JMIR Publications

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  Focus Groups and Qualitative Research...

  Jun 19, 2017

  Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults’ Perceptions of Opportunities and Challenges

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  Authors List:

  • Julian Hamm  
  • Arthur Money  
  • Anita Atwal  

  Abstract:

  Background: In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as “poor fit” of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. Objective: The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. Methods: Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application’s usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. Results: The quantitative SUS results revealed that the application may be described as having “marginal-high” and “good” levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. Conclusions: Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets.

  • JMIR Hum Factors 2017;4(2):e15

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  Desgin and Usability of Clinical...

  May 18, 2017

  Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection

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  Authors List:

  • Christopher Ansel Aakre  
  • Jaben E Kitson  
  • Man Li  
  • Vitaly Herasevich  

  Abstract:

  Background: The new sepsis definition has increased the need for frequent sequential organ failure assessment (SOFA) score recalculation and the clerical burden of information retrieval makes this score ideal for automated calculation. Objective: The aim of this study was to (1) estimate the clerical workload of manual SOFA score calculation through a time-motion analysis and (2) describe a user-centered design process for an electronic medical record (EMR) integrated, automated SOFA score calculator with subsequent usability evaluation study. Methods: First, we performed a time-motion analysis by recording time-to-task-completion for the manual calculation of 35 baseline and 35 current SOFA scores by 14 internal medicine residents over a 2-month period. Next, we used an agile development process to create a user interface for a previously developed automated SOFA score calculator. The final user interface usability was evaluated by clinician end users with the Computer Systems Usability Questionnaire. Results: The overall mean (standard deviation, SD) time-to-complete manual SOFA score calculation time was 61.6 s (33). Among the 24% (12/50) usability survey respondents, our user-centered user interface design process resulted in >75% favorability of survey items in the domains of system usability, information quality, and interface quality. Conclusions: Early stakeholder engagement in our agile design process resulted in a user interface for an automated SOFA score calculator that reduced clinician workload and met clinicians’ needs at the point of care. Emerging interoperable platforms may facilitate dissemination of similarly useful clinical score calculators and decision support algorithms as “apps.” A user-centered design process and usability evaluation should be considered during creation of these tools.

  • JMIR Hum Factors 2017;4(2):e14

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  User-centred Design Case Studies

  May 12, 2017

  Tablet-Based Well-Being Check for the Elderly: Development and Evaluation of Usability and Acceptability

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  Authors List:

  • Pradeep Ray  
  • Junhua Li  
  • Arni Ariani  
  • Vasvi Kapadia  

  Abstract:

  Background: Many elderly people prefer to live at home independently. One of the major concerns raised by the family members is the safety and well-being of their elderly family members when living independently in a home environment. To address this issue, assistive technology solutions have been available in the market. Despite their availability and proliferation, these types of solutions are not popular with the elderly due to their intrusive nature, privacy-related issues, social stigma, and fear of losing human interaction. This study shares the experience in the development of a digital photo frame system that helps family members to check the well-being of the elderly, exploiting their desire to remain socially connected. Objectives: The aim of this study was to iteratively design, implement, and assess the usability, user friendliness, and acceptability of a tablet-based system to check the well-being of the elderly. Methods: Our study methodology comprises three separate stages: initial system development, contextual assessment, and comparative case study evaluation. Results: In the first stage, requirements were elicited from the elderly to design a well-being check prototype. In the second stage, areas for improvements (eg, privacy features) were identified. Also, additional features (such as medication prompts or food reminders) were suggested to help aged and health care service providers with effective but subtle monitoring of the elderly. These would lower their operating cost by reducing visits by care providers to the homes of the elderly. In the third stage, the results highlighted the difference (between users in India and Australia) in the levels of familiarity of the elderly with this technology. Some elderly participants at the Kalyani Institute for Study, Planning and Action for Rural Change, India latched onto this technology quickly while a few refused to use the system. However, in all cases, the support of family members was crucial for their willingness to use the technology. Conclusions: This project has three major outcomes. First, a picture frame prototype was tested with the elderly to leverage the benefits of social communication. Second, the project helped us test and implement the “Silvercare” model for supporting the elderly through young retired people residing in the area. Finally, the project helped formalize the agile three-stage design methodology to develop information technology solutions for the elderly. Also, the project contributed to an ongoing European Union Project called Victoryahome, which involves more than 50 sites across 5 countries (Norway, Sweden, Netherlands, Portugal, and Australia) to assess the use of telepresence robots, wearable fall detectors, and medication dispensers for the elderly living independently.

  • JMIR Hum Factors 2017;4(2):e12

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  Usability Evaluation Case Studies

  May 8, 2017

  A Web-Based Graphical Food Frequency Assessment System: Design, Development and Usability Metrics

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  Authors List:

  • Rodrigo Zenun Franco  
  • Balqees Alawadhi  
  • Rosalind Fallaize  
  • Julie A Lovegrove  
  • Faustina Hwang  

  Abstract:

  Background: Food frequency questionnaires (FFQs) are well established in the nutrition field, but there remain important questions around how to develop online tools in a way that can facilitate wider uptake. Also, FFQ user acceptance and evaluation have not been investigated extensively. Objective: This paper presents a Web-based graphical food frequency assessment system that addresses challenges of reproducibility, scalability, mobile friendliness, security, and usability and also presents the utilization metrics and user feedback from a deployment study. Methods: The application design employs a single-page application Web architecture with back-end services (database, authentication, and authorization) provided by Google Firebase’s free plan. Its design and responsiveness take advantage of the Bootstrap framework. The FFQ was deployed in Kuwait as part of the EatWellQ8 study during 2016. The EatWellQ8 FFQ contains 146 food items (including drinks). Participants were recruited in Kuwait without financial incentive. Completion time was based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS higher than 70 are considered to be good. Results: A total of 235 participants created accounts in the system, and 163 completed the FFQ. Of those 163 participants, 142 reported their gender (93 female, 49 male) and 144 reported their date of birth (mean age of 35 years, range from 18-65 years). The mean completion time for all FFQs (n=163), excluding periods of interruption, was 14.2 minutes (95% CI 13.3-15.1 minutes). Female participants (n=93) completed in 14.1 minutes (95% CI 12.9-15.3 minutes) and male participants (n=49) completed in 14.3 minutes (95% CI 12.6-15.9 minutes). Participants using laptops or desktops (n=69) completed the FFQ in an average of 13.9 minutes (95% CI 12.6-15.1 minutes) and participants using smartphones or tablets (n=91) completed in an average of 14.5 minutes (95% CI 13.2-15.8 minutes). The median SUS score (n=141) was 75.0 (interquartile range [IQR] 12.5), and 84% of the participants who completed the SUS classified the system either “good” (n=50) or “excellent” (n=69). Considering only participants using smartphones or tablets (n=80), the median score was 72.5 (IQR 12.5), slightly below the SUS median for desktops and laptops (n=58), which was 75.0 (IQR 12.5). No significant differences were found between genders or age groups (below and above the median) for the SUS or completion time. Conclusions: Taking into account all the requirements, the deployment used professional cloud computing at no cost, and the resulting system had good user acceptance. The results for smartphones/tablets were comparable with desktops/laptops. This work has potential to promote wider uptake of online tools that can assess dietary intake at scale.

  • JMIR Hum Factors 2017;4(2):e13

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  Heuristic Usability Evaluations

  Apr 24, 2017

  Toward a More Usable Home-Based Video Telemedicine System: A Heuristic Evaluation of the Clinician User Interfaces of Home-Based Video Telemedicine Systems

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  Authors List:

  • Sruthy Agnisarman  
  • Shraddhaa Narasimha  
  • Kapil Chalil Madathil  
  • Brandon Welch  
  • FNU Brinda  
  • Aparna Ashok  
  • James McElligott  

  Abstract:

  Background: Telemedicine is the use of technology to provide and support health care when distance separates the clinical service and the patient. Home-based telemedicine systems involve the use of such technology for medical support and care connecting the patient from the comfort of their homes with the clinician. In order for such a system to be used extensively, it is necessary to understand not only the issues faced by the patients in using them but also the clinician. Objectives: The aim of this study was to conduct a heuristic evaluation of 4 telemedicine software platforms—Doxy.me, Polycom, Vidyo, and VSee—to assess possible problems and limitations that could affect the usability of the system from the clinician’s perspective. Methods: It was found that 5 experts individually evaluated all four systems using Nielsen’s list of heuristics, classifying the issues based on a severity rating scale. Results: A total of 46 unique problems were identified by the experts. The heuristics most frequently violated were visibility of system status and Error prevention amounting to 24% (11/46 issues) each. Esthetic and minimalist design was second contributing to 13% (6/46 issues) of the total errors. Conclusions: Heuristic evaluation coupled with a severity rating scale was found to be an effective method for identifying problems with the systems. Prioritization of these problems based on the rating provides a good starting point for resolving the issues affecting these platforms. There is a need for better transparency and a more streamlined approach for how physicians use telemedicine systems. Visibility of the system status and speaking the users’ language are keys for achieving this.

  • JMIR Hum Factors 2017;4(2):e11

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  Safety and Error Prevention in Health

  Apr 13, 2017

  Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patterns, and Distraction Potential

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  Authors List:

  • Deborah L McBride  
  • Sandra A LeVasseur  

  Abstract:

  Background: Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care. Objective: Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non‒work-related activities and to assess the impact of these devices on in-patient care. Methods: A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues’ work. Results: Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non‒work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of respondents believe that on average personal communication devices have a more negative than positive impact on patient care and 39.07% (481/1231) reported that personal communication devices were always or often a distraction while working. Respondents acknowledged their own device use negatively affected their work performance (7.56%, 94/1243), or caused them to miss important clinical information (3.83%, 47/1225) or make a medical error (0.90%, 11/1218). Respondents reported witnessing another nurse’s use of devices negatively affect their work performance (69.41%, 860/1239), or cause them to miss important clinical information (30.61%, 378/1235) or make a medical error (12.51%, 155/1239). Younger respondents reported greater device use while at work than older respondents and generally had more positive opinions about the impact of personal communication devices on their work. Conclusions: The majority of registered nurses believe that the use of personal communication devices on hospital units raises significant safety issues. The high rate of respondents who saw colleagues distracted by their devices compared to the rate who acknowledged their own distraction may be an indication that nurses are unaware of their own attention deficits while using their devices. There were clear generational differences in personal communication device use at work and opinions about the impact of these devices on patient care. Professional codes of conduct for personal communication device use by hospital nurses need to be developed that maximize the benefits of personal communication device use, while reducing the potential for distraction and adverse outcomes.

  • JMIR Hum Factors 2017;4(2):e10

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  Focus Groups and Qualitative Research...

  Mar 24, 2017

  Design and Usability of a Heart Failure mHealth System: A Pilot Study

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  Authors List:

  • Nagla Alnosayan  
  • Samir Chatterjee  
  • Ala Alluhaidan  
  • Edward Lee  
  • Linda Houston Feenstra  

  Abstract:

  Background: Despite the advances in mobile health (mHealth) systems, little is known about patients’ and providers’ experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants’ feedback on the system’s design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users’ satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users’ experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes.

  • JMIR Hum Factors 2017;4(1):e9

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  Methods in Human Factors Research

  Mar 16, 2017

  A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase Methodology

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  Authors List:

  • Richard Harte  
  • Liam Glynn  
  • Alejandro Rodríguez-Molinero  
  • Paul MA Baker  
  • Thomas Scharf  
  • Leo R Quinlan  
  • Gearóid ÓLaighin  

  Abstract:

  Background: Design processes such as human-centered design, 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 human-centered design can often present a challenge when design teams are faced with the necessary, rapid, product development life cycles associated with the competitive connected health industry. Objective: We wanted to derive a structured methodology that followed the principles of human-centered design that would allow designers and developers to ensure that the needs of the user are taken into account throughout the design process, while maintaining a rapid pace of development. In this paper, we present the methodology and its rationale before outlining how it was applied to assess and enhance the usability, human factors, and user experience of a connected health system known as the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system, a system designed to continuously assess fall risk by measuring gait and balance parameters associated with fall risk. Methods: We derived a three-phase methodology. In Phase 1 we emphasized the construction of a use case document. This document can be used to detail the context of use of the system by utilizing storyboarding, paper prototypes, and mock-ups in conjunction with user interviews to gather insightful user feedback on different proposed concepts. In Phase 2 we emphasized the use of expert usability inspections such as heuristic evaluations and cognitive walkthroughs with small multidisciplinary groups to review the prototypes born out of the Phase 1 feedback. Finally, in Phase 3 we emphasized classical user testing with target end users, using various metrics to measure the user experience and improve the final prototypes. Results: We report a successful implementation of the methodology for the design and development of a system for detecting and predicting falls in older adults. We describe in detail what testing and evaluation activities we carried out to effectively test the system and overcome usability and human factors problems. Conclusions: We feel this methodology can be applied to a wide variety of connected health devices and systems. We consider this a methodology that can be scaled to different-sized projects accordingly.

  • JMIR Hum Factors 2017;4(1):e8

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  Usability Evaluation Case Studies

  Mar 3, 2017

  Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis

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  Authors List:

  • Joelle C Ferron  
  • Mary F Brunette  
  • Pamela Geiger  
  • Lisa A Marsch  
  • Anna M Adachi-Mejia  
  • Stephen J Bartels  

  Abstract:

  Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly—66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills.

  • JMIR Hum Factors 2017;4(1):e7

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  User-centred Design Case Studies

  Mar 1, 2017

  Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome

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  Authors List:

  • Holly O Witteman  
  • Justin Presseau  
  • Emily Nicholas Angl  
  • Iffat Jokhio  
  • JD Schwalm  
  • Jeremy M Grimshaw  
  • Beth Bosiak  
  • Madhu K Natarajan  
  • Noah M Ivers  

  Abstract:

  Background: Taking all recommended secondary prevention cardiac medications and fully participating in a formal cardiac rehabilitation program significantly reduces mortality and morbidity in the year following a heart attack. However, many people who have had a heart attack stop taking some or all of their recommended medications prematurely and many do not complete a formal cardiac rehabilitation program. Objective: The objective of our study was to develop a user-centered, theory-based, scalable intervention of printed educational materials to encourage and support people who have had a heart attack to use recommended secondary prevention cardiac treatments. Methods: Prior to the design process, we conducted theory-based interviews and surveys with patients who had had a heart attack to identify key determinants of secondary prevention behaviors. Our interdisciplinary research team then partnered with a patient advisor and design firm to undertake an iterative, theory-informed, user-centered design process to operationalize techniques to address these determinants. User-centered design requires considering users’ needs, goals, strengths, limitations, context, and intuitive processes; designing prototypes adapted to users accordingly; observing how potential users respond to the prototype; and using those data to refine the design. To accomplish these tasks, we conducted user research to develop personas (archetypes of potential users), developed a preliminary prototype using behavior change theory to map behavior change techniques to identified determinants of medication adherence, and conducted 2 design cycles, testing materials via think-aloud and semistructured interviews with a total of 11 users (10 patients who had experienced a heart attack and 1 caregiver). We recruited participants at a single cardiac clinic using purposive sampling informed by our personas. We recorded sessions with users and extracted key themes from transcripts. We held interdisciplinary team discussions to interpret findings in the context of relevant theory-based evidence and iteratively adapted the intervention accordingly. Results: Through our iterative development and testing, we identified 3 key tensions: (1) evidence from theory-based studies versus users’ feelings, (2) informative versus persuasive communication, and (3) logistical constraints for the intervention versus users’ desires or preferences. We addressed these by (1) identifying root causes for users’ feelings and addressing those to better incorporate theory- and evidence-based features, (2) accepting that our intervention was ethically justified in being persuasive, and (3) making changes to the intervention where possible, such as attempting to match imagery in the materials to patients’ self-images. Conclusions: Theory-informed interventions must be operationalized in ways that fit with user needs. Tensions between users’ desires or preferences and health care system goals and constraints must be identified and addressed to the greatest extent possible. A cluster randomized controlled trial of the final intervention is currently underway.

  • JMIR Hum Factors 2017;4(1):e6

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  Focus Groups and Qualitative Research...

  Feb 1, 2017

  A Self-Regulation Theory–Based Asthma Management Mobile App for Adolescents: A Usability Assessment

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  Authors List:

  • Adam Sage  
  • Courtney Roberts  
  • Lorie Geryk  
  • Betsy Sleath  
  • Deborah Tate  
  • Delesha Carpenter  

  Abstract:

  Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of a high-fidelity wireframe for an asthma self-management app intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18 years) with persistent asthma who owned a smartphone (N=8). Adolescents were asked to evaluate a PDF app wireframe consisting of 76 screen shots displaying app features, including log in and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: (1) usability, (2) behavioral intentions to use, (3) confusing aspects, and (4) suggestions for improvement. Results: The app wireframe was generally well received, and several suggestions for improvement were recorded. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the wireframe useful for managing their asthma. Conclusions: Early stage usability tests guided by government usability guidelines (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes.

  • JMIR Hum Factors 2017;4(1):e5

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  User Training and Skills

  Jan 27, 2017

  eHealth Literacy: Predictors in a Population With Moderate-to-High Cardiovascular Risk

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  Authors List:

  • Sarah S Richtering  
  • Karice Hyun  
  • Lis Neubeck  
  • Genevieve Coorey  
  • John Chalmers  
  • Tim Usherwood  
  • David Peiris  
  • Clara K Chow  
  • Julie Redfern  

  Abstract:

  Background: Electronic health (eHealth) literacy is a growing area of research parallel to the ongoing development of eHealth interventions. There is, however, little and conflicting information regarding the factors that influence eHealth literacy, notably in chronic disease. We are similarly ill-informed about the relationship between eHealth and health literacy, 2 related yet distinct health-related literacies. Objective: The aim of our study was to investigate the demographic, socioeconomic, technology use, and health literacy predictors of eHealth literacy in a population with moderate-to-high cardiovascular risk. Methods: Demographic and socioeconomic data were collected from 453 participants of the CONNECT (Consumer Navigation of Electronic Cardiovascular Tools) study, which included age, gender, education, income, cardiovascular-related polypharmacy, private health care, main electronic device use, and time spent on the Internet. Participants also completed an eHealth Literacy Scale (eHEALS) and a Health Literacy Questionnaire (HLQ). Univariate analyses were performed to compare patient demographic and socioeconomic characteristics between the low (eHEALS<26) and high (eHEALS≥26) eHealth literacy groups. To then determine the predictors of low eHealth literacy, multiple-adjusted generalized estimating equation logistic regression model was used. This technique was also used to examine the correlation between eHealth literacy and health literacy for 4 predefined literacy themes: navigating resources, skills to use resources, usefulness for oneself, and critical evaluation. Results: The univariate analysis showed that patients with lower eHealth literacy were older (68 years vs 66 years, P=.01), had lower level of education (P=.007), and spent less time on the Internet (P<.001). However, multiple-adjusted generalized estimating equation logistic regression model demonstrated that only the time spent on the Internet (P=.01) was associated with the level of eHealth literacy. Regarding the comparison between the eHEALS items and HLQ scales, a positive linear relationship was found for the themes “usefulness for oneself” (P=.049) and “critical evaluation” (P=.01). Conclusions: This study shows the importance of evaluating patients’ familiarity with the Internet as reflected, in part, by the time spent on the Internet. It also shows the importance of specifically assessing eHealth literacy in conjunction with a health literacy assessment in order to assess patients’ navigational knowledge and skills using the Internet, specific to the use of eHealth applications.

  • JMIR Hum Factors 2017;4(1):e4

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