JMIR Human Factors

Making health care interventions and technologies usable, safe, and effective

2014-04-17

Announcing a New Journal: JMIR Human Factors JMIR Human Factors is a new spin-off journal of JMIR, the leading open access eHealth journal (Impact Factor 2010: 4.7). JMIR Human Factors is a multidisciplinary journal with contributions from medical researchers, engineers, and social scientists. JMIR Human Factors focuses on understanding how the behaviour and thinking of humans can influence and shape the design of health care interventions and technologies, and how the design can be evaluated and improved to make health care interventions and technologies usable, safe, and effective. We are currently soliciting papers for the inaugural issue - be a founding author of this new journal and submit your paper before 1. Dec 2014. All articles are professionally copyedited and typeset, ready for indexing in PubMed/PubMed Central. Possible contributions include usability studies and heuristic evaluations, studies concerning ergonomics and error prevention, design studies for medical devices and healthcare systems/workflows, enhancing teamwork through Human Factors based teamwork training, measuring non-technical skills in staff like leadership, communication, situational awareness and teamwork, and healthcare policies and procedures to reduce errors and increase safety. EDITORIAL BOARD MEMBERS ARE ALSO CURRENTLY BEING RECRUITED, PLEASE CONTACT jmir.editorial.office@gmail.com IF YOU ARE INTERESTED. Open Access *** No Submission Fees or Publication Fees humanfactors.jmir.org

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Journal Description

Announcing a New Journal:  JMIR Human Factors

JMIR Human Factors is a new spin-off journal of JMIR, the leading open access eHealth journal (Impact Factor 2013: 4.7). 

JMIR Human Factors is a multidisciplinary journal with contributions from medical researchers, engineers, and social scientists. JMIR Human Factors focuses on understanding how the behaviour and thinking of humans can influence and shape the design of health care interventions and technologies, and how the design can be evaluated and improved to make health care interventions and technologies usable, safe, and effective.

We are currently soliciting papers for the inaugural issue - be a founding author of this new journal and submit your paper before 1. October 2014. All articles are professionally copyedited and typeset, ready for indexing in PubMed/PubMed Central. Possible contributions include usability studies and heuristic evaluations, studies concerning ergonomics and error prevention, design studies for medical devices and healthcare systems/workflows, enhancing teamwork through Human Factors based teamwork training, measuring non-technical skills in staff like leadership, communication, situational awareness and teamwork, and healthcare policies and procedures to reduce errors and increase safety.

Submit your paper before October 1st, 2014 to be a founding author of this new journal.

Editorial Board members are currently being recruited, please contact us if you are interested (jmir.editorial.office at gmail.com).

 
Open Access *** No Submission Fees or Publication Fees

 
 

Recent Articles:

  • Computer users image from Ethiopia- image created by our group. (cc) Alwan et al, CC-BY-SA-2.0, please cite as (http://humanfactors.jmir.org/article/viewFile/4184/1/55880).

    Knowledge and Utilization of Computers Among Health Professionals in a Developing Country: A Cross-Sectional Study

    Abstract:

    Background: Incorporation of information communication technology in health care has gained wide acceptance in the last two decades. Developing countries are also incorporating information communication technology into the health system including the implementation of electronic medical records in major hospitals and the use of mobile health in rural community-based health interventions. However, the literature on the level of knowledge and utilization of information communication technology by health professionals in those settings is scarce for proper implementation planning. Objective: The objective of this study is to assess knowledge, computer utilization, and associated factors among health professionals in hospitals and health institutions in Ethiopia. Methods: A quantitative cross-sectional study was conducted on 554 health professionals working in 7 hospitals, 19 primary health centers, and 10 private clinics in the Harari region of Ethiopia. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and logistic regression techniques using SPSS version 16.0 (IBM Corporation) were applied to determine the level of knowledge and identify determinants of utilization of information communication technology. Results: Out of 554 participants, 482 (87.0%) of them responded to the questionnaire. Among them, 90 (18.7%) demonstrated good knowledge of computers while 142 (29.5%) demonstrated good utilization habits. Health professionals who work in the primary health centers were found to have lower knowledge (3.4%) and utilization (18.4%). Age (adjusted odds ratio [AOR]=3.06, 95% CI 0.57-5.37), field of study (AOR=3.08, 95% CI 1.65-5.73), level of education (AOR=2.78, 95% CI 1.43-5.40), and previous computer training participation (AOR=3.65, 95% CI 1.62-8.21) were found to be significantly associated with computer utilization habits of health professionals. Conclusions: Computer knowledge and utilization habits of health professionals, especially those who work in primary health centers, were found to be low. Providing trainings and continuous follow-up are necessary measures to increase the likelihood of the success of implemented eHealth systems in those settings.

  • ICU room. (cc) Sowan et al. please cite as (http://humanfactors.jmir.org/article/viewFile/4196/1/55291).

    Nurses' Perceptions and Practices Toward Clinical Alarms in a Transplant Cardiac Intensive Care Unit: Exploring Key Issues Leading to Alarm Fatigue

    Abstract:

    Background: Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses’ perceptions and common clinical practices toward clinical alarms, where little information is available. Objective: Our aim was to determine perceptions and practices of transplant/cardiac ICU (TCICU) nurses toward clinical alarms and benchmark the results against the 2011 Healthcare Technology Foundation’s (HTF) Clinical Alarms Committee Survey. Methods: A quality improvement project was conducted on a 20-bed TCICU with 39 full- and part-time nurses. Nurses were surveyed about their perceptions and attitudes toward and practices on clinical alarms using an adapted HTF clinical alarms survey. Results were compared to the 2011 HTF data. Correlations among variables were examined. Results: All TCICU nurses provided usable responses (N=39, 100%). Almost all nurses (95%-98%) believed that false alarms are frequent, disrupt care, and reduce trust in alarm systems, causing nurses to inappropriately disable them. Unlike the 2011 HTF clinical alarms survey results, a significantly higher percentage of our TCICU nurses believed that existing devices are complex, questioned the ability and adequacy of the new monitoring systems to solve alarm management issues, pointed to the lack of prompt response to alarms, and indicated the lack of clinical policy on alarm management (P<.01). Major themes in the narrative data focused on nurses’ frustration related to the excessive number of alarms and poor usability of the cardiac monitors. A lack of standardized approaches exists in changing patients’ electrodes and individualizing parameters. Around 60% of nurses indicated they received insufficient training on bedside and central cardiac monitors. A correlation also showed the need for training on cardiac monitors, specifically for older nurses (P=.01). Conclusions: False and non-actionable alarms continue to desensitize TCICU nurses, perhaps resulting in missing fatal alarms. Nurses’ attitudes and practices related to clinical alarms are key elements for designing contextually sensitive quality initiatives to fight alarm fatigue. Alarm management in ICUs is a multidimensional complex process involving usability of monitoring devices, and unit, clinicians, training, and policy-related factors. This indicates the need for a multi-method approach to decrease alarm fatigue and improve alarm systems safety.

  • Screenshot of icon array from the InformedTogether decision aid.

    InformedTogether: Usability Evaluation of a Web-Based Decision Aid to Facilitate Shared Advance Care Planning for Severe Chronic Obstructive Pulmonary Disease

    Abstract:

    Background: Advance care planning may help patients receive treatments that better align with their goals for care. We developed a Web-based decision aid called InformedTogether to facilitate shared advance care planning between chronic obstructive pulmonary disease (COPD) patients and their doctors. Objective: Our objective was to assess the usability of the InformedTogether decision aid, including whether users could interact with the decision aid to engage in tasks required for shared decision making, whether users found the decision aid acceptable, and implications for redesign. Methods: We conducted an observational study with 15 patients and 8 doctors at two ethnically and socioeconomically diverse outpatient clinics. Data included quantitative and qualitative observations of patients and doctors using the decision aid on tablet or laptop computers and data from semistructured interviews. Patients were shown the decision aid by a researcher acting as the doctor. Pulmonary doctors were observed using the decision aid independently and asked to think aloud (ie, verbalize their thoughts). A thematic analysis was implemented to explore key issues related to decision aid usability. Results: Although patients and doctors found InformedTogether acceptable and would recommend that doctors use the decision aid with COPD patients, many patients had difficulty understanding the icon arrays that were used to communicate estimated prognoses and could not articulate the definitions of the two treatment choices—Full Code and Do Not Resuscitate (DNR). Minor usability problems regarding content, links, layout, and consistency were also identified and corresponding recommendations were outlined. In particular, participants suggested including more information about potential changes in quality of life resulting from the alternative advance directives. Some doctor participants thought the decision aid was too long and some thought it may cause nervousness among patients due to the topic area. Conclusions: A decision aid for shared advance care planning for severe COPD was found acceptable to most COPD patients and their doctors. However, many patient participants did not demonstrate understanding of the treatment options or prognostic estimates. Many participants endorsed the use of the decision aid between doctors and their patients with COPD, although they desired more information about quality of life. The design must optimize comprehensibility, including revising the presentation of statistical information in the icon array, and feasibility of integration into clinical workflow, including shortening the decision aid.

  • Example of a website prototype (Values and actions).

    Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients

    Abstract:

    Background: A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed. Objective: In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)—both as a website and as a mobile app—was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs. Methods: In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors. Results: The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users. Conclusions: This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors. Trial Registration: Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D).

  • Diversity. Image source: http://www.istockphoto.com/photo/company-team-32422766.

    Applying Human Factors Principles to Mitigate Usability Issues Related to Embedded Assumptions in Health Information Technology Design

    Abstract:

    Background: There is growing recognition that design flaws in health information technology (HIT) lead to increased cognitive work, impact workflows, and produce other undesirable user experiences that contribute to usability issues and, in some cases, patient harm. These usability issues may in turn contribute to HIT utilization disparities and patient safety concerns, particularly among “non-typical” HIT users and their health care providers. Health care disparities are associated with poor health outcomes, premature death, and increased health care costs. HIT has the potential to reduce these disparate outcomes. In the computer science field, it has long been recognized that embedded cultural assumptions can reduce the usability, usefulness, and safety of HIT systems for populations whose characteristics differ from “stereotypical” users. Among these non-typical users, inappropriate embedded design assumptions may contribute to health care disparities. It is unclear how to address potentially inappropriate embedded HIT design assumptions once detected. Objective: The objective of this paper is to explain HIT universal design principles derived from the human factors engineering literature that can help to overcome potential usability and/or patient safety issues that are associated with unrecognized, embedded assumptions about cultural groups when designing HIT systems. Methods: Existing best practices, guidance, and standards in software usability and accessibility were subjected to a 5-step expert review process to identify and summarize those best practices, guidance, and standards that could help identify and/or address embedded design assumptions in HIT that could negatively impact patient safety, particularly for non-majority HIT user populations. An iterative consensus-based process was then used to derive evidence-based design principles from the data to address potentially inappropriate embedded cultural assumptions. Results: Design principles that may help identify and address embedded HIT design assumptions are available in the existing literature. Conclusions: Evidence-based HIT design principles derived from existing human factors and informatics literature can help HIT developers identify and address embedded cultural assumptions that may underlie HIT-associated usability and patient safety concerns as well as health care disparities.

  • Fatigue. Image Source: bark, https://www.flickr.com/photos/barkbud/4906055297/, licensed under Creative Commons Attribution V.2.

    Acceptance of New Technology: A Usability Test of a Computerized Adaptive Test for Fatigue in Rheumatoid Arthritis

    Abstract:

    Background: Little is known about the acceptance and usability of computerized adaptive tests (CATs) among patients with rheumatoid arthritis (RA). The main difference between completing a CAT and a traditional questionnaire concerns item presentation. CATs only provide one item at a time on the screen, and skipping forward or backward to review and change already given answers is often not possible. Objective: The objective of this study was to examine how patients with RA experience a Web-based CAT for fatigue. Methods: In individual sessions, participants filled in the CAT while thinking aloud, and were subsequently interviewed about their experience with the new instrument. The technology acceptance model (TAM) was used to structure the results. Results: The participants were 15 patients with RA. They perceived the CAT as clear, brief, and easy to use. They were positive about answering one question per screen, the changing response options, layout, progress bar, and item number. There were 40% (6/15) of the participants that also mentioned that they experienced the completion of the CAT as useful and pleasant, and liked the adaptive test mechanism. However, some participants noted that not all items were applicable to everybody, and that the wordings of questions within the severity dimension were often similar. Conclusions: Participants perceived the “CAT Fatigue RA” as easy to use, and also its usefulness was expressed. A 2.0 version has been improved according to the participants’ comments, and is currently being used in a validation study before it will be implemented in daily clinical practice. Our results give a first indication that CAT methodology may outperform traditional questionnaires not merely on measurement precision, but also on usability and acceptance valuation.

  • iCanFit homepage.

    Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults

    Abstract:

    Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants’ comments were addressed to improve the site’s senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users’ experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway.

  • Narrowing the skills gap for innovation in the hospital sector. Source: Can Stock Photo Inc, 2014. Invoice / Order Id : 4800451.

    Narrowing the Skills Gap for Innovation: An Empirical Study in the Hospital Sector

    Abstract:

    Background: The current financial crisis and the increasing burden of chronic diseases are challenging hospitals to enhance their innovation capacity to deliver new and more effective health services. However, the shortage of skills has been widely recognized as a key obstacle for innovation. Ensuring the presence of a skilled workforce has become a priority for the health system in Portugal and across Europe. Objective: The aim of this study was to examine the demand of new skills and their influence in both investments in innovation and development of skills. Methods: We used a mixed-methods approach combining statistical analysis of data survey and content analysis of semistructured interviews with the Administration Boards of hospitals, using a nominal group technique. Results: The results illustrate an increasing demand of a broad range of skills for innovation development, including responsibility and quality consciousness (with a significant increase of 55%, 52/95), adaptation skills (with an increase of 44%, 42/95) and cooperation and communication skills (with an increase of 55%, 52/95). Investments in the development of skills for innovation are mainly focused on aligning professional training with an organizational strategy (69%, 66/95) as well as collaboration in taskforces (61%, 58/95) and cross-department teams (60%, 57/95). However, the dynamics between the supply and demand of skills for innovation are better explained through a broader perspective of organizational changes towards enhancing learning opportunities and engagement of health professionals to boost innovation. Conclusions: The results of this study illustrate that hospitals are unlikely to enhance their innovation capacity if they pursue strategies failing to match the skills needed. Within this context, hospitals with high investments in innovation tend to invest more in skills development. The demand of skills and investments in training are influenced by many other factors, including the hospital’s strategies, as well as changes in the work organization. Relevant implications for managers and policy makers can be drawn from the empirical findings of this paper, building on the current efforts from leading innovating hospitals that are already defining the future of health care.

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