - e151 VL - 6 IS - 8 KW - usability KW - questionnaire KW - mobile health app KW - systematic review N2 - 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. UR - http://www.researchprotocols.org/2017/8/e151/ UR - http://dx.doi.org/10.2196/resprot.7826 UR - http://www.ncbi.nlm.nih.gov/pubmed/28765101 ID - info:doi/10.2196/resprot.7826 ER - TY - JOUR AU - Henton, Michelle AU - Gaglio, Bridget AU - Cynkin, Laurie AU - Feuer, J. Eric AU - Rabin, A. Borsika PY - 2017/07/20 TI - Development, Feasibility, and Small-Scale Implementation of a Web-Based Prognostic Tool?Surveillance, Epidemiology, and End Results Cancer Survival Calculator JO - JMIR Cancer SP - e9 VL - 3 IS - 2 KW - clinical decision-making KW - communication KW - neoplasms KW - patient care team KW - Internet N2 - 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. UR - http://cancer.jmir.org/2017/2/e9/ UR - http://dx.doi.org/10.2196/cancer.7120 UR - http://www.ncbi.nlm.nih.gov/pubmed/28729232 ID - info:doi/10.2196/cancer.7120 ER - TY - JOUR AU - Hamm, Julian AU - Money, Arthur AU - Atwal, Anita PY - 2017/06/19 TI - Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults? Perceptions of Opportunities and Challenges JO - JMIR Hum Factors SP - e15 VL - 4 IS - 2 KW - health informatics KW - falls KW - occupational therapy KW - assistive equipment provision process KW - self-assessment KW - measurement guidance KW - extrinsic risk factors KW - 3D visualization KW - technology-based systems N2 - 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. UR - http://humanfactors.jmir.org/2017/2/e15/ UR - http://dx.doi.org/10.2196/humanfactors.7161 UR - http://www.ncbi.nlm.nih.gov/pubmed/28630034 ID - info:doi/10.2196/humanfactors.7161 ER - TY - JOUR AU - Rodrigues, M. Angela AU - Sniehotta, F. Falko AU - Birch-Machin, A. Mark AU - Olivier, Patrick AU - Araújo-Soares, Vera PY - 2017/06/12 TI - 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 JO - JMIR Res Protoc SP - e112 VL - 6 IS - 6 KW - sun-protection KW - sunburn KW - sunscreening agents KW - sunbathing KW - health behavior KW - health promotion KW - formative research KW - intervention N2 - 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. UR - http://www.researchprotocols.org/2017/6/e112/ UR - http://dx.doi.org/10.2196/resprot.7172 UR - http://www.ncbi.nlm.nih.gov/pubmed/28606892 ID - info:doi/10.2196/resprot.7172 ER - TY - JOUR AU - Harte, Richard AU - Quinlan, R. Leo AU - Glynn, Liam AU - Rodríguez-Molinero, Alejandro AU - Baker, MA Paul AU - Scharf, Thomas AU - ÓLaighin, Gearóid PY - 2017/05/30 TI - 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 JO - JMIR Mhealth Uhealth SP - e71 VL - 5 IS - 5 KW - human-centered design KW - user-centered design KW - human-computer interface KW - human factors engineering KW - eHealth KW - engineering psychology KW - mHealth N2 - 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. UR - http://mhealth.jmir.org/2017/5/e71/ UR - http://dx.doi.org/10.2196/mhealth.7046 UR - http://www.ncbi.nlm.nih.gov/pubmed/28559227 ID - info:doi/10.2196/mhealth.7046 ER - TY - JOUR AU - Melnick, R. Edward AU - Hess, P. Erik AU - Guo, George AU - Breslin, Maggie AU - Lopez, Kevin AU - Pavlo, J. Anthony AU - Abujarad, Fuad AU - Powsner, M. Seth AU - Post, A. Lori PY - 2017/05/19 TI - 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 JO - J Med Internet Res SP - e174 VL - 19 IS - 5 KW - clinical decision support KW - decision aids KW - head injury, minor KW - medical informatics KW - spiral computed tomography KW - health services overuse KW - patient-centered outcomes research N2 - 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. UR - http://www.jmir.org/2017/5/e174/ UR - http://dx.doi.org/10.2196/jmir.7846 UR - http://www.ncbi.nlm.nih.gov/pubmed/28526667 ID - info:doi/10.2196/jmir.7846 ER - TY - JOUR AU - Aakre, Ansel Christopher AU - Kitson, E. Jaben AU - Li, Man AU - Herasevich, Vitaly PY - 2017/05/18 TI - Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection JO - JMIR Hum Factors SP - e14 VL - 4 IS - 2 KW - automation KW - organ dysfunction scores KW - software design KW - user-computer interface N2 - 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. UR - http://humanfactors.jmir.org/2017/2/e14/ UR - http://dx.doi.org/10.2196/humanfactors.7567 UR - http://www.ncbi.nlm.nih.gov/pubmed/28526675 ID - info:doi/10.2196/humanfactors.7567 ER - TY - JOUR AU - Boudreaux, D. Edwin AU - Brown, K. Gregory AU - Stanley, Barbara AU - Sadasivam, S. Rajani AU - Camargo, A. Carlos AU - Miller, W. Ivan PY - 2017/05/15 TI - Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing JO - J Med Internet Res SP - e149 VL - 19 IS - 5 KW - technology KW - safety KW - health planning KW - suicide KW - computers KW - telemedicine N2 - 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. UR - http://www.jmir.org/2017/5/e149/ UR - http://dx.doi.org/10.2196/jmir.6816 UR - http://www.ncbi.nlm.nih.gov/pubmed/28506957 ID - info:doi/10.2196/jmir.6816 ER - TY - JOUR AU - Ingadottir, Brynja AU - Blondal, Katrin AU - Thue, David AU - Zoega, Sigridur AU - Thylen, Ingela AU - Jaarsma, Tiny PY - 2017/05/10 TI - Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study JO - JMIR Serious Games SP - e10 VL - 5 IS - 2 KW - evaluation studies KW - knowledge KW - pain management KW - patient education KW - self care KW - surgical procedures, operative KW - video games N2 - 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. UR - http://games.jmir.org/2017/2/e10/ UR - http://dx.doi.org/10.2196/games.6894 UR - http://www.ncbi.nlm.nih.gov/pubmed/28490419 ID - info:doi/10.2196/games.6894 ER - TY - JOUR AU - Lauritsen, Lise AU - Andersen, Louise AU - Olsson, Emilia AU - Søndergaard, Rauff Stine AU - Nørregaard, Benn Lasse AU - Løventoft, Kaare Philip AU - Svendsen, Dunker Signe AU - Frøkjær, Erik AU - Jensen, Mørch Hans AU - Hageman, Ida AU - Kessing, Vedel Lars AU - Martiny, Klaus PY - 2017/04/21 TI - Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards JO - J Med Internet Res SP - e123 VL - 19 IS - 4 KW - depressive disorder, major KW - electronic monitoring KW - graph drawing KW - sleep KW - self-assessment KW - observational study KW - inpatients KW - patient participation KW - chronotherapeutics N2 - 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. UR - http://www.jmir.org/2017/4/e123/ UR - http://dx.doi.org/10.2196/jmir.6673 UR - http://www.ncbi.nlm.nih.gov/pubmed/28432040 ID - info:doi/10.2196/jmir.6673 ER - TY - JOUR AU - Hayashi, Aki AU - Yamaguchi, Satoko AU - Waki, Kayo AU - Fujiu, Katsuhito AU - Hanafusa, Norio AU - Nishi, Takahiro AU - Tomita, Hyoe AU - Kobayashi, Haruka AU - Fujita, Hideo AU - Kadowaki, Takashi AU - Nangaku, Masaomi AU - Ohe, Kazuhiko PY - 2017/04/20 TI - Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study JO - JMIR Res Protoc SP - e63 VL - 6 IS - 4 KW - telemedicine KW - mobile phone app KW - hemodialysis KW - self-management N2 - 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. UR - http://www.researchprotocols.org/2017/4/e63/ UR - http://dx.doi.org/10.2196/resprot.7105 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428168 ID - info:doi/10.2196/resprot.7105 ER - TY - JOUR AU - Alnosayan, Nagla AU - Chatterjee, Samir AU - Alluhaidan, Ala AU - Lee, Edward AU - Houston Feenstra, Linda PY - 2017/03/24 TI - Design and Usability of a Heart Failure mHealth System: A Pilot Study JO - JMIR Hum Factors SP - e9 VL - 4 IS - 1 KW - mHealth KW - telehealth KW - heart failure KW - human factors engineering KW - self-management N2 - 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. UR - http://humanfactors.jmir.org/2017/1/e9/ UR - http://dx.doi.org/10.2196/humanfactors.6481 UR - http://www.ncbi.nlm.nih.gov/pubmed/28341615 ID - info:doi/10.2196/humanfactors.6481 ER - TY - JOUR AU - Sullivan, S. Patrick AU - Driggers, Robert AU - Stekler, D. Joanne AU - Siegler, Aaron AU - Goldenberg, Tamar AU - McDougal, J. Sarah AU - Caucutt, Jason AU - Jones, Jeb AU - Stephenson, Rob PY - 2017/03/09 TI - Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study JO - JMIR Mhealth Uhealth SP - e26 VL - 5 IS - 3 KW - homosexuality, male KW - mobile applications KW - pilot projects KW - sexual minorities KW - condoms KW - pre-exposure prophylaxis N2 - 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. UR - http://mhealth.jmir.org/2017/3/e26/ UR - http://dx.doi.org/10.2196/mhealth.7199 UR - http://www.ncbi.nlm.nih.gov/pubmed/28279949 ID - info:doi/10.2196/mhealth.7199 ER - TY - JOUR AU - Ferron, C. Joelle AU - Brunette, F. Mary AU - Geiger, Pamela AU - Marsch, A. Lisa AU - Adachi-Mejia, M. Anna AU - Bartels, J. Stephen PY - 2017/03/03 TI - Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis JO - JMIR Hum Factors SP - e7 VL - 4 IS - 1 KW - mHealth KW - mobile apps KW - smoking cessation KW - schizophrenia KW - psychotic disorders N2 - 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. UR - http://humanfactors.jmir.org/2017/1/e7/ UR - http://dx.doi.org/10.2196/humanfactors.5933 UR - http://www.ncbi.nlm.nih.gov/pubmed/28258047 ID - info:doi/10.2196/humanfactors.5933 ER - TY - JOUR AU - Munro, Sarah AU - Hui, Amber AU - Salmons, Vanessa AU - Solomon, Carolyn AU - Gemmell, Emily AU - Torabi, Nahal AU - Janssen, A. Patricia PY - 2017/02/07 TI - SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women?s Perceptions JO - JMIR Public Health Surveill SP - e7 VL - 3 IS - 1 KW - pregnancy KW - text messaging KW - prenatal education KW - health behavior N2 - 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. UR - http://publichealth.jmir.org/2017/1/e7/ UR - http://dx.doi.org/10.2196/publichealth.6949 UR - http://www.ncbi.nlm.nih.gov/pubmed/28174149 ID - info:doi/10.2196/publichealth.6949 ER - TY - JOUR AU - Meiland, Franka AU - Innes, Anthea AU - Mountain, Gail AU - Robinson, Louise AU - van der Roest, Henriëtte AU - García-Casal, Antonio J. AU - Gove, Dianne AU - Thyrian, René Jochen AU - Evans, Shirley AU - Dröes, Rose-Marie AU - Kelly, Fiona AU - Kurz, Alexander AU - Casey, Dympna AU - Szcze?niak, Dorota AU - Dening, Tom AU - Craven, P. Michael AU - Span, Marijke AU - Felzmann, Heike AU - Tsolaki, Magda AU - Franco-Martin, Manuel PY - 2017/01/16 TI - Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics JO - JMIR Rehabil Assist Technol SP - e1 VL - 4 IS - 1 KW - dementia KW - technology KW - evaluation studies KW - diffusion of innovation KW - ethics N2 - 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. UR - http://rehab.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/rehab.6376 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582262 ID - info:doi/10.2196/rehab.6376 ER - TY - JOUR AU - Pereira-Azevedo, Nuno AU - Osório, Luís AU - Fraga, Avelino AU - Roobol, J. Monique PY - 2017/01/06 TI - Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App JO - JMIR Cancer SP - e1 VL - 3 IS - 1 KW - mHealth KW - prostate cancer KW - nomogram N2 - 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. UR - http://cancer.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/cancer.6750 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410180 ID - info:doi/10.2196/cancer.6750 ER - TY - JOUR AU - Rotondi, J. Armando AU - Spring, R. Michael AU - Hanusa, H. Barbara AU - Eack, M. Shaun AU - Haas, L. Gretchen PY - 2017/01/05 TI - Designing eHealth Applications to Reduce Cognitive Effort for Persons With Severe Mental Illness: Page Complexity, Navigation Simplicity, and Comprehensibility JO - JMIR Hum Factors SP - e1 VL - 4 IS - 1 KW - Internet technology KW - mobile application KW - cognitive impairment KW - eHealth KW - eHealth design KW - e-mental health KW - schizophrenia KW - severe mental illness KW - usability KW - website design N2 - 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. UR - http://humanfactors.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/humanfactors.6221 UR - http://www.ncbi.nlm.nih.gov/pubmed/28057610 ID - info:doi/10.2196/humanfactors.6221 ER - TY - JOUR AU - Lobach, F. David AU - Johns, B. Ellis AU - Halpenny, Barbara AU - Saunders, Toni-Ann AU - Brzozowski, Jane AU - Del Fiol, Guilherme AU - Berry, L. Donna AU - Braun, M. Ilana AU - Finn, Kathleen AU - Wolfe, Joanne AU - Abrahm, L. Janet AU - Cooley, E. Mary PY - 2016/11/08 TI - Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention JO - JMIR Med Inform SP - e36 VL - 4 IS - 4 KW - rule-based clinical decision support KW - clinical algorithms KW - Web services KW - software as a service KW - symptom management KW - patient-reported outcomes KW - lung cancer N2 - 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. UR - http://medinform.jmir.org/2016/4/e36/ UR - http://dx.doi.org/10.2196/medinform.5728 UR - http://www.ncbi.nlm.nih.gov/pubmed/27826132 ID - info:doi/10.2196/medinform.5728 ER - TY - JOUR AU - Bolle, Sifra AU - Romijn, Geke AU - Smets, A. Ellen M. AU - Loos, F. Eugene AU - Kunneman, Marleen AU - van Weert, M. Julia C. PY - 2016/07/25 TI - Older Cancer Patients? User Experiences With Web-Based Health Information Tools: A Think-Aloud Study JO - J Med Internet Res SP - e208 VL - 18 IS - 7 KW - user experience KW - eHealth KW - usability KW - think aloud KW - aging KW - cancer N2 - 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. UR - http://www.jmir.org/2016/7/e208/ UR - http://dx.doi.org/10.2196/jmir.5618 UR - http://www.ncbi.nlm.nih.gov/pubmed/27457709 ID - info:doi/10.2196/jmir.5618 ER - TY - JOUR AU - Hattink, Bart AU - Droes, Rose-Marie AU - Sikkes, Sietske AU - Oostra, Ellen AU - Lemstra, W. Afina PY - 2016/07/21 TI - Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers JO - JMIR Res Protoc SP - e144 VL - 5 IS - 3 KW - dementia KW - Alzheimer disease KW - patient portal KW - electronic health record KW - eHealth N2 - 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. UR - http://www.researchprotocols.org/2016/3/e144/ UR - http://dx.doi.org/10.2196/resprot.5040 UR - http://www.ncbi.nlm.nih.gov/pubmed/27444209 ID - info:doi/10.2196/resprot.5040 ER - TY - JOUR AU - Press, Anne AU - DeStio, Catherine AU - McCullagh, Lauren AU - Kapoor, Sandeep AU - Morley, Jeanne AU - AU - Conigliaro, Joseph PY - 2016/07/08 TI - Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records JO - JMIR Hum Factors SP - e18 VL - 3 IS - 2 KW - clinical decision support KW - adoption KW - primary care KW - usability KW - SBIRT N2 - 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. UR - http://humanfactors.jmir.org/2016/2/e18/ UR - http://dx.doi.org/10.2196/humanfactors.5820 UR - http://www.ncbi.nlm.nih.gov/pubmed/27393643 ID - info:doi/10.2196/humanfactors.5820 ER - TY - JOUR AU - Arvidsson, Susann AU - Gilljam, Britt-Mari AU - Nygren, Jens AU - Ruland, Maria Cornelia AU - Nordby-Bøe, Trude AU - Svedberg, Petra PY - 2016/06/24 TI - Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer JO - JMIR Mhealth Uhealth SP - e76 VL - 4 IS - 2 KW - cancer KW - children KW - communication KW - mobile app KW - participation KW - validation N2 - 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. UR - http://mhealth.jmir.org/2016/2/e76/ UR - http://dx.doi.org/10.2196/mhealth.5715 UR - http://www.ncbi.nlm.nih.gov/pubmed/27343004 ID - info:doi/10.2196/mhealth.5715 ER - TY - JOUR AU - Ammerlaan, W. Judy AU - Mulder, K. Olga AU - de Boer-Nijhof, C. Nienke AU - Maat, Bertha AU - Kruize, A. Aike AU - van Laar, Jaap AU - van Os-Medendorp, Harmieke AU - Geenen, Rinie PY - 2016/06/23 TI - 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 JO - JMIR Res Protoc SP - e113 VL - 5 IS - 2 KW - Web-based KW - self-management KW - tailored KW - intervention KW - pilot study KW - randomized controlled trial KW - personal goal KW - rheumatic diseases N2 - 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. UR - http://www.researchprotocols.org/2016/2/e113/ UR - http://dx.doi.org/10.2196/resprot.5735 UR - http://www.ncbi.nlm.nih.gov/pubmed/27339472 ID - info:doi/10.2196/resprot.5735 ER - TY - JOUR AU - Williams, A. Pamela AU - Furberg, D. Robert AU - Bagwell, E. Jacqueline AU - LaBresh, A. Kenneth PY - 2016/06/21 TI - Usability Testing and Adaptation of the Pediatric Cardiovascular Risk Reduction Clinical Decision Support Tool JO - JMIR Hum Factors SP - e17 VL - 3 IS - 1 KW - adaptation KW - cardiovascular diseases KW - clinical decision support KW - decision aids KW - guidelines KW - mHealth KW - pediatrics KW - risk factors KW - usability N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e17/ UR - http://dx.doi.org/10.2196/humanfactors.5440 UR - http://www.ncbi.nlm.nih.gov/pubmed/27328761 ID - info:doi/10.2196/humanfactors.5440 ER - TY - JOUR AU - Staziaki, Vinícius Pedro AU - Kim, Phillip AU - Vadvala, V. Harshna AU - Ghoshhajra, B. Brian PY - 2016/06/08 TI - Medical Registry Data Collection Efficiency: A Crossover Study Comparing Web-Based Electronic Data Capture and a Standard Spreadsheet JO - J Med Internet Res SP - e141 VL - 18 IS - 6 KW - electronic data capture KW - clinical research KW - translational research KW - registry KW - data management N2 - 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±2.3, whereas using Excel was 8.0±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. UR - http://www.jmir.org/2016/6/e141/ UR - http://dx.doi.org/10.2196/jmir.5576 UR - http://www.ncbi.nlm.nih.gov/pubmed/27277523 ID - info:doi/10.2196/jmir.5576 ER - TY - JOUR AU - Pang, Cheong-Iao Patrick AU - Chang, Shanton AU - Verspoor, Karin AU - Pearce, Jon PY - 2016/06/06 TI - Designing Health Websites Based on Users? Web-Based Information-Seeking Behaviors: A Mixed-Method Observational Study JO - J Med Internet Res SP - e145 VL - 18 IS - 6 KW - consumer health information KW - public health informatics KW - exploratory behavior KW - hypermedia N2 - 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. UR - http://www.jmir.org/2016/6/e145/ UR - http://dx.doi.org/10.2196/jmir.5661 UR - http://www.ncbi.nlm.nih.gov/pubmed/27267955 ID - info:doi/10.2196/jmir.5661 ER - TY - JOUR AU - Wipfli, Rolf AU - Ehrler, Frederic AU - Bediang, Georges AU - Bétrancourt, Mireille AU - Lovis, Christian PY - 2016/06/02 TI - How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians? Prescription Behavior: Results of a Crossover Randomized Trial JO - JMIR Human Factors SP - e15 VL - 3 IS - 1 KW - medical order entry systems KW - clinical decision support systems KW - adverse drug reaction reporting systems KW - User-Computer Interface KW - eye tracking N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e15/ UR - http://dx.doi.org/10.2196/humanfactors.5320 UR - http://www.ncbi.nlm.nih.gov/pubmed/27255612 ID - info:doi/10.2196/humanfactors.5320 ER - TY - JOUR AU - Price, M. Margaux AU - Crumley-Branyon, J. Jessica AU - Leidheiser, R. William AU - Pak, Richard PY - 2016/06/01 TI - Effects of Information Visualization on Older Adults? Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study JO - JMIR Hum Factors SP - e16 VL - 3 IS - 1 KW - Information visualization KW - aging KW - health-related websites KW - working memory N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e16/ UR - http://dx.doi.org/10.2196/humanfactors.5106 UR - http://www.ncbi.nlm.nih.gov/pubmed/27251110 ID - info:doi/10.2196/humanfactors.5106 ER - TY - JOUR AU - Neville, Carolyn AU - Da Costa, Deborah AU - Rochon, Murray AU - Peschken, A. Christine AU - Pineau, A. Christian AU - Bernatsky, Sasha AU - Keeling, Stephanie AU - Avina-Zubieta, Antonio AU - Lye, Elizabeth AU - Eng, Davy AU - Fortin, R. Paul PY - 2016/05/30 TI - Development of the Lupus Interactive Navigator as an Empowering Web-Based eHealth Tool to Facilitate Lupus Management: Users Perspectives on Usability and Acceptability JO - JMIR Res Protoc SP - e44 VL - 5 IS - 2 KW - Systemic lupus erythematosus KW - web-based eHealth tool KW - self-management KW - empowerment KW - usability KW - navigation N2 - 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. UR - http://www.researchprotocols.org/2016/2/e44/ UR - http://dx.doi.org/10.2196/resprot.4219 UR - http://www.ncbi.nlm.nih.gov/pubmed/27240666 ID - info:doi/10.2196/resprot.4219 ER - TY - JOUR AU - Thilakanathan, Danan AU - Calvo, A. Rafael AU - Chen, Shiping AU - Nepal, Surya AU - Glozier, Nick PY - 2016/05/27 TI - Facilitating Secure Sharing of Personal Health Data in the Cloud JO - JMIR Med Inform SP - e15 VL - 4 IS - 2 KW - self care KW - telemedicine KW - privacy KW - computer security KW - information dissemination N2 - 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. UR - http://medinform.jmir.org/2016/2/e15/ UR - http://dx.doi.org/10.2196/medinform.4756 UR - http://www.ncbi.nlm.nih.gov/pubmed/27234691 ID - info:doi/10.2196/medinform.4756 ER - TY - JOUR AU - LeGrand, Sara AU - Muessig, Elizabeth Kathryn AU - McNulty, Tobias AU - Soni, Karina AU - Knudtson, Kelly AU - Lemann, Alex AU - Nwoko, Nkechinyere AU - Hightow-Weidman, B. Lisa PY - 2016/05/13 TI - Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men JO - JMIR Serious Games SP - e6 VL - 4 IS - 1 KW - mobile applications KW - video games KW - serious games KW - HIV KW - medication adherence KW - health knowledge, attitudes, practice KW - youth KW - men who have sex with men N2 - 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. UR - http://games.jmir.org/2016/1/e6/ UR - http://dx.doi.org/10.2196/games.5687 UR - http://www.ncbi.nlm.nih.gov/pubmed/27178752 ID - info:doi/10.2196/games.5687 ER - TY - JOUR AU - Nelson, A. Lyndsay AU - Bethune, C. Magaela AU - Lagotte, E. Andrea AU - Osborn, Y. Chandra PY - 2016/05/12 TI - The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence JO - JMIR Human Factors SP - e13 VL - 3 IS - 1 KW - Website KW - Usability Testing KW - Type 2 Diabetes Mellitus KW - Medication Adherence KW - Intervention N2 - 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 ± 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 ± 6.3 years, average A1c was 7.4 ± 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. UR - http://humanfactors.jmir.org/2016/1/e13/ UR - http://dx.doi.org/10.2196/humanfactors.5177 UR - http://www.ncbi.nlm.nih.gov/pubmed/27174496 ID - info:doi/10.2196/humanfactors.5177 ER - TY - JOUR AU - Barbara, M. Angela AU - Dobbins, Maureen AU - Haynes, Brian R. AU - Iorio, Alfonso AU - Lavis, N. John AU - Raina, Parminder AU - Levinson, J. Anthony PY - 2016/05/11 TI - The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website JO - JMIR Human Factors SP - e14 VL - 3 IS - 1 KW - online health information KW - health informatics KW - elderly KW - consumer health information KW - qualitative research KW - usability testing KW - Internet KW - evidence-based medicine KW - knowledge translation KW - aging KW - website N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e14/ UR - http://dx.doi.org/10.2196/humanfactors.4800 UR - http://www.ncbi.nlm.nih.gov/pubmed/27170443 ID - info:doi/10.2196/humanfactors.4800 ER - TY - JOUR AU - Choo, Seryung AU - Kim, Young Ju AU - Jung, Young Se AU - Kim, Sarah AU - Kim, Eun Jeong AU - Han, Soo Jong AU - Kim, Sohye AU - Kim, Hyun Jeong AU - Kim, Jeehye AU - Kim, Yongseok AU - Kim, Dongouk AU - Steinhubl, Steve PY - 2016/03/31 TI - 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 JO - JMIR mHealth uHealth SP - e24 VL - 4 IS - 1 KW - mobile apps KW - electronic health record KW - weight reduction programs KW - physician-patient relations N2 - 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. UR - http://mhealth.jmir.org/2016/1/e24/ UR - http://dx.doi.org/10.2196/mhealth.4546 UR - http://www.ncbi.nlm.nih.gov/pubmed/27032541 ID - info:doi/10.2196/mhealth.4546 ER - TY - JOUR AU - Kurahashi, M. Allison AU - Weinstein, B. Peter AU - Jamieson, Trevor AU - Stinson, N. Jennifer AU - Cafazzo, A. Joseph AU - Lokuge, Bhadra AU - Morita, P. Plinio AU - Cohen, Eyal AU - Rapoport, Adam AU - Bezjak, Andrea AU - Husain, Amna PY - 2016/03/24 TI - In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System JO - JMIR Human Factors SP - e12 VL - 3 IS - 1 KW - collaborative care KW - patient-centered care KW - patient engagement KW - chronic disease KW - communication KW - Internet communication tools KW - Internet communication technologies N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e12/ UR - http://dx.doi.org/10.2196/humanfactors.4996 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025912 ID - info:doi/10.2196/humanfactors.4996 ER - TY - JOUR AU - Boudreaux, D. Edwin AU - Fischer, Christopher Andrew AU - Haskins, Lyn Brianna AU - Saeed Zafar, Zubair AU - Chen, Guanling AU - Chinai, A. Sneha PY - 2016/03/09 TI - Implementation of a Computerized Screening Inventory: Improved Usability Through Iterative Testing and Modification JO - JMIR Human Factors SP - e10 VL - 3 IS - 1 KW - behavioral medicine KW - computers KW - electronic health records KW - public health KW - screening KW - telemedicine N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e10/ UR - http://dx.doi.org/10.2196/humanfactors.4896 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025766 ID - info:doi/10.2196/humanfactors.4896 ER - TY - JOUR AU - Clarke, A. Martina AU - Belden, L. Jeffery AU - Kim, Soon Min PY - 2016/02/15 TI - How Does Learnability of Primary Care Resident Physicians Increase After Seven Months of Using an Electronic Health Record? A Longitudinal Study JO - JMIR Human Factors SP - e9 VL - 3 IS - 1 KW - primary care, physicians, usability, electronic health records, computerized physician order entry, user-computer interface N2 - 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. UR - http://humanfactors.jmir.org/2016/1/e9/ UR - http://dx.doi.org/10.2196/humanfactors.4601 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025237 ID - info:doi/10.2196/humanfactors.4601 ER - TY - JOUR AU - English, Lacey Lauren AU - Dunsmuir, Dustin AU - Kumbakumba, Elias AU - Ansermino, Mark John AU - Larson, P. Charles AU - Lester, Richard AU - Barigye, Celestine AU - Ndamira, Andrew AU - Kabakyenga, Jerome AU - Wiens, O. Matthew PY - 2016/02/15 TI - The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda JO - JMIR mHealth uHealth SP - e16 VL - 4 IS - 1 KW - infectious disease KW - postdischarge mortality KW - mHealth KW - prediction model KW - risk assessment KW - usability KW - Africa KW - resource-limited settings N2 - 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. UR - http://mhealth.jmir.org/2016/1/e16/ UR - http://dx.doi.org/10.2196/mhealth.5167 UR - http://www.ncbi.nlm.nih.gov/pubmed/26879041 ID - info:doi/10.2196/mhealth.5167 ER - TY - JOUR AU - Jay, Caroline AU - Harper, Simon AU - Dunlop, Ian AU - Smith, Sam AU - Sufi, Shoaib AU - Goble, Carole AU - Buchan, Iain PY - 2016/01/14 TI - Natural Language Search Interfaces: Health Data Needs Single-Field Variable Search JO - J Med Internet Res SP - e13 VL - 18 IS - 1 KW - searching behavior KW - search engine KW - research data archives KW - user-computer interface N2 - 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 × 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. UR - http://www.jmir.org/2016/1/e13/ UR - http://dx.doi.org/10.2196/jmir.4912 UR - http://www.ncbi.nlm.nih.gov/pubmed/26769334 ID - info:doi/10.2196/jmir.4912 ER - TY - JOUR AU - Gustafson Jr, H. David AU - Maus, Adam AU - Judkins, Julianne AU - Dinauer, Susan AU - Isham, Andrew AU - Johnson, Roberta AU - Landucci, Gina AU - Atwood, K. Amy PY - 2016/01/14 TI - Using the NIATx Model to Implement User-Centered Design of Technology for Older Adults JO - JMIR Human Factors SP - e2 VL - 3 IS - 1 KW - eHealth KW - user-centered design KW - technology KW - aging in place KW - independent living KW - consumer participation KW - accessibility UR - http://humanfactors.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.4853 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025985 ID - info:doi/10.2196/humanfactors.4853 ER - TY - JOUR AU - Jing, Xia AU - Cimino, J. James AU - Del Fiol, Guilherme PY - 2015/11/30 TI - Usability and Acceptance of the Librarian Infobutton Tailoring Environment: An Open Access Online Knowledge Capture, Management, and Configuration Tool for OpenInfobutton JO - J Med Internet Res SP - e272 VL - 17 IS - 11 KW - clinical decision support systems/instrumentation KW - evaluation studies as topic KW - knowledge management tool KW - The Librarian Infobutton Tailoring Environment N2 - 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. UR - http://www.jmir.org/2015/11/e272/ UR - http://dx.doi.org/10.2196/jmir.4281 UR - http://www.ncbi.nlm.nih.gov/pubmed/26621250 ID - info:doi/10.2196/jmir.4281 ER - TY - JOUR AU - Rowsell, Alison AU - Muller, Ingrid AU - Murray, Elizabeth AU - Little, Paul AU - Byrne, D. Christopher AU - Ganahl, Kristin AU - Müller, Gabriele AU - Gibney, Sarah AU - Lyles, R. Courtney AU - Lucas, Antonia AU - Nutbeam, Don AU - Yardley, Lucy PY - 2015/10/12 TI - 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 JO - J Med Internet Res SP - e230 VL - 17 IS - 10 KW - health literacy, digital intervention, diabetes, qualitative, physical activity N2 - 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. UR - http://www.jmir.org/2015/10/e230/ UR - http://dx.doi.org/10.2196/jmir.4999 UR - http://www.ncbi.nlm.nih.gov/pubmed/26459743 ID - info:doi/10.2196/jmir.4999 ER - TY - JOUR AU - Kortum, Philip AU - Peres, Camille S. PY - 2015/06/05 TI - Evaluation of Home Health Care Devices: Remote Usability Assessment JO - JMIR Human Factors SP - e10 VL - 2 IS - 1 KW - health care evaluation mechanisms KW - human-computer interaction design and evaluation methods KW - patient satisfaction KW - usability testing N2 - 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. UR - http://humanfactors.jmir.org/2015/1/e10/ UR - http://dx.doi.org/10.2196/humanfactors.4570 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025664 ID - info:doi/10.2196/humanfactors.4570 ER - TY - JOUR AU - Kayser, Lars AU - Kushniruk, Andre AU - Osborne, H. Richard AU - Norgaard, Ole AU - Turner, Paul PY - 2015/05/20 TI - Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs JO - JMIR Human Factors SP - e9 VL - 2 IS - 1 KW - eHealth literacy KW - requirements KW - user involvement N2 - 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. UR - http://humanfactors.jmir.org/2015/1/e9/ UR - http://dx.doi.org/10.2196/humanfactors.3696 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025228 ID - info:doi/10.2196/humanfactors.3696 ER - TY - JOUR AU - Payne, YM Ada AU - Surikova, Jelena AU - Liu, Sam AU - Ross, Heather AU - Mechetiuc, Teodora AU - Nolan, P. Robert PY - 2015/05/08 TI - Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure JO - JMIR Human Factors SP - e7 VL - 2 IS - 1 KW - chronic heart failure KW - self-care behaviors KW - e-counseling KW - usability assessment N2 - 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. UR - http://humanfactors.jmir.org/2015/1/e7/ UR - http://dx.doi.org/10.2196/humanfactors.4125 UR - http://www.ncbi.nlm.nih.gov/pubmed/27026267 ID - info:doi/10.2196/humanfactors.4125 ER - TY - JOUR AU - Hong, Yan AU - Goldberg, Daniel AU - Dahlke, Vollmer Deborah AU - Ory, G. Marcia AU - Cargill, S. Jessica AU - Coughlin, Rachel AU - Hernandez, Edgar AU - Kellstedt, K. Debra AU - Peres, Camille S. PY - 2014/10/13 TI - Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults JO - JMIR Human Factors SP - e2 VL - 1 IS - 1 KW - physical activity KW - mobile health, older adults KW - usability testing KW - user experience N2 - 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. UR - http://humanfactors.jmir.org/2014/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.3787 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025254 ID - info:doi/10.2196/humanfactors.3787 ER - TY - JOUR AU - Vermeulen, Joan AU - Verwey, Renée AU - Hochstenbach, MJ Laura AU - van der Weegen, Sanne AU - Man, Ping Yan AU - de Witte, P. Luc PY - 2014/05/19 TI - Experiences of Multidisciplinary Development Team Members During User-Centered Design of Telecare Products and Services: A Qualitative Study JO - J Med Internet Res SP - e124 VL - 16 IS - 5 KW - user-centered design KW - telecare KW - eHealth KW - participation KW - multidisciplinary team KW - barriers and facilitators N2 - 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. UR - http://www.jmir.org/2014/5/e124/ UR - http://dx.doi.org/10.2196/jmir.3195 UR - http://www.ncbi.nlm.nih.gov/pubmed/24840245 ID - info:doi/10.2196/jmir.3195 ER - TY - JOUR AU - Arnhold, Madlen AU - Quade, Mandy AU - Kirch, Wilhelm PY - 2014/04/09 TI - Mobile Applications for Diabetics: A Systematic Review and Expert-Based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or Older JO - J Med Internet Res SP - e104 VL - 16 IS - 4 KW - mobile applications KW - apps KW - mobile health KW - mHealth KW - diabetes mellitus KW - market analysis KW - systematic review KW - elderly KW - usability test KW - expert review N2 - 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 ?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?. UR - http://www.jmir.org/2014/4/e104/ UR - http://dx.doi.org/10.2196/jmir.2968 UR - http://www.ncbi.nlm.nih.gov/pubmed/24718852 ID - info:doi/10.2196/jmir.2968 ER - TY - JOUR AU - Spook, Eline Jorinde AU - Paulussen, Theo AU - Kok, Gerjo AU - Van Empelen, Pepijn PY - 2013/09/24 TI - Monitoring Dietary Intake and Physical Activity Electronically: Feasibility, Usability, and Ecological Validity of a Mobile-Based Ecological Momentary Assessment Tool JO - J Med Internet Res SP - e214 VL - 15 IS - 9 KW - mobile-based Ecological Momentary Assessment (mEMA) KW - feasibility KW - usability KW - ecological validity KW - dietary intake KW - physical activity N2 - 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. UR - http://www.jmir.org/2013/9/e214/ UR - http://dx.doi.org/10.2196/jmir.2617 UR - http://www.ncbi.nlm.nih.gov/pubmed/24067298 ID - info:doi/10.2196/jmir.2617 ER - TY - JOUR AU - Yu, Bei AU - Willis, Matt AU - Sun, Peiyuan AU - Wang, Jun PY - 2013/06/03 TI - Crowdsourcing Participatory Evaluation of Medical Pictograms Using Amazon Mechanical Turk JO - J Med Internet Res SP - e108 VL - 15 IS - 6 KW - crowdsourcing KW - Amazon Mechanical Turk KW - participatory design KW - medical instruction KW - pictogram KW - patient communication KW - readability KW - health literacy N2 - 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. UR - http://www.jmir.org/2013/6/e108/ UR - http://dx.doi.org/10.2196/jmir.2513 UR - http://www.ncbi.nlm.nih.gov/pubmed/23732572 ID - info:doi/10.2196/jmir.2513 ER - TY - JOUR AU - Daugherty, L. Bethany AU - Schap, E. TusaRebecca AU - Ettienne-Gittens, Reynolette AU - Zhu, M. Fengqing AU - Bosch, Marc AU - Delp, J. Edward AU - Ebert, S. David AU - Kerr, A. Deborah AU - Boushey, J. Carol PY - 2012/04/13 TI - Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents JO - J Med Internet Res SP - e58 VL - 14 IS - 2 KW - Mobile telephone food record KW - dietary assessment KW - technology KW - image analysis KW - volume estimation N2 - 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. UR - http://www.jmir.org/2012/2/e58/ UR - http://dx.doi.org/10.2196/jmir.1967 UR - http://www.ncbi.nlm.nih.gov/pubmed/22504018 ID - info:doi/10.2196/jmir.1967 ER - TY - JOUR AU - van der Krieke, Lian AU - Emerencia, C. Ando AU - Aiello, Marco AU - Sytema, Sjoerd PY - 2012/02/06 TI - Usability Evaluation of a Web-Based Support System for People With a Schizophrenia Diagnosis JO - J Med Internet Res SP - e24 VL - 14 IS - 1 KW - Schizophrenia KW - Web-Based systems KW - Recommendation systems KW - usability testing KW - self-management N2 - 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. UR - http://www.jmir.org/2012/1/e24/ UR - http://dx.doi.org/10.2196/jmir.1921 UR - http://www.ncbi.nlm.nih.gov/pubmed/22311883 ID - info:doi/10.2196/jmir.1921 ER - TY - JOUR AU - Hall, Valerie AU - Conboy-Hill, Suzanne AU - Taylor, Dave PY - 2011/11/14 TI - Using Virtual Reality to Provide Health Care Information to People With Intellectual Disabilities: Acceptability, Usability, and Potential Utility JO - J Med Internet Res SP - e91 VL - 13 IS - 4 KW - Learning disabilities KW - intellectual disabilities KW - virtual reality KW - health information KW - participatory research KW - capacity to consent KW - presence N2 - 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. UR - http://www.jmir.org/2011/4/e91/ UR - http://dx.doi.org/10.2196/jmir.1917 UR - http://www.ncbi.nlm.nih.gov/pubmed/22082765 ID - info:doi/10.2196/jmir.1917 ER -