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Journal Description

JMIR Human Factors (JHF) is a PubMed-indexed, peer-reviewed sister journal of JMIR, a leading open access eHealth journal (Impact Factor 2017: 4.671).
 
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. JHF aspires to lead health care towards a culture of testing 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.

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

 
 
 
 

Recent Articles:

  • Source: Wikimedia Commons; Copyright: Kgbo; URL: https://commons.wikimedia.org/wiki/File:Princess_Alexandra_Hospital_nurse_with_mobile_computer_work_station.jpg; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study

    Abstract:

    Background: The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. Objective: This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. Methods: A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. Results: Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system (P=.10 to P=.25). Conclusions: Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

  • Source: Pixabay; Copyright: engin akyurt; URL: https://pixabay.com/en/surgery-hospital-doctor-operation-3034133/; License: Licensed by JMIR.

    A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency...

    Abstract:

    Background: Many emergency departments (EDs) have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients’ vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients’ informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so. Objective: This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care. Methods: From July to December 2017, semistructured interviews were iteratively conducted with health care professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1000 beds, and approximately 128,000 patients visit its 2 EDs annually. In response to poor wait times, in 2013, the hospital’s 2 EDs underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency. Results: Overall, 15 nurses and 5 physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. Although, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members, and visitors. In an attempt to work around limitations they encountered and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better protected individuals’ informational and physical privacy. Conclusions: To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better affording privacy and confidentiality for patient encounters. These searches likely increased clinical time and added to these patients’ length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean’s principle of value-added activities. Future exploration of the perspectives of patients, family members, and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/grandfather-granddaughter-exercising_903804.htm; License: Licensed by JMIR.

    Supporting Older Adults in Exercising With a Tablet: A Usability Study

    Abstract:

    Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies.

  • Source: Pexels; Copyright: Brett Sayles; URL: https://www.pexels.com/photo/photography-of-women-using-mobile-phones-1000739/; License: Licensed by JMIR.

    Designing Online Interventions in Consideration of Young People’s Concepts of Well-Being: Exploratory Qualitative Study

    Abstract:

    Background: A key challenge in developing online well-being interventions for young people is to ensure that they are based on theory and reflect adolescent concepts of well-being. Objective: This exploratory qualitative study aimed to understand young people’s concepts of well-being in Australia. Methods: Data were collected via workshops at five sites across rural and metropolitan sites with 37 young people from 15 to 21 years of age, inclusive. Inductive, data-driven coding was then used to analyze transcripts and artifacts (ie, written or image data). Results: Young adults’ conceptions of well-being were diverse, personally contextualized, and shaped by ongoing individual experiences related to physical and mental health, along with ecological accounts acknowledging the role of family, community, and social factors. Key emerging themes were (1) positive emotions and enjoyable activities, (2) physical wellness, (3) relationships and social connectedness, (4) autonomy and control, (5) goals and purpose, (6) being engaged and challenged, and (7) self-esteem and confidence. Participants had no difficulty describing actions that led to positive well-being; however, they only considered their own well-being at times of stress. Conclusions: In this study, young people appeared to think mostly about their well-being at times of stress. The challenge for online interventions is to encourage young people to monitor well-being prior to it becoming compromised. A more proactive focus that links the overall concept of well-being to everyday, concrete actions and activities young people engage in, and that encourages the creation of routine good habits, may lead to better outcomes from online well-being interventions.

  • Source: Unsplash; Copyright: Rawpixel; URL: https://unsplash.com/photos/tQ3ADldKIoI; License: Licensed by the authors.

    Advancing Cardiac Surgery Case Planning and Case Review Conferences Using Virtual Reality in Medical Libraries: Evaluation of the Usability of Two Virtual...

    Abstract:

    Background: Care providers and surgeons prepare for cardiac surgery using case conferences to review, discuss, and run through the surgical procedure. Surgeons visualize a patient’s anatomy to decide the right surgical approach using magnetic resonance imaging and echocardiograms in a presurgical case planning session. Previous studies have shown that surgical errors can be reduced through the effective use of immersive virtual reality (VR) to visualize patient anatomy. However, inconsistent user interfaces, delegation of view control, and insufficient depth information cause user disorientation and interaction difficulties in using VR apps for case planning. Objective: The objective of the study was to evaluate and compare the usability of 2 commercially available VR apps—Bosc (Pyrus Medical systems) and Medical Holodeck (Nooon Web & IT GmbH)—using the Vive VR headset (HTC Corporation) to evaluate ease of use, physician attitudes toward VR technology, and viability for presurgical case planning. The role of medical libraries in advancing case planning is also explored. Methods: After screening a convenience sample of surgeons, fellows, and residents, ethnographic interviews were conducted to understand physician attitudes and experience with VR. Gaps in current case planning methods were also examined. We ran a usability study, employing a concurrent think-aloud protocol. To evaluate user satisfaction, we used the system usability scale (SUS) and the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). A poststudy questionnaire was used to evaluate the VR experience and explore the role of medical libraries in advancing presurgical case planning. Semistructured interview data were analyzed using content analysis with feedback categorization. Results: Participants were residents, fellows, and surgeons from the University of Washington with a mean age of 41.5 (SD 11.67) years. A total of 8 surgeons participated in the usability study, 3 of whom had prior exposure to VR. Users found Medical Holodeck easier to use than Bosc. Mean adjusted NASA-TLX score for Medical Holodeck was 62.71 (SD 18.25) versus Bosc’s 40.87 (SD 13.90). Neither app passed the mean SUS score of 68 for an app to be considered usable, though Medical Holodeck (66.25 [SD 12.87]) scored a higher mean SUS than Bosc (37.19 [SD 22.41]). One user rated the Bosc usable, whereas 3 users rated Medical Holodeck usable. Conclusions: Interviews highlighted the importance of precise anatomical conceptualization in presurgical case planning and teaching, identifying it as the top reason for modifying a surgical procedure. The importance of standardized user interaction features such as labeling is justified. The study also sheds light on the new roles medical librarians can play in curating VR content and promoting interdisciplinary collaboration.

  • Mobile app for reporting medication errors anonymously (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://humanfactors.jmir.org/2018/4/e12232/; License: Creative Commons Attribution (CC-BY).

    Usability Testing of a Mobile App to Report Medication Errors Anonymously: Mixed-Methods Approach

    Abstract:

    Background: Reporting of medication errors is one of the essential mechanisms to identify risky health care systems and practices that lead to medication errors. Unreported medication errors are a real issue; one of the identified causes is a burdensome medication error reporting system. An anonymous and user-friendly mobile app for reporting medication errors could be an alternative method of reporting medication error in busy health care settings. Objective: The objective of this paper is to report usability testing of the Medication Error Reporting App (MERA), a mobile app for reporting medication errors anonymously. Methods: Quantitative and qualitative methods were employed involving 45 different testers (pharmacists, doctors, and nurses) from a large tertiary hospital in Malaysia. Quantitative data was retrieved using task performance and rating of MERA and qualitative data were retrieved through focus group discussions. Three sessions, with 15 testers each session, were conducted from January to March 2018. Results: The majority of testers were pharmacists (23/45, 51%), female (35/45, 78%), and the mean age was 36 (SD 9) years. A total of 135 complete reports were successfully submitted by the testers (three reports per tester) and 79.2% (107/135) of the reports were correct. There was significant improvement in mean System Usability Scale scores in each session of the development process (P<.001) and mean time to report medication errors using the app was not significantly different between each session (P=.70) with an overall mean time of 6.7 (SD 2.4) minutes. Testers found the app easy to use, but doctors and nurses were unfamiliar with terms used especially medication process at which error occurred and type of error. Although, testers agreed the app can be used in the future for reporting, they were apprehensive about security, validation, and abuse of feedback featured in the app. Conclusions: MERA can be used to report medication errors easily by various health care personnel and it has the capacity to provide feedback on reporting. However, education on medication error reporting should be provided to doctors and nurses in Malaysia and the security of the app needs to be established to boost reporting by this method.

  • Source: Image created by the Authors; Copyright: Astrid Torbjørnsen; URL: http://humanfactors.jmir.org/2018/4/e10255/; License: Creative Commons Attribution (CC-BY).

    The Service User Technology Acceptability Questionnaire: Psychometric Evaluation of the Norwegian Version

    Abstract:

    Background: When developing a mobile health app, users’ perception of the technology should preferably be evaluated. However, few standardized and validated questionnaires measuring acceptability are available. Objective: The aim of this study was to assess the validity of the Norwegian version of the Service User Technology Acceptability Questionnaire (SUTAQ). Methods: Persons with type 2 diabetes randomized to the intervention groups of the RENEWING HEALTH study used a diabetes diary app. At the one-year follow-up, participants in the intervention groups (n=75) completed the self-reported instrument SUTAQ to measure the acceptability of the equipment. We conducted confirmatory factor analysis for evaluating the fit of the original five-factor structure of the SUTAQ. Results: We confirmed only 2 of the original 5 factors of the SUTAQ, perceived benefit and care personnel concerns. Conclusions: The original five-factor structure of the SUTAQ was not confirmed in the Norwegian study, indicating that more research is needed to tailor the questionnaire to better reflect the Norwegian setting. However, a small sample size prevented us from drawing firm conclusions about the translated questionnaire.

  • Untitled. Source: Adobe Stock; Copyright: angellodeco; URL: https://stock.adobe.com/ca/images/doctor-with-tablet-data-consulting-a-medical-report-of-a-patient-practitioner-with-a-medical-record-health-on-the-screen-a-digital-device/112970588; License: Licensed by the authors.

    An Optimization Program to Help Practices Assess Data Quality and Workflow With Their Electronic Medical Records: Observational Study

    Abstract:

    Background: Electronic medical record (EMR) adoption among Canadian primary care physicians continues to grow. In Ontario, >80% of primary care providers now use EMRs. Adopting an EMR does not guarantee better practice management or patient care; however, EMR users must understand how to effectively use it before they can realize its full benefit. OntarioMD developed an EMR Practice Enhancement Program (EPEP) to overcome challenges of clinicians and staff in finding time to learn a new technology or workflow. EPEP deploys practice consultants to work with clinicians onsite to harness their EMR toward practice management and patient care goals. Objective: This paper aims to illustrate the application of the EPEP approach to address practice-level factors that impede or enhance the effective use of EMRs to support patient outcomes and population health. The secondary objective is to draw attention to the potential impact of this practice-level work to population health (system-level), as priority population health indicators are addressed by quality improvement work at the practice-level. Methods: EPEP’s team of practice consultants work with clinicians to identify gaps in their knowledge of EMR functionality, analyze workflow, review EMR data quality, and develop action plans with achievable tasks. Consultants establish baselines for data quality in key clinical indicators and EMR proficiency using OntarioMD-developed maturity assessment tools. We reassessed and compared postengagement, data quality, and maturity. Three examples illustrating the EPEP approach and results are presented to illuminate strengths, limitations, and implications for further analysis. In each example, a different consultant was responsible for engaging with the practice to conduct the EPEP method. No standard timeframe exists for an EPEP engagement, as requirements differ from practice to practice, and EPEP tailors its approach and timeframe according to the needs of the practice. Results: After presenting findings of the initial data quality review, workflow, and gap analysis to the practice, consultants worked with practices to develop action plans and begin implementing recommendations. Each practice had different objectives in engaging the EPEP; here, we compared improvements across measures that were common priorities among all 3—screening (colorectal, cervical, and breast), diabetes diagnosis, and documentation of the smoking status. Consultants collected postengagement data at intervals (approximately 6, 12, and 18 months) to assess the sustainability of the changes. The postengagement assessment showed data quality improvements across several measures, and new confidence in their data enabled practices to implement more advanced functions (such as toolbars) and targeted initiatives for subpopulations of patients. Conclusions: Applying on-site support to analyze gaps in EMR knowledge and use, identify efficiencies to improve workflow, and correct data quality issues can make dramatic improvements in a practice’s EMR proficiency, allowing practices to experience greater benefit from their EMR, and consequently, improve their patient care.

  • Source: Freepik; Copyright: peoplecreations; URL: https://www.freepik.com/free-photo/business-executives-writing-on-sticky-notes_1005841.htm; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Innovating From Within: A Process Model for User-Centered Digital Development in Academic Medical Centers

    Abstract:

    Background: Design thinking and human-centered design approaches have become increasingly common in health care literature, particularly in relation to health information technology (HIT), as a pathway toward the development of usable, diffusible tools and processes. There is a need in academic medical centers tasked with digital innovation for a comprehensive process model to guide development that incorporates current industry trends, including design thinking and lean and agile approaches to digital development. Objective: This study aims to describe the foundations and phases of our model for user-centered HIT development. Methods: Based on our experience, we established an integrated approach and rigorous process for HIT development that leverages design thinking and lean and agile strategies in a pragmatic way while preserving methodological integrity in support of academic research goals. Results: A four-phased pragmatic process model was developed for user-centered digital development in HIT. Conclusions: The model for user-centered HIT development that we developed is the culmination of diverse innovation projects and represents a multiphased, high-fidelity process for making more creative, flexible, efficient, and effective tools. This model is a critical step in building a rigorous approach to HIT design that incorporates a multidisciplinary, pragmatic perspective combined with academic research practices and state-of-the-art approaches to digital product development to meet the unique needs of health care.

  • Source: Pexels; Copyright: Pixabay; URL: https://www.pexels.com/photo/ambulance-architecture-building-business-263402/; License: Public Domain (CC0).

    Easier and Faster Is Not Always Better: Grounded Theory of the Impact of Large-Scale System Transformation on the Clinical Work of Emergency Medicine Nurses...

    Abstract:

    Background: The effectiveness of Lean Thinking as a quality improvement method for health care has been contested due, in part, to our limited contextual understanding of how it affects the working conditions and clinical workflow of nurses and physicians. Although there are some initial indications, arising from prevalence surveys and interviews, that Lean may intensify work performed within medical environments, the evidence base still requires detailed descriptions of the changes that were actually introduced to individuals’ clinical workflow and how these changes impacted health care professionals. Objective: The aim of this study was to explore ways in which a Lean intervention may impact the clinical work of emergency medicine nurses and physicians. Methods: We used a realist grounded theory approach to explore the clinical work of nurses and physicians practicing in 2 emergency medicine departments from a single teaching hospital in Canada. The hospital has 1000 beds with 128,000 emergency department (ED) visits annually. In 2013, both sites began a large-scale, Lean-driven system transformation of their practice environments. In-person interviews were iteratively conducted with health care professionals from July to December 2017. Information from transcripts was coded into categories and compared with existing codes. With repeated review of transcripts and evolving coding, we organized categories into themes. Data collection continued to theoretical sufficiency. Results: A total of 15 emergency medicine nurses and 5 physicians were interviewed. Of these, 18 individuals had practiced for at least 10 years. Our grounded theory involved 3 themes: (1) organization of our clinical work, (2) pushed pace in the front cell, and (3) the toll this all takes on us. Although the intervention was supposed to make the EDs work easier, faster, and better, the participants in our study indicated that the changes made had the opposite impact. Nurses and physicians described ways in which the reconfigured EDs disrupted their established practice routines and resulted in the intensification of their work. Participants also identified indications of deskilling of nurses’ work and how the new push-forward model of patient care had detrimental impacts on their physical, cognitive, and emotional well-being. Conclusions: To our knowledge, this is the first study to describe the impact of Lean health care on the working conditions and actual work of emergency medicine nurses and physicians. We theorize that rather than support health care professionals in their management of the complexities that characterize emergency medicine, the physical and process-based changes introduced by the Lean intervention acted to further complicate their working environment. We have illuminated some unintended consequences associated with accelerating patient flow on the clinical workflow and perceived well-being of health care professionals. We identify some areas for reconsideration by the departments and put forward ideas for future research.

  • Source: Unsplash; Copyright: rawpizel; URL: https://unsplash.com/photos/Sv1iuZl-5a8; License: Licensed by JMIR.

    Bridging the Gap Between Academic Research and Pragmatic Needs in Usability: A Hybrid Approach to Usability Evaluation of Health Care Information Systems

    Abstract:

    Background: Technology is increasingly embedded into the full spectrum of health care. This movement has benefited from the application of software development practices such as usability testing and agile development processes. These practices are frequently applied in both commercial or operational and academic settings. However, the relative importance placed on rapid iteration, validity, reproducibility, generalizability, and efficiency differs between the 2 settings and the needs and objectives of academic versus pragmatic usability evaluations. Objective: This paper explores how usability evaluation typically varies on key dimensions in pragmatic versus academic settings that impact the rapidity, validity, and reproducibility of findings and proposes a hybrid approach aimed at satisfying both pragmatic and academic objectives. Methods: We outline the characteristics of pragmatic versus academically oriented usability testing in health care, describe the tensions and gaps resulting from differing contexts and goals, and present a model of this hybrid process along with 2 case studies of digital development projects in which we demonstrate this integrated approach to usability evaluation. Results: The case studies presented illustrate design choices characteristic of our hybrid approach to usability evaluation. Conclusions: Designed to leverage the strengths of both pragmatically and academically focused usability studies, a hybrid approach allows new development projects to efficiently iterate and optimize from usability data as well as preserves the ability of these projects to produce deeper insights via thorough qualitative analysis to inform further tool development and usability research by way of academically focused dissemination.

  • ReX device. Source: The Authors; Copyright: The Authors; URL: http://humanfactors.jmir.org/2018/4/e10128/; License: Licensed by JMIR.

    Use of a Digital Medication Management System for Effective Assessment and Enhancement of Patient Adherence to Therapy (ReX): Feasibility Study

    Abstract:

    Background: Medication nonadherence is a major problem in health care, imposing poor clinical outcomes and a heavy financial burden on all stakeholders. Current methods of medication adherence assessment are severely limited: they are applied only periodically, do not relate to actual pill intake, and suffer from patient bias due to errors, misunderstanding, or intentional nonadherence. ReX is an innovative medication management system designed to address poor patient adherence and enhance patient engagement with their therapy. ReX controls and tracks pills from the point of packaging right through to the patient’s mouth. ReX generates robust, real-time adherence data. The system enables patients to report outcomes, complete surveys, and receive messages and instructions. ReX includes a reusable drug dispensing unit, disposable cassette containing pills, and a cloud-based data portal. Objective: We aimed to evaluate ReX feasibility by human factor studies including evaluation of ReX safety; ReX acceptance and usability; and ReX efficacy of providing pills according to a preprogrammed dose regimen, managing reminders and adherence data, and enhancing the adherence rate compared with the standard of care. Methods: The ReX system was evaluated in 2 human factor, nonclinical feasibility studies. Human subjects used ReX for the administration of pill-shaped Tic Tac sweets. The initial study evaluated ReX use and pill intake administration; second was a self-controlled, 4-day home-use study. All subjects took pills at home, according to a preprogrammed dose regimen, for 4 days each via the device (ReX test) or from standard packaging (control test). The adherence rate (percent of pills taken) was measured by the study subject’s report, remaining pills count, and ReX records (in the ReX test). ReX safety and usability were evaluated by a questionnaire filled out by the subject. Results: The initial feasibility study evaluated usability and acceptance of the ReX novel approach to pill dispensing. All subjects successfully managed 2 pill intakes. The ReX device was rated as easy to use by 81% (48/59) of subjects. The 4-day home-use study evaluated the safety, efficacy, and usability of the ReX system. No adverse event occurred; no pill overdose or pill malformation was reported. The overall adherence rate in the ReX test was 97.6% compared with 76.3% in the control test (P<.001). Real-time, personalized reminders provided in the event of a delay in pill intake contributed to 18.0% of doses taken during the ReX test. The ReX system was found easy to use by 87% (35/40) of subjects; 90% (36/40) felt comfortable using it for their medication. Conclusions: ReX’s novel “tracking to the mouth” technology was found usable and accepted by subjects. The assessment of adherence rates was reliable; adherence of subjects to the dose regimen was significantly enhanced when using ReX compared with the standard of care.

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  • Identifying key steps in developing a one-stop shop for health policy and system information in a limited-resource setting: A case study.

    Date Submitted: Feb 4, 2019

    Open Peer Review Period: Feb 4, 2019 - Feb 18, 2019

    Background: There is limited understanding about the development and implementation of the one-stop shops for evidence in a limited-resource setting such as Uganda. Previous efforts to develop one-sto...

    Background: There is limited understanding about the development and implementation of the one-stop shops for evidence in a limited-resource setting such as Uganda. Previous efforts to develop one-stop shops have focused on global research evidence and local policy-relevant documents to address questions about health interventions and health systems in high-income countries. Objective: This study aimed to identify key steps in the development of on-line evidence-based information resources for health policy and system for a limited-resource setting. Methods: We utilised a case study design to address our objective where the case (i.e. unit of analysis) was defined as “the development process of the Uganda Clearinghouse for Health Policy and System”. We collected data from multiples sources including key informant interviews, participant observations and archival records to develop a comprehensive account for the case under investigation. Results: We found out that the development of the Uganda Clearinghouse for Health Policy and System followed a seven-step process, characterized by iterations that occurred within and between the steps. The essential components of the process included developing the concept; prototyping of the key structure; engaging with policy makers, researchers and other stakeholders; conducting a scoping review of policy relevant documents to identify and index the content; dissemination of the resource; user-testing; and updating of the system. Conclusions: Our study provides key steps for developing a one-stop shop for local evidence to inform health policy and system decisions in a limited resource setting. Researchers, especially those in similar settings may apply this step by step inventory to develop similar resources. Clinical Trial: N/A

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