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Journal Description

JMIR Human Factors (JHF, ISSN 2292-9495; Editor-in-Chief: Prof. Andre Kushniruk) is a multidisciplinary journal with contributions from design experts, 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. This includes 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.
 
JHF aspires to lead health care towards a culture of "usability by design", as well as to a culture of testing, error-prevention and safety, by promoting and publishing reports rigorously evaluating the usability and human factors aspects in health care, as well as encouraging the development and debate on new methods in this emerging field. 
 

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. Reviews, viewpoint papers and tutorials are as welcome as original research.
 
 
 
 

Recent Articles:

  • Telehealth. Source: Shutterstock; Copyright: Rawpixel.com; URL: https://www.shutterstock.com/image-photo/health-laptop-healthcare-wellness-senior-concept-520843072?src=PWWhn0v8eQxKmDlCUwGn2w-1-10; License: Licensed by the authors.

    Social Cognitive Theories and Electronic Health Design: Scoping Review

    Abstract:

    Background: There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective: This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods: The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results: Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions: This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution.

  • Source: Flickr; Copyright: US Department of Agriculture; URL: https://www.flickr.com/photos/usdagov/8575100693/in/album-72157633043832227/; License: Creative Commons Attribution (CC-BY).

    Understanding the Situated Roles of Electronic Medical Record Systems to Enable Redesign: Mixed Methods Study

    Abstract:

    Background: Redesigning electronic medical record (EMR) systems is needed to improve their usability and usefulness. Similar to other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways in which a system is appropriated by its users, that is, the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers as they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system’s situated roles can expose the unarticulated needs of the users and enable redesign opportunities. Objective: This study aimed to find EMR redesign opportunities by understanding the situated roles of EMR systems in prenatal care settings. Methods: We conducted a field-based observational study at a Japanese prenatal care clinic. We observed 3 obstetricians and 6 midwives providing prenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to 5 obstetricians and 10 midwives to validate our results and understand the attitudes of the prenatal care staff regarding the situated roles of the EMR system. Results: We identified 10 distinct situated roles that EMR systems play in prenatal care settings. Among them, 4 roles were regarded as favorable as most users wanted to experience them more frequently, and 4 roles were regarded as unfavorable as most users wanted to experience them less frequently; 2 ambivalent roles highlighted the providers’ reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, wants, and priorities regarding the use of the EMR system. Conclusions: Currently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in prenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users’ wants and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.

  • Source: Freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/senior-woman-patient-touching-female-nurse-hand-shoulder_2652909.htm; License: Licensed by JMIR.

    Evaluating the Feasibility of a Software Prototype Supporting the Management of Multimorbid Seniors: Mixed Methods Study in General Practices

    Abstract:

    Background: Longitudinal, patient-centered care represents a challenge for general practices. Decision support and reminder systems can offer targeted support. Objective: The objective of this study was to follow a user-oriented, stepwise approach to develop an add-on for German electronic health record (EHR) systems, which aims to support longitudinal care management of multimorbid seniors, using a flag system displaying patient-centered information relevant for comprehensive health care management. This study evaluated the prototype’s feasibility from both a technical and users’ perspective. Methods: The study was conducted with 18 general practitioners (GPs) and practice assistants (PAs) from 9 general practices using a mixed methods approach. In all practices, 1 GP and 1 PA tested the software each for 4 multimorbid seniors selected from the practice patient data. Technical feasibility was evaluated by documenting all technical problems. To evaluate the feasibility from the users’ perspective, participants’ responses during the software test were documented. In addition, they completed a self-administered questionnaire, including the validated System Usability Scale (SUS). Data were merged by transforming qualitative data into quantitative data. Analyses were performed using univariate statistics in IBM SPSS statistics. Results: From a technical perspective, the new software was easy to install and worked without problems. Difficulties during the installation occurred in practices lacking a 64-bit system or a current version of Microsoft .NET. As EHRs used in German practices do not provide an interface to extract the data needed, additional software was required. Incomplete flags for some laboratory data occurred, although this function was implemented in our software as shown in previous tests. From the users’ perspective, the new add-on provided a better overview of relevant patient information, reminded more comprehensively about upcoming examinations, and better supported guideline-based care when compared with their individual practice strategies. A total of 14 out of 18 participants (78%) were interested in using the software long-term. Furthermore, 8 of 9 GPs were willing to pay 5 to 25 Euros (mean 14.75, SD 5.93) monthly for its use. The usability was rated as 75% (43%-95%). Conclusions: The new EHR add-on was well accepted and achieved a good usability rating measured by the validated SUS. In perspective, the legally consolidated, standardized interface to German EHRs will facilitate the technical integration. In view of the high feasibility, we plan to study the software’s effectiveness in everyday primary care. Trial Registration: German Clinical Trials Register DRKS00008777; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00008777

  • Source: Image created by the Authors; Copyright: The Authors; URL: https://humanfactors.jmir.org/2019/3/e13847; License: Creative Commons Attribution (CC-BY).

    Health Care Professionals’ Clinical Perspectives and Acceptance of a Blood Glucose Meter and Mobile App Featuring a Dynamic Color Range Indicator and Blood...

    Abstract:

    Background: Despite many new therapies and technologies becoming available in the last decade, people with diabetes continue to struggle to achieve good glycemic control. Innovative and affordable solutions are needed to support health care professionals (HCPs) to improve patient outcomes. Objective: To gather current self-management perceptions of HCPs in seven countries and investigate HCP satisfaction with a new glucose meter and mobile app featuring a dynamic color range indicator and a blood sugar mentor. Methods: A total of 355 HCPs, including 142 endocrinologists (40.0%), 108 primary care physicians (30.4%), and 105 diabetes nurses (29.6%), were recruited from the United Kingdom (n=50), France (n=50), Germany (n=50), India (n=54), Algeria (50), Canada (n=51), and the United States (n=50). HCPs experienced the OneTouch Verio Reflect glucose meter and the OneTouch Reveal mobile app online from their own office computers using interactive demonstrations via webpages and multiple animations. After providing demographic and clinical practice insights, HCPs responded to statements about the utility of the system. Results: Concerning current practice, 83.1% (295/355) of HCPs agreed that poor numeracy or health literacy was a barrier for their patients. A total of 85.9% (305/355) and 92.1% (327/355) of HCPs responded that type 2 diabetes (T2D) and type 1 diabetes (T1D) patients were aware of what represented a low, in-range, or high blood glucose result. Only 62.0% (220/355) felt current glucose meters made it easy for patients to understand if results were in range. A total of 50.1% (178/355) and 78.0% (277/355) of HCPs were confident that T1D and T2D patients took action for low or high results. A total of 87.0% (309/355) agreed that the ColorSure Dynamic Range Indicator could help them teach patients how to interpret results and 88.7% (315/355) agreed it made them more aware of hyper- and hypoglycemic results so they could take action. A total of 83.7% (297/355) of HCPs agreed that the Blood Sugar Mentor feature gave personalized guidance, insight, and encouragement so patients could take action. A total of 82.8% (294/355) of HCPs also agreed that the Blood Sugar Mentor provided real-time guidance to reinforce the goals HCPs had set so patients could take steps to manage their diabetes between office visits. After experiencing the full system, 85.9% (305/355) of HCPs agreed it was beneficial for patients with lower numeracy or health literacy; 96.1% (341/355) agreed that it helped patients understand when results were low, in range, or high; and 91.0% (323/355) agreed that the way it displayed diabetes information would make patients more inclined to act upon results. A total of 89.0% (316/355) of HCPs agreed that it would be helpful for agreeing upon appropriate in-range goals for their patients for their next clinic visit. Conclusions: This multi-country online study provides evidence that HCPs were highly satisfied with the OneTouch Verio Reflect meter and the OneTouch Reveal mobile app. Each of these use color-coded information and the Blood Sugar Mentor feature to assist patients with interpreting, analyzing, and acting upon their blood glucose results, which is particularly beneficial to keep patients on track between scheduled office visits.

  • Source: Image created by the Authors; Copyright: The Authors; URL: https://humanfactors.jmir.org/2019/2/e12055; License: Creative Commons Attribution (CC-BY).

    Development of a Clinical Interface for a Novel Newborn Resuscitation Device: Human Factors Approach to Understanding Cognitive User Requirements

    Abstract:

    Background: A novel medical device has been developed to address an unmet need of standardizing and facilitating heart rate recording during neonatal resuscitation. In a time-critical emergency resuscitation, where failure can mean death of an infant, it is vital that clinicians are provided with information in a timely, precise, and clear manner to capacitate appropriate decision making. This new technology provides a hands-free, wireless heart rate monitoring solution that easily fits the clinical pathway and procedure for neonatal resuscitation. Objective: This study aimed to understand the requirements of the interface design for a new device by using a human factors approach. This approach combined a traditional user-centered design approach with an applied cognitive task analysis to understand the tasks involved, the cognitive requirements, and the potential for error during a neonatal resuscitation scenario. Methods: Fourteen clinical staff were involved in producing the final design requirements. Two pediatric doctors supported the development of a visual representation of the activities associated with neonatal resuscitation. This design was used to develop a scenario-based workshop. Two workshops were carried out in parallel and involved three pediatric doctors, three neonatal nurses, two advance neonatal practitioners, and four midwives. Both groups came together at the end to reflect on the findings from the separate sessions. Results: The outputs of this study have provided a comprehensive description of information requirements during neonatal resuscitation and enabled product developers to understand the preferred requirements of the user interface design for the device. The study raised three key areas for the designers to consider, which had not previously been highlighted: (1) interface layout and information priority, as heart rate should be central and occupy two-thirds of the screen; (2) size and portability, to enable positioning of the product local to the baby’s head and allow visibility from all angles; and (3) auditory feedback, to support visual information on heart rate rhythm and reliability of the trace with an early alert for intervention while avoiding parental distress. Conclusions: This study demonstrates the application of human factors and the applied cognitive task analysis method, which identified previously unidentified user requirements. This methodology provides a useful approach to aid development of the clinical interface for medical devices.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://humanfactors.jmir.org/2019/2/e9481/; License: Creative Commons Attribution (CC-BY).

    Complementing a Clinical Trial With Human-Computer Interaction: Patients’ User Experience With Telehealth

    Abstract:

    Background: The use of telehealth to monitor patients from home is on the rise. Telehealth technology is evaluated in a clinical trial with measures of health outcomes and cost-effectiveness. However, what happens between a technology and the patients is not investigated during a clinical trial—the telehealth technology remains as a “black box.” Meanwhile, three decades of research in the discipline of human-computer interaction (HCI) presents design, implementation, and evaluation of technologies with a primary emphasis on users. HCI research has exposed the importance of user experience (UX) as an essential part of technology development and evaluation. Objective: This research investigates the UX of patients with type 2 diabetes mellitus (T2D) with a telehealth in-home monitoring device to manage T2D from home. We investigate how the UX during a clinical trial can be researched and what a clinical trial can learn from HCI research. Methods: We adopted an ethnographic philosophy and conducted a contextual inquiry due to time limitations followed by semistructured interviews of 9 T2D patients. We defined the method as Clinical User-experience Evaluation (CUE). The patients were enrolled in a telehealth clinical trial of T2D; however, this research was an independent study conducted by information technologists and health researchers for a user-centered evaluation of telehealth. Results: Key analytical findings were that patients valued the benefits of in-home monitoring, but the current device did not possess all functionalities that patients wanted. The results include patients’ experiences and emotions while using the device, patients’ perceived benefits of the device, and how patients domesticated the device. Further analysis showed the influence of the device on patients’ awareness, family involvement, and design implications for telehealth for T2D. Conclusions: HCI could complement telehealth clinical trials and uncover knowledge about T2D patients’ UX and future design implications. Through HCI we can look into the “black box” phenomenon of clinical trials and create patient-centered telehealth solutions.

  • The NeuroCare app. Source: The Authors / Placeit; Copyright: The Authors; URL: http://humanfactors.jmir.org/2019/2/e12135/; License: Licensed by JMIR.

    A Mobile Phone App for the Self-Management of Pediatric Concussion: Development and Usability Testing

    Abstract:

    Background: Concussion is a common injury among Canadian children and adolescents that leads to a range of neurobehavioral deficits. However, noticeable gaps continue to exist in the management of pediatric concussion, with poor health outcomes associated with the inadequate application of best practice guidelines. Objective: The aim of this study was to describe the development and assess the usability of a mobile phone app to aid youth in the self-management of concussion. A secondary objective was to assess the usefulness of the app. Methods: An agile user-centered design approach was used to develop the technology, followed by a formative lab-based usability study for assessment and improvement proposals. Youths aged 10 to 18 years with a history of concussion and health care professionals involved in concussion management were recruited. This study included participants performing 12 tasks with the mobile phone app while using the think aloud protocol and the administration of the System Usability Scale (SUS), posttest questionnaire, and a semistructured interview. Results: A mobile phone app prototype called NeuroCare, an easily accessible pediatric concussion management intervention that provides easy access to expert-informed concussion management strategies and helps guide youth in self-managing and tracking their concussion recovery, was developed. A total of 7 youths aged between 10 and 18 years with a history of concussion and 7 health care professionals were recruited. The mean SUS score was 81.9, mean task success rates were greater than 90% for 92% (11/12) of the tasks, 92% (11/12) of tasks had a total error frequency of less than 11 errors, and mean task completion times were less than 2 min for 100% of the tasks. Conclusions: Results suggest that participants rated this app as highly usable, acceptable to users, and that it may be useful in helping youth self-manage concussion.

  • A woman reviews the results of her child's developmental screen. This image was adapted from the original Rawpixel Ltd photo. Source: The Authors / Rawpixel Ltd; Copyright: The Authors / Rawpixel Ltd; URL: https://www.flickr.com/photos/byrawpixel/40821283974; License: Creative Commons Attribution (CC-BY).

    Communicating Bad News: Insights for the Design of Consumer Health Technologies

    Abstract:

    Background: As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective: The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods: On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results: We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions: The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next.

  • Source: Flickr; Copyright: Ars Electronica; URL: https://www.flickr.com/photos/arselectronica/4295204410/in/photolist-7xy3Cs-im1wd2-G1ZxVr-nDy2cK-5aMK6r-nE6egv-Q6VmYm-nYm5tZ-6ysJZc-29bTnbC-aCrR7x-27oDHaC-HW4Ngr-53yW-nE5j3C-aCuvMJ-eEc4Aq-nGMcz-nWtc6A-7L5Pzm-Rwi4c2-Rqubam-2dwWdPe-aCuvyj-aCrQZT-29Ukday-YMe; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Anthropomorphism of Robots: Study of Appearance and Agency

    Abstract:

    Background: As the prevalence of robots increases each year, understanding how we anthropomorphize and interact with them is extremely important. The three-factor theory of anthropomorphism, called the Sociality, Effectance, Elicited agent Knowledge model, guided this study. As anthropomorphism involves a person making attributions of human likeness toward a nonhuman object, this model implies that anthropomorphism can be influenced either by factors related to the person or the object. Objective: The aim of this study was to explore factors influencing the anthropomorphism of robots, specifically the robot’s appearance (humanoid vs nonhumanoid) and agency (autonomous vs nonautonomous). We expected a humanoid robot would be anthropomorphized to a greater extent than one that was nonhumanoid. In addition, we expected that inducing an agency belief to the effect that a robot was making its own decisions would increase anthropomorphism compared with a nonagency belief that the robot was being remotely controlled by a human. We also sought to identify any role gender might play in anthropomorphizing the robot. Methods: Participants (N=99) were primed for agency or nonagency belief conditions and then saw a brief video depicting either a humanoid or nonhumanoid robot interacting with a confederate. After viewing the video, they completed 4 measures: perception to humanoid robots scale (PERNOD), the Epley anthropomorphic adjectives measure, the Fussel anthropomorphic adjective checklist, and the Anthropomorphic Tendencies Scale (ATS). Results: Findings with the PERNOD scale indicated subjects did perceive the 2 robots differently, F6,86=6.59, P<.001, which means the appearance manipulation was effective. Results with the Epley adjectives indicated that participants were more willing to attribute humanlike behavioral traits to the nonhumanoid rather than the humanoid robot, F1,91=5.76, P=.02. The Fussel adjective checklist results showed that subjects were more willing to attribute humanlike social qualities to the remote controlled than the autonomous robot, F1,91=5.30, P=.02. Finally, the ATS revealed the only gender effects in this study, with females reporting more endorsement of anthropomorphism for pets (P=.02) and less for showing negative emotions toward anthropomorphized objects (P<.001) if they had witnessed the humanoid rather than the nonhumanoid robot. Conclusions: Contrary to our expectations, participants were less willing to make humanlike attributions toward a robot when its morphology was more humanlike and were more willing to make those attributions when they were told that the robot was being remotely controlled by a person rather than acting on its own. In retrospect, these outcomes may have occurred because the humanoid robot used here had a smaller overall stature than the nonhumanoid robot, perhaps making it seem more toylike and because subjects made attributions toward the person behind the remote-controlled robot rather than toward the robot itself.

  • Source: The Authors / Placeit; Copyright: The Authors; URL: http://humanfactors.jmir.org/2019/2/e13017/; License: Creative Commons Attribution (CC-BY).

    Prototyping the Automated Food Imaging and Nutrient Intake Tracking System: Modified Participatory Iterative Design Sprint

    Abstract:

    Background: A total of 45% of older adults living in long-term care (LTC) have some form of malnutrition. Several methods of tracking food and fluid intake exist, but they are limited in terms of their accuracy and ease of application. An easy-to-use, objective, accurate, and comprehensive food intake system designed with LTC in mind may provide additional insights regarding nutritional support systems and nutritional interventions. Objective: The aim of this study was to conduct a multistage participatory iterative design sprint of a Goldilocks quality horizontal prototype for the Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) system. Specific design objectives included the following: (1) identify practice-relevant problems and solutions through user-centered participatory design, (2) mitigate feasibility-related barriers to uptake, and (3) employ user-centered technology development. Methods: A 6-stage iterative participatory design sprint was developed and executed. A total of 38 participants and advisors representing 15 distinct roles (eg, personal support worker, nurse, and dietitian) were engaged in the design sprint. Subjective workload (Raw Task Load Index), subjective usability scales, and a modified Ravden checklist were used to assess project advisors’ perceptions of the AFINI-T system prototype compared with the current method of food and fluid intake charting. Results: The top priorities for this system were identified as the following: ease of use, high accuracy, system reliability, ease of maintenance, and requirement of integrating with the current PointClickCare system. Data from project advisors informed design decisions leading to a Goldilocks quality horizontal prototype of the AFINI-T system. Compared with the current food and fluid intake charting system, AFINI-T was perceived to have the following: less time demands (t10.8=4.89; P<.001), less effort (t13.5=5.55; P<.001), and less frustration (t13.0=3.80; P=.002). Usability ratings of the AFINI-T prototype were high, with a subjective usability score mean of 89.2 and the highest ratings on a modified Ravden usability checklist of “very satisfactory” for 7 out of 8 sections. Conclusions: The AFINI-T concept system appears to have good practice relevance as a tool for an intelligent food and fluid intake tracking system in LTC. The AFINI-T concept system may provide improvement over the current system, and advisors are keen to try the AFINI-T system. This research gives tangible examples of how the sprint method can be adapted and applied to the development of novel needs-based application-driven technology.

  • Source: rawpixel.com; Copyright: Pexels; URL: https://www.pexels.com/photo/photo-of-woman-holding-smartphone-1842623/; License: Licensed by the authors.

    Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach

    Abstract:

    Background: Patients are increasingly using mobile health (mHealth) apps to monitor their health and educate themselves about medical issues. Despite the increasing popularity of such apps, poor design and usability often lead to suboptimal continued use of these apps and subsequently to poor adherence to the behavior changes at which they are aimed. One solution to these design problems is for app developers to use user-centered design (UCD) principles to consider the context and needs of users during the development process. Objective: This study aimed to present a case study on the design and development process for an mHealth app that uses virtual human technology (VHT) to encourage colorectal cancer (CRC) screening among patients aged 50 years and above. Methods: We have first provided an overview of the project and discussed its utilization of VHT. We have then reviewed UCD principles and how they can be incorporated into the development of health apps. We have described how we used UCD processes during the app’s development. We have then discussed the unique roles played by communication researchers, computer scientists, clinicians, and community participants in creating an mHealth app that is credible, usable, effective, and accessible to its target audience. Results: The principles of UCD were woven throughout the project development, with researchers collecting feedback from patients and providers at all stages and using that feedback to improve the credibility, usability, effectiveness, and accessibility of the mHealth app. The app was designed in an iterative process, which encouraged feedback and improvement of the app and allowed teams from different fields to revisit topics and troubleshoot problems. Conclusions: Implementing a UCD process contributed to the development of an app, which not only reflected cross-disciplinary expertise but also the needs, wants, and concerns of patients.

  • Source: Freepik; Copyright: jcomp; URL: https://www.freepik.com/free-photo/elderly-couple-using-tablet-computer_4107904.htm; License: Licensed by JMIR.

    The Effect of Age on Electronic Health Literacy: Mixed-Method Study

    Authors List:

    Abstract:

    Background: The world’s internet penetration rate is increasing yearly; approximately 25% of the world’s population are internet users. In Asia, Taiwan has the fifth highest internet usage, and has an internet penetration rate higher than the world average. Electronic health (eHealth) literacy is the ability to read, understand, and utilize Web health information. eHealth literacy is gaining attention worldwide. Objective: This study aimed compare the differences in eHealth literacy between traditional college students (aged between 18 and 22 years) and older adult students (aged between 55 and 72 years). It also summarizes the experiences and performances of these 2 groups in terms of searching online health-related information. Methods: A mixed-method approach was used, including questionnaire surveys and interviews. A total of 208 respondents were interviewed: 65 traditional college students (31.3%) and 143 older adult students (68.7%). The results of the interviews were used to compare the eHealth literacy scores of the 2 groups. Results: There were significant differences in the overall eHealth literacy scores (t207=2.98; P=.001) and the functional eHealth literacy dimension (t207=12.17; P<.001). The findings showed a significant gap in eHealth literacy between the 2 groups. Most participants believed that online health information could be largely read and understood. However, they were skeptical about the quality of the information and noted that it consisted of either subjective judgments or objective standards. Conclusions: Traditional college students preferred esthetically pleasing health information, whereas older adult students focused on its promotion. Furthermore, the first group often used websites for solving health problems, whereas the second group forwarded health information through communication software.

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    Background: Atrial fibrillation (AF) is the most common clinically significant heart rhythm disorder and poses a growing disease burden around the world due to a rapidly aging population. A multidisci...

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    Open Peer Review Period: Jul 17, 2019 - Jul 31, 2019

    Background: Background: Lack of knowledge and poor attitude is one of the barriers to colorectal cancer screening participation. Printed material such as pamphlets and posters were the main approach...

    Background: Background: Lack of knowledge and poor attitude is one of the barriers to colorectal cancer screening participation. Printed material such as pamphlets and posters were the main approach in health education on disease prevention. Current information technology advancement had seen an increasing trend of the public to read from websites and mobile app using their smartphone. Thus, health information dissemination should also be diverted to the current trend of information search. Increase in knowledge and awareness will hopefully increase the screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of ColorApp mobile applications in improving the knowledge and attitude on colorectal cancer among user aged 50 years old and above who are the population at risk for the disease in Kedah. Methods: Methods: A quasi-experimental study has been conducted involving 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment program in Kota Setar district was chosen as the intervention group while Kuala Muda district was chosen as the control group. Participants were given a self-administered validated questionnaire on knowledge and attitude towards colorectal cancer. A usable mobile application, the ColorApp (Colorectal Cancer Application) was developed as a new educational tool on colorectal cancer prevention. The intervention group were given 2 weeks to use the ColorApp. The same questionnaire was redistributed to both groups after two weeks. The mean percentage score for knowledge and attitude between groups were compared using Repeated Measure ANCOVA. Results: Result: There was no significant difference of age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in intervention groups as compared to control group and it has been controlled during analysis. There was a significant difference in mean knowledge score between intervention and control group with regards to time [Huynh Feldt: F (1,95) = 19.81; p < 0.001]. However, there was no significant difference in mean attitude score between intervention and control group with regards to time [F (1,95) = 0.36, p = 0.550]. Conclusions: Conclusion: The mobile application can be one of the adjunct approaches in educating the public on colorectal cancer.

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