@Article{info:doi/10.2196/65163,
author="Butorac, Isobel
and McNaney, Roisin
and Seguin, Paolo Joshua
and Olivier, Patrick
and Northam, C. Jaimie
and Tully, A. Lucy
and Carl, Talia
and Carter, Adrian",
title="Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Apr",
day="22",
volume="8",
pages="e65163",
keywords="digital mental health",
keywords="young people",
keywords="cultural diversity",
keywords="web-based and mobile health interventions",
keywords="qualitative methods",
keywords="user-centered design",
keywords="human-computer interaction",
abstract="Background: Approximately 39\% of young people (aged 16-24 y) experience mental ill health, but only 23\% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. Objective: The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based ``check-in'' tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. Methods: We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44\%; young people: n=10, 56\%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Results: Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. Conclusions: The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study's findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations. ",
doi="10.2196/65163",
url="https://pediatrics.jmir.org/2025/1/e65163"
}


@Article{info:doi/10.2196/58095,
author="Benavent, Diego
and Iniesta-Chamorro, M. Jose
and Novella-Navarro, Marta
and P{\'e}rez-Mart{\'i}nez, Miguel
and Mart{\'i}nez-S{\'a}nchez, Nuria
and Kaffati, M{\'o}nica
and Ju{\'a}rez-Garc{\'i}a, Manuel
and Molinari-P{\'e}rez, Marina
and Gonz{\'a}lez-Torbay, Andrea
and Guti{\'e}rrez, Mariana
and L{\'o}pez-Juanes, Natalia
and Navarro-Comp{\'a}n, Victoria
and Monjo-Henry, Irene
and Rodr{\'i}guez-Rosales, Germ{\'a}n
and Bachiller, Javier
and Calvo-Aranda, Enrique
and Michelena, Xabier
and Berbel-Arcob{\'e}, Laura
and Balsa, Alejandro
and 
and G{\'o}mez, J. Enrique
and Plasencia-Rodr{\'i}guez, Chamaida",
title="Digital Health Intervention for Patient Monitoring in Immune-Mediated Inflammatory Diseases: Cocreation and Feasibility Study of the IMIDoc Platform",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="21",
volume="12",
pages="e58095",
keywords="immune-mediated inflammatory diseases",
keywords="cocreation",
keywords="health care provider",
keywords="digital health solution",
keywords="inflammatory",
keywords="inflammatory disease",
keywords="monitoring",
keywords="care model",
keywords="patient care",
keywords="development",
keywords="app",
keywords="user centered",
keywords="patient monitoring",
keywords="decision-making",
keywords="user needs",
abstract="Background: Immune-mediated inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis, pose challenges due to recurrent flares and gaps in patient monitoring. Traditional health care models often fail to capture disease progression effectively. Objective: This study aimed to describes the structured cocreation of the IMIDoc platform, an interdisciplinary initiative aimed at improving patient monitoring, education, and health care provider decision-making. Methods: IMIDoc was cocreated through an interdisciplinary team involving clinical experts, biomedical engineers, and technical developers, using user-centered design principles. The development process included the identification of unmet clinical needs, user-centered app design, implementation of medication management features, patient data recording capabilities, and educational content. A 3-month feasibility and functionality testing was performed to evaluate the usability and technical performance of the apption. Results: During the feasibility testing, 111 entries were logged for the patient mobile app, comprising 76 errors identified and corrected, 16 improvements addressing functionality, usability, and performance, and 10 evolutionary suggestions. The professional interface received 45 entries, identifying 40 errors and 5 evolutionary suggestions. Ten iterative updates significantly enhanced the user interface intuitiveness and medication reminder functionality, aligning the solution closely with clinical workflows and user needs. Conclusions: The IMIDoc platform, developed by a multidisciplinary cocreation methodology, shows potential to improve the management of immune-mediated inflammatory diseases ithrough enhanced communication and monitoring. A multicenter clinical study with 360 patients across 5 Spanish hospitals will further evaluate its impact. Trial Registration: ClinicalTrials.gov NCT06273306; https://tinyurl.com/4t6ubcsf ",
doi="10.2196/58095",
url="https://humanfactors.jmir.org/2025/1/e58095"
}


@Article{info:doi/10.2196/68891,
author="Seo, Woosuk
and Li, Jiaqi
and Zhang, Zhan
and Zheng, Chuxuan
and Singh, Hardeep
and Pasupathy, Kalyan
and Mahajan, Prashant
and Park, Young Sun",
title="Designing Health Care Provider--Centered Emergency Department Interventions: Participatory Design Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="21",
volume="9",
pages="e68891",
keywords="emergency departments",
keywords="participatory design",
keywords="health care providers",
keywords="technology",
keywords="interventions",
keywords="artificial intelligence",
abstract="Background: In the emergency department (ED), health care providers face extraordinary pressures in delivering accurate diagnoses and care, often working with fragmented or inaccessible patient histories while managing severe time constraints and constant interruptions. These challenges and pressures may lead to potential errors in the ED diagnostic process and risks to patient safety. With advances in technology, interventions have been developed to support ED providers in such pressured settings. However, these interventions may not align with the current practices of ED providers. To better design ED provider--centered interventions, identifying their needs in the diagnostic process is critical. Objective: This study aimed to identify ED providers' needs in the diagnostic process through participatory design sessions and to propose design guidelines for provider?centered technological interventions that support decision?making and reduce errors. Methods: We conducted a participatory design study with ED providers to validate their needs and identify considerations for designing ED provider--centered interventions to improve diagnostic safety. We used 9 technological intervention ideas as storyboards to address the study participants' needs. We had participants discuss the use cases of each intervention idea to assess their needs during the ED care process and facilitated co-design activities with the participants to improve the technological intervention designs. We audio- and video-recorded the design sessions. We then analyzed session transcripts, field notes, and design sketches. In total, we conducted 6 design sessions with 17 ED frontline providers. Results: Through design sessions with ED providers, we identified 4 key needs in the diagnostic process: information integration, patient prioritization, ED provider-patient communication, and care coordination. We interpreted them as insights for designing technological interventions for ED patients. Hence, we discussed the design implications for technological interventions in four key areas: (1) enhancing ED provider--ED provider communication, (2) enhancing ED provider-patient communication, (3) optimizing the integration of advanced technology, and (4) unleashing the potential of artificial intelligence tools in the ED to improve diagnosis. This work offers evidence-based technology design suggestions for improving diagnostic processes. Conclusions: This study provides unique insights for designing technological interventions to support ED diagnostic processes. By inviting ED providers into the design process, we present unique insights into the diagnostic process and design considerations for designing novel technological interventions that meet ED providers' needs in the diagnostic process. International Registered Report Identifier (IRRID): RR2-10.2196/55357 ",
doi="10.2196/68891",
url="https://formative.jmir.org/2025/1/e68891"
}


@Article{info:doi/10.2196/65889,
author="Burch, E. Kathleen
and Tryon, L. Valerie
and Pierce, M. Katherine
and Tully, M. Laura
and Ereshefsky, Sabrina
and Savill, Mark
and Smith, Leigh
and Wilcox, B. Adam
and Hakusui, Komei Christopher
and Padilla, E. Viviana
and McNamara, P. Amanda
and Kado-Walton, Merissa
and Padovani, J. Andrew
and Miller, Chelyah
and Miles, J. Madison
and Sharma, Nitasha
and Nguyen, H. Khanh Linh
and Zhang, Yi
and Niendam, A. Tara",
title="Co-Designing a Web-Based and Tablet App to Evaluate Clinical Outcomes of Early Psychosis Service Users in a Learning Health Care Network: User-Centered Design Workshop and Pilot Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="9",
volume="12",
pages="e65889",
keywords="eHealth",
keywords="user-centered design",
keywords="learning health system",
keywords="psychosis",
keywords="early psychosis",
keywords="user-driven development",
keywords="web-based",
keywords="data visualization",
keywords="surveys and questionnaires",
keywords="measurement-based care",
abstract="Background: The Early Psychosis Intervention Network of California project, a learning health care network of California early psychosis intervention (EPI) programs, prioritized incorporation of community partner feedback while designing its eHealth app, Beehive. Though eHealth apps can support learning health care network data collection aims, low user acceptance or adoption can pose barriers to successful implementation. Adopting user-centered design (UCD) approaches, such as incorporation of user feedback, prototyping, iterative design, and continuous evaluation, can mitigate these potential barriers. Objective: We aimed to use UCD during development of a data collection and data visualization web-based and tablet app, Beehive, to promote engagement with Beehive as part of standard EPI care across a diverse user-base. Methods: Our UCD approach included incorporation of user feedback, prototyping, iterative design, and continuous evaluation. This started with user journey mapping to create storyboards, which were then presented in UCD workshops with service users, their support persons, and EPI providers. We incorporated feedback from these workshops into the alpha version of Beehive, which was also presented in a UCD workshop. Feedback was again incorporated into the beta version of Beehive. We provided Beehive training to 4 EPI programs who then piloted Beehive's beta version. During piloting, service users, their support persons, and EPI program providers completed Beehive surveys at enrollment and every 6 months after treatment initiation. To examine preliminary user acceptance and adoption during the piloting phase, we assessed rates of participant enrollment and survey completion, with a particular focus on completion of a prioritized survey: the Modified Colorado Symptom Index. Results: UCD workshop feedback resulted in the creation of new workflows and interface changes in Beehive to improve the user experience. During piloting, 48 service users, 42 support persons, and 72 EPI program providers enrolled in Beehive. Data were available for 88\% (n=42) of service users, including self-reported data for 79\% (n=38), collateral-reported data for 42\% (n=20), and clinician-entered data for 17\% (n=8). The Modified Colorado Symptom Index was completed by 54\% (n=26) of service users (total score: mean 24.16, SD 16.81). In addition, 35 service users had a support person who could complete the Modified Colorado Symptom Index, and 56\% (n=19) of support persons completed it (mean 26.71, SD 14.43). Conclusions: Implementing UCD principles while developing the Beehive app resulted in early workflow changes and produced an app that was acceptable and feasible for collection of self-reported clinical outcomes data from service users. Additional support is needed to increase collateral-reported and clinician-entered data. ",
doi="10.2196/65889",
url="https://humanfactors.jmir.org/2025/1/e65889"
}


@Article{info:doi/10.2196/72469,
author="McAlister, Kelsey
and Baez, Lara
and Huberty, Jennifer
and Kerppola, Marianna",
title="Chatbot to Support the Mental Health Needs of Pregnant and Postpartum Women (Moment for Parents): Design and Pilot Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="8",
volume="9",
pages="e72469",
keywords="perinatal support",
keywords="human-centered design",
keywords="digital health",
keywords="maternal health",
keywords="chatbot",
keywords="digital tool",
abstract="Background: Maternal mental health disorders are prevalent, yet many individuals do not receive adequate support due to stigma, financial constraints, and limited access to care. Digital interventions, particularly chatbots, have the potential to provide scalable, low-cost support, but few are tailored specifically to the needs of perinatal individuals. Objective: This study aimed to (1) design and develop Moment for Parents, a tailored chatbot for perinatal mental health education and support, and (2) assess usability through engagement, usage patterns, and user experience. Methods: This study used a human-centered design to develop Moment for Parents, a rules-based chatbot to support pregnant and postpartum individuals. In phase 1, ethnographic interviews (n=43) explored user needs to inform chatbot development. In phase 2, a total of 108 pregnant and postpartum individuals were recruited to participate in a pilot test and had unrestricted access to the chatbot. Engagement was tracked over 8 months to assess usage patterns and re-engagement rates. After 1 month, participants completed a usability, relevance, and satisfaction survey, providing key insights for refining the chatbot. Results: Key themes that came from the ethnographic interviews in phase 1 included the need for trusted resources, emotional support, and better mental health guidance. These insights informed chatbot content, including mood-based exercises and coping strategies. Re-engagement was high (69/108, 63.9\%), meaning users who had stopped interacting for at least 1 week returned to the chatbot at least once. A large proportion (28/69, 40.6\%) re-engaged 3 or more times. Overall, 28/30 (93.3\%) found the chatbot relevant for them, though some noted repetitive content and limited response options. Conclusions: The Moment for Parents chatbot successfully engaged pregnant and postpartum individuals with higher-than-typical retention and re-engagement patterns. The findings underscore the importance of flexible, mood-based digital support tailored to perinatal needs. Future research should examine how intermittent chatbot use influences mental health outcomes and refine content delivery to enhance long-term engagement and effectiveness. ",
doi="10.2196/72469",
url="https://formative.jmir.org/2025/1/e72469"
}


@Article{info:doi/10.2196/66966,
author="S{\o}rensen, Marie Nikita
and Skaarnes, Helene
and Mathiasen, Kim
and Thastum, Mikael
and Lomholt, Jeppesen Johanne",
title="Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="8",
volume="9",
pages="e66966",
keywords="user-centered design",
keywords="digital treatment",
keywords="digital mental health",
keywords="internet-based",
keywords="cognitive behavioral therapy",
keywords="anxiety",
keywords="adolescents",
abstract="Background: Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation. Objective: This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework. Methods: The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback. Results: In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled ``humans'' received more votes as adolescents could better ``identify'' themselves with them. Communication should preferably be ``supportive'' and feel ``like a friend'' talking to them. Statements including praise---such as ``You're well on your way. How are you today?''---received the most votes (12 votes), whereas directive statements such as ``Tell us how your day has been?'' and ``How is practicing your steps going?'' received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks. Conclusions: Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice. ",
doi="10.2196/66966",
url="https://formative.jmir.org/2025/1/e66966"
}


@Article{info:doi/10.2196/59942,
author="Biernetzky, A. Olga
and Thyrian, Ren{\'e} Jochen
and Boekholt, Melanie
and Berndt, Matthias
and Hoffmann, Wolfgang
and Teipel, J. Stefan
and Kilimann, Ingo",
title="Identifying Unmet Needs of Informal Dementia Caregivers in Clinical Practice: User-Centered Development of a Digital Assessment Tool",
journal="JMIR Aging",
year="2025",
month="Apr",
day="7",
volume="8",
pages="e59942",
keywords="unmet needs",
keywords="assessment development",
keywords="family caregivers of people with dementia",
keywords="dementia",
keywords="need",
keywords="Alzheimer",
keywords="self-guided",
keywords="self-reported",
keywords="caregiver",
keywords="informal care",
keywords="spousal care",
keywords="interview",
keywords="qualitative",
keywords="thematic",
keywords="usability",
keywords="mHealth",
keywords="tablet",
keywords="self-completed",
keywords="aging",
keywords="patient care",
keywords="health interventions",
keywords="care giver",
keywords="digital health",
keywords="ehealth",
keywords="digital assessment",
keywords="memory",
abstract="Background: Despite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective. Objective: Our study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting. Methods: The development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angeh{\"o}rige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers' biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically. Results: Data from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings. Conclusions: The input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial. Trial Registration: ClinicalTrials.gov NCT04037501; https://clinicaltrials.gov/study/NCT04037501 ",
doi="10.2196/59942",
url="https://aging.jmir.org/2025/1/e59942"
}


@Article{info:doi/10.2196/58337,
author="Kato, Daigo
and Okuno, Akiko
and Ishikawa, Tetsuo
and Itakura, Shoji
and Oguchi, Shinji
and Kasahara, Yoshiyuki
and Kanenishi, Kenji
and Kitadai, Yuzo
and Kimura, Yoshitaka
and Shimojo, Naoki
and Nakahara, Kazushige
and Hanai, Akiko
and Hamada, Hiromichi
and Mogami, Haruta
and Morokuma, Seiichi
and Sakurada, Kazuhiro
and Konishi, Yukuo
and Kawakami, Eiryo",
title="Multilevel Factors and Indicators of Atypical Neurodevelopment During Early Infancy in Japan: Prospective, Longitudinal, Observational Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Apr",
day="4",
volume="8",
pages="e58337",
keywords="early developmental signs",
keywords="neurodevelopmental screening",
keywords="risk factors",
keywords="prediction",
keywords="early intervention",
keywords="longitudinal study",
abstract="Background: The early identification of developmental concerns requires understanding individual differences that may represent early signs of neurodevelopmental conditions. However, few studies have longitudinally examined how child and maternal factors interact to shape these early developmental characteristics. Objective: We aim to identify factors from the perinatal to infant periods associated with early developmental characteristics that may precede formal diagnoses and propose a method for evaluating individual differences in neurodevelopmental trajectories. Methods: A prospective longitudinal observational study of 147 mother-child pairs was conducted from gestation to 12 months post partum. Assessments included prenatal questionnaires and blood collection, cord blood at delivery, and postpartum questionnaires at 1, 6, and 12 months. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to evaluate developmental characteristics that might indicate early signs of atypical neurodevelopment. Polychoric or polyserial correlation coefficients assessed relationships between M-CHAT scores and longitudinal variables. L2-regularized logistic regression and Shapley Additive Explanations predicted M-CHAT scores and determined feature contributions. Results: Twenty-one factors (4 prenatal, 3 at birth, and 14 postnatal) showed significant associations with M-CHAT scores (adjusted P values<.05). The predictive accuracy for M-CHAT scores demonstrated reasonable predictive accuracy (area under the receiver operating characteristic curve=0.79). Key predictors included infant sleep status after 6 months (nighttime sleep duration, bedtime, and difficulties falling asleep), maternal Kessler Psychological Distress Scale scores, and Mother-to-Infant Bonding Scale scores after late gestation. Conclusion: Maternal psychological distress, mother-infant bonding, and infant sleep patterns were identified as significant predictors of early developmental characteristics that may indicate emerging developmental concerns. This study advances our understanding of early developmental assessment by providing a novel approach to identifying and evaluating early indicators of atypical neurodevelopment. ",
doi="10.2196/58337",
url="https://pediatrics.jmir.org/2025/1/e58337"
}


@Article{info:doi/10.2196/64131,
author="Dougherty, Kylie
and Tesfaye, Yihenew
and Biza, Heran
and Belew, Mulusew
and Benda, Natalie
and Gebremariam Gobezayehu, Abebe
and Cranmer, John
and Bakken, Suzanne",
title="User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="3",
volume="12",
pages="e64131",
keywords="health information technology",
keywords="design and evaluation",
keywords="Ethiopia",
keywords="usability",
keywords="nursing informatics",
keywords="user-centered design",
keywords="basic emergency obstetric care",
keywords="obstetric",
keywords="nurse",
keywords="user-centered",
keywords="design",
keywords="maternal mortality",
keywords="maternal",
keywords="develop",
keywords="sub-Saharan Africa",
keywords="Africa",
keywords="dashboard",
keywords="tracking",
keywords="emergency care",
abstract="Background: Maternal mortality remains a persistent public health concern in sub-Saharan African countries such as Ethiopia. Health information technology solutions are a flexible and low-cost method for improving health outcomes with proven benefits in low- to middle-income countries' health systems. Objective: This study aimed to develop and assess the usability of an electronic dashboard to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboard: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain, (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboard, and (3) usability heuristic evaluation with human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboard informed by end-user preferences and perceptions, with recommendations focusing on aesthetic design, filtering and sorting, and matching with the real world. An example of an end-user recommendation included increasing font sizes on the dashboard and using a red, yellow, and green color-coding scheme. Next, domain and visualization SMEs continued the dashboard's iterative refinement, focusing on aesthetic design and navigation, by confirming design choices incorporated from the user-centered design sessions and recommending changes to enhance user experience moving through the dashboard, such as adding more filtering options. HCI SMEs rated the dashboard as highly usable (0.82 on a scale of 0-4, with 0 being no usability concern and 4 being a catastrophic usability concern). The principle with the highest usability severity scores was a match between the system and the real world with a score of 1.4. The HCI SMEs also rated the information visualization aspects of the dashboard favorably with 2 usability principles, spatial organization and information coding, scoring 0. Conclusions: Dashboards are a novel method for promoting and tracking facility capacity to manage BEmOC. By including targeted end users and SMEs in the design process, the team was able to tailor the dashboard to meet user needs, fit it into the existing government health systems, and ensure that the dashboard follows design best practices. Collectively, the novel, customized BEmOC dashboard can be used to track and improve facility-level readiness in Amhara, Ethiopia, and similar global BEmOC facilities. ",
doi="10.2196/64131",
url="https://humanfactors.jmir.org/2025/1/e64131"
}


@Article{info:doi/10.2196/64096,
author="March, A. Christine
and Naame, Elissa
and Libman, Ingrid
and Proulx, N. Chelsea
and Siminerio, Linda
and Miller, Elizabeth
and Lyon, R. Aaron",
title="School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners",
journal="JMIR Diabetes",
year="2025",
month="Mar",
day="26",
volume="10",
pages="e64096",
keywords="type 1 diabetes",
keywords="user-centered design",
keywords="school health",
keywords="collaborative care model",
keywords="implementation research",
keywords="pediatric",
keywords="usability testing",
keywords="virtual intervention",
keywords="multisystem community partners",
keywords="children",
keywords="youth",
keywords="diabetes management support",
keywords="health system partners",
keywords="psychosocial interventions",
keywords="quantitative assessments",
keywords="qualitative assessments",
abstract="Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation. Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams. Methods: We recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA. Results: In the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100\% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10\%-60\% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30\% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60\% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue ($\rho$=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings. Conclusions: Cross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing. ",
doi="10.2196/64096",
url="https://diabetes.jmir.org/2025/1/e64096"
}


@Article{info:doi/10.2196/52121,
author="Daniels, Joseph
and van der Merwe, Leigh-Ann Leonashia
and Portle, Sarah
and Bongo, Cikizwa
and Nadkarni, Shiv
and Petrus Peters, Remco",
title="Tailoring a Skills-Based Serostatus Disclosure Intervention for Transgender Women in South Africa: Protocol for a Usability and Feasibility Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="26",
volume="14",
pages="e52121",
keywords="transgender women",
keywords="intervention development",
keywords="relationships",
keywords="HIV treatment",
keywords="South Africa",
keywords="mobile phones, smartphones",
keywords="skills-based",
keywords="serostatus disclosure",
keywords="HIV",
keywords="HIV prevention",
keywords="transgender",
keywords="treatment outcomes",
keywords="transmission",
keywords="HIV-discordant partnerships",
keywords="behavioral intervention",
keywords="safe sex",
keywords="human-centered design",
keywords="viral suppression",
keywords="Speaking Out and Allying Relationships",
keywords="LGBTQ2S",
keywords="LGBTQ",
keywords="2SILGBTQ",
abstract="Background: Transgender women have few interventions to support their HIV prevention and treatment outcomes in South Africa. Further, increased focus should be on intervention development that will reduce HIV transmission within HIV-discordant partnerships, especially for transgender women who navigate gender, sexuality, and relationship stigma. The Speaking Out and Allying Relationships (SOAR) intervention has been developed for sexual minority men to address these outcomes in South Africa. It is a behavioral intervention that is delivered in groups via videoconference to develop coping skills to manage HIV-related stress, assist with disclosure to partners, and establish and maintain safer sex practices with partners. Tailoring SOAR may be feasible for transgender women to support their HIV care while reducing transmission within their relationships. Objective: This study aims to (1) adapt SOAR for transgender women and test its usability, then (2) assess its feasibility. Methods: To achieve aim 1, we will use a human-centered design approach to tailor the existing SOAR intervention for transgender women. Interviews and a survey will be administered to transgender women (N=15) to assess intervention preferences. Findings will be used to tailor content like roleplays, scenarios, and media to align with transgender women's lived experiences navigating HIV and relationships. Afterward, we will conduct a usability test with 7 (47\%) of the 15 participants to determine intervention understanding and satisfaction. Participants will be transgender women living with HIV and in a relationship with a man who has unknown HIV status or is HIV-negative. All participants will be recruited using community-based approaches. In aim 2, we will examine SOAR feasibility using a 1-arm pilot study. Transgender women (N=20) will be recruited using aim 1 methods and eligibility criteria, with participants completing feasibility surveys and interviews, as well as behavioral and biomedical assessments. Results: Intervention adaptation began in May 2023 with interviews. Feasibility pilot testing was conducted with 14 transgender women, with study completion in January 2025. Conclusions: Transgender women need more intervention options that engage their relationships since these can present barriers to HIV treatment outcomes like hindering viral suppression in South Africa. Delivering an existing yet tailored intervention via videoconference expands its reach to transgender women and allows them to engage with others and learn new skills in a secure setting like their homes. SOAR has the potential to improve relationship dynamics and reduce violence, which will in turn enhance HIV treatment and prevention engagement. International Registered Report Identifier (IRRID): PRR1-10.2196/52121 ",
doi="10.2196/52121",
url="https://www.researchprotocols.org/2025/1/e52121"
}


@Article{info:doi/10.2196/60296,
author="Lazo-Porras, Maria
and Tateishi-Serruto, Jose Francisco
and Butler, Christopher
and Cuba-Fuentes, Sof{\'i}a Mar{\'i}a
and Rossini-Vilchez, Daniela
and Perez-Leon, Silvana
and L{\'u}car-Flores, Miriam
and Miranda, Jaime J.
and Bernabe-Ortiz, Antonio
and Diez-Canseco, Francisco
and Moore, Graham
and Landeiro, Filipa
and Cardenas, Kathia Maria
and Vera Tudela, Carlos Juan
and White, Lee
and Calvo, A. Rafael
and Whiteley, William
and Hawkins, Jemma
and ",
title="Assessment of Health System Readiness and Quality of Dementia Services in Peru: Protocol for a Qualitative Study With Stakeholder Interviews and Documentation Review",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="21",
volume="14",
pages="e60296",
keywords="dementia",
keywords="health system readiness",
keywords="caregiver",
keywords="comorbidities",
keywords="Peru",
keywords="study protocol",
keywords="quality of care",
keywords="comorbidity",
keywords="patient journey",
keywords="mHealth",
abstract="Background: Dementia is a global health priority with significant challenges due to its complex nature and increasing prevalence. Health systems worldwide struggle to address chronic conditions like dementia, often providing fragmented care. However, information about how health systems respond to the needs of people with dementia and their carers, and the quality of care provided, is scarce in low- and middle-income countries. Objective: This study aims to assess the quality of the health system to provide diagnosis and care for people with dementia and their carers in Peru. In order to do this, the study will explore the response of the Peruvian health system to people with dementia and their carers, and explore the experiences of people with dementia of receiving their diagnosis, management, and quality of care for this condition. Methods: This study is part of a research program called ``IMPACT Salud: Innovations using Mhealth for people with dementia and Co-morbidities,'' aimed at strengthening health systems to provide care for people with dementia and their carers. The study has a descriptive, cross-sectional design that uses a qualitative methodology, including stakeholder interviews and documentation review, and consists of 2 substudies, a health system assessment (HSA) and an exploration of the patient journey. The first substudy uses an HSA methodology suitable for low- and middle-income countries, conducting 160 structured interviews with 12 different stakeholder types across 3 levels of the health system (micro, meso, and macro) in 4 Peruvian regions, each with distinct geographical and urbanization profiles. The second substudy uses a patient journey methodology, which involves conducting 40 in-depth interviews with people with dementia, carers, and health care workers from the same 4 regions. The insights into the people with dementia patient and caregiver experience within the health system from the interviews will be used to produce a patient journey map. The analysis will be guided by the high-quality health system framework, and the findings from the HSA and patient journey will be structured using the domains included in the framework through the lens of quality of services. Results: Data collection began in March 2024. As of the end of September 2024, a total of 156 interviews from the HSA and 38 interviews from the patient journey study have been conducted across 4 regions. Conclusions: This study will provide a national, multilevel insight into the current operation of the Peruvian health system, including an analysis of the quality of services provided with regard to dementia diagnosis, management, and care from the perspectives of stakeholders, patients, and their carers. International Registered Report Identifier (IRRID): DERR1-10.2196/60296 ",
doi="10.2196/60296",
url="https://www.researchprotocols.org/2025/1/e60296"
}


@Article{info:doi/10.2196/59691,
author="Rooper, R. Isabel
and Ortega, Adrian
and Massion, A. Thomas
and Lakhtakia, Tanvi
and Kruger, Macarena
and Parsons, M. Leah
and Lipman, D. Lindsay
and Azubuike, Chidiebere
and Tack, Emily
and Obleada, T. Katrina
and Graham, K. Andrea",
title="Optimizing Testimonials for Behavior Change in a Digital Intervention for Binge Eating: Human-Centered Design Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="21",
volume="9",
pages="e59691",
keywords="health behavior",
keywords="health narratives",
keywords="binge eating",
keywords="user engagement",
keywords="personalization",
keywords="behavior change",
keywords="digital health",
keywords="intervention",
keywords="human-centered design",
keywords="behavioral health",
keywords="preferences",
abstract="Background: Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (eg, physical activity and healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions. Objective: We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multisession digital binge eating intervention. Methods: We applied human-centered design methods to learn users' preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as ``nudges'' for selecting positive behavior change strategies they could practice). We recruited target users of our multisession intervention to complete design sessions. Adults (N=22, 64\% self-identified as female; 32\% as non-Hispanic Black, 41\% as non-Hispanic White, and 27\% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis. Results: Most participants preferred designs with testimonials (vs without) for their motivation and validation of the intervention's efficacy. A few distrusted testimonials for appearing too ``commercial'' or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with ``how-to'' advice, whereas others preferred ``big picture'' success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allowed users to choose between actions (eg, behavioral strategies), participants preferred testimonials to be available across all actions but said that selectively delivering a testimonial with one action could ``nudge'' them to select it. Conclusions: Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users' most pertinent identities and tailor testimonials accordingly. Likewise, users' divided preferences for testimonial messaging (ie, ``big picture'' vs ``how-to'') suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as ``nudges'' within interventions---a ripe area for further inquiry---though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors. ",
doi="10.2196/59691",
url="https://formative.jmir.org/2025/1/e59691"
}


@Article{info:doi/10.2196/63089,
author="M{\"u}ller, Pascal
and Hofstetter, Sebastian
and Jahn, Patrick",
title="Sustainable Implementation of Digital Assistive Technologies in Health Care Through a Simplified Interaction and Control Platform: Protocol for a Cocreative Feasibility Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="18",
volume="14",
pages="e63089",
keywords="digital assistive technologies",
keywords="human-technology interaction",
keywords="mixed methods",
keywords="cocreation",
keywords="user-centered design",
keywords="health care",
keywords="intention to use",
keywords="feasibility study",
keywords="long-term care",
abstract="Background: With the expected increase in the number of people needing care and the increasing shortage of skilled care workers, new care concepts are required. Therefore, digital assistive technologies (DATs), especially robotics, can improve the situation of people with different needs and create opportunities for participation. For a human-technology interaction to have a high level of usability, DAT's meaningfulness and effectiveness must be accessible to end users. Significant barriers to the use of DATs in health care are the lack of controllability and adaptivity, as well as control functions that are too complex. Objective: The objective of this paper is to develop an interaction and control platform that is understandable to a layperson and has a programming interface for DAT interactions. The innovation consists of the expansion of usage and interaction options for carers of existing DAT in a more individual manner. This is to be achieved by combining modern interactive media, a modular software architecture, and already available DAT. Methods: The project is planned as a mixed methods study with a longitudinal design, with multiple user involvements and measurement times in collaboration with 3 care facilities in Germany. When assessing technologies, the satisfaction of the basic human needs of competence, connection, and autonomy plays an important role in the actual use of the technology. These needs can be measured in the form of usability (System Usability Scale), intention to use (Technology Usage Inventory), and satisfaction with the carers' needs (Technology-Based Experience of Need Satisfaction). In the qualitative assessment, user experience is recorded using the think-aloud method and focus groups in order to obtain information about potential improvements of the platform. Results: The EduXBot (Educational Exploration Robot Application Platform) project was initiated in January 2023 and is scheduled to conclude in December 2025, at which point the project's final results are expected to be available. The initial results were attained in the summer of 2024 when the final concept for the platform prototype was developed. In November 2024, an initial prototype of a functional platform for the simplified interaction and control of DAT was evaluated. Conclusions: It is expected that the open DAT system architecture enables caregivers without any previous technical knowledge to assemble their individual DAT functional portfolio. The results of the project will provide low-threshold access to interaction options for existing DAT as well as expand the usage of such technologies in an individual and patient-centered way. Trial Registration: Deutsches Register Klinischer Studien DRKS00034195; https://drks.de/search/de/trial/DRKS00034195 International Registered Report Identifier (IRRID): DERR1-10.2196/63089 ",
doi="10.2196/63089",
url="https://www.researchprotocols.org/2025/1/e63089"
}


@Article{info:doi/10.2196/59913,
author="Lenker, Puzino Kristina
and Felix, L. Laura
and Cichy, Sarah
and Lehman, Erik
and Logan, M. Jeanne
and Murray, Michael
and Kraschnewski, L. Jennifer",
title="Using the Community Resilience Model and Project ECHO to Build Resiliency in Direct Support Professionals: Protocol for a Longitudinal Survey",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="6",
volume="14",
pages="e59913",
keywords="neurodiversity",
keywords="community resilience model",
keywords="Project ECHO",
keywords="direct support professionals",
keywords="autism",
keywords="telementoring",
keywords="methods and feasibility",
keywords="resiliency",
keywords="intellectual disabilities",
keywords="ASD",
keywords="autism spectrum disorder",
keywords="DSP",
keywords="supportive care",
keywords="community resilience",
keywords="burnout",
keywords="resilience",
keywords="neurodivergent client",
keywords="neurodevelopmental disorders",
keywords="evidence-based knowledge",
abstract="Background: Individuals with intellectual disabilities or autism spectrum disorder (ID/A) sometimes require supportive services from direct support professionals (DSPs). The supportive care provided to individuals with ID/A by DSPs can vary from assistance with daily living activities to navigating society. The COVID-19 pandemic not only exacerbated poor outcomes for individuals with ID/A but also for DSPs, who report experiencing burnout in the aftermath of the pandemic. DSPs are critical to providing much-needed support to individuals with ID/A. Objective: The goal of this study is to evaluate the impact of the community resilience model on DSP burnout and neurodivergent client outcomes using the Project ECHO (Extension for Community Healthcare Outcomes) telementoring platform as a dissemination tool. Methods: This protocol leverages community resilience theory and telementoring through the Project ECHO model to foster resilience in DSPs and their neurodiverse client population. ECHO participants' resilience behaviors will be evaluated via surveys including the Connor Davison Resilience Scale and the WHO-5 Well-Being Index. These surveys will be administered preprogram, at the end of the 8-week ECHO program, and 90 days after the ECHO program's completion. Pre-post relationships will be assessed using generalized estimating equations. The main outcomes will be self-reported changes in knowledge, self-efficacy, and resilience. Results: All ECHO program cohorts and follow-up data collection have concluded, with 131 survey participants. The project team is currently analyzing and interpreting the data. We anticipate having all data analyzed and interpreted by February 2025. Conclusions: DSPs provide critical services to individuals with ID/A. By providing skills in resiliency via the ECHO model, participants will be able to apply resiliency to their own professional lives while fostering resilience within their neurodiverse client base, leading to increased positive outcomes for both groups. International Registered Report Identifier (IRRID): DERR1-10.2196/59913 ",
doi="10.2196/59913",
url="https://www.researchprotocols.org/2025/1/e59913",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053792"
}


@Article{info:doi/10.2196/58715,
author="Lu, Lincoln
and Jake-Schoffman, E. Danielle
and Lavoie, A. Hannah
and Agharazidermani, Maedeh
and Boyer, Elizabeth Kristy",
title="Preadolescent Children Using Real-Time Heart Rate During Moderate to Vigorous Physical Activity: A Feasibility Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="6",
volume="12",
pages="e58715",
keywords="smartphone app",
keywords="physical activity",
keywords="heart rate",
keywords="wearable sensors",
keywords="youth",
keywords="commercial wearable device",
keywords="Garmin",
keywords="mobile phone",
abstract="Background: Given the global burden of insufficient physical activity (PA) in children, effective behavioral interventions are needed to increase PA levels. Novel technologies can help expand the reach and accessibility of these programs. Despite the potential to use heart rate (HR) to target moderate- to vigorous-intensity PA (MVPA), most HR research to date has focused on the accuracy of HR devices or used HR for PA surveillance rather than as an intervention tool. Furthermore, most commercial HR sensors are designed for adults, and their suitability for children is unknown. Further research about the feasibility and usability of commercial HR devices is required to understand how children may use HR during PA. Objective: This study aimed to explore the use of a chest-worn HR sensor paired with a real-time HR display as an intervention tool among preadolescent children and the usability of a custom-designed app (Connexx) for viewing real-time HR. Methods: We developed Connexx, an HR information display app with an HR analytics portal to view HR tracking. Children were recruited via flyers distributed at local public schools, word of mouth, and social media posts. Eligible participants were children aged 9 to 12 years who did not have any medical contraindications to MVPA. Participants took part in a single in-person study session where they monitored their own HR using a commercial HR sensor, learned about HR, and engaged in a series of PAs while using the Connexx app to view their real-time HR. We took field note observations about participant interactions with the HR devices. Participants engaged in a semistructured interview about their experience using Connexx and HR during PA and completed the System Usability Scale (SUS) about the Connexx app. Study sessions were audio and video recorded and transcribed verbatim. Results: A total of 11 participants (n=6, 55\% male; n=9, 82\%, non-Hispanic White) with an average age of 10.4 (SD 1.0) years were recruited for the study. Data from observations, interviews, and SUS indicated that preadolescent children can use real-time HR information during MVPA. Observational and interview data indicated that the participants were able to understand their HR after a basic lesson and demonstrated the ability to make use of their HR information during PA. Interview and SUS responses demonstrated that the Connexx app was highly usable, despite some accessibility challenges (eg, small display font). Feedback about usability issues has been incorporated into a redesign of the Connexx app, including larger, color-coded fonts for HR information. Conclusions: The results of this study indicate that preadolescent children understood their HR data and were able to use it in real time during PA. The findings suggest that future interventions targeting MVPA in this population should test strategies to use HR and HR monitoring as direct program targets. ",
doi="10.2196/58715",
url="https://humanfactors.jmir.org/2025/1/e58715",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053729"
}


@Article{info:doi/10.2196/59485,
author="Dewan, Ananya
and Eifler, M.
and Hood, Amelia
and Sanchez, William
and Gross, Marielle",
title="Building a Decentralized Biobanking App for Research Transparency and Patient Engagement: Participatory Design Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="5",
volume="12",
pages="e59485",
keywords="mobile health",
keywords="mHealth",
keywords="application",
keywords="smartphone",
keywords="digital health",
keywords="digital intervention",
keywords="participatory design",
keywords="biobanking",
keywords="research transparency",
keywords="donation",
keywords="patient-derived biospecimens",
keywords="plain language communications",
keywords="patient education",
abstract="Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities. Objective: In this paper, we describe the use of participatory design methods to build a decentralized biobanking ``de-bi'' mobile app where patients could learn about biobanking, track their specimens, and engage with ongoing research via patient-friendly interfaces overlaying institutional biobank databases, initially developed for a breast cancer use case. Methods: This research occurred in 2 phases. In phase 1, we designed app screens from which patients could learn about ongoing research involving their samples. We embedded these screens in a survey (n=94) to gauge patients' interests regarding types of feedback and engagement opportunities; survey responses were probed during 6 comprehensive follow-up interviews. We then held an immersive participatory design workshop where participants (approximately 50) provided general feedback about our approach, with an embedded codesign workshop where a subset (n=15) provided targeted feedback on screen designs. For phase 2, we refined user interfaces and developed a functional app prototype in consultation with institutional stakeholders to ensure regulatory compliance, workflow compatibility, and composability with local data architectures. We presented the app at a second workshop, where participants (n=25, across 9 groups) shared thoughts on the app's usability and design. In this phase, we conducted cognitive walkthroughs (n=13) to gain in-depth feedback on in-app task navigation. Results: Most of the survey participants (61/81, 75\%) were interested in learning the outcomes of research on their specimens, and 49\% (41/83) were interested in connecting with others with the same diagnosis. Participants (47/60, 78\%) expressed strong interest in receiving patient-friendly summaries of scientific information from scientists using their biospecimens. The first design workshop identified confusion in terminology and data presentation (eg, 9/15, 60\% of co-designers were unclear on the biospecimens ``in use''), though many appreciated the ability to view their personal biospecimens (7/15, 47\%), and most were excited about connecting with others (12/15, 80\%). In the second workshop, all groups found the app's information valuable. Moreover, 44\% (5/9) noted they did not like the onboarding process, which was echoed in cognitive walkthroughs. Walkthroughs further confirmed interest in biospecimen tracking, and 23\% (3/13) had confusion about not finding any of their biospecimens in the app. These findings guided refinements in onboarding, design, and user experience. Conclusions: Designing a patient-facing app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study. ",
doi="10.2196/59485",
url="https://humanfactors.jmir.org/2025/1/e59485",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053747"
}


@Article{info:doi/10.2196/57911,
author="Hacking, Coen
and de Boer, Bram
and Verbeek, Hilde
and Hamers, Jan
and Aarts, Sil",
title="Developing an App for Real-Time Daily Life Observations in a Nursing Home Setting: Qualitative User-Centered Co-Design Approach",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="27",
volume="12",
pages="e57911",
keywords="co-design",
keywords="user-centered design",
keywords="app development",
keywords="nursing home",
keywords="user-centered",
keywords="design",
keywords="efficiency",
keywords="usability",
keywords="tablet",
keywords="mobile phone",
abstract="Background: Assessing the daily lives of older adults, including their activities, social interactions, and well-being is essential, particularly in nursing homes, as it gains insights into their quality of life. Methods such as the Microsoft Excel-based Maastricht Electronic Daily Life Observation (MEDLO) tool are time-consuming and require extensive manual input, making them difficult to use. Objective: This study aimed to develop an app-based version of the MEDLO using a user-centered design (UCD) and co-design approach to enhance efficiency and usability. We looked to actively involve researchers and care professionals who have used the MEDLO before, throughout the development process. Methods: Participants included a diverse group of researchers and care professionals experienced in using the MEDLO tool. The UCD approach involved multiple iterative phases including semistructured interviews, user research sessions, and application development. Data were analyzed using a qualitative (thematic) approach of UCD and user research sessions. The app, which was preferred to the traditional Excel-based MEDLO, underwent multiple iterations. This method primed the continuous iterative development of the app, aimed for a minimum viable product (MVP). Results: This study included 14 participants, primarily female, from diverse professional backgrounds. Their feedback highlighted the need for efficiency improvements in tool preparation and data management. Key improvements included automated data handling, an intuitive tablet interface, and functionalities such as randomization and offline data syncing. Conclusions: The iterative development process led to an app that aligns with end-user needs, indicating potential for improved usability. Early and continuous user involvement was key in enhancing the application's usability, demonstrating the importance of user feedback in the development process. ",
doi="10.2196/57911",
url="https://humanfactors.jmir.org/2025/1/e57911"
}


@Article{info:doi/10.2196/68419,
author="Rooper, R. Isabel
and Liem, W. William
and Burla, Martha
and Gordon, Jacob
and Baez, M. Lara
and Kornfield, Rachel
and Berry, L. Andrew B.",
title="Designing Values Elicitation Technologies for Mental Health and Chronic Care Integration: User-Centered Design Approach",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="19",
volume="9",
pages="e68419",
keywords="chronic care management",
keywords="anxiety",
keywords="depression",
keywords="values elicitation",
keywords="eHealth",
keywords="patient-centered care",
keywords="technology-enabled services",
keywords="human-centered design",
keywords="multimorbidity",
keywords="user-centered design",
keywords="multiple chronic conditions",
abstract="Background: Individuals with multiple chronic conditions (MCCs) and mental health challenges such as depression or anxiety have complex health needs and experience significant challenges with care coordination. Approaches to enhance care for patients with MCCs typically focus on eliciting patients' values to identify and align treatment priorities across patients and providers. However, these efforts are often hindered by both systems- and patient-level barriers, which are exacerbated for patients with co-occurring mental health symptoms. Technology-enabled services (TES) offer a promising avenue to facilitate values elicitation and promote patient-centered care for these patients, though TES have not yet been tailored to their unique needs. Objective: This study aimed to identify design and implementation considerations for TES that facilitate values elicitation among patients with MCCs and depression or anxiety. We sought to understand the preferences of both clinicians and patients for TES that could bridge the gap between mental and physical health care. Methods: Using human-centered design methods, we conducted 7 co-design workshops with 18 participants, including primary care clinicians, mental health clinicians, and patients with MCCs and depression or anxiety. Participants were introduced to TES prototypes that used various formats (eg, worksheets and artificial intelligence chatbots) to elicit and communicate patients' values. Prototypes were iteratively refined based on participant feedback. Data from these sessions were analyzed using reflexive thematic analysis to uncover themes related to service, technology, and implementation considerations. Results: Three primary themes were identified. (1) Service considerations: TES should help patients translate elicited values into actionable treatment plans and include low-burden, flexible activities to accommodate fluctuations in their mental health symptoms. Both patients and clinicians indicated that TES could be valuable for improving appointment preparation and patient-provider communication through interpersonal skill-building. (2) Technology considerations: Patients expressed openness to TES prototypes that used artificial intelligence, particularly those that provided concise summaries of appointment priorities. Visual aids and simplified language were highlighted as essential features to support accessibility for neurodiverse patients. (3) Implementation considerations: Clinicians and patients favored situating values elicitation in mental health care settings over primary care and preferred self-guided TES that patients could complete independently before appointments. Conclusions: Findings indicate that TES can address the unique needs of patients with MCCs and mental health challenges by facilitating values-based care. Key design considerations include ensuring TES flexibility to account for fluctuating mental health symptoms, facilitating skill-building for effective communication, and creating user-friendly technology interfaces. Future research should explore how TES can be integrated into health care settings to enhance care coordination and support patient-centered treatment planning. By aligning TES design with patient and clinician preferences, there is potential to bridge gaps in care for this complex patient population. ",
doi="10.2196/68419",
url="https://formative.jmir.org/2025/1/e68419"
}


@Article{info:doi/10.2196/63364,
author="Abdulai, Abdul-Fatawu
and Duong, Cam
and Stroulia, Eleni
and Czerniak, Efrat
and Chiu, Rachel
and Mehta, Aashay
and Koike, Ken
and Norman, V. Wendy",
title="A Health Professional Mentorship Platform to Improve Equitable Access to Abortion: Development, Usability, and Content Evaluation",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="19",
volume="12",
pages="e63364",
keywords="medication abortion",
keywords="mifepristone",
keywords="web-based platform",
keywords="user-centered design",
keywords="underserved populations",
keywords="abortion",
keywords="equitable",
keywords="accessibility",
keywords="open-access website",
keywords="gender-affirming",
keywords="user-centered",
keywords="Canada",
keywords="unwanted pregnancy",
keywords="framework",
abstract="Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are overrepresented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help health care and allied helping professionals provide culturally competent and gender-affirming abortion care to such a population group. Objective: This project aimed to redesign and adapt an existing subscription-based medication abortion mentorship platform into a culturally appropriate and gender-affirming open-access website of curated health professional resources to promote equitable, accessible, high-quality abortion care, particularly for underserved populations. Methods: We drew on a user-centered design framework to redesign the web platform in 5 iterative phases. Health care and allied helping professionals were engaged in each stage of the development process including the initial design of the platform, curation of the resources, review of the content, and evaluation of the wireframes and the end product. Results: This project resulted in an open-access bilingual (English and French) web-based platform containing comprehensive information and resources on abortion care for health care providers (physicians, nurse practitioners, and pharmacists) and allied helping professionals (midwives, medical officers, community workers, and social workers). The website incorporated information on clinical, logistical, and administrative guidance, including culturally competent and gender-affirming toolkits that could equip health care professionals with the requisite knowledge to provide abortion care for underserved populations. Conclusions: This platform contains resources that can increase the competencies of health care professionals to initiate and sustain culturally and contextually appropriate abortion care for underserved groups while clarifying myths and misconceptions that often militate against initiating abortion. Our resource also has the potential to support equitable access to high-quality abortion care, particularly for those among underserved populations who may have the greatest unmet need for abortion services yet face the greatest barriers to accessing care. ",
doi="10.2196/63364",
url="https://humanfactors.jmir.org/2025/1/e63364"
}


@Article{info:doi/10.2196/65923,
author="She, Jou Wan
and Siriaraya, Panote
and Iwakoshi, Hibiki
and Kuwahara, Noriaki
and Senoo, Keitaro",
title="An Explainable AI Application (AF'fective) to Support Monitoring of Patients With Atrial Fibrillation After Catheter Ablation: Qualitative Focus Group, Design Session, and Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="13",
volume="12",
pages="e65923",
keywords="atrial fibrillation",
keywords="explainable artificial intelligence",
keywords="explainable AI",
keywords="user-centered design",
keywords="prevention",
keywords="postablation monitoring",
abstract="Background: The opaque nature of artificial intelligence (AI) algorithms has led to distrust in medical contexts, particularly in the treatment and monitoring of atrial fibrillation. Although previous studies in explainable AI have demonstrated potential to address this issue, they often focus solely on electrocardiography graphs and lack real-world field insights. Objective: We addressed this gap by incorporating standardized clinical interpretation of electrocardiography graphs into the system and collaborating with cardiologists to co-design and evaluate this approach using real-world patient cases and data. Methods: We conducted a 3-stage iterative design process with 23 cardiologists to co-design, evaluate, and pilot an explainable AI application. In the first stage, we identified 4 physician personas and 7 explainability strategies, which were reviewed in the second stage. A total of 4 strategies were deemed highly effective and feasible for pilot deployment. On the basis of these strategies, we developed a progressive web application and tested it with cardiologists in the third stage. Results: The final progressive web application prototype received above-average user experience evaluations and effectively motivated physicians to adopt it owing to its ease of use, reliable information, and explainable functionality. In addition, we gathered in-depth field insights from cardiologists who used the system in clinical contexts. Conclusions: Our study identified effective explainability strategies, emphasized the importance of curating actionable features and setting accurate expectations, and suggested that many of these insights could apply to other disease care contexts, paving the way for future real-world clinical evaluations. ",
doi="10.2196/65923",
url="https://humanfactors.jmir.org/2025/1/e65923"
}


@Article{info:doi/10.2196/59386,
author="Grieve, Natalie
and Braaten, Kyra
and MacPherson, Megan
and Liu, Sam
and Jung, E. Mary",
title="Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="11",
volume="9",
pages="e59386",
keywords="usability evaluation",
keywords="mHealth",
keywords="usability testing",
keywords="app",
keywords="end-user",
keywords="focus group",
keywords="participant",
keywords="survey",
keywords="diabetes",
keywords="user-centered",
keywords="cognitive walkthrough",
keywords="cognitive walkthroughs",
keywords="questionnaire",
keywords="mobile phone",
keywords="digital health",
keywords="prediabetes",
abstract="Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app's usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8\% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client's preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes' program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. ",
doi="10.2196/59386",
url="https://formative.jmir.org/2025/1/e59386"
}


@Article{info:doi/10.2196/60825,
author="Amhaz, Haneen
and Chen, Xuanping Sally
and Elchehimi, Amanee
and Han, Jialin Kylin
and Gil, Morales Jade
and Yao, Lu
and Vidler, Marianne
and Berry-Einarson, Kathryn
and Dewar, Kathryn
and Tuason, May
and Prestley, Nicole
and Doan, Quynh
and van Rooij, Tibor
and Costa, Tina
and Ogilvie, Gina
and Payne, A. Beth",
title="The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="30",
volume="12",
pages="e60825",
keywords="digital health",
keywords="co-design",
keywords="digital strategy",
keywords="human-centered design",
keywords="eHealth",
keywords="cocreation",
keywords="codevelopment",
keywords="perinatal intervention",
keywords="quality of care",
keywords="digital tools",
keywords="pregnancy",
keywords="patient autonomy",
keywords="patient support",
keywords="mobile phone",
abstract="Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. ",
doi="10.2196/60825",
url="https://humanfactors.jmir.org/2025/1/e60825"
}


@Article{info:doi/10.2196/60829,
author="Karasek, Deborah
and Williams, C. Jazzmin
and Taylor, A. Michaela
and De La Cruz, M. Monica
and Arteaga, Stephanie
and Bell, Sabra
and Castillo, Esperanza
and Chand, A. Maile
and Coats, Anjeanette
and Hubbard, M. Erin
and Love-Goodlett, Latriece
and Powell, Breezy
and Spellen, Solaire
and Malawa, Zea
and Gomez, Manchikanti Anu",
title="Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="27",
volume="9",
pages="e60829",
keywords="maternal and child health",
keywords="economics",
keywords="public health",
keywords="qualitative research methods",
keywords="programs (evaluation and funding)",
keywords="community-centered",
keywords="pregnancy",
keywords="first pregnancy",
keywords="behavioral interventions",
keywords="racial health",
keywords="financial stress",
keywords="Abundant Birth Project",
keywords="infant health",
keywords="infant",
keywords="Black",
abstract="Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States---the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP's program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US \$1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. ",
doi="10.2196/60829",
url="https://formative.jmir.org/2025/1/e60829"
}


@Article{info:doi/10.2196/60585,
author="Mazzella-Ebstein, Marie Ann
and Daly, Robert
and Huang, Jennie
and Bernal, Camila
and Wilhelm, Clare
and Panageas, S. Katherine
and Holland, Jessie
and Salvaggio, Rori
and Ackerman, Jill
and Cracchiolo, Jennifer
and Kuperman, Gilad
and Mao, Jun
and Begue, Aaron
and Barton-Burke, Margaret",
title="Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="24",
volume="12",
pages="e60585",
keywords="cancer",
keywords="oncology",
keywords="clinician end users",
keywords="remote patient monitoring",
keywords="digital health",
keywords="implementation science",
keywords="patient monitoring",
keywords="patient access",
keywords="care",
keywords="communication",
keywords="usability",
keywords="functionality",
keywords="survey",
keywords="interview",
keywords="efficiency",
keywords="workflow",
keywords="user",
keywords="clinician support",
abstract="Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31\% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30\% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians' workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program's utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. ",
doi="10.2196/60585",
url="https://humanfactors.jmir.org/2025/1/e60585"
}


@Article{info:doi/10.2196/58128,
author="McMullan, Christel
and Turner, Grace
and Retzer, Ameeta
and Belli, Antonio
and Davies, Haf Elin
and Nice, Laura
and Flavell, Luke
and Flavell, Jackie
and Calvert, Melanie",
title="Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="23",
volume="9",
pages="e58128",
keywords="usability study",
keywords="usability",
keywords="patient reported outcome",
keywords="PRO",
keywords="electronic patient reported outcome",
keywords="ePRO",
keywords="traumatic brain injury",
keywords="TBI",
keywords="think aloud",
keywords="cognitive interviews",
keywords="early warning",
keywords="early detection",
keywords="mobile phone",
abstract="Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform---Atom5---for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK---an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the ``Think Aloud'' method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury -- Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. ",
doi="10.2196/58128",
url="https://formative.jmir.org/2025/1/e58128"
}


@Article{info:doi/10.2196/65022,
author="Zeiler, Michael
and Dietzel, Nikolas
and Haug, Fabian
and Haug, Julian
and Kammerer, Klaus
and Pryss, R{\"u}diger
and Heuschmann, Peter
and Graessel, Elmar
and Kolominsky-Rabas, L. Peter
and Prokosch, Hans-Ulrich",
title="A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="22",
volume="12",
pages="e65022",
keywords="dementia",
keywords="usability",
keywords="development",
keywords="digiDEM",
keywords="cognitive impairment",
keywords="older adults",
keywords="aging",
keywords="mobile health",
keywords="mHealth",
keywords="design",
keywords="feedback",
keywords="screening",
keywords="user centred",
keywords="cognitive disorder",
keywords="user-centered",
keywords="mobile app",
abstract="Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ?65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams' experiences. The prototype was tested in several iterations by various end users and continuously improved. The app's usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. ",
doi="10.2196/65022",
url="https://humanfactors.jmir.org/2025/1/e65022"
}


@Article{info:doi/10.2196/65142,
author="Salwei, Elizabeth Megan
and Anders, Shilo
and Reale, Carrie
and Slagle, M. Jason
and Ricketts, Todd
and Weinger, B. Matthew",
title="Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="20",
volume="12",
pages="e65142",
keywords="usability",
keywords="human factors",
keywords="patient safety",
keywords="over-the-counter hearing aids",
keywords="direct-to-consumer hearing aids",
keywords="medical device",
keywords="hearing loss",
keywords="adult",
keywords="hearing impairment",
keywords="hearing aid use",
keywords="hearing care",
keywords="formative usability test",
keywords="safety",
keywords="mobile phone",
abstract="Background: Only 15\% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2?5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. ",
doi="10.2196/65142",
url="https://humanfactors.jmir.org/2025/1/e65142"
}


@Article{info:doi/10.2196/58265,
author="Rizzi, Silvia
and Pavesi, Chiara Maria
and Moser, Alessia
and Paolazzi, Francesca
and Marchesoni, Michele
and Poggianella, Stefania
and Gadotti, Erik
and Forti, Stefano",
title="A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="17",
volume="9",
pages="e58265",
keywords="mindfulness",
keywords="promoting well-being",
keywords="pregnancy",
keywords="eHealth",
keywords="mHealth",
keywords="mobile apps",
keywords="development",
keywords="usability",
keywords="user-centered design",
keywords="well-being",
keywords="maternal health",
keywords="digital health",
keywords="intervention",
keywords="design",
keywords="preliminary testing",
keywords="technology-based",
keywords="interview",
keywords="multidisciplinary approach",
keywords="mother",
keywords="women",
keywords="WhatsApp",
keywords="email",
keywords="midwife",
abstract="Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention's design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. ",
doi="10.2196/58265",
url="https://formative.jmir.org/2025/1/e58265"
}


@Article{info:doi/10.2196/63015,
author="Laukka, Elina
and Tuunanen, Tuure
and Jansson, Miia
and Vanhanen, Minna
and Hirvonen, Nina
and Palukka, Jenni
and Vesinurm, M{\"a}rt
and Torkki, Paulus",
title="Value Cocreation and Codestruction in Digital Health Services: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="14",
volume="14",
pages="e63015",
keywords="value cocreation",
keywords="value codestruction",
keywords="telemedicine",
keywords="eHealth",
keywords="systematic review",
abstract="Background: To successfully design, develop, implement, and deliver digital health services that provide value, they should be cocreated with patients. However, occasionally, the value may also be codestructed. In the field of health care, the concepts of value cocreation and codestruction still need to be better established within emerging digital health services. Studying these concepts is essential for developing effective and sustainable patient-centered care. Objective: The aim of the study is (1) to understand the antecedents, decisions, and outcomes of value cocreation and codestruction in digital health services, (2) to define the dynamics between value cocreation and codestruction, and (3) to map future research areas of value cocreation and codestruction within digital health services. Methods: The systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for mixed method systematic reviews and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The review considers scientific qualitative, quantitative, or mixed method studies published in English, Finnish, or Swedish that concern either value cocreation or codestruction in digital health services. Studies focusing on physical robotics and online health communities, as well as non--peer-reviewed and nonscientific papers, will be excluded. The searches were conducted using Scopus and MEDLINE during this protocol creation. Critical appraisal will be done using suitable checklists for qualitative, quantitative, and mixed method studies. The review will adhere to a convergent integrated approach as outlined in the Joanna Briggs Institute methodology for mixed methods systematic reviews. Results: The searches resulted in a total of 837 records. The antecedents, decisions, and outcomes of value cocreation and codestruction in the context of digital health services will be described in a finalized systematic review. In the outcomes, our main interest is the effect on patient outcomes and experiences and professional experiences. Conclusions: Since our study involves diverse scientific fields, there is a risk that our search does not capture all relevant papers. To mitigate this risk, we used 2 large databases for the searches. In addition, the value cocreation or codestruction terms may not have been used in all studies focusing on the collaborative roles of patients and providers, especially in the medical field, and that may be difficult to capture. The review reveals the current understanding of value cocreation and codestruction in digital health services and shapes the research agenda for these phenomena. Value cocreation can be used to both design and efficiently use digital health services trying to maximize the value for patients. International Registered Report Identifier (IRRID): DERR1-10.2196/63015 ",
doi="10.2196/63015",
url="https://www.researchprotocols.org/2025/1/e63015"
}


@Article{info:doi/10.2196/58073,
author="Saito, Chihiro
and Nakatani, Eiji
and Sasaki, Hatoko
and E Katsuki, Naoko
and Tago, Masaki
and Harada, Kiyoshi",
title="Predictive Factors and the Predictive Scoring System for Falls in Acute Care Inpatients: Retrospective Cohort Study",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="13",
volume="12",
pages="e58073",
keywords="falls",
keywords="inpatient falls",
keywords="acute care hospital",
keywords="predictive factor",
keywords="risk factors",
abstract="Background: Falls in hospitalized patients are a serious problem, resulting in physical injury, secondary complications, impaired activities of daily living, prolonged hospital stays, and increased medical costs. Establishing a fall prediction scoring system to identify patients most likely to fall can help prevent falls among hospitalized patients. Objectives: This study aimed to identify predictive factors of falls in acute care hospital patients, develop a scoring system, and evaluate its validity. Methods: This single-center, retrospective cohort study involved patients aged 20 years or older admitted to Shizuoka General Hospital between April 2019 and September 2020. Demographic data, candidate predictors at admission, and fall occurrence reports were collected from medical records. The outcome was the time from admission to a fall requiring medical resources. Two-thirds of cases were randomly selected as the training set for analysis, and univariable and multivariable Cox regression analyses were used to identify factors affecting fall risk. We scored the fall risk based on the estimated hazard ratios (HRs) and constructed a fall prediction scoring system. The remaining one-third of cases was used as the test set to evaluate the predictive performance of the new scoring system. Results: A total of 13,725 individuals were included. During the study period, 2.4\% (326/13,725) of patients experienced a fall. In the training dataset (n=9150), Cox regression analysis identified sex (male: HR 1.60, 95\% CI 1.21?2.13), age (65 to <80 years: HR 2.26, 95\% CI 1.48?3.44; ?80 years: HR 2.50, 95\% CI 1.60?3.92 vs 20-<65 years), BMI (18.5 to <25 kg/m{\texttwosuperior}: HR 1.36, 95\% CI 0.94?1.97; <18.5 kg/m{\texttwosuperior}: HR 1.57, 95\% CI 1.01?2.44 vs ?25 kg/m{\texttwosuperior}), independence degree of daily living for older adults with disabilities (bedriddenness rank A: HR 1.81, 95\% CI 1.26?2.60; rank B: HR 2.03, 95\% CI 1.31?3.14; rank C: HR 1.23, 95\% CI 0.83?1.83 vs rank J), department (internal medicine: HR 1.23, 95\% CI 0.92?1.64; emergency department: HR 1.81, 95\% CI 1.26?2.60 vs department of surgery), and history of falls within 1 year (yes: HR 1.66, 95\% CI 1.21?2.27) as predictors of falls. Using these factors, we developed a fall prediction scoring system categorizing patients into 3 risk groups: low risk (0-4 points), intermediate risk (5-9 points), and high risk (10-15 points). The c-index indicating predictive performance in the test set (n=4575) was 0.733 (95\% CI 0.684?0.782). Conclusions: We developed a new fall prediction scoring system for patients admitted to acute care hospitals by identifying predictors of falls in Japan. This system may be useful for preventive interventions in patient populations with a high likelihood of falling in acute care settings. ",
doi="10.2196/58073",
url="https://humanfactors.jmir.org/2025/1/e58073"
}


@Article{info:doi/10.2196/67272,
author="Lee, Heui Yoon
and Choi, Hanna
and Lee, Soo-Kyoung",
title="Development of Personas and Journey Maps for Artificial Intelligence Agents Supporting the Use of Health Big Data: Human-Centered Design Approach",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="8",
volume="9",
pages="e67272",
keywords="analysis",
keywords="health big data",
keywords="human-centered design",
keywords="persona",
keywords="user journey map",
keywords="artificial intelligence",
keywords="human-AI",
keywords="interviews",
keywords="users' experiences",
abstract="Background: The rapid proliferation of artificial intelligence (AI) requires new approaches for human-AI interfaces that are different from classic human-computer interfaces. In developing a system that is conducive to the analysis and use of health big data (HBD), reflecting the empirical characteristics of users who have performed HBD analysis is the most crucial aspect to consider. Recently, human-centered design methodology, a field of user-centered design, has been expanded and is used not only to develop types of products but also technologies and services. Objective: This study was conducted to integrate and analyze users' experiences along the HBD analysis journey using the human-centered design methodology and reflect them in the development of AI agents that support future HBD analysis. This research aims to help accelerate the development of novel human-AI interfaces for AI agents that support the analysis and use of HBD, which will be urgently needed in the near future. Methods: Using human-centered design methodology, we collected data through shadowing and in-depth interviews with 16 people with experience in analyzing and using HBD. We identified users' empirical characteristics, emotions, pain points, and needs related to HBD analysis and use and created personas and journey maps. Results: The general characteristics of participants (n=16) were as follows: the majority were in their 40s (n=6, 38\%) and held a PhD degree (n=10, 63\%). Professors (n=7, 44\%) and health care personnel (n=10, 63\%) represented the largest professional groups. Participants' experiences with big data analysis varied, with 25\% (n=4) being beginners and 38\% (n=6) having extensive experience. Common analysis methods included statistical analysis (n=7, 44\%) and data mining (n=6, 38\%). Qualitative findings from shadowing and in-depth interviews revealed key challenges: lack of knowledge on using analytical solutions, crisis management difficulties during errors, and inadequate understanding of health care data and clinical decision-making, especially among non--health care professionals. Three types of personas and journey maps---health care professionals as big data analysis beginners, health care professionals who have experience in big data analytics, and non--health care professionals who are experts in big data analytics---were derived. They showed a need for personalized platforms tailored to the user level, appropriate direction through a navigation function, a crisis management support system, communication and sharing among users, and expert linkage service. Conclusions: The knowledge obtained from this study can be leveraged in designing an AI agent to support future HBD analysis and use. This is expected to further increase the usability of HBD by helping users perform effective use of HBD more easily. ",
doi="10.2196/67272",
url="https://formative.jmir.org/2025/1/e67272"
}


@Article{info:doi/10.2196/57833,
author="Doyle, A. Tom
and Vershaw, L. Samantha
and Conboy, Erin
and Halverson, E. Colin M.",
title="Improving Social Media-Based Support Groups for the Rare Disease Community: Interview Study With Patients and Parents of Children with Rare and Undiagnosed Diseases",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="30",
volume="11",
pages="e57833",
keywords="social media",
keywords="rare disease",
keywords="support groups",
keywords="pediatric rare disease",
keywords="Ehlers-Danlos syndrome",
keywords="collagen disease",
keywords="fibrillar collagen",
keywords="cutis elastica",
keywords="connective tissue disorders",
keywords="hyperelasticity",
keywords="hypermobility of joints, inherited",
keywords="genetic disorder",
keywords="genetics",
keywords="pediatric",
abstract="Background: The rarity that is inherent in rare disease (RD) often means that patients and parents of children with RDs feel uniquely isolated and therefore are unprepared or unsupported in their care. To overcome this isolation, many within the RD community turn to the internet, and social media groups in particular, to gather useful information about their RDs. While previous research has shown that social media support groups are helpful for those affected by RDs, it is unclear what these groups are particularly useful or helpful for patients and parents of children with RDs. Objective: This study aimed to identify what specific features of disease-related support groups (DRSGs) the RD community finds particularly useful or supportive and provide a set of recommendations to improve social media--based RD support groups based on this information. Methods: Semistructured qualitative interviews were performed with patients and parents of patients with RDs. Interview participants had to be at least 18 years of age at the time of the interview, be seen by a genetics specialist at a partner health care institution and be proficient in the English language. Social media use was not a prerequisite for participation, so interview participants ranged from extensive users of social media to those who chose to remain off all social media. All interviews were conducted by phone, recorded, and then transcribed. Interview transcripts were then coded using the 6 steps outlined by Braun and Clarke. Three researchers (TAD, SLV, and CMEH) performed initial coding. After this, the study team conducted a review of themes and all members of the team agreed upon a final analysis and presentation of data. Results: We conducted 31 interviews (mean age 40, SD 10.04 years; n=27, 87\% were women; n=30, 97\% were non-Hispanic White). Thematic analysis revealed that social media DRSG users identified the informational usefulness of these groups as being related to the gathering and sharing of specific information about an RD, clarification about the importance and meaning of certain symptoms, and obtaining insight into an RD's progression and prognosis. Participants also identified that DRSGs were useful sources of practical information, such as tips and tricks about managing RD-related issues and concerns. In addition, participants found DRSGs to be a useful space for sharing their disease-related stories but also highlighted a feeling of exhaustion from overexposure and overuse of DRSGs. Conclusions: This study identifies the usefulness of DRSGs for the RD community and provides a set of recommendations to improve future instances of DRSGs. These recommendations can be used to create DRSGs that are less prone to splintering into other DRSGs, thus minimizing the risk of having important RD-related information unhelpfully dispersed amongst a multitude of support groups. ",
doi="10.2196/57833",
url="https://humanfactors.jmir.org/2024/1/e57833",
url="http://www.ncbi.nlm.nih.gov/pubmed/39752188"
}


@Article{info:doi/10.2196/48170,
author="Lally, Phillippa
and May, N. Christine
and Mitchell, Siobhan E.
and McCallum, Meaghan
and Michaelides, Andreas
and Fisher, Abigail",
title="Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="20",
volume="10",
pages="e48170",
keywords="breast cancer",
keywords="self-management",
keywords="app",
keywords="health behaviors",
keywords="weight",
keywords="prototype",
keywords="user experience",
keywords="development",
keywords="application",
keywords="coaching",
keywords="peer support",
keywords="oncology",
abstract="Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ?18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88\%) were white, 6 (75\%) had a graduate degree or above, and 6 (75\%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. ",
doi="10.2196/48170",
url="https://cancer.jmir.org/2024/1/e48170"
}


@Article{info:doi/10.2196/59372,
author="Taylor, V. Kayla
and Garchitorena, Laurent
and Scaramutti-Gladfelter, Carolina
and Wyrick, Mykayla
and Grill, B. Katherine
and Seixas, A. Azizi",
title="A Digital Mental Health Solution to Improve Social, Emotional, and Learning Skills for Youth: Protocol for an Efficacy and Usability Study",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="19",
volume="13",
pages="e59372",
keywords="mental health",
keywords="digital health",
keywords="mHealth",
keywords="usability",
keywords="pilot study",
keywords="United States",
keywords="mental health crisis",
keywords="Science Technology Engineering Math and Social and Emotional Learning",
keywords="STEMSEL",
keywords="efficacy",
keywords="well-being",
keywords="barriers",
keywords="facilitators",
keywords="resources",
keywords="youth",
keywords="adolescents",
keywords="teenagers",
keywords="students",
keywords="feasibility",
keywords="adoption",
keywords="evidence-based",
keywords="intervention",
keywords="anxiety",
keywords="depression",
keywords="Neolth",
keywords="digital app",
abstract="Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth's functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study's completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention's efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/59372 ",
doi="10.2196/59372",
url="https://www.researchprotocols.org/2024/1/e59372"
}


@Article{info:doi/10.2196/48323,
author="van Dam, Lotte
and Christensen, H{\o}jlund Sine
and Tetens, Inge
and Riley III, William
and Timmer, Mari{\"e}lle
and Suciu Jr, George
and Marin, Iuliana
and De Groot, Lisette
and Grootswagers, Pol",
title="Developing a Digital Tool to Calculate Protein Quality in Plant-Based Meals of Older Adults: User Engagement Design Approach With End Users",
journal="J Particip Med",
year="2024",
month="Dec",
day="19",
volume="16",
pages="e48323",
keywords="digital tool",
keywords="protein quality",
keywords="user engagement design approach",
keywords="plant-based diets",
keywords="healthy ageing",
keywords="mobile phone",
abstract="Background: The global shift toward plant-based diets has been increasing, with more people making the transition for various reasons. In vulnerable subgroups such as older adults, the transition to plant-based diets deserves attention due to the potentially detrimental consequences of lower protein quantity and quality. Objective: We aimed to develop a digital tool that ensures adequate protein quality in plant-based meals for older adults experiencing low protein intake through an interdisciplinary collaboration and user engagement with potential end users. Methods: Three focus group interviews of Dutch and Danish dietitians and older adults as potential end users were conducted to identify their needs, preferences, and deal-breakers. Focus group interviews were based on a user-task-environment analysis, the Walt Disney method, the brainwriting method, and a cognitive walkthrough. The interview transcripts were analyzed with a thematic analysis. The front end and backend development of a potential tool took place in parallel and was well-synced to the focus group interviews. Results: Both dietitians and older adults from Dutch and Danish sites expressed high interest in a tool that provides feedback and background information on protein quality, sustainability, and nutrients or micronutrients. The user-task-environment analysis delivered input among others that dietitians and older adults are good potential users, the tool should be functional as an app as well as a website and the tool should provide preprogrammed meals or recipes. The Walt Disney method delivered usable and realistic solutions to the 4 challenges presented. Thirty-two percent of the solutions on all themes presented with the brainwriting method appeared to be highly feasible and relevant, having the potential to be implemented in a tool. The cognitive walkthrough identified certain screens as unclear, necessitating revisions for improved understandability, for example, the need for explanation in selecting food item filters is shown in screenshot 2, with an overall usability score of 59\%. Conclusions: Our user engagement design approach resulted in a prototype that ensured end users' wishes and needs, with a finetuned output tested in focus groups. We conclude that our user engagement design approach was a suitable and meaningful stepwise approach to ensure the relevance of the tool and identify potential barriers. The focus group results indicate that dietitians have a clear understanding and need for a tool to aid in meal planning for enhanced protein quality, highlighting its absence in their current resources despite increasing demands arising from the protein transition. Conversely, for older adults, the introduction of a digital tool appears less appropriate; instead, there is a necessity for foundational education on protein quality before such a tool can be effectively used. Future studies are needed to further implement the prototype into practice. ",
doi="10.2196/48323",
url="https://jopm.jmir.org/2024/1/e48323"
}


@Article{info:doi/10.2196/58051,
author="Naud{\'e}, B{\'e}rang{\`e}re
and Rigaud, Anne-Sophie
and Pino, Maribel",
title="Investigating the Acceptability of an Interactive Television Intervention Promoting Social Links Among Older Adults Living at Home and in Care Institutions: Qualitative Interview and Questionnaire Study",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="2",
volume="11",
pages="e58051",
keywords="interactive television",
keywords="iTV",
keywords="acceptance",
keywords="older adults",
keywords="nursing home",
keywords="residential facility",
keywords="technology acceptance model",
keywords="TAM",
keywords="mobile phone",
abstract="Background: When older adults (OAs) can no longer live independently at home, they have the option to choose from various types of geriatric care institutions, such as residential facilities or nursing homes. For several years now, thanks to the development of interactive television (iTV), social link functions have been accessible directly on televisions, tools that are already integrated into residents' rooms. The acceptance of technologies specifically targeting older users, as well as iTV, has been widely documented in the literature, incorporating factors from the innovation resistance model. Objective: This research aims to enrich the acceptance of existing models of innovation by OAs living in different settings. Methods: User tests were carried out to evaluate OAs' experiences with iTV and identify the factors involved in its acceptance. A total of 32 OAs living at home, in nursing homes, or in residential facilities in France were interviewed between November 2022 and June 2023. iTV acceptance was examined using an interview grid based on the technology acceptance model and included the following factors: intention to use, perceived usefulness, perceived ease of use, user resistance, anxiety, facilitating conditions, and user characteristics. Results: The deductive qualitative analysis based on the technology acceptance model helped to identify 33 concepts. Conclusions: This study has contributed to the literature on the acceptance of iTV by OAs living at home and in geriatric institutions, particularly by enriching existing models and proposing new avenues for reflection. ",
doi="10.2196/58051",
url="https://humanfactors.jmir.org/2024/1/e58051"
}


@Article{info:doi/10.2196/52715,
author="H{\"a}rk{\"o}nen, Henna
and Myllykangas, Kirsi
and K{\"a}rpp{\"a}, Mikko
and Rasmus, Maaria Kirsi
and Gomes, Francis Julius
and Immonen, Milla
and Hyv{\"a}m{\"a}ki, Piia
and Jansson, Miia",
title="Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e52715",
keywords="cerebrovascular disease",
keywords="stroke",
keywords="digitalization",
keywords="interventions",
keywords="health care professional",
keywords="client",
keywords="patient",
keywords="mHealth",
keywords="mobile health",
keywords="application",
keywords="digital health",
keywords="smartphones",
keywords="health system",
keywords="qualitative",
keywords="descriptive study",
keywords="brain",
keywords="blood vessel disease",
keywords="cerebrovascular disorder",
keywords="Finland",
keywords="interviews",
keywords="efficiency",
keywords="information",
keywords="quality",
keywords="accountability",
keywords="neurology",
keywords="neuroscience",
keywords="brain injury",
keywords="mobile phone",
abstract="Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. Objective: This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care. Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care. ",
doi="10.2196/52715",
url="https://www.jmir.org/2024/1/e52715",
url="http://www.ncbi.nlm.nih.gov/pubmed/39622027"
}


@Article{info:doi/10.2196/63434,
author="Mitchell, E. Suzanne
and Kallen, A. Michael
and Troost, P. Jonathan
and De La Cruz, A. Barbara
and Bragg, Alexa
and Martin-Howard, Jessica
and Moldovan, Ioana
and Miner, A. Jennifer
and Jack, W. Brian
and Carlozzi, E. Noelle",
title="Four New Patient-Reported Outcome Measures Examining Health-Seeking Behavior in Persons With Type 2 Diabetes Mellitus (REDD-CAT): Instrument Development Study",
journal="JMIR Diabetes",
year="2024",
month="Nov",
day="22",
volume="9",
pages="e63434",
keywords="diabetes mellitus",
keywords="social determinants of health",
keywords="patient-reported outcome measures",
keywords="outcomes assessment",
keywords="health care",
keywords="patient reported",
keywords="health-seeking behavior",
keywords="type 2 diabetes",
keywords="hospitalization",
keywords="diabetes computer adaptive test",
keywords="primary care",
keywords="socioeconomic",
keywords="assessments",
abstract="Background: The management of type 2 diabetes mellitus (T2DM) includes mastery of complex care activities, self-management skills, and routine health care encounters to optimize glucose control and achieve good health. Given the lifelong course of T2DM, patients are faced with navigating complex medical and disease-specific information. This health-seeking behavior is a driver of health disparities and is associated with hospitalization and readmission. Given that health-seeking behavior is a potentially intervenable social determinant of health, a better understanding of how people navigate these complex systems is warranted. Objective: To address this need, we aimed to develop new patient-reported outcome (PRO) measures that evaluate health-seeking behavior in persons with T2DM. These new PROs were designed to be included in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system, which includes several other PROs that capture the importance of social determinants of health. Methods: Overall, 225 participants with T2DM completed 56 self-report items that examined health-seeking behaviors. Classical Test Theory and Item Response Theory were used for measurement development. Exploratory factor analysis (EFA; criterion ratio of eigenvalue 1 to eigenvalue 2 being >4; variance for eigenvalue 1 ?40\%) and confirmatory factor analysis (CFA; criterion 1-factor CFA loading <.50; 1-factor CFA residual correlation >.20; comparative fit index ?0.90; Tucker-Lewis index ?0.90; root mean square error of approximation <0.15) were used to determine unidimensional sets of items. Items with sparse responses, low-adjusted total score correlations, nonmonotonicity, low factor loading, and high residual correlations of high error modification indices were candidates for exclusion. A constrained graded response model was used to examine item misfit, and differential item functioning was examined to identify item bias. Cronbach $\alpha$ was used to examine internal consistency reliability for the new PROs (criterion ?0.70), and floor and ceiling effects were examined (criterion ?20\%). Results: Four unidimensional sets of items were supported by EFA (all EFA eigenvalue ratios >4; variance for eigenvalue 1=41.4\%-67.3\%) and CFA (fit statistics all exceeded criterion values). This included (1) ``Health-Seeking Behavior: PCP-Specific'' (6 items); (2) ``Health-Seeking Behavior: General Beliefs'' (13 items); (3) ``Health-Seeking Behavior: Family or Friends-Specific'' (5 items); and (4) ``Health-Seeking Behavior: Internet-Specific'' (4 items). All items were devoid of differential item functioning for age, sex, education, or socioeconomic status factors. ``Health-Seeking Behavior: General Beliefs'' was developed to include both a computer adaptive test and a 6-item short form version; all other PROs were developed as static short forms. The psychometric reliability of these new PROs was supported; internal consistency ranged from acceptable to excellent (Cronbach $\alpha$=.78-.91), and measures were free of significant floor or ceiling effects (floor effects range: 0\%-8.9\%; ceiling effects range: 0\%-8.4\%). Conclusions: The new REDD-CAT Health-Seeking Behavior PROs provide reliable assessments of health-seeking behaviors among those with T2DM. ",
doi="10.2196/63434",
url="https://diabetes.jmir.org/2024/1/e63434",
url="http://www.ncbi.nlm.nih.gov/pubmed/39576685"
}


@Article{info:doi/10.2196/60692,
author="Gerchow, Lauren
and Lanier, Yzette
and Fayard, Anne-Laure
and Squires, Allison",
title="Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City",
journal="JMIR Pediatr Parent",
year="2024",
month="Nov",
day="19",
volume="7",
pages="e60692",
keywords="adolescent",
keywords="reproductive health",
keywords="sexual health",
keywords="cocreation",
keywords="co-design",
keywords="human-centered design",
abstract="Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63\%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. ",
doi="10.2196/60692",
url="https://pediatrics.jmir.org/2024/1/e60692"
}


@Article{info:doi/10.2196/60865,
author="Liu, Jianyi
and Giannone, Alyssa
and Wang, Hailing
and Wetherall, Lucy
and Juarascio, Adrienne",
title="Understanding Patients' Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="18",
volume="8",
pages="e60865",
keywords="bulimia nervosa",
keywords="binge eating",
keywords="digital intervention",
keywords="deterioration prevention",
keywords="eating disorder",
keywords="bulimia",
keywords="digital health",
keywords="deterioration",
keywords="maintenance",
keywords="mHealth",
keywords="mobile health app",
keywords="interviews",
keywords="qualitative",
keywords="user-centered design",
keywords="psychotherapy",
keywords="CBT",
keywords="cognitive behavioral therapy",
keywords="needs",
keywords="preferences",
keywords="mobile phone",
abstract="Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients' interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. ",
doi="10.2196/60865",
url="https://formative.jmir.org/2024/1/e60865"
}


@Article{info:doi/10.2196/57628,
author="Tandon, Animesh
and Cobb, Bryan
and Centra, Jacob
and Izmailova, Elena
and Manyakov, V. Nikolay
and McClenahan, Samantha
and Patel, Smit
and Sezgin, Emre
and Vairavan, Srinivasan
and Vrijens, Bernard
and Bakker, P. Jessie
and ",
title="Human Factors, Human-Centered Design, and Usability of Sensor-Based Digital Health Technologies: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="15",
volume="26",
pages="e57628",
keywords="digital health",
keywords="remote",
keywords="decentralized",
keywords="sensors",
keywords="connected care",
keywords="usability",
keywords="ergonomics",
keywords="human-centered design",
keywords="user experience",
keywords="systematic scoping review",
keywords="human factors",
keywords="screening",
keywords="clinicians",
keywords="wearable",
keywords="mobile phone",
abstract="Background: Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly. Objective: This review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability. Methods: We conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured. Results: Our literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86\%) sDHTs were wearable tools while the remaining 23 (14\%) sDHTs were ambient tools. The majority of studies (55/83, 66\%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99\%) captured data from targeted end users, but only 18 (22\%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83\% (136/164) and 91\% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7\%), 4 (2\%), and 2 (1\%) out of 164 sDHTs, respectively. A total of 14 (9\%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25\% of all studies and 17/55, 31\% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17\% of studies). Conclusions: Based on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use. ",
doi="10.2196/57628",
url="https://www.jmir.org/2024/1/e57628"
}


@Article{info:doi/10.2196/57873,
author="Merry, Kohle
and MacPherson, M. Megan
and Whittaker, L. Jackie
and Napier, Christopher
and Holsti, Liisa
and Scott, Alex",
title="An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="13",
volume="11",
pages="e57873",
keywords="exercise therapy",
keywords="physical therapy modalities",
keywords="rehabilitation",
keywords="tendons",
keywords="tendinopathy",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective: This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods: The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results: By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions: Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies. ",
doi="10.2196/57873",
url="https://humanfactors.jmir.org/2024/1/e57873"
}


@Article{info:doi/10.2196/59158,
author="Straand, J. Ingjerd
and F{\o}lstad, Asbj{\o}rn
and W{\"u}nsche, C. Burkhard",
title="A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e59158",
keywords="web-based intervention",
keywords="positive psychology",
keywords="mental health",
keywords="user experience",
keywords="persuasive design",
abstract="Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named R{\O}ST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. ",
doi="10.2196/59158",
url="https://formative.jmir.org/2024/1/e59158"
}


@Article{info:doi/10.2196/59897,
author="Berger, Mathilde
and Deblock-Bellamy, Anne
and Ch{\`e}ze, Laurence
and Robert, Thomas
and Desrosiers, J. Julie
and Christe, Guillaume
and Bertrand, Martine Anne",
title="Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="7",
volume="11",
pages="e59897",
keywords="chronic low back pain",
keywords="needs",
keywords="self-management",
keywords="physical activity",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
abstract="Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. ",
doi="10.2196/59897",
url="https://humanfactors.jmir.org/2024/1/e59897"
}


@Article{info:doi/10.2196/58276,
author="Sommers, W. Stuart
and Tolle, J. Heather
and Trinkley, E. Katy
and Johnston, G. Christine
and Dietsche, L. Caitlin
and Eldred, V. Stephanie
and Wick, T. Abraham
and Hoppe, A. Jason",
title="Clinical Decision Support to Increase Emergency Department Naloxone Coprescribing: Implementation Report",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="6",
volume="12",
pages="e58276",
keywords="clinical decision support systems",
keywords="order sets",
keywords="drug monitoring",
keywords="opioid analgesic",
keywords="opioid use",
keywords="opioid prescribing",
keywords="drug overdose",
keywords="opioid overdose",
keywords="naloxone",
keywords="naloxone coprescribing",
keywords="harm reduction",
keywords="harm minimization",
abstract="Background: Coprescribing naloxone with opioid analgesics is a Centers for Disease Control and Prevention (CDC) best practice to mitigate the risk of fatal opioid overdose, yet coprescription by emergency medicine clinicians is rare, occurring less than 5\% of the time it is indicated. Clinical decision support (CDS) has been associated with increased naloxone prescribing; however, key CDS design characteristics and pragmatic outcome measures necessary to understand replicability and effectiveness have not been reported. Objective: This study aimed to rigorously evaluate and quantify the impact of CDS designed to improve emergency department (ED) naloxone coprescribing. We hypothesized CDS would increase naloxone coprescribing and the number of naloxone prescriptions filled by patients discharged from EDs in a large health care system. Methods: Following user-centered design principles, we designed and implemented a fully automated, interruptive, electronic health record--based CDS to nudge clinicians to coprescribe naloxone with high-risk opioid prescriptions. ``High-risk'' opioid prescriptions were defined as any opioid analgesic prescription ?90 total morphine milligram equivalents per day or for patients with a prior diagnosis of opioid use disorder or opioid overdose. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate pragmatic CDS outcomes of reach, effectiveness, adoption, implementation, and maintenance. Effectiveness was the primary outcome of interest and was assessed by (1) constructing a Bayesian structural time-series model of the number of ED visits with naloxone coprescriptions before and after CDS implementation and (2) calculating the percentage of naloxone prescriptions associated with CDS that were filled at an outpatient pharmacy. Mann-Kendall tests were used to evaluate longitudinal trends in CDS adoption. All outcomes were analyzed in R (version 4.2.2; R Core Team). Implementation (Results): Between November 2019 and July 2023, there were 1,994,994 ED visits. CDS reached clinicians in 0.83\% (16,566/1,994,994) of all visits and 15.99\% (16,566/103,606) of ED visits where an opioid was prescribed at discharge. Clinicians adopted CDS, coprescribing naloxone in 34.36\% (6613/19,246) of alerts. CDS was effective, increasing naloxone coprescribing from baseline by 18.1 (95\% CI 17.9?18.3) coprescriptions per week or 2,327\% (95\% CI 3390?3490). Patients filled 43.80\% (1989/4541) of naloxone coprescriptions. The CDS was implemented simultaneously at every ED and no adaptations were made to CDS postimplementation. CDS was maintained beyond the study period and maintained its effect, with adoption increasing over time ($\tau$=0.454; P<.001). Conclusions: Our findings advance the evidence that electronic health record--based CDS increases the number of naloxone coprescriptions and improves the distribution of naloxone. Our time series analysis controls for secular trends and strongly suggests that minimally interruptive CDS significantly improves process outcomes. ",
doi="10.2196/58276",
url="https://medinform.jmir.org/2024/1/e58276"
}


@Article{info:doi/10.2196/55754,
author="Gargot, Thomas
and Vachaud, Amandine
and Gilard, Cl{\'e}mence
and Audrain, Alexia
and Gomot, Marie
and Guidotti, Marco
and Briend, Fr{\'e}d{\'e}ric
and Malvy, Jo{\"e}lle
and Bonnet Brilhault, Fr{\'e}d{\'e}rique",
title="A Compressive Armchair (OTO) to Perform Deep Pressure Therapy in Children With Autism Spectrum Disorder: User-Centered Design and Feasibility Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="5",
volume="11",
pages="e55754",
keywords="deep pressure therapy",
keywords="proprioception",
keywords="compression",
keywords="autism spectrum disorder",
abstract="Background: Deep pressure therapy (DPT) is widely used to reduce anxiety in children with autism spectrum disorder (ASD), but evidence of its efficacy is limited. Objective: This study aims to design a usable, nonstigmatizing compressive armchair that can be easily controlled, electronically, by the user. Methods: A user-centered approach was used to assess the usability of the device. Testing was carried out in a day hospital for children with ASD in France, with a convenience sample of children with severe forms of ASD and intellectual deficiency (N=39). The Witteman design guideline was used. The System Usability Scale and time of use were reported. Results: The final product is a compressive armchair designed to be user centered, with 4 different cells that can be inflated to induce tailored pressure on the body. The pressure level is recorded electronically. Usability was between good and excellent. The device was used by 39 children, once or twice weekly, over a period of 31 months. Each session lasted between 3 and 20 minutes. The armchair takes up less space than a hug machine. Performing sessions with the chair is feasible. Conclusions: First clinical impressions show a decrease in anxiety, improved emotional regulation, and improved attention. DPT is widely used in occupational therapy and frequently requested by parents, but efficacy studies are too scarce to make evidence-based recommendations for its use. The results presented here support further controlled efficacy studies of DPT in the treatment of anxiety in children with ASD. ",
doi="10.2196/55754",
url="https://humanfactors.jmir.org/2024/1/e55754"
}


@Article{info:doi/10.2196/58683,
author="Jackson, Michael Tim
and Ward, Kanesha
and Saad, Shannon
and White, J. Sarah
and Poudel, Shila
and Raffan, Freya
and Amanatidis, Sue
and Bartyn, Jenna
and Hutchings, Owen
and Coiera, Enrico
and Chan, Kevin
and Lau, S. Annie Y.",
title="Virtual Hospitals and Patient Experience: Protocol for a Mixed Methods Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="29",
volume="13",
pages="e58683",
keywords="virtual care",
keywords="patient experience",
keywords="virtual hospital",
keywords="mixed method",
keywords="co-design",
keywords="barriers",
keywords="facilitators",
keywords="virtual services",
abstract="Background: Virtual care is increasingly incorporated within routine health care settings to improve patient experience and access to care. A patient's experience encompasses all the interactions an individual has with the health care system. This includes a greater emphasis on actively involving carers in the decisions and activities surrounding a patient's health care. Objective: This study aimed to investigate the variety of health care delivery challenges encountered in a virtual hospital and explore potential ways to improve the patient experience. Methods: Focusing on acute respiratory, this protocol outlines a mixed methods study exploring the patient experience of a virtual hospital in Australia, Royal Prince Alfred Virtual Hospital (rpavirtual). We will use an exploratory mixed methods approach comprising of secondary data analysis, observations, interviews, and co-design focus groups. Participants will include patients, their carers, and health care workers who are involved in the acute respiratory virtual hospital model of care. Together, the data will be triangulated to explore views and experiences of using this model of care, as well as co-designing recommendations for further improvement. Results: Findings from this study will identify current barriers and facilitators to implementing virtual care, such as work-as-done versus work-as-imagined, equity of care, the role of carers, and patient safety during virtual care. As of August 2024, a total of 25 participants have been interviewed. Conclusions: This protocol outlines a mixed methods case study on the acute respiratory model of care from Australia's first virtual hospital, rpavirtual. This study will collect the experiences of patients, carers, and health care workers to co-design a series of recommendations to improve the patient experience. International Registered Report Identifier (IRRID): DERR1-10.2196/58683 ",
doi="10.2196/58683",
url="https://www.researchprotocols.org/2024/1/e58683"
}


@Article{info:doi/10.2196/53394,
author="Branitsky, Alison
and Bee, Penny
and Bucci, Sandra
and Lovell, Karina
and Foster, Simon
and Whelan, Pauline",
title="Co-Designing a Digital App to Support Young People's Patient and Public Involvement and Engagement (VoiceIn): Development and Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="24",
volume="11",
pages="e53394",
keywords="patient and public involvement and engagement",
keywords="PPIE",
keywords="digital mental health",
keywords="young people",
keywords="co-design",
keywords="mental health",
abstract="Background: While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people's involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meetings or group discussions can further compound this difficulty. The VoiceIn app and digital platform were codeveloped by a multidisciplinary team of young people, mental health researchers, and software designers, and enables young people to engage directly with PPIE opportunities via a mobile app. Objective: This paper aims to describe how VoiceIn was developed through a series of co-design workshops with relevant stakeholders, specifically (1) how the initial design of VoiceIn was informed and driven by focus groups with young people, mental health professionals, and PPIE leads; (2) how VoiceIn was refined through collaboration with the aforementioned stakeholders; (3) the priorities for an app to support PPIE; (4) the key features necessary in the PPIE app; and (5) the recommended next steps in testing and deploying the digital platform. Methods: Initial co-design workshops took place with young people, mental health professionals, and PPIE leads to identify key features of an app to support PPIE. A series of VoiceIn design prototypes were developed and iterated based on the priorities and preferences of the stakeholders. The MoSCoW (must have, should have, could have, won't have) prioritization method was used throughout the process to identify priorities across the different stakeholder groups. Results: Co-design with young people, mental health professionals, and PPIE leads supported the successful development and improvement of the VoiceIn app. As a result of this process, key features were identified, including allowing for various modes of providing feedback (eg, polls and comments), reviewing project updates, and expressing interest in categories of research. The researcher platform was developed to support multimedia uploads for project descriptions; a jargon detector; a dedicated section for providing project updates; and a visually appealing, user-friendly design. While all stakeholder groups emphasized the importance of allowing app users to engage with the app in various ways and for there to be ongoing progress updates, group differences were also noticed. Young people expressed a desire for incentives and rewards for engaging with the app (eg, to post on their public social media profiles), and mental health professionals and PPIE leads prioritized flexibility in describing the project and its PPIE needs. Conclusions: A co-design approach was pivotal to the development of the VoiceIn app. This collaborative approach enabled the app to meet the divergent needs of young people, mental health professionals, and PPIE leads. This process mirrored the aspirations of PPIE initiatives by cocreating a digital health research tool with key stakeholders. ",
doi="10.2196/53394",
url="https://humanfactors.jmir.org/2024/1/e53394"
}


@Article{info:doi/10.2196/57338,
author="Ramasawmy, Mel
and Roland Persson, Dan
and Sunkersing, David
and Gill, Paramjit
and Khunti, Kamlesh
and Poole, Lydia
and Hanif, Wasim
and Blandford, Ann
and Sajid, Madiha
and Stevenson, Fiona
and Khan, Nushrat
and Banerjee, Amitava",
title="Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="24",
volume="11",
pages="e57338",
keywords="digital health",
keywords="cardiometabolic disease",
keywords="cardiology",
keywords="cardiovascular risk",
keywords="health inequality",
keywords="health disparity",
keywords="usability",
keywords="user experience",
keywords="think aloud",
keywords="cultural barriers",
keywords="digital divide",
keywords="digital literacy",
abstract="Background: Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Objective: Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Methods: Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted ``think-aloud'' interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Results: Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. Conclusions: DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs. ",
doi="10.2196/57338",
url="https://humanfactors.jmir.org/2024/1/e57338"
}


@Article{info:doi/10.2196/64614,
author="Fietta, Valentina
and Rizzi, Silvia
and De Luca, Chiara
and Gios, Lorenzo
and Pavesi, Chiara Maria
and Gabrielli, Silvia
and Monaro, Merylin
and Forti, Stefano",
title="A Chatbot-Based Version of the World Health Organization--Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="18",
volume="11",
pages="e64614",
keywords="acceptance and commitment therapy",
keywords="ACT",
keywords="well-being",
keywords="pregnancy",
keywords="breast cancer",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="development",
keywords="usability",
keywords="user-centered design",
abstract="Background: Advancements in technology offer new opportunities to support vulnerable populations, such as pregnant women and women diagnosed with breast cancer, during physiologically and psychologically stressful periods. Objective: This study aims to adapt and co-design the World Health Organization's Self-Help Plus intervention into a mobile health intervention for these target groups. Methods: On the basis of the Obesity-Related Behavioral Intervention Trials and Center for eHealth Research and Disease Management models, low-fidelity and high-fidelity prototypes were developed. Prototypes were evaluated by 13 domain experts from diverse sectors and 15 participants from the target groups to assess usability, attractiveness, and functionality through semantic differential scales, the User Version of the Mobile Application Rating Scale questionnaire, and semistructured interviews. Results: Feedback from participants indicated positive perceptions of the mobile health intervention, highlighting its ease of use, appropriate language, and attractive multimedia content. Areas identified for improvement included enhancing user engagement through reminders, monitoring features, and increased personalization. The quality of the content and adherence to initial protocols were positively evaluated. Conclusions: This research provides valuable insights for future studies aiming to enhance the usability, efficacy, and effectiveness of the app, suggesting the potential role of a chatbot-delivered Self-Help Plus intervention as a supportive tool for pregnant women and women with a breast cancer diagnosis. ",
doi="10.2196/64614",
url="https://humanfactors.jmir.org/2024/1/e64614",
url="http://www.ncbi.nlm.nih.gov/pubmed/39355954"
}


@Article{info:doi/10.2196/56949,
author="Lazzarino, Runa
and Borek, J. Aleksandra
and Honeyford, Kate
and Welch, John
and Brent, J. Andrew
and Kinderlerer, Anne
and Cooke, Graham
and Patil, Shashank
and Gordon, Anthony
and Glampson, Ben
and Goodman, Philippa
and Ghazal, Peter
and Daniels, Ron
and Costelloe, E. C{\'e}ire
and Tonkin-Crine, Sarah",
title="Views and Uses of Sepsis Digital Alerts in National Health Service Trusts in England: Qualitative Study With Health Care Professionals",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="15",
volume="11",
pages="e56949",
keywords="digital alerts",
keywords="electronic health records",
keywords="computerized clinical decision support systems",
keywords="sepsis",
keywords="patient deterioration",
keywords="decision-making",
keywords="secondary care",
keywords="emergency care",
keywords="intensive care",
keywords="England",
keywords="qualitative study",
abstract="Background: Sepsis is a common cause of serious illness and death. Sepsis management remains challenging and suboptimal. To support rapid sepsis diagnosis and treatment, screening tools have been embedded into hospital digital systems to appear as digital alerts. The implementation of digital alerts to improve the management of sepsis and deterioration is a complex intervention that has to fit with team workflow and the views and practices of hospital staff. Despite the importance of human decision-making and behavior in optimal implementation, there are limited qualitative studies that explore the views and experiences of health care professionals regarding digital alerts as sepsis or deterioration computerized clinician decision support systems (CCDSSs). Objective: This study aims to explore the views and experiences of health care professionals on the use of sepsis or deterioration CCDSSs and to identify barriers and facilitators to their implementation and use in National Health Service (NHS) hospitals. Methods: We conducted a qualitative, multisite study with unstructured observations and semistructured interviews with health care professionals from emergency departments, outreach teams, and intensive or acute units in 3 NHS hospital trusts in England. Data from both interviews and observations were analyzed together inductively using thematic analysis. Results: A total of 22 health care professionals were interviewed, and 12 observation sessions were undertaken. A total of four themes regarding digital alerts were identified: (1) support decision-making as nested in electronic health records, but never substitute professionals' knowledge and experience; (2) remind to take action according to the context, such as the hospital unit and the job role; (3) improve the alerts and their introduction, by making them more accessible, easy to use, not intrusive, more accurate, as well as integrated across the whole health care system; and (4) contextual factors affecting views and use of alerts in the NHS trusts. Digital alerts are more optimally used in general hospital units with a lower senior decision maker:patient ratio and by health care professionals with experience of a similar technology. Better use of the alerts was associated with quality improvement initiatives and continuous sepsis training. The trusts' features, such as the presence of a 24/7 emergency outreach team, good technological resources, and staffing and teamwork, favored a more optimal use. Conclusions: Trust implementation of sepsis or deterioration CCDSSs requires support on multiple levels and at all phases of the intervention, starting from a prego-live analysis addressing organizational needs and readiness. Advancements toward minimally disruptive and smart digital alerts as sepsis or deterioration CCDSSs, which are more accurate and specific but at the same time scalable and accessible, require policy changes and investments in multidisciplinary research. ",
doi="10.2196/56949",
url="https://humanfactors.jmir.org/2024/1/e56949"
}


@Article{info:doi/10.2196/53557,
author="Ditmore, H. Melissa
and Florez-Arango, Fernando Jose",
title="User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="9",
volume="11",
pages="e53557",
keywords="mobile health",
keywords="sex worker",
keywords="user-centered design methods",
keywords="usability",
keywords="heuristic analysis",
keywords="cognitive walkthrough",
keywords="aggression",
keywords="abuse",
keywords="occupational health",
keywords="reporting",
keywords="prototype",
keywords="heuristics",
keywords="human-centered design",
keywords="implementation",
keywords="barriers",
keywords="enablers",
keywords="data collection",
keywords="digital health",
keywords="underreporting",
abstract="Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing. ",
doi="10.2196/53557",
url="https://humanfactors.jmir.org/2024/1/e53557"
}


@Article{info:doi/10.2196/63222,
author="Wegener, Kauffeldt Emilie
and M Bergsch{\"o}ld, Jenny
and Kramer, Tina
and Schmidt, Wong Camilla
and Borgnakke, Karen",
title="Co-Designing a Conversational Agent With Older Adults With Chronic Obstructive Pulmonary Disease Who Age in Place: Qualitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="8",
volume="11",
pages="e63222",
keywords="eHealth",
keywords="aging in place",
keywords="digital health technology",
keywords="health literacy",
keywords="everyday life",
keywords="co-design",
keywords="co-designing",
keywords="conversational agent",
keywords="older adults",
keywords="elderly",
keywords="COPD",
keywords="thematic analysis",
keywords="design",
keywords="development",
keywords="interview data",
keywords="cocreation",
keywords="chronic obstructive pulmonary disease",
keywords="mobile phone",
abstract="Background: As a reaction to the global demographic increase in older adults (aged 60+ years), policy makers call for initiatives to enable healthy aging. This includes a focus on person-centered care and access to long-term care for older adults, such as developing different services and digital health technologies. This can enable patients to engage in their health and reduce the burden on the health care systems and health care professionals. The European Union project Smart Inclusive Living Environments (SMILE) focuses on well-being and aging in place using new digital health technologies. The novelty of the SMILE project is the use of a cocreational approach focused on the needs and preferences of older adults with chronic obstructive pulmonary disease (COPD) in technology development, to enhance access, adaptation, and usability and to reduce stigma. Objective: The study aimed to describe the perspective, needs, and preferences of older adults living with COPD in the context of the design and development of a conversational agent. Methods: This study carried out a data-driven thematic analysis of interview data from 11 cocreation workshops with 33 older adults living with COPD. Results: The three particular features that the workshop participants wanted to implement in a new technology were (1) a ``my health'' function, to use technology to manage and learn more about their condition; (2) a ``daily activities'' function, including an overview and information about social and physical activities in their local area; and (3) a ``sleep'' function, to manage circadian rhythm and enhance sleep quality, for example, through online video guides. In total, 2 overarching themes were identified for the 3 functions: measurements, which were actively discussed and received mixed interest among the participants, and health literacy, due to an overall interest in learning more about their condition in relation to everyday life. Conclusions: The future design of digital health technology must embrace the complexities of the everyday life of an older adult living with COPD and cater to their needs and preferences. Measurements should be optional and personalized, and digital solutions should be used as a supplement to health care professionals, not as substitute. ",
doi="10.2196/63222",
url="https://humanfactors.jmir.org/2024/1/e63222",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378067"
}


@Article{info:doi/10.2196/51606,
author="Marelli, Ariane
and Rozenblum, Ronen
and Bolster-Foucault, Clara
and Via-Dufresne Ley, Alicia
and Maynard, Noemie
and Amaria, Khush
and Galuppi, Barb
and Strohm, Sonya
and Nguyen, Linda
and Dawe-McCord, Claire
and Putterman, Connie
and Kovacs, H. Adrienne
and Gorter, Willem Jan",
title="Development of MyREADY Transition BBD Mobile App, a Health Intervention Technology Platform, to Improve Care Transition for Youth With Brain-Based Disabilities: User-Centered Design Approach",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="1",
volume="7",
pages="e51606",
keywords="patient-centered care",
keywords="patient engagement",
keywords="mobile app",
keywords="health IT",
keywords="health care transition",
keywords="mobile phone",
abstract="Background: Transition from pediatric to adult health care varies and is resource intensive. Patient-centered health information technology (HIT) interventions are increasingly being developed in partnership with patients. Objective: This study aims to develop an internet-based mobile app intervention for patients with brain-based disabilities to improve transition in care readiness. Methods: The app was designed for patients aged 15 to 17 years with brain-based disabilities having the ability to use a mobile app. A multidisciplinary team, an industry partner, and a patient and family advisory council was assembled. We hypothesized that existing tools could be migrated into the app to address education, empowerment, and navigation. We used cognitive learning theory to support chapters targeting transition in care skill sets. We used the agile iterative methodology to engage stakeholders. Results: We developed a novel MyREADY Transition HIT platform. An electronic mentor supported cognitive learning with messaging, quizzes, rewards, and videos. We used gaming to guide navigation through a fictitious health care city. Adapting existing tools was achieved by the patient and family advisory council requesting personalization. Our iterative design required time-consuming back-end technology management. Developing the platform took 24 months instead of our grant-approved 12 months, impacting the onset of the planned trial within the allotted budget. Conclusions: A novel patient-centered HIT platform to improve health care transition was successfully developed in partnership with patients and industry. Careful resource management was needed to achieve timely delivery of the end product, flagging the cautious planning required to deliver HIT tools in time for the much-needed trials informing their clinical application. Trial Registration: ClinicalTrials.gov NCT03852550; https://clinicaltrials.gov/study/NCT03852550 ",
doi="10.2196/51606",
url="https://pediatrics.jmir.org/2024/1/e51606"
}


@Article{info:doi/10.2196/59269,
author="Ng, Ying Wei
and Lau, Yin Ni
and Lee, Vien V.
and Vijayakumar, Smrithi
and Leong, Ying Qiao
and Ooi, Delicia Shu Qin
and Su, Lin Lin
and Lee, Seng Yung
and Chan, Shiao-Yng
and Blasiak, Agata
and Ho, Dean",
title="Shaping Adoption and Sustained Use Across the Maternal Journey: Qualitative Study on Perceived Usability and Credibility in Digital Health Tools",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="1",
volume="11",
pages="e59269",
keywords="maternal and child health",
keywords="conception",
keywords="pregnancy",
keywords="perinatal care",
keywords="postpartum",
keywords="maternal care",
keywords="obstetric care",
keywords="user engagement",
keywords="Unified Theory of Acceptance and Use of Technology",
keywords="femtech",
abstract="Background: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. Objective: This study aims to explore the factors that shape women's DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. Methods: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women's maternal experiences with health care and DH and focuses on the factors that affected women's DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results: Five main themes and 10 subthemes were identified that affected women's adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. Conclusions: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. Trial Registration: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900 ",
doi="10.2196/59269",
url="https://humanfactors.jmir.org/2024/1/e59269",
url="http://www.ncbi.nlm.nih.gov/pubmed/39352732"
}


@Article{info:doi/10.2196/59306,
author="Flessa, J. Sarah
and Harrison, D. James
and Turnigan, Roniela
and Rathfon, Megan
and Chandler, Michael
and Newton-Small, Jay
and Rogers, E. Stephanie",
title="Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="27",
volume="7",
pages="e59306",
keywords="co-design",
keywords="storytelling",
keywords="dementia",
keywords="delirium",
keywords="older adults",
keywords="person-centered care",
abstract="Background: Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient--care team relationships and providing information to enable care tailored to individual needs and values. Objective: This study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting. Methods: We recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data. Results: In total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients' key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner--IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium. Conclusions: This study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting. ",
doi="10.2196/59306",
url="https://aging.jmir.org/2024/1/e59306"
}


@Article{info:doi/10.2196/60129,
author="Quilter, V. Emily E.
and Downes, Samuel
and Deighan, Therese Mairi
and Stuart, Liz
and Charles, Rosie
and Tittensor, Phil
and Junges, Leandro
and Kissack, Peter
and Qureshi, Yasser
and Kamaraj, Kumar Aravind
and Brigden, Amberly",
title="A Digital Intervention for Capturing the Real-Time Health Data Needed for Epilepsy Seizure Forecasting: Protocol for a Formative Co-Design and Usability Study (The ATMOSPHERE Study)",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="19",
volume="13",
pages="e60129",
keywords="epilepsy",
keywords="seizure forecasting",
keywords="data science",
keywords="artificial intelligence",
keywords="machine learning",
keywords="wearable technology",
keywords="mobile phone",
abstract="Background: Epilepsy is a chronic neurological disorder affecting individuals globally, marked by recurrent and apparently unpredictable seizures that pose significant challenges, including increased mortality, injuries, and diminished quality of life. Despite advancements in treatments, a significant proportion of people with epilepsy continue to experience uncontrolled seizures. The apparent unpredictability of these events has been identified as a major concern for people with epilepsy, highlighting the need for innovative seizure forecasting technologies. Objective: The ATMOSPHERE study aimed to develop and evaluate a digital intervention, using wearable technology and data science, that provides real-time, individualized seizure forecasting for individuals living with epilepsy. This paper reports the protocol for one of the workstreams focusing on the design and testing of a prototype to capture real-time input data needed for predictive modeling. The first aim was to collaboratively design the prototype (work completed). The second aim is to conduct an ``in-the-wild'' study to assess usability and refine the prototype (planned research). Methods: This study uses a person-based approach to design and test the usability of a prototype for real-time seizure precipitant data capture. Phase 1 (work completed) involved co-design with individuals living with epilepsy and health care professionals. Sessions explored users' requirements for the prototype, followed by iterative design of low-fidelity, static prototypes. Phase 2 (planned research) will be an ``in-the-wild'' usability study involving the deployment of a mid-fidelity, functional prototype for 4 weeks, with the collection of mixed methods usability data to assess the prototype's real-world application, feasibility, acceptability, and engagement. This phase involves primary participants (adults diagnosed with epilepsy) and, optionally, their nominated significant other. The usability study will run in 3 rounds of deployment and data collection, aiming to recruit 5 participants per round, with prototype refinement between rounds. Results: The phase-1 co-design study engaged 22 individuals, resulting in the development of a mid-fidelity, functional prototype based on identified requirements, including the tracking of evidence-based and personalized seizure precipitants. The upcoming phase-2 usability study is expected to provide insights into the prototype's real-world usability, identify areas for improvement, and refine the technology for future development. The estimated completion date of phase 2 is the last quarter of 2024. Conclusions: The ATMOSPHERE study aims to make a significant step forward in epilepsy management, focusing on the development of a user-centered, noninvasive wearable device for seizure forecasting. Through a collaborative design process and comprehensive usability testing, this research aims to address the critical need for predictive seizure forecasting technologies, offering a promising approach to improving the lives of individuals with epilepsy. By leveraging predictive analytics and personalized machine learning models, this technology seeks to offer a novel approach to managing epilepsy, potentially improving clinical outcomes, including quality of life, through increased predictability and seizure management. International Registered Report Identifier (IRRID): DERR1-10.2196/60129 ",
doi="10.2196/60129",
url="https://www.researchprotocols.org/2024/1/e60129"
}


@Article{info:doi/10.2196/56816,
author="Butler, Sonia
and Sculley, Dean
and Santos, Derek
and Giron{\`e}s, Xavier
and Singh-Grewal, Davinder
and Coda, Andrea",
title="Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Sep",
day="17",
volume="7",
pages="e56816",
keywords="phone app",
keywords="smart watch",
keywords="juvenile idiopathic arthritis",
keywords="pain",
keywords="medication adherence",
keywords="physical activity",
keywords="integrated care",
keywords="medication",
keywords="development",
keywords="usability study",
keywords="chronic inflammatory disorder",
keywords="children",
keywords="child",
keywords="usability",
keywords="survey",
keywords="thematic analysis",
keywords="gamification",
keywords="modules",
keywords="web-based platform",
keywords="support",
abstract="Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7\%) and 1 parent for each child (n=12; female: n=8, 66.7\%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Trial Registration: ANZCTR ACTRN12616000665437; https://tinyurl.com/mwwfje8r ",
doi="10.2196/56816",
url="https://pediatrics.jmir.org/2024/1/e56816"
}


@Article{info:doi/10.2196/58046,
author="M{\"u}ller, Pascal
and Jahn, Patrick",
title="Cocreative Development of Robotic Interaction Systems for Health Care: Scoping Review",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="12",
volume="11",
pages="e58046",
keywords="human-robot interaction",
keywords="cocreation",
keywords="robotics",
keywords="user-centered design",
keywords="health care",
abstract="Background: Robotic technologies present challenges to health care professionals and are therefore rarely used. Barriers such as lack of controllability and adaptability and complex control functions affect the human-robot relationship. In addition to educational opportunities, the possibility of individual adaptation can improve the usability and practical implementation of robotics. Previous work has focused on developments from a technology-centered perspective and has included user interests too late in the process. Objective: This study addresses the following research question: What cocreative research approaches are used in the field of nursing robotics to improve the usability, intended use, and goal-directed application of robotic developments for nurses and to support the nursing process? Methods: This scoping review provides an overview of the topic and the research activities taking place within it. Five databases and the reference lists of the identified publications were searched for studies without further restrictions. Studies were included if they developed and evaluated interaction and control platforms for robotic systems in health care in a cocreative way with end users. Results: The search resulted in 419 hits, of which 3 publications were included. All publications were feasibility or user studies that were mainly carried out in the European Union. The 3 interaction and control platforms presented were all prototypes and not commercially available. In addition to those in need of care, all studies also included family carers and health care professionals. Conclusions: Robotic interaction and control platforms in health care are rarely, if ever, developed and evaluated with feasibility or user studies that include prototypes and end users. While the involvement of end users is crucial, this review emphasizes that all stakeholders, including health care professionals, should participate in the development process to ensure a holistic understanding of application needs and a focus on user experiences and practical health care needs. It is emphasized that the active involvement of end users in the development process is critical to effectively meeting the needs of the target group. Trial Registration: Deutsches Register Klinischer Studien DRKS00034195; https://drks.de/search/de/trial/DRKS00034195 ",
doi="10.2196/58046",
url="https://humanfactors.jmir.org/2024/1/e58046"
}


@Article{info:doi/10.2196/55790,
author="Meidani, Zahra
and Omidvar, Aydine
and Akbari, Hossein
and Asghari, Fatemeh
and Khajouei, Reza
and Nazemi, Zahra
and Nabovati, Ehsan
and Holl, Felix",
title="Evaluating the Usability and Quality of a Clinical Mobile App for Assisting Physicians in Head Computed Tomography Scan Ordering: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="9",
volume="11",
pages="e55790",
keywords="mobile apps",
keywords="user-centered design",
keywords="user-computer interface",
keywords="physicians",
keywords="tomography",
keywords="x-ray computed",
keywords="mobile phone",
abstract="Background: Among the numerous factors contributing to health care providers' engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. Objective: This study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians' computed tomography scan ordering. Methods: Our study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. Results: The efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8\% and 96.9\%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was ``customization'' (63.6 out of 100). In the Functionality subscale, the HAC app's lowest value was ``performance'' (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. Conclusions: Evaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps. ",
doi="10.2196/55790",
url="https://humanfactors.jmir.org/2024/1/e55790"
}


@Article{info:doi/10.2196/57827,
author="Goodday, M. Sarah
and Karlin, Emma
and Brooks, Alexa
and Chapman, Carol
and Harry, Christiana
and Lugo, Nelly
and Peabody, Shannon
and Rangwala, Shazia
and Swanson, Ella
and Tempero, Jonell
and Yang, Robin
and Karlin, R. Daniel
and Rabinowicz, Ron
and Malkin, David
and Travis, Simon
and Walsh, Alissa
and Hirten, P. Robert
and Sands, E. Bruce
and Bettegowda, Chetan
and Holdhoff, Matthias
and Wollett, Jessica
and Szajna, Kelly
and Dirmeyer, Kallan
and Dodd, Anna
and Hutchinson, Shawn
and Ramotar, Stephanie
and Grant, C. Robert
and Boch, Adrien
and Wildman, Mackenzie
and Friend, H. Stephen",
title="Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="3",
volume="26",
pages="e57827",
keywords="wearables",
keywords="wearable",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="engagement",
keywords="adherence",
keywords="retention",
keywords="participatory medicine",
keywords="participatory",
keywords="DHT",
keywords="digital health technology",
keywords="DHTs",
keywords="digital health technologies",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. Objective: The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Methods: Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. Results: The median proportion of participants retained in the study across the 6 studies was 77.2\% (IQR 72.6\%-88\%). The probability of staying in the study stayed above 80\% for all studies during the first month of study participation and stayed above 50\% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80\% and 90\%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50\%, IQR 20\%-75\%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Conclusions: Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user. ",
doi="10.2196/57827",
url="https://www.jmir.org/2024/1/e57827"
}


@Article{info:doi/10.2196/62866,
author="Zhou, Huan
and Fang, Cheng
and Pan, Yifeng",
title="Development of a System for Predicting Hospitalization Time for Patients With Traumatic Brain Injury Based on Machine Learning Algorithms: User-Centered Design Case Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="30",
volume="11",
pages="e62866",
keywords="machine learning",
keywords="traumatic brain injury",
keywords="support vector regression machine",
keywords="predictive model",
keywords="hospitalization",
abstract="Background: Currently, the treatment and care of patients with traumatic brain injury (TBI) are intractable health problems worldwide and greatly increase the medical burden in society. However, machine learning--based algorithms and the use of a large amount of data accumulated in the clinic in the past can predict the hospitalization time of patients with brain injury in advance, so as to design a reasonable arrangement of resources and effectively reduce the medical burden of society. Especially in China, where medical resources are so tight, this method has important application value. Objective: We aimed to develop a system based on a machine learning model for predicting the length of hospitalization of patients with TBI, which is available to patients, nurses, and physicians. Methods: We collected information on 1128 patients who received treatment at the Neurosurgery Center of the Second Affiliated Hospital of Anhui Medical University from May 2017 to May 2022, and we trained and tested the machine learning model using 5 cross-validations to avoid overfitting; 28 types of independent variables were used as input variables in the machine learning model, and the length of hospitalization was used as the output variables. Once the models were trained, we obtained the error and goodness of fit (R2) of each machine learning model from the 5 rounds of cross-validation and compared them to select the best predictive model to be encapsulated in the developed system. In addition, we externally tested the models using clinical data related to patients treated at the First Affiliated Hospital of Anhui Medical University from June 2021 to February 2022. Results: Six machine learning models were built, including support vector regression machine, convolutional neural network, back propagation neural network, random forest, logistic regression, and multilayer perceptron. Among them, the support vector regression has the smallest error of 10.22\% on the test set, the highest goodness of fit of 90.4\%, and all performances are the best among the 6 models. In addition, we used external datasets to verify the experimental results of these 6 models in order to avoid experimental chance, and the support vector regression machine eventually performed the best in the external datasets. Therefore, we chose to encapsulate the support vector regression machine into our system for predicting the length of stay of patients with traumatic brain trauma. Finally, we made the developed system available to patients, nurses, and physicians, and the satisfaction questionnaire showed that patients, nurses, and physicians agreed that the system was effective in providing clinical decisions to help patients, nurses, and physicians. Conclusions: This study shows that the support vector regression machine model developed using machine learning methods can accurately predict the length of hospitalization of patients with TBI, and the developed prediction system has strong clinical use. ",
doi="10.2196/62866",
url="https://humanfactors.jmir.org/2024/1/e62866"
}


@Article{info:doi/10.2196/57227,
author="Kerr, Andrew
and Grealy, Madeleine
and Slachetka, Milena
and Wodu, Obinuchi Chioma
and Sweeney, Gillian
and Boyd, Fiona
and Colville, David
and Rowe, Philip",
title="A Participatory Model for Cocreating Accessible Rehabilitation Technology for Stroke Survivors: User-Centered Design Approach",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Aug",
day="23",
volume="11",
pages="e57227",
keywords="rehabilitation",
keywords="rehabilitative",
keywords="rehab",
keywords="rehabilitation technology",
keywords="accessibility",
keywords="accessible",
keywords="stroke",
keywords="design",
keywords="participatory",
keywords="participatory design",
keywords="participatory designs",
keywords="participatory model",
keywords="participatory models",
keywords="user-centred",
keywords="user-centered",
keywords="user-focused",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="digital interventions",
keywords="participatory medicine",
keywords="technology",
abstract="Background: Globally, 1 in 3 people live with health conditions that could be improved with rehabilitation. Ideally, this is provided by trained professionals delivering evidence-based dose, intensity, and content of rehabilitation for optimal recovery. The widely acknowledged inability of global health care providers to deliver recommended levels of rehabilitation creates an opportunity for technological innovation. Design processes that lack close consideration of users' needs and budgets, however, mean that many rehabilitation technologies are neither useful nor used. To address this problem, our multidisciplinary research group have established a cocreation center for rehabilitation technology that places the end user at the center of the innovation process. Objective: This study aims to present the participatory cocreation model that has been developed from our center and illustrate the approach with 2 cases studies. Methods: The model is built around user participation in an intensive rehabilitation program (2-hour sessions, 2?5 times per week, and 8-week duration), supervised by qualified therapists but delivered exclusively through commercial and prototype technology. This provides participants (chronic stroke survivors with movement and/or speech disability) with a rich experience of rehabilitation technology, enabling them to provide truly informed feedback, as well as creating an observatory for the research team. This process is supported by short-term focus groups for specific product development and a longer-term advisory group to consider broader issues of adoption and translation into everyday health care. Results: Our model has been active for 3 years with 92 (92\%) out of 100 participants completing the program. Five new technologies have evolved from the process with further ideas logged for future development. In addition, it has led to a set of cocreated protocols for technology-enriched rehabilitation, including recruitment, outcome measures, and intervention structure, which has allowed us to replicate this approach in an acute hospital ward. Conclusions: Suboptimal rehabilitation limits recovery from health conditions. Technology offers the potential support to increase access to recommended levels of rehabilitation but needs to be designed to suit end users and not just their impairment. Our cocreation model, built around participation in an intensive, technology-based program, has produced new accessible technology and demonstrated the feasibility of our overall approach to providing the rehabilitation that people need, for as long as needed. ",
doi="10.2196/57227",
url="https://rehab.jmir.org/2024/1/e57227"
}


@Article{info:doi/10.2196/56319,
author="Franco, Pamela
and Olhaberry, Marcia
and Muzard, Antonia
and Harismendy, {\'A}ngeles
and Kelders, Saskia",
title="Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="19",
volume="8",
pages="e56319",
keywords="internet-based intervention",
keywords="postpartum depression",
keywords="user-centered development",
keywords="perinatal mental health",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders' openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype's final version. The resulting intervention, named Mam{\'a}, te entiendo (``Mom, I get you''), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. ",
doi="10.2196/56319",
url="https://formative.jmir.org/2024/1/e56319"
}


@Article{info:doi/10.2196/53939,
author="Lyles, Courtney
and Berrean, Beth
and Buenaventura, Ana
and Milter, Svetlana
and Hernandez, Daniel Dayana
and Sarkar, Urmimala
and Gutierrez, Christian
and Palmer, Nynikka
and Brown III, William",
title="Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="16",
volume="11",
pages="e53939",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="electronic health",
keywords="application",
keywords="digital health",
keywords="digital ecosystem",
keywords="informatics",
keywords="community-based",
keywords="community",
keywords="co-design",
keywords="human-centered design",
keywords="community health",
keywords="population health",
keywords="technology",
keywords="innovation",
keywords="operations",
keywords="social needs",
keywords="health resources",
keywords="qualitative analysis",
abstract="Background: Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective: We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods: Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results: Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled ``Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN),'' was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions: Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, and customization needed in these settings. ",
doi="10.2196/53939",
url="https://humanfactors.jmir.org/2024/1/e53939"
}


@Article{info:doi/10.2196/57670,
author="Zheng, Yingbin
and Cai, Yunping
and Yan, Yiwei
and Chen, Sai
and Gong, Kai",
title="Novel Approach to Personalized Physician Recommendations Using Semantic Features and Response Metrics: Model Evaluation Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="15",
volume="11",
pages="e57670",
keywords="web-based medical service",
keywords="text analysis",
keywords="Sentence Bidirectional Encoder Representations From Transformers",
keywords="SBERT",
keywords="smart triage systems",
keywords="patient-physician hybrid recommendation",
keywords="PPHR",
keywords="PPHR model",
abstract="Background: The rapid growth of web-based medical services has highlighted the significance of smart triage systems in helping patients find the most appropriate physicians. However, traditional triage methods often rely on department recommendations and are insufficient to accurately match patients' textual questions with physicians' specialties. Therefore, there is an urgent need to develop algorithms for recommending physicians. Objective: This study aims to develop and validate a patient-physician hybrid recommendation (PPHR) model with response metrics for better triage performance. Methods: A total of 646,383 web-based medical consultation records from the Internet Hospital of the First Affiliated Hospital of Xiamen University were collected. Semantic features representing patients and physicians were developed to identify the set of most similar questions and semantically expand the pool of recommended physician candidates, respectively. The physicians' response rate feature was designed to improve candidate rankings. These 3 characteristics combine to create the PPHR model. Overall, 5 physicians participated in the evaluation of the efficiency of the PPHR model through multiple metrics and questionnaires as well as the performance of Sentence Bidirectional Encoder Representations from Transformers and Doc2Vec in text embedding. Results: The PPHR model reaches the best recommendation performance when the number of recommended physicians is 14. At this point, the model has an F1-score of 76.25\%, a proportion of high-quality services of 41.05\%, and a rating of 3.90. After removing physicians' characteristics and response rates from the PPHR model, the F1-score decreased by 12.05\%, the proportion of high-quality services fell by 10.87\%, the average hit ratio dropped by 1.06\%, and the rating declined by 11.43\%. According to whether those 5 physicians were recommended by the PPHR model, Sentence Bidirectional Encoder Representations from Transformers achieved an average hit ratio of 88.6\%, while Doc2Vec achieved an average hit ratio of 53.4\%. Conclusions: The PPHR model uses semantic features and response metrics to enable patients to accurately find the physician who best suits their needs. ",
doi="10.2196/57670",
url="https://humanfactors.jmir.org/2024/1/e57670",
url="http://www.ncbi.nlm.nih.gov/pubmed/39146009"
}


@Article{info:doi/10.2196/53508,
author="Bilal, Ayesha-Mae
and Pagoni, Konstantina
and Iliadis, I. Stavros
and Papadopoulos, C. Fotios
and Skalkidou, Alkistis
and {\"O}ster, Caisa",
title="Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="8",
volume="8",
pages="e53508",
keywords="digital phenotyping",
keywords="smartphone app",
keywords="mHealth",
keywords="mobile health",
keywords="qualitative study",
keywords="user experience",
keywords="usability",
keywords="perinatal depression",
keywords="depression",
keywords="app",
keywords="user",
keywords="users",
keywords="qualitative",
keywords="perinatal",
keywords="mobile app",
keywords="clinical research",
keywords="acceptability",
keywords="behavioral data",
keywords="depressive symptoms",
keywords="interview",
keywords="pregnant",
keywords="postpartum",
keywords="women",
keywords="thematic analysis",
keywords="well-being",
keywords="monitor",
keywords="mobile phone",
abstract="Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users' perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user's concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. ",
doi="10.2196/53508",
url="https://formative.jmir.org/2024/1/e53508",
url="http://www.ncbi.nlm.nih.gov/pubmed/39115893"
}


@Article{info:doi/10.2196/56924,
author="Katzburg, Omer
and Roimi, Michael
and Frenkel, Amit
and Ilan, Roy
and Bitan, Yuval",
title="The Impact of Information Relevancy and Interactivity on Intensivists' Trust in a Machine Learning--Based Bacteremia Prediction System: Simulation Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="1",
volume="11",
pages="e56924",
keywords="user-interface design",
keywords="user-interface designs",
keywords="user interface",
keywords="human-automation interaction",
keywords="human-automation interactions",
keywords="trust in automation",
keywords="automation",
keywords="human-computer interaction",
keywords="human-computer interactions",
keywords="human-ML",
keywords="human-ML interaction",
keywords="human-ML interactions",
keywords="decision making",
keywords="decision support system",
keywords="clinical decision support",
keywords="decision support",
keywords="decision support systems",
keywords="machine learning",
keywords="ML",
keywords="artificial intelligence",
keywords="AI",
keywords="machine learning algorithm",
keywords="machine learning algorithms",
keywords="digitization",
keywords="digitization of information",
abstract="Background: The exponential growth in computing power and the increasing digitization of information have substantially advanced the machine learning (ML) research field. However, ML algorithms are often considered ``black boxes,'' and this fosters distrust. In medical domains, in which mistakes can result in fatal outcomes, practitioners may be especially reluctant to trust ML algorithms. Objective: The aim of this study is to explore the effect of user-interface design features on intensivists' trust in an ML-based clinical decision support system. Methods: A total of 47 physicians from critical care specialties were presented with 3 patient cases of bacteremia in the setting of an ML-based simulation system. Three conditions of the simulation were tested according to combinations of information relevancy and interactivity. Participants' trust in the system was assessed by their agreement with the system's prediction and a postexperiment questionnaire. Linear regression models were applied to measure the effects. Results: Participants' agreement with the system's prediction did not differ according to the experimental conditions. However, in the postexperiment questionnaire, higher information relevancy ratings and interactivity ratings were associated with higher perceived trust in the system (P<.001 for both). The explicit visual presentation of the features of the ML algorithm on the user interface resulted in lower trust among the participants (P=.05). Conclusions: Information relevancy and interactivity features should be considered in the design of the user interface of ML-based clinical decision support systems to enhance intensivists' trust. This study sheds light on the connection between information relevancy, interactivity, and trust in human-ML interaction, specifically in the intensive care unit environment. ",
doi="10.2196/56924",
url="https://humanfactors.jmir.org/2024/1/e56924"
}


@Article{info:doi/10.2196/55961,
author="Lukkien, M. Dirk R.
and Ipakchian Askari, Sima
and Stolwijk, E. Nathalie
and Hofstede, M. Bob
and Nap, Herman Henk
and Boon, C. Wouter P.
and Peine, Alexander
and Moors, M. Ellen H.
and Minkman, N. Mirella M.",
title="Making Co-Design More Responsible: Case Study on the Development of an AI-Based Decision Support System in Dementia Care",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="31",
volume="11",
pages="e55961",
keywords="responsible innovation",
keywords="co-design",
keywords="ethics",
keywords="decision support systems",
keywords="gerontechnology",
keywords="dementia",
keywords="long-term care",
abstract="Background: Emerging technologies such as artificial intelligence (AI) require an early-stage assessment of potential societal and ethical implications to increase their acceptability, desirability, and sustainability. This paper explores and compares 2 of these assessment approaches: the responsible innovation (RI) framework originating from technology studies and the co-design approach originating from design studies. While the RI framework has been introduced to guide early-stage technology assessment through anticipation, inclusion, reflexivity, and responsiveness, co-design is a commonly accepted approach in the development of technologies to support the care for older adults with frailty. However, there is limited understanding about how co-design contributes to the anticipation of implications. Objective: This paper empirically explores how the co-design process of an AI-based decision support system (DSS) for dementia caregivers is complemented by explicit anticipation of implications. Methods: This case study investigated an international collaborative project that focused on the co-design, development, testing, and commercialization of a DSS that is intended to provide actionable information to formal caregivers of people with dementia. In parallel to the co-design process, an RI exploration took place, which involved examining project members' viewpoints on both positive and negative implications of using the DSS, along with strategies to address these implications. Results from the co-design process and RI exploration were analyzed and compared. In addition, retrospective interviews were held with project members to reflect on the co-design process and RI exploration. Results: Our results indicate that, when involved in exploring requirements for the DSS, co-design participants naturally raised various implications and conditions for responsible design and deployment: protecting privacy, preventing cognitive overload, providing transparency, empowering caregivers to be in control, safeguarding accuracy, and training users. However, when comparing the co-design results with insights from the RI exploration, we found limitations to the co-design results, for instance, regarding the specification, interrelatedness, and context dependency of implications and strategies to address implications. Conclusions: This case study shows that a co-design process that focuses on opportunities for innovation rather than balancing attention for both positive and negative implications may result in knowledge gaps related to social and ethical implications and how they can be addressed. In the pursuit of responsible outcomes, co-design facilitators could broaden their scope and reconsider the specific implementation of the process-oriented RI principles of anticipation and inclusion. ",
doi="10.2196/55961",
url="https://humanfactors.jmir.org/2024/1/e55961"
}


@Article{info:doi/10.2196/51491,
author="Shetty, B. Vinutha
and Fried, Leanne
and Roby, C. Heather
and Soon, K. Wayne H.
and Nguyen, Rebecca
and Ong, Arthur
and Jaimangal, Mohinder
and Francis, Jacinta
and Paramalingam, Nirubasini
and Cross, Donna
and Davis, Elizabeth",
title="Development of a Novel Mobile Health App to Empower Young People With Type 1 Diabetes to Exercise Safely: Co-Design Approach",
journal="JMIR Diabetes",
year="2024",
month="Jul",
day="30",
volume="9",
pages="e51491",
keywords="Mobile health application",
keywords="Exercise",
keywords="fitness",
keywords="physical activity",
keywords="design",
keywords="co-design",
keywords="focus group",
keywords="focus groups",
keywords="acT1ve",
keywords="Type 1 diabetes",
keywords="Young people",
keywords="Blood glucose level",
keywords="diabetic",
keywords="diabetes",
keywords="young",
keywords="youth",
keywords="type 1",
keywords="prototype",
keywords="develop",
keywords="development",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Blood glucose management around exercise is challenging for youth with type 1 diabetes (T1D). Previous research has indicated interventions including decision-support aids to better support youth to effectively contextualize blood glucose results and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) apps help deliver health behavior interventions to youth with T1D, given the use of technology for glucose monitoring, insulin dosing, and carbohydrate counting. Objective: We aimed to develop a novel prototype mHealth app to support exercise management among youth with T1D, detail the application of a co-design process and design thinking principles to inform app design and development, and identify app content and functionality that youth with T1D need to meet their physical activity goals. Methods: A co-design approach with a user-centered design thinking framework was used to develop a prototype mHealth app ``acT1ve'' during the 18-month design process (March 2018 to September 2019). To better understand and respond to the challenges among youth with diabetes when physically active, 10 focus groups were conducted with youth aged 13-25 years with T1D and parents of youth with T1D. Thereafter, we conducted participatory design workshops with youth to identify key app features that would support individual needs when physically active. These features were incorporated into a wireframe, which was critically reviewed by participants. A beta version of ``acT1ve'' was built in iOS and android operating systems, which underwent critical review by end users, clinicians, researchers, experts in exercise and T1D, and app designers. Results: Sixty youth with T1D, 14 parents, 6 researchers, and 10 clinicians were engaged in the development of ``acT1ve.'' acT1ve included key features identified by youth, which would support their individual needs when physically active. It provided advice on carbohydrates and insulin during exercise, information on hypoglycemia treatment, pre- and postexercise advice, and an educational food guide regarding exercise management. ``acT1ve'' contained an exercise advisor algorithm comprising 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. It also contains other features including an activity log, which displays a complete record of the end users' activities and associated exercise advice provided by the app's algorithm for later reference, and regular reminder notifications for end users to check or monitor their glucose levels. Conclusions: The co-design approach and the practical application of the user-centered design thinking framework were successfully applied in developing ``acT1ve.'' The design thinking processes allowed youth with T1D to identify app features that would support them to be physically active, and particularly enabled the delivery of individualized advice. Furthermore, app development has been described in detail to help guide others embarking on a similar project. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001414101; https://tinyurl.com/mu9jvn2d ",
doi="10.2196/51491",
url="https://diabetes.jmir.org/2024/1/e51491",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078700"
}


@Article{info:doi/10.2196/52496,
author="Hasson, E. Rebecca
and Xie, Michelle
and Tadikamalla, Dhiraj
and Beemer, R. Lexie",
title="Using a Human-Centered Design Process to Evaluate and Optimize User Experience of a Website (InPACT at Home) to Promote Youth Physical Activity: Case Study",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="15",
volume="11",
pages="e52496",
keywords="web-based interventions",
keywords="children",
keywords="adolescents",
keywords="child",
keywords="adolescent",
keywords="youth",
keywords="user experience",
keywords="website",
keywords="websites",
keywords="implementation science",
keywords="human-centered design",
keywords="human-centred design",
keywords="HCD",
keywords="web based",
keywords="home based",
keywords="interview",
keywords="heuristics",
keywords="interviews",
keywords="heuristic",
keywords="competitive analysis",
keywords="video",
keywords="videos",
keywords="YouTube",
keywords="physical activity",
keywords="exercise",
keywords="fitness",
abstract="Background: Web-based physical activity interventions often fail to reach the anticipated public health impact due to insufficient use by the intended audiences. Objective: The purpose of this study was to use a human-centered design process to optimize the user experience of the Interrupting Prolonged sitting with ACTivity (InPACT) at Home website to promote youth physical activity participation. Methods: Qualitative interviews were conducted to assess engagement and pain points with the InPACT at Home website. Interview data were used to create affinity maps to identify themes of user responses, conduct a heuristic evaluation according to Nielsen's usability heuristics framework, and complete a competitive analysis to identify the strengths and weaknesses of competitors who offered similar products. Results: Key themes from end user interviews included liking the website design, finding the website difficult to navigate, and wanting additional features (eg, library of watched videos). The website usability issues identified were lack of labeling and categorization of exercise videos, hidden necessary actions and options hindering users from decision-making, error-prone conditions, and high cognitive load of the website. Competitive analysis results revealed that YouTube received the highest usability ratings followed by the Just Dance and Presidential Youth Fitness Program websites. Conclusions: Human-centered design approaches are useful for bringing end users and developers together to optimize user experience and impact public health. Future research is needed to examine the effectiveness of the InPACT at Home website redesign to attract new users and retain current users, with the end goal of increasing youth physical activity engagement. ",
doi="10.2196/52496",
url="https://humanfactors.jmir.org/2024/1/e52496"
}


@Article{info:doi/10.2196/54532,
author="Syed, Ahmed Toufeeq
and Thompson, L. Erika
and Johnson, Jason
and Latif, Zainab
and Kennedy, Nan
and Javier, Damaris
and Stinson, Katie
and Vishwanatha, K. Jamboor",
title="A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="2",
volume="11",
pages="e54532",
keywords="diversity",
keywords="mentoring",
keywords="health workforce",
keywords="underrepresented groups",
keywords="online platform",
keywords="user-computer interface",
keywords="A/B testing",
keywords="split testing",
keywords="recommendation algorithm",
keywords="network of mentors",
keywords="groups",
keywords="enrollment",
abstract="Background: The National Research Mentoring Network (NRMN) is a National Institutes of Health--funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform---MyNRMN. Objective: MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce. Methods: To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways. Results: Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95\% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95\% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3\% (784/1368) with the legacy form to 74.5\% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members. Conclusions: Our technical efforts expanded MyNRMN's membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement. ",
doi="10.2196/54532",
url="https://humanfactors.jmir.org/2024/1/e54532"
}


@Article{info:doi/10.2196/58551,
author="Hall, Evelyn
and Keyser, Laura
and McKinney, Jessica
and Pulliam, Samantha
and Weinstein, Milena",
title="Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="27",
volume="8",
pages="e58551",
keywords="urinary incontinence",
keywords="digital health",
keywords="pelvic floor muscle training",
keywords="real-world",
keywords="evidence",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women's access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. Objective: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. Methods: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ?18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Results: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74\% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89\% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ?10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. Conclusions: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ?10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9\% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes. ",
doi="10.2196/58551",
url="https://formative.jmir.org/2024/1/e58551"
}


@Article{info:doi/10.2196/58501,
author="Ahmed, Mona
and Mar{\'i}n, Mayca
and Gangas, Pilar
and Bentlage, Ellen
and Louro, Claudia
and Brach, Michael",
title="Improving the Acceptability and Implementation of Information and Communication Technology--Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="27",
volume="8",
pages="e58501",
keywords="acceptability",
keywords="implementation",
keywords="neurodegenerative diseases",
keywords="Parkinson disease",
keywords="dementia",
keywords="chronic diseases",
keywords="health care technologies",
keywords="older people",
keywords="stakeholders",
keywords="information and communication technology",
keywords="ICT",
keywords="user-centered design",
keywords="co-design",
abstract="Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union--funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users' needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 ",
doi="10.2196/58501",
url="https://formative.jmir.org/2024/1/e58501",
url="http://www.ncbi.nlm.nih.gov/pubmed/38935424"
}


@Article{info:doi/10.2196/49785,
author="Soni, Hiral
and Ivanova, Julia
and Wilczewski, Hattie
and Ong, Triton
and Ross, Nalubega J.
and Bailey, Alexandra
and Cummins, Mollie
and Barrera, Janelle
and Bunnell, Brian
and Welch, Brandon",
title="User Preferences and Needs for Health Data Collection Using Research Electronic Data Capture: Survey Study",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="25",
volume="12",
pages="e49785",
keywords="Research Electronic Data Capture",
keywords="REDCap",
keywords="user experience",
keywords="electronic data collection",
keywords="health data",
keywords="personal health information",
keywords="clinical research",
keywords="mobile phone",
abstract="Background: Self-administered web-based questionnaires are widely used to collect health data from patients and clinical research participants. REDCap (Research Electronic Data Capture; Vanderbilt University) is a global, secure web application for building and managing electronic data capture. Unfortunately, stakeholder needs and preferences of electronic data collection via REDCap have rarely been studied. Objective: This study aims to survey REDCap researchers and administrators to assess their experience with REDCap, especially their perspectives on the advantages, challenges, and suggestions for the enhancement of REDCap as a data collection tool. Methods: We conducted a web-based survey with representatives of REDCap member organizations in the United States. The survey captured information on respondent demographics, quality of patient-reported data collected via REDCap, patient experience of data collection with REDCap, and open-ended questions focusing on the advantages, challenges, and suggestions to enhance REDCap's data collection experience. Descriptive and inferential analysis measures were used to analyze quantitative data. Thematic analysis was used to analyze open-ended responses focusing on the advantages, disadvantages, and enhancements in data collection experience. Results: A total of 207 respondents completed the survey. Respondents strongly agreed or agreed that the data collected via REDCap are accurate (188/207, 90.8\%), reliable (182/207, 87.9\%), and complete (166/207, 80.2\%). More than half of respondents strongly agreed or agreed that patients find REDCap easy to use (165/207, 79.7\%), could successfully complete tasks without help (151/207, 72.9\%), and could do so in a timely manner (163/207, 78.7\%). Thematic analysis of open-ended responses yielded 8 major themes: survey development, user experience, survey distribution, survey results, training and support, technology, security, and platform features. The user experience category included more than half of the advantage codes (307/594, 51.7\% of codes); meanwhile, respondents reported higher challenges in survey development (169/516, 32.8\% of codes), also suggesting the highest enhancement suggestions for the category (162/439, 36.9\% of codes). Conclusions: Respondents indicated that REDCap is a valued, low-cost, secure resource for clinical research data collection. REDCap's data collection experience was generally positive among clinical research and care staff members and patients. However, with the advancements in data collection technologies and the availability of modern, intuitive, and mobile-friendly data collection interfaces, there is a critical opportunity to enhance the REDCap experience to meet the needs of researchers and patients. ",
doi="10.2196/49785",
url="https://medinform.jmir.org/2024/1/e49785"
}


@Article{info:doi/10.2196/53131,
author="Schmidt, Wong Camilla
and Borgnakke, Karen
and Fr{\o}lich, Anne
and Kayser, Lars",
title="Preferences, Needs, and Values of Patients With Chronic Obstructive Pulmonary Disease Attending a Telehealth Service: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="21",
volume="11",
pages="e53131",
keywords="people with long-term health condition",
keywords="patient education",
keywords="COPD",
keywords="digital health",
keywords="ethnography",
keywords="inductive",
keywords="ethnographic",
keywords="chronic",
keywords="lung",
keywords="lungs",
keywords="pulmonary",
keywords="respiratory",
keywords="self-management",
keywords="interview",
keywords="interviews",
keywords="qualitative",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
abstract="Background: Digitally assisted health care services and technologies are gaining popularity. They assist patients in managing their conditions, thereby reducing the burden on health care staff. Digital health care enables individuals to receive care that is more tailored to their needs and preferences. When implemented properly, it can promote equity by considering each person's opportunities and limitations in the context of health care needs, preferences, values, and capabilities. Objective: This study aims to understand the needs, values, and preferences of individuals with chronic obstructive pulmonary disease (COPD) who are provided with a 24/7 digital health care service. Furthermore, we aim to understand the dynamics of the communities to which they belong and how these communities intersect. This will provide us with the essential knowledge to establish new methods of providing education, including the development of educational activities for health professionals to engage, train, and empower people living with COPD. Methods: The study included 7 informants diagnosed with COPD who received 24/7 digital health care service support from a regional project in Region Zealand, Denmark. The informants were visited 4 times during 2 months, including a ``Hello'' visit, a day with a semistructured interview, and 2 days with field observations. The informants participated in a semistructured interview, following participant observation and an ethnographic approach. The interview content was analyzed using an inductive methodology to categorize the empirical data. Results: Using the inductive approach, we identified 3 main categories related to the informants' needs, values, and preferences: (1) Health, (2) Value Creation, and (3) Resources. These 3 main categories were based on 9 subcategories: (1) health and barriers, (2) self-monitoring, (3) medication, (4) behavior, (5) motivation, (6) hobbies, (7) social networks, (8) health professionals, and (9) technology. These findings revealed that the informants placed value on maintaining their daily activities and preserving their sense of identity before the onset of COPD. Furthermore, they expressed a desire not to be defined by their COPD, as conversations about COPD often shifted away from the topic. Conclusions: Digital health solutions and the health care professionals who offer them should prioritize the individuals they serve, considering their needs, values, and preferences rather than solely focusing on the medical condition. This approach ensures the highest level of daily living and empowerment for those living with long-term health conditions. The communities surrounding individuals must engage in constant interaction and collaboration. They should work together to incorporate people's needs, values, and preferences into future digital health services, thereby promoting empowerment and self-management. New educational programs aimed at developing the digital health service competencies of registered nurses should facilitate collaboration between the 2 communities. This collaboration is essential for supporting patients with long-term health conditions in their daily activities. ",
doi="10.2196/53131",
url="https://humanfactors.jmir.org/2024/1/e53131"
}


@Article{info:doi/10.2196/50195,
author="Buffey, John Aidan
and Langley, Kate Christina
and Carson, P. Brian
and Donnelly, E. Alan
and Salsberg, Jon",
title="Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="19",
volume="10",
pages="e50195",
keywords="participatory research approach",
keywords="workplace health promotion",
keywords="physical activity",
keywords="sedentary behavior",
keywords="end user involvement",
keywords="office based",
keywords="desk based",
keywords="intervention",
keywords="cocreation",
keywords="public and patient involvement",
abstract="Background: Participatory research (PR) involves engaging in cocreation with end users and relevant stakeholders throughout the research process, aiming to distribute power equitably between the end users and research team. Engagement and adherence in previous workplace health promotion (WHP) studies have been shown to be lacking. By implementing a PR approach, the insights of end users and stakeholders are sought in the co-design of feasible and acceptable intervention strategies, thereby increasing the relevance of the research. Objective: This scoping review aims to explore, identify, and map PR techniques and their impact when used in office-based WHP interventions designed to improve physical activity (PA) or reduce sedentary behavior (SB). Methods: The reporting of this scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). A systematic literature search of 5 electronic databases---Web of Science, PubMed, Scopus, Google Scholar, and OpenGrey---was conducted, searching from January 1, 1995, to February 8, 2023. In total, 2 independent reviewers first screened the retrieved articles by title and abstract, and then assessed the full texts based on the inclusion and exclusion criteria. The search strategy and eligibility criteria were developed and guided by an a priori population (office-based working adults), intervention (a PA WHP intervention that took a PR approach), comparison (no comparison required), and outcome (PA or SB) framework. Data were charted and discussed via a narrative synthesis, and a thematic analysis was conducted. The included studies were evaluated regarding the degree of end user engagement throughout the research process and power shared by the researchers, using Arnstein's ladder of citizen participation. Results: The search retrieved 376 records, of which 8 (2.1\%) met the inclusion criteria. Four key strategies were identified: (1) end user focus groups, (2) management involvement, (3) researcher facilitators, and (4) workplace champions. The degree of engagement and power shared was relatively low, with 25\% (2/8) of the studies determined to be nonparticipation studies, 25\% (2/8) determined to be tokenistic, and 50\% (4/8) determined to provide citizen power. Conclusions: This review provides a foundation of evidence on the current practices when taking a PR approach, highlighting that previous office-based PA WHP studies have been largely tokenistic or nonparticipative, and identified that the end user is only engaged with in the conception and implementation of the WHP studies. However, a positive improvement in PA and reduction in SB were observed in the included studies, which were largely attributed to implementing a PR approach and including the end user in the design of the WHP intervention. Future studies should aim to collaborate with workplaces, building capacity and empowering the workforce by providing citizen control and letting the end users ``own'' the research for a sustainable WHP intervention. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054402 ",
doi="10.2196/50195",
url="https://publichealth.jmir.org/2024/1/e50195",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896458"
}


@Article{info:doi/10.2196/55548,
author="Straand, J. Ingjerd
and Baxter, A. Kimberley
and F{\o}lstad, Asbj{\o}rn",
title="Remote Inclusion of Vulnerable Users in mHealth Intervention Design: Retrospective Case Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="14",
volume="12",
pages="e55548",
keywords="user testing",
keywords="user participation in research",
keywords="COVID-19",
keywords="remote testing",
keywords="intervention design",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) interventions that promote healthy behaviors or mindsets are a promising avenue to reach vulnerable or at-risk groups. In designing such mHealth interventions, authentic representation of intended participants is essential. The COVID-19 pandemic served as a catalyst for innovation in remote user-centered research methods. The capability of such research methods to effectively engage with vulnerable participants requires inquiry into practice to determine the suitability and appropriateness of these methods. Objective: In this study, we aimed to explore opportunities and considerations that emerged from involving vulnerable user groups remotely when designing mHealth interventions. Implications and recommendations are presented for researchers and practitioners conducting remote user-centered research with vulnerable populations. Methods: Remote user-centered research practices from 2 projects involving vulnerable populations in Norway and Australia were examined retrospectively using visual mapping and a reflection-on-action approach. The projects engaged low-income and unemployed groups during the COVID-19 pandemic in user-based evaluation and testing of interactive, web-based mHealth interventions. Results: Opportunities and considerations were identified as (1) reduced barriers to research inclusion; (2) digital literacy transition; (3) contextualized insights: a window into people's lives; (4) seamless enactment of roles; and (5) increased flexibility for researchers and participants. Conclusions: Our findings support the capability and suitability of remote user methods to engage with users from vulnerable groups. Remote methods facilitate recruitment, ease the burden of research participation, level out power imbalances, and provide a rich and relevant environment for user-centered evaluation of mHealth interventions. There is a potential for a much more agile research practice. Future research should consider the privacy impacts of increased access to participants' environment via webcams and screen share and how technology mediates participants' action in terms of privacy. The development of support procedures and tools for remote testing of mHealth apps with user participants will be crucial to capitalize on efficiency gains and better protect participants' privacy. ",
doi="10.2196/55548",
url="https://mhealth.jmir.org/2024/1/e55548",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875700"
}


@Article{info:doi/10.2196/50086,
author="Espinoza Chamorro, Roberto
and Santos, O. Luciano H.
and Mori, Yukiko
and Liu, Chang
and Yamamoto, Goshiro
and Kuroda, Tomohiro",
title="Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="14",
volume="11",
pages="e50086",
keywords="blood donation",
keywords="deferral experience",
keywords="Theory of Planned Behavior",
keywords="Self-Determination Theory",
keywords="gamification",
keywords="ICT design",
keywords="motivation",
keywords="patient education",
keywords="prototype",
keywords="feasibility",
abstract="Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. ",
doi="10.2196/50086",
url="https://humanfactors.jmir.org/2024/1/e50086",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875005"
}


@Article{info:doi/10.2196/50939,
author="Yoon, Sungwon
and Goh, Hendra
and Lee, Ching Phong
and Tan, Chang Hong
and Teh, Ming Ming
and Lim, Ting Dawn Shao
and Kwee, Ann
and Suresh, Chandran
and Carmody, David
and Swee, Soon Du
and Tan, Tse Sarah Ying
and Wong, Jun-Wei Andy
and Choo, Hui-Min Charlotte
and Wee, Zongwen
and Bee, Mong Yong",
title="Assessing the Utility, Impact, and Adoption Challenges of an Artificial Intelligence--Enabled Prescription Advisory Tool for Type 2 Diabetes Management: Qualitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="13",
volume="11",
pages="e50939",
keywords="clinical decision support system",
keywords="artificial intelligence",
keywords="endocrinology",
keywords="diabetes management",
keywords="human factors",
abstract="Background: The clinical management of type 2 diabetes mellitus (T2DM) presents a significant challenge due to the constantly evolving clinical practice guidelines and growing array of drug classes available. Evidence suggests that artificial intelligence (AI)--enabled clinical decision support systems (CDSSs) have proven to be effective in assisting clinicians with informed decision-making. Despite the merits of AI-driven CDSSs, a significant research gap exists concerning the early-stage implementation and adoption of AI-enabled CDSSs in T2DM management. Objective: This study aimed to explore the perspectives of clinicians on the use and impact of the AI-enabled Prescription Advisory (APA) tool, developed using a multi-institution diabetes registry and implemented in specialist endocrinology clinics, and the challenges to its adoption and application. Methods: We conducted focus group discussions using a semistructured interview guide with purposively selected endocrinologists from a tertiary hospital. The focus group discussions were audio-recorded and transcribed verbatim. Data were thematically analyzed. Results: A total of 13 clinicians participated in 4 focus group discussions. Our findings suggest that the APA tool offered several useful features to assist clinicians in effectively managing T2DM. Specifically, clinicians viewed the AI-generated medication alterations as a good knowledge resource in supporting the clinician's decision-making on drug modifications at the point of care, particularly for patients with comorbidities. The complication risk prediction was seen as positively impacting patient care by facilitating early doctor-patient communication and initiating prompt clinical responses. However, the interpretability of the risk scores, concerns about overreliance and automation bias, and issues surrounding accountability and liability hindered the adoption of the APA tool in clinical practice. Conclusions: Although the APA tool holds great potential as a valuable resource for improving patient care, further efforts are required to address clinicians' concerns and improve the tool's acceptance and applicability in relevant contexts. ",
doi="10.2196/50939",
url="https://humanfactors.jmir.org/2024/1/e50939",
url="http://www.ncbi.nlm.nih.gov/pubmed/38869934"
}


@Article{info:doi/10.2196/52251,
author="Narang, Gaurav
and Chen, J. Yaozhu
and Wedel, Nicole
and Wu, Melody
and Luo, Michelle
and Atreja, Ashish",
title="Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="6",
volume="8",
pages="e52251",
keywords="cyclic vomiting syndrome",
keywords="vomiting",
keywords="vomit",
keywords="emetic",
keywords="emesis",
keywords="gut",
keywords="GI",
keywords="gastrointestinal",
keywords="internal medicine",
keywords="prototype",
keywords="prototypes",
keywords="iterative",
keywords="self-management",
keywords="disease management",
keywords="gut-brain interaction",
keywords="gut-brain",
keywords="artificial intelligence",
keywords="digital patient assistant",
keywords="assistant",
keywords="assistants",
keywords="design thinking",
keywords="design",
keywords="patient-centric",
keywords="patient centred",
keywords="patient centered",
keywords="patient-centric approach",
keywords="System Usability Scale",
keywords="symptom tracking",
keywords="digital health solution",
keywords="user experience",
keywords="usability",
keywords="symptom",
keywords="symptoms",
keywords="tracking",
keywords="monitoring",
keywords="participatory",
keywords="co-design digital health technology",
keywords="patient assistance",
keywords="patient experience",
keywords="mobile phone",
abstract="Background: Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. Objective: We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. Methods: The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. Results: The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. Conclusions: The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios. ",
doi="10.2196/52251",
url="https://formative.jmir.org/2024/1/e52251",
url="http://www.ncbi.nlm.nih.gov/pubmed/38842924"
}


@Article{info:doi/10.2196/51666,
author="Heitkemper, Elizabeth
and Hulse, Scott
and Bekemeier, Betty
and Schultz, Melinda
and Whitman, Greg
and Turner, M. Anne",
title="The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="5",
volume="11",
pages="e51666",
keywords="data dashboard",
keywords="rural health",
keywords="health equity",
keywords="usability",
keywords="nursing informatics",
keywords="dashboard",
keywords="rural",
keywords="informatics",
keywords="satisfaction",
keywords="think aloud",
keywords="content analysis",
keywords="user experience",
keywords="public health",
keywords="visualization",
keywords="information systems",
abstract="Background: Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. Objective: This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. Methods: Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. Results: Of the 9 participants, all were female and most worked at a local health department (7/9, 78\%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting---89\% (n=8) participants for task 1 and 67\% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be ``extremely useful'' for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. Conclusions: Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities. ",
doi="10.2196/51666",
url="https://humanfactors.jmir.org/2024/1/e51666",
url="http://www.ncbi.nlm.nih.gov/pubmed/38837192"
}


@Article{info:doi/10.2196/50024,
author="Burn, Anne-Marie
and Hall, Poppy
and Anderson, Joanna",
title="A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="4",
volume="8",
pages="e50024",
keywords="self-harm",
keywords="schools",
keywords="young people",
keywords="youth",
keywords="school staff",
keywords="training",
keywords="coproduction",
keywords="qualitative",
abstract="Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person's self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program's effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. ",
doi="10.2196/50024",
url="https://formative.jmir.org/2024/1/e50024",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833286"
}


@Article{info:doi/10.2196/45055,
author="de Frel, Leonhard Daan
and Schroijen, A. Mari{\"e}lle
and Aardoom, J. Jiska
and van Gils, Wesley
and Huisman, D. Sasja
and Janssen, R. Veronica
and Versluis, Anke
and Kleinsmann, S. Maaike
and Atsma, E. Douwe
and Pijl, Hanno",
title="Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="31",
volume="11",
pages="e45055",
keywords="diabetes mellitus",
keywords="type 2",
keywords="telemedicine",
keywords="self-management",
keywords="patient education as topic",
keywords="activation",
keywords="glucose regulation",
keywords="Center for eHealth and Wellbeing Research",
keywords="CeHRes",
keywords="type 2 diabetes",
keywords="tele",
keywords="patient education",
keywords="CeHRes roadmap",
keywords="diabetes",
keywords="glucose",
keywords="insulin",
keywords="education",
keywords="development",
keywords="usability",
keywords="medical",
keywords="behavioral",
keywords="psychological",
keywords="digital consultation",
keywords="feasibility",
keywords="endocrinology",
keywords="endocrine",
keywords="focus group",
keywords="dietitian",
keywords="psychologist",
keywords="nurse",
keywords="lifestyle factor",
keywords="diet",
keywords="exercise",
keywords="stress",
keywords="sleep",
keywords="cardiovascular disease",
keywords="heath care professional",
keywords="mobile phone",
abstract="Background: Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. Objective: The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. Methods: The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. Results: The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. Conclusions: After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail. ",
doi="10.2196/45055",
url="https://humanfactors.jmir.org/2024/1/e45055",
url="http://www.ncbi.nlm.nih.gov/pubmed/38819880"
}


@Article{info:doi/10.2196/56561,
author="Adedoja, Dorcas
and Kuhns, M. Lisa
and Radix, Asa
and Garofalo, Robert
and Brin, Maeve
and Schnall, Rebecca",
title="MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation",
journal="JMIR Form Res",
year="2024",
month="May",
day="30",
volume="8",
pages="e56561",
keywords="HIV",
keywords="mobile app",
keywords="transgender men",
keywords="transmasculine",
abstract="Background: Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community--informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term---at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. Objective: The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. Methods: The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. Results: MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). Conclusions: Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth. ",
doi="10.2196/56561",
url="https://formative.jmir.org/2024/1/e56561",
url="http://www.ncbi.nlm.nih.gov/pubmed/38814701"
}


@Article{info:doi/10.2196/52027,
author="Li, Wenhao
and O'Hara, Rebecca
and Hull, Louise M.
and Slater, Helen
and Sirohi, Diksha
and Parker, A. Melissa
and Bidargaddi, Niranjan",
title="Enabling Health Information Recommendation Using Crowdsourced Refinement in Web-Based Health Information Applications: User-Centered Design Approach and EndoZone Informatics Case Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="29",
volume="11",
pages="e52027",
keywords="information recommendation",
keywords="crowdsourcing",
keywords="health informatics",
keywords="digital health",
keywords="endometriosis",
abstract="Background: In the digital age, search engines and social media platforms are primary sources for health information, yet their commercial interests--focused algorithms often prioritize irrelevant content. Web-based health applications by reputable sources offer a solution to circumvent these biased algorithms. Despite this advantage, there remains a significant gap in research on the effective integration of content-ranking algorithms within these specialized health applications to ensure the delivery of personalized and relevant health information. Objective: This study introduces a generic methodology designed to facilitate the development and implementation of health information recommendation features within web-based health applications. Methods: We detail our proposed methodology, covering conceptual foundation and practical considerations through the stages of design, development, operation, review, and optimization in the software development life cycle. Using a case study, we demonstrate the practical application of the proposed methodology through the implementation of recommendation functionalities in the EndoZone platform, a platform dedicated to providing targeted health information on endometriosis. Results: Application of the proposed methodology in the EndoZone platform led to the creation of a tailored health information recommendation system known as EndoZone Informatics. Feedback from EndoZone stakeholders as well as insights from the implementation process validate the methodology's utility in enabling advanced recommendation features in health information applications. Preliminary assessments indicate that the system successfully delivers personalized content, adeptly incorporates user feedback, and exhibits considerable flexibility in adjusting its recommendation logic. While certain project-specific design flaws were not caught in the initial stages, these issues were subsequently identified and rectified in the review and optimization stages. Conclusions: We propose a generic methodology to guide the design and implementation of health information recommendation functionality within web-based health information applications. By harnessing user characteristics and feedback for content ranking, this methodology enables the creation of personalized recommendations that align with individual user needs within trusted health applications. The successful application of our methodology in the development of EndoZone Informatics marks a significant progress toward personalized health information delivery at scale, tailored to the specific needs of users. ",
doi="10.2196/52027",
url="https://humanfactors.jmir.org/2024/1/e52027",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809588"
}


@Article{info:doi/10.2196/54145,
author="Bridges, Bronwyn
and Taylor, Jake
and Weber, Thomas John",
title="Evaluation of the Parkinson's Remote Interactive Monitoring System in a Clinical Setting: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="24",
volume="11",
pages="e54145",
keywords="Parkinson disease",
keywords="usability",
keywords="remote monitoring",
keywords="motor examination",
keywords="movement disorders",
keywords="thematic analysis",
keywords="System Usability Scale",
keywords="mobile phone",
abstract="Background: The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient's symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient's condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson's Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely. Objective: We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting. Methods: Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society--sponsored revision of the Unified Parkinson's Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics. Results: In total, 11 people with PD participated in the study (female individuals: n=5, 45\%; male individuals: n=6, 55\%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer's notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant's orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants' perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70. Conclusions: Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients' needs. ",
doi="10.2196/54145",
url="https://humanfactors.jmir.org/2024/1/e54145",
url="http://www.ncbi.nlm.nih.gov/pubmed/38787603"
}


@Article{info:doi/10.2196/54101,
author="Teh, Pei-Lee
and Kwok, J. Andrei O.
and Cheong, Loong Wing
and Lee, Shaun",
title="Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="21",
volume="8",
pages="e54101",
keywords="digital health",
keywords="older adults",
keywords="digital divide",
keywords="aging",
keywords="pilot",
keywords="Malaysia",
keywords="coach",
keywords="digital access",
keywords="social barrier",
keywords="virtual",
keywords="virtual coach",
keywords="digital tool",
keywords="tool",
keywords="engagement",
keywords="gamification",
keywords="user experience",
keywords="app",
keywords="technology tool",
keywords="digital literacy",
keywords="user experience design",
keywords="decision support",
keywords="support",
abstract="Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual's health condition, and improvement in the user-experience design to accommodate older users' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. ",
doi="10.2196/54101",
url="https://formative.jmir.org/2024/1/e54101",
url="http://www.ncbi.nlm.nih.gov/pubmed/38772022"
}


@Article{info:doi/10.2196/56125,
author="Kauppinen, Kaisa
and Keikhosrokiani, Pantea
and Khan, Sehrish",
title="Human-Centered Design and Benefit Realization Management in Digital Health Care Solution Development: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="21",
volume="13",
pages="e56125",
keywords="human-centered design",
keywords="digital health care solution",
keywords="electronic health record",
keywords="benefit realization management",
keywords="digital health care",
keywords="health care software",
keywords="digital health",
keywords="information technology",
keywords="IT",
keywords="usability",
abstract="Background: Earlier research shows that a significant number of resources are wasted on software projects delivering less than the planned benefits. It has, however, been evidenced that adopting a human-centered design approach when designing health devices can be beneficial. This understanding from earlier research has raised our interest in investigating how human-centered design might contribute to realizing the potential benefits of health care software projects. To our current knowledge, this intersection of human-centered design and benefit realization management has not yet comprehensively and consistently been researched within the context of digital health care solutions. Therefore, there is a need for evidence synthesis using systematic reviews to address this potential research gap. Objective: The objective of this study is to examine if human-centered design helps benefit realization management processes in the development of digital health care solutions and thereby enables better benefit realization. We explore the evidence of assumed or confirmed benefits of using human-centered design in the health care domain and whether better results have been reported when the benefit realization management process is followed. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent studies (reported in English) to see if there is evidence that using human-centered design and benefit realization management has a positive effect on realizing set benefits in those projects. We will commence a systematic literature search using human-centered design, benefit realization management, and health care--related search terms within 5 repositories (ACM Digital Library, PubMed Central, Scopus, PubMed, and Web of Science). After removing duplicate results, a preliminary scan for titles and abstracts will be done by at least 2 reviewers. Any incongruities regarding whether to include articles for full-text review will be resolved by a third reviewer based on the predefined criteria. Results: Initial queries of 2086 records have been executed and papers are being prescreened for inclusion. The search was initiated in December 2023 and the results are expected in 2024. We anticipate finding evidence of the use of human-centered design in the development of digital health care solutions. However, we expect evidence of benefitting from both human-centered design and benefit realization management in this context to be scarce. Conclusions: This protocol will guide the review of existing literature on the use of human-centered design and benefit realization management when developing digital health care solutions. The review will specifically focus on finding evidence of confirmed benefits derived from the use of human-centered design and benefit realization management. There may be an opportunity to gain a broader understanding of the tools or approaches that provide evidence of increased benefit realization within the health care domain. International Registered Report Identifier (IRRID): DERR1-10.2196/56125 ",
doi="10.2196/56125",
url="https://www.researchprotocols.org/2024/1/e56125",
url="http://www.ncbi.nlm.nih.gov/pubmed/38772023"
}


@Article{info:doi/10.2196/50098,
author="Mancinelli, Elisa
and Gabrielli, Silvia
and Salcuni, Silvia",
title="A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="16",
volume="11",
pages="e50098",
keywords="digital intervention",
keywords="behavioral activation",
keywords="feasibility",
keywords="pregnancy",
keywords="subclinical depression symptoms",
abstract="Background: Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. Objective: This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women's needs. Usability and user engagement were evaluated. Methods: A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55\%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45\%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. Results: Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50\%; unguided: 4/5, 80\%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention's goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. Conclusions: Overall, the findings have emphasized both the intervention's merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention's content to pregnant women's needs. ",
doi="10.2196/50098",
url="https://humanfactors.jmir.org/2024/1/e50098",
url="http://www.ncbi.nlm.nih.gov/pubmed/38753421"
}


@Article{info:doi/10.2196/53691,
author="Aspelund, Anna
and Valkonen, Paula
and Viitanen, Johanna
and Rauta, Virpi",
title="Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="14",
volume="11",
pages="e53691",
keywords="usability",
keywords="UX",
keywords="user experience",
keywords="PX",
keywords="patient experience",
keywords="user-based evaluation",
keywords="patients",
keywords="eHealth",
keywords="digital health solution",
keywords="kidney disease",
keywords="home dialysis",
abstract="Background: Chronic kidney disease affects 10\% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients' quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease. Objective: Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution. Methods: We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores. Results: Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients' own health-related goals and fits with the needs of their everyday lives with the disease. Conclusions: A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions. ",
doi="10.2196/53691",
url="https://humanfactors.jmir.org/2024/1/e53691",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743476"
}


@Article{info:doi/10.2196/45115,
author="Schnoor, Kyma
and Talboom-Kamp, A. Esther P. W.
and Hajti{\'c}, Muamer
and Chavannes, H. Niels
and Versluis, Anke",
title="Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="10",
volume="11",
pages="e45115",
keywords="eHealth",
keywords="usability",
keywords="self-management",
keywords="diagnostic test service",
keywords="diagnostic",
keywords="testing",
keywords="test service",
keywords="perspective",
keywords="focus group",
keywords="user need",
keywords="user testing",
keywords="implementation",
keywords="qualitative",
keywords="test result",
keywords="laboratory test",
keywords="laboratory result",
abstract="Background: Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals' willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. Objective: This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. Methods: A qualitative method was used from a potential user's perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. Results: In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users' health and to maintain their health. Conclusions: According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online. ",
doi="10.2196/45115",
url="https://humanfactors.jmir.org/2024/1/e45115",
url="http://www.ncbi.nlm.nih.gov/pubmed/38728071"
}


@Article{info:doi/10.2196/55470,
author="Opara, Ijeoma
and Pierre, Kimberly
and Cayo, Sandy
and Aneni, Kammarauche
and Mwai, Catherine
and Hogue, Aaron
and Becker, Sara",
title="Brief Parent-Child Substance Use Education Intervention for Black Families in Urban Cities in New Jersey: Protocol for a Formative Study Design",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="9",
volume="13",
pages="e55470",
keywords="black families",
keywords="parents",
keywords="drug use",
keywords="prevention",
keywords="urban community",
abstract="Background: Substance use continues to remain a public health issue for youths in the United States. Black youths living in urban communities are at a heightened risk of poor outcomes associated with substance use and misuse due to exposure to stressors in their neighborhoods, racial discrimination, and lack of prevention education programs specifically targeting Black youths. Many Black youths, especially those who live in urban communities, do not have access to culturally tailored interventions, leaving a critical gap in prevention. Since family is a well-known protective factor against substance misuse for Black youths, it is essential to create sustainable and accessible programming that incorporates Black youths' and their families' voices to develop a suitable prevention program for them. Objective: We aim to understand the cultural and environmental level factors that influence substance use among Black youths and develop a prevention program to increase parent-child substance use education among Black families. Methods: This study will take place within urban cities in New Jersey such as Paterson and East Orange, New Jersey, which will be the main study sites. Both cities have a large population of Black youths and this study's team has strong ties with youths-serving organizations there. A formative, qualitative study will be conducted first. Using the first 3 steps of the ADAPT-ITT (Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing) framework we begin the development of an intervention for Black families. Three aims will be described: aim 1, collect qualitative data from Black parents and youths aged 11-17 years from parent-child dyads (N=20) on the challenges, barriers, and facilitators to communicating about substance use; aim 2, adapt a selected evidence-based intervention for Black families and develop a family advisory board to guide the adaptation; and aim 3 assess the feasibility of the intervention through theater testing, involving the family and community advisory board. Results: This study is part of a 2-year research pilot study award from the National Institutes of Drug Abuse. Data collection began in May 2023, and for aim 1, it is 95\% complete. All aim 1 data collection is expected to be complete by December 30, 2023. Data analysis will immediately follow. Aim 2 activity will occur in spring 2024. Aim 3 activity may begin in fall 2024 and conclude in 2025. Conclusions: This study will be one of the few interventions that address substance use among youths and uses parents and families in urban communities as a protective factor within the program. We anticipate that the intervention will benefit Black youths not only in New Jersey but across the nation, working on building culturally appropriate, community-specific prevention education and building on strong families' relationships, resulting in a reduction of or delayed substance use. International Registered Report Identifier (IRRID): DERR1-10.2196/55470 ",
doi="10.2196/55470",
url="https://www.researchprotocols.org/2024/1/e55470",
url="http://www.ncbi.nlm.nih.gov/pubmed/38722676"
}


@Article{info:doi/10.2196/53194,
author="O'Donnell, A. Elizabeth
and Van Citters, D. Aricca
and Khayal, S. Inas
and Wilson, M. Matthew
and Gustafson, David
and Barnato, E. Amber
and Buccellato, C. Andrea
and Young, Colleen
and Holthoff, M. Megan
and Korsunskiy, Eugene
and Tomlin, C. Stephanie
and Cullinan, M. Amelia
and Steinbaugh, C. Alexandra
and Hinson, J. Jennifer
and Johnson, R. Kristen
and Williams, Andrew
and Thomson, M. Ruth
and Haines, M. Janet
and Holmes, B. Anne
and Bradley, D. Ann
and Nelson, C. Eugene
and Kirkland, B. Kathryn",
title="A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="8",
volume="11",
pages="e53194",
keywords="human-centered design",
keywords="caregivers",
keywords="care partners",
keywords="serious illness",
keywords="peer support",
keywords="online support network",
keywords="virtual network",
keywords="online network",
keywords="caregiver",
keywords="unmet need",
keywords="unmet needs",
keywords="active care",
keywords="bereaved care",
keywords="bereavement",
keywords="clinician",
keywords="clinicians",
keywords="function",
keywords="functions",
keywords="specification",
keywords="information",
keywords="emotional support",
keywords="technical support",
keywords="privacy protection",
keywords="rural",
keywords="viability",
keywords="impact",
keywords="engineering design",
keywords="care provider",
keywords="care providers",
keywords="mortality",
keywords="quality of life",
keywords="tertiary care",
keywords="caregiving",
abstract="Background: Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available. Objective: This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement. Methods: An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network. Results: The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period. Conclusions: A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network. ",
doi="10.2196/53194",
url="https://humanfactors.jmir.org/2024/1/e53194",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717809"
}


@Article{info:doi/10.2196/51587,
author="Fink, Franziska
and Kalter, Ivonne
and Steindorff, Jenny-Victoria
and Helmbold, Konrad Hans
and Paulicke, Denny
and Jahn, Patrick",
title="Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="30",
volume="11",
pages="e51587",
keywords="human-drone interaction",
keywords="medical supplies",
keywords="participative research",
keywords="user-centered design",
keywords="technology acceptance",
abstract="Background: The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones. Objective: This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones). Methods: A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations. Results: The study found a positive correlation between the usability of a pharmacy drone app and participants' willingness to use it (r=0.833). Participants' perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=?0.542; System Usability Scale and r=?0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration. Conclusions: With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable. ",
doi="10.2196/51587",
url="https://humanfactors.jmir.org/2024/1/e51587",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687589"
}


@Article{info:doi/10.2196/54581,
author="Thunstr{\"o}m, Osmanovic Almira
and Carlsen, Krage Hanne
and Ali, Lilas
and Larson, Tomas
and Hellstr{\"o}m, Andreas
and Steingrimsson, Steinn",
title="Usability Comparison Among Healthy Participants of an Anthropomorphic Digital Human and a Text-Based Chatbot as a Responder to Questions on Mental Health: Randomized Controlled Trial",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="29",
volume="11",
pages="e54581",
keywords="chatbot",
keywords="chatbots",
keywords="chat-bot",
keywords="chat-bots",
keywords="text-only chatbot, voice-only chatbot",
keywords="mental health",
keywords="mental illness",
keywords="mental disease",
keywords="mental diseases",
keywords="mental illnesses",
keywords="mental health service",
keywords="mental health services",
keywords="interface",
keywords="system usability",
keywords="usability",
keywords="digital health",
keywords="machine learning",
keywords="ML",
keywords="artificial intelligence",
keywords="AI",
keywords="algorithm",
keywords="algorithms",
keywords="NLP",
keywords="natural language processing",
abstract="Background: The use of chatbots in mental health support has increased exponentially in recent years, with studies showing that they may be effective in treating mental health problems. More recently, the use of visual avatars called digital humans has been introduced. Digital humans have the capability to use facial expressions as another dimension in human-computer interactions. It is important to study the difference in emotional response and usability preferences between text-based chatbots and digital humans for interacting with mental health services. Objective: This study aims to explore to what extent a digital human interface and a text-only chatbot interface differed in usability when tested by healthy participants, using BETSY (Behavior, Emotion, Therapy System, and You) which uses 2 distinct interfaces: a digital human with anthropomorphic features and a text-only user interface. We also set out to explore how chatbot-generated conversations on mental health (specific to each interface) affected self-reported feelings and biometrics. Methods: We explored to what extent a digital human with anthropomorphic features differed from a traditional text-only chatbot regarding perception of usability through the System Usability Scale, emotional reactions through electroencephalography, and feelings of closeness. Healthy participants (n=45) were randomized to 2 groups that used a digital human with anthropomorphic features (n=25) or a text-only chatbot with no such features (n=20). The groups were compared by linear regression analysis and t tests. Results: No differences were observed between the text-only and digital human groups regarding demographic features. The mean System Usability Scale score was 75.34 (SD 10.01; range 57-90) for the text-only chatbot versus 64.80 (SD 14.14; range 40-90) for the digital human interface. Both groups scored their respective chatbot interfaces as average or above average in usability. Women were more likely to report feeling annoyed by BETSY. Conclusions: The text-only chatbot was perceived as significantly more user-friendly than the digital human, although there were no significant differences in electroencephalography measurements. Male participants exhibited lower levels of annoyance with both interfaces, contrary to previously reported findings. ",
doi="10.2196/54581",
url="https://humanfactors.jmir.org/2024/1/e54581",
url="http://www.ncbi.nlm.nih.gov/pubmed/38683664"
}


@Article{info:doi/10.2196/54852,
author="Andrikopoulou, Elisavet
and Chatzistergos, Panagiotis
and Chockalingam, Nachiappan",
title="Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="24",
volume="13",
pages="e54852",
keywords="diabetic foot",
keywords="first-ever diabetic foot ulcer",
keywords="qualitative research",
keywords="quantitative evaluation",
keywords="surveys and questionnaires",
keywords="telephone interviews",
keywords="primary care",
keywords="community care",
keywords="acute care",
keywords="education of patients",
keywords="foot ulcer",
keywords="exploration",
keywords="diabetes",
keywords="foot ulceration",
keywords="United Kingdom",
keywords="diabetic foot ulceration",
keywords="DFU",
keywords="amputation",
keywords="complication",
keywords="perspectives",
keywords="experiences",
keywords="health care professionals",
keywords="barrier",
keywords="barriers",
keywords="effective care",
keywords="foot care",
keywords="primary ulcers",
keywords="quality of life",
abstract="Background: Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19\% to 34\% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. Objective: This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. Methods: This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. Results: The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. Conclusions: This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. International Registered Report Identifier (IRRID): DERR1-10.2196/54852 ",
doi="10.2196/54852",
url="https://www.researchprotocols.org/2024/1/e54852",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656782"
}


@Article{info:doi/10.2196/50832,
author="Blanchard, Marc
and Koller, Nadana Cinja
and Azevedo, Ming Pedro
and Pr{\'e}tat, Tiffany
and H{\"u}gle, Thomas",
title="Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="19",
volume="8",
pages="e50832",
keywords="digital health",
keywords="patient preference",
keywords="user experience",
keywords="patient-centricity",
keywords="platform",
keywords="development",
keywords="fibromyalgia",
keywords="self-management",
keywords="quality of life",
keywords="patient outcome",
keywords="musculoskeletal",
keywords="usability testing",
keywords="digital health solution",
abstract="Background: Persistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30\% of patients with post--COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. Objective: This research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app's design and functionality, the study intends to facilitate better self-management practices and improve adherence. Methods: Using an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients' expectations regarding design features, content, and usability to steer the iterative app development. Results: The study uncovered crucial insights from patient surveys and usability testing, which influenced the app's design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. Conclusions: Incorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID): RR2-10.2196/32193 ",
doi="10.2196/50832",
url="https://formative.jmir.org/2024/1/e50832",
url="http://www.ncbi.nlm.nih.gov/pubmed/38639986"
}


@Article{info:doi/10.2196/54172,
author="McCallum, Claire
and Campbell, Miglena
and Vines, John
and Rapley, Tim
and Ellis, Jason
and Deary, Vincent
and Hackett, Katie",
title="A Smartphone App to Support Self-Management for People Living With Sj{\"o}gren's Syndrome: Qualitative Co-Design Workshops",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="17",
volume="11",
pages="e54172",
keywords="self-management",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="Sj{\"o}gren's syndrome",
keywords="patient participation",
keywords="patient involvement",
keywords="fatigue",
keywords="chronic disease",
keywords="focus groups",
keywords="complex intervention development",
keywords="mobile phone",
abstract="Background: Sj{\"o}gren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. Objective: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. Methods: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. Results: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. Conclusions: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies.?For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities. ",
doi="10.2196/54172",
url="https://humanfactors.jmir.org/2024/1/e54172",
url="http://www.ncbi.nlm.nih.gov/pubmed/38630530"
}


@Article{info:doi/10.2196/49409,
author="Howdle, Charlotte
and Wright, Alexander William James
and Mant, Jonathan
and De Simoni, Anna",
title="Factors Influencing Recovery From Pediatric Stroke Based on Discussions From a UK-Based Online Stroke Community: Qualitative Thematic Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="16",
volume="26",
pages="e49409",
keywords="child",
keywords="stroke",
keywords="rehabilitation",
keywords="barriers",
keywords="facilitators",
keywords="internet-based intervention",
keywords="self-help group",
keywords="thematic analysis",
abstract="Background: The incidence of stroke in children is low, and pediatric stroke rehabilitation services are less developed than adult ones. Survivors of pediatric stroke have a long poststroke life expectancy and therefore have the potential to experience impairments from their stroke for many years. However, there are relatively few studies characterizing these impairments and what factors facilitate or counteract recovery. Objective: This study aims to characterize the main barriers to and facilitators of recovery from pediatric stroke. A secondary aim was to explore whether these factors last into adulthood, whether they change, or if new factors impacting recovery emerge in adulthood. Methods: We performed a qualitative thematic analysis based on posts from a population of participants from a UK-based online stroke community, active between 2004 and 2011. The analysis focused on users who talked about their experiences with pediatric stroke, as identified by a previous study. The posts were read by 3 authors, and factors influencing recovery from pediatric stroke were mapped into 4 areas: medical, physical, emotional, and social. Factors influencing recovery were divided into short-term and long-term factors. Results: There were 425 posts relating to 52 survivors of pediatric stroke. Some survivors of stroke posted for themselves, while others were talked about by a third party (mostly parents; 31/35, 89\% mothers). In total, 79\% (41/52) of survivors of stroke were aged ?18 years and 21\% (11/52) were aged >18 years at the time of posting. Medical factors included comorbidities as a barrier to recovery. Medical interventions, such as speech and language therapy and physiotherapy, were also deemed useful. Exercise, particularly swimming, was deemed a facilitator. Among physical factors, fatigue and chronic pain could persist decades after a stroke, with both reported as a barrier to feeling fully recovered. Tiredness could worsen existing stroke-related impairments. Other long-standing impairments were memory loss, confusion, and dizziness. Among emotional factors, fear and uncertainty were short-term barriers, while positivity was a major facilitator in both short- and long-term recovery. Anxiety, grief, and behavioral problems hindered recovery. The social barriers were loneliness, exclusion, and hidden disabilities not being acknowledged by third parties. A good support network and third-party support facilitated recovery. Educational services were important in reintegrating survivors into society. Participants reported that worrying about losing financial support, such as disability allowances, and difficulties in obtaining travel insurance and driving licenses impacted recovery. Conclusions: The lived experience of survivors of pediatric stroke includes long-term hidden disabilities and barriers to rehabilitation. These are present in different settings, such as health care, schools, workplaces, and driving centers. Greater awareness of these issues by relevant professional groups may help ameliorate them. ",
doi="10.2196/49409",
url="https://www.jmir.org/2024/1/e49409",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625726"
}


@Article{info:doi/10.2196/50157,
author="Dorronzoro-Zubiete, Enrique
and Castro-Marrero, Jes{\'u}s
and Ropero, Jorge
and Sevillano-Ramos, Luis Jos{\'e}
and Dolores Hern{\'a}ndez, Mar{\'i}a
and Sanmartin Senta{\~n}es, Ramon
and Alegre-Martin, Jose
and Launois-Obreg{\'o}n, Patricia
and Martin-Garrido, Isabel
and Luque Budia, Asuncion
and Lacalle-Remigio, R. Juan
and B{\'e}jar Prado, Luis
and Rivera Romero, Octavio",
title="Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="12",
volume="13",
pages="e50157",
keywords="acceptability",
keywords="myalgic encephalomyelitis/chronic fatigue syndrome",
keywords="long COVID",
keywords="mHealth",
keywords="fatigue",
keywords="physical activity",
keywords="lifestyle health",
keywords="personalized self-management",
keywords="user-centered design",
abstract="Background: Fatigue is the most common symptom in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, impacting patients' quality of life; however, there is currently a lack of evidence-based context-aware tools for fatigue self-management in these populations. Objective: This study aimed to (1) address fatigue in ME/CFS and long COVID through the development of digital mobile health solutions for self-management, (2) predict perceived fatigue severity using real-time data, and (3) assess the feasibility and potential benefits of personalized digital mobile health solutions. Methods: The MyFatigue project adopts a patient-centered approach within the participatory health informatics domain. Patient representatives will be actively involved in decision-making processes. This study combines inductive and deductive research approaches, using qualitative studies to generate new knowledge and quantitative methods to test hypotheses regarding the relationship between factors like physical activity, sleep behaviors, and perceived fatigue in ME/CFS and long COVID. Co-design methods will be used to develop a personalized digital solution for fatigue self-management based on the generated knowledge. Finally, a pilot study will evaluate the feasibility, acceptance, and potential benefits of the digital health solution. Results: The MyFatigue project opened to enrollment in November 2023. Initial results are expected to be published by the end of 2024. Conclusions: This study protocol holds the potential to expand understanding, create personalized self-management approaches, engage stakeholders, and ultimately improve the well-being of individuals with ME/CFS and long COVID. International Registered Report Identifier (IRRID): PRR1-10.2196/50157 ",
doi="10.2196/50157",
url="https://www.researchprotocols.org/2024/1/e50157",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608263"
}


@Article{info:doi/10.2196/51849,
author="Morrow, M. Melissa
and Hughes, C. Lynne
and Collins, M. Diane
and Vos-Draper, L. Tamara",
title="Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="10",
volume="13",
pages="e51849",
keywords="wheelchair user",
keywords="seating and mobility",
keywords="weight shift behavior",
keywords="pressure injury",
keywords="mobile phone",
abstract="Background: Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. Objective: This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. Methods: For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. Results: Currently, 6 participants have been recruited for our aim-1 qualitative study. Conclusions: This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. International Registered Report Identifier (IRRID): DERR1-10.2196/51849 ",
doi="10.2196/51849",
url="https://www.researchprotocols.org/2024/1/e51849",
url="http://www.ncbi.nlm.nih.gov/pubmed/38598267"
}


@Article{info:doi/10.2196/53117,
author="Krakowczyk, Barbara Julia
and Truijens, Femke
and Teufel, Martin
and Lalgi, Tania
and Heinen, Jana
and Schug, Caterina
and Erim, Yesim
and Pantf{\"o}rder, Michael
and Graf, Johanna
and B{\"a}uerle, Alexander",
title="Evaluation of the e--Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="9",
volume="10",
pages="e53117",
keywords="psycho-oncology",
keywords="eHealth",
keywords="digital health",
keywords="cancer",
keywords="Reduct trial",
keywords="oncology",
abstract="Background: Make It Training is an e--mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. Objective: This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. Methods: In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Results: Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. Conclusions: e--Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support. ",
doi="10.2196/53117",
url="https://cancer.jmir.org/2024/1/e53117",
url="http://www.ncbi.nlm.nih.gov/pubmed/38592764"
}


@Article{info:doi/10.2196/46979,
author="Dang, Ha Thu
and Wickramasinghe, Nilmini
and Forkan, Mohammad Abdur Rahim
and Jayaraman, Prakash Prem
and Burbury, Kate
and O'Callaghan, Clare
and Whitechurch, Ashley
and Schofield, Penelope",
title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="3",
volume="10",
pages="e46979",
keywords="cancer",
keywords="behavioral science",
keywords="design science research",
keywords="digital",
keywords="medication adherence",
keywords="mobile solution",
keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology",
keywords="SAMSON",
keywords="mobile phone",
abstract="Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78\%). The app was engaging (18/27, 67\%), informative, increased user interactions, and well organized (19/27, 70\%). Most of the participants (21/27, 78\%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63\%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. ",
doi="10.2196/46979",
url="https://cancer.jmir.org/2024/1/e46979",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569178"
}


@Article{info:doi/10.2196/56206,
author="Correia de Barros, Ana
and Bergmans, Mari{\"e}tte
and Hasanaj, Kreshnik
and Krasniqi, Drian{\"e}
and N{\'o}brega, Catarina
and Carvalho Carneiro, Bruna
and Vasconcelos, A. Priscila
and Quinta-Gomes, Lu{\'i}sa Ana
and Nobre, J. Pedro
and Couto da Silva, Joana
and Mendes-Santos, Cristina",
title="Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="3",
volume="11",
pages="e56206",
keywords="internet interventions",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="sexual health",
keywords="smartphone",
keywords="user experience",
keywords="pilot study",
keywords="mobile phone",
abstract="Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app's usefulness and ease of use. Usability was assessed as ``Ok/Fair.'' The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants' perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. ",
doi="10.2196/56206",
url="https://humanfactors.jmir.org/2024/1/e56206",
url="http://www.ncbi.nlm.nih.gov/pubmed/38568726"
}


@Article{info:doi/10.2196/51522,
author="Adler, F. Rachel
and Baez, Kevin
and Morales, Paulina
and Sotelo, Jocelyn
and Victorson, David
and Magasi, Susan",
title="Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="2",
volume="11",
pages="e51522",
keywords="mobile health",
keywords="mHealth",
keywords="apps",
keywords="usability",
keywords="cancer survivors",
keywords="accessibility",
keywords="disabilities",
keywords="cancer",
keywords="oncology",
keywords="heuristics",
keywords="empowerment",
keywords="advocacy",
keywords="mindfulness",
keywords="problem-solving",
abstract="Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen's 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app's design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. ",
doi="10.2196/51522",
url="https://humanfactors.jmir.org/2024/1/e51522",
url="http://www.ncbi.nlm.nih.gov/pubmed/38564261"
}


@Article{info:doi/10.2196/52365,
author="Silva, Rui
and Morou{\c{c}}o, Pedro
and Lains, Jorge
and Amorim, Paula
and Alves, Nuno
and Veloso, Prieto Ant{\'o}nio",
title="Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="2",
volume="13",
pages="e52365",
keywords="3D printing",
keywords="3D scanner",
keywords="ankle foot orthosis",
keywords="biomechanical analysis",
keywords="equinovarus foot",
abstract="Background: Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. Objective: This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. Methods: A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications. Results: Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. Conclusions: Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/52365 ",
doi="10.2196/52365",
url="https://www.researchprotocols.org/2024/1/e52365",
url="http://www.ncbi.nlm.nih.gov/pubmed/38564249"
}


@Article{info:doi/10.2196/51974,
author="Monachelli, Rebecca
and Davis, Watkins Sharon
and Barnard, Allison
and Longmire, Michelle
and Docherty, P. John
and Oakley-Girvan, Ingrid",
title="Designing mHealth Apps to Incorporate Evidence-Based Techniques for Prolonging User Engagement",
journal="Interact J Med Res",
year="2024",
month="Mar",
day="26",
volume="13",
pages="e51974",
keywords="adherence",
keywords="app design",
keywords="attrition",
keywords="mHealth",
keywords="user engagement",
keywords="user experience",
keywords="proof-of-concept",
doi="10.2196/51974",
url="https://www.i-jmr.org/2024/1/e51974",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416858"
}


@Article{info:doi/10.2196/54854,
author="Haag, Susan
and Kepros, John",
title="Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="19",
volume="11",
pages="e54854",
keywords="health care interventions and technologies",
keywords="user experience research",
keywords="usability",
keywords="brain injury",
keywords="ground-level fall (GLF)",
keywords="head protection device (HPD)",
keywords="fall risk",
keywords="patient compliance",
abstract="Background: Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. Objective: We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. Methods: A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. Results: Of the 26 patients enrolled, 12 (46\%) were female, 18 (69\%) were on anticoagulants, and 25 (96\%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85\%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30\%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age ($\chi$12=4.27; P=.04) but not sex ($\chi$12=1.58; P=.23) or race ($\chi$12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. Conclusions: The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population. ",
doi="10.2196/54854",
url="https://humanfactors.jmir.org/2024/1/e54854",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502170"
}


@Article{info:doi/10.2196/49110,
author="Milton, Alyssa
and Ozols A?M, Ingrid
and Cassidy, Tayla
and Jordan, Dana
and Brown, Ellie
and Arnautovska, Urska
and Cook, Jim
and Phung, Darren
and Lloyd-Evans, Brynmor
and Johnson, Sonia
and Hickie, Ian
and Glozier, Nick",
title="Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="23",
volume="8",
pages="e49110",
keywords="self-management",
keywords="serious mental illness",
keywords="self-care",
keywords="digital health tools",
keywords="blended interventions",
keywords="peer support",
keywords="mobile phone",
abstract="Background: Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. Objective: This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. Methods: This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ?18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. Results: The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals' unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. Conclusions: There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step. ",
doi="10.2196/49110",
url="https://formative.jmir.org/2024/1/e49110",
url="http://www.ncbi.nlm.nih.gov/pubmed/38393768"
}


@Article{info:doi/10.2196/51604,
author="Parsell, C. Maren
and Greenleaf, N. Morgan
and Kombara, G. Greeshma
and Sukhatme, P. Vikas
and Lam, A. Wilbur",
title="Engaging Cancer Care Physicians in Off-Label Drug Clinical Trials: Human-Centered Design Approach",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="15",
volume="8",
pages="e51604",
keywords="human-centered design",
keywords="clinical trial design",
keywords="design methods",
keywords="clinical trial",
keywords="trial methodology",
keywords="barriers",
keywords="off-label drugs",
keywords="stakeholders",
keywords="cancer",
keywords="medications",
abstract="Background: Using a human-centered design (HCD) approach can provide clinical trial design teams with a better understanding of the needs, preferences, and attitudes of clinical trial stakeholders. It can also be used to understand the challenges and barriers physician stakeholders face in initiating and completing clinical trials, especially for using off-label drugs (OLDs) to treat unmet clinical needs in cancer treatment. However, the HCD approach is not commonly taught in the context of clinical trial design, and few step-by-step guides similar to this study are available to demonstrate its application. Objective: This study aims to demonstrate the feasibility and process of applying an HCD approach to creating clinical trial support resources for physician stakeholders to overcome barriers to pursuing clinical trials for OLDs to treat cancer. Methods: An HCD approach was used to develop OLD clinical trial support concepts. In total, 45 cancer care physicians were contacted, of which 15 participated in semistructured interviews to identify barriers to prescribing OLDs or participating in cancer OLD clinical trials. Design research is qualitative---it seeks to answer ``why'' and ``how'' questions; thus, a sample size of 15 was sufficient to provide insight saturation to address the design problem. The team used affinity mapping and thematic analysis of qualitative data gathered from the interviews to inform subsequent web-based co-design sessions, which included creative matrix exercises and voting to refine and prioritize the ideas used in the final 3 recommended concepts. Results: The findings demonstrate the potential of HCD methods to uncover important insights into the barriers physicians face in participating in OLD clinical trials or prescribing OLDs, such as recruitment challenges, low willingness to prescribe without clinical data, and stigma. Notably, only palliative care participants self-identified as ``frequent prescribers'' of OLDs, despite high national OLD prescription rates among patients with cancer. Participants found the HCD approach engaging, with 60\% (9/15) completing this study; scheduling conflicts caused most of the dropouts. Over 150 ideas were generated in 3 co-design sessions, with the groups voting on 15 priority ideas that the design team then refined into 3 final recommendations, especially focused on increasing the participation of physicians in OLD clinical trials. Conclusions: Using participatory HCD methods, we delivered 3 concepts for clinical trial support resources to help physician stakeholders overcome barriers to pursuing clinical trials for OLDs to treat cancer. Overall, integrating the HCD approach can aid in identifying important stakeholders, such as prescribing physicians; facilitating their engagement; and incorporating their perspectives and needs into the solution design process. This paper highlights the process, methods, and potential of HCD to improve cancer clinical trial design. Future work is needed to train clinical trial designers in the HCD approach and encourage adoption in the field. ",
doi="10.2196/51604",
url="https://formative.jmir.org/2024/1/e51604",
url="http://www.ncbi.nlm.nih.gov/pubmed/38358789"
}


@Article{info:doi/10.2196/53412,
author="Maikos, T. Jason
and Pruziner, L. Alison
and Hendershot, D. Brad
and Herlihy, V. David
and Chomack, M. John
and Hyre, J. Michael
and Phillips, L. Samuel
and Sidiropoulos, N. Alexis
and Dearth, L. Christopher
and Nelson, M. Leif",
title="Effects of a Powered Ankle-Foot Prosthesis and Physical Therapy on Function for Individuals With Transfemoral Limb Loss: Rationale, Design, and Protocol for a Multisite Clinical Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="26",
volume="13",
pages="e53412",
keywords="amputation",
keywords="limb loss",
keywords="physical therapy",
keywords="powered prosthetic ankle-foot device",
keywords="lower extremity",
abstract="Background: Powered ankle-foot prosthetic devices can generate net positive mechanical work during gait, which mimics the physiological ankle. However, gait deviations can persist in individuals with transfemoral limb loss because of habit or lack of rehabilitation. Prosthetic research efforts favor the design or evaluation of prosthetic componentry and rarely incorporate any type of rehabilitation, despite evidence suggesting that it is critical for minimizing gait imbalances. Given the accelerated rate of innovation in prosthetics, there is a fundamental knowledge gap concerning how individuals with transfemoral limb loss should learn to correctly use powered ankle-foot devices for maximum functional benefit. Because of the recent advances in prosthetic technology, there is also a critical unmet need to develop guidelines for the prescription of advanced prosthetic devices that incorporate both physical and psychological components to identify appropriate candidates for advanced technology. Objective: The primary goal of this investigation is to examine the roles of advanced prosthetic technology and a device-specific rehabilitative intervention on gait biomechanics, functional efficacy, and pain in individuals with transfemoral limb loss. The secondary goal is to develop preliminary rehabilitation guidelines for advanced lower limb prosthetic devices to minimize gait imbalances and maximize function and to establish preliminary guidelines for powered ankle-foot prosthetic prescription. Methods: This prospective, multisite study will enroll 30 individuals with unilateral transfemoral limb loss. At baseline, participants will undergo a full gait analysis and assessment of function, neurocognition, cognitive load, subjective preferences, and pain using their current passive prosthesis. The participants will then be fitted with a powered ankle-foot device and randomized into 2 equal groups: a powered device with a device-specific rehabilitation intervention (group A) or a powered device with the current standard of practice (group B). Group A will undergo 4 weeks of device-specific rehabilitation. Group B will receive the current standard of practice, which includes basic device education but no further device-specific rehabilitation. Data collection procedures will then be repeated after 4 weeks and 8 weeks of powered ankle use. Results: This study was funded in September 2017. Enrollment began in September 2018. Data collection will conclude by March 2024. The initial dissemination of results is expected in August 2024. Conclusions: The projected trends indicate that the number of individuals with limb loss will dramatically increase in the United States. The absence of effective, evidence-based interventions may make individuals with transfemoral limb loss more susceptible to increased secondary physical conditions and degenerative changes. With this expected growth, considerable resources will be required for prosthetic and rehabilitation services. Identifying potential mechanisms for correcting gait asymmetries, either through advanced prosthetic technology or rehabilitative interventions, can provide a benchmark for understanding the optimal treatment strategies for individuals with transfemoral limb loss. Trial Registration: ClinicalTrials.gov NCT03625921; https://clinicaltrials.gov/study/NCT03625921 International Registered Report Identifier (IRRID): DERR1-10.2196/53412 ",
doi="10.2196/53412",
url="https://www.researchprotocols.org/2024/1/e53412",
url="http://www.ncbi.nlm.nih.gov/pubmed/38277197"
}


@Article{info:doi/10.2196/50732,
author="Skaria, Geena
and Reshmi, Bhageerathy
and K M, Sabu
and Shetty, Sahana
and Lakshmi R, Vani",
title="Development and Testing of an Electronic Diabetes Diary Integrated With a Hospital Information System for Individuals With Type 2 Diabetes Mellitus: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="23",
volume="13",
pages="e50732",
keywords="self-management of blood glucose",
keywords="SMBG",
keywords="diabetes self-management",
keywords="DSM",
keywords="personal health records",
keywords="electronic diabetes diary",
keywords="glycemic control",
keywords="patient adherence",
keywords="digital health",
abstract="Background: Type 2 diabetes mellitus (T2DM) is one of the leading noncommunicable diseases that require diabetes self-management (DSM) practices. This study proposes to develop a customized mobile health (mHealth) app integrated with a hospital information system (HIS) to enable real-time, two-way transfer of information between the patient and physician. The captured information in the electronic health record will facilitate physicians to have a chronological account of the patient's diabetes history and enable tweaking of the treatment. Objective: The objectives of the study are (1) to develop the HIS-integrated Electronic Diabetes Diary (EDDy) per the end-user expectations at a tertiary care hospital in a south Indian state with a high prevalence of T2DM and (2) to evaluate and test adherence to EDDy in the management of T2DM. Methods: The study will be carried out in 3 phases. Phase 1 involved in-depth interviews with primary end users to gather information regarding their expectations from the hospital-based EDDy. Phase 2 will use this information to develop a customized mHealth app using an iterative model of software development. Phase 3 will involve a pre- and posttest design; the developed app will be tested among consenting patients, where physicians will receive the patients' data through the HIS-integrated mHealth app. The pre- and posttest values will be analyzed for adherence leading to improvement in patients' self-management of blood glucose, user experience, glycemic control, and clinical utility. Results: Phase 1 was completed on November 28, 2023. Phase 2 commenced in December 2023 and will end in May 2025. Phase 3 will follow afterward. Conclusions: The proposed app will include a convenient and simple alert system that enables the patient to test glucose values at self-selected intervals, provide grading options to enter diabetic-related complications, enhance patients' knowledge of tracking and managing the complications of diabetes, and help in maintaining the visual representation of glucose values and complications. The simplicity and usability of the modules are its novelty, which may motivate the patients to keep track of their glucose values and help them attain better health outcomes. Trial Registration: Clinical Trial Registry India CTRI/2023/03/051077; http://tinyurl.com/4tau4ndb International Registered Report Identifier (IRRID): PRR1-10.2196/50732 ",
doi="10.2196/50732",
url="https://www.researchprotocols.org/2024/1/e50732",
url="http://www.ncbi.nlm.nih.gov/pubmed/38261369"
}


@Article{info:doi/10.2196/44423,
author="Straand, Jevnaker Ingjerd
and F{\o}lstad, Asbj{\o}rn
and Bj{\o}rnestad, Ravndal Jone",
title="Exploring a Gaming-Based Intervention for Unemployed Young Adults: Thematic Analysis",
journal="JMIR Hum Factors",
year="2024",
month="Jan",
day="18",
volume="11",
pages="e44423",
keywords="positive psychology intervention",
keywords="digital mental health",
keywords="serious gaming",
keywords="intervention design",
keywords="research through design",
keywords="gaming-based intervention",
abstract="Background: Promoting positive psychologies that promote resilience such as a growth mindset could be beneficial for young, unemployed adults, as many lack the self-esteem and self-efficacy to cope with job search adversity. These young people may be reached at scale through the web-based delivery of self-administered positive psychology interventions. However, past studies report unsatisfying user experiences and a lack of user engagement. A gaming-based experience could be an approach to overcoming these challenges. Objective: Our research objective was to explore how young, unemployed adults experience a positive psychology intervention designed as a game to extract learning and principles for future intervention research and development. Methods: To respond to the research question, a team of researchers at the University of Stavanger worked with designers and developers to conceptualize and build a gaming-based intervention. Feedback from the users was collected through formative usability testing with 18 young adults in the target group. Retrospectively, recordings and notes were transcribed and subjected to thematic analysis to extract learnings for the purposes of this paper. Results: A total of 3 themes were identified that pinpoint what we consider to be key priorities for future gaming interventions for unemployed young adults: adaptation to user preferences (eg, need for responding to user preferences), empathic player interaction (eg, need for responsiveness to user inputs and a diverse set of interaction modes), and sensemaking of experience and context (eg, need for explicit presentation of game objectives and need for management of user expectations related to genre). Conclusions: Feedback from end users in usability-testing sessions was vital to understanding user preferences and needs, as well as to inform ongoing intervention design and development. Our study also shows that game design could make interventions more entertaining and engaging but may distort the intervention if the game narrative is not properly aligned with the intervention intent and objectives. By contrast, a lack of adaptation to user needs may cause a less motivating user experience. Thus, we propose a structured approach to promote alignment between user preferences and needs, intervention objectives, and gameplay. ",
doi="10.2196/44423",
url="https://humanfactors.jmir.org/2024/1/e44423",
url="http://www.ncbi.nlm.nih.gov/pubmed/38236624"
}


@Article{info:doi/10.2196/50823,
author="Shanmugavel, Aarthi
and Shakya, Raj Prabin
and Shrestha, Archana
and Nepal, Jyoti
and Shrestha, Abha
and Daneault, Jean-Francois
and Rawal, Shristi",
title="Designing and Developing a Mobile App for Management and Treatment of Gestational Diabetes in Nepal: User-Centered Design Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="17",
volume="8",
pages="e50823",
keywords="mHealth",
keywords="mobile health",
keywords="gestational diabetes",
keywords="telehealth",
keywords="usability testing",
keywords="LMICs",
keywords="low- and middle-income countries",
keywords="user-centric design",
keywords="social cognitive theory",
keywords="South Asians",
keywords="maternal health",
keywords="diabetes",
keywords="diabetes mellitus",
keywords="daily glucose monitoring",
keywords="hospital",
keywords="medical institution",
keywords="health center",
keywords="clinical utility",
keywords="Nepal",
keywords="low income",
keywords="clinical trial",
keywords="focus group",
keywords="interview",
keywords="health care provider",
keywords="medical practitioner",
keywords="mobile app",
keywords="application",
keywords="digital health",
keywords="app",
keywords="apps",
keywords="health education",
keywords="web based",
keywords="self-monitoring",
keywords="glucose",
keywords="physical activity",
keywords="intervention",
abstract="Background: Mobile apps can aid with the management of gestational diabetes mellitus (GDM) by providing patient education, reinforcing regular blood glucose monitoring and diet/lifestyle modification, and facilitating clinical and social support. Objective: This study aimed to describe our process of designing and developing a culturally tailored app, Garbhakalin Diabetes athawa Madhumeha---Dhulikhel Hospital (GDM-DH), to support GDM management among Nepalese patients by applying a user-centered design approach. Methods: A multidisciplinary team of experts, as well as health care providers and patients in Dhulikhel Hospital (Dhulikhel, Nepal), contributed to the development of the GDM-DH app. After finalizing the app's content and features, we created the app's wireframe, which illustrated the app's proposed interface, navigation sequences, and features and function. Feedback was solicited on the wireframe via key informant interviews with health care providers (n=5) and a focus group and in-depth interviews with patients with GDM (n=12). Incorporating their input, we built a minimum viable product, which was then user-tested with 18 patients with GDM and further refined to obtain the final version of the GDM-DH app. Results: Participants in the focus group and interviews unanimously concurred on the utility and relevance of the proposed mobile app for patients with GDM, offering additional insight into essential modifications and additions to the app's features and content (eg, inclusion of example meal plans and exercise videos).The mean age of patients in the usability testing (n=18) was 28.8 (SD 3.3) years, with a mean gestational age of 27.2 (SD 3.0) weeks. The mean usability score across the 10 tasks was 3.50 (SD 0.55; maximum score=5 for ``very easy''); task completion rates ranged from 55.6\% (n=10) to 94.4\% (n=17). Findings from the usability testing were reviewed to further optimize the GDM-DH app (eg, improving data visualization). Consistent with social cognitive theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose, blood pressure, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden, as well as automatic feedback and data visualization. The app also includes a social network ``follow'' feature to add friends and family and give them permission to view logged data and a progress summary. Health care providers can use the web-based admin portal of the GDM-DH app to enter/review glucose levels and other clinical measures, track patient progress, and guide treatment and counseling accordingly. Conclusions: To the best of our knowledge, this is the first mobile health platform for GDM developed for a low-income country and the first one containing a social support feature. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app. ",
doi="10.2196/50823",
url="https://formative.jmir.org/2024/1/e50823",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231562"
}


@Article{info:doi/10.2196/49331,
author="Block, J. Valerie
and Koshal, Kanishka
and Wijangco, Jaeleene
and Miller, Nicolette
and Sara, Narender
and Henderson, Kyra
and Reihm, Jennifer
and Gopal, Arpita
and Mohan, D. Sonam
and Gelfand, M. Jeffrey
and Guo, Chu-Yueh
and Oommen, Lauren
and Nylander, Alyssa
and Rowson, A. James
and Brown, Ethan
and Sanders, Stephen
and Rankin, Katherine
and Lyles, R. Courtney
and Sim, Ida
and Bove, Riley",
title="A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack",
journal="JMIR Hum Factors",
year="2024",
month="Jan",
day="11",
volume="11",
pages="e49331",
keywords="digital health",
keywords="mobile tools",
keywords="falls",
keywords="prevention",
keywords="behavioral medicine",
keywords="implementation science",
keywords="closed-loop monitoring",
keywords="multiple sclerosis",
keywords="mobile phone",
abstract="Background: Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient's specific context. Objective: This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. Methods: Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users' needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. Results: A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility---with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient's community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). Conclusions: To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record--embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences. ",
doi="10.2196/49331",
url="https://humanfactors.jmir.org/2024/1/e49331",
url="http://www.ncbi.nlm.nih.gov/pubmed/38206662"
}


@Article{info:doi/10.2196/47991,
author="Gasciauskaite, Greta
and Castellucci, Clara
and Malorgio, Amos
and Budowski, D. Alexandra
and Schweiger, Giovanna
and Kolbe, Michaela
and Fries, Daniel
and Grande, Bastian
and N{\"o}thiger, B. Christoph
and Spahn, R. Donat
and Roche, R. Tadzio
and Tscholl, W. David
and Akbas, Samira",
title="User Perceptions of Visual Clot in a High-Fidelity Simulation Study: Mixed Qualitative-Quantitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Jan",
day="11",
volume="11",
pages="e47991",
keywords="Visual Clot",
keywords="blood coagulation",
keywords="blood coagulation test",
keywords="hemostasis",
keywords="rotational thromboelastometry",
keywords="situation awareness",
keywords="user-centered design",
keywords="visualization",
keywords="user",
keywords="perception",
keywords="interpretation",
keywords="thromboelastography",
keywords="viscoelastic hemostatic",
keywords="technology",
keywords="coagulation",
keywords="quantitative information",
abstract="Background: Viscoelastic hemostatic assays, such as rotational thromboelastometry (ROTEM) or thromboelastography, enable prompt diagnosis and accelerate targeted treatment. However, the complex interpretation of the results remains challenging. Visual Clot---a situation awareness-based visualization technology---was developed to assist clinicians in interpreting viscoelastic tests. Objective: Following a previous high-fidelity simulation study, we analyzed users' perceptions of the technology, to identify its strengths and limitations from clinicians' perspectives. Methods: This is a mixed qualitative-quantitative study consisting of interviews and a survey. After solving coagulation scenarios using Visual Clot in high-fidelity simulations, we interviewed anesthesia personnel about the perceived advantages and disadvantages of the new tool. We used a template approach to identify dominant themes in interview responses. From these themes, we defined 5 statements, which were then rated on Likert scales in a questionnaire. Results: We interviewed 77 participants and 23 completed the survey. We identified 9 frequently mentioned topics by analyzing the interview responses. The most common themes were ``positive design features,'' ``intuitive and easy to learn,'' and ``lack of a quantitative component.'' In the survey, 21 respondents agreed that Visual Clot is easy to learn and 16 respondents stated that a combination of Visual Clot and ROTEM would help them manage complex hemostatic situations. Conclusions: A group of anesthesia care providers found Visual Clot well-designed, intuitive, and easy to learn. Participants highlighted its usefulness in emergencies, especially for clinicians inexperienced in coagulation management. However, the lack of quantitative information is an area for improvement. ",
doi="10.2196/47991",
url="https://humanfactors.jmir.org/2024/1/e47991",
url="http://www.ncbi.nlm.nih.gov/pubmed/38206666"
}


@Article{info:doi/10.2196/54202,
author="Veldmeijer, Lars
and Terlouw, Gijs
and Van Os, Jim
and Van 't Veer, Job
and Boonstra, Nynke",
title="The Frequency of Design Studies Targeting People With Psychotic Symptoms and Features in Mental Health Care Innovation: Secondary Analysis of a Systematic Review",
journal="JMIR Ment Health",
year="2024",
month="Jan",
day="9",
volume="11",
pages="e54202",
keywords="design approaches",
keywords="design",
keywords="innovation",
keywords="innovative",
keywords="innovate",
keywords="innovations",
keywords="psychiatry",
keywords="mental health care",
keywords="mental health",
keywords="mental illness",
keywords="mental disease",
keywords="involvement",
keywords="service users",
keywords="people with lived experience",
keywords="people with lived experiences",
keywords="lived experience",
keywords="lived experiences",
keywords="co-creation",
keywords="cocreation",
keywords="psychosis",
keywords="psychotic",
keywords="schizophrenia",
keywords="schizoid",
keywords="schizotypal",
keywords="paranoia",
keywords="neurosis",
keywords="hallucinosis",
keywords="hallucination",
keywords="hallucinations",
doi="10.2196/54202",
url="https://mental.jmir.org/2024/1/e54202",
url="http://www.ncbi.nlm.nih.gov/pubmed/38194249"
}


@Article{info:doi/10.2196/44619,
author="Luu, Phuoc An
and Nguyen, Thanh Truong
and Cao, Cam Van Thi
and Ha, Diem Trinh Hoang
and Chung, Thu Lien Thi
and Truong, Ngoc Trung
and Nguyen Le Nhu, Tung
and Dao, Bach Khoa
and Nguyen, Van Hao
and Khanh, Quoc Phan Nguyen
and Le, Thuy Khanh Thuy
and Tran, Bao Luu Hoai
and Nhat, Huy Phung Tran
and Tran, Minh Duc
and Lam, Minh Yen
and Thwaites, Louise Catherine
and Mcknight, Jacob
and Vinh Chau, Van Nguyen
and Van Nuil, Ilo Jennifer
and ",
title="Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19--Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project",
journal="JMIR Hum Factors",
year="2024",
month="Jan",
day="5",
volume="11",
pages="e44619",
keywords="vital signs",
keywords="wearable devices",
keywords="action learning",
keywords="technology acceptance model",
keywords="TAM",
keywords="COVID-19",
keywords="user-centered design",
keywords="wearables",
keywords="remote monitoring",
keywords="technology acceptance",
keywords="oximeter",
abstract="Background: Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. Objective: A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. Methods: We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. Results: In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Conclusions: Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period. ",
doi="10.2196/44619",
url="https://humanfactors.jmir.org/2024/1/e44619",
url="http://www.ncbi.nlm.nih.gov/pubmed/38180799"
}


@Article{info:doi/10.2196/49353,
author="Young, Karen
and Xiong, Ting
and Lee, Rachel
and Banerjee, Tina Ananya
and Leslie, Myles
and Ko, Yu Wellam
and Pham, Quynh",
title="User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study",
journal="JMIR Hum Factors",
year="2024",
month="Jan",
day="1",
volume="11",
pages="e49353",
keywords="digital health",
keywords="virtual care",
keywords="digital therapeutics",
keywords="prostate cancer",
keywords="cancer survivorship",
keywords="user-centred design",
keywords="usability",
keywords="supportive care",
keywords="cultural adaptation",
keywords="Chinese Canadians",
abstract="Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants' desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. ",
doi="10.2196/49353",
url="https://humanfactors.jmir.org/2024/1/e49353",
url="http://www.ncbi.nlm.nih.gov/pubmed/38163295"
}


@Article{info:doi/10.2196/52799,
author="Rochon, A. Elizabeth
and Sy, Maimouna
and Phillips, Mirelle
and Anderson, Erik
and Plys, Evan
and Ritchie, Christine
and Vranceanu, Ana-Maria",
title="Bio-Experiential Technology to Support Persons With Dementia and Care Partners at Home (TEND): Protocol for an Intervention Development Study",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="29",
volume="12",
pages="e52799",
keywords="dementia",
keywords="dyadic",
keywords="bio-experiential",
keywords="serious gaming",
keywords="psychosocial",
abstract="Background: Alzheimer disease and related dementias are debilitating and incurable diseases. Persons with dementia and their informal caregivers (ie, dyads) experience high rates of emotional distress and negative health outcomes. Several barriers prevent dyads from engaging in psychosocial care including cost, transportation, and a lack of treatments that target later stages of dementia and target the dyad together. Technologically informed treatment and serious gaming have been shown to be feasible and effective among persons living with dementia and their care partners. To increase access, there is a need for technologically informed psychosocial interventions which target the dyad, together in the home. Objective: This study aims to develop the toolkit for experiential well-being in dementia, a dyadic, ``bio-experiential'' intervention for persons with dementia and their caregivers. Per our conceptual model, the toolkit for experiential well-being in dementia platform aims to target sustained attention, positive emotions, and active engagement among dyads. In this paper, we outline the protocol and conceptual model for intervention development and partnership with design and development experts. Methods: We followed the National Institutes of Health (NIH) stage model (stage 1A) and supplemented the model with principles of user-centered design. The first step includes understanding user needs, goals, and strengths. We met this step by engaging in methodology and definition synthesis and conducting focus groups with dementia care providers (N=10) and persons with dementia and caregivers (N=11). Step 2 includes developing and refining the prototype. We will meet this step by engaging dyads in up to 20 iterations of platform $\beta$ testing workshops. Step 3 includes observing user interactions with the prototype. We will meet this step by releasing the platform for feasibility testing. Results: Key takeaways from the focus groups include balancing individualization and the dyadic relationship and avoiding confusing stimuli. As of September 2023, we have completed focus groups with providers, persons with dementia, and their caregivers. Additionally, we have conducted 4 iterations of $\beta$ testing workshops with dyads. Feedback from focus groups informed the $\beta$ testing workshops; data have not yet been formally analyzed and will be reported in future publications. Conclusions: Technological interventions, particularly ``bio-experiential'' technology, can be used in dementia care to support emotional health among persons with a diagnosis and caregivers. Here, we outline a collaborative intervention development process of bio-experiential technology through a research, design, and development partnership. Next, we are planning to test the platform's feasibility as well as its impact on clinical outcomes and mechanisms of action. International Registered Report Identifier (IRRID): DERR1-10.2196/52799 ",
doi="10.2196/52799",
url="https://www.researchprotocols.org/2023/1/e52799",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157239"
}


@Article{info:doi/10.2196/45035,
author="Benmessaoud, Camila
and Pfisterer, J. Kaylen
and De Leon, Anjelica
and Saragadam, Ashish
and El-Dassouki, Noor
and Young, M. Karen G.
and Lohani, Raima
and Xiong, Ting
and Pham, Quynh",
title="Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="25",
volume="10",
pages="e45035",
keywords="digital therapeutics",
keywords="disease management",
keywords="heart failure",
keywords="informal caregivers",
keywords="mHealth",
keywords="mobile health",
keywords="shared care",
keywords="telemedicine",
abstract="Background: The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care ``Caretown for Medly,'' which empowers ICs to concurrently expand patients' self-care abilities while acknowledging ICs' eagerness to provide greater support. Objective: We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly. Methods: We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint's ability to quickly ``solve big problems and test new ideas,'' which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the ``KTA Sprint.'' Results: We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care's synergistic benefits. Features were designed for customizability to suit the patient's condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care. Conclusions: These disease-invariant features were designed to address ICs' needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads. ",
doi="10.2196/45035",
url="https://humanfactors.jmir.org/2023/1/e45035",
url="http://www.ncbi.nlm.nih.gov/pubmed/38145480"
}


@Article{info:doi/10.2196/48677,
author="Huguet, Anna
and Rozario, Sharlene
and Wozney, Lori
and McGrath, J. Patrick",
title="An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="12",
volume="10",
pages="e48677",
keywords="adolescents",
keywords="cognitive-behavioral intervention",
keywords="design process",
keywords="end users",
keywords="headaches",
keywords="internet",
keywords="usability",
keywords="young adult",
abstract="Background: Headache disorders are common, debilitating health problems. Cognitive-behavioral therapy (CBT) is recommended but rarely easily available. With the use of the internet and communication technologies among youth and young adults, these individuals could be self-trained in CBT skills. There is an increasing number of internet-based interventions for headaches, but there has been little research into the usability of these interventions because evaluating usability across the intervention development life cycle is costly. We developed an internet-based CBT program, the Specialized Program for Headache Reduction (SPHERE). While developing it, we aimed to improve SPHERE through rapid usability testing cycles. Objective: This study aims to presents a rapid and affordable usability testing approach that can be performed throughout the intervention development life cycle. This paper also provides evidence of the usability of SPHERE. Methods: We used the ``think aloud'' usability testing method based on Krug's approach to test user interaction within a lab setting. This was followed by a short posttest interview. We planned to test SPHERE with 3-5 participants testing the same part of the program each cycle. Both the design and development team and the research team actively participated in the usability testing process. Observers independently identified the top 3 usability issues, rated their severity, and conducted debriefing sessions to come to consensus on major issues and generate potential solutions. Results: The testing process allowed major usability issues to be identified and rectified rapidly before piloting SPHERE in a real-world context. A total of 2 cycles of testing were conducted. Of the usability issues encountered in cycles 1 and 2, a total of 68\% (17/25) and 32\% (12/38), respectively, were rated as major, discussed, and fixed. Conclusions: This study shows that rapid usability testing is an essential part of the design process that improves program functionality and can be easy and inexpensive to undertake. ",
doi="10.2196/48677",
url="https://humanfactors.jmir.org/2023/1/e48677",
url="http://www.ncbi.nlm.nih.gov/pubmed/38085567"
}


@Article{info:doi/10.2196/52088,
author="Turesson, Christina
and Liedberg, Gunilla
and Bj{\"o}rk, Mathilda",
title="Evaluating the Clinical Use and Utility of a Digital Support App for Employees With Chronic Pain Returning to Work (SWEPPE): Observational Study",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="11",
volume="10",
pages="e52088",
keywords="chronic pain",
keywords="digital support",
keywords="eHealth",
keywords="return-to-work",
keywords="user data",
keywords="mobile phone",
abstract="Background: The digital app SWEPPE (sustainable worker, a digital support for persons with chronic pain and their employers) was developed to improve the support of people with chronic pain in their return-to-work process after sick leave and includes functions such as the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. Objective: This study aims to describe the use of the smartphone app SWEPPE among people with chronic pain who have participated in an interdisciplinary pain rehabilitation program. Methods: This is a case study including 16 people participating in a feasibility study. The analyses were based on user data collected for 3 months. Quantitative data regarding used functions were analyzed with descriptive statistics, and qualitative data of identified needs of support from the employer were grouped into 8 categories. Results: Self-monitoring was used by all participants (median 26, IQR 8-87 daily registrations). A total of 11 (N=16, 69\%) participants set a work-related goal and performed weekly evaluations of goal fulfillment and ratings of their work ability. In total, 9 (56\%) participants shared information with their employer and 2 contacted the coach. A total of 15 (94\%) participants identified a total of 51 support interventions from their employer. Support to adapt to work assignments and support to adapt to work posture were the 2 biggest categories. The most common type of support identified by 53\% (8/15) of the participants was the opportunity to take breaks and short rests. Conclusions: Participants used multiple SWEPPE functions, such as daily self-registration, goal setting, self-monitoring, and employer support identification. This shows the flexible nature of SWEPPE, enabling individuals to select functions that align with their needs. Additional research is required to investigate the extended use of SWEPPE and how employers use shared employee information. ",
doi="10.2196/52088",
url="https://humanfactors.jmir.org/2023/1/e52088",
url="http://www.ncbi.nlm.nih.gov/pubmed/38079212"
}


@Article{info:doi/10.2196/45453,
author="Hsu, Che-Wei
and Stahl, Daniel
and Mouchlianitis, Elias
and Peters, Emmanuelle
and Vamvakas, George
and Keppens, Jeroen
and Watson, Miles
and Schmidt, Nora
and Jacobsen, Pamela
and McGuire, Philip
and Shergill, Sukhi
and Kabir, Thomas
and Hirani, Tia
and Yang, Ziyang
and Yiend, Jenny",
title="User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="8",
volume="10",
pages="e45453",
keywords="cognitive bias modification",
keywords="paranoia",
keywords="content specificity",
keywords="mental health",
keywords="mobile app",
keywords="mhealth",
keywords="digital therapeutic",
keywords="user-centered development",
keywords="user",
keywords="user-friendly app",
keywords="paranoid",
keywords="persecution",
keywords="persecution complex",
keywords="delusions",
keywords="obsession",
keywords="megalomania",
keywords="monomania",
keywords="psychosis",
keywords="psychotic",
abstract="Background: Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP (``Successful Treatment of Paranoia''). Objective: This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype. Methods: We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts. Results: All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ?1; control items: ?1, readability: ?3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users' ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful. Conclusions: Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users. ",
doi="10.2196/45453",
url="https://humanfactors.jmir.org/2023/1/e45453",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064256"
}


@Article{info:doi/10.2196/46928,
author="Shaker, Abbas Ali
and Austin, F. Stephen
and J{\o}rgensen, Sedoc Mie
and S{\o}rensen, Aasted John
and Bechmann, Henrik
and Kinnerup, E. Henriette
and Petersen, Juul Charlotte
and Olsen, Klein Ragnar
and Simonsen, Erik",
title="Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="30",
volume="10",
pages="e46928",
keywords="software models",
keywords="in-house development",
keywords="psychiatric services",
keywords="borderline personality disorder",
keywords="mobile application",
keywords="development",
keywords="mental health",
keywords="user design",
keywords="design",
keywords="psychiatric",
keywords="implementation",
keywords="innovation",
abstract="Background: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. Objective: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. Methods: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. Results: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house--developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. Conclusions: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology. ",
doi="10.2196/46928",
url="https://humanfactors.jmir.org/2023/1/e46928",
url="http://www.ncbi.nlm.nih.gov/pubmed/38032709"
}


@Article{info:doi/10.2196/52315,
author="Michaud, L. Alexis
and Bice, Briana
and Miklos, Eva
and McCormick, Katherine
and Medeiros-Nancarrow, Cheryl
and Zhou, S. Eric
and Recklitis, J. Christopher",
title="Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA): Protocol for an Efficacy Trial",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="29",
volume="12",
pages="e52315",
keywords="insomnia",
keywords="cancer survivors",
keywords="young adults",
keywords="protocol",
keywords="coaching",
keywords="mood",
abstract="Background: Young adult cancer survivors (YACS) are at elevated risk for chronic insomnia, even years after completing treatment. In addition to potential health consequences, insomnia can interrupt social, educational, and vocational development just as they are trying to ``make up'' for time lost to cancer. Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment for insomnia but remains largely unavailable to YACS due to several barriers (ie, shortage of trained providers, geographic limitations, financial limitations). Traditional CBTI has not been adapted to meet YACS' unique developmental and circadian challenges. To improve availability of effective behavioral insomnia treatment for this population, we developed the Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA), a low-intensity educational intervention delivered virtually online. Objective: In this phase 2 ``proof of concept'' trial, primary aims are to test the efficacy of STEP-YA to improve insomnia symptoms and mood in YACS and assess the utility of individualized coaching to improve treatment effects. A secondary aim will explore participant variables associated with clinically significant response to STEP-YA. Methods: This 2-arm randomized prospective trial will enroll 74 off-treatment YACS aged 20 years to 39 years with clinically significant insomnia. Each participant completes the STEP-YA intervention in a 1-on-1 synchronous online session led by a trained interventionist following a structured outline. The 90-minute intervention presents educational information on the development of insomnia after cancer and offers specific suggestions for improving insomnia symptoms. During the session, participants review the suggestions and develop a personalized sleep action plan for implementing them. After the session, participants are randomized to either the coaching condition, in which they receive 2 telephone coaching sessions, or the no-coaching condition, which offers no subsequent coaching. The Insomnia Severity Index (ISI) and the Profile of Mood States: Short Form (POMS-SF) are assessed at baseline and 4 and 8 weeks postintervention. Results: Enrollment began in November 2022, with 28 participants currently enrolled. We anticipate recruitment will be completed in 2024. The primary endpoint is a change in ISI score from baseline to 8 weeks postintervention. The secondary endpoint is change in mood symptoms (POMS-SF) from baseline to 8 weeks postintervention. Change scores will be treated as continuous variables. Primary analyses will use ANOVA methods. A within-subjects analysis will examine if the STEP-YA intervention is associated with significant changes in insomnia and mood over time. A 2-way ANOVA will be used to evaluate the utility of coaching sessions to improve treatment effects. Conclusions: Chronic insomnia has significant negative effects on YACS' medical, educational, and psychological functioning. STEP-YA aims to address their needs; study results will determine if the intervention warrants future effectiveness and dissemination studies and if individualized coaching is necessary for adequate treatment response. Trial Registration: ClinicalTrials.gov NCT05358951: https://clinicaltrials.gov/study/NCT05358951 International Registered Report Identifier (IRRID): DERR1-10.2196/52315 ",
doi="10.2196/52315",
url="https://www.researchprotocols.org/2023/1/e52315/"
}


@Article{info:doi/10.2196/44194,
author="Tully, M. Laura
and Nye, E. Kathleen
and Ereshefsky, Sabrina
and Tryon, L. Valerie
and Hakusui, Komei Christopher
and Savill, Mark
and Niendam, A. Tara",
title="Incorporating Community Partner Perspectives on eHealth Technology Data Sharing Practices for the California Early Psychosis Intervention Network: Qualitative Focus Group Study With a User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="14",
volume="10",
pages="e44194",
keywords="attitude",
keywords="content analysis",
keywords="data sharing",
keywords="eHealth",
keywords="ethic",
keywords="focus group",
keywords="health information exchange",
keywords="mental health",
keywords="perspective",
keywords="preference",
keywords="psychosis",
keywords="psychotic",
keywords="qualitative data",
abstract="Background: Increased use of eHealth technology and user data to drive early identification and intervention algorithms in early psychosis (EP) necessitates the implementation of ethical data use practices to increase user acceptability and trust. Objective: First, the study explored EP community partner perspectives on data sharing best practices, including beliefs, attitudes, and preferences for ethical data sharing and how best to present end-user license agreements (EULAs). Second, we present a test case of adopting a user-centered design approach to develop a EULA protocol consistent with community partner perspectives and priorities. Methods: We conducted an exploratory, qualitative, and focus group--based study exploring mental health data sharing and privacy preferences among individuals involved in delivering or receiving EP care within the California Early Psychosis Intervention Network. Key themes were identified through a content analysis of focus group transcripts. Additionally, we conducted workshops using a user-centered design approach to develop a EULA that addresses participant priorities. Results: In total, 24 participants took part in the study (14 EP providers, 6 clients, and 4 family members). Participants reported being receptive to data sharing despite being acutely aware of widespread third-party sharing across digital domains, the risk of breaches, and motives hidden in the legal language of EULAs. Consequently, they reported feeling a loss of control and a lack of protection over their data. Participants indicated these concerns could be mitigated through user-level control for data sharing with third parties and an understandable, transparent EULA, including multiple presentation modalities, text at no more than an eighth-grade reading level, and a clear definition of key terms. These findings were successfully integrated into the development of a EULA and data opt-in process that resulted in 88.1\% (421/478) of clients who reviewed the video agreeing to share data. Conclusions: Many of the factors considered pertinent to informing data sharing practices in a mental health setting are consistent among clients, family members, and providers delivering or receiving EP care. These community partners' priorities can be successfully incorporated into developing EULA practices that can lead to high voluntary data sharing rates. ",
doi="10.2196/44194",
url="https://humanfactors.jmir.org/2023/1/e44194",
url="http://www.ncbi.nlm.nih.gov/pubmed/37962921"
}


@Article{info:doi/10.2196/47718,
author="Shuldiner, Jennifer
and Kiran, Tara
and Agarwal, Payal
and Daneshvarfard, Maryam
and Eldridge, Kirsten
and Kim, Susie
and Greiver, Michelle
and Jokhio, Iffat
and Ivers, Noah",
title="Developing an Audit and Feedback Dashboard for Family Physicians: User-Centered Design Process",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="9",
volume="10",
pages="e47718",
keywords="audit and feedback",
keywords="primary care",
keywords="design",
keywords="user-centered",
keywords="audit",
keywords="feedback",
keywords="development",
keywords="dashboard",
keywords="family physician",
keywords="clinical performance",
keywords="implementation",
keywords="users",
keywords="care",
abstract="Background: Audit and feedback (A\&F), the summary and provision of clinical performance data, is a common quality improvement strategy. Successful design and implementation of A\&F---or any quality improvement strategy---should incorporate evidence-informed best practices as well as context-specific end user input. Objective: We used A\&F theory and user-centered design to inform the development of a web-based primary care A\&F dashboard. We describe the design process and how it influenced the design of the dashboard. Methods: Our design process included 3 phases: prototype development based on A\&F theory and input from clinical improvement leaders; workshop with family physician quality improvement leaders to develop personas (ie, fictional users that represent an archetype character representative of our key users) and application of those personas to design decisions; and user-centered interviews with family physicians to learn about the physician's reactions to the revised dashboard. Results: The team applied A\&F best practices to the dashboard prototype. Personas were used to identify target groups with challenges and behaviors as a tool for informed design decision-making. Our workshop produced 3 user personas, Dr Skeptic, Frazzled Physician, and Eager Implementer, representing common users based on the team's experience of A\&F. Interviews were conducted to further validate findings from the persona workshop and found that (1) physicians were interested in how they compare with peers; however, if performance was above average, they were not motivated to improve even if gaps compared to other standards in their care remained; (2) burnout levels were high as physicians are trying to catch up on missed care during the pandemic and are therefore less motivated to act on the data; and (3) additional desired features included integration within the electronic medical record, and more up-to-date and accurate data. Conclusions: We found that carefully incorporating data from user interviews helped operationalize generic best practices for A\&F to achieve an acceptable dashboard that could meet the needs and goals of physicians. We demonstrate such a design process in this paper. A\&F dashboards should address physicians' data skepticism, present data in a way that spurs action, and support physicians to have the time and capacity to engage in quality improvement work; the steps we followed may help those responsible for quality improvement strategy implementation achieve these aims. ",
doi="10.2196/47718",
url="https://humanfactors.jmir.org/2023/1/e47718",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943586"
}


@Article{info:doi/10.2196/49377,
author="Seinsche, Julia
and de Bruin, D. Eling
and Saibene, Enrico
and Rizzo, Francesco
and Carpinella, Ilaria
and Ferrarin, Maurizio
and Ifanger, Sarina
and Moza, Sotiria
and Giannouli, Eleftheria",
title="Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="9",
volume="12",
pages="e49377",
keywords="telerehabilitation",
keywords="home-based",
keywords="eHealth",
keywords="exergaming",
keywords="older adults",
keywords="motor-cognitive training",
keywords="feasibility",
keywords="pragmatic trial",
abstract="Background: Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. Objective: The aim of this study is to test the feasibility and effectiveness of this novel training system. Methods: A total of 180 older adults from Switzerland, Italy, and Cyprus aged ?60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. Results: Data collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. Conclusions: Owing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. Trial Registration: ClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551 International Registered Report Identifier (IRRID): DERR1-10.2196/49377 ",
doi="10.2196/49377",
url="https://www.researchprotocols.org/2023/1/e49377",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943591"
}


@Article{info:doi/10.2196/50105,
author="Palazzolo, Beatrice
and Carbone, Loretta
and James, G. Tyler
and Heizelman, Robert
and Sen, Ananda
and Mahmoudi, Elham
and McKee, Michael",
title="Model Clinic to Increase Preventive Screenings Among Patients With Physical Disabilities: Protocol for a Mixed Methods Intervention Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="25",
volume="12",
pages="e50105",
keywords="clinical decision support",
keywords="electronic health records",
keywords="mixed methods",
keywords="people with physical disabilities",
keywords="primary care",
abstract="Background: People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote healthier aging and more equitable health care. Objective: This project will evaluate the implementation of a health program designed for people with physical disabilities. The proposed evaluation result is to generate the first best-practice protocol focused specifically on developing primary care to help reduce preventable causes of morbidity and improve functioning among people with physical disabilities. Methods: We will design and implement a pilot health program for people with physical disabilities at a primary care clinic within Michigan Medicine. The health program for people with physical disabilities will be an integrated intervention involving a tailored best practice alert designed to prompt family medicine providers to screen and monitor for common, preventable health conditions. The program will also collect social and functional status information to determine the patient's need for further care coordination and support. Adult participants from this clinic with identified physical disabilities will be targeted for potential enrollment. To create a quasi-experimental setting, a separate departmental clinic will serve as a control site for comparison purposes. A quantitative analysis to estimate the treatment effect of implementing this health program will be conducted using a difference-in-differences approach. Outcomes of interest will include the use of preventative services (eg, hemoglobin A1c for diabetes screening), social work assistance, and emergency and hospital services. These data will be extracted from electronic health records. Time-invariant covariates, particularly sociodemographic covariates, will be included in the models. A qualitative analysis of patient and health care provider interviews will also be completed to assess the effect of the health program. Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scores will be assessed to both screen for depression and anxiety as well as explore program impacts related to addressing health and functioning needs related to physical disabilities in a primary care setting. These will be summarized through descriptive analyses. Results: This study was funded in September 2018, data collection started in September 2021, and data collection is expected to be concluded in September 2023. Conclusions: This study is a mixed methods evaluation of the effectiveness of an integrated health program designed for people with physical disabilities, based on a quasi-experimental comparison between an intervention and a control clinic site. The intervention will be considered successful if it leads to improvements in greater use of screening and monitoring for preventable health conditions, increased social worker referrals to assist with health and functioning needs, and improvements in emergency and hospital-based services. The findings will help inform best practices for people with physical disabilities in a primary care setting. International Registered Report Identifier (IRRID): DERR1-10.2196/50105 ",
doi="10.2196/50105",
url="https://www.researchprotocols.org/2023/1/e50105",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878375"
}


@Article{info:doi/10.2196/47813,
author="Yan, Xinghui
and Newman, W. Mark
and Park, Young Sun
and Sander, Angelle
and Choi, Won Sung
and Miner, Jennifer
and Wu, Zhenke
and Carlozzi, Noelle",
title="Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="24",
volume="7",
pages="e47813",
keywords="mHealth intervention",
keywords="mobile health",
keywords="behavior change",
keywords="qualitative study",
keywords="user adherence",
keywords="behavioral messages",
keywords="general well-being",
abstract="Background: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. Objective: The goal of this study was to understand the factors that impact care partners' decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. Methods: We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64\%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants' thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. Results: The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one's ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. Conclusions: Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people's perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). International Registered Report Identifier (IRRID): RR2-10.2196/32842 ",
doi="10.2196/47813",
url="https://formative.jmir.org/2023/1/e47813",
url="http://www.ncbi.nlm.nih.gov/pubmed/37874621"
}


@Article{info:doi/10.2196/51020,
author="Reale, Elena
and Hopf, B. Nancy
and Breider, Florian
and Grandjean, Dominique
and Pirard, Catherine
and Charlier, Corinne
and Koch, M. Holger
and Berthet, Aur{\'e}lie
and Suarez, Guillaume
and Borgatta, Myriam",
title="Repeated Human Exposure to Semivolatile Organic Compounds by Inhalation: Novel Protocol for a Nonrandomized Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="13",
volume="12",
pages="e51020",
keywords="DEHP",
keywords="diethylhexyl phthalate",
keywords="healthy participants",
keywords="inhalation exposure",
keywords="phthalates",
keywords="portable aerosol-generating device",
keywords="protocol",
keywords="semi-volatile organic compounds",
keywords="SVOCs",
keywords="toxicokinetics study",
keywords="toxicology",
abstract="Background: Semivolatile organic compounds (SVOCs) comprise several different chemical families used mainly as additives in many everyday products. SVOCs can be released into the air as aerosols and deposit on particulate matter during use by dispersion, evaporation, or abrasion. Phthalates are SVOCs of growing concern due to their endocrine-disrupting effects. Human data on the absorption, distribution, metabolism, and excretion (ADME) of these compounds upon inhalation are almost nonexistent. Objective: The goal of this study is to develop a method for repeated inhalation exposures to SVOCs to characterize their ADME in humans. Methods: We will use diethylhexyl phthalate (DEHP), a major indoor air pollutant, as a model SVOC in this novel protocol. The Swiss official Commission on Ethics in Human Research, Canton de Vaud, approved the study on October 14, 2020 (project-ID 2020-01095). Participants (n=10) will be repeatedly exposed (2 short daily exposures over 4 days) to isotope-labeled DEHP (DEHP-d4) to distinguish administered exposures from background exposures. DEHP-d4 aerosols will be generated with a small, portable, aerosol-generating device. Participants will inhale DEHP-d4-containing aerosols themselves with this device at home. Air concentrations of the airborne phthalates will be less than or equal to their occupational exposure limit (OEL). DEHP-d4 and its metabolites will be quantified in urine and blood before, during, and after exposure. Results: Our developed device can generate DEHP-d4 aerosols with diameters of 2.5 $\mu$m or smaller and a mean DEHP-d4 mass of 1.4 (SD 0.2) $\mu$g per puff (n=6). As of May 2023, we have enrolled 5 participants. Conclusions: The portable device can be used to generate phthalate aerosols for repeated exposure in human studies. International Registered Report Identifier (IRRID): DERR1-10.2196/51020 ",
doi="10.2196/51020",
url="https://www.researchprotocols.org/2023/1/e51020",
url="http://www.ncbi.nlm.nih.gov/pubmed/37831504"
}


@Article{info:doi/10.2196/46809,
author="Sangeorzan, Irina
and Antonacci, Grazia
and Martin, Anne
and Grodzinski, Ben
and Zipser, M. Carl
and Murphy, J. Rory K.
and Andriopoulou, Panoraia
and Cook, E. Chad
and Anderson, B. David
and Guest, James
and Furlan, C. Julio
and Kotter, N. Mark R.
and Boerger, F. Timothy
and Sadler, Iwan
and Roberts, A. Elizabeth
and Wood, Helen
and Fraser, Christine
and Fehlings, G. Michael
and Kumar, Vishal
and Jung, Josephine
and Milligan, James
and Nouri, Aria
and Martin, R. Allan
and Blizzard, Tammy
and Vialle, Roberto Luiz
and Tetreault, Lindsay
and Kalsi-Ryan, Sukhvinder
and MacDowall, Anna
and Martin-Moore, Esther
and Burwood, Martin
and Wood, Lianne
and Lalkhen, Abdul
and Ito, Manabu
and Wilson, Nicky
and Treanor, Caroline
and Dugan, Sheila
and Davies, M. Benjamin",
title="Toward Shared Decision-Making in Degenerative Cervical Myelopathy: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="9",
volume="12",
pages="e46809",
keywords="degenerative cervical myelopathy",
keywords="spine",
keywords="spinal cord",
keywords="chronic",
keywords="aging",
keywords="geriatric",
keywords="patient engagement",
keywords="shared decision-making",
keywords="process mapping",
keywords="core information set",
keywords="decision-making",
keywords="patient education",
keywords="common data element",
keywords="Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy",
keywords="RECODE-DCM",
abstract="Background: Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this. Objective: The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes. Methods: Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders. Results: Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway. Conclusions: This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community. International Registered Report Identifier (IRRID): DERR1-10.2196/46809 ",
doi="10.2196/46809",
url="https://www.researchprotocols.org/2023/1/e46809",
url="http://www.ncbi.nlm.nih.gov/pubmed/37812472"
}


@Article{info:doi/10.2196/47390,
author="L{\'o}pez Segu{\'i}, Francesc
and Cos Codina, Joan
and Ricou R{\'i}os, Laura
and Mart{\'i}nez Segura, Isabel Mar{\'i}a
and Mir{\'o} Mezquita, Laura
and Escrich Navarro, Raquel
and Davins Riu, Meritxell
and Estrada Cuxart, Oriol
and Anashkin Kachalin, German
and Moreno-Mart{\'i}nez, Daniel",
title="Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="6",
volume="10",
pages="e47390",
keywords="change management",
keywords="normalization process theory",
keywords="NPT",
keywords="3D printing",
keywords="readiness for change",
keywords="Normalization Measure Development questionnaire",
keywords="NoMAD",
keywords="implementation",
keywords="tertiary hospital",
keywords="barrier",
keywords="readiness",
keywords="printing",
keywords="survey",
keywords="development",
keywords="questionnaire",
keywords="support",
keywords="communicate",
keywords="assessment",
keywords="users",
keywords="transformation",
abstract="Background: The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. Objective: This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. Methods: We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. Results: In this study, 58 professionals, including heads of service (n=30, 51\%), doctors (n=18, 31\%), nurses (n=7, 12\%), and support staff (n=3, 5\%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. Conclusions: The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation. ",
doi="10.2196/47390",
url="https://humanfactors.jmir.org/2023/1/e47390",
url="http://www.ncbi.nlm.nih.gov/pubmed/37801353"
}


@Article{info:doi/10.2196/48395,
author="Metzler-Baddeley, Claudia
and Busse, Monica
and Drew, Cheney
and Pallmann, Philip
and Cantera, Jaime
and Ioakeimidis, Vasileios
and Rosser, Anne",
title="HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="6",
volume="7",
pages="e48395",
keywords="Huntington disease",
keywords="electronic health",
keywords="intervention",
keywords="training application",
keywords="rhythm",
keywords="timing",
keywords="drumming",
keywords="movement",
keywords="cognition",
keywords="integrated knowledge translation",
keywords="gamification",
keywords="Template for Intervention Description and Replication (TIDieR)",
keywords="TIDieR",
keywords="mobile phone",
abstract="Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users' performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. ",
doi="10.2196/48395",
url="https://formative.jmir.org/2023/1/e48395",
url="http://www.ncbi.nlm.nih.gov/pubmed/37801351"
}


@Article{info:doi/10.2196/49675,
author="Rego, Chryselle
and Montague, Enid",
title="The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="5",
volume="10",
pages="e49675",
keywords="physician-patient interaction",
keywords="cognitive load",
keywords="visual feedback",
keywords="haptic feedback",
keywords="postsession feedback",
abstract="Background: The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors' ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors' ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes. Objective: Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants. Methods: This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques. Results: Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual's cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of ?3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of ?2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score. Conclusions: Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted. ",
doi="10.2196/49675",
url="https://humanfactors.jmir.org/2023/1/e49675",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796596"
}


@Article{info:doi/10.2196/42450,
author="Mundra, Anuj
and Kalantri, Ashwini
and Jakasania, Arjunkumar
and Sathe, Harshal
and Raut, Abhishek
and Maliye, Chetna
and Bahulekar, Pramod
and Dawale, Ajay
and Paradkar, J. Rameshwar
and Siriah, Sakshi
and Kumar, Satish
and Gupta, S. Subodh
and Garg, Bishan",
title="Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="29",
volume="12",
pages="e42450",
keywords="noncommunicable diseases",
keywords="action research",
keywords="implementation research",
keywords="community-based participatory research",
keywords="salutogenesis",
keywords="primary prevention",
abstract="Background: Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. Objective: This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. Methods: The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. Results: We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. Conclusions: This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial Registration: Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597\&EncHid=\&userName=V-CaN International Registered Report Identifier (IRRID): DERR1-10.2196/42450 ",
doi="10.2196/42450",
url="https://www.researchprotocols.org/2023/1/e42450",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773622"
}


@Article{info:doi/10.2196/49902,
author="Newman, Bronwyn
and Chin, Melvin
and Robinson, Louisa
and Chauhan, Ashfaq
and Manias, Elizabeth
and Wilson, Carlene
and Harrison, Reema",
title="Improving Medication Safety in Cancer Services for Ethnic Minority Consumers: Protocol for a Pilot Feasibility and Acceptability Study of a Co-Designed Consumer Engagement Intervention",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="18",
volume="12",
pages="e49902",
keywords="co-design",
keywords="ethnic minority",
keywords="health care equity",
keywords="patient engagement",
keywords="patient participation",
keywords="patient safety",
keywords="medication safety",
keywords="medication therapy",
keywords="medication therapy management",
keywords="patient transfer",
keywords="consumer",
keywords="engagement",
keywords="intervention",
abstract="Background: People from ethnic minorities are often exposed to unsafe care contributing to poorer health care outcomes. Medication safety is a high-risk area requiring intervention to improve care outcomes. Using an adapted, experience-based co-design process with cancer service staff and patients from ethnic minorities, a medication communication tool was created: Making it Meaningful (MiM). Objective: We aim to test whether the MiM tool is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. Methods: A single site, controlled before and after this pilot study, will be used. Patients from Mandarin- and Russian-speaking backgrounds are eligible for inclusion. In total, 40 patients from these cultural backgrounds will be recruited and stratified by language to the intervention and control groups, with 20 participants in the intervention and 20 in the control group. Further, 4 health practitioners will be recruited and trained to use the MiM. Clinicians providing care for patients in the intervention will use the MiM during their usual appointment while providing medication communication using standard care processes for the control group. Telephone surveys will be conducted with participants at 3 time points, T1 before the intervention, T2 1 week post intervention, and T3 1 month post intervention, to assess knowledge and self-efficacy in medication management, perceived usability, and acceptability of the MiM. Qualitative interviews with clinicians who have used the MiM will be conducted 1 month postintervention to explore their perceptions of MiM feasibility and acceptability. Results: Ethical approval for this research has been provided by the South Eastern Sydney Area Health Human Research Ethics Committee (HRECXXX). Bilingual field-workers, 1 Mandarin-speaking and 1 Russian-speaking, are contacting eligible patients to enroll. It is anticipated that recruitment will be completed by October 2023, with data collection completed by December 2023. Conclusions: Using experience-based co-design, we identified communication about medication, particularly between appointments, as a key issue impacting the safety of care for patients from ethnic minorities accessing cancer services. Increasing consumer engagement in medication management was identified as a strategy to reduce medication safety problems in cancer care; the MiM strategy was developed to address this issue. It is anticipated that by using the MiM, patient knowledge about prescribed medications and confidence in medication management will increase. Evidence from the pilot study will be used to inform a full-scale trial of the MiM tool with a range of ethnic minority communities accessing cancer services. A full-scale trial will seek to determine whether the MiM intervention is effective in knowledge and confidence about medication management, but also whether this improves patient outcomes in cancer care. Trial Registration: Australian New Zealand Clinical Trials ACTRN12622001260718p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384658\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/49902 ",
doi="10.2196/49902",
url="https://www.researchprotocols.org/2023/1/e49902",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721784"
}


@Article{info:doi/10.2196/45957,
author="Wagner, Liliana
and Corona, Laura
and Khan, Nibraas
and Hooper, Madison
and Dixon, Alexa
and Munoz Lavanderos, Ambar
and Zheng, Zhaobo
and Sarkar, Nandan
and Sarkar, Nilanjan
and Warren, Zachary",
title="Development of an App for Tracking Family Engagement With Early Intervention Services: Focus Groups and Pilot Evaluation Study",
journal="JMIR Hum Factors",
year="2023",
month="Sep",
day="12",
volume="10",
pages="e45957",
keywords="mobile health",
keywords="early intervention",
keywords="families",
keywords="mobile phone",
keywords="autism",
keywords="focus groups",
abstract="Background: Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special health care needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish appropriate services. Such challenges disproportionately affect families from traditionally underserved communities. Mobile health apps can improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, the implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in health care delivery. Objective: In study 1, we conducted focus groups to access a broad range of perspectives on the process of navigating the EI system, with the dual goals of identifying ways in which a patient-facing app might facilitate this process and identifying barriers to use with traditionally underrepresented and underserved groups. In study 2, focus group findings informed the development of a patient-facing app, which was subsequently tested with a pilot sample of 5 families. Methods: In study 1, the focus groups included 29 participants from 4 shareholder groups. Targeted sampling was used to recruit participants from traditionally underrepresented groups. Focus group questions sought information about barriers families experience as they navigate the EI system, ideal features of a patient-facing app designed to track family engagement with the EI system, and potential barriers. Focus group procedures were informed by the Consolidated Framework for Implementation Research framework. In study 2, a pilot app was developed. The app was tested with a sample of 5 families of young children involved in the EI system. Families provided information on app functionality and usability. Results: Qualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, potential utility of an app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track app and related implementation supports. App features included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. Field testing provided preliminary information about app usability, including identifying future directions. Conclusions: The results of this study could support the development of a new way for the EI system to communicate and connect with families, provide families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child's care. ",
doi="10.2196/45957",
url="https://humanfactors.jmir.org/2023/1/e45957",
url="http://www.ncbi.nlm.nih.gov/pubmed/37698912"
}


@Article{info:doi/10.2196/45694,
author="An, Qingfan
and Kelley, M. Marjorie
and Hanners, Audra
and Yen, Po-Yin",
title="Sustainable Development for Mobile Health Apps Using the Human-Centered Design Process",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="25",
volume="7",
pages="e45694",
keywords="mHealth",
keywords="mobile health",
keywords="apps",
keywords="human-centered design",
keywords="sociotechnical",
keywords="sustainability",
keywords="mobile technology",
keywords="speculative design",
keywords="mobile phone",
doi="10.2196/45694",
url="https://formative.jmir.org/2023/1/e45694",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624639"
}


@Article{info:doi/10.2196/45418,
author="Xiao, Jin
and Kopycka-Kedzierawski, Dorota
and Ragusa, Patricia
and Mendez Chagoya, Alberto Luis
and Funkhouser, Kimberly
and Lischka, Tamara
and Wu, Tong Tong
and Fiscella, Kevin
and Kar, Saswati Kumari
and Al Jallad, Nisreen
and Rashwan, Noha
and Ren, Johana
and Meyerowitz, Cyril
and ",
title="Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Aug",
day="18",
volume="10",
pages="e45418",
keywords="teledentistry",
keywords="mDentistry",
keywords="oral diseases",
keywords="virtual visit",
keywords="intraoral camera",
keywords="COVID-19",
keywords="pandemic response",
keywords="mobile phone",
abstract="Background: Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP). Objective: This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic. Methods: This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model. Results: A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos.?Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients' conditions. Conclusions: The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health--promoting behaviors. ",
doi="10.2196/45418",
url="https://humanfactors.jmir.org/2023/1/e45418",
url="http://www.ncbi.nlm.nih.gov/pubmed/37594795"
}


@Article{info:doi/10.2196/47436,
author="Ross, Jamie
and Hawkes, E. Rhiannon
and Miles, M. Lisa
and Cotterill, Sarah
and Bower, Peter
and Murray, Elizabeth",
title="Design and Early Use of the Nationally Implemented Healthier You National Health Service Digital Diabetes Prevention Programme: Mixed Methods Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="17",
volume="25",
pages="e47436",
keywords="digital health",
keywords="engagement",
keywords="diabetes prevention",
keywords="mobile phone",
abstract="Background: The Healthier You National Health Service Digital Diabetes Prevention Programme (NHS-digital-DPP) is a 9-month digital behavior change intervention delivered by 4 independent providers that is implemented nationally across England. No studies have explored the design features included by service providers of digital diabetes prevention programs to promote engagement, and little is known about how participants of nationally implemented digital diabetes prevention programs such as this one make use of them. Objective: This study aimed to understand engagement with the NHS-digital-DPP. The specific objectives were to describe how engagement with the NHS-digital-DPP is promoted via design features and strategies and describe participants' early engagement with the NHS-digital-DPP apps. Methods: Mixed methods were used. The qualitative study was a secondary analysis of documents detailing the NHS-digital-DPP intervention design and interviews with program developers (n=6). Data were deductively coded according to an established framework of engagement with digital health interventions. For the quantitative study, anonymous use data collected over 9 months for each provider representing participants' first 30 days of use of the apps were obtained for participants enrolled in the NHS-digital-DPP. Use data fields were categorized into 4 intervention features (Track, Learn, Coach Interactions, and Peer Support). The amount of engagement with the intervention features was calculated for the entire cohort, and the differences between providers were explored statistically. Results: Data were available for 12,857 participants who enrolled in the NHS-digital-DPP during the data collection phase. Overall, 94.37\% (12,133/12,857) of those enrolled engaged with the apps in the first 30 days. The median (IQR) number of days of use was 11 (2-25). Track features were engaged with the most (number of tracking events: median 46, IQR 3-22), and Peer Support features were the least engaged with, a median value of 0 (IQR 0-0). Differences in engagement with features were observed across providers. Qualitative findings offer explanations for the variations, including suggesting the importance of health coaches, reminders, and regular content updates to facilitate early engagement. Conclusions: Almost all participants in the NHS-digital-DPP started using the apps. Differences across providers identified by the mixed methods analysis provide the opportunity to identify features that are important for engagement with digital health interventions and could inform the design of other digital behavior change interventions. ",
doi="10.2196/47436",
url="https://www.jmir.org/2023/1/e47436",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590056"
}


@Article{info:doi/10.2196/44290,
author="Van Dooren, Martijn
and De Croon, Robin
and Swillen, Ann
and Verbert, Katrien",
title="Bridging the Communication Gap Between People With Cognitive Impairments and Their Caregivers Using mHealth Apps: User-Centered Design and Evaluation Study With People With 22q11 Deletion Syndrome",
journal="JMIR Hum Factors",
year="2023",
month="Aug",
day="16",
volume="10",
pages="e44290",
keywords="22q11 deletion syndrome",
keywords="22q11 DS",
keywords="cognitive impairments",
keywords="communication gap",
keywords="mHealth",
abstract="Background: In families with children with cognitive impairments, both parents and children experience tension and have questions because of a lack of communication and adequate information. Therefore, there is a great need to develop tools that can help bridge the communication gap between patients and caregivers by stimulating conversations and providing psychoeducational tools. mHealth apps show great potential in this context. Objective: The objective of this research is to discover the specific ways young people with cognitive impairments and their families interact with mHealth apps in the context of bridging the communication gap. This newly discovered information leads to potentially more impactful mHealth interventions in the future. Therefore, this paper documents the design and development of a mHealth app for a specific group of people with cognitive impairments---people with 22q11 deletion syndrome (22q11 DS)---and their caregivers, as well as key learnings from the evaluation of this app. Methods: An iterative, user-centered design approach is used to design and develop the app. Design and evaluation happens in 2 phases. During the design phase, feedback is gathered from 2 medical experts and 3 human computer interaction (HCI) experts using a low-fidelity paper prototype. During the evaluation phase, feedback is gathered from 8 families with a child with 22q11 DS using a fully working proof of concept. This phase consists of a semistructured interview, a 2-4--week trial period, and a concluding semistructured interview. Results: The evaluation results of the fully working proof of concept led to design recommendations related to four different topics: (1) overcoming usage barriers, (2) stimulating conversation through a mHealth app, (3) providing information, and (4) bringing continual added value. Results are presented according to six different categories obtained in a thematic analysis: (1) feedback about the app ``as is,'' (2) difficulties, (3) comparison between physical and digital tool, (4) extensions, (5) intention, and (6) other. Conclusions: In this research, the need for apps that help bridge the communication gap between a person with cognitive impairment and their caregiver is confirmed. All participating families express their gratitude and mention the added value for other families. Therefore, it is highly encouraged for clinics and institutions to take action and develop an app to be used in practice. Furthermore, considerations when developing for people with 22q11 DS, or more broadly, people with cognitive impairments, are proposed. First, one should keep design principles in mind to overcome usage barriers. Next, recognition is a key concept when stimulating conversations through mobile apps. Third, information should be provided by a trusted source, and more than just clinical information can be considered valuable. Finally, having the possibility of using a digital tool that can be personalized brings continual added value. ",
doi="10.2196/44290",
url="https://humanfactors.jmir.org/2023/1/e44290",
url="http://www.ncbi.nlm.nih.gov/pubmed/37585257"
}


@Article{info:doi/10.2196/46056,
author="Fischer, Ann-Kathrin
and M{\"u}hlbacher, C. Axel",
title="Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="10",
volume="12",
pages="e46056",
keywords="health preference research",
keywords="stated preference survey",
keywords="discrete choice experiment",
keywords="study protocol",
keywords="digital transformation",
keywords="digital technologies",
keywords="digital interventions",
keywords="health care",
keywords="rehabilitation",
keywords="stroke",
keywords="mobile phone",
abstract="Background: Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients' unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. Objective: This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. Methods: To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. Results: The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. Conclusions: Our results will inform decision makers about patients' and publics' acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. International Registered Report Identifier (IRRID): DERR1-10.2196/46056 ",
doi="10.2196/46056",
url="https://www.researchprotocols.org/2023/1/e46056",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561559"
}


@Article{info:doi/10.2196/45240,
author="Avramovi{\'c}, Petra
and Rietdijk, Rachael
and Kenny, Belinda
and Power, Emma
and Togher, Leanne",
title="Developing a Digital Health Intervention for Conversation Skills After Brain Injury (convers-ABI-lity) Using a Collaborative Approach: Mixed Methods Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="9",
volume="25",
pages="e45240",
keywords="brain injury",
keywords="cognitive-communication",
keywords="communication partner training",
keywords="digital health",
keywords="co-design",
abstract="Background: People with acquired brain injury (ABI) experience communication breakdown in everyday interactions many years after injury, negatively impacting social and vocational relationships. Communication partner training (CPT) is a recommended intervention approach in communication rehabilitation after ABI. Access to long-term services is essential, both in rural and remote locations. Digital health has potential to overcome the challenges of travel and improve cost efficiencies, processes, and clinical outcomes. Objective: We aimed to collaboratively develop a novel, multimodal web-based CPT intervention (convers-ABI-lity) with key stakeholders and evaluate its feasibility for improving conversation skills after brain injury. Methods: This mixed methods study consisted of 3 key stages guided by the Integrate, Design, Assess, and Share (IDEAS) framework for developing effective digital health interventions. Stage 1 included the integration of current end-user needs and perspectives with key treatment and theoretical components of existing evidence-based interventions, TBI Express and TBIconneCT. Stage 2 included the iterative design of convers-ABI-lity with feedback from end-user interviews (n=22) analyzed using content analysis. Participants were individuals with ABI, family members, health professionals, and paid support workers. Stage 3 included the evaluation of the feasibility through a proof-of-concept study (n=3). A total of 3 dyads (a person with ABI and their communication partner [CP]) completed 7 weeks of convers-ABI-lity, guided by a clinician. The outcome measures included blinded ratings of conversation samples and self-report measures. We analyzed postintervention participant interviews using content analysis to inform further intervention refinement and development. Results: Collaborative and iterative design and development during stages 1 and 2 resulted in the development of convers-ABI-lity. Results in stage 3 indicated positive changes in the blinded ratings of conversation samples for the participants with traumatic brain injury and their CPs. Statistically reliable positive changes were also observed in the self-report measures of social communication skills and quality of life. Intervention participants endorsed aspects of convers-ABI-lity, such as its complementary nature, self-guided web-based modules, clinician sessions, engaging content, and novel features. They reported the intervention to be relevant to their personal experience with cognitive-communication disorders. Conclusions: This study presents the outcome of using the IDEAS framework to guide the development of a web-based multimodal CPT intervention with input from key stakeholders. The results indicate promising outcomes for improving the conversation skills of people with ABI and their CPs. Further evaluation of intervention effectiveness and efficacy using a larger sample size is required. ",
doi="10.2196/45240",
url="https://www.jmir.org/2023/1/e45240",
url="http://www.ncbi.nlm.nih.gov/pubmed/37556179"
}


@Article{info:doi/10.2196/42912,
author="Mehra, Richa
and Pulman, Andy
and Dogan, Huseyin
and Murphy, Jane
and Bitters, Fiona",
title="A Tailored mHealth App for Improving Health and Well-Being Behavioral Transformation in UK Police Workers: Usability Testing via a Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Aug",
day="4",
volume="10",
pages="e42912",
keywords="nutrition",
keywords="activity",
keywords="behavior change",
keywords="telemedicine",
keywords="mobile health",
keywords="police",
keywords="lifestyle management",
keywords="management",
keywords="usability testing",
keywords="design",
keywords="build",
keywords="prototype",
keywords="testing",
keywords="survey",
keywords="interview",
keywords="development",
keywords="user center",
keywords="officer",
keywords="law enforcement",
keywords="cop",
keywords="detective",
keywords="policeman",
keywords="policing",
keywords="mobile phone",
abstract="Background: When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. Objective: The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. Methods: This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19\%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. Results: Data collected during usability testing concerned the 6 domains of the app---food and diet, activity, fluid intake, sleep, good mental health, and financial well-being---and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented---including shift management and catch-up cards---during this cycle of development. Conclusions: This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change. ",
doi="10.2196/42912",
url="https://humanfactors.jmir.org/2023/1/e42912",
url="http://www.ncbi.nlm.nih.gov/pubmed/37540549"
}


@Article{info:doi/10.2196/46050,
author="Figg, Lauren
and Addala, Ananta
and Jain, Ishaan
and Anez, Claudia
and Midney, Paul
and DeChirico, Corin
and Symanski, Colleen
and Fitzgerald, C. Brian
and Colbert, Kristi
and Raymer, Terry
and Stockton-Joreteg, Candy
and Murphy, Elizabeth
and Collins, Leah
and Bernstein, Cyd
and Hechavarria, Melanie
and Sheehan, P. Eleni
and Bernier, Angelina
and Westen, C. Sarah
and Hood, K. Korey
and Zaharieva, P. Dessi
and Basina, Marina
and Cuttriss, Nicolas
and Filipp, L. Stephanie
and Gurka, J. Matthew
and Walker, F. Ashby
and Maahs, M. David
and Haller, J. Michael
and Lal, A. Rayhan",
title="The Promising Success of Project Extension for Community Healthcare Outcomes (ECHO) Diabetes: Case Series",
journal="JMIR Diabetes",
year="2023",
month="Aug",
day="3",
volume="8",
pages="e46050",
keywords="type 1 diabetes",
keywords="care delivery",
keywords="primary care",
keywords="community health care",
abstract="Background: In the United States, there are over 37 million people with diabetes but only 8000 endocrinologists. Therefore, many people with diabetes receive care exclusively from primary care providers (PCPs). To democratize knowledge regarding insulin-requiring diabetes through tele-education, Stanford University and the University of Florida developed Project Extension for Community Healthcare Outcomes (ECHO) Diabetes. Objective: ECHO Diabetes uses a Hub and Spoke model connecting specialists (the ``Hub'') with PCPs (the ``Spokes''). One-hour, weekly sessions include Hub diabetes didactic presentations and Spoke deidentified case presentations. Lessons learned during these sessions target provider knowledge and confidence surrounding diabetes management and patient care. Methods: Spokes were asked to provide short descriptions of people with diabetes whose diabetes management improved directly or indirectly from their providers' participation or their involvement with a Diabetes Support Coach (DSC). We provide a case series to describe individuals and outcomes. Because this study was not a randomized controlled trial and was a prospective observation of patients with the intervention delivered to providers, the trial is not registered in a public trials registry. Results: A case series of 11 people with diabetes was compiled from 10 PCPs and 1 DSC from California and Florida between 2021 and 2022. The principal impact of ECHO Diabetes is the education amplified from PCPs and DSCs to people with diabetes. In all cases, people with diabetes reported increased engagement and improved diabetes management. Several cases reflected increased access to diabetes technology, improvement in glycemic outcomes, and positive trends in mental health measures. Conclusions: This case series elucidates the potential value of the ECHO Diabetes program to people with diabetes who receive their diabetes care from PCPs. Those matched with a DSC saw clinically significant improvements in hemoglobin A1c and mental health outcomes. ",
doi="10.2196/46050",
url="https://diabetes.jmir.org/2023/1/e46050",
url="http://www.ncbi.nlm.nih.gov/pubmed/37535407"
}


@Article{info:doi/10.2196/47877,
author="M{\"u}ssener, Ulrika
and Henriksson, Pontus
and Gustavsson, Catharina
and Henriksson, Hanna
and Tyrberg, J. M{\aa}rten
and Johansson, Stefan
and Alfredsson {\AA}gren, Kristin",
title="Promoting Healthy Behaviors Among Adolescents and Young Adults With Intellectual Disability: Protocol for Developing a Digital Intervention With Co-Design Workshops",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="28",
volume="12",
pages="e47877",
keywords="intellectual disability",
keywords="lifestyle behavior",
keywords="eHealth",
keywords="co-design",
keywords="digital intervention",
keywords="lifestyle",
keywords="adolescents",
keywords="young adult",
keywords="healthy diet",
abstract="Background: Intellectual disability (ID) is a neurodevelopmental disorder associated with a poorer health profile and higher mortality. Young people with ID have more sedentary lifestyles than their typically developing peers. Consequently, this group is at significant risk of developing lifestyle diseases (ie, noncommunicable diseases) later in life. Increasing physical activity and eating a healthier diet have been argued to be effective ways to improve the health of adolescents and young adults with ID. Digital interventions are a viable option for improving health behaviors. Objective: This research protocol describes a co-design approach using workshops to develop a digital intervention that promotes healthy behaviors, including increasing physical activity and eating a healthier diet, among adolescents and young adults with ID. Methods: A participatory design using a co-design approach will be applied as a strategy to include potential users of the digital intervention and other stakeholders in the research process, comprising research design, data collection, and data analysis. A total of 7 to 10 workshops will be conducted aimed at developing a digital intervention and will include procedures for assessing needs; facilitators and barriers to health promotion; physical, mental, and social well-being; participation; and relationships. The workshops will include 12 to 18 stakeholders with experience of clinical practice and research related to young people with ID, including relatives, as well as adolescents and young adults (aged 16-25 years) with mild to moderate ID. Participants will perform a mixture of individual and group work using whiteboards, sticky notes, felt-tip pens, cards, balls, stickers, and wireframe templates. Data analysis will take place concurrently with data collection as an iterative process. Transcribed data from the audio and video recordings of the groups' discussions will be analyzed following a qualitative methodological procedure. Results: This study protocol provides a systematic record of the scientific methodologies used when developing the digital intervention and provides insights into the potential practical solutions and challenges when following a co-design approach in which relatives and professionals, as well as adolescents and young adults with ID, are included as research partners. Recruitment of participants started in April 2023. Data collection, analysis, and reporting will be completed in December 2023. Conclusions: This study will explore the effectiveness of workshops at gathering rich, reliable, and valid data in a co-design approach with participants. The results will provide increased knowledge in how to use technology to develop novel, evidence-based, and scalable interventions that adolescents and young adults with ID can and want to use to motivate physical activity and a healthier diet. The project will provide a simple and cognitively accessible digital solution for promoting lifestyle behaviors tailored to the needs of adolescents and young adults with ID. International Registered Report Identifier (IRRID): PRR1-10.2196/47877 ",
doi="10.2196/47877",
url="https://www.researchprotocols.org/2023/1/e47877",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505807"
}


@Article{info:doi/10.2196/42768,
author="McCue, Maggie
and Khatib, Rasha
and Kabir, Christopher
and Blair, Chris
and Fehnert, Ben
and King, James
and Spalding, Alexander
and Zaki, Lara
and Chrones, Lambros
and Roy, Anit
and Kemp, E. David",
title="User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="26",
volume="10",
pages="e42768",
keywords="depression",
keywords="major depressive disorder",
keywords="depression management",
keywords="patient engagement",
keywords="user-centered design",
keywords="mobile app",
keywords="digital platform",
keywords="qualitative research",
keywords="shared decision-making",
keywords="measurement-based care",
keywords="mobile phone",
abstract="Background: Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. Objective: This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. Methods: Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. Results: In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. Conclusions: Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team--facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey. ",
doi="10.2196/42768",
url="https://humanfactors.jmir.org/2023/1/e42768",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494099"
}


@Article{info:doi/10.2196/45099,
author="Wong, K. Alex W.
and Fong, M. Mandy W.
and Munsell, S. Elizabeth G.
and Metts, L. Christopher
and Lee, I. Sunghoon
and Nicol, E. Ginger
and DePaul, Olivia
and Tomazin, E. Stephanie
and Kaufman, J. Katherine
and Mohr, C. David",
title="Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="24",
volume="10",
pages="e45099",
keywords="mobile health",
keywords="digital intervention",
keywords="technology",
keywords="SMS text messaging",
keywords="intervention mapping",
keywords="behavior change",
keywords="self-management",
keywords="stroke",
keywords="rehabilitation",
keywords="mobile phone",
abstract="Background: Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. Objective: This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. Methods: We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. Results: In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). Conclusions: We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life. ",
doi="10.2196/45099",
url="https://humanfactors.jmir.org/2023/1/e45099",
url="http://www.ncbi.nlm.nih.gov/pubmed/37486748"
}


@Article{info:doi/10.2196/47916,
author="Judica, Elda
and Tropea, Peppino
and Bou{\c{c}}a-Machado, Raquel
and Mar{\'i}n, Mayca
and Calarota, Elisa
and Cozma, Liviu
and Badea, Raluca
and Ahmed, Mona
and Brach, Michael
and Ferreira, J. Joaquim
and Corbo, Massimo",
title="Personalized Integrated Care Promoting Quality of Life for Older People: Protocol for a Multicenter Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="24",
volume="12",
pages="e47916",
keywords="Parkinson disease",
keywords="dementia",
keywords="neurodegenerative",
keywords="chronic diseases",
keywords="health care technologies",
keywords="integrated care",
abstract="Background: Alzheimer disease (AD) and Parkinson disease (PD) are the 2 most common neurodegenerative diseases affecting millions of people worldwide. The Personalized Integrated Care Promoting Quality of Life for Older People (PC4L) project proposes an integrated, scalable, and interactive care ecosystem that can be easily adapted to the needs of several neurodegenerative and chronic diseases, care institutions, and end user requirements. Objective: The study protocol developed within the framework of the PC4L project aims to iteratively test the integrated platform and its modules, and focuses primarily on assessing the impact of the proposed solution (ie, the PC4L platform) on patients' quality of life, as well as its usability and feasibility on a large-scale sample size in 3 different scenarios (home, neurorehabilitation, and day care centers). Methods: A prospective multicenter clinical study is conducted in 5 European countries (Germany, Italy, Portugal, Romania, and Spain) at 6 different pilot centers, for 3 months, in patients with PD, Parkinsonism, AD, and other dementias (ODs). Patients were randomized in a ratio of 1:1 to the intervention group (use of the PC4L system) or the control group (no intervention). The PC4L system consists mainly of a wristband for monitoring parameters such as steps and levels of physical activity, and the PC4L app, which includes different engaging functionalities. Both groups are assessed through baseline and end-of-study clinical evaluations, including assessment of quality of life through the EQ-5D-3L scale. Results: The study protocol is part of a project approved and funded by the European Commission Horizon 2020 (grant agreement number 875221). The ethics committees of all involved centers reviewed and approved the study protocol. The study began with the recruitment phase in September 2022, and enrollment ended in February 2023. Recruitment is now closed (April 2023). The results of this study are expected to be published in summer 2023. A total of 558 patients, 279 per study group, were recruited. The results will allow to clarify the impact of PC4L on quality of life, will assess the empowerment of patients and the medical resources use, as well as the usability of the final version of the PC4L system. It will also provide information on the support of the system as a tool to facilitate the decision-making process. Conclusions: The PC4L project intends to test a technology-based, integrated, scalable, and interactive care platform on patients with neurodegenerative diseases and proposes a good coordinated care model between all involved actors. Future developments of the PC4L solution may involve caregivers and socio-health professionals in the decision-making process in order to facilitate efficient communication between all stakeholders and ensure reliable and protected access to data within Europe. Trial Registration: ClinicalTrials.gov NCT05538455; https://clinicaltrials.gov/study/NCT05538455 International Registered Report Identifier (IRRID): DERR1-10.2196/47916 ",
doi="10.2196/47916",
url="https://www.researchprotocols.org/2023/1/e47916",
url="http://www.ncbi.nlm.nih.gov/pubmed/37486732"
}


@Article{info:doi/10.2196/46849,
author="Wrightson-Hester, Aimee-Rose
and Anderson, Georgia
and Dunstan, Joel
and McEvoy, M. Peter
and Sutton, J. Christopher
and Myers, Bronwyn
and Egan, Sarah
and Tai, Sara
and Johnston-Hollitt, Melanie
and Chen, Wai
and Gedeon, Tom
and Mansell, Warren",
title="An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="21",
volume="10",
pages="e46849",
keywords="mental health",
keywords="conversational agents",
keywords="chatbots",
keywords="young people",
keywords="acceptability",
keywords="feasibility",
keywords="co-design",
keywords="artificial therapist",
keywords="artificial intelligence",
keywords="youth",
keywords="child",
keywords="adolescent",
keywords="chatbot",
keywords="Manage Your Life Online",
keywords="MYLO",
keywords="support",
keywords="mobile phone",
abstract="Background: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems. Objective: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems. Methods: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements. Results: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants' problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks. Conclusions: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants' symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial. ",
doi="10.2196/46849",
url="https://humanfactors.jmir.org/2023/1/e46849",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477969"
}


@Article{info:doi/10.2196/44943,
author="Barker, M. Mary
and Chauhan, Radhika
and Davies, J. Melanie
and Brough, Christopher
and Northern, Alison
and Stribling, Bernie
and Schreder, Sally
and Khunti, Kamlesh
and Hadjiconstantinou, Michelle",
title="User Retention and Engagement in the Digital-Based Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (myDESMOND) Program: Descriptive Longitudinal Study",
journal="JMIR Diabetes",
year="2023",
month="Jul",
day="21",
volume="8",
pages="e44943",
keywords="retention",
keywords="engagement",
keywords="digital self-management",
keywords="type 2 diabetes",
keywords="mobile phone",
abstract="Background: Digital health interventions have the potential to improve the physical and psychosocial health of people living with type 2 diabetes. However, research investigating the long-term (?1 year) retention and engagement of users within these programs is limited. Objective: The aim of this study was to evaluate long-term user retention and engagement in the digital-based Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (myDESMOND) program, using real-world data. Methods: Anonymized data from all myDESMOND users who registered with the program on or before November 16, 2020, were included in the analyses. User retention was defined as the period between the day a user registered with the myDESMOND program and their last day of access. The primary engagement outcome was defined as the total number of log-ins to the program per user. The associations between retention, engagement, and sociodemographic factors (age, sex, and ethnicity) were tested using Cox regression models and Wilcoxon rank sum tests. Results: A total of 9522 myDESMOND users were included in this analysis. Of the 9522 users, 5360 (56.29\%) remained on the program for at least a month, whereas 1676 (17.6\%) remained on the program for at least 1 year. Retention was significantly higher among older users; the adjusted hazard ratio (representing the risk of users leaving the program within the first year) among users aged ?50 years, compared with those aged <50 years, was 0.79 (95\% CI 0.75-0.84; P<.001). The median number of myDESMOND log-ins per user was 8 (IQR 4-8); however, this was significantly lower among users aged <50 years (P<.001). Engagement metrics also differed according to sociodemographic characteristics; the estimated time spent per log-in was 5.35 (IQR 2.22-11.80) minutes among all users; however, this was significantly higher among female users (P<.001), users aged ?50 years (P<.001), and users of White ethnicity (P=.02). Conclusions: Although retention and engagement of users within myDESMOND were found to be high, these findings highlight the need for age- and culture-specific implementation strategies and content adaptations to improve retention and engagement among all users of self-management programs. ",
doi="10.2196/44943",
url="https://diabetes.jmir.org/2023/1/e44943",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477963"
}


@Article{info:doi/10.2196/45598,
author="Busse, Sophie Theresa
and Jux, Chantal
and Laser, Johannes
and Rasche, Peter
and Vollmar, Christian Horst
and Ehlers, P. Jan
and Kernebeck, Sven",
title="Involving Health Care Professionals in the Development of Electronic Health Records: Scoping Review",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="10",
volume="10",
pages="e45598",
keywords="user-centered design",
keywords="electronic health records",
keywords="electronic medical records",
keywords="digital technology",
keywords="technology development",
keywords="stakeholder participation",
abstract="Background: Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences. Objective: Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes. Methods: We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved. Results: In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63\%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used. Conclusions: This review provides insights into the diversity of health care professionals' involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies. ",
doi="10.2196/45598",
url="https://humanfactors.jmir.org/2023/1/e45598",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428524"
}


@Article{info:doi/10.2196/43214,
author="Shouldice, Claire Ainslie
and Beatty, Madison
and Adams, Sherri
and Dharmaraj, Blossom
and Moore, Clara
and Stinson, Nan Jennifer
and Desai, Arti
and Bartlett, Leah
and Culbert, Erin
and Cohen, Eyal
and Orkin, Julia",
title="Caregivers' Experiences With a Web- and Mobile-Based Platform for Children With Medical Complexity and the Role of a Live Platform Coach: Thematic Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="5",
volume="6",
pages="e43214",
keywords="care coordination",
keywords="care",
keywords="children with medical complexity",
keywords="children",
keywords="chronic condition",
keywords="electronic data",
keywords="engagement",
keywords="health information exchange",
keywords="medical",
keywords="patient care planning",
keywords="pediatrics",
keywords="usage",
keywords="utilization",
abstract="Background: Children with medical complexity (CMC) are individuals with complex chronic conditions who have substantial health care needs, functional limitations, and significant use of health care. By nature of their health status, they have many care providers across multiple settings, making information sharing critical to their health and safety. Connecting2gether (C2), a web- and mobile-based patient-facing platform, was codeveloped with families to support and empower parental caregivers, improve information sharing, and facilitate care delivery. C2 also provided a live platform coach to conduct parental feedback and coaching sessions, which included answering questions, providing advice on usage, and addressing technological issues. Objective: This study was conducted to understand the experience of parental caregivers using the C2 platform and the role of the live platform coach. This study is a subset of a larger study assessing the feasibility of C2 in the care of CMC. Methods: Parental caregivers (n=33) participated in biweekly sessions to provide feedback and receive real-time platform use support from a trained research team member acting as a live platform coach. Parental caregivers were asked about the utility and usability of C2's features. Questions, platform issues, and feedback were recorded on a standardized electronic data collection tool. A thematic analysis was performed to analyze parental comments, and codes were categorized into key themes. The number of comments corresponding with each code was quantified. Results: A total of 166 parental feedback and coaching sessions were conducted, with an average of 5 sessions per parental caregiver (range 1-7). There were 33 (85\%) parental caregivers that participated in at least one coaching session. Technical issues and difficulties navigating C2 were addressed in real time during the sessions to encourage platform engagement. Four key themes were identified: (1) live platform coach, (2) barriers to platform usage and technical challenges, (3) platform requests and modifications, and (4) parent partnership and empowerment. Conclusions: Parental caregivers describe C2 as a valuable tool, acting as a facilitator for enhanced care coordination and communication. Parental caregiver feedback showed that the live platform coach was a critical tool in educating on platform use and addressing technological concerns. Further study of the use of the C2 platform and its role in the care of CMC is needed to understand the possible benefits and cost-effectiveness of this technology. ",
doi="10.2196/43214",
url="https://pediatrics.jmir.org/2023/1/e43214",
url="http://www.ncbi.nlm.nih.gov/pubmed/37405834"
}


@Article{info:doi/10.2196/48499,
author="Lin, Yufen
and Porter, S. Laura
and Chee, Wonshik
and Alese, B. Olatunji
and Curseen, A. Kimberly
and Higgins, K. Melinda
and Northouse, Laurel
and Xiao, Canhua",
title="A Web-Based Dyadic Intervention to Manage Psychoneurological Symptoms for Patients With Colorectal Cancer and Their Caregivers: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="28",
volume="12",
pages="e48499",
keywords="chemotherapy",
keywords="colorectal cancer",
keywords="intervention",
keywords="symptoms",
keywords="web-based program",
abstract="Background: Patients with colorectal cancer (CRC) receiving chemotherapy often experience psychoneurological symptoms (PNS; ie, fatigue, depression, anxiety, sleep disturbance, pain, and cognitive dysfunction) that negatively impact both patients' and their caregivers' health outcomes. Limited information is available on PNS management for CRC patient and caregiver dyads. Objective: The purposes of this study are to (1) develop a web-based dyadic intervention for patients with CRC receiving chemotherapy and their caregivers (CRCweb) and (2) evaluate the feasibility, acceptability, and preliminary effects of CRCweb among patient-caregiver dyads in a cancer clinic. Methods: A mixed methods approach will be used. Semistructured interviews among 8 dyads will be conducted to develop CRCweb. A single-group pre- and posttest clinical trial will be used to examine the feasibility, acceptability, and preliminary effects of the intervention (CRCweb) among 20 dyads. Study assessments will be conducted before (T1) and after intervention (T2). Content analysis will be performed for semistructured interviews. Descriptive statistics will be calculated separately for patients and caregivers, and pre-post paired t tests will be used to evaluate treatment effects. Results: This study was funded in November 2022. As of April 2023, we have obtained institutional review board approval and completed clinical trial registration and are currently recruiting patient-caregiver dyads in a cancer clinic. The study is expected to be completed in October 2024. Conclusions: Developing a web-based dyadic intervention holds great promise to reduce the PNS burden in patients with CRC receiving chemotherapy and their caregivers. The findings from this study will advance intervention development and implementation of symptom management and palliative care for patients with cancer and their caregivers. Trial Registration: ClinicalTrials.gov NCT05663203; https://clinicaltrials.gov/ct2/show/NCT05663203 International Registered Report Identifier (IRRID): PRR1-10.2196/48499 ",
doi="10.2196/48499",
url="https://www.researchprotocols.org/2023/1/e48499",
url="http://www.ncbi.nlm.nih.gov/pubmed/37379055"
}


@Article{info:doi/10.2196/44549,
author="Alpers, Rieke
and K{\"u}hne, Lisa
and Truong, Hong-Phuc
and Zeeb, Hajo
and Westphal, Max
and J{\"a}ckle, Sonja",
title="Evaluation of the EsteR Toolkit for COVID-19 Decision Support: Sensitivity Analysis and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="27",
volume="7",
pages="e44549",
keywords="COVID-19",
keywords="public health",
keywords="decision support tool",
keywords="sensitivity analysis",
keywords="web application",
keywords="usability study",
abstract="Background: During the COVID-19 pandemic, local health authorities were responsible for managing and reporting current cases in Germany. Since March 2020, employees had to contain the spread of COVID-19 by monitoring and contacting infected persons as well as tracing their contacts. In the EsteR project, we implemented existing and newly developed statistical models as decision support tools to assist in the work of the local health authorities. Objective: The main goal of this study was to validate the EsteR toolkit in two complementary ways: first, investigating the stability of the answers provided by our statistical tools regarding model parameters in the back end and, second, evaluating the usability and applicability of our web application in the front end by test users. Methods: For model stability assessment, a sensitivity analysis was carried out for all 5 developed statistical models. The default parameters of our models as well as the test ranges of the model parameters were based on a previous literature review on COVID-19 properties. The obtained answers resulting from different parameters were compared using dissimilarity metrics and visualized using contour plots. In addition, the parameter ranges of general model stability were identified. For the usability evaluation of the web application, cognitive walk-throughs and focus group interviews were conducted with 6 containment scouts located at 2 different local health authorities. They were first asked to complete small tasks with the tools and then express their general impressions of the web application. Results: The simulation results showed that some statistical models were more sensitive to changes in their parameters than others. For each of the single-person use cases, we determined an area where the respective model could be rated as stable. In contrast, the results of the group use cases highly depended on the user inputs, and thus, no area of parameters with general model stability could be identified. We have also provided a detailed simulation report of the sensitivity analysis. In the user evaluation, the cognitive walk-throughs and focus group interviews revealed that the user interface needed to be simplified and more information was necessary as guidance. In general, the testers rated the web application as helpful, especially for new employees. Conclusions: This evaluation study allowed us to refine the EsteR toolkit. Using the sensitivity analysis, we identified suitable model parameters and analyzed how stable the statistical models were in terms of changes in their parameters. Furthermore, the front end of the web application was improved with the results of the conducted cognitive walk-throughs and focus group interviews regarding its user-friendliness. ",
doi="10.2196/44549",
url="https://formative.jmir.org/2023/1/e44549",
url="http://www.ncbi.nlm.nih.gov/pubmed/37368487"
}


@Article{info:doi/10.2196/41881,
author="Massa, Paula
and de Souza Ferraz, Aur{\'e}lia Dulce
and Magno, Laio
and Silva, Paula Ana
and Greco, Mar{\'i}lia
and Dourado, In{\^e}s
and Grangeiro, Alexandre",
title="A Transgender Chatbot (Amanda Selfie) to Create Pre-exposure Prophylaxis Demand Among Adolescents in Brazil: Assessment of Acceptability, Functionality, Usability, and Results",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="23",
volume="25",
pages="e41881",
keywords="artificial intelligence",
keywords="adolescent",
keywords="HIV pre-exposure prophylaxis",
keywords="transgender women",
keywords="men who have sex with men",
keywords="chatbot",
keywords="PrEP",
keywords="transgender",
keywords="HIV",
keywords="prevention",
keywords="prophylaxis",
keywords="acceptability",
abstract="Background: HIV incidence rates have increased in adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). Thus, it is essential to promote access to HIV prevention, including pre-exposure prophylaxis (PrEP), among these groups. Moreover, using artificial intelligence and online social platforms to create demand and access to health care services are essential tools for adolescents and youth. Objective: This study aims to describe the participative process of developing a chatbot using artificial intelligence to create demand for PrEP use among AMSM and ATGW in Brazil. Furthermore, it analyzes the chatbot's acceptability, functionality, and usability and its results on the demand creation for PrEP. Methods: The chatbot Amanda Selfie integrates the demand creation strategies based on social networks (DCSSNs) of the PrEP1519 study. She was conceived as a Black transgender woman and to function as a virtual peer educator. The development process occurred in 3 phases (conception, trial, and final version) and lasted 21 months. A mixed methodology was used for the evaluations. Qualitative approaches, such as in-depth adolescent interviews, were used to analyze acceptability and usability, while quantitative methods were used to analyze the functionality and result of the demand creation for PrEP based on interactions with Amanda and information from health care services about using PrEP. To evaluate Amanda's result on the demand creation for PrEP, we analyzed sociodemographic profiles of adolescents who interacted at least once with her and developed a cascade model containing the number of people at various stages between the first interaction and initiation of PrEP (PrEP uptake). These indicators were compared with other DCSs developed in the PrEP1519 study using chi-square tests and residual analysis (P=.05). Results: Amanda Selfie was well accepted as a peer educator, clearly and objectively communicating on topics such as gender identity, sexual experiences, HIV, and PrEP. The chatbot proved appropriate for answering questions in an agile and confidential manner, using the language used by AMSM and ATGW and with a greater sense of security and less judgment. The interactions with Amanda Selfie combined with a health professional were well evaluated and improved the appointment scheduling. The chatbot interacted with most people (757/1239, 61.1\%) reached by the DCSSNs. However, when compared with the other DCSSNs, Amanda was not efficient in identifying AMSM/ATGW (359/482, 74.5\% vs 130/757, 17.2\% of total interactions, respectively) and in PrEP uptake (90/359, 25.1\% vs 19/130, 14.6\%). The following profiles were associated (P<.001) with Amanda Selfie's demand creation, when compared with other DCS: ATGW and adolescents with higher levels of schooling and White skin color. Conclusions: Using a chatbot to create PrEP demand among AMSM and ATGW was well accepted, especially for ATGW with higher levels of schooling. A complimentary dialog with a health professional increased PrEP uptake, although it remained lower than the results of the other DCSSNs. ",
doi="10.2196/41881",
url="https://www.jmir.org/2023/1/e41881",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351920"
}


@Article{info:doi/10.2196/44089,
author="Rouleau, Genevi{\`e}ve
and Thiruganasambandamoorthy, Venkatesh
and Wu, Kelly
and Ghaedi, Bahareh
and Nguyen, Anh Phuong
and Desveaux, Laura",
title="Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid Physicians in the Clinical Management of Patients With Syncope: Systematic Theoretical and User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="13",
volume="10",
pages="e44089",
keywords="emergency medicine",
keywords="physicians",
keywords="qualitative research",
keywords="risk management",
keywords="syncope",
keywords="user-centered design",
abstract="Background: The Canadian Syncope Risk Score (CSRS) was developed to improve syncope management in emergency department settings. Evidence-based tools often fail to have the intended impact because of suboptimal uptake or poor implementation. Objective: In this paper, we aimed to describe the process of developing evidence-based implementation strategies to support the deployment and use of the CSRS in real-world emergency department settings to improve syncope management among physicians. Methods: We followed a systematic approach for intervention development, including identifying who needs to do what differently, identifying the barriers and enablers to be addressed, and identifying the intervention components and modes of delivery to overcome the identified barriers. We used the Behaviour Change Wheel to guide the selection of implementation strategies. We engaged CSRS end users (ie, emergency medicine physicians) in a user-centered design approach to generate and refine strategies. This was achieved over a series of 3 qualitative user-centered design workshops lasting 90 minutes each with 3 groups of emergency medicine physicians. Results: A total of 14 physicians participated in the workshops. The themes were organized according to the following intervention development steps: theme 1---identifying and refining barriers and theme 2---identifying the intervention components and modes of delivery. Theme 2 was subdivided into two subthemes: (1) generating high-level strategies and developing strategies prototypes and (2) refining and testing strategies. The main strategies identified to overcome barriers included education in the format of meetings, videos, journal clubs, and posters (to address uncertainty around when and how to apply the CSRS); the development of a web-based calculator and integration into the electronic medical record (to address uncertainty in how to apply the CSRS); a local champion (to address the lack of team buy-in); and the dissemination of evidence summaries and feedback through email communications (to address a lack of evidence about impact). Conclusions: The ability of the CSRS to effectively improve patient safety and syncope management relies on broad buy-in and uptake across physicians. To ensure that the CSRS is well positioned for impact, a comprehensive suite of strategies was identified to address known barriers. ",
doi="10.2196/44089",
url="https://humanfactors.jmir.org/2023/1/e44089",
url="http://www.ncbi.nlm.nih.gov/pubmed/37310783"
}


@Article{info:doi/10.2196/42843,
author="Monkman, Helen
and Griffith, Janessa
and MacDonald, Leah
and Lesselroth, Blake",
title="Consumers' Needs for Laboratory Results Portals: Questionnaire Study",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="12",
volume="10",
pages="e42843",
keywords="consumer health information",
keywords="user-centered design",
keywords="clinical laboratory information systems",
keywords="laboratory test result",
keywords="patient portal",
keywords="laboratory result",
keywords="facilitator",
keywords="barrier",
keywords="information system",
keywords="questionnaire",
keywords="usability",
abstract="Background: Over the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment. Objective: We aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety. Methods: A web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed. Results: Participants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention. Conclusions: There are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety. ",
doi="10.2196/42843",
url="https://humanfactors.jmir.org/2023/1/e42843",
url="http://www.ncbi.nlm.nih.gov/pubmed/37307049"
}


@Article{info:doi/10.2196/43551,
author="Stringer, Eleah
and Lum, J. Julian
and Livergant, Jonathan
and Kushniruk, W. Andre",
title="Decision Aids for Patients With Head and Neck Cancer: Qualitative Elicitation of Design Recommendations From Patient End Users",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="5",
volume="10",
pages="e43551",
keywords="decision support",
keywords="decision aid",
keywords="app design",
keywords="oncology",
keywords="head and neck cancer",
keywords="patient information needs",
keywords="qualitative",
abstract="Background: Patients with head and neck cancer (HNC) carry a clinically significant symptom burden, have alterations in function (eg, impaired ability to chew, swallow, and talk), and decrease in quality of life. Furthermore, treatment impacts social activities and interactions as patients report reduced sexuality and shoulder the highest rates of depression across cancer types. Patients suffer undue anxiety because they find the treatment incomprehensible, which is partially a function of limited, understandable information. Patients' perceptions of having obtained adequate information prior to and during treatment are predictive of positive outcomes. Providing patient-centered decision support and utilizing visual images may increase understanding of treatment options and associated risks to improve satisfaction with their decision and consultation, while reducing decisional conflict. Objective: This study aims to gather requirements from survivors of HNC on the utility of key visual components to be used in the design of an electronic decision aid (eDA) to assist with decision-making on treatment options. Methods: Informed by a scoping review on eDAs for patients with HNC, screens and visualizations for an eDA were created and then presented to 12 survivors of HNC for feedback on their utility, features, and further requirements. The semistructured interviews were video-recorded and thematically analyzed to inform co-design recommendations. Results: A total of 9 themes were organized into 2 categories. The first category, eDAs and decision support, included 3 themes: familiarity with DAs, support of concept, and versatility of the prototype. The second category, evaluation of mock-up, contained 6 themes: reaction to the screens and visualizations, favorite features, complexity, preference for customizability, presentation device, and suggestions for improvement. Conclusions: All participants felt an eDA, used in the presence of their oncologist, would support a more thorough and transparent explanation of treatment or augment the quality of education received. Participants liked the simple design of the mock-ups they were shown but, ultimately, desired customizability to adapt the eDA to their individual information needs. This research highlights the value of user-centered design, rooted in acceptability and utility, in medical health informatics, recognizing cancer survivors as the ultimate knowledge holders. This research highlights the value of incorporating visuals into technology-based innovations to engage all patients in treatment decisions. ",
doi="10.2196/43551",
url="https://humanfactors.jmir.org/2023/1/e43551",
url="http://www.ncbi.nlm.nih.gov/pubmed/37276012"
}


@Article{info:doi/10.2196/41810,
author="Stawarz, Katarzyna
and Liang, Ju Ian
and Alexander, Lyndsay
and Carlin, Angela
and Wijekoon, Anjana
and Western, J. Max",
title="Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study",
journal="JMIR Aging",
year="2023",
month="May",
day="24",
volume="6",
pages="e41810",
keywords="physical activity",
keywords="older adults",
keywords="Internet of Things",
keywords="user-centered design",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Older adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Objective: Our aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. Methods: Following a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults' (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants' homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. Results: The results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants' everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants' attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. Conclusions: Older adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them. ",
doi="10.2196/41810",
url="https://aging.jmir.org/2023/1/e41810",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223992"
}


@Article{info:doi/10.2196/44462,
author="Johansen, Kristoffer Simon
and Kanstrup, Marie Anne
and Haseli, Kian
and Stenmo, Hildebrandt Visti
and Thomsen, Laust Janus
and Rathleff, Skovdal Michael",
title="Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study",
journal="JMIR Hum Factors",
year="2023",
month="Apr",
day="28",
volume="10",
pages="e44462",
keywords="mobile health",
keywords="mHealth",
keywords="design",
keywords="patient physician relationship",
keywords="collaborative care",
keywords="shared decision-making",
keywords="adolescents",
keywords="parents",
keywords="knee pain",
keywords="patellofemoral pain",
keywords="Osgood Schlatter",
keywords="musculoskeletal",
keywords="general practice",
keywords="primary care",
keywords="mobile phone",
abstract="Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. Objective: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. Methods: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. Results: Overall, 38\% (9/24) young adults with chronic knee pain since adolescence, 25\% (6/24) parents, and 38\% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. Conclusions: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. ",
doi="10.2196/44462",
url="https://humanfactors.jmir.org/2023/1/e44462",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115609"
}


@Article{info:doi/10.2196/44354,
author="Tomas, Vanessa
and Hsu, Shaelynn
and Kingsnorth, Shauna
and Anagnostou, Evdokia
and Kirsh, Bonnie
and Lindsay, Sally",
title="Development and Usability Testing of a Web-Based Workplace Disability Disclosure Decision Aid Tool for Autistic Youth and Young Adults: Qualitative Co-design Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="27",
volume="7",
pages="e44354",
keywords="autism",
keywords="decision aids",
keywords="co-design",
keywords="disability disclosure",
keywords="employment",
keywords="knowledge translation",
keywords="patient-oriented research",
keywords="qualitative",
keywords="usability testing",
keywords="youth and young adults",
abstract="Background: Deciding whether and how to disclose one's autism at work is complex, especially for autistic youth and young adults who are newly entering the labor market and still learning important decision-making and self-determination skills. Autistic youth and young adults may benefit from tools to support disclosure processes at work; however, to our knowledge, no evidence-based, theoretically grounded tool exists specifically for this population. There is also limited guidance on how to pursue the development of such a tool in collaboration with knowledge users. Objective: This study aimed to co-design a prototype of a disclosure decision aid tool with and for Canadian autistic youth and young adults, explore the perceived usability of the prototype (usefulness, satisfaction, and ease of use) and make necessary revisions, and outline the process used to achieve the aforementioned objectives. Methods: Taking a patient-oriented research approach, we engaged 4 autistic youths and young adults as collaborators on this project. Prototype development was guided by co-design principles and strategies, and tool content was informed by a previous needs assessment led by our team, the autistic collaborators' lived experiences, considering intersectionality, research on knowledge translation (KT) tool development, and recommendations from the International Patient Decision Aid Standards. We co-designed a web-based PDF prototype. To assess perceived usability and experiences with the prototype, we conducted 4 participatory design and focus group Zoom (Zoom Video Communications) sessions with 19 Canadian autistic youths and young adults aged 16 to 29 (mean 22.8, SD 4.1) years. We analyzed the data using a combined conventional (inductive) and modified framework method (deductive) analysis to map the data onto usability indicators (usefulness, satisfaction, and ease of use). Grounded in participants' feedback, considering factors of feasibility and availability of resources, and ensuring tool fidelity, we revised the prototype. Results: We developed 4 categories pertaining to the perceived usability of and participant experiences with the prototype: past disclosure experiences, prototype information and activities, prototype design and structure, and overall usability. Participant feedback was favorable and indicative of the tool's potential impact and usability. The usability indicator requiring the most attention was ease of use, which was prioritized when revising the prototype. Our findings highlight the importance of engaging knowledge users throughout the entire prototype co-design and testing processes; incorporating co-design strategies and principles; and having content informed by relevant theories, evidence, and knowledge users' experiences. Conclusions: We outline an innovative co-design process that other researchers, clinicians, and KT practitioners may consider when developing KT tools. We also developed a novel, evidence-based, and theoretically informed web-based disclosure decision aid tool that may help autistic youth and young adults navigate disclosure processes and improve their transitional outcomes as they enter the workforce. ",
doi="10.2196/44354",
url="https://formative.jmir.org/2023/1/e44354",
url="http://www.ncbi.nlm.nih.gov/pubmed/37104002"
}


@Article{info:doi/10.2196/42564,
author="Xie, Feng Li
and Housni, Asmaa
and Nakhla, Meranda
and Cianci, Rosemarie
and Leroux, Catherine
and Da Costa, Deborah
and Brazeau, Anne-Sophie",
title="Adaptation of an Adult Web Application for Type 1 Diabetes Self-management to Youth Using the Behavior Change Wheel to Tailor the Needs of Health Care Transition: Qualitative Interview Study",
journal="JMIR Diabetes",
year="2023",
month="Apr",
day="26",
volume="8",
pages="e42564",
keywords="type 1 diabetes",
keywords="youth",
keywords="eHealth",
keywords="self-management",
keywords="mobile phone",
keywords="peer support",
abstract="Background: Youth (aged 14-24 years) living with type 1 diabetes (T1D) encounter increased challenges in their diabetes self-management (DSM), especially during the transition to adult care. Although DSM education and support are imperative, there is insufficient information on how web-based digital tools tailored to their demands can be developed. Objective: On the basis of the Behavior Change Wheel, this study aims to identify, among youth living with T1D, the needs and factors influencing their DSM in the context of health care transition and to inform the adaptation (content and features) of an adult self-guided web application (Support). Methods: Internet-based semistructured individual interviews based on a phenomenological study design were conducted with 21 youths, and transcripts were analyzed using an inductive approach with concept mapping. Results: Factors influencing T1D self-management were categorized into barriers and facilitators and then as external or internal. Features influencing the accessibility to information, increasing the sense of support, and use of the tool were positively accepted. Features unrelated to their expectations of digital tool use or difficulty navigating were viewed negatively. Participants expressed an interest in reliable, practical, and novel educational content. Although youth considered the information provided by medical professionals to be important, peer exchange was deemed necessary to obtain a practical perspective and real-life examples. Conclusions: Compared with the adult population, in addition to tailored content and a simplified information search process, when building a DSM education and support digital tool for youth, features should be selected to encourage supervised peer exchange. ",
doi="10.2196/42564",
url="https://diabetes.jmir.org/2023/1/e42564",
url="http://www.ncbi.nlm.nih.gov/pubmed/37121571"
}


@Article{info:doi/10.2196/41179,
author="Speiser, Dorothee
and Heibges, Maren
and Besch, Laura
and Hilger, Caren
and Keinert, Marie
and Klein, Katharina
and Rauwolf, Gudrun
and Schmid, Christine
and Schulz-Niethammer, Sven
and Stegen, Steffi
and Westfal, Viola
and Witzel, Isabell
and Zang, Benedikt
and Kendel, Friederike
and Feufel, A. Markus",
title="Paradigmatic Approach to Support Personalized Counseling With Digital Health (iKNOW)",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="21",
volume="7",
pages="e41179",
keywords="hereditary breast and ovarian cancer",
keywords="BRCA",
keywords="genetic counseling",
keywords="digital health",
keywords="online counseling tool",
keywords="user-centered design principles",
keywords="risk communication",
keywords="cancer risk",
keywords="hereditary cancer",
keywords="breast cancer",
keywords="ovarian cancer",
doi="10.2196/41179",
url="https://formative.jmir.org/2023/1/e41179",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083496"
}


@Article{info:doi/10.2196/37515,
author="Chen, Elizabeth
and Bishop, Jared
and Guge Cozon, Lindsay
and Hernandez, Eduardo
and Sadeghzadeh, Claire
and Bradley, Megan
and Dearth-Wesley, Tracy
and De Marco, Molly",
title="Integrating Human-Centered Design Methods Into a Health Promotion Project: Supplemental Nutrition Assistance Program Education Case Study for Intervention Design",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="21",
volume="7",
pages="e37515",
keywords="human-centered design",
keywords="design thinking",
keywords="program development",
keywords="stakeholder engagement",
keywords="nutrition",
keywords="parenting",
keywords="children",
keywords="pediatrics",
abstract="Background: Human-centered design, or design thinking, offers an extensive toolkit of methods and strategies for user-centered engagement that lends itself well to intervention development and implementation. These methods can be applied to the fields of public health and medicine to design interventions that may be more feasible and viable in real-world contexts than those developed with different methods. Objective: The design team aimed to develop approaches to building food skills among caregivers of children aged 0-5 years who are eligible for a federal food assistance program while they were in the grocery store. Methods: They applied 3 specific human-centered design methods---Extremes and Mainstreams, Journey Mapping, and Co-Creation Sessions---to collaboratively develop intervention approaches to enhance Supplemental Nutrition Assistance Program Education (SNAP-Ed) reach and impact across food retail settings. Extremes and Mainstreams is a specific kind of purposive sampling that selects individuals based on characteristics beyond demographics. Journey Mapping is a visual tool that asks individuals to identify key moments and decision points during an experience. Co-Creation Sessions are choreographed opportunities for individuals to explicitly contribute to the design of a solution alongside research or design team members. Results: Ten caregivers with diverse lived experiences were selected to participate in remote design thinking workshops and create individual journey maps to depict their grocery store experiences. Common happy points and pain points were identified. Nine stakeholders, including caregivers, SNAP-Ed staff, and grocery store dieticians, cocreated 2 potential intervention approaches informed by caregivers' experiences and needs: a rewards program and a meal box option. Conclusions: These 3 human-centered design methods led to a meaningful co-design process where proposed interventions aligned with caregivers' wants and needs. This case study provides other public health practitioners with specific examples of how to use these methods in program development and stakeholder engagement as well as lessons learned when adapting these methods to remote settings. ",
doi="10.2196/37515",
url="https://formative.jmir.org/2023/1/e37515",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083485"
}


@Article{info:doi/10.2196/43782,
author="Sch{\"u}ttler, Christina
and Zerlik, Maria
and Gruendner, Julian
and K{\"o}hler, Thomas
and Rosenau, Lorenz
and Prokosch, Hans-Ulrich
and Sedlmayr, Brita",
title="Empowering Researchers to Query Medical Data and Biospecimens by Ensuring Appropriate Usability of a Feasibility Tool: Evaluation Study",
journal="JMIR Hum Factors",
year="2023",
month="Apr",
day="19",
volume="10",
pages="e43782",
keywords="usability evaluation",
keywords="ontology",
keywords="feasibility queries",
keywords="user-centered design",
keywords="clinical research informatics",
keywords="user interface",
abstract="Background: The Aligning Biobanking and Data Integration Centers Efficiently project aims to harmonize technologies and governance structures of German university hospitals and their biobanks to facilitate searching for patient data and biospecimens. The central element will be a feasibility tool for researchers to query the availability of samples and data to determine the feasibility of their study project. Objective: The objectives of the study were as follows: an evaluation of the overall user interface usability of the feasibility tool, the identification of critical usability issues, comprehensibility of the underlying ontology operability, and analysis of user feedback on additional functionalities. From these, recommendations for quality-of-use optimization, focusing on more intuitive usability, were derived. Methods: To achieve the study goal, an exploratory usability test consisting of 2 main parts was conducted. In the first part, the thinking aloud method (test participants express their thoughts aloud throughout their use of the tool) was complemented by a quantitative questionnaire. In the second part, the interview method was combined with supplementary mock-ups to collect users' opinions on possible additional features. Results: The study cohort rated global usability of the feasibility tool based on the System Usability Scale with a good score of 81.25. The tasks assigned posed certain challenges. No participant was able to solve all tasks correctly. A detailed analysis showed that this was mostly because of minor issues. This impression was confirmed by the recorded statements, which described the tool as intuitive and user friendly. The feedback also provided useful insights regarding which critical usability problems occur and need to be addressed promptly. Conclusions: The findings indicate that the prototype of the Aligning Biobanking and Data Integration Centers Efficiently feasibility tool is headed in the right direction. Nevertheless, we see potential for optimization primarily in the display of the search functions, the unambiguous distinguishability of criteria, and the visibility of their associated classification system. Overall, it can be stated that the combination of different tools used to evaluate the feasibility tool provided a comprehensive picture of its usability. ",
doi="10.2196/43782",
url="https://humanfactors.jmir.org/2023/1/e43782",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074765"
}


@Article{info:doi/10.2196/41321,
author="Hollier, M. John
and Strickland, A. Tiant{\'a}
and Fordis, Michael C.
and van Tilburg, AL Miranda
and Shulman, J. Robert
and Thompson, Debbe",
title="Children's and Caregivers' Review of a Guided Imagery Therapy Mobile App Designed to Treat Children With Functional Abdominal Pain Disorders: Leveraging a Mixed Methods Approach With User-Centered Design",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="19",
volume="7",
pages="e41321",
keywords="guided imagery therapy",
keywords="guided imagery",
keywords="psychotherapy",
keywords="disorders of gut-brain interaction",
keywords="functional abdominal pain disorders",
keywords="pediatric",
keywords="pain",
keywords="mobile app",
keywords="mobile health",
keywords="mHealth",
keywords="mixed methods research",
keywords="usability",
keywords="gamification",
keywords="user-centered design",
keywords="guided image therapy",
keywords="app prototype",
keywords="prototype",
keywords="feedback",
keywords="children",
keywords="child",
keywords="youths",
keywords="caregiver",
keywords="mobile phone",
abstract="Background: Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform. Objective: Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers. Methods: Children aged 7 to 12 years with Rome IV--defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized. Results: We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69\% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75\% (12/16) of children and 69\% (11/16) of caregivers had difficulty setting the reminder notification. The children's interviews confirmed the app's usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app's usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app's ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children's motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation. Conclusions: Children and caregivers rated our GIT app's usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements. ",
doi="10.2196/41321",
url="https://formative.jmir.org/2023/1/e41321",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074773"
}


@Article{info:doi/10.2196/44661,
author="Murray, B. Jennifer
and Sharp, Alexander
and Munro, Sarah
and Janssen, A. Patricia",
title="Expectant Parents' Preferences for Teaching by Texting: Development and Usability Study of SmartMom",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="18",
volume="7",
pages="e44661",
keywords="pregnancy",
keywords="pregnant",
keywords="prenatal",
keywords="patient education",
keywords="text message",
keywords="SMS text messaging",
keywords="prenatal education",
keywords="mHealth",
keywords="evidence-based health care",
keywords="mobile app",
keywords="Canada",
keywords="mobile health",
keywords="preference",
keywords="focus group",
keywords="information need",
keywords="user need",
abstract="Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81\%) used at least 1 app for prenatal education. Our analysis revealed that ``having reliable information is the most important thing'' (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (``It was nice to have that [information] fed to you''; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom's opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology--based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations. ",
doi="10.2196/44661",
url="https://formative.jmir.org/2023/1/e44661",
url="http://www.ncbi.nlm.nih.gov/pubmed/37071451"
}


@Article{info:doi/10.2196/41726,
author="Yip, Jason
and Wong, Kelly
and Oh, Isabella
and Sultan, Farisha
and Roldan, Wendy
and Lee, Jin Kung
and Huh, Jimi",
title="Co-design Tensions Between Parents, Children, and Researchers Regarding Mobile Health Technology Design Needs and Decisions: Case Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="14",
volume="7",
pages="e41726",
keywords="just-in-time adaptive intervention",
keywords="JITAI",
keywords="mobile health",
keywords="mHealth",
keywords="participatory design",
keywords="co-design",
keywords="children and families",
keywords="Black, Indigenous, and people of color",
keywords="BIPOC",
keywords="child-computer interaction",
keywords="design",
keywords="children",
keywords="mobile intervention",
keywords="intervention",
keywords="development",
keywords="mobile phone",
abstract="Background: Just-in-time adaptive interventions (JITAIs) in mobile health are an intervention design that provides behavior change support based on an individual's changing and dynamic contextual state. However, few studies have documented how end users of JITAI technologies are involved in their development, particularly from historically marginalized families and children. Less is known for public health researchers and designers of the tensions that occur as families negotiate their needs. Objective: We aimed to broaden our understanding of how historically marginalized families are included in co-design from a public health perspective. We sought to address research questions surrounding JITAIs; co-design; and working with historically marginalized families, including Black, Indigenous, and people of color (BIPOC) children and adults, regarding improving sun protection behaviors. We sought to better understand value tensions in parents' and children's needs regarding mobile health technologies and how design decisions are made. Methods: We examined 2 sets of co-design data (local and web-based) pertaining to a larger study on mobile SunSmart JITAI technologies with families in Los Angeles, California, United States, who were predominantly of Latinx and multiracial backgrounds. In these co-design sessions, we conducted stakeholder analysis through perceptions of harms and benefits and an assessment of stakeholder views and values. We open coded the data and compared the developed themes using a value-sensitive design framework by examining value tensions to help organize our qualitative data. Our study is formatted through a narrative case study that captures the essential meanings and qualities that are difficult to present, such as quotes in isolation. Results: We presented 3 major themes from our co-design data: different experiences with the sun and protection, misconceptions about the sun and sun protection, and technological design and expectations. We also provided value flow (opportunities for design), value dam (challenges to design), or value flow or dam (a hybrid problem) subthemes. For each subtheme, we provided a design decision and a response we ended up making based on what was presented and the kinds of value tensions we observed. Conclusions: We provide empirical data to show what it is like to work with multiple BIPOC stakeholders in the roles of families and children. We demonstrate the use of the value tension framework to explain the different needs of multiple stakeholders and technology development. Specifically, we demonstrate that the value tension framework helps sort our participants' co-design responses into clear and easy-to-understand design guidelines. Using the value tension framework, we were able to sort the tensions between children and adults, family socioeconomic and health wellness needs, and researchers and participants while being able to make specific design decisions from this organized view. Finally, we provide design implications and guidance for the development of JITAI mobile interventions for BIPOC families. ",
doi="10.2196/41726",
url="https://formative.jmir.org/2023/1/e41726",
url="http://www.ncbi.nlm.nih.gov/pubmed/37058350"
}


@Article{info:doi/10.2196/41211,
author="Yates, Eloise
and Buckley, Lisa
and Sterling, Michele
and Cruwys, Tegan
and Ashton-James, E. Claire
and Rankin, Renee
and Elphinston, A. Rachel",
title="Interest in Digital Peer-Delivered Interventions and Preferences to Improve Pain Self-efficacy and Reduce Loneliness Among Patients With Chronic Pain: Mixed Methods Co-design Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="14",
volume="7",
pages="e41211",
keywords="chronic noncancer pain",
keywords="pain",
keywords="self-efficacy",
keywords="peer support",
keywords="peer-led intervention",
keywords="peer-led",
keywords="peer delivered",
keywords="peer intervention",
keywords="pain self-efficacy",
keywords="social connectedness",
keywords="social support",
keywords="loneliness",
keywords="lonely",
keywords="social isolation",
keywords="co-design",
keywords="participatory design",
keywords="qualitative research",
keywords="digital health",
abstract="Background: Two important factors that prolong and exacerbate chronic noncancer pain (CNCP) and disability are low pain self-efficacy and loneliness. Yet, few interventions have shown long-term sustained improvements in pain self-efficacy, and there are no evidence-based treatments that target social connectedness in people living with CNCP. More effective and accessible interventions designed to target self-efficacy and social connectedness could ease the burden of CNCP. Objective: To co-design accessible interventions to increase pain self-efficacy, social connection, pain-related outcomes, and quality of life, this study explored patients' interest and preferences for digital peer-delivered interventions for CNCP as well as implementation barriers and enablers. Methods: This cross-sectional mixed methods study was part of a larger longitudinal cohort study. Adult Australian residents (N=186) with CNCP diagnosed by a medical professional or pain specialist were included. Participants were initially recruited through advertising on professional pain social media accounts and websites. Questions examined whether patients were interested in digital peer-delivered interventions and their preferences for specific features (eg, Newsfeed). Pain self-efficacy and loneliness were assessed using validated questionnaires, and the association between these factors and interest in digital peer-delivered support was explored. Open-ended questions explored implementation barriers, enablers, and suggestions for consideration in intervention design. Results: There was interest in accessing digital peer-delivered interventions, with almost half of the sample indicating that they would access it if it was available. Those who indicated an interest in digital peer interventions reported both lower pain self-efficacy and greater loneliness than those who were not interested. Intervention content that incorporated education, links to health services and resources, and delivery of support by peer coaches were the most frequently preferred intervention features. Three potential benefits were identified: shared experience, social connection, and shared pain management solutions. Five potential barriers were identified: negative focus on pain, judgment, lack of engagement, negative impact on mental health, privacy and security concerns, and unmet personal preferences. Finally, there were 8 suggestions from participants: moderation of the group, interest subgroups, professional-led activities, psychological strategies, links to professional pain resources, newsletter, motivational content, live streaming, and online meetups. Conclusions: Digital peer-delivered interventions were of particular interest to those with CNCP who had lower levels of pain self-efficacy and higher levels of loneliness. Future co-design work could tailor digital peer-delivered interventions to these unmet needs. Intervention preferences and implementation barriers and enablers identified in this study could guide further co-design and the development of such interventions. ",
doi="10.2196/41211",
url="https://formative.jmir.org/2023/1/e41211",
url="http://www.ncbi.nlm.nih.gov/pubmed/37058351"
}


@Article{info:doi/10.2196/35112,
author="Faber, S. Jasper
and Poot, C. Charlotte
and Dekkers, Tessa
and Romero Herrera, Natalia
and Chavannes, H. Niels
and Meijer, Eline
and Visch, T. V.",
title="Developing a Digital Medication Adherence Intervention for and With Patients With Asthma and Low Health Literacy: Protocol for a Participatory Design Approach",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="12",
volume="7",
pages="e35112",
keywords="participatory design",
keywords="low health literacy",
keywords="eHealth",
keywords="medication adherence",
keywords="asthma",
keywords="mHealth",
keywords="health literacy",
keywords="participatory medicine",
keywords="health care",
keywords="medication",
abstract="Background: Current eHealth interventions are poorly adopted by people with low health literacy (LHL) as they often fail to meet their needs, skills, and preferences. A major reason for this poor adoption is the generic, one-size-fits-all approach taken by designers of these interventions, without addressing the needs, skills, and preferences of disadvantaged groups. Participatory design approaches are effective for developing interventions that fit the needs of specific target groups; yet, very little is known about the practical implications of executing a participatory design project for and with people with LHL. Objective: This study aimed to demonstrate the application of participatory design activities specifically selected to fit the needs and skills of people with LHL and how these were manifested within an overarching eHealth design process. In addition, the study aims to present reflections and implications of these activities that could support future designers to engage people with LHL in their design processes. Methods: We used the design process of a smart asthma inhaler for people with asthma and LHL to demonstrate participatory design activities. The study was framed under 5 stages of design thinking: empathize, define, ideate, prototype, and test within 2 major iteration cycles. We integrated 3 participatory design activities deemed specifically appropriate for people with LHL: co-constructing stories, experience prototype exhibition, and video prototype evaluation. Results: Co-constructing stories was found to deepen the understanding of the participant's motivation to use or not to use maintenance medication. This understanding informed and facilitated the subsequent development of diverse preliminary prototypes of possible interventions. Discussing these prototypes in the experience prototype exhibition helped provoke reactions, thoughts, and feelings about the interventions, and potential scenarios of use. Through the video prototype evaluation, we were able to clearly communicate the goal and functionality of the final version of our intervention and gather appropriate responses from our participants. Conclusions: This study demonstrates a participatory design approach for and with patients with asthma and LHL. We demonstrated that careful consideration and selection of activities can result in participants that are engaged and feel understood. This paper provides insight into the practical implications of participatory activities with people with LHL and supports and inspires future designers to engage with this disadvantaged target group. ",
doi="10.2196/35112",
url="https://formative.jmir.org/2023/1/e35112",
url="http://www.ncbi.nlm.nih.gov/pubmed/37043260"
}


@Article{info:doi/10.2196/43904,
author="Hernandez Hernandez, Elena Maria
and Michalak, Erin
and Choudhury, Nusrat
and Hewko, Mark
and Torres, Ivan
and Menon, Mahesh
and Lam, W. Raymond
and Chakrabarty, Trisha",
title="Co-design of a Virtual Reality Cognitive Remediation Program for Depression (bWell-D) With Patient End Users and Clinicians: Qualitative Interview Study Among Patients and Clinicians",
journal="JMIR Serious Games",
year="2023",
month="Apr",
day="7",
volume="11",
pages="e43904",
keywords="depression",
keywords="cognitive remediation",
keywords="cognitive dysfunction",
keywords="thematic analysis",
keywords="virtual reality",
keywords="VR",
keywords="qualitative study",
keywords="user-centered design",
keywords="immersive",
keywords="co-design",
keywords="depressive",
keywords="mental health",
keywords="mental illness",
abstract="Background: Major depressive disorder (MDD) is the leading cause of global disability; however, the existing treatments do not always address cognitive dysfunction---a core feature of MDD. Immersive virtual reality (VR) has emerged as a promising modality to enhance the real-world effectiveness of cognitive remediation. Objective: This study aimed to develop the first prototype VR cognitive remediation program for MDD (``bWell-D''). This study gathered qualitative data from end users early in the design process to enhance its efficacy and feasibility in clinical settings. Methods: Semistructured end-user interviews were conducted remotely (n=15 patients and n=12 clinicians), assessing the participants' perceptions and goals for a VR cognitive remediation program. Video samples of bWell-D were also shared to obtain feedback regarding the program. The interviews were transcribed, coded, and analyzed via thematic analysis. Results: End users showed an optimistic outlook toward VR as a treatment modality, and perceived it as a novel approach with the potential of having multiple applications. The participants expressed a need for an engaging VR treatment that included realistic and multisensorial settings and activities, as well as customizable features. Some skepticism regarding its effectiveness was also reported, especially when the real-world applications of the practiced skills were not made explicit, as well as some concerns regarding equipment accessibility. A home-based or hybrid (ie, home and clinic) treatment modality was preferred. Conclusions: Patients and clinicians considered bWell-D interesting, acceptable, and potentially feasible, and provided suggestions to enhance its real-world applicability. The inclusion of end-user feedback is encouraged when developing future VR programs for clinical purposes. ",
doi="10.2196/43904",
url="https://games.jmir.org/2023/1/e43904",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027183"
}


@Article{info:doi/10.2196/40932,
author="Lundstedt, Rikard
and Persson, Johanna
and H{\aa}kansson, Carita
and Frennert, Susanne
and Wallerg{\aa}rd, Mattias",
title="Designing Virtual Natural Environments for Older Adults: Think-Aloud Study",
journal="JMIR Hum Factors",
year="2023",
month="Apr",
day="7",
volume="10",
pages="e40932",
keywords="virtual natural environments",
keywords="user-centered design",
keywords="qualitative method",
keywords="real-time 3D graphics",
keywords="older adults",
abstract="Background: Spending time in natural environments is beneficial for human health, but many older adults have limited or no access to natural environments. Virtual reality technology may be a means to facilitate nature experiences, and so, there is a need for knowledge on how to design virtual restorative natural environments for older adults. Objective: The aim of this study was to identify, implement, and test older adults' preferences and ideas regarding virtual natural environments. Methods: A total of 14 older adults (mean age 75, SD 5.9 years) participated in an iterative process to design such an environment. We used think-aloud protocols and qualitative content analysis and established questionnaires that targeted usability, affective aspects, and side effects. These data guided the design decisions for incremental implementations of a prototype. Results: The participants' preferences included trueness to reality in terms of rendition and behavior; traces of human activity and natural processes that trigger the imagination and provide believability; the ability to roam, explore, and interact with the environment; and a familiar, relatable environment that evokes memories. The iterative design process resulted in a prototype featuring many of the participants' ideas and preferences, including a seated locomotion technique, animals, a boat ride, the discovery of a boat wreck, and apple picking. The questionnaire results indicated high perceived usability, interest, and enjoyment; low pressure and tension; moderate value and usefulness; and negligible side effects. Conclusions: We suggested 3 principles for virtual natural environments for older adults: realness, interactivity, and relatedness. Virtual natural environments should also provide a diversity of content and activities to accommodate the heterogeneity in older adults' preferences. These results can contribute to a framework for designing virtual natural environments for older adults. However, these findings need to be tested and potentially revised in future studies. ",
doi="10.2196/40932",
url="https://humanfactors.jmir.org/2023/1/e40932",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027206"
}


@Article{info:doi/10.2196/42556,
author="Bally, S. Esmee L.
and Cheng, Demi
and van Grieken, Amy
and Ferri Sanz, Mireia
and Zanutto, Oscar
and Carroll, Aine
and Darley, Andrew
and Roozenbeek, Bob
and Dippel, J. Diederik W.
and Raat, Hein",
title="Patients' Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="4",
volume="25",
pages="e42556",
keywords="stroke patients",
keywords="digital health technology",
keywords="self-management",
keywords="co-design",
keywords="user-requirements",
keywords="user-centered design",
keywords="qualitative research",
abstract="Background: Digital technologies such as mobile apps and robotics have the potential to involve stroke patients better in the care process and to promote self-management. However, barriers exist that constrain the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for health-related technology. To address these barriers, co-design can be used to enable patients to reflect on their experiences of a service and to tailor digital technologies to the needs and preferences of end users regarding content and usability. Objective: This study aims to explore the perspectives of stroke patients toward how digital health technology could support self-management regarding health and well-being, as well as integrated stroke care. Methods: A qualitative study was conducted to understand patient perspectives. Data were collected in co-design sessions during the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on sociodemographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach. Results: Patients held mixed attitudes toward digital health technologies. Some patients viewed digital technology as a convenient product or service, while others expressed no desire or need to use technology for self-management or care. Digital features suggested by stroke patients included (1) information about the causes of stroke, medication, prognosis, and follow-up care; (2) an online library with information regarding stroke-related health and care issues; (3) a personal health record by which patients can retrieve and manage their own health information; and (4) online rehabilitation support to empower patients to exercise at home. Regarding the user interface of future digital health technology, patients emphasized the need for easy-to-use and simple designs. Conclusions: Stroke patients mentioned credible health information, an online library with stroke-related health and care information, a personal health record, and online rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the ``voice of the stroke patients'' regarding both functionality and the characteristics of the interface. International Registered Report Identifier (IRRID): RR2-10.1186/s12877-022-03333-8 ",
doi="10.2196/42556",
url="https://www.jmir.org/2023/1/e42556",
url="http://www.ncbi.nlm.nih.gov/pubmed/37014677"
}


@Article{info:doi/10.2196/41222,
author="Lobchuk, Michelle
and Hoplock, Lisa
and Harder, Nicole
and Friesen, Marcia
and Rempel, Julie
and Bathi, Reddy Prachotan",
title="Usability Testing of a Web-Based Empathy Training Portal: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="4",
volume="7",
pages="e41222",
keywords="web application",
keywords="usability",
keywords="mixed design research",
keywords="internet",
keywords="empathy",
keywords="mobile phone",
keywords="mobile devices",
abstract="Background: The prepandemic period saw a rise in web-based teaching. However, web-based tools for teaching the essential clinical skill of cognitive empathy (also known as perspective taking) remain limited. More of these tools are needed and require testing for ease of use and understanding by students. Objective: This study aimed to evaluate the usability of the In Your Shoes web-based empathy training portal application for students using quantitative and qualitative methods. Methods: This 3-phase formative usability study used a mixed methods design. In mid-2021, we conducted a remote observation of student participants interacting with our portal application. Their qualitative reflections were captured, followed by data analysis and iterative design refinements of the application. Overall, 8 third- and fourth-year nursing students from an undergraduate baccalaureate program at a Canadian university, in the western province of Manitoba, were included in this study. Participants in phases 1 and 2 were remotely observed by 3 research personnel while engaged in predefined tasks. In phase 3, two student participants were asked to use the application as they liked in their own environments, after which a video-recorded exit interview with a think-aloud process was conducted as participants responded to the System Usability Scale. We calculated descriptive statistics and performed content analysis to analyze the results. Results: This small study included 8 students with a range of technology skills. Usability themes were based on participants' comments on the application's appearance, content, navigation, and functionality. The biggest issues that participants experienced were with navigating the application's ``tagging'' features during video analysis and the length of educational material. We also observed variations in 2 participants' system usability scores in phase 3. This may be because of their different comfort levels with technology; however, additional research is required. We made iterative refinements to our prototype application (eg, added pop-up messages and provided a narrated video on the application's ``tagging'' function) based on participant feedback. Conclusions: With increasing engagement in web-based teaching, technology has become an essential medium for receiving health care education. We developed a novel prototype application as a supplemental classroom tool to foster students' self-directed learning of empathy. This study provided direction for refinements to optimize the usability of and satisfaction with this innovative application. Qualitative feedback revealed favorable input toward learning perspective taking place on the web and helpful recommendations for improving user experiences with the application. We could not fully assess the application's key functions owing to the COVID-19 protocols. Thus, our next step is to obtain feedback from a larger sample of student users, whose experiences performing ``live'' video capture, annotation, and analysis will be more authentic and wholesome with the refined application. We discuss our findings in relation to research on nursing education, perspective taking, and adaptive e-learning. ",
doi="10.2196/41222",
url="https://formative.jmir.org/2023/1/e41222",
url="http://www.ncbi.nlm.nih.gov/pubmed/37014693"
}


@Article{info:doi/10.2196/41441,
author="McCann, Lisa
and Hewitt, Christopher
and McMillan, A. Kathryn",
title="Developing an e-Prehabilitation System of Care for Young Adults Diagnosed With Cancer: User-Centered Design Study",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="30",
volume="9",
pages="e41441",
keywords="digital health",
keywords="human factors",
keywords="user-centered",
keywords="prehabilitation",
keywords="young adults",
keywords="cancer",
abstract="Background: A diagnosis of cancer in adolescence or young adulthood can pose many different and unique challenges for individuals, as well as their families and friends. Drawing on the concept of prehabilitation, the provision of high-quality, accessible, timely, reliable, and appropriate information, care, and support for young adults with cancer and their families is critical to ensure that they feel equipped and empowered to make informed decisions relating to their treatment and care. Increasingly, digital health interventions offer opportunities to augment current health care information and support provision. Co-designing these digital health interventions can help to ensure that they are meaningful and relevant to the patient cohort, thereby maximizing their accessibility and acceptability. Objective: This study had 4 primary interlinked objectives: understand the support needs of young adults with cancer at the time of diagnosis, understand the potential role of a digital health solution to assist in the delivery of prehabilitation for young adults with cancer, identify appropriate technologies and technological platforms for a digital prehabilitation system of care, and develop a prototype for a digital prehabilitation system of care. Methods: This was a qualitative study using interviews and surveys. Young adults aged 16 to 26 years diagnosed with cancer within the last 3 years were invited to participate in individual user-requirement interviews or surveys. Health care professionals specializing in the treatment and care of young adults with cancer and digital health professionals working in the industry were also interviewed or completed a survey. Consensus feedback interviews were conducted with 3 young adults and 2 health care professionals after the development of the first generation of the prototype app. Results: In total, 7 individual interviews and 8 surveys were completed with young adults with a range of cancer diagnoses. Moreover, 6 individual interviews and 9 surveys were completed with health care professionals, and 3 digital health professionals participated in one-on-one interviews. A prototype app with the working name of Cancer Helpmate was developed based on these collective participant data. Overall, feedback from participants across the data collection activities suggests that the concept for the app was positive during these developmental stages. Further insightful ideas for the app's future development were also identified. Conclusions: Young adults with cancer and health care professionals are responsive to the need for more digitally driven services to be developed. Further development of an app such as Cancer Helpmate, which incorporates key features and functionalities directly informed by users, could help to augment the support provided to young adults with cancer. ",
doi="10.2196/41441",
url="https://cancer.jmir.org/2023/1/e41441",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995740"
}


@Article{info:doi/10.2196/43251,
author="Chen, You
and Clayton, Wright Ellen
and Novak, Lovett Laurie
and Anders, Shilo
and Malin, Bradley",
title="Human-Centered Design to Address Biases in Artificial Intelligence",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="24",
volume="25",
pages="e43251",
keywords="artificial intelligence",
keywords="human-centered AI",
keywords="biases",
keywords="AI",
keywords="care",
keywords="biomedical",
keywords="research",
keywords="application",
keywords="human-centered",
keywords="development",
keywords="design",
keywords="patient",
keywords="health",
keywords="benefits",
doi="10.2196/43251",
url="https://www.jmir.org/2023/1/e43251",
url="http://www.ncbi.nlm.nih.gov/pubmed/36961506"
}


@Article{info:doi/10.2196/38504,
author="Mak, S. Winnie W.
and Ng, Man Sin
and Leung, T. Florence H.",
title="A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="22",
volume="7",
pages="e38504",
keywords="user-centered design",
keywords="qualitative research",
keywords="usability testing",
keywords="mental health",
keywords="self-care",
keywords="stratified stepped care",
keywords="internet-based psychological interventions",
abstract="Background: Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users' continued adoption and practice of self-care for their mental health. Objective: The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users' perceptions on mental self-care and feedback on the platform design and incorporates them into the design. Methods: The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach. Results: In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses. Conclusions: The design process and findings presented in the study are important in developing a user-centric platform to optimize users' acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users' perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web. ",
doi="10.2196/38504",
url="https://formative.jmir.org/2023/1/e38504",
url="http://www.ncbi.nlm.nih.gov/pubmed/36947112"
}


@Article{info:doi/10.2196/44122,
author="Day, Sarah
and Ncube, Vuyolwethu
and Maja, Lactricia
and Wasunna, Beatrice
and Pienaar, Jacqueline
and Setswe, Geoffrey
and Waweru, Evelyn
and Feldacker, Caryl",
title="Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="22",
volume="7",
pages="e44122",
keywords="digital health innovation",
keywords="usability",
keywords="health care workers perspectives",
keywords="low- and middle-income countries",
keywords="two-way texting",
keywords="postoperative telehealth",
keywords="male circumcision",
keywords="South Africa",
keywords="mobile phone",
abstract="Background: Voluntary medical male circumcision (VMMC) is a safe and effective HIV prevention strategy. However, adherence to recommended in-person, postoperative follow-up is inefficient for procedures with few adverse events. Two-way texting (2wT)--based follow-up appears to be a safe and an efficient alternative to scheduled clinic visits for low-risk patients who underwent VMMC. To ensure that 2wT responds to the needs of health care workers (HCWs) and patients, HCWs were closely involved in app design using a human-centered design (HCD) approach. Objective: Embedded within an ongoing randomized controlled trial of 2wT in South Africa and complementary HCD processes of 2wT app optimization, this qualitative study aimed to use key informant interviews (KIIs) to explore the thoughts, suggestions, and opinions on and perceptions of 2wT's usability and acceptability among HCWs involved in 2wT implementation in both urban and rural South Africa. Methods: A total of 7 HCWs using 2wT in Gauteng and the North West province participated in KIIs regarding the usability and acceptability of 2wT. HCWs were asked for their opinions on 2wT as a viable, useful, appropriate, and accessible method of postoperative VMMC care. They were also asked about 2wT-related working, exploring areas where 2wT could add to or reduce their daily tasks. The KII data were explored, coded, and analyzed by 3 qualitative researchers using thematic content analysis and the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software. Results: Most HCWs felt confident, comfortable, satisfied, and well supported using a 2wT-based follow-up as an alternative to in-person clinical reviews. They felt that 2wT was easy to use and required little technical support after initial mentoring on how to use the 2wT system. Few noted safety concerns, as men can receive clinical guidance, reassurance, and referral via 2wT. Although fewer in-person visits reduced the in-person review workload and eased clinical flow, HCWs noted the added burden of having to interact with clients via SMS text messages on evenings or weekends. HCWs reinforced the need for enhanced postoperative counseling to ensure that 2wT patients could recognize and understood how to respond to early signs of complications. HCWs suggested a rotation to spread the evening and weekend workload and ensure swift patient responses. Conclusions: In this formative qualitative study focused on HCWs, 2wT was a highly usable alternative to in-person postoperative reviews for patients who underwent VMMC in South Africa. The HCD processes likely improved the usability and acceptability of 2wT for HCWs. HCWs supported the scale-up of 2wT given the distance from the clinic to the men's homes and the potential for reducing workload. To ensure success, providers urged sensitizing patients to the fact that 2wT augments, but does not replace, the existing after-hours and emergency care services. ",
doi="10.2196/44122",
url="https://formative.jmir.org/2023/1/e44122",
url="http://www.ncbi.nlm.nih.gov/pubmed/36947127"
}


@Article{info:doi/10.2196/45095,
author="Voorheis, Paula
and Bhuiya, R. Aunima
and Kuluski, Kerry
and Pham, Quynh
and Petch, Jeremy",
title="Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="15",
volume="25",
pages="e45095",
keywords="behavioral science",
keywords="behavior change",
keywords="health behavior",
keywords="digital health",
keywords="mobile health",
keywords="theories",
keywords="models",
keywords="frameworks",
abstract="Background: Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design. Objective: The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design? Methods: This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach. Results: Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice. Conclusions: When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice. ",
doi="10.2196/45095",
url="https://www.jmir.org/2023/1/e45095",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920442"
}


@Article{info:doi/10.2196/42145,
author="Kim, Chan Joo
and Saguna, Saguna
and {\AA}hlund, Christer",
title="Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study",
journal="JMIR Hum Factors",
year="2023",
month="Mar",
day="8",
volume="10",
pages="e42145",
keywords="Internet of Things",
keywords="health monitoring",
keywords="older adults",
keywords="augmented reality",
keywords="user experience",
keywords="independent living",
keywords="design study",
keywords="mobile phone",
abstract="Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user's role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult's daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user's role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant's experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of ?3.0 to 3.0. The overall impression of our app was favorable, and we identified that ``simple'' and ``intuitive'' were the main factors affecting older adults' and caregivers' preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91\% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. ",
doi="10.2196/42145",
url="https://humanfactors.jmir.org/2023/1/e42145",
url="http://www.ncbi.nlm.nih.gov/pubmed/36884275"
}


@Article{info:doi/10.2196/43101,
author="Bazzano, N. Alessandra
and Noel, Lesley-Ann
and Patel, Tejal
and Dominique, Chantel C.
and Haywood, Catherine
and Moore, Shenitta
and Mantsios, Andrea
and Davis, A. Patricia",
title="Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="28",
volume="7",
pages="e43101",
keywords="health equity",
keywords="patient participation",
keywords="health behavior",
keywords="universal design",
keywords="human-centered design",
keywords="COVID-19",
abstract="Background: Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. Objective: This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. Methods: Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. Results: Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. Conclusions: The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity. ",
doi="10.2196/43101",
url="https://formative.jmir.org/2023/1/e43101",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649162"
}


@Article{info:doi/10.2196/43529,
author="Fossouo Tagne, Joel
and Yakob, Amin Reginald
and Mcdonald, Rachael
and Wickramasinghe, Nilmini",
title="Linking Activity Theory Within User-Centered Design: Novel Framework to Inform Design and Evaluation of Adverse Drug Reaction Reporting Systems in Pharmacy",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="24",
volume="10",
pages="e43529",
keywords="pharmacovigilance",
keywords="adverse drug reaction",
keywords="pharmacist",
keywords="user-centered design",
keywords="activity theory",
abstract="Background: Adverse drug reactions (ADRs) may cause serious injuries including death. Timely reporting of ADRs may play a significant role in patient safety; however, underreporting exists. Enhancing the electronic communication of ADR information to regulators and between health care providers has the potential to reduce recurrent ADRs and improve patient safety. Objective: The main objectives were to explore the low rate of ADR reporting by community pharmacists (CPs) in Australia, evaluate the usability of an existing reporting system, and how this knowledge may influence the design of subsequent electronic ADR reporting systems. Methods: The study was carried out in 2 stages. Stage 1 involved qualitative semistructured interviews to identify CPs' perceived barriers and facilitators to ADR reporting. Data were analyzed by thematic analysis, and identified themes were subsequently aligned to the task-technology fit (TTF) framework. The second stage involved a usability evaluation of a commercial web-based ADR reporting system. A structured interview protocol that combined virtual observation, think-aloud moderating techniques, retrospective questioning of the overall user experience, and a System Usability Scale (SUS). The field notes from the interviews were subjected to thematic analysis. Results: In total, 12 CPs were interviewed in stage 1, and 7 CPs participated in stage 2. The interview findings show that CPs are willing to report ADRs but face barriers from environmental, organizational, and IT infrastructures. Increasing ADR awareness, improving workplace practices, and implementing user-focused electronic reporting systems were seen as facilitators of ADR reporting. User testing of an existing system resulted in above average usability (SUS 68.57); however, functional and user interpretation issues were identified. Design elements such as a drop-down menu, free-text entry, checkbox, and prefilled data fields were perceived to be extremely useful for navigating the system and facilitating ADR reporting. Conclusions: Existing reporting systems are not suited to report ADRs, or adapted to workflow, and are rarely used by CPs. Our study uncovered important contextual information for the design of future ADR reporting interventions. Based on our study, a multifaceted, theory-guided, user-centered, and best practice approach to design, implementation, and evaluation may be critical for the successful adoption of ADR reporting electronic interventions and patient safety. Future studies are needed to evaluate the effectiveness of theory-driven frameworks used in the design and implementation of ADR reporting systems. ",
doi="10.2196/43529",
url="https://humanfactors.jmir.org/2023/1/e43529",
url="http://www.ncbi.nlm.nih.gov/pubmed/36826985"
}


@Article{info:doi/10.2196/40785,
author="Lee, Rebecca Abigail
and Csipke, Emese
and Yates, Lauren
and Moniz-Cook, Esme
and McDermott, Orii
and Taylor, Steven
and Stephens, Michael
and Kelleher, Daniel
and Orrell, Martin",
title="A Web-Based Self-management App for Living Well With Dementia: User-Centered Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="24",
volume="10",
pages="e40785",
keywords="dementia",
keywords="self-management",
keywords="independence",
keywords="quality of life",
keywords="web-based",
keywords="website",
keywords="psychosocial",
abstract="Background: Self-management, autonomy, and quality of life are key constructs in enabling people to live well with dementia. This population often becomes isolated following diagnosis, but it is important for them to feel encouraged to maintain their daily activities and stay socially active. Promoting Independence in Dementia (PRIDE) fosters social inclusion and greater dementia self-management through an interactive handbook. Objective: This study aimed to develop a paper-based PRIDE manual on a web-based platform. Methods: Two overarching stages were used to create the web-based version of PRIDE. The first was Preliminary Development, which encompassed tendering, preliminary development work, consultations, beta version of the website, user testing and consultation on beta version, and production of the final web-based prototype. The second stage was Development of the Final PRIDE App, which included 2 sprints and further user testing. Results: Through a lengthy development process, modifications were made to app areas such as the log-in process, content layout, and aesthetic appearance. Feedback from the target population was incorporated into the process to achieve a dementia-friendly product. The finished PRIDE app has defined areas for reading dementia-related topics, creating activity plans, and logging these completed activities. Conclusions: The PRIDE app has evolved from its initial prototype into a more dementia-friendly and usable program that is suitable for further testing. The finished version will be tested in a reach, effectiveness, adoption, implementation, and maintenance study, with its potential reach, effectiveness, and adoption explored. Feedback gathered during the reach, effectiveness, adoption, implementation, and maintenance study will lead to any further developments in the app to increase its applicability to the target audience and usability. ",
doi="10.2196/40785",
url="https://humanfactors.jmir.org/2023/1/e40785",
url="http://www.ncbi.nlm.nih.gov/pubmed/36826978"
}


@Article{info:doi/10.2196/44144,
author="Vanterpool, B. Karen
and Gacki-Smith, Jessica
and Kuramitsu, Brianna
and Downey, Max
and Nordstrom, J. Michelle
and Luken, Michelle
and Riggleman, Tiffany
and Fichter, Shannon
and Altema, Withney
and Brucker, B. James
and Cooney, M. Carisa
and Dumanian, Gregory
and Jensen, Sally
and Levan, Macey
and Tintle, M. Scott
and Brandacher, Gerald
and Gordon, J. Elisa",
title="A Patient-Centered Website (Within Reach) to Foster Informed Decision-making About Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="7",
volume="7",
pages="e44144",
keywords="hand transplantation",
keywords="patient education",
keywords="upper limb amputation",
keywords="interviews",
keywords="focus groups",
keywords="disability",
keywords="decision-making",
keywords="accessible",
abstract="Background: Upper extremity (UE) vascularized composite allotransplantation (VCA; hand transplantation) is a reconstructive treatment option for patients with UE loss. Approximately 37 UE VCAs have been performed in the United States to date; thus, little is known about long-term psychosocial outcomes and whether the benefits outweigh the risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available providing unbiased, comprehensive information about UE VCA. Objective: This paper described the development of a neutral, and accessible, educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations. Methods: Website content development was informed by 9 focus groups conducted with individuals with UE amputations at 3 study sites. After initial website development, we conducted usability testing to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Participants were administered the After-Scenario Questionnaire to assess user performance after completing navigational tasks, System Usability Scale to measure the perceived usability of the website, and Net Promoter Score to measure user satisfaction. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using rapid thematic analysis. Results: A total of 44 individuals with UE amputations participated in focus groups (n=37, 84\%) and usability testing (n=14, 32\%). Most participants in the focus groups and usability testing were male (24/37, 65\% and 11/14, 79\%, respectively) and White (27/37, 73\% and 9/14, 64\%, respectively), had unilateral limb loss (22/37, 59\% and 12/14, 86\%, respectively), and had mean ages of 48 (SD 9.2) and 50 (SD 12.0) years, respectively. Focus group results are organized into accessibility, website design, website development, website tone and values, sitemap, terminology, images and videos, and tables and graphics. Usability testing revealed that participants had a positive impression of the website. The mean After-Scenario Questionnaire score of 1.3 to 2.3 across task scenarios indicated high satisfaction with website usability, the mean System Usability Scale score of 88.9 indicated user satisfaction with website usability, and the mean Net Promoter Score of 9.6 indicated that users were enthusiastic and would likely refer individuals to the website. Conclusions: The findings suggest that our educational website, Within Reach, provides neutral, patient-centered information and may be a useful resource about UE VCA for individuals with UE amputations, their families, and health care professionals. Health care professionals may inform UE VCA candidates about Within Reach to supplement current VCA education processes. Within Reach serves as a resource about treatment options for patients preparing for scheduled or recovering from traumatic UE amputations. Future research should assess whether Within Reach improves knowledge about UE VCA and enhances informed decision-making about UE VCA as a treatment option. ",
doi="10.2196/44144",
url="https://formative.jmir.org/2023/1/e44144",
url="http://www.ncbi.nlm.nih.gov/pubmed/36749618"
}


@Article{info:doi/10.2196/41861,
author="Brown, Carter
and Roucoux, Guillaume
and Dimi, Svetlane
and Fahmi, Saleh
and Jeevan, Raj-Banou
and Chassany, Olivier
and Chaplin, John
and Duracinsky, Martin",
title="Evaluating Clinician Expectations of mHealth Solutions to Increase Rapid-Screening for HIV and Hepatitis in Migrant Populations in France: Qualitative Study",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="3",
volume="10",
pages="e41861",
keywords="app development",
keywords="acceptability",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="communication barriers",
keywords="migrants",
keywords="HIV",
keywords="AIDS",
keywords="hepatitis",
keywords="rapid diagnostic testing",
keywords="public health",
keywords="communication tool",
keywords="screening",
keywords="language barrier",
abstract="Background: Migrants underuse screening opportunities for HIV, hepatitis B, and hepatitis C despite elevated risk factors for contracting these infections. Language barriers are an often given as reasons for limiting access to services. Translation and communication apps increase communication and overall patient satisfaction in the patient-provider relationship. In the development and adoption of new technology, expectations play an important role. Objective: This study aimed to explore health care professionals' opinions and attitudes regarding their screening practices with migrants and their expectations for a new communication tool that could improve migrants' screening use. Methods: In this qualitative study, a purposive (diverse) sampling method was used to invite doctors and nurses who conduct rapid screening tests with migrants from 4 centers of the French Office of Immigration and Integration in 3 geographic regions of France. Semistructured interviews were conducted to survey their opinions on the rapid testing of migrants, the use of telephone interpreters, the concept of health literacy, and their expectations of a new communication tool that could overcome language barriers and promote rapid screening in the new migrant population. Results: In all, 20 interviews were conducted with 11 doctors and 9 nurses with a median age of 58 (range 25-67) years. Participants favored the integration of an innovative communication tool in the context of rapid screening of migrants. However, there were concerns related to the implementation and added value of the tool while migrants were already reluctant to be screened. Expectations were for a tool that would present information in simplified French or a chosen language but also supports a positive attitude toward screening. Health professionals also expressed the wish that the technology could help with the collection of health data. Conclusions: Feedback from health professionals provides a better understanding of potential formats, characteristics, functions, content, and use of an innovative, digital method to communicate with migrants with limited French proficiency. Findings contribute to the conceptual development of an electronic app and its implementation within the ApiD{\'e} study, which aims to validate a digital app to address language barriers to increase the use of screening among migrants with limited French proficiency in France. ",
doi="10.2196/41861",
url="https://humanfactors.jmir.org/2023/1/e41861",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735323"
}


@Article{info:doi/10.2196/41788,
author="Ma, Kwan Kris Pui
and Stephens, A. Kari
and Geyer, E. Rachel
and Prado, G. Maria
and Mollis, L. Brenda
and Zbikowski, M. Susan
and Waters, Deanna
and Masterson, Jo
and Zhang, Ying",
title="Developing Digital Therapeutics for Chronic Pain in Primary Care: A Qualitative Human-Centered Design Study of Providers' Motivations and Challenges",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="3",
volume="7",
pages="e41788",
keywords="chronic pain",
keywords="pain management",
keywords="primary care",
keywords="digital therapeutics",
keywords="mHealth",
keywords="mobile health",
keywords="human-centered design",
keywords="digital health",
keywords="pain",
keywords="qualitative",
keywords="interview",
keywords="challenge",
keywords="perspective",
keywords="health care provider",
keywords="physician",
keywords="doctor",
abstract="Background: Digital therapeutics are growing as a solution to manage pain for patients; yet, they are underused in primary care where over half of the patients with chronic pain seek care. Little is known about how to successfully engage primary care providers in recommending digital therapeutics to their patients. Exploring provider motivations in chronic pain management would potentially help to improve their engagement and inform the development of digital therapeutics. Objective: This study examined primary care providers' motivations for chronic pain management, including their strategies and challenges, to inform the future development of chronic pain-related digital therapeutics tailored to primary care settings. Methods: We conducted qualitative semistructured interviews with health care providers recruited from 3 primary care clinics in Washington and 1 clinic in Colorado between July and October 2021. The sample (N=11) included 7 primary care physicians, 2 behavioral health providers, 1 physician assistant, and 1 nurse. Most providers worked in clinics affiliated with urban academic health systems. Guided by the human-centered design approach and Christensen's Job-to-be-Done framework, we asked providers their goals and priorities in chronic pain management, their experiences with challenges and strategies used to care for patients, and their perceptions of applying digital therapeutics in clinical practice. Transcripts were analyzed using a thematic analysis approach. Results: We found that primary care providers were motivated but challenged to strengthen the patient-provider alliance, provide team-based care, track and monitor patients' progress, and address social determinants of health in chronic pain management. Specifically, providers desired additional resources to improve patient-centered communication, pain education and counseling, and goal setting with patients. Providers also requested greater accessibility to multidisciplinary care team consultations and nonpharmacological pain treatments. When managing chronic pain at the population level, providers need infrastructure and systems to systematically track and monitor patients' pain and provide wraparound health and social services for underserved patients. Recommendations on digital therapeutic features that might address provider challenges in achieving these motivations were discussed. Conclusions: Given the findings, to engage primary care providers, digital therapeutics for chronic pain management need to strengthen the patient-provider alliance, increase access to nonpharmacological treatment options, support population health tracking and management, and provide equitable reach. Leveraging digital therapeutics in a feasible, appropriate, and acceptable way to aid primary care providers in chronic pain management may require multimodal features that address provider motivations at an individual care and clinic or system level. ",
doi="10.2196/41788",
url="https://formative.jmir.org/2023/1/e41788",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735284"
}


@Article{info:doi/10.2196/25361,
author="Verma, Neha
and Lehmann, Harold
and Alam, Afroz Amal
and Yazdi, Youseph
and Acharya, Soumyadipta",
title="Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="2",
volume="10",
pages="e25361",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="community health workers",
keywords="frontline health workers",
keywords="digital health assistant",
keywords="task shifting",
abstract="Background: Many low- and middle-income countries have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with physicians in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographical barriers, these health worker--to-physician telemedicine programs have the potential to increase health care quality, expand the specialties available to patients, and reduce the time and cost required to deliver care. Objective: We aimed to identify, validate, and prioritize unmet needs in the health care space of health worker--to-physician telemedicine programs and develop and refine a solution that addresses those needs. Methods: We collected information regarding user needs through ethnographic research, direct observation, and semistructured interviews with 37 stakeholders (n=5, 14\% physicians; n=1, 3\% public health program manager; n=12, 32\% community health workers; and n=19, 51\% patients) at 2 telemedicine clinics in rural West Bengal, India. We used the Spiral-Iterative Innovation Model to design and develop a prototype solution to meet these needs. Results: We identified 74 unmet needs through our immersion in health worker--to-physician telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in low- and middle-income countries often requires shifting tasks such as history taking and physical examination from high-skilled remote physicians to FHWs. To meet this need, we developed a prototype digital assistant that would allow FHWs to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, physicians, and health organizations) were incorporated into the design and features of the task-shifting tool. The final prototype was shared with the health workers, physicians, and public health program managers who expressed that the tool would be useful and valuable. Conclusions: The final prototype that was developed was released as an open-source digital public good and may improve the quality and efficiency of care delivery in health worker--to-physician telemedicine programs. ",
doi="10.2196/25361",
url="https://humanfactors.jmir.org/2023/1/e25361",
url="http://www.ncbi.nlm.nih.gov/pubmed/36729578"
}


@Article{info:doi/10.2196/41262,
author="Zoellner, Jamie
and Reid, Annie
and Porter, Kathleen
and Frederick, Christina
and Hilgart, Michelle
and Ritterband, Lee",
title="Development of a Digital Behavioral Intervention to Reduce the Consumption of Sugar-Sweetened Beverages Among Rural Appalachian Adults: Multiphased, Human-Centered Design Approach",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="1",
volume="10",
pages="e41262",
keywords="eHealth",
keywords="human-centered design",
keywords="internet-based intervention",
keywords="digital technology",
keywords="Model for Internet Interventions",
keywords="beverages",
keywords="behavioral research",
keywords="rural population",
keywords="mobile phone",
abstract="Background: To avoid the low engagement and limited efficacy of digital behavioral health interventions, robust human-centered design (HCD) processes are needed. Objective: The primary objective of this study was to describe a flexible, step-by-step HCD process to develop digital behavioral health interventions by illustrating iSIPsmarter as an example. iSIPsmarter is a digital intervention for reducing the consumption of sugar-sweetened beverages (SSBs) that comprises 6 internet-based cores metered out over time to deliver the program content, an integrated SMS text message strategy to engage users in reporting SSB behaviors, and an electronic cellular-enabled scale for in-home weighing. The secondary objective is to illustrate the key components and characteristics of iSIPsmarter that resulted from the HCD process. Methods: The methods were guided by the Model for Internet Interventions and by best practices in HCD and instructional design processes (eg, rapid prototype development and think-aloud protocol). The 3-phased (ie, contextual, prototype testing, end user testing phases) process followed in this study included a series of 13 semistructured one-on-one interviews with 7 advisory team participants from the targeted Appalachian user group. The interviews were content coded by 2 researchers and then deductively coded to the suggested areas of digital behavioral health interventions. Results: The participants provided rich perspectives pertaining to iSIPsmarter's appearance, behavioral prescriptions, burdens, content, delivery, message, participation, and assessment. These inputs included requests for built-in flexibility to account for varying internet and SMS text message accessibility among users; ideas to resolve the issues and problems encountered when using the prototypes, including those related to navigation and comprehension of content; ideas to enhance personalized feedback to support motivation and goal setting for SSB consumption and weight; and feedback to refine the development of realistic and relatable vignettes. The participants were able to interact with multiple prototype drafts, allowing researchers to capture and incorporate feedback related to the iSIPsmarter dashboard, daily SSB and weight diaries, action planning, core content, interactions, and vignettes. Conclusions: Using scientific models and established processes is critical for building robust and efficacious interventions. By applying an existing model and HCD and instructional design processes, we were able to identify assumptions and address the key areas of the iSIPsmarter intervention that were hypothesized to support users' engagement and promote behavior change. As evidenced by the rich feedback received from the advisory team members and the resulting iSIPsmarter product, the HCD methodology was instrumental in the development process. Although the final iSIPsmarter content is specific to improving SSB consumption behaviors among adults in rural areas, the intent is that this HCD process will have wide applications in the development of digital behavioral health interventions across multiple geographic and behavioral contexts. ",
doi="10.2196/41262",
url="https://humanfactors.jmir.org/2023/1/e41262",
url="http://www.ncbi.nlm.nih.gov/pubmed/36724036"
}


@Article{info:doi/10.2196/37596,
author="Hu, Yung-Shin Tiffany
and Ali, Iman
and Heisler, Michele
and Levy, Helen
and Fagerlin, Angela
and Kullgren, T. Jeffrey",
title="Helping Patients With Chronic Conditions Overcome Challenges of High-Deductible Health Plans: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="31",
volume="7",
pages="e37596",
keywords="high-deductible health plan",
keywords="HDHP",
keywords="chronic conditions",
keywords="cost-conscious strategies",
keywords="consumer behaviors",
keywords="health care costs",
keywords="out-of-pocket spending",
keywords="OOP",
keywords="behavioral intervention",
keywords="mobile phone",
abstract="Background: A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket costs and often delay or forgo needed care owing to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using web-based tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown which intervention features would be most valued and used by this patient population. Objective: This study aimed to assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports the use of cost-conscious strategies when planning for and seeking health care. Methods: In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semistructured telephone interviews and then surveyed 432 participants using a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants' health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care. Results: Approximately half (11/20, 55\%) of the interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that the use of cost-conscious strategies would be very time consuming. Most (18/20, 90\%) interviewees who had discussed costs with providers, saved for medical expenses, or used web-based price comparison tools found these strategies to be helpful for managing their health care costs. Most (17/20, 85\%) interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website-based or email-based intervention that they would use a few times a year. Conclusions: Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Interventions to encourage the use of cost-conscious strategies should be delivered through a web-based modality and focus on helping these patients in navigating their HDHPs to better manage their out-of-pocket spending. ",
doi="10.2196/37596",
url="https://formative.jmir.org/2023/1/e37596",
url="http://www.ncbi.nlm.nih.gov/pubmed/36719718"
}


@Article{info:doi/10.2196/40017,
author="Hietbrink, G. Eclaire A.
and Middelweerd, Anouk
and van Empelen, Pepijn
and Preuhs, Katharina
and Konijnendijk, J. Annemieke A.
and Oude Nijeweme-d'Hollosy, Wendy
and Schrijver, K. Laura
and Laverman, D. Gozewijn
and Vollenbroek-Hutten, R. Miriam M.",
title="A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="12",
volume="10",
pages="e40017",
keywords="eHealth",
keywords="mHealth",
keywords="diet",
keywords="nutrition",
keywords="physical activity",
keywords="lifestyle change",
keywords="coaching",
keywords="dynamic tailoring",
keywords="behavior change",
keywords="blended care",
keywords="type 2 diabetes",
keywords="design",
keywords="treatment",
keywords="chronic disease",
keywords="behavioral",
keywords="theory",
keywords="intervention",
keywords="acceptability",
keywords="usability",
keywords="cost",
abstract="Background: A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). Objective: This paper aimed to describe the systematic development of E-Supporter 1.0. Methods: Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. Results: The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. Conclusions: The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness. ",
doi="10.2196/40017",
url="https://humanfactors.jmir.org/2023/1/e40017",
url="http://www.ncbi.nlm.nih.gov/pubmed/36633898"
}


@Article{info:doi/10.2196/41735,
author="Donovan, Gemma
and Hall, Nicola
and Smith, Felicity
and Ling, Jonathan
and Wilkes, Scott",
title="Two-way Automated Text Messaging Support From Community Pharmacies for Medication Taking in Multiple Long-term Conditions: Human-Centered Design With Nominal Group Technique Development Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="21",
volume="6",
number="12",
pages="e41735",
keywords="medication adherence",
keywords="text messaging",
keywords="human-centered design",
keywords="complex interventions",
keywords="community pharmacy",
abstract="Background: Reviews of digital communication technologies suggest that they can be effective in supporting medication use; however, their use alongside nondigital components is unclear. We also explored the delivery of a digital communication intervention in a relatively novel setting of community pharmacies and how such an intervention might be delivered to patients with multiple long-term conditions. This meant that despite the large number of intervention examples available in the literature, design questions remained, which we wanted to explore with key stakeholders. Examples of how to involve stakeholders in the design of complex health care interventions are lacking; however, human-centered design (HCD) has been suggested as a potential approach. Objective: This study aimed to design a new community pharmacy text messaging intervention to support medication use for multiple long-term conditions, with patient and health care professional stakeholders in primary care. Methods: HCD was used to map the intervention ``journey'' and identify design questions to explore with patients and health care professionals. Six prototypes were developed to communicate the intervention concept, and a modified version of the Nominal Group Technique was used to gather feedback. Nominal group meetings generated qualitative data using questions about the aspects that participants liked for each prototype and any suggested changes. The discussion was analyzed using a framework approach to transform feedback into statements. These statements were then ranked using a web-based questionnaire to establish a consensus about what elements of the design were valued by stakeholders and what changes to the design were most important. Results: A total of 30 participants provided feedback on the intervention design concept over 5 nominal group meetings (21 health care professionals and 9 patients) with a 57\% (17/30) response rate to the ranking questionnaire. Furthermore, 51 proposed changes in the intervention were generated from the framework analysis. Of these 51 changes, 27 (53\%) were incorporated into the next design stage, focusing on changes that were ranked highest. These included suggestions for how text message content might be tailored, patient information materials, and the structure for pharmacist consultation. All aspects that the participants liked were retained in the future design and provided evidence that the proposed intervention concept had good acceptability. Conclusions: HCD incorporating the Nominal Group Technique is an appropriate and successful approach for obtaining feedback from key stakeholders as part of an iterative design process. This was particularly helpful for our intervention, which combined digital and nondigital components for delivery in the novel setting of a community pharmacy. This approach enabled the collection and prioritization of useful multiperspective feedback to inform further development and testing of our intervention. This model has the potential to minimize research waste by gathering feedback early in the complex intervention design process. ",
doi="10.2196/41735",
url="https://formative.jmir.org/2022/12/e41735",
url="http://www.ncbi.nlm.nih.gov/pubmed/36542458"
}


@Article{info:doi/10.2196/42051,
author="Bradley, Kolbi
and Arconada Alvarez, J. Santiago
and Gilmore, K. Amanda
and Greenleaf, Morgan
and Herbert, Aayahna
and Kottke, J. Melissa
and Parsell, Maren
and Patterson, Sierra
and Smith, Tymirra
and Sotos-Prieto, Mercedes
and Zeichner, Elizabeth
and Gooding, C. Holly",
title="Assessing and Promoting Cardiovascular Health for Adolescent Women: User-Centered Design Approach",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="19",
volume="6",
number="12",
pages="e42051",
keywords="adolescent",
keywords="heart disease",
keywords="mHealth",
keywords="digital health intervention",
keywords="user-centered design",
keywords="cardiovascular disease",
keywords="CVD",
keywords="women's health",
keywords="risk assessment",
keywords="young adults",
keywords="assessment tool",
abstract="Background: Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A considerable number of young women already have risk factors for CVD. Awareness of CVD and its risk factors is critical to preventing CVD, yet younger women are less aware of CVD prevalence, its risk factors, and preventative behaviors compared to older women. Objective: The purpose of this study is to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for the promotion of CVD awareness among this population. Methods: This study used a 3-phase iterative design process with young women and health care practitioners from primary care and reproductive care clinics in Atlanta, Georgia. In phase 1, we administered a modified version of the American Heart Association Women's Health Survey to young women, aged 15-24 years (n=67), to assess their general CVD awareness. In phase 2, we interviewed young women, aged 13-21 years (n=10), and their health care practitioners (n=10), to solicit suggestions for adapting the Healthy Heart Score, an existing adult cardiovascular risk assessment tool, for use with this age group. We also aimed to learn more about the barriers and challenges to health behavior change within this population and the clinical practices that serve them. In phase 3, we used the findings from the first 2 phases to create a prototype of a new online cardiovascular risk assessment tool designed specifically for young women. We then used an iterative user-centered design process to collect feedback from approximately 105 young women, aged 13-21 years, as we adapted the tool. Results: Only 10.5\% (7/67) of the young women surveyed correctly identified CVD as the leading cause of death among women in the United States. Few respondents reported having discussed their personal risk (4/67, 6\%) or family history of CVD (8/67, 11.9\%) with a health care provider. During the interviews, young women reported better CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. Health care practitioners emphasized shortening the assessment for easier use within practice and discussed other barriers adolescents may face in adopting heart-healthy behaviors. The result of the iterative design process was a youth-friendly prototype of a cardiovascular risk assessment tool. Conclusions: Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a cardiovascular risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions. ",
doi="10.2196/42051",
url="https://formative.jmir.org/2022/12/e42051",
url="http://www.ncbi.nlm.nih.gov/pubmed/36534450"
}


@Article{info:doi/10.2196/41628,
author="Barbaric, Antonia
and Munteanu, Cosmin
and Ross, Heather
and Cafazzo, A. Joseph",
title="Design of a Patient Voice App Experience for Heart Failure Management: Usability Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="6",
volume="6",
number="12",
pages="e41628",
keywords="heart failure",
keywords="self-management",
keywords="digital therapeutics",
keywords="voice-activated technology",
keywords="smart speaker",
keywords="usability study",
keywords="formative evaluation",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: The use of digital therapeutics (DTx) in the prevention and management of medical conditions has increased through the years, with an estimated 44 million people using one as part of their treatment plan in 2021, nearly double the number from the previous year. DTx are commonly accessed through smartphone apps, but offering these treatments through additional platforms can improve the accessibility of these interventions. Voice apps are an emerging technology in the digital health field; not only do they have the potential to improve DTx adherence, but they can also create a better user experience for some user groups. Objective: This research aimed to identify the acceptability and feasibility of offering a voice app for a chronic disease self-management program. The objective of this project was to design, develop, and evaluate a voice app of an already-existing smartphone-based heart failure self-management program, Medly, to be used as a case study. Methods: A voice app version of Medly was designed and developed through a user-centered design process. We conducted a usability study and semistructured interviews with patients with heart failure (N=8) at the Peter Munk Cardiac Clinic in Toronto General Hospital to better understand the user experience. A Medly voice app prototype was built using a software development kit in tandem with a cloud computing platform and was verified and validated before the usability study. Data collection and analysis were guided by a mixed methods triangulation convergence design. Results: Common themes were identified in the results of the usability study, which involved 8 participants with heart failure. Almost all participants (7/8, 88\%) were satisfied with the voice app and felt confident using it, although half of the participants (4/8, 50\%) were unsure about using it in the future. Six main themes were identified: changes in physical behavior, preference between voice app and smartphone, importance of music during voice app interaction, lack of privacy concerns, desired reassurances during voice app interaction, and helpful aids during voice app interaction. These findings were triangulated with the quantitative data, and it concluded that the main area for improvement was related to the ease of use; design changes were then implemented to better improve the user experience. Conclusions: This work offered preliminary insight into the acceptability and feasibility of a Medly voice app. Given the recent emergence of voice apps in health care, we believe that this research offered invaluable insight into successfully deploying DTx for chronic disease self-management using this technology. ",
doi="10.2196/41628",
url="https://formative.jmir.org/2022/12/e41628",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472895"
}


@Article{info:doi/10.2196/39199,
author="Ahmed, Mona
and Mar{\'i}n, Mayca
and How, Daniella
and Judica, Elda
and Tropea, Peppino
and Bentlage, Ellen
and J Ferreira, Joaquim
and Bou{\c{c}}a-Machado, Raquel
and Brach, Michael",
title="End Users' and Other Stakeholders' Needs and Requirements in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People With Dementia or Parkinson Disease: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e39199",
keywords="neurodegenerative",
keywords="Parkinson disease",
keywords="dementia",
keywords="chronic diseases",
keywords="health care technologies",
keywords="integrated care",
keywords="information and communication technology",
keywords="ICT",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: With what has been known as the ``triple-win effect'', introducing information and communication technologies (ICTs) in the health care of neurodegenerative diseases is beneficial in delaying the need for institutional care, reducing the associated health care costs, reducing the caregiving burden, and improving individuals' quality of life. Nevertheless, the mismatch between the users' expectations and their actual needs remains one of the main challenges that can reduce the usability of technology solutions. Therefore, the European project Personalized Integrated Care Promoting Quality of Life for Older People (PROCare4Life), which aimed to develop an ICT-based platform for all parties involved in the health care of neurodegenerative diseases, adopted a user-centered design approach, where all users are involved from the inception and throughout the platform development and implementation to integrate their needs and requirements in the proposed platform. Objective: This paper presents the results of a study on the needs and requirements of the potential end users (older people with neurodegenerative diseases, caregivers, and health care professionals) and other key stakeholders in the development of the PROCare4Life platform. Methods: A mixed qualitative and quantitative study design was used, including 2 web-based surveys, 40 interviews, and 4 workshops. The study was conducted between April and September 2020 in 5 European countries: Germany, Italy, Portugal, Romania, and Spain. Both data types were analyzed separately and then merged and interpreted, with greater priority placed on qualitative research. Results: A total of 217 participants were recruited; 157 (72.4\%) of them completed the web-based surveys (n=85, 54.1\% patients and n=72, 45.9\% caregivers), and 60 (27.6\%) individuals participated in the qualitative research (20/60, 33\% health care professionals; 5/60, 8\% patients; 5/60, 8\% caregivers; and 30/60, 50\% key stakeholders). We identified 3 main themes (T): (T1) experiences associated with illness, (T2) thoughts about the platform technology, and (T3) desired properties. Alerts for adverse events, communication tools, reminders, and monitoring are constantly needed functionalities, whereas ease of use, personalization, and user-friendliness are foreseen as necessary features. Conclusions: This paper identified the key personal, social, and health factors that influence the daily lives of the potential end users and reflected on their needs and expectations regarding the design of the proposed PROCare4Life platform. The collected data were useful for the development of the PROCare4Life platform. Although the combination and collection of features for diverse user groups are typical for integrated care platforms, it results in exponential complexity for designers, developers, and users. Contradicting opinions and several concerns in this study demonstrate that an ICT-integrated care platform should not promise too much for too many. Instead, selection, focus, and, sometimes, restriction to essentials are necessary. Users and other stakeholders should be involved in these decisions. International Registered Report Identifier (IRRID): RR2-10.2196/22463 ",
doi="10.2196/39199",
url="https://formative.jmir.org/2022/11/e39199",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449340"
}


@Article{info:doi/10.2196/38678,
author="Holmen, Heidi
and Singstad, Tone
and Ribu, Lis
and Jensen, Lunde Annesofie
and Weldingh, Mickelson Nina
and Torbj{\o}rnsen, Astrid",
title="Adapting a Patient-Reported Outcome Measure to Digital Outpatient Specialist Health Care Services for Type 1 Diabetes: User Involvement Study",
journal="JMIR Hum Factors",
year="2022",
month="Nov",
day="15",
volume="9",
number="4",
pages="e38678",
keywords="patient-reported outcome measures",
keywords="user involvement",
keywords="type 1 diabetes",
keywords="digital interventions",
abstract="Background: Diabetes self-management is crucial for patients with type 1 diabetes, and digital services can support their self-management and facilitate flexible follow-up. The potential of using digital patient-reported outcome (PRO) measures in routine outpatient care is not fully used owing to a lack of adapted PRO measures. Objective: This study presents the process of identifying and adapting a digital PRO measure for use in clinical diabetes practice and describes the preferred item topics of the adapted PRO measure, as reported by patients and diabetes specialist nurses. Methods: With the involvement of patients, diabetes specialist nurses, management, and researchers, we hosted a series of workshops and 2 dialogue conferences. Scoping searches to identify relevant PRO measures formed the foundation for the process. An in-person dialogue conference was conducted with diabetes specialist nurses as participants, and a digital dialogue conference was conducted with patients with type 1 diabetes as participants. A diabetes-specific PRO measure was translated and adapted to our digital platform. Notes and summaries from the dialogue conferences were imported into NVivo (QSR International) and thematically analyzed as a single combined data set. Results: The thematic analysis of the 2 dialogue conferences aimed to explore the views of patients with type 1 diabetes and diabetes specialist nurses on the outcomes necessary to measure. An overarching theme, Ensuring that the PRO measure captures the patients' needs precisely and accurately, in a way that facilitates care and communication with health care personnel, was identified and supported with data from both the patients and diabetes specialist nurses. This theme contained four categories: The need for explanatory text after questions to ensure understanding and accurate response, Capturing individual needs in standardized questions, getting to the heart of the patient's problem, and The questions increase patient reflection. Conclusions: We successfully conducted an iterative process that identified a PRO measure aligned with the topics raised by the diabetes specialist nurses. Similarly, the patients found the PRO measure to be relevant and one that was addressing their needs. Only minor adjustments were necessary when programming the PRO measure in the digital platform. Our management, patients, and diabetes specialist nurses had a valuable impact on the results. User involvement facilitated a specific focus on the clinical requests to be met by PRO measures and how they must be adapted to local and digital platforms. Overall, this has facilitated the current implementation of the adapted digital PRO measure. ",
doi="10.2196/38678",
url="https://humanfactors.jmir.org/2022/4/e38678",
url="http://www.ncbi.nlm.nih.gov/pubmed/36378513"
}


@Article{info:doi/10.2196/40507,
author="Magee, R. Michael
and Gholamrezaei, Ali
and McNeilage, G. Amy
and Sim, Alison
and Dwyer, Leah
and Ferreira, L. Manuela
and Darnall, D. Beth
and Glare, Paul
and Ashton-James, E. Claire",
title="A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e40507",
keywords="chronic pain",
keywords="deprescribing",
keywords="tapering",
keywords="dose reduction",
keywords="opioids",
keywords="mHealth",
keywords="mobile health",
keywords="SMS",
keywords="text messaging",
keywords="digital health",
keywords="behavior change",
keywords="self-efficacy",
keywords="consumer engagement",
keywords="co-design",
keywords="coproduction",
abstract="Background: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ?8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77\% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82\% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians' ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research. ",
doi="10.2196/40507",
url="https://formative.jmir.org/2022/11/e40507",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355415"
}


@Article{info:doi/10.2196/38886,
author="Oakley-Girvan, Ingrid
and Docherty, P. John",
title="A New Approach to Enhancing Engagement in eHealth Apps",
journal="Interact J Med Res",
year="2022",
month="Nov",
day="9",
volume="11",
number="2",
pages="e38886",
keywords="user engagement",
keywords="eHealth",
keywords="attrition",
keywords="adherence",
keywords="apps",
keywords="app design",
keywords="user experience",
doi="10.2196/38886",
url="https://www.i-jmr.org/2022/2/e38886",
url="http://www.ncbi.nlm.nih.gov/pubmed/36279587"
}


@Article{info:doi/10.2196/37865,
author="Dauber, Sarah
and Hammond, Cori
and Hogue, Aaron
and Henderson, Craig
and Nugent, Jessica
and Ford, Veronica
and Brown, Jill
and Scott, Lenore
and Ondersma, Steven",
title="Development of an Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: Qualitative User-Centered Approach",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e37865",
keywords="pregnant women",
keywords="postpartum women",
keywords="home visiting",
keywords="substance use",
keywords="computerized intervention",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e--SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective: This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e--SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e--SBI-HV prototype and describe the e--SBI-HV prototype. Methods: Adaptation of the original e-SBI into the e--SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e--SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results: The e--SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor--client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e--SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. Conclusions: This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e--SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e--SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e--SBI-HV. ",
doi="10.2196/37865",
url="https://formative.jmir.org/2022/11/e37865",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346648"
}


@Article{info:doi/10.2196/39637,
author="Timmers, Thomas
and van der Weegen, Walter
and Janssen, Loes
and Kremer, Jan
and Kool, Bertijn Rudolf",
title="Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="3",
volume="6",
number="11",
pages="e39637",
keywords="eHealth",
keywords="qualitative research",
keywords="qualitative",
keywords="focus group",
keywords="knee",
keywords="surgery",
keywords="feedback",
keywords="user need",
keywords="patient need",
keywords="user centered",
keywords="content codevelopment",
keywords="patient involvement",
keywords="co-design",
keywords="participatory",
keywords="app design",
keywords="mobile health",
keywords="mHealth",
keywords="health app",
keywords="orthopedic",
keywords="mobile phone",
abstract="Background: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients' priorities. Objective: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app's content. Conclusions: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app's content from the patient's perspective. Given the growing emphasis on patients' self-management, it is crucial that the information they receive is not only relevant from a health care provider's perspective but also aligns with what really matters to patients. Trial Registration: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295 ",
doi="10.2196/39637",
url="https://formative.jmir.org/2022/11/e39637",
url="http://www.ncbi.nlm.nih.gov/pubmed/36326799"
}


@Article{info:doi/10.2196/36949,
author="Jarvis, Tamika
and Mah, L. Allison M.
and Wang, H. Rosalie
and Wilson, G. Michael",
title="Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="3",
volume="6",
number="11",
pages="e36949",
keywords="assistive technology",
keywords="program funding",
keywords="usability testing",
keywords="internet",
keywords="web-based database",
keywords="health services",
abstract="Background: Assistive technology (AT) can contribute to how individuals participate and engage in everyday activities, such as communication and mobility, and facilitates access to the services they require. Navigating Canada's AT system has been described as fragmented and complex, presenting barriers for individuals who require AT, caregivers, and health service providers. AccessATCanada was developed as a centralized web-based resource to help support access to AT by providing information about the existing jurisdictional funding programs and services. Objective: This study aimed to evaluate the usability of AccessATCanada by gathering feedback about its features, functionality, and areas of strength and opportunity from potential end users. Methods: A usability testing study using a think-aloud approach and semistructured interviews was conducted to measure the effectiveness and efficiency of and user satisfaction with AccessATCanada and to identify issues with the interface during end-user interaction. A qualitative thematic analysis was used to generate insights into and core themes about user experiences. User feedback was used to inform subsequent updates of the database with the goal of enhancing website friendliness and functionality before its official launch. Results: A total of 10 participants (6 consumers, 1 caregiver, and 3 providers) participated in the usability testing study. The usability performance and scores tended to improve between the 2 testing cycles. Most participants were able to successfully complete all the tasks independently. The efficiency scores tended to improve as the users continued to engage with the interface. The website received an overall System Usability Score of 62.22, which was ranked as ``OK/fair to good.'' The users provided an overall positive evaluation of the beta version of the web-based resource tested over 2 cycles and helped to identify areas for improvement. They commented on the functionality and added value of the website, discovery of new programs and resources, and design aesthetics. Most usability issues were reported as minor challenges related to presentation, functionality, and language, and feedback was adopted into later iterations of the website. Conclusions: This study provides reflections on the value of usability testing and elements that are key to the creation of user-centered resources, such as the inclusion of participants with various abilities and considerations regarding website design and accessibility in an increasingly web-based world. AccessATCanada is now part of a growing global response to expand the reach of AT programs and services, improve the equity of access to AT, and reduce the complexity of navigating AT systems. ",
doi="10.2196/36949",
url="https://formative.jmir.org/2022/11/e36949",
url="http://www.ncbi.nlm.nih.gov/pubmed/36326813"
}


@Article{info:doi/10.2196/38048,
author="Isakadze, Nino
and Molello, Nancy
and MacFarlane, Zane
and Gao, Yumin
and Spaulding, M. Erin
and Commodore Mensah, Yvonne
and Marvel, A. Francoise
and Khoury, Shireen
and Marine, E. Joseph
and Michos, D. Erin
and Spragg, David
and Berger, D. Ronald
and Calkins, Hugh
and Cooper, A. Lisa
and Martin, S. Seth",
title="The Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework for Atrial Fibrillation: Co-design and Development Study",
journal="JMIR Hum Factors",
year="2022",
month="Oct",
day="31",
volume="9",
number="4",
pages="e38048",
keywords="atrial fibrillation",
keywords="digital health intervention",
keywords="human-centered design",
keywords="health equity",
keywords="smartphone",
keywords="mobile application",
keywords="cardiac",
keywords="cardiology",
keywords="virtual meeting",
keywords="virtual health",
keywords="medication adherence",
abstract="Background: Smartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and engage users, intervention development should be guided by user input, which is best achieved by the process of co-design. Digital health interventions co-designed with the active engagement of users have the potential to increase the uptake of guideline recommendations, which can reduce morbidity and mortality and advance health equity. Objective: We aimed to co-design a digital health intervention for patients with atrial fibrillation, the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to describe our approach to human-centered design for building digital health interventions. Methods: We conducted virtual meetings with patients with atrial fibrillation (n=8), their caregivers, and clinicians (n=8). We used the following 7 steps in our co-design process: step 1, a virtual meeting focused on defining challenges and empathizing with problems that are faced in daily life by individuals with atrial fibrillation and clinicians; step 2, a virtual meeting focused on ideation and brainstorming the top challenges identified during the first meeting; step 3, individualized onboarding of patients with an existing minimally viable version of the atrial fibrillation app; step 4, virtual prototyping of the top 3 ideas generated during ideation; step 5, further ranking by the study investigators and engineers of the ideas that were generated during ideation but were not chosen as top-3 solutions to be prototyped in step 4; step 6, ongoing engineering work to incorporate top-priority features in the app; and step 7, obtaining further feedback from patients and testing the atrial fibrillation digital health intervention in a pilot clinical study. Results: The top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence, and guidance during atrial fibrillation episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable atrial fibrillation risk factors, and remote atrial fibrillation episode management. Patients brainstormed more than 30 ideas to address the top challenges, and the clinicians generated more than 20 ideas. Ranking of the ideas informed several novel or modified features aligned with the Theory of Health Behavior Change, features that were geared toward risk factor modification; patient education; rhythm, symptom, and trigger correlation for remote atrial fibrillation management; and social support. Conclusions: We co-designed an atrial fibrillation digital health intervention in partnership with patients, caregivers, and clinicians by virtually engaging in collaborative creation through the design process. We summarize our experience and describe a flexible approach to human-centered design for digital health intervention development that can guide innovative clinical investigators. ",
doi="10.2196/38048",
url="https://humanfactors.jmir.org/2022/4/e38048",
url="http://www.ncbi.nlm.nih.gov/pubmed/36315217"
}


@Article{info:doi/10.2196/38387,
author="Jarman, K. Hannah
and McLean, A. Si{\^a}n
and Rodgers, Rachel
and Fuller-Tyszkiewicz, Matthew
and Paxton, Susan
and O'Gorman, Beth
and Harris, Emily
and Shatte, Adrian
and Bishop, Katie
and Baumann, Tahlia
and Mahoney, Danielle
and Daugelat, Melissa-Claire
and Yager, Zali",
title="Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="31",
volume="6",
number="10",
pages="e38387",
keywords="eating disorders",
keywords="app-based intervention",
keywords="lived experience",
keywords="design thinking",
keywords="interviews",
keywords="young women",
keywords="co-design",
keywords="mobile health",
keywords="mHealth",
abstract="Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. ",
doi="10.2196/38387",
url="https://formative.jmir.org/2022/10/e38387",
url="http://www.ncbi.nlm.nih.gov/pubmed/36315225"
}


@Article{info:doi/10.2196/39189,
author="Tong, Catherine
and Kernoghan, Alison
and Lemmon, Kassandra
and Fernandes, Paige
and Elliott, Jacobi
and Sacco, Veronica
and Bodemer, Sheila
and Stolee, Paul",
title="Lessons and Reflections From an Extended Co-design Process Developing an mHealth App With and for Older Adults: Multiphase, Mixed Methods Study",
journal="JMIR Aging",
year="2022",
month="Oct",
day="28",
volume="5",
number="4",
pages="e39189",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="health care providers",
keywords="co-design",
keywords="user experience or UX design",
keywords="qualitative",
keywords="apps",
keywords="elderly",
keywords="health care",
keywords="care provider",
abstract="Background: There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective: The aim of this study was to reflect on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods: Our work to conceptualize, develop, and test the mHealth app consisted of 4 phases: phase 1, consulting stakeholders; phase 2, app development and co-designing with older adults; phase 3, field-testing with a smaller sample of older adult volunteer testers; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results: In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions: Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. ",
doi="10.2196/39189",
url="https://aging.jmir.org/2022/4/e39189",
url="http://www.ncbi.nlm.nih.gov/pubmed/36306166"
}


@Article{info:doi/10.2196/36976,
author="Silvestri, A. Jasmine
and Kmiec, E. Tyler
and Bishop, S. Nicholas
and Regli, H. Susan
and Weissman, E. Gary",
title="Desired Characteristics of a Clinical Decision Support System for Early Sepsis Recognition: Interview Study Among Hospital-Based Clinicians",
journal="JMIR Hum Factors",
year="2022",
month="Oct",
day="21",
volume="9",
number="4",
pages="e36976",
keywords="sepsis",
keywords="predictive information",
keywords="clinical decision support",
keywords="human factors",
keywords="sepsis onset",
abstract="Background: Sepsis is a major burden for health care systems in the United States, with over 750,000 cases annually and a total cost of approximately US \$20 billion. The hallmark of sepsis treatment is early and appropriate initiation of antibiotic therapy. Although sepsis clinical decision support (CDS) systems can provide clinicians with early predictions of suspected sepsis or imminent clinical decline, such systems have not reliably demonstrated improvements in clinical outcomes or care processes. Growing evidence suggests that the challenges of integrating sepsis CDS systems into clinical workflows, gaining the trust of clinicians, and making sepsis CDS systems clinically relevant at the bedside are all obstacles to successful deployment. However, there are significant knowledge gaps regarding the achievement of these implementation and deployment goals. Objective: We aimed to identify perceptions of predictive information in sepsis CDS systems based on clinicians' past experiences, explore clinicians' perceptions of a hypothetical sepsis CDS system, and identify the characteristics of a CDS system that would be helpful in promoting timely recognition and management of suspected sepsis in a multidisciplinary, team-based clinical setting. Methods: We conducted semistructured interviews with practicing bedside nurses, advanced practice providers, and physicians at a large academic medical center between September 2020 and March 2021. We used modified human factor methods (contextual interview and cognitive walkthrough performed over video calls because of the COVID-19 pandemic) and conducted a thematic analysis using an abductive approach for coding to identify important patterns and concepts in the interview transcripts. Results: We interviewed 6 bedside nurses and 9 clinicians responsible for ordering antibiotics (advanced practice providers or physicians) who had a median of 4 (IQR 4-6.5) years of experience working in an inpatient setting. We then synthesized critical content from the thematic analysis of the data into four domains: clinician perceptions of prediction models and alerts; previous experiences of clinician encounters with predictive information and risk scores; desired characteristics of a CDS system build, including predictions, supporting information, and delivery methods for a potential alert; and the clinical relevance and potential utility of a CDS system. These 4 domains were strongly linked to clinicians' perceptions of the likelihood of adoption and the impact on clinical workflows when diagnosing and managing patients with suspected sepsis. Ultimately, clinicians desired a trusted and actionable CDS system to improve sepsis care. Conclusions: Building a trusted and actionable sepsis CDS alert is paramount to achieving acceptability and use among clinicians. These findings can inform the development, implementation, and deployment strategies for CDS systems that support the early detection and treatment of sepsis. This study also highlights several key opportunities when eliciting clinician input before the development and deployment of prediction models. ",
doi="10.2196/36976",
url="https://humanfactors.jmir.org/2022/4/e36976",
url="http://www.ncbi.nlm.nih.gov/pubmed/36269653"
}


@Article{info:doi/10.2196/37137,
author="Kenter, Francisca Robin Maria
and Sch{\o}nning, Adrian
and Inal, Yavuz",
title="Internet-Delivered Self-help for Adults With ADHD (MyADHD): Usability Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="21",
volume="6",
number="10",
pages="e37137",
keywords="usability testing",
keywords="user evaluation",
keywords="attention-deficit/hyperactivity disorder",
keywords="self-guided intervention",
keywords="internet-delivered",
keywords="self-help",
keywords="adults with attention-deficit/hyperactivity disorder",
keywords="intervention",
keywords="usability study",
keywords="care needs",
keywords="usability",
abstract="Background: Although effective pharmacological treatment exists, many adults with attention-deficit/hyperactivity disorder (ADHD) prefer a nonpharmacological option for managing their symptoms. Internet-delivered self-help interventions have the potential to address this unmet supportive care need reported by adults with ADHD, at relatively low costs. However, if the intervention does not offer optimal functions, content, and layout, it could decrease adherence and engagement and potentially compromise the effectiveness of such interventions. Thus, there is a need for examining the usability and factors that enhance and impair the usability of internet-delivered self-help interventions. Objective: This study evaluates the usability of an internet-delivered self-help intervention for adults with ADHD (MyADHD). The main goals were to (1) collect qualitative and quantitative data on usability and (2) identify usability problems. Methods: Individual think-aloud interviews and staged usability testing (N=5) were conducted to evaluate the usability of the MyADHD intervention in terms of function, content, and design. MyADHD end users provided iterative feedback to maximize engagement and usability. They performed tasks involved in operating the intervention and provided ``think-aloud'' commentary and postsession usability ratings. The interviews were recorded, transcribed verbatim, and analyzed. Results: Participants were satisfied with the overall usability of the program. The average perceived usability score out of 100 was 70 for the first round of testing and improved to 77.5 after applying modifications, with a mean score of 75.5 (SD 5.9) for all rounds of usability testing. The analysis of the interviews revealed 3 central themes: functionality, content, and layout. Conclusions: Optimizing the usability of internet-delivered self-guided interventions is a critical step in the design and development process. The usability testing in this study provided valuable information from users' perspectives on the content and platform of the intervention. Analysis revealed the need for intervention enhancement with regard to design, functionality, and content from the perspective of potential end users. Overall, participants saw value in the MyADHD intervention and were confident that they could use it for the self-management of symptoms and expressed the desire to use the entire intervention when it becomes available. Through this development process, we produced an intervention that is likely to be used successfully and is ready for deployment in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 ",
doi="10.2196/37137",
url="https://formative.jmir.org/2022/10/e37137",
url="http://www.ncbi.nlm.nih.gov/pubmed/36269662"
}


@Article{info:doi/10.2196/39301,
author="Boccardi, Alyssa
and Wu, Fangzheng
and Pearlman, Jon
and Mhatre, Anand",
title="Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study",
journal="JMIR Aging",
year="2022",
month="Oct",
day="18",
volume="5",
number="4",
pages="e39301",
keywords="aging",
keywords="older adults",
keywords="maintenance",
keywords="mobile phone",
keywords="repair",
keywords="smartphone",
keywords="wheelchair",
abstract="Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults' interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65\%), wheelchair service providers (15/57, 26\%), manufacturers (2/57, 4\%), seating and mobility researchers (1/57, 2\%), and insurance plan providers (2/57, 4\%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83\% women; and n=2, 17\% men) participated in the usability testing study. Of the 12 participants, 9 (75\%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. ",
doi="10.2196/39301",
url="https://aging.jmir.org/2022/4/e39301",
url="http://www.ncbi.nlm.nih.gov/pubmed/36256830"
}


@Article{info:doi/10.2196/37772,
author="Tran-Nguyen, Kevin
and Berger, Caroline
and Bennett, Roxanne
and Wall, Michelle
and Morin, N. Suzanne
and Rajabiyazdi, Fateme",
title="Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach",
journal="JMIR Aging",
year="2022",
month="Oct",
day="17",
volume="5",
number="4",
pages="e37772",
keywords="older adults",
keywords="mobile app",
keywords="skeletal fracture",
keywords="usability",
keywords="patient-centered",
keywords="human-centered design",
keywords="digital health",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="acute pain self-management",
keywords="mobile phone",
abstract="Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. ",
doi="10.2196/37772",
url="https://aging.jmir.org/2022/4/e37772",
url="http://www.ncbi.nlm.nih.gov/pubmed/36251348"
}


@Article{info:doi/10.2196/36987,
author="Kyt{\"o}, Mikko
and Koivusalo, Saila
and Ruonala, Antti
and Str{\"o}mberg, Lisbeth
and Tuomonen, Heli
and Heinonen, Seppo
and Jacucci, Giulio",
title="Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features",
journal="JMIR Hum Factors",
year="2022",
month="Oct",
day="12",
volume="9",
number="4",
pages="e36987",
keywords="gestational diabetes",
keywords="mobile app",
keywords="features",
keywords="behavior change",
keywords="digital health",
keywords="eHealth",
keywords="telehealth",
keywords="self-tracking",
keywords="self-management",
keywords="personalized health care",
abstract="Background: Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother's and the offspring's risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective: The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods: We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results: We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions: The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration: ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652 ",
doi="10.2196/36987",
url="https://humanfactors.jmir.org/2022/4/e36987",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222806"
}


@Article{info:doi/10.2196/37341,
author="van Velsen, Lex
and Ludden, Geke
and Gr{\"u}nloh, Christiane",
title="The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="5",
volume="24",
number="10",
pages="e37341",
keywords="user-centered design",
keywords="human-centered design",
keywords="eHealth, value-sensitive design",
keywords="citizen science",
doi="10.2196/37341",
url="https://www.jmir.org/2022/10/e37341",
url="http://www.ncbi.nlm.nih.gov/pubmed/36197718"
}


@Article{info:doi/10.2196/37894,
author="Diehl, Ceci
and Martins, Ana
and Almeida, Ana
and Silva, Telmo
and Ribeiro, {\'O}scar
and Santinha, Gon{\c{c}}alo
and Rocha, Nelson
and Silva, G. Anabela",
title="Defining Recommendations to Guide User Interface Design: Multimethod Approach",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="30",
volume="9",
number="3",
pages="e37894",
keywords="user interface design",
keywords="usability principles",
keywords="interaction paradigm",
keywords="generic recommendations",
keywords="specific recommendations",
abstract="Background: For the development of digital solutions, different aspects of user interface design must be taken into consideration. Different technologies, interaction paradigms, user characteristics and needs, and interface design components are some of the aspects that designers and developers should pay attention to when designing a solution. Many user interface design recommendations for different digital solutions and user profiles are found in the literature, but these recommendations have numerous similarities, contradictions, and different levels of detail. A detailed critical analysis is needed that compares, evaluates, and validates existing recommendations and allows the definition of a practical set of recommendations. Objective: This study aimed to analyze and synthesize existing user interface design recommendations and propose a practical set of recommendations that guide the development of different technologies. Methods: Based on previous studies, a set of recommendations on user interface design was generated following 4 steps: (1) interview with user interface design experts; (2) analysis of the experts' feedback and drafting of a set of recommendations; (3) reanalysis of the shorter list of recommendations by a group of experts; and (4) refining and finalizing the list. Results: The findings allowed us to define a set of 174 recommendations divided into 12 categories, according to usability principles, and organized into 2 levels of hierarchy: generic (69 recommendations) and specific (105 recommendations). Conclusions: This study shows that user interface design recommendations can be divided according to usability principles and organized into levels of detail. Moreover, this study reveals that some recommendations, as they address different technologies and interaction paradigms, need further work. ",
doi="10.2196/37894",
url="https://humanfactors.jmir.org/2022/3/e37894",
url="http://www.ncbi.nlm.nih.gov/pubmed/36178714"
}


@Article{info:doi/10.2196/41201,
author="Lau, L. Karen P.
and Agarwal, Payal
and Parente, Laura
and Marcello, Olivia
and Lovas, Mike
and Van, Jason
and Vigod, N. Simone
and Champagne, Trevor
and Mohan, Tanya
and Arents, WM Bernd
and Burton, Tim
and Flohr, Carsten
and Drucker, M. Aaron",
title="Development of a Website for a Living Network Meta-analysis of Atopic Dermatitis Treatments Using a User-Centered Design: Multimethod Study",
journal="JMIR Dermatol",
year="2022",
month="Sep",
day="26",
volume="5",
number="3",
pages="e41201",
keywords="atopic dermatitis",
keywords="skin",
keywords="dermatology",
keywords="dermatitis",
keywords="eczema",
keywords="network meta-analysis",
keywords="knowledge translation",
keywords="health literacy",
keywords="user-centered design",
keywords="patient education",
keywords="information seeking",
keywords="health information",
keywords="website development",
keywords="web development",
keywords="web design",
keywords="website design",
keywords="allergist",
keywords="user experience",
keywords="interface",
keywords="usability",
keywords="visualization",
keywords="decision-making",
keywords="online resource",
keywords="education material",
abstract="Background: A rapid expansion of systemic immunological treatment options for atopic dermatitis (AD) has created a need for clinically relevant and understandable comparative efficacy and safety information for patients and clinicians. Given the scarcity of head-to-head trials, network meta-analysis (NMA) is an alternative way to enable robust comparisons among treatment options; however, NMA results are often complex and difficult to directly implement in shared decision-making. Objective: The aim of this study is to develop a website that effectively presents the results of a living systematic review and NMA on AD treatments to patient and clinician users. Methods: We conducted a multimethod study using iterative feedback from adults with AD, adult caregivers of children with AD, dermatologists, and allergists within a user-centered design framework. We used questionnaires followed by workshops among patients and clinicians to develop and improve the website interface. Usability testing was done with a caregiver of a patient with eczema. Results: Questionnaires were completed by 31 adults with AD or caregivers and 94 clinicians. Patients and caregivers felt it was very important to know about new treatments (20/31, 65\%). Clinicians felt the lack of evidence-based comparisons between treatments was a barrier to care (55/93, 59\%). ``Avoiding dangerous side effects'' was ranked as the most important priority for patients (weighted ranking 5.2/7, with higher ranking being more important), and ``improving patients' overall symptoms'' was the most important priority for clinicians (weighted ranking 5.0/6). A total of 4 patients and 7 clinicians participated in workshops; they appreciated visualizations of the NMA results and found the website valuable for comparing different treatments. The patients suggested changes to simplify the interface and clarify terminology related to comparative efficacy. The user in the usability testing found the website intuitive to navigate. Conclusions: We developed a website, ``eczematherapies.com,'' with a user-centered design approach. Visualizations of NMA results enable users to compare treatments as part of their shared decision-making process. ",
doi="10.2196/41201",
url="https://derma.jmir.org/2022/3/e41201",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632894"
}


@Article{info:doi/10.2196/37606,
author="Shuldiner, Jennifer
and Shah, Nida
and Reis, Catherine
and Chalmers, Ian
and Ivers, Noah
and Nathan, Paul",
title="Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="13",
volume="9",
number="3",
pages="e37606",
keywords="design",
keywords="cancer screening",
keywords="childhood cancer survivor",
keywords="late effects",
keywords="surveillance",
keywords="cancer",
keywords="cancer survivor",
keywords="morbidity",
keywords="mortality",
keywords="cancer treatment",
keywords="mammogram",
keywords="echocardiogram",
abstract="Background: Survivors of childhood cancer are at lifelong risk of morbidity (such as new cancers or heart failure) and premature mortality due to their cancer treatment. These are termed late effects. Therefore, they require lifelong, risk-tailored surveillance. However, most adult survivors of childhood cancer do not complete recommended surveillance tests such as mammograms or echocardiograms. Objective: In partnership with survivors, family physicians, and health system partners, we are designing a provincial support system for high-priority tests informed by principles of implementation science, behavioral science, and design thinking. Methods: Our multiphase process was structured as follows. Step 1 consisted of a qualitative study to explore intervention components essential to accessing surveillance tests. Step 2 comprised a workshop with childhood cancer survivors, family physicians, and health system stakeholders that used the Step 1 findings and ``personas'' (a series of fictional but data-informed characters) to develop and tailor the intervention for different survivor groups. Step 3 consisted of intervention prototype development, and Step 4 involved iterative user testing. Results: The qualitative study of 30 survivors and 7 family physicians found a high desire for information on surveillance for late effects. Respondents indicated that the intervention should help patients book appointments when they are due in addition to providing personalized information. Insights from the workshop included the importance of partnering with both family physicians and survivorship clinics and providing emotional support for survivors who may experience distress upon learning of their risk for late effects. In our user-testing process, prototypes went through iterations that incorporated feedback from users regarding acceptability, usability, and functionality. We sought to address the needs of survivors and physicians while balancing the capacity and infrastructure available for a lifelong intervention via our health system partners. Conclusions: In partnership with childhood cancer survivors, family physicians, and health system partners, we elucidated the barriers and enablers to accessing guideline-recommended surveillance tests and designed a multifaceted solution that will support survivors and their family physicians. The next step is to evaluate the intervention in a pragmatic randomized controlled trial. ",
doi="10.2196/37606",
url="https://humanfactors.jmir.org/2022/3/e37606",
url="http://www.ncbi.nlm.nih.gov/pubmed/36099013"
}


@Article{info:doi/10.2196/31991,
author="Bui, An Truong
and Pohl, Megan
and Rosenfelt, Cory
and Ogourtsova, Tatiana
and Yousef, Mahdieh
and Whitlock, Kerri
and Majnemer, Annette
and Nicholas, David
and Demmans Epp, Carrie
and Zaiane, Osmar
and Bolduc, V. Fran{\c{c}}ois",
title="Identifying Potential Gamification Elements for A New Chatbot for Families With Neurodevelopmental Disorders: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Aug",
day="19",
volume="9",
number="3",
pages="e31991",
keywords="gamification",
keywords="chatbot",
keywords="neurodevelopmental disorders",
keywords="engagement",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="focus group",
keywords="interview",
keywords="user-centered design",
keywords="health information technologies",
abstract="Background: Chatbots have been increasingly considered for applications in the health care field. However, it remains unclear how a chatbot can assist users with complex health needs, such as parents of children with neurodevelopmental disorders (NDDs) who need ongoing support. Often, this population must deal with complex and overwhelming health information, which can make parents less likely to use a software that may be very helpful. An approach to enhance user engagement is incorporating game elements in nongame contexts, known as gamification. Gamification needs to be tailored to users; however, there has been no previous assessment of gamification use in chatbots for NDDs. Objective: We sought to examine how gamification elements are perceived and whether their implementation in chatbots will be well received among parents of children with NDDs. We have discussed some elements in detail as the initial step of the project. Methods: We performed a narrative literature review of gamification elements, specifically those used in health and education. Among the elements identified in the literature, our health and social science experts in NDDs prioritized five elements for in-depth discussion: goal setting, customization, rewards, social networking, and unlockable content. We used a qualitative approach, which included focus groups and interviews with parents of children with NDDs (N=21), to assess the acceptability of the potential implementation of these elements in an NDD-focused chatbot. Parents were asked about their opinions on the 5 elements and to rate them. Video and audio recordings were transcribed and summarized for emerging themes, using deductive and inductive thematic approaches. Results: From the responses obtained from 21 participants, we identified three main themes: parents of children with NDDs were familiar with and had positive experiences with gamification; a specific element (goal setting) was important to all parents, whereas others (customization, rewards, and unlockable content) received mixed opinions; and the social networking element received positive feedback, but concerns about information accuracy were raised. Conclusions: We showed for the first time that parents of children with NDDs support gamification use in a chatbot for NDDs. Our study illustrates the need for a user-centered design in the medical domain and provides a foundation for researchers interested in developing chatbots for populations that are medically vulnerable. Future studies exploring wide range of gamification elements with large number of potential users are needed to understand the impact of gamification elements in enhancing knowledge mobilization. ",
doi="10.2196/31991",
url="https://humanfactors.jmir.org/2022/3/e31991",
url="http://www.ncbi.nlm.nih.gov/pubmed/35984679"
}


@Article{info:doi/10.2196/34463,
author="Anglade, Carole
and Breton, Mylaine
and Simard, Frederic
and Fitzpatrick, Terry
and Fitzpatrick, Meighen
and Bruneau, Genevi{\`e}ve
and Gaboury, Isabelle",
title="Development and Implementation of an Interprofessional Digital Platform to Increase Therapeutic Adherence: Protocol for a Mixed Design Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="12",
volume="11",
number="8",
pages="e34463",
keywords="adherence",
keywords="disease management",
keywords="primary health care",
keywords="electronic platform",
keywords="chronic disease",
keywords="design thinking",
keywords="acceptability",
abstract="Background: Adherence to care plans is a major issue in health care systems. Improved adherence has several potential benefits such as ensuring treatment effectiveness and control of chronic diseases. There is currently a lack of tools to maximize treatment adherence in an integrated manner, that is, covering multiple aspects of patients' health continuously throughout their medical care. To ensure better adherence, such tools must meet the needs of patients with chronic conditions as well as those of health care professionals. Acknowledging the health issues associated with nonadherence to treatment, an industry-research-clinical partnership aims to adapt a digital platform---facilitating patient-health care professional interactions---to improve therapeutic adherence in patients with chronic illnesses. The platform allows for exchanges between patients and health care professionals to facilitate the timing of medication use or chronic disease management and maximize patient adherence. Objective: This study aims to (1) identify the needs of patients living with a chronic condition and their health professionals concerning their interactions regarding treatment; (2) codevelop an adaptation of an interactive patient-professional platform that meets the needs identified; and (3) then test the platform and document its effects and acceptability in a clinical setting. Methods: The study will use a creative design thinking process based on the needs expressed by users (patients and health professionals) concerning treatment adherence for chronic diseases (eg, diabetes, asthma, high blood pressure, depression and anxiety, chronic obstructive pulmonary disease). A mixed method evaluation research design will be used to develop and evaluate the platform. Qualitative data will be used to assess user needs and acceptability of the platform, and quantitative data will provide the necessary insights to document its effects. Results: Technological development of the platform has been completed. Recruitment for the first part of Phase 1 started in May 2022. The results of this project to codevelop an interprofessional digital platform to increase therapeutic adherence will be relevant to clinicians and managers seeking contemporary solutions that support patient adherence to treatment for chronic diseases. These results will enable optimal use of the platform and identify areas for improvement in interactive patient-health care professional apps. Conclusions: The adoption of an interactive digital platform to facilitate effective exchanges between patients and health care professionals in primary care settings could improve adherence to treatment. The platform tested in this project takes a first step in this direction by ensuring that the technological product is developed according to the needs of patients as well as the health professionals who are likely to use it. International Registered Report Identifier (IRRID): DERR1-10.2196/34463 ",
doi="10.2196/34463",
url="https://www.researchprotocols.org/2022/8/e34463",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969433"
}


@Article{info:doi/10.2196/35577,
author="Tremblay, Melanie
and Hamel, Christine
and Viau-Guay, Anabelle
and Giroux, Dominique",
title="User Experience of the Co-design Research Approach in eHealth: Activity Analysis With the Course-of-Action Framework",
journal="JMIR Hum Factors",
year="2022",
month="Aug",
day="9",
volume="9",
number="3",
pages="e35577",
keywords="co-design",
keywords="caregivers",
keywords="activity analysis",
keywords="course-of-action framework",
keywords="participant experience",
keywords="intrinsic description",
keywords="guidelines",
keywords="affordances",
abstract="Background: The cocreation of eHealth solutions with potential users, or co-design, can help make the solution more acceptable. However, the co-design research approach requires substantial investment, and projects are not always fruitful. Researchers have provided guidelines for the co-design approach, but these are either applicable only in specific situations or not supported by empirical data. Ways to optimize the experience of the co-design process from the point of view of the participants are also missing. Scientific literature in the co-design field generally provides an extrinsic description of the experience of participants in co-design projects. Objective: We addressed this issue by describing a co-design project and focusing on the participants' experiences looking at what was significant from their point of view. Methods: We used a qualitative situated cognitive anthropology approach for this study. Data were collected on a co-design research project that aimed to support the help-seeking process of caregivers of functionally dependent older adults. The methodology was based on the perspective of experience by Dewey and used the course-of-action theoretical and methodological framework. Data collection was conducted in 2 phases: observation of participants and recording of sessions and participant self-confrontation interviews using the session recordings. We interviewed 27\% (20/74) of the participants. We analyzed the data through nonexclusive emerging categorization of themes using the constant comparative method. Results: In total, 5 emerging themes were identified. The perception of extrinsic constraints and the effects of the situation was central and the most important theme, affecting other themes (frustrating interactions with others, learning together, destabilization, and getting personal benefits). Co-occurrences between codes allowed for a visual and narrative understanding of what was significant for the participants during this project. The results highlighted the importance of the role of the research team in preparing and moderating the sessions. They also provided a detailed description of the interactions between participants during the sessions, which is a core aspect of the co-design approach. There were positive and negative aspects of the participants' experiences during this co-design project. Reflecting on our results, we provided potential affordances to shape the experience of participants in co-design. Conclusions: Potential users are an essential component of the co-design research approach. Researchers and designers should seek to offer these users a positive and contributory experience to encourage participation in further co-design initiatives. Future research should explore how the proposed affordances influence the success of the intervention. ",
doi="10.2196/35577",
url="https://humanfactors.jmir.org/2022/3/e35577",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943783"
}


@Article{info:doi/10.2196/34821,
author="Pinard, St{\'e}phanie
and Bottari, Carolina
and Lalibert{\'e}, Catherine
and Pigot, H{\'e}l{\`e}ne
and Olivares, Marisnel
and Couture, M{\'e}lanie
and Aboujaoud{\'e}, Aline
and Giroux, Sylvain
and Bier, Nathalie",
title="Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study",
journal="JMIR Hum Factors",
year="2022",
month="Aug",
day="4",
volume="9",
number="3",
pages="e34821",
keywords="user-centered design",
keywords="needs assessment",
keywords="assistive technology",
keywords="brain injury",
keywords="activities of daily living",
keywords="cognitive rehabilitation",
keywords="meal preparation",
keywords="mobile phone",
abstract="Background: Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. Objective: This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users' profiles and establishing the clinical requirements of the ATC. Methods: In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. Results: The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. Conclusions: This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability. ",
doi="10.2196/34821",
url="https://humanfactors.jmir.org/2022/3/e34821",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925663"
}


@Article{info:doi/10.2196/36936,
author="Almeqbaali, Mariam
and Ouhbi, Sofia
and Serhani, Adel Mohamed
and Amiri, Leena
and Jan, K. Reem
and Zaki, Nazar
and Sharaf, Ayman
and Al Helali, Abdulla
and Almheiri, Eisa",
title="A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study",
journal="JMIR Serious Games",
year="2022",
month="Aug",
day="2",
volume="10",
number="3",
pages="e36936",
keywords="connected mental health",
keywords="mental health",
keywords="anxiety",
keywords="digital game",
keywords="biofeedback",
keywords="app",
keywords="serious game",
keywords="gaming",
keywords="gamification",
keywords="young adult",
keywords="user-centered design",
keywords="stress",
keywords="stress relief",
keywords="user-centred design",
keywords="youth",
keywords="user feedback",
keywords="user experience",
keywords="usability",
keywords="user need",
keywords="development",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Following the outbreak of COVID-19, several studies have reported that young adults encountered a rise in anxiety symptoms, which could negatively affect their quality of life. Promising evidence suggests that mobile apps with biofeedback, serious games, breathing exercises, and positive messaging, among other features, are useful for anxiety self-management and treatment. Objective: This study aimed to develop and evaluate the usability of a biofeedback-based app with serious games for young adults with anxiety in the United Arab Emirates (UAE). Methods: This study consists of two phases: Phase I describes the design and development of the app, while Phase II presents the results of a usability evaluation by experts. To elicit the app's requirements during Phase I, we conducted (1) a survey to investigate preferences of young adults in the UAE for mobile games for stress relief; (2) an analysis of serious games for anxiety; and (3) interviews with mental health professionals and young adults in the UAE. In Phase II, five experts tested the usability of the developed app using a set of Nielsen's usability heuristics. Results: A fully functional biofeedback-based app with serious games was co-designed with mental health professionals. The app included 4 games (ie, a biofeedback game, card game, arcade game, and memory game), 2 relaxation techniques (ie, a breathing exercise and yoga videos), and 2 additional features (ie, positive messaging and a mood tracking calendar). The results of Phase II showed that the developed app is efficient, simple, and easy to use. Overall, the app design scored an average of 4 out of 5. Conclusions: The elicitation techniques used in Phase I resulted in the development of an easy-to-use app for the self-management of anxiety. Further research is required to determine the app's usability and effectiveness in the target population. ",
doi="10.2196/36936",
url="https://games.jmir.org/2022/3/e36936",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916692"
}


@Article{info:doi/10.2196/37189,
author="Reszel, Jessica
and van den Hoek, Joan
and Nguyen, Tram
and Aravind, Gayatri
and Bayley, T. Mark
and Bird, Marie-Louise
and Edwards, Kate
and Eng, J. Janice
and Moore, L. Jennifer
and Nelson, A. Michelle L.
and Ploughman, Michelle
and Richardson, Julie
and Salbach, M. Nancy
and Tang, Ada
and Graham, D. Ian",
title="The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="29",
volume="6",
number="7",
pages="e37189",
keywords="stroke",
keywords="rehabilitation",
keywords="community-based exercise programs",
keywords="knowledge translation",
keywords="knowledge mobilization",
keywords="implementation science",
abstract="Background: As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective: This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods: This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results: A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner's comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions: We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke. ",
doi="10.2196/37189",
url="https://formative.jmir.org/2022/7/e37189",
url="http://www.ncbi.nlm.nih.gov/pubmed/35904870"
}


@Article{info:doi/10.2196/38616,
author="Bray, Alice Emily
and Everett, Bronwyn
and George, Ajesh
and Salamonson, Yenna
and Ramjan, M. Lucie",
title="Developing a Health Care Transition Intervention With Young People With Spinal Cord Injuries: Co-design Approach",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="28",
volume="6",
number="7",
pages="e38616",
keywords="co-design",
keywords="participatory action research",
keywords="health care transition",
keywords="pediatric health care",
keywords="adult health care",
keywords="spinal cord injury",
abstract="Background: Successful transition from pediatric to adult health care settings supports long-term health management and better overall outcomes in all domains. However, young people with spinal cord injuries (SCIs) continue to report challenges and unmet needs during the transition process. Including end users in health care research and intervention design is paramount as interventions designed in this way better meet their specific needs and are often more innovative. Although studies have reported involving young people with chronic conditions in the development of health care transition (HCT) interventions, few details have been provided as to how this was achieved. Objective: This study outlined the co-design and development of an HCT intervention to support young people with SCIs. It contextualized the co-design process, methods, materials used, and steps implemented from defining the problem to conceiving and designing the solution. This was accomplished by understanding and listening to end users' needs and recommendations for HCT. Methods: Using participatory methods, this qualitative study reports the co-design of an HCT intervention to support young people with SCIs and parents or caregivers. Two co-design workshops were conducted: one with young people with SCIs and one with parents and caregivers. Categories were defined through a hybrid deductive and inductive qualitative content analysis process that was informed by the Care Transitions Framework and guided the development of the HCT intervention. Following the creation of a prototype intervention, young people with SCIs, parents and caregivers, and key pediatric SCI stakeholders provided feedback on the intervention content and design in focus groups. Similar to the workshops, the focus groups were analyzed using a hybrid deductive and inductive qualitative content analysis process informed by the Care Transitions Framework. The Enhancing the Quality and Transparency of Health Research guidelines for qualitative research (Consolidated Criteria for Reporting Qualitative Research) were applied. Results: Overall, 4 young people and 4 parents or caregivers participated in the co-design workshops. Key recommendations for the HCT intervention were that participants wanted a ``one-stop shop'' for all their transition information needs and an editable portable medical summary to take with them to appointments. On the basis of the analysis of participants' recommendations from the workshops, it was determined that a website would be an appropriate hosting platform for the interventions. The focus group feedback on the design and content of the prototype website was extremely positive, with minor recommendations for improvement. Conclusions: This is the first study to co-design and develop an HCT intervention in partnership with young people with SCIs and parents and caregivers. Although the study sample was small, it has shown that it is possible to meaningfully engage and empower young people with SCIs and parents and caregivers in the co-design of an HCT intervention. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-053212 ",
doi="10.2196/38616",
url="https://formative.jmir.org/2022/7/e38616",
url="http://www.ncbi.nlm.nih.gov/pubmed/35900814"
}


@Article{info:doi/10.2196/36280,
author="Arigo, Danielle
and Lobo, F. Andrea
and Ainsworth, Cole M.
and Baga, Kiri
and Pasko, Kristen",
title="Development and Initial Testing of a Personalized, Adaptive, and Socially Focused Web Tool to Support Physical Activity Among Women in Midlife: Multidisciplinary and User-Centered Design Approach",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="26",
volume="6",
number="7",
pages="e36280",
keywords="user-centered design",
keywords="digital health",
keywords="eHealth",
keywords="women's health",
keywords="midlife",
keywords="physical activity",
keywords="social support",
keywords="social comparison",
keywords="mobile phone",
abstract="Background: Women in midlife are vulnerable to developing cardiovascular disease, particularly those who have conditions such as hypertension. Physical activity (PA) can reduce risk, but efforts to promote PA in this population have been only modestly effective. More attention to social influences on PA behavior may be useful, particularly social support and social comparison processes. Activating these processes with digital tools can provide easy access that is flexible to the needs of women in midlife. Objective: This paper describes the user-centered design processes of developing and conducting initial evaluation of a personalized and adaptive web application, tailored to the social needs of women in midlife. The goal was to gather feedback from the population of interest, before and during the design process. Methods: This study was conducted in 4 stages. The first and second authors (DA and AFL) developed technical specifications, informed by their experience with the population of interest. We collected feedback on potential content for the web application with women in midlife using both interviews (5/10, 50\%; mean age 47.4, SD 6.66 years; mean BMI 35.3, SD 9.55 kg/m2) and surveys (5/10, 50\%; mean age 51, SD 6.60 years; mean BMI 32.7, SD 8.39 kg/m2). We used their feedback to inform support messages and peer profiles (ie, sources of social comparison information). Nine members of the behavioral science team and 3 testers unfamiliar with the web application completed internal testing. We conducted naturalistic functionality testing with a different group of women in midlife (n=5; mean age 50, SD 6.26 years; mean BMI 30.1, SD 5.83 kg/m2), who used the web application as intended for 4 days and provided feedback at the end of this period. Results: Iterative storyboard development resulted in programming specifications for a prototype of the web application. We used content feedback to select and refine the support messages and peer profiles to be added. The following 2 rounds of internal testing identified bugs and other problems regarding the web application's functioning and full data collection procedure. Problems were addressed or logged for future consideration. Naturalistic functionality testing revealed minimal further problems; findings showed preliminary acceptability of the web application and suggested that women may select different social content across days. Conclusions: A multidisciplinary and user-centered design approach led to a personalized and adaptive web application, tailored to the social needs of women in midlife. Findings from testing with this population demonstrated the feasibility and acceptability of the new application and supported further development toward its use in daily life. We describe several potential uses of the web application and next steps for its development. We also discuss the lessons learned and offer recommendations for future collaborations between behavioral and computer scientists to develop similar tools. ",
doi="10.2196/36280",
url="https://formative.jmir.org/2022/7/e36280",
url="http://www.ncbi.nlm.nih.gov/pubmed/35881431"
}


@Article{info:doi/10.2196/37350,
author="Skeen, J. Simone
and Jones, Scott Stephen
and Cruse, Marie Carolyn
and Horvath, J. Keith",
title="Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="21",
volume="9",
number="3",
pages="e37350",
keywords="mHealth",
keywords="mobile health",
keywords="HIV",
keywords="natural language",
keywords="thematic analysis",
keywords="human-centered design",
keywords="human-centered",
keywords="user-centered",
keywords="user-generated content",
keywords="proof-of-concept",
keywords="user feedback",
keywords="web-based",
keywords="web app",
keywords="men's health",
keywords="peer support",
keywords="informal support",
keywords="support group",
keywords="digital health",
keywords="eHealth",
keywords="sentiment",
keywords="design insight",
keywords="user insight",
keywords="Python",
keywords="model",
keywords="machine learning",
abstract="Background: HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth. Objective: In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum. Methods: UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes. Results: The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support. Conclusions: With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media. ",
doi="10.2196/37350",
url="https://humanfactors.jmir.org/2022/3/e37350",
url="http://www.ncbi.nlm.nih.gov/pubmed/35862171"
}


@Article{info:doi/10.2196/35376,
author="Waddington, Claire
and Harding, Emma
and Brotherhood, V. Emilie
and Davies Abbott, Ian
and Barker, Suzanne
and Camic, M. Paul
and Ezeofor, Victory
and Gardner, Hannah
and Grillo, Adetola
and Hardy, Chris
and Hoare, Zoe
and McKee-Jackson, Roberta
and Moore, Kirsten
and O'Hara, Trish
and Roberts, Jennifer
and Rossi-Harries, Samuel
and Suarez-Gonzalez, Aida
and Sullivan, Pat Mary
and Edwards, Tudor Rhiannon
and Van Der Byl Williams, Millie
and Walton, Jill
and Willoughby, Alicia
and Windle, Gill
and Winrow, Eira
and Wood, Olivia
and Zimmermann, Nikki
and Crutch, J. Sebastian
and Stott, Joshua",
title="The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="20",
volume="11",
number="7",
pages="e35376",
keywords="dementia",
keywords="Alzheimer disease",
keywords="frontotemporal dementia",
keywords="posterior cortical atrophy",
keywords="Lewy body dementia",
keywords="Lewy body disease",
keywords="primary progressive aphasia",
keywords="young-onset dementia",
keywords="early-onset dementia",
keywords="atypical dementia",
keywords="virtual",
keywords="web-based",
keywords="videoconference",
keywords="videophone",
keywords="support group",
abstract="Background: People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. Objective: We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. Methods: We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. Results: The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. Conclusions: The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. International Registered Report Identifier (IRRID): DERR1-10.2196/35376 ",
doi="10.2196/35376",
url="https://www.researchprotocols.org/2022/7/e35376",
url="http://www.ncbi.nlm.nih.gov/pubmed/35857375"
}


@Article{info:doi/10.2196/37353,
author="Wood, D. Michael
and Correa, Kim
and Ding, Peijia
and Sreepada, Rama
and Loftsgard, C. Kent
and Jordan, Isabel
and West, C. Nicholas
and Whyte, D. Simon
and Portales-Casamar, Elodie
and G{\"o}rges, Matthias",
title="Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members",
journal="JMIR Pediatr Parent",
year="2022",
month="Jul",
day="15",
volume="5",
number="3",
pages="e37353",
keywords="eHealth",
keywords="risk communication",
keywords="risk",
keywords="decision aid",
keywords="pain",
keywords="individualized risk",
keywords="surgery",
keywords="anesthesia",
keywords="anesthetic",
keywords="anesthesiology",
keywords="focus group",
keywords="requirement definition",
keywords="prototyping",
keywords="prototype",
keywords="pediatrics",
keywords="pediatric",
keywords="child",
keywords="postoperative",
keywords="prediction",
keywords="digital health",
keywords="development",
keywords="user feedback",
keywords="patient feedback",
keywords="user-centered design",
abstract="Background: Pediatric surgery is associated with a risk of postoperative pain that can impact the family's quality of life. Although some risk factors for postoperative pain are known, these are often not consistently communicated to families. In addition, although tools for risk communication exist in other domains, none are tailored to pediatric surgery. Objective: As part of a larger project to develop pain risk prediction tools, we aimed to design an easy-to-use tool to effectively communicate a child's risk of postoperative pain to both clinicians and family members. Methods: With research ethics board approval, we conducted virtual focus groups ({\textasciitilde}1 hour each) comprising clinicians and family members (people with lived surgical experience and parents of children who had recently undergone surgery/medical procedures) at a tertiary pediatric hospital to understand and evaluate potential design approaches and strategies for effectively communicating and visualizing postoperative pain risk. Data were analyzed thematically to generate design requirements and to inform iterative prototype development. Results: In total, 19 participants (clinicians: n=10, 53\%; family members: n=9, 47\%) attended 6 focus group sessions. Participants indicated that risk was typically communicated verbally by clinicians to patients and their families, with severity indicated using a descriptive or a numerical representation or both, which would only occasionally be contextualized. Participants indicated that risk communication tools were seldom used but that families would benefit from risk information, time to reflect on the information, and follow-up with questions. In addition, 9 key design requirements and feature considerations for effective risk communication were identified: (1) present risk information clearly and with contextualization, (2) quantify the risk and contextualize it, (3) include checklists for preoperative family preparation, (4) provide risk information digitally to facilitate recall and sharing, (5) query the family's understanding to ensure comprehension of risk, (6) present the risk score using multimodal formats, (7) use color coding that is nonthreatening and avoids limitations with color blindness, (8) present the most significant factors contributing to the risk prediction, and (9) provide risk mitigation strategies to potentially decrease the patient's level of risk. Conclusions: Key design requirements for a pediatric postoperative pain risk visualization tool were established and guided the development of an initial prototype. Implementing a risk communication tool into clinical practice has the potential to bridge existing gaps in the accessibility, utilization, and comprehension of personalized risk information between health care professionals and family members. Future iterative codesign and clinical evaluation of this risk communication tool are needed to confirm its utility in practice. ",
doi="10.2196/37353",
url="https://pediatrics.jmir.org/2022/3/e37353",
url="http://www.ncbi.nlm.nih.gov/pubmed/35838823"
}


@Article{info:doi/10.2196/31529,
author="Schwartz-Lasfargues, Christel
and Roux-Gendron, Camille
and Edomskis, Pim
and Marque, Isabelle
and Bayon, Yves
and Lange, F. Johan
and Faucheron, Luc Jean
and Trilling, Bertrand",
title="Development of a Connected Sensor System in Colorectal Surgery: User-Centered Design Case Study",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="8",
volume="9",
number="3",
pages="e31529",
keywords="user-centered design",
keywords="usability",
keywords="formative evaluation",
keywords="medical device",
keywords="innovation",
keywords="Internet of Things",
keywords="IoT",
keywords="colorectal surgery",
keywords="colorectal anastomotic leakage",
keywords="mobile phone",
abstract="Background: A successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals' daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development. Objective: The case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices. Methods: UCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months. Results: Functional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design. Conclusions: This paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case. ",
doi="10.2196/31529",
url="https://humanfactors.jmir.org/2022/3/e31529",
url="http://www.ncbi.nlm.nih.gov/pubmed/35802406"
}


@Article{info:doi/10.2196/29725,
author="Hardy, Amy
and Ward, Thomas
and Emsley, Richard
and Greenwood, Kathryn
and Freeman, Daniel
and Fowler, David
and Kuipers, Elizabeth
and Bebbington, Paul
and Garety, Philippa",
title="Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="1",
volume="9",
number="3",
pages="e29725",
keywords="paranoia",
keywords="psychosis",
keywords="digital health",
keywords="apps",
keywords="human-centered design",
keywords="user experience",
keywords="adherence",
keywords="engagement",
keywords="therapy",
abstract="Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the ``digital divide.'' Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the ``digital divide.'' SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the ``digital divide'' and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7\% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75\%, SD 17.1\%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the ``digital divide.'' Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the ``digital divide'' on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 ",
doi="10.2196/29725",
url="https://humanfactors.jmir.org/2022/3/e29725",
url="http://www.ncbi.nlm.nih.gov/pubmed/35776506"
}


@Article{info:doi/10.2196/37585,
author="Munson, A. Sean
and Friedman, C. Emily
and Osterhage, Katie
and Allred, Ryan
and Pullmann, D. Michael
and Are{\'a}n, A. Patricia
and Lyon, R. Aaron
and ",
title="Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="14",
volume="24",
number="6",
pages="e37585",
keywords="evidence-based psychosocial interventions",
keywords="usability",
keywords="implementation strategies",
keywords="mental health",
keywords="human-centered design",
keywords="implementation science",
abstract="Background: People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies. Objective: This study aimed to identify and categorize usability issues in EBPIs and their implementation strategies. Methods: We adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health---funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies. Results: The 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues. Conclusions: Usability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies. International Registered Report Identifier (IRRID): RR2-10.2196/14990 ",
doi="10.2196/37585",
url="https://www.jmir.org/2022/6/e37585",
url="http://www.ncbi.nlm.nih.gov/pubmed/35700016"
}


@Article{info:doi/10.2196/36066,
author="Itelman, Edward
and Shlomai, Gadi
and Leibowitz, Avshalom
and Weinstein, Shiri
and Yakir, Maya
and Tamir, Idan
and Sagiv, Michal
and Muhsen, Aia
and Perelman, Maxim
and Kant, Daniella
and Zilber, Eyal
and Segal, Gad",
title="Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="9",
volume="6",
number="6",
pages="e36066",
keywords="remote patient monitoring",
keywords="noninvasive monitoring",
keywords="general ward",
keywords="early warning score system",
keywords="patient deterioration",
keywords="clinical prediction",
keywords="wearable devices",
keywords="uHealth",
abstract="Background: Patients admitted to general wards are inherently at risk of deterioration. Thus, tools that can provide early detection of deterioration may be lifesaving. Frequent remote patient monitoring (RPM) has the potential to allow such early detection, leading to a timely intervention by health care providers. Objective: This study aimed to assess the potential of a novel wearable RPM device to provide timely alerts in patients at high risk for deterioration. Methods: This prospective observational study was conducted in two general wards of a large tertiary medical center. Patients determined to be at high risk to deteriorate upon admission and assigned to a telemetry bed were included. On top of the standard monitoring equipment, a wearable monitor was attached to each patient, and monitoring was conducted in parallel. The data gathered by the wearable monitors were analyzed retrospectively, with the medical staff being blinded to them in real time. Several early warning scores of the risk for deterioration were used, all calculated from frequent data collected by the wearable RPM device: these included (1) the National Early Warning Score (NEWS), (2) Airway, Breathing, Circulation, Neurology, and Other (ABCNO) score, and (3) deterioration criteria defined by the clinical team as a ``wish list'' score. In all three systems, the risk scores were calculated every 5 minutes using the data frequently collected by the wearable RPM device. Data generated by the early warning scores were compared with those obtained from the clinical records of actual deterioration among these patients. Results: In total, 410 patients were recruited and 217 were included in the final analysis. The median age was 71 (IQR 62-78) years and 130 (59.9\%) of them were male. Actual clinical deterioration occurred in 24 patients. The NEWS indicated high alert in 16 of these 24 (67\%) patients, preceding actual clinical deterioration by 29 hours on average. The ABCNO score indicated high alert in 18 (75\%) of these patients, preceding actual clinical deterioration by 38 hours on average. Early warning based on wish list scoring criteria was observed for all 24 patients 40 hours on average before clinical deterioration was detected by the medical staff. Importantly, early warning based on the wish list scoring criteria was also observed among all other patients who did not deteriorate. Conclusions: Frequent remote patient monitoring has the potential for early detection of a high risk to deteriorate among hospitalized patients, using both grouped signal-based scores and algorithm-based prediction. In this study, we show the ability to formulate scores for early warning by using RPM. Nevertheless, early warning scores compiled on the basis of these data failed to deliver reasonable specificity. Further efforts should be directed at improving the specificity and sensitivity of such tools. Trial Registration: ClinicalTrials.gov NCT04220359; https://clinicaltrials.gov/ct2/show/NCT04220359 ",
doi="10.2196/36066",
url="https://formative.jmir.org/2022/6/e36066",
url="http://www.ncbi.nlm.nih.gov/pubmed/35679119"
}


@Article{info:doi/10.2196/31485,
author="Karni, Liran
and Jusufi, Ilir
and Nyholm, Dag
and Klein, Oskar Gunnar
and Memedi, Mevludin",
title="Toward Improved Treatment and Empowerment of Individuals With Parkinson Disease: Design and Evaluation of an Internet of Things System",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="9",
volume="6",
number="6",
pages="e31485",
keywords="Internet of Things",
keywords="wearable technology",
keywords="Parkinson disease",
keywords="patient empowerment",
keywords="objective measures",
keywords="self-assessment",
keywords="self-management",
keywords="web interface",
abstract="Background: Parkinson disease (PD) is a chronic degenerative disorder that causes progressive neurological deterioration with profound effects on the affected individual's quality of life. Therefore, there is an urgent need to improve patient empowerment and clinical decision support in PD care. Home-based disease monitoring is an emerging information technology with the potential to transform the care of patients with chronic illnesses. Its acceptance and role in PD care need to be elucidated both among patients and caregivers. Objective: Our main objective was to develop a novel home-based monitoring system (named EMPARK) with patient and clinician interface to improve patient empowerment and clinical care in PD. Methods: We used elements of design science research and user-centered design for requirement elicitation and subsequent information and communications technology (ICT) development. Functionalities of the interfaces were the subject of user-centric multistep evaluation complemented by semantic analysis of the recorded end-user reactions. The ICT structure of EMPARK was evaluated using the ICT for patient empowerment model. Results: Software and hardware system architecture for the collection and calculation of relevant parameters of disease management via home monitoring were established. Here, we describe the patient interface and the functional characteristics and evaluation of a novel clinician interface. In accordance with our previous findings with regard to the patient interface, our current results indicate an overall high utility and user acceptance of the clinician interface. Special characteristics of EMPARK in key areas of interest emerged from end-user evaluations, with clear potential for future system development and deployment in daily clinical practice. Evaluation through the principles of ICT for patient empowerment model, along with prior findings from patient interface evaluation, suggests that EMPARK has the potential to empower patients with PD. Conclusions: The EMPARK system is a novel home monitoring system for providing patients with PD and the care team with feedback on longitudinal disease activities. User-centric development and evaluation of the system indicated high user acceptance and usability. The EMPARK infrastructure would empower patients and could be used for future applications in daily care and research. ",
doi="10.2196/31485",
url="https://formative.jmir.org/2022/6/e31485",
url="http://www.ncbi.nlm.nih.gov/pubmed/35679097"
}


@Article{info:doi/10.2196/34476,
author="Cederved, Catarina
and Back, Jon
and {\AA}ngstr{\"o}m-Br{\"a}nnstr{\"o}m, Charlotte
and Ljungman, Gustaf
and Engvall, Gunn",
title="Co-creation of a Serious Game About Radiotherapy: Participatory Action Research Study With Children Treated for Cancer",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="31",
volume="9",
number="2",
pages="e34476",
keywords="children",
keywords="participatory action research",
keywords="game design",
keywords="radiotherapy",
keywords="education",
keywords="supportive care",
keywords="oncology",
abstract="Background: Children with cancer who have to undergo radiotherapy can experience fear, because they have no prior knowledge of the treatment. One way of teaching children about the treatment and reducing their fear is to prepare them for it through serious games. Involvement of the end user in the design process within medicine is a way of ensuring that the product being developed will fit the intended user. Objective: The aim was to outline the contributions made by children and their parents through participatory action research when designing a serious game about radiotherapy. Methods: By means of participatory action research, children and their parents participated in the development of a serious game about radiotherapy. Nine children (7-10 years old) were included, each with an accompanying parent. A qualitative approach was used that included interviews and participant observation. Six rounds of iterative development process were used with the children and their parents. Meetings with the children were held either face-to-face or online. Each round resulted in a list of suggestions for changes to the game. A thematic analysis was performed based on the list of proposed changes, underpinned by all gathered data, to highlight how the children's participation changed the game. Results: Two main themes were identified. The first theme was ``The children's participation was affected by their health and treatment'' and included the following subthemes: ``an opportunity to share emotions and perceptions of radiotherapy'' and ``the possibility to participate was affected by the severity of the disease.'' The second theme was ``participation allowed becoming an active part of game development'' and included the following subthemes: ``the opportunity to express sentiments about the game,'' ``the emergence of a playable game through the children's contributions,'' and ``the necessity of understanding the text.'' Conclusions: The method used in this study made the children active participants, and our results suggest that this method can be used by health care researchers to cocreate serious games with children. It is necessary to inform the children involved that the process takes time, and that the process can be altered to allow as much participation as possible without placing a burden on them. The children's illness affected their possibility to take part; thus, it is crucial to accommodate the children's needs when conducting similar studies. The parents' participation facilitated the meetings for their children, even though their involvement in the game design was negligible. ",
doi="10.2196/34476",
url="https://humanfactors.jmir.org/2022/2/e34476/",
url="http://www.ncbi.nlm.nih.gov/pubmed/35639467"
}


@Article{info:doi/10.2196/33304,
author="Benedict, Catherine
and Dauber-Decker, L. Katherine
and Ford, S. Jennifer
and King, D'Arcy
and Spiegel, David
and Schapira, Lidia
and Simon, Pamela
and Diefenbach, Michael",
title="Development of a Web-Based Decision Aid and Planning Tool for Family Building After Cancer (Roadmap to Parenthood): Usability Testing",
journal="JMIR Cancer",
year="2022",
month="May",
day="31",
volume="8",
number="2",
pages="e33304",
keywords="young adult cancer",
keywords="cancer survivorship",
keywords="decision-making",
keywords="decision aids",
keywords="fertility",
keywords="reproductive health",
keywords="mobile phone",
abstract="Background: Owing to gonadotoxic cancer treatments, young adult female survivors often report uncertainty about their fertility, reproductive potential, and family-building options after treatment. Roadmap to Parenthood is a web-based decision aid and planning tool for family building after cancer. Objective: As part of a patient-centered development process, this study evaluated the usability of the decision aid website to inform design modifications and improve user experience. Methods: In total, 2 rounds of usability testing were conducted with the target population of young adult female cancer survivors. During the testing sessions, participants viewed the website twice; first, as a think-aloud exercise, and second, while a researcher interrupted at key points to obtain user feedback. Quantitative and qualitative data were collected to assess website usability. Quantitative measures included the System Usability Scale, WebQual, and eHealth Impact Questionnaire. An exit interview with open-ended questions gathered feedback on likes and dislikes and suggestions for improvement. Results: Participants (N=10) were young adult women, with average age of 30.9 (SD 4.51) years, and average time since treatment was 4.44 (SD 3.56) years. Website usability scores improved on the System Usability Scale from ``acceptable'' in round 1 to ``excellent'' in round 2 after making design changes based on user feedback (scores of 68 and 89.4, respectively). WebQual scores showed similar improvement from round 1 to round 2 of testing (mean 5.6 to 6.25; range 1-7). On the eHealth Impact Questionnaire, the information and presentation of the website was perceived as comprehensive, easy to understand, and trustworthy. Participants also reported improved confidence to discuss and manage fertility and family-building issues and felt encouraged to play a more active role in managing their fertility. In all, 3 usability themes were identified from the qualitative feedback: ease of use, visibility and navigation, and informational content and usefulness. Overall feedback was positive, and participants reported intentions to use the decision aid website in the future. In total, 10\% (1/10) of the participants reported negative emotions when learning about infertility risks and potential family-building challenges. Conclusions: Website usability improved after design changes were made in response to user feedback. Young adult female survivors reported positive views about the website and indicated that the decision aid would be useful in decision-making about family building after cancer. Future studies will include further design modifications to consider the emotional experiences of users and any additional navigational features or content to optimize the ease of use and support provided by the tool. ",
doi="10.2196/33304",
url="https://cancer.jmir.org/2022/2/e33304/",
url="http://www.ncbi.nlm.nih.gov/pubmed/35639461"
}


@Article{info:doi/10.2196/29706,
author="Korngiebel, M. Diane
and West, McGlone Kathleen",
title="Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet",
journal="JMIRx Med",
year="2022",
month="May",
day="31",
volume="3",
number="2",
pages="e29706",
keywords="user-centered design",
keywords="genomic medicine",
keywords="patient portals",
keywords="electronic health records",
keywords="return of results",
keywords="bioethics",
keywords="genetics",
keywords="genetic testing",
keywords="patient preferences",
keywords="design",
keywords="human factors",
keywords="mobile phone",
abstract="Background: Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. Objective: This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. Methods: Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. Results: In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. Conclusions: Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results. ",
doi="10.2196/29706",
url="https://med.jmirx.org/2022/2/e29706/",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725563"
}


@Article{info:doi/10.2196/37372,
author="Asbj{\o}rnsen, Aune Rikke
and Hjelmes{\ae}th, J{\o}ran
and Smedsr{\o}d, Lien Mirjam
and Wentzel, Jobke
and Ollivier, Marianne
and Clark, M. Matthew
and van Gemert-Pijnen, C. Julia E. W.
and Solberg Nes, Lise",
title="Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="27",
volume="9",
number="2",
pages="e37372",
keywords="eHealth",
keywords="weight loss maintenance",
keywords="behavior change",
keywords="persuasive technology",
keywords="digital health interventions",
keywords="design thinking",
keywords="co-design",
keywords="Agile development",
keywords="human-centered design",
keywords="mobile phone",
abstract="Background: Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective: This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods: This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38\%; ie, people with obesity who had lost ?8\% of their weight), health care providers (n=9, 20\%), healthy volunteers (n=4, 9\%), a service designer (n=1, 2\%), and stakeholders from the multidisciplinary research and development team (n=14, 31\%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results: A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions: Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Trial Registration: ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988 ",
doi="10.2196/37372",
url="https://humanfactors.jmir.org/2022/2/e37372",
url="http://www.ncbi.nlm.nih.gov/pubmed/35622394"
}


@Article{info:doi/10.2196/36068,
author="Birrell, Louise
and Furneaux-Bate, Ainsley
and Debenham, Jennifer
and Spallek, Sophia
and Newton, Nicola
and Chapman, Catherine",
title="Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach",
journal="JMIR Form Res",
year="2022",
month="May",
day="27",
volume="6",
number="5",
pages="e36068",
keywords="mobile health",
keywords="depression",
keywords="anxiety",
keywords="psychosocial support system",
keywords="alcohol drinking",
keywords="adolescent",
keywords="digital technology",
keywords="mobile intervention",
keywords="intervention",
keywords="social",
keywords="economic",
keywords="development",
keywords="mind your mate",
keywords="app",
keywords="application",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective: This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods: The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results: This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use--related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions: The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program. ",
doi="10.2196/36068",
url="https://formative.jmir.org/2022/5/e36068",
url="http://www.ncbi.nlm.nih.gov/pubmed/35622401"
}


@Article{info:doi/10.2196/34120,
author="Scherpbier, A. Iza C.
and Abrahamse, E. Mari{\"e}lle
and Belleman, G. Robert
and Popma, Arne
and Lindauer, L. Ram{\'o}n J.",
title="Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: Study Protocol for Single-Case Experimental Design With Multiple Baselines",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="20",
volume="11",
number="5",
pages="e34120",
keywords="PCIT",
keywords="virtual reality",
keywords="single-case experimental design",
keywords="positive parenting skills",
keywords="disruptive behavioral problems",
keywords="parenting",
keywords="child",
keywords="disruptive behavior",
keywords="behavioral",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Disruptive behavior is a common reason for young children to be referred to mental health care services worldwide. Research indicates that treatments for child disruptive behavior where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, this study focuses on creating the opportunity for parents to practice positive parenting skills more outside of the clinical setting by adding virtual reality (VR) as an additional homework element. PCIT has shown to make impactful long-term improvements in parental warmth, responsiveness, and the parent-child relationship. Through VR, parents practice the taught parenting skills out loud in the comfort of their own homes in VR scenarios. We expect that VR addition will innovatively increase the effectiveness of PCIT. Objective: This study aimed to evaluate the added value of VR to PCIT by using a multiple baseline single-case experimental design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR element, we secondarily expected that meeting the skill criteria will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will be better, whereas parental stress and child disruptive behavior will decrease. Methods: A total of 15 children (aged 2-7 years) with disruptive behavior and their parents will be followed throughout the PCIT-VR treatment. Using a multiple baseline SCED with 3 phases, 15 families will fill out questionnaires weekly, in addition to having pre- and posttreatment and follow-up measurements to monitor their positive parenting skills, child disruptive behavior, parenting stress, and VR progress. Moreover, quantitative information and qualitative interviews will be analyzed visually and statistically and summarized to provide a complete picture of experiences. Results: As of February 2021, 6 families have been enrolled in the study at the moment of submission. Data collection is projected to be completed in 2023. Quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences. Conclusions: The SCED---with its phased design, randomization, and the opportunity to replicate and assess both individual and group treatment effects---and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects, or technological failure will be mitigated with the right statistical support. This study aims to magnify the scope of the treatment through additional skill training, ultimately in support of routinely implementing VR within PCIT. International Registered Report Identifier (IRRID): DERR1-10.2196/34120 ",
doi="10.2196/34120",
url="https://www.researchprotocols.org/2022/5/e34120",
url="http://www.ncbi.nlm.nih.gov/pubmed/35594138"
}


@Article{info:doi/10.2196/34257,
author="Johnston, William
and Keogh, Alison
and Dickson, Jane
and Leslie, J. Stephen
and Megyesi, Peter
and Connolly, Rachelle
and Burke, David
and Caulfield, Brian",
title="Human-Centered Design of a Digital Health Tool to Promote Effective Self-care in Patients With Heart Failure: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="10",
volume="6",
number="5",
pages="e34257",
keywords="digital health",
keywords="heart failure",
keywords="cardiology",
keywords="self-care",
keywords="behavior change",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Effective self-care is an important factor in the successful management of patients with heart failure (HF). Despite the importance of self-care, most patients with HF are not adequately taught the wide range of skills required to become proficient in self-care. Digital health technology (DHT) may provide a novel solution to support patients at home in effective self-care, with the view to enhancing the quality of life and ultimately improving patient outcomes. However, many of the solutions developed to date have failed to consider users' perspectives at the point of design, resulting in poor effectiveness. Leveraging a human-centered design (HCD) approach to the development of DHTs may lead to the successful promotion of self-care behaviors in patients with HF. Objective: This study aimed to outline the HCD, development, and evaluation process of a DHT designed to promote effective self-care in patients with HF. Methods: A design thinking approach within the HCD framework was undertaken, as described in the International Organization for Standardization 9241-210:2019 regulations, using a 5-step process: empathize, ideate, design, develop, and test. Patients with HF were involved throughout the design and evaluation of the system. The designed system was grounded in behavior change theory using the Theoretical Domains Framework and included behavior change techniques. Mixed methods were used to evaluate the DHT during the testing phase. Results: Steps 1 to 3 of the process resulted in a set of evidence- and user-informed design requirements that were carried forward into the iterative development of a version 1 system. A cross-platform (iOS and Android) mobile app integrated with Fitbit activity trackers and smart scales was developed. A 2-week user testing phase highlighted the ease of use of the system, with patients demonstrating excellent adherence. Qualitative analysis of semistructured interviews identified the early potential for the system to positively influence self-care. Specifically, users perceived that the system increased their confidence and motivation to engage in key self-care behaviors, provided them with skills and knowledge that made them more aware of the importance of self-care behaviors, and might facilitate timely help seeking. Conclusions: The use of an HCD methodology in this research has resulted in the development of a DHT that may engage patients with HF and potentially affect their self-care behaviors. This comprehensive work lays the groundwork for further development and evaluation of this solution before its implementation in health care systems. A detailed description of the HCD process used in this research will help guide the development and evaluation of future DHTs across a range of disease use cases. ",
doi="10.2196/34257",
url="https://formative.jmir.org/2022/5/e34257",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536632"
}


@Article{info:doi/10.2196/33967,
author="Brown, G. Ethan
and Schleimer, Erica
and Bledsoe, O. Ian
and Rowles, William
and Miller, A. Nicolette
and Sanders, J. Stephan
and Rankin, P. Katherine
and Ostrem, L. Jill
and Tanner, M. Caroline
and Bove, Riley",
title="Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="6",
volume="9",
number="2",
pages="e33967",
keywords="human-centered design",
keywords="personal health record",
keywords="visualization in eHealth",
keywords="Parkinson disease",
keywords="digital health",
abstract="Background: People with Parkinson disease (PD) have a variety of complex medical problems that require detailed review at each clinical encounter for appropriate management. Care of other complex conditions has benefited from digital health solutions that efficiently integrate disparate clinical information. Although various digital approaches have been developed for research and care in PD, no digital solution to personalize and improve communication in a clinical encounter is readily available. Objective: We intend to improve the efficacy and efficiency of clinical encounters with people with PD through the development of a platform (PD-BRIDGE) with personalized clinical information from the electronic health record (EHR) and patient-reported outcome (PRO) data. Methods: Using human-centered design (HCD) processes, we engaged clinician and patient stakeholders in developing PD-BRIDGE through three phases: an inspiration phase involving focus groups and discussions with people having PD, an ideation phase generating preliminary mock-ups for feedback, and an implementation phase testing the platform. To qualitatively evaluate the platform, movement disorders neurologists and people with PD were sent questionnaires asking about the technical validity, usability, and clinical relevance of PD-BRIDGE after their encounter. Results: The HCD process led to a platform with 4 modules. Among these, 3 modules that pulled data from the EHR include a longitudinal module showing motor ratings over time, a display module showing the most recently collected clinical rating scales, and another display module showing relevant laboratory values and diagnoses; the fourth module displays motor symptom fluctuation based on an at-home diary. In the implementation phase, PD-BRIDGE was used in 17 clinical encounters for patients cared for by 1 of 11 movement disorders neurologists. Most patients felt that PD-BRIDGE facilitated communication with their clinician (n=14, 83\%) and helped them understand their disease trajectory (n=11, 65\%) and their clinician's recommendations (n=11, 65\%). Neurologists felt that PD-BRIDGE improved their ability to understand the patients' disease course (n=13, 75\% of encounters), supported clinical care recommendations (n=15, 87\%), and helped them communicate with their patients (n=14, 81\%). In terms of improvements, neurologists noted that data in PD-BRIDGE were not exhaustive in 62\% (n=11) of the encounters. Conclusions: Integrating clinically relevant information from EHR and PRO data into a visually efficient platform (PD-BRIDGE) can facilitate clinical encounters with people with PD. Developing new modules with more disparate information could improve these complex encounters even further. ",
doi="10.2196/33967",
url="https://humanfactors.jmir.org/2022/2/e33967",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522472"
}


@Article{info:doi/10.2196/32456,
author="Tendedez, Helena
and Ferrario, Maria-Angela
and McNaney, Roisin
and Gradinar, Adrian",
title="Exploring Human-Data Interaction in Clinical Decision-making Using Scenarios: Co-design Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="6",
volume="9",
number="2",
pages="e32456",
keywords="data-supported decision-making",
keywords="health care professionals",
keywords="respiratory care",
keywords="scenario-based design",
keywords="clinical decision-making",
keywords="decision support",
keywords="COPD",
keywords="respiratory conditions",
keywords="digital health",
keywords="user-centered design",
keywords="health technologies",
abstract="Background: When caring for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD), health care professionals (HCPs) rely on multiple data sources to make decisions. Collating and visualizing these data, for example, on clinical dashboards, holds the potential to support timely and informed decision-making. Most studies on data-supported decision-making (DSDM) technologies for health care have focused on their technical feasibility or quantitative effectiveness. Although these studies are an important contribution to the literature, they do not further our limited understanding of how HCPs engage with these technologies and how they can be designed to support specific contexts of use. To advance our knowledge in this area, we must work with HCPs to explore this space and the real-world complexities of health care work and service structures. Objective: This study aimed to qualitatively explore how DSDM technologies could support HCPs in their decision-making regarding COPD care. We created a scenario-based research tool called Respire, which visualizes HCPs' data needs about their patients with COPD and services. We used Respire with HCPs to uncover rich and nuanced findings about human-data interaction in this context, focusing on the real-world challenges that HCPs face when carrying out their work and making decisions. Methods: We engaged 9 respiratory HCPs from 2 collaborating health care organizations to design Respire. We then used Respire as a tool to investigate human-data interaction in the context of decision-making about COPD care. The study followed a co-design approach that had 3 stages and spanned 2 years. The first stage involved 5 workshops with HCPs to identify data interaction scenarios that would support their work. The second stage involved creating Respire, an interactive scenario-based web app that visualizes HCPs' data needs, incorporating feedback from HCPs. The final stage involved 11 one-to-one sessions with HCPs to use Respire, focusing on how they envisaged that it could support their work and decisions about care. Results: We found that HCPs trust data differently depending on where it came from and who recorded it, sporadic and subjective data generated by patients have value but create challenges for decision-making, and HCPs require support in interpreting and responding to new data and its use cases. Conclusions: Our study uncovered important lessons for the design of DSDM technologies to support health care contexts. We show that although DSDM technologies have the potential to support patient care and health care delivery, important sociotechnical and human-data interaction challenges influence the design and deployment of these technologies. Exploring these considerations during the design process can ensure that DSDM technologies are designed with a holistic view of how decision-making and engagement with data occur in health care contexts. ",
doi="10.2196/32456",
url="https://humanfactors.jmir.org/2022/2/e32456",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522463"
}


@Article{info:doi/10.2196/28558,
author="Schneider, Manuel",
title="A Platform to Develop and Apply Digital Methods for Empirical Bioethics Research: Mixed Methods Design and Development Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="5",
volume="6",
number="5",
pages="e28558",
keywords="digital bioethics",
keywords="digital humanities",
keywords="digital methods",
keywords="computational methods",
keywords="empirical bioethics",
keywords="research platform",
keywords="digital health",
keywords="bioethics",
keywords="digital platform",
abstract="Background: The rise of digital methods and computational tools has opened up the possibility of collecting and analyzing data from novel sources, such as discussions on social media. At the same time, these methods and tools introduce a dependence on technology, often resulting in a need for technical skills and expertise. Researchers from various disciplines engage in empirical bioethics research, and software development and similar skills are not usually part of their background. Therefore, researchers often depend on technical experts to develop and apply digital methods, which can create a bottleneck and hinder the broad use of digital methods in empirical bioethics research. Objective: This study aimed to develop a research platform that would offer researchers the means to better leverage implemented digital methods, and that would simplify the process of developing new methods. Methods: This study used a mixed methods approach to design and develop a research platform prototype. I combined established methods from user-centered design, rapid prototyping, and agile software development to iteratively develop the platform prototype. In collaboration with two other researchers, I tested and extended the platform prototype in situ by carrying out a study using the prototype. Results: The resulting research platform prototype provides three digital methods, which are composed of functional components. This modular concept allows researchers to use existing methods for their own experiments and combine implemented components into new methods. Conclusions: The platform prototype illustrates the potential of the modular concept and empowers researchers without advanced technical skills to carry out experiments using digital methods and develop new methods. However, more work is needed to bring the prototype to a production-ready state. ",
doi="10.2196/28558",
url="https://formative.jmir.org/2022/5/e28558",
url="http://www.ncbi.nlm.nih.gov/pubmed/35511234"
}


@Article{info:doi/10.2196/36579,
author="Krause-J{\"u}ttler, Grit
and Weitz, J{\"u}rgen
and Bork, Ulrich",
title="Interdisciplinary Collaborations in Digital Health Research: Mixed Methods Case Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="4",
volume="9",
number="2",
pages="e36579",
keywords="team science",
keywords="interdisciplinary",
keywords="research collaboration",
keywords="digital health",
keywords="team processes",
abstract="Background: Digital innovations in medicine are disruptive technologies that can change the way diagnostic procedures and treatments are delivered. Such innovations are typically designed in teams with different disciplinary backgrounds. This paper concentrates on 2 interdisciplinary research teams with 20 members from the medicine and engineering sciences working jointly on digital health solutions. Objective: The aim of this paper was to identify factors on the individual, team, and organizational levels that influence the implementation of interdisciplinary research projects elaborating on digital applications for medicine and, based on the results, to draw conclusions for the proactive design of the interdisciplinary research process to make these projects successful. Methods: To achieve this aim, 2 interdisciplinary research teams were observed, and a small case study (response rate: 15/20, 75\%) was conducted using a web-based questionnaire containing both closed and open self-report questions. The Spearman rank correlation coefficient was calculated to analyze the quantitative data. The answers to the open-ended questions were subjected to qualitative content analysis. Results: With regard to the interdisciplinary research projects investigated, the influencing factors of the three levels presented (individual, team, and organization) have proven to be relevant for interdisciplinary research cooperation. Conclusions: With regard to recommendations for the future design of interdisciplinary cooperation, management aspects are addressed, that is, the installation of a coordinator, systematic definition of goals, required resources, and necessary efforts on the part of the involved interdisciplinary research partners. As only small groups were investigated, further research in this field is necessary to derive more general recommendations for interdisciplinary research teams. Trial Registration: German Clinical Trials Register, DRKS00023909, https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00023909?; German Clinical Trials Register, DRKS00025077, https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00025077 ",
doi="10.2196/36579",
url="https://humanfactors.jmir.org/2022/2/e36579",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507400"
}


@Article{info:doi/10.2196/35094,
author="Pit, Sabrina
and Ramsden, Robyn
and Tan, JH Aaron
and Payne, Kristy
and Barr, James
and Eames, Benjamin
and Edwards, Mike
and Colbran, Richard",
title="Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help?",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="2",
volume="9",
number="2",
pages="e35094",
keywords="health",
keywords="wellness",
keywords="mobile apps",
keywords="persuasive strategies",
keywords="behavior change",
keywords="review",
keywords="health workforce",
keywords="capability",
keywords="career",
keywords="employment",
keywords="rural",
keywords="workforce planning",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="health professional",
keywords="user experience",
keywords="health application",
keywords="task support",
keywords="social support",
keywords="dialog support",
abstract="Background: Health professionals' perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals' perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini's Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific--based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals' perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. ",
doi="10.2196/35094",
url="https://humanfactors.jmir.org/2022/2/e35094",
url="http://www.ncbi.nlm.nih.gov/pubmed/35499866"
}


@Article{info:doi/10.2196/25249,
author="Polhemus, Ashley
and Novak, Jan
and Majid, Shazmin
and Simblett, Sara
and Morris, Daniel
and Bruce, Stuart
and Burke, Patrick
and Dockendorf, F. Marissa
and Temesi, Gergely
and Wykes, Til",
title="Data Visualization for Chronic Neurological and Mental Health Condition Self-management: Systematic Review of User Perspectives",
journal="JMIR Ment Health",
year="2022",
month="Apr",
day="28",
volume="9",
number="4",
pages="e25249",
keywords="digital health",
keywords="remote measurement technology",
keywords="neurology",
keywords="mental health",
keywords="data visualization",
keywords="user-centered design",
abstract="Background: Remote measurement technologies (RMT) such as mobile health devices and apps are increasingly used by those living with chronic neurological and mental health conditions. RMT enables real-world data collection and regular feedback, providing users with insights about their own conditions. Data visualizations are an integral part of RMT, although little is known about visualization design preferences from the perspectives of those living with chronic conditions. Objective: The aim of this review was to explore the experiences and preferences of individuals with chronic neurological and mental health conditions on data visualizations derived from RMT to manage health. Methods: In this systematic review, we searched peer-reviewed literature and conference proceedings (PubMed, IEEE Xplore, EMBASE, Web of Science, Association for Computing Machinery Computer-Human Interface proceedings, and the Cochrane Library) for original papers published between January 2007 and September 2021 that reported perspectives on data visualization of people living with chronic neurological and mental health conditions. Two reviewers independently screened each abstract and full-text article, with disagreements resolved through discussion. Studies were critically appraised, and extracted data underwent thematic synthesis. Results: We identified 35 eligible publications from 31 studies representing 12 conditions. Coded data coalesced into 3 themes: desire for data visualization, impact of visualizations on condition management, and visualization design considerations. Data visualizations were viewed as an integral part of users' experiences with RMT, impacting satisfaction and engagement. However, user preferences were diverse and often conflicting both between and within conditions. Conclusions: When used effectively, data visualizations are valuable, engaging components of RMT. They can provide structure and insight, allowing individuals to manage their own health more effectively. However, visualizations are not ``one-size-fits-all,'' and it is important to engage with potential users during visualization design to understand when, how, and with whom the visualizations will be used to manage health. ",
doi="10.2196/25249",
url="https://mental.jmir.org/2022/4/e25249",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482368"
}


@Article{info:doi/10.2196/34606,
author="Gooch, Daniel
and Mehta, Vikram
and Stuart, Avelie
and Katz, Dmitri
and Bennasar, Mohamed
and Levine, Mark
and Bandara, Arosha
and Nuseibeh, Bashar
and Bennaceur, Amel
and Price, Blaine",
title="Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="27",
volume="9",
number="2",
pages="e34606",
keywords="older adults",
keywords="health",
keywords="emotion",
keywords="affect",
keywords="well-being",
keywords="tangible interaction",
keywords="TUI",
abstract="Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. ",
doi="10.2196/34606",
url="https://humanfactors.jmir.org/2022/2/e34606",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475781"
}


@Article{info:doi/10.2196/34735,
author="Taxter, Alysha
and Johnson, Lisa
and Tabussi, Doreen
and Kimura, Yukiko
and Donaldson, Brittany
and Lawson, Erica
and Del Gaizo, Vincent
and Vitelli, Daniela
and Pinter, Corinne
and Van Citters, Aricca
and Nelson, Eugene
and Lee, Tzielan",
title="Co-design of an Electronic Dashboard to Support the Coproduction of Care in Pediatric Rheumatic Disease: Human-Centered Design and Usability Testing",
journal="J Particip Med",
year="2022",
month="Apr",
day="22",
volume="14",
number="1",
pages="e34735",
keywords="human-centered design",
keywords="coproduction",
keywords="dashboard",
keywords="pediatric rheumatology",
keywords="juvenile idiopathic arthritis",
keywords="JIA",
keywords="juvenile arthritis",
keywords="patient centered",
keywords="patient-reported outcomes",
keywords="patient communication",
keywords="patient education",
keywords="family education",
abstract="Background: The coproduction of care involves patients and families partnering with their clinicians and care teams, with the premise that each brings their own perspective, knowledge, and expertise, as well as their own values, goals, and preferences, to the partnership. Dashboards can display meaningful patient and clinical data to assess how a patient is doing and inform shared decision-making. Increasing communication between patients and care teams is particularly important for children with chronic conditions. Juvenile idiopathic arthritis (JIA), the most common chronic pediatric rheumatic condition, is associated with increased pain, decreased function, and decreased quality of life. Objective: The aim of this study is to design a dashboard prototype for use in coproducing care in patients with JIA. We evaluated the use and needs of end users, obtained a consensus on the necessary dashboard data elements, and constructed display prototypes to inform meaningful discussions for coproduction. Methods: A human-centered design approach involving parents, patients, clinicians, and care team members was used to develop a dashboard to support the coproduction of care in 4 ambulatory pediatric rheumatology clinics. We engaged a multidisciplinary team (n=18) of patients, parents, clinicians, nurses, and staff during an in-person kick-off meeting followed by biweekly meetings. We also leveraged advisory panels. Teams mapped workflows and patient journeys, created personas, and developed dashboard sketches. The final dashboard components were determined via Delphi consensus voting. Low-tech dashboard testing was completed during clinic visits, and visual display prototypes were iterated by using the Plan-Do-Study-Act methodology. Patients and clinicians were surveyed regarding their experiences. Results: Teams achieved consensus on what data mattered most at the point of care to support patients with JIA, families, and clinicians collaborating to make the best possible health care decisions. Notable themes included the right data in the right place at the right time, data in once for multiple purposes, patient and family self-management components, and the opportunity for education and increased transparency. A final set of 11 dashboard data elements was identified, including patient-reported outcomes, clinical data, and medications. Important design considerations featured the incorporation of real-time data, clearly labeled graphs, and vertical orientation to facilitate review and discussion. Prototype paper-testing with 36 patients and families yielded positive feedback, with 89\% (8/9) to 100\% (9/9) of parents (n=9) and 80\% (8/10) to 90\% (9/10) of clinicians (n=10) strongly agreeing or agreeing that the dashboard was useful during clinic discussions, helped to talk about what mattered most, and informed health care decision-making. Conclusions: We developed a dashboard prototype that displays patient-reported and clinical data over time, along with medications that can be used during a clinic visit to support meaningful conversations and shared decision-making among patients with JIA, their families, and their clinicians and care teams. ",
doi="10.2196/34735",
url="https://jopm.jmir.org/2022/1/e34735",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133283"
}


@Article{info:doi/10.2196/34903,
author="Dennett, M. Amy
and Tang, Y. Clarice
and Chiu, April
and Osadnik, Christian
and Granger, L. Catherine
and Taylor, F. Nicholas
and Campbell, L. Kristin
and Barton, Christian",
title="A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="21",
volume="8",
number="2",
pages="e34903",
keywords="cancer",
keywords="website",
keywords="online learning",
keywords="professional development",
keywords="physiotherapy",
keywords="exercise",
keywords="cancer survivorship",
keywords="cancer survivor",
keywords="digital health",
keywords="online health",
keywords="online toolkit",
abstract="Background: Access to exercise therapy for cancer survivors is poor. Professional development to support exercise professionals in delivering these interventions is needed. Few online resources exist for exercise professionals to address this issue. Objective: To develop and evaluate a freely available online toolkit to support exercise professionals working with cancer survivors. Methods: A 2-phase, experience-based co-design approach was used to develop and evaluate the online toolkit. The two phases were as follows: 1) needs identification and co-design of resources and platform and 2) pilot evaluation. Four co-design workshops were conducted, transcribed, and thematically analyzed to identify key elements for the toolkit. For the pilot evaluation, a customized survey (the Determinants of Implementation Behavior Questionnaire) was distributed to exercise professionals at baseline and 3 months after launch of the online toolkit to determine its usability, utility, and effectiveness in improving their knowledge, confidence, and behavior. Results were reported as the median and interquartile range and changes were calculated using non-parametric tests. Website analytics described site usage after the initial evaluation. Results: Twenty-five exercise professionals participated in co-designing 8 key elements of the online Cancer Exercise Toolkit: the homepage and pages for getting started, screening and safety, assessment, exercise prescription, education, locations, and resources. For the pilot evaluation, 277/320 respondents (87\% of whom were physiotherapists) from 26 countries completed the survey at baseline, with 58 exercise professionals completing follow-up surveys at 3 months. Exercise professionals' knowledge, skills, and confidence in delivering exercise therapy to cancer survivors increased 3 months after baseline (items 1, 6, and 8: median score 5, IQR 3 to 6) to follow-up (items 1 and 6: median score 6, IQR 5 to 6; item 8: median score 5, IQR 5 to 7; P<.001) on a 1 to 7 Likert scale. Most participants (35/44, 80\%) agreed or strongly agreed they would recommend the toolkit to colleagues. In the 6 months following the pilot evaluation, the toolkit received an average of 866 views per month. Conclusions: The co-designed online Cancer Exercise Toolkit was a useful resource for exercise professionals that may increase their knowledge, skills, and confidence in providing exercise therapy to cancer survivors. ",
doi="10.2196/34903",
url="https://cancer.jmir.org/2022/2/e34903",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451966"
}


@Article{info:doi/10.2196/33416,
author="Preuhs, Katharina
and van Keulen, Hilde
and Andree, Rosa
and Wins, Sophie
and van Empelen, Pepijn",
title="A Tailored Web-Based Video Intervention (ParentCoach) to Support Parents With Children With Sleeping Problems: User-Centered Design Approach",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="19",
volume="6",
number="4",
pages="e33416",
keywords="positive parenting",
keywords="usability testing",
keywords="lower health literacy",
keywords="user-centered design",
keywords="iterative development",
keywords="eHealth",
keywords="web-based intervention",
keywords="mobile health",
keywords="mHealth",
keywords="parenting",
abstract="Background: Many parents frequently struggle with undesirable or problematic behavior (ie, temper tantrums and whining) displayed by their child. To support parents in promoting positive parenting skills (ie, recognizing challenging situations and reacting appropriately), the interactive video e-learning tool ParentCoach was developed. The tool aims to teach parents generic behavioral responses by means of situational learning, tailoring, and problem solving. The first demonstration focused on sleeping problems. Objective: The aim of this paper is to illustrate the user-centered development of ParentCoach. Methods: We conducted usability, understandability, and acceptance tests among the target group (29 parents, 7 youth health care professionals, and 4 individuals with former lower health literacy) in different phases of the development process via focus groups, interviews, and surveys. This allowed for relevant insights on specifications and user requirements to guide the development and revision of the tool in each iteration. Results: Iterative testing and development allowed for the final demonstration of ParentCoach to be experienced as a relevant and accessible parenting intervention that can be used as a stand-alone program or in combination with another program. Conclusions: This paper elaborates on the iterative development process and its benefits for the final demonstration of ParentCoach. ",
doi="10.2196/33416",
url="https://formative.jmir.org/2022/4/e33416",
url="http://www.ncbi.nlm.nih.gov/pubmed/35438640"
}


@Article{info:doi/10.2196/29846,
author="Hill, Claire
and Reardon, Tessa
and Taylor, Lucy
and Creswell, Cathy",
title="Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="13",
volume="6",
number="4",
pages="e29846",
keywords="user-centered design",
keywords="co-design",
keywords="usability testing",
keywords="internet-based treatment",
keywords="app",
keywords="CBT",
keywords="anxiety",
keywords="children",
keywords="mobile phone",
abstract="Background: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. Objective: The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. Methods: Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. Results: In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. Conclusions: Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use. ",
doi="10.2196/29846",
url="https://formative.jmir.org/2022/4/e29846",
url="http://www.ncbi.nlm.nih.gov/pubmed/35416781"
}


@Article{info:doi/10.2196/29492,
author="Aronoff-Spencer, Eliah
and McComsey, Melanie
and Chih, Ming-Yuan
and Hubenko, Alexandra
and Baker, Corey
and Kim, John
and Ahern, K. David
and Gibbons, Christopher Michael
and Cafazzo, A. Joseph
and Nyakairu, Pia
and Vanderpool, C. Robin
and Mullett, W. Timothy
and Hesse, W. Bradford",
title="Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="12",
volume="24",
number="4",
pages="e29492",
keywords="cancer care",
keywords="distress screening",
keywords="human-centered design",
keywords="participatory design",
keywords="Appalachia",
keywords="mobile phone",
abstract="Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=--0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. ",
doi="10.2196/29492",
url="https://www.jmir.org/2022/4/e29492",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412457"
}


@Article{info:doi/10.2196/35418,
author="Williams, H. Patricia A.
and Lovelock, Brendan
and Cabarrus, Antonio Javier",
title="A Sense of Coherence Approach to Improving Patient Experience Using Information Infrastructure Modeling: Design Science Research",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="12",
volume="6",
number="4",
pages="e35418",
keywords="medical informatics",
keywords="information infrastructure",
keywords="digital hospitals",
keywords="patient experience",
keywords="implementation",
keywords="eHealth",
abstract="Background: Health care provider organizations are complex and dynamic environments. Consequently, how the physical and social environment of such organizations interact with an individual is a primary driver of an individual's experience. Increasingly, the capabilities required for them to successfully interact with those within their care are critically dependent on the information infrastructure they have in place, which enables people, both patients and staff, to work optimally together to deliver their clinical and operational objectives. Objective: This study aims to design a framework to address the challenge of how to assemble information systems in health care to support an improved sense of coherence for patients, as well as potentially innovate patients' experiences, by connecting and orchestrating the synergy among people, processes, and systems. Methods: It is necessary to understand the needs of health care providers and patients to address this challenge at a level relevant to information process design and technology development. This paper describes the design science research method used to combine the sense of coherence, which is a core concept within the Antonosky salutogenic approach to health and well-being, with an established information infrastructure maturity framework, demonstrating the coalescence of 2 distinct conceptual perspectives on care delivery. This paper provides an approach to defining a positive and supportive health care experience and linking this to the capabilities of an information- and technology-enabled environment. Results: This research delivers a methodology for describing the patient experience in a form relevant to information infrastructure design, articulating a pathway from information infrastructure to patient experience. It proposes that patient experience can be viewed pragmatically in terms of the established sense of coherence concept, with its ability to identify and guide resources to modulate a patient's environmental stressors. This research establishes a framework for determining and optimizing the capability of a facility's information infrastructure to support the sense of coherence defined by the experiences of its patients. Conclusions: This groundbreaking research provides a framework for health care provider organizations to understand and assess the ability of their information infrastructure to support and improve the patient experience. The tool assists providers in defining their technology-dependent operational goals around patient experience and, consequently, in identifying the information capabilities needed to support these goals. The results demonstrate how a fundamental shift in thinking about the use of information infrastructure can transform the patient experience. This study details an approach to describing information infrastructure within an experience-oriented framework that enables the impact of technology on experience to be designed explicitly. The contribution to knowledge is a new perspective on modeling how information infrastructure can contribute to supportive health-promoting environments. Furthermore, it may significantly affect the design and deployment of future digital infrastructures in health care. ",
doi="10.2196/35418",
url="https://formative.jmir.org/2022/4/e35418",
url="http://www.ncbi.nlm.nih.gov/pubmed/35307641"
}


@Article{info:doi/10.2196/31277,
author="Shin, Youn Ji
and Okammor, Nkiru
and Hendee, Karly
and Pawlikowski, Amber
and Jenq, Grace
and Bozaan, David",
title="Development of the Socioeconomic Screening, Active Engagement, Follow-up, Education, Discharge Readiness, and Consistency (SAFEDC) Model for Improving Transitions of Care: Participatory Design",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="12",
volume="6",
number="4",
pages="e31277",
keywords="care transition",
keywords="discharge",
keywords="readmission",
keywords="patient-centered care",
keywords="design",
keywords="participatory design",
abstract="Background: Transition to home after hospitalization involves the potential risk of adverse patient events, such as knowledge deficits related to self-care, medication errors, and readmissions. Despite broad organizational efforts to provide better care transitions for patients, there are challenges in implementing interventions that effectively improve care transition outcomes, as evidenced by readmission rates. Collaborative efforts that require health care professionals, patients, and caregivers to work together are necessary to identify gaps associated with transitions of care and generate effective transitional care interventions. Objective: This study aims to understand the usefulness of participatory design approaches in identifying the design implications of transition of care interventions in health care settings. Through a series of participatory design workshops, we have brought stakeholders of the health care system together. With a shared understanding of care transition and patient experience, we have provided participants with opportunities to generate possible design implications for care transitions. Methods: We selected field observations in clinical settings and participatory design workshops to develop transitional care interventions that serve each hospital's unique situation and context. Patient journey maps were created and functioned as tools for creating a shared understanding of the discharge process across different stakeholders in the health care environment. The intervention sustainability was also assessed. By applying thematic analysis methods, we analyzed the problem statements and proposed interventions collected from participatory design workshops. The findings showed patterns of major discussion during the workshop. Results: On the basis of the workshop results, we formalized the transition of care model---the socioeconomic, active engagement, follow-up, education, discharge readiness tool, and consistency (Integrated Michigan Patient-centered Alliance in Care Transitions transition of care model)---which other organizations can apply to improve patient experiences in care transition. This model highlights the most significant themes that should necessarily be considered to improve the transition of care. Conclusions: Our study presents the benefits of the participatory design approach in defining the challenges associated with transitions of care related to patient discharge and generating sustainable interventions to improve care transitions. ",
doi="10.2196/31277",
url="https://formative.jmir.org/2022/4/e31277",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412461"
}


@Article{info:doi/10.2196/25880,
author="Khowaja, Kamran
and Syed, Waheeda Wafa
and Singh, Meghna
and Taheri, Shahrad
and Chagoury, Odette
and Al-Thani, Dena
and Aupetit, Micha{\"e}l",
title="A Participatory Design Approach to Develop Visualization of Wearable Actigraphy Data for Health Care Professionals: Case Study in Qatar",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="8",
volume="9",
number="2",
pages="e25880",
keywords="participatory design",
keywords="user-centered design",
keywords="visualization",
keywords="health care professional",
keywords="persona",
keywords="brainwriting",
keywords="heuristic walkthrough",
keywords="use case",
keywords="interface walkthrough",
abstract="Background: Several tools have been developed for health care professionals to monitor the physical activity of their patients, but most of these tools have been considering only the needs of users in North American and European countries and applicable for only specific analytic tasks. To our knowledge, no research study has utilized the participatory design (PD) approach in the Middle East region to develop such tools, involving all the stakeholders in the product development phases, and no clear use cases have been derived from such studies that could serve future development in the field. Objective: This study aims to develop an interactive visualization tool (ActiVis) to support local health care professionals in monitoring the physical activity of their patients measured through wearable sensors, with the overall objective of improving the health of the Qatari population. Methods: We used PD and user-centered design methodologies to develop ActiVis, including persona development, brainwriting, and heuristic walkthrough as part of user evaluation workshops; and use cases, heuristic walkthrough, interface walkthrough, and survey as part of expert evaluation sessions. Results: We derived and validated 6 data analysis use cases targeted at specific health care professionals from a collaborative design workshop and an expert user study. These use cases led to improving the design of the ActiVis tool to support the monitoring of patients' physical activity by nurses and family doctors. The ActiVis research prototype (RP) compared favorably with the Fitbit Dashboard, showing the importance of design tools specific to end users' needs rather than relying on repurposing existing tools designed for other types of users. The use cases we derived happen to be culturally agnostic, despite our assumption that the local Muslim and Arabic culture could impact the design of such visualization tools. At last, taking a step back, we reflect on running collaborative design sessions in a multicultural environment and oil-based economy. Conclusions: Beyond the development of the ActiVis tool, this study can serve other visualization and human--computer interaction designers in the region to prepare their design projects and encourage health care professionals to engage with designers and engineers to improve the tools they use for supporting their daily routine. The development of the ActiVis tool for nurses, and other visualization tools specific to family doctors and clinician researchers, is still ongoing and we plan to integrate them into an operational platform for health care professionals in Qatar in the near future. ",
doi="10.2196/25880",
url="https://humanfactors.jmir.org/2022/2/e25880",
url="http://www.ncbi.nlm.nih.gov/pubmed/35394442"
}


@Article{info:doi/10.2196/34301,
author="Marcu, Gabriela
and Ondersma, J. Steven
and Spiller, N. Allison
and Broderick, M. Brianna
and Kadri, Reema
and Buis, R. Lorraine",
title="Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="30",
volume="24",
number="3",
pages="e34301",
keywords="computers",
keywords="mobile apps",
keywords="screening",
keywords="brief interventions",
keywords="diagnosis",
keywords="computer-assisted/methods",
keywords="surveys and questionnaires",
keywords="motivational interviewing",
keywords="therapy",
keywords="implementation",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective: This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94\%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients' technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions: Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space. ",
doi="10.2196/34301",
url="https://www.jmir.org/2022/3/e34301",
url="http://www.ncbi.nlm.nih.gov/pubmed/35353043"
}


@Article{info:doi/10.2196/33955,
author="N{\o}rlev, Jannie
and Derosche, Christina
and Sondrup, Katrine
and Hejlesen, Ole
and Hangaard, Stine",
title="Using Distance Communication for the User-Centered Development of a Smartphone-Based Serious Game for Children With Type 1 Diabetes: Participatory Design Approach",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="29",
volume="10",
number="1",
pages="e33955",
keywords="type 1 diabetes",
keywords="children",
keywords="serious game",
keywords="distance communication",
keywords="user-centered approach",
keywords="evaluation",
keywords="playtest",
keywords="mobile phone",
abstract="Background: The complications of type 1 diabetes (T1D) can be delayed or prevented in children with T1D who receive proper self-management education. Smartphone-based serious games are increasingly being used as an effective tool for teaching self-management. When developing a serious game, it is important that the development process be user-centered. Traditionally, different face-to-face methods have been used when children participate in the development process. However, face-to-face data collection is not always feasible. In such situations, distance communication can be used when developing a serious game. Objective: The objective of this study is to develop a user-centered smartphone-based serious game that teaches self-management focused on carbohydrate intake in children aged 8-14 years with T1D using distance communication in both the development and evaluation of the game. Methods: The development and evaluation of a smartphone-based serious game prototype was inspired by the Lean principles, and a user-centered approach was applied. The development process included 1 expert interview and design workshops with children with T1D. On the basis of the interview and design workshop results, a serious game prototype was developed using Microsoft PowerPoint. The evaluation of the serious game prototype included an interview with a dietitian and a playtest with children with T1D. All data were collected using distance communication. Results: A user-centered smartphone-based serious game prototype was developed and evaluated. The expert interview with the dietitian formed the basis for the learning outcomes in the game. Four children and their parents contributed to the preferences, needs, requirements, and ideas for selected parts of the game design. The dietitian evaluated the prototype positively and validated its content and accuracy. The serious game prototype was well-received by the children and their parents during the playtest. The serious game prototype was perceived as a useful and engaging way to learn. However, the difficulty level was not appropriate, and the information was too basic for participants who had been diagnosed over a year ago. The use of digital communication platforms did not cause any problems. Conclusions: The smartphone-based serious game prototype has the potential to be a useful and attractive tool for teaching disease self-management. The use of distance communication proved to be a useful approach in the development of a serious game. ",
doi="10.2196/33955",
url="https://games.jmir.org/2022/1/e33955",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348466"
}


@Article{info:doi/10.2196/33087,
author="Robles, Cielito Maria
and Newman, W. Mark
and Doshi, Aalap
and Bailey, Sarah
and Huang, Linde
and Choi, Ji Soo
and Kurien, Chris
and Merid, Beza
and Cowdery, Joan
and Golbus, R. Jessica
and Huang, Christopher
and Dorsch, P. Michael
and Nallamothu, Brahmajee
and Skolarus, E. Lesli",
title="A Physical Activity Just-in-time Adaptive Intervention Designed in Partnership With a Predominantly Black Community: Virtual, Community-Based Participatory Design Approach",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="28",
volume="6",
number="3",
pages="e33087",
keywords="just-in-time adaptive intervention",
keywords="design",
keywords="community participatory design",
keywords="health equity",
keywords="hypertension",
keywords="healthy lifestyle",
keywords="blood pressure",
keywords="physical activity",
abstract="Background: Black people are disproportionally impacted by hypertension. New approaches for encouraging healthy lifestyles are needed to reduce hypertension and promote health equity in Black communities. Objective: In this report, we describe the early-stage, virtual design of a just-in-time adaptive intervention (JITAI) to increase physical activity in partnership with members of a low-income, predominantly Black community. Methods: The hallmark of JITAIs is highly contextualized mobile app push notifications. Thus, understanding participants' context and determinants of physical activity are critical. During the height of the COVID-19 pandemic, we conducted virtual discovery interviews and analysis guided by the Behavior Change Wheel (which focuses on participants' capacity, opportunity, and motivation to engage in physical activity), as well as empathy mapping. We then formed a community-academic participatory design team that partnered in the design sprint, storyboarding, and paper prototyping. Results: For this study, 5 community members participated in the discovery interviews, 12 stakeholders participated in the empathy mapping, 3 community members represented the community on the design team, and 10 community members provided storyboard or paper prototyping feedback. Only one community member had used videoconferencing prior to partnering with the academic team, and none had design experience. A set of 5 community-academic partner design principles were created: (1) keep users front and center, (2) tailor to the individual, (3) draw on existing motivation, (4) make physical activity feel approachable, and (5) make data collection transparent yet unobtrusive. To address community-specific barriers, the community-academic design team decided that mobile app push notifications will be tailored to participants' baseline mobility level and community resources (eg, local parks and events). Push notifications will also be tailored based on the day (weekday versus weekend), time of day, and weather. Motivation will be enhanced via adaptive goal setting with supportive feedback and social support via community-generated notifications. Conclusions: We completed early-stage virtual design of a JITAI in partnership with community participants and a community design team with limited design and videoconferencing experience. We found that designing JITAIs with the community enables these interventions to address community-specific needs, which may lead to a more meaningful impact on users' health. ",
doi="10.2196/33087",
url="https://formative.jmir.org/2022/3/e33087",
url="http://www.ncbi.nlm.nih.gov/pubmed/35343906"
}


@Article{info:doi/10.2196/26461,
author="Stambler, Mollie Danielle
and Feddema, Erin
and Riggins, Olivia
and Campeau, Kari
and Breuch, Kastman Lee-Ann
and Kessler, M. Molly
and Misono, Stephanie",
title="REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="25",
volume="9",
number="1",
pages="e26461",
keywords="web-based intervention",
keywords="REDCap",
keywords="voice disorders",
keywords="usability study",
keywords="heuristics",
keywords="eHealth",
keywords="online",
keywords="health",
keywords="web-based participation",
keywords="patients",
keywords="web-based platform",
abstract="Background: Web-based health interventions are increasingly common and are promising for patients with voice disorders because web-based participation does not require voice use. To address needs such as Health Insurance Portability and Accountability Act compliance, unique user access, the ability to send automated reminders, and a limited development budget, we used the Research Electronic Data Capture (REDCap) data management platform to deliver a patient-facing psychological intervention designed for patients with voice disorders. This was a novel use of REDCap. Objective: We aimed to evaluate the usability of the intervention, with this intervention serving as a use case for REDCap-based patient-facing interventions. Methods: We used REDCap survey instruments to develop the web-based voice intervention modules, then conducted usability evaluations using (1) heuristic evaluations by 2 evaluators, and (2) formal usability testing with 7 participants, consisting of predetermined tasks, a think-aloud protocol, ease-of-use measurements, a product reaction card, and a debriefing interview. Results: Heuristic evaluations found strengths in visibility of system status and real-world match, and weaknesses in user control and help documentation. Based on this feedback, changes to the intervention were made before usability testing. Overall, usability testing participants found the intervention useful and easy to use, although testing revealed some concerns with design, content, and terminology. Some concerns were readily addressed, and others required adaptations within REDCap. Conclusions: The REDCap version of a complex web-based patient-facing intervention performed well in heuristic evaluation and formal usability testing. REDCap can effectively be used for patient-facing intervention delivery, particularly if the limitations of the platform are anticipated and mitigated. ",
doi="10.2196/26461",
url="https://humanfactors.jmir.org/2022/1/e26461",
url="http://www.ncbi.nlm.nih.gov/pubmed/35333191"
}


@Article{info:doi/10.2196/30130,
author="Strauss, T. Alexandra
and Morgan, Cameron
and El Khuri, Christopher
and Slogeris, Becky
and Smith, G. Aria
and Klein, Eili
and Toerper, Matt
and DeAngelo, Anthony
and Debraine, Arnaud
and Peterson, Susan
and Gurses, P. Ayse
and Levin, Scott
and Hinson, Jeremiah",
title="A Patient Outcomes--Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP)",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="23",
volume="9",
number="1",
pages="e30130",
keywords="emergency medicine",
keywords="usability",
keywords="human-centered design",
keywords="health informatics",
keywords="feedback",
keywords="practice-based learning and improvement",
keywords="emergency room",
keywords="ER",
keywords="platform",
keywords="outcomes",
keywords="closed-loop learning",
abstract="Background: The availability of patient outcomes--based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning. Objective: This study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use. Methods: This multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ?30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR. Results: An initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63\% respondents identified as useful), escalation of care (20/24, 83\%), and return to ED (16/24, 67\%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from ``not easy'' to ``very easy'' to obtain and from ``not confident'' to ``very confident'' in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague. Conclusions: This study demonstrates the potential for human-centered design of a patient outcomes--driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning. ",
doi="10.2196/30130",
url="https://humanfactors.jmir.org/2022/1/e30130",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319469"
}


@Article{info:doi/10.2196/35134,
author="Lee, M. Jennifer
and Woon, Rex
and Ramsum, Mandy
and Halperin, S. Daniel
and Jain, Roshini",
title="User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials",
journal="JMIR eHum Factors",
year="2022",
month="Mar",
day="23",
volume="9",
number="1",
pages="e35134",
keywords="spinal cord stimulation",
keywords="SCS",
keywords="chronic pain",
keywords="digital health",
keywords="smartphone app",
keywords="mobile health",
keywords="mHealth",
keywords="smart device",
keywords="digital application",
keywords="application",
keywords="app",
keywords="spine",
abstract="Background: Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective: In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods: This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new ``mySCS'' mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results: When provided the opportunity, the percentage of users who engaged with the tracking app for ?50\% of the time during their trial was found to be 64.43\% (n=8589). Among the 13,331 patients who used the app, 58.24\% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05\%). Of those patients who undertook a 7-day SCS trial, 62.30\% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84\% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04\% (n=11,070) of those who reached trial completion. A trial success rate of 91\% was determined for those who used the app (versus 85\% success rate for nonusers). Conclusions: Data from this initial, real-world examination of a mobile, digital-health--based tracking app (``mySCS''), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success. ",
doi="10.2196/35134",
url="https://humanfactors.jmir.org/2022/1/e35134",
url="http://www.ncbi.nlm.nih.gov/pubmed/35167484"
}


@Article{info:doi/10.2196/30829,
author="Rothmann, Juel Mette
and Mouritsen, Drotner Julie
and Ladefoged, Skov Nanna
and Jeppesen, Nedergaard Marie
and Lillevang, Sofie Anna
and Laustrup, Helle
and Ellingsen, Torkell",
title="The Use of Telehealth for Psychological Counselling of Vulnerable Adult Patients With Rheumatic Diseases or Diabetes: Explorative Study Inspired by Participatory Design",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="21",
volume="9",
number="1",
pages="e30829",
keywords="telehealth",
keywords="videoconferencing",
keywords="app",
keywords="co-production",
keywords="co-creation",
keywords="psychologist",
keywords="psychology",
keywords="rheumatic diseases",
keywords="diabetes",
keywords="mobile phone",
abstract="Background: Video consultation is increasingly used in different health care settings to reach patients. However, little is known about telehealth in psychological counselling for vulnerable patients with somatic and chronic conditions such as rheumatoid arthritis and diabetes. Objective: This study aimed to develop and pilot test a telepsychology module for inclusion in the app My Hospital (Mit Sygehus) to provide remote psychological counselling to vulnerable adults with either rheumatic diseases or diabetes. Methods: With inspiration from participatory design, the content of the telepsychology module was developed through user involvement and evaluated by individual interviews with patients and psychologists as well as questionnaires. Results: We developed a module with our patient partners that targeted patients with rheumatic diseases and diabetes in relation to the psychological challenges of living with chronic diseases. The module included information, tools, exercises, and videoconferencing. In total, 16 patients and 3 psychologists participated in the pilot test. Psychological counselling was described by 4 themes: ``The good relation despite physical distance,'' ``The comfort of being at home,'' ``The pros of saving time on transport and energy,'' and ``A therapeutic alliance at a distance.'' Conclusions: Psychological counselling in relation to somatic care can be provided by videoconferencing supported by web-based or mobile delivery of tailored information, tools, and exercises without compromising on the quality of care. To ensure a good alliance between the patient and psychologist, a first face-to-face meeting is important. The home location provided patients with a safe environment and increased accessibility and reduced travel time to the hospital. ",
doi="10.2196/30829",
url="https://humanfactors.jmir.org/2022/1/e30829",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311690"
}


@Article{info:doi/10.2196/34458,
author="Eiken, Anne-Grethe
and Nordanger, {\O} Dag
and Solberg Nes, Lise
and Varsi, Cecilie",
title="Patients' Experiences of Using an eHealth Pain Management Intervention Combined With Psychomotor Physiotherapy: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="16",
volume="6",
number="3",
pages="e34458",
keywords="chronic pain",
keywords="psychomotor physiotherapy",
keywords="EPIO",
keywords="self-management",
keywords="telemedicine",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Chronic pain is a major health challenge to those affected. Blended care with psychomotor physiotherapy (PMP) combined with eHealth self-management might be beneficial. Objective: This study aims to explore how patients with chronic pain experience the combination of PMP and the use of EPIO, an eHealth self-management intervention for chronic pain. Methods: Individual semistructured interviews were conducted with 5 adult patients with chronic pain (ie, participants) who used EPIO in combination with PMP over a period of 10 to 15 weeks. Interviews explored participants' experiences using this treatment combination in relation to their pain and analyzed their experiences using systematic text condensation. Results: Participants described having benefited from using EPIO in combination with PMP in terms of increased awareness of bodily signals and how pain was related to stress and activity. They also described changes in the relationship to themselves in terms of increased self-acceptance, self-assertion, and hope and their relationship to their pain in terms of seeing pain as less harmful and engaging in more active coping strategies. Conclusions: Results indicate that a blended care approach combining eHealth self-management interventions such as EPIO with PMP may be of value to patients living with chronic pain. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 ",
doi="10.2196/34458",
url="https://formative.jmir.org/2022/3/e34458",
url="http://www.ncbi.nlm.nih.gov/pubmed/35293866"
}


@Article{info:doi/10.2196/33571,
author="Turesson, Christina
and Liedberg, Gunilla
and Bj{\"o}rk, Mathilda",
title="Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="14",
volume="9",
number="1",
pages="e33571",
keywords="agile design process",
keywords="chronic pain",
keywords="digital support",
keywords="eHealth",
keywords="return to work",
keywords="self-management",
keywords="smartphone apps",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. Objective: This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). Methods: A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. Results: The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. Conclusions: This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting. ",
doi="10.2196/33571",
url="https://humanfactors.jmir.org/2022/1/e33571",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285814"
}


@Article{info:doi/10.2196/30655,
author="Poncette, Akira-Sebastian
and Mosch, Katharina Lina
and Stablo, Lars
and Spies, Claudia
and Schieler, Monique
and Weber-Carstens, Steffen
and Feufel, A. Markus
and Balzer, Felix",
title="A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="11",
volume="9",
number="1",
pages="e30655",
keywords="digital health",
keywords="patient monitoring",
keywords="intensive care medicine",
keywords="intensive care unit",
keywords="technological innovation",
keywords="user-centered design",
keywords="usability",
keywords="user experience",
keywords="implementation science",
keywords="qualitative research",
keywords="interview",
keywords="mixed methods",
keywords="mobile phone",
abstract="Background: Continuous monitoring of vital signs is critical for ensuring patient safety in intensive care units (ICUs) and is becoming increasingly relevant in general wards. The effectiveness of health information technologies such as patient-monitoring systems is highly determined by usability, the lack of which can ultimately compromise patient safety. Usability problems can be identified and prevented by involving users (ie, clinicians). Objective: In this study, we aim to apply a human-centered design approach to evaluate the usability of a remote patient-monitoring system user interface (UI) in the ICU context and conceptualize and evaluate design changes. Methods: Following institutional review board approval (EA1/031/18), a formative evaluation of the monitoring UI was performed. Simulated use tests with think-aloud protocols were conducted with ICU staff (n=5), and the resulting qualitative data were analyzed using a deductive analytic approach. On the basis of the identified usability problems, we conceptualized informed design changes and applied them to develop an improved prototype of the monitoring UI. Comparing the UIs, we evaluated perceived usability using the System Usability Scale, performance efficiency with the normative path deviation, and effectiveness by measuring the task completion rate (n=5). Measures were tested for statistical significance using a 2-sample t test, Poisson regression with a generalized linear mixed-effects model, and the N-1 chi-square test. P<.05 were considered significant. Results: We found 37 individual usability problems specific to monitoring UI, which could be assigned to six subcodes: usefulness of the system, response time, responsiveness, meaning of labels, function of UI elements, and navigation. Among user ideas and requirements for the UI were high usability, customizability, and the provision of audible alarm notifications. Changes in graphics and design were proposed to allow for better navigation, information retrieval, and spatial orientation. The UI was revised by creating a prototype with a more responsive design and changes regarding labeling and UI elements. Statistical analysis showed that perceived usability improved significantly (System Usability Scale design A: mean 68.5, SD 11.26, n=5; design B: mean 89, SD 4.87, n=5; P=.003), as did performance efficiency (normative path deviation design A: mean 8.8, SD 5.26, n=5; design B: mean 3.2, SD 3.03, n=5; P=.001), and effectiveness (design A: 18 trials, failed 7, 39\% times, passed 11, 61\% times; design B: 20 trials, failed 0 times, passed 20 times; P=.002). Conclusions: Usability testing with think-aloud protocols led to a patient-monitoring UI with significantly improved usability, performance, and effectiveness. In the ICU work environment, difficult-to-use technology may result in detrimental outcomes for staff and patients. Technical devices should be designed to support efficient and effective work processes. Our results suggest that this can be achieved by applying basic human-centered design methods and principles. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 ",
doi="10.2196/30655",
url="https://humanfactors.jmir.org/2022/1/e30655",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275071"
}


@Article{info:doi/10.2196/30364,
author="Wilj{\'e}n, Angelica
and Chaplin, Eric John
and Crine, Vanessa
and Jobe, William
and Johnson, Ensa
and Karlsson, Katarina
and Lindroth, Tomas
and Schwarz, Anneli
and Stenmarker, Margaretha
and Thunberg, Gunilla
and {\"O}hl{\'e}n, Joakim
and Nilsson, Stefan",
title="The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach",
journal="JMIR Pediatr Parent",
year="2022",
month="Mar",
day="8",
volume="5",
number="1",
pages="e30364",
keywords="children",
keywords="communication",
keywords="long-term illness",
keywords="mHealth",
keywords="pediatric care",
keywords="person-centered care",
keywords="symptom assessment",
keywords="universal design",
abstract="Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents' views and health care professionals' expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non--clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child's voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings. ",
doi="10.2196/30364",
url="https://pediatrics.jmir.org/2022/1/e30364",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258466"
}


@Article{info:doi/10.2196/13635,
author="Kumar, Dinesh
and Bhardwaj, Ashok
and Sharma, Shruti
and Malhotra, Bhavya
and Amadi-Mgbenka, Chioma
and Grover, Ashoo
and Joshi, Ashish",
title="Designing and Evaluating a Personalized, Human-Centered Dietary Decision Support System for Use Among People With Diabetes in an Indian Setting: Protocol for a Quasi-Experimental Study",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="8",
volume="11",
number="3",
pages="e13635",
keywords="type 2 diabetes",
keywords="diabetes management",
keywords="dietary decision support",
keywords="diet record",
keywords="India",
abstract="Background: Human-centered dietary decision support systems are fundamental to diabetes management, and they address the limitations of existing diet management systems. Objective: The objective of the proposed study is to evaluate the use of an interactive, telephone-linked, personalized, human-centered decision support system for facilitating the delivery of personalized nutrition care for patients with diabetes. Methods: A quasi-experimental trial was conducted between the period of June and December 2018. Study participants were recruited from Community Health Center, Dharamshala, Kangra (urban population), and Model Rural Health Unit, Haroli Block, Una (rural population). Eligible participants included adults aged ?30 years with controlled or uncontrolled diabetes, those who agreed to participate in the study, those who were available for follow-up interviews, and those with a telephone or computer at home. Diabetic status was determined via a physician's diagnosis. Individuals with mental or physical challenges that affected their ability to use an electronic diet record, those who were not available for a telephone follow-up, and those who were involved in other protocols related to dietary assessments were excluded. The study participants were randomized into the following two groups: the intervention group (telephone-linked dietary decision support system) and the control group (paper-based diet record). Study participants in the intervention group recorded their daily dietary intake by using a telephone-linked, personalized, human-centered dietary decision support system and received personalized feedback and diet education via SMS text messaging. Study participants in the control group were provided with only a paper-based diet record for documenting their daily dietary intake. Follow-up visits were conducted at 3 and 6 months from the baseline in both groups. Differences in diabetes knowledge, attitudes, and practices will be measured across groups. Results: The collection of baseline data from 800 study participants in both the intervention (n=400) and control groups (n=400), which were stratified by urban (control group: n=200; intervention group: n=200) and rural settings (control group: n=200; intervention group: n=200), has been completed. Follow-up data collection for months 3 and 6 is ongoing and is expected to be completed by October 2019. Conclusions: We anticipate that the intervention group will show significant changes in nutrition knowledge, attitudes, and practices; satisfaction with care; and overall diabetes management. We also expect to see urban-rural differences across the groups. The uniqueness of our nutrient data capture process is demonstrated by its cultural and contextually relevant features---diet capture in both English and Hindi, diet conversion into caloric components, sustained diet data collection and participant adherence through telephone-linked care, and auto-generated reminders. International Registered Report Identifier (IRRID): DERR1-10.2196/13635 ",
doi="10.2196/13635",
url="https://www.researchprotocols.org/2022/3/e13635",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258472"
}


@Article{info:doi/10.2196/31376,
author="Ward, E. Rebecca
and Setiawan, Agus I. Made
and Quinby, Eleanor
and Fair, Melva
and Ambadar, Zara
and Parmanto, Bambang
and Dicianno, E. Brad",
title="Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="4",
volume="9",
number="1",
pages="e31376",
keywords="community integration",
keywords="self-care",
keywords="mobile health",
keywords="smartphone",
keywords="rehabilitation",
keywords="disability",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration. Objective: The purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements. Methods: Community Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management. Results: We gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition. Conclusions: A successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration. ",
doi="10.2196/31376",
url="https://humanfactors.jmir.org/2022/1/e31376",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254274"
}


@Article{info:doi/10.2196/31317,
author="Abdulai, Abdul-Fatawu
and Howard, Fuchsia A.
and Yong, J. Paul
and Noga, Heather
and Parmar, Gurkiran
and Currie, M. Leanne",
title="Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="3",
volume="9",
number="1",
pages="e31317",
keywords="endometriosis",
keywords="sexual pain",
keywords="dyspareunia",
keywords="usability testing",
keywords="think-aloud",
keywords="stigma",
keywords="web sites",
keywords="digital health",
keywords="informatics",
abstract="Background: Endometriosis is a chronic condition that affects approximately 10\% of women worldwide. Despite its wide prevalence, knowledge of endometriosis symptoms, such as pelvic pain, and treatments remains relatively low. This not only leads to a trivialization of symptoms and delayed diagnosis but also fuels myths and misconceptions about pain symptoms. At the same time, the use of web-based platforms for information seeking is particularly common among people with conditions that are perceived as stigmatizing and difficult to discuss. The Sex, Pain, and Endometriosis website is an educational resource designed to provide evidence-based information on endometriosis and sexual pain to help people understand the condition, feel empowered, dispel myths, and destigmatize endometriosis-associated sexual pain. Objective: The study objective is to evaluate the usability of the website and assess for destigmatizing properties of sexual health--related web-based resources. Methods: We conducted a usability analysis by using a think-aloud observation, a postsystem usability questionnaire, and follow-up interviews with 12 women with endometriosis. The think-aloud data were analyzed using the framework by Kushniruk and Patel for analyzing usability video data, the questionnaire data were analyzed using descriptive statistics, and the follow-up interviews were analyzed using simple content analysis. We conducted a usability assessment by deductively analyzing the interview data via a trauma-informed care framework and a content analysis approach. Results: Through usability analysis, we found the website to be simple, uncluttered, satisfying, and easy to use. However, 30 minor usability problems related to navigation; website response; the comprehension of graphics, icons, and tabs; the understanding of content; and mismatch between the website and users' expectations were reported. In our stigma analysis, we found the web content to be nonstigmatizing. The participants suggested ways in which websites could be designed to address stigma, including ensuring privacy, anonymity, inclusiveness, and factual and nonjudgmental content, as well as providing opportunities for web-based engagement. Conclusions: Overall, the participants found the website to be useful, easy to use, and satisfying. The usability problems identified were largely minor and informed the website redesign process. In the context of the limited literature on stigma and website design, this paper offers useful strategies on how sexual health--related websites can be designed to be acceptable and less stigmatizing to individuals with sensitive health issues. ",
doi="10.2196/31317",
url="https://humanfactors.jmir.org/2022/1/e31317",
url="http://www.ncbi.nlm.nih.gov/pubmed/35238789"
}


@Article{info:doi/10.2196/30797,
author="Germini, Federico
and Borg Debono, Victoria
and Page, David
and Zuk, Victoria
and Kucher, Alexandra
and Cotoi, Chris
and Hobson, Nicholas
and Sevestre, Michael
and Skinner, W. Mark
and Iorio, Alfonso
and ",
title="User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="2",
volume="9",
number="1",
pages="e30797",
keywords="health-related quality of life",
keywords="EQ-5D",
keywords="mobile app",
keywords="Patient-Reported Outcomes, Burdens, and Experiences (PROBE)",
keywords="hemophilia",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telehealth",
keywords="user-centered design",
abstract="Background: The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective: The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods: We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results: The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions: The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice. ",
doi="10.2196/30797",
url="https://humanfactors.jmir.org/2022/1/e30797",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234648"
}


@Article{info:doi/10.2196/23794,
author="Chowdhary, Kuntal
and Yu, Xie Daihua
and Pramana, Gede
and Mesoros, Matthew
and Fairman, Andrea
and Dicianno, Edward Brad
and Parmanto, Bambang",
title="User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="24",
volume="9",
number="1",
pages="e23794",
keywords="cellular phone",
keywords="mobile apps",
keywords="telemedicine",
keywords="adaptive mHealth",
keywords="rehabilitation",
keywords="self-care",
keywords="spinal cord injury",
keywords="spina bifida",
keywords="chronic disease",
keywords="persons with disability",
keywords="accessibility",
keywords="dexterity impairments",
keywords="mobile phone",
abstract="Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules---MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants' dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. ",
doi="10.2196/23794",
url="https://humanfactors.jmir.org/2022/1/e23794",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200144"
}


@Article{info:doi/10.2196/34117,
author="Sonney, Jennifer
and Cho, E. Emily
and Zheng, Qiming
and Kientz, A. Julie",
title="Refinement of a Parent--Child Shared Asthma Management Mobile Health App: Human-Centered Design Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="17",
volume="5",
number="1",
pages="e34117",
keywords="parent--child shared management",
keywords="school-age children",
keywords="asthma",
keywords="participatory design",
keywords="mHealth",
keywords="prototype",
keywords="usability",
keywords="family health informatics",
abstract="Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent--child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent--child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent--child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. ",
doi="10.2196/34117",
url="https://pediatrics.jmir.org/2022/1/e34117",
url="http://www.ncbi.nlm.nih.gov/pubmed/35175214"
}


@Article{info:doi/10.2196/32568,
author="Bangash, Hana
and Makkawy, Ahmed
and Gundelach, H. Justin
and Miller, A. Alexandra
and Jacobson, A. Kimberly
and Kullo, J. Iftikhar",
title="Web-Based Tool (FH Family Share) to Increase Uptake of Cascade Testing for Familial Hypercholesterolemia: Development and Evaluation",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="15",
volume="9",
number="1",
pages="e32568",
keywords="familial hypercholesterolemia",
keywords="cascade testing",
keywords="communication",
keywords="genetic counselors",
keywords="digital tools",
keywords="website",
keywords="usability",
keywords="user experience",
keywords="public health",
abstract="Background: Familial hypercholesterolemia, a prevalent genetic disorder, remains significantly underdiagnosed in the United States. Cascade testing, wherein individuals diagnosed with familial hypercholesterolemia--- probands---contact their family members to inform them of their risk for familial hypercholesterolemia, has low uptake in the United States. Digital tools are needed to facilitate communication between familial hypercholesterolemia probands and their family members and to promote sharing of familial hypercholesterolemia--related risk information. Objective: We aimed to create and evaluate a web-based tool designed to enhance familial communication and promote cascade testing for familial hypercholesterolemia. Methods: A hybrid type 1 implementation science framework and a user-centered design process were used to develop an interactive web-based tool---FH Family Share---that enables familial hypercholesterolemia probands to communicate information about their familial hypercholesterolemia diagnosis with at-risk relatives. Probands can also use the tool to draw a family pedigree and learn more about familial hypercholesterolemia through education modules and curated knowledge resources. Usability guidelines and standards were taken into account during the design and development of the tool. The initial prototype underwent a cognitive walkthrough, which was followed by usability testing with key stakeholders including genetic counselors and patients with familial hypercholesterolemia. Participants navigated the prototype using the think-aloud technique, and their feedback was used to refine features of the tool. Results: Key themes that emerged from the cognitive walkthrough were design, format, navigation, terminology, instructions, and learnability. Expert feedback from the cognitive walkthrough resulted in a rebuild of the web-based tool to align it with institutional standards. Usability testing with genetic counselors and patients with familial hypercholesterolemia provided insights on user experience, satisfaction and interface design and highlighted specific modifications that were made to refine the features of FH Family Share. Genetic counselors and patients with familial hypercholesterolemia suggested inclusion of the following features in the web-based tool: (1) a letter-to-family-member email template, (2) education modules, and (3) knowledge resources. Surveys revealed that 6 of 9 (67\%) genetic counselors found information within FH Family Share very easy to find, and 5 of 9 (56\%) genetic counselors found information very easy to understand; 5 of 9 (56\%) patients found information very easy to find within the website, and 7 of 9 (78\%) patients found information very easy to understand. All genetic counselors and patients indicated that FH Family Share was a resource worth returning to. Conclusions: FH Family Share facilitates communication between probands and their relatives. Once informed, at-risk family members have the option to seek testing and treatment for familial hypercholesterolemia. ",
doi="10.2196/32568",
url="https://humanfactors.jmir.org/2022/1/e32568",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166678"
}


@Article{info:doi/10.2196/27500,
author="Bassi, Giulia
and Donadello, Ivan
and Gabrielli, Silvia
and Salcuni, Silvia
and Giuliano, Claudio
and Forti, Stefano",
title="Early Development of a Virtual Coach for Healthy Coping Interventions in Type 2 Diabetes Mellitus: Validation Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="11",
volume="6",
number="2",
pages="e27500",
keywords="virtual coach",
keywords="early development",
keywords="type 2 diabetes mellitus",
keywords="healthy coping",
keywords="Wizard of Oz",
keywords="ORBIT model",
keywords="pilot study",
keywords="mobile phone",
abstract="Background: Mobile health solutions aimed at monitoring tasks among people with diabetes mellitus (DM) have been broadly applied. However, virtual coaches (VCs), embedded or not in mobile health, are considered valuable means of improving patients' health-related quality of life and ensuring adherence to self-care recommendations in diabetes management. Despite the growing need for effective, healthy coping digital interventions to support patients' self-care and self-management, the design of psychological digital interventions that are acceptable, usable, and engaging for the target users still represents the main challenge, especially from a psychosocial perspective. Objective: This study primarily aims to test VC interventions based on psychoeducational and counseling approaches to support and promote healthy coping behaviors in adults with DM. As a preliminary study, university students have participated in it and have played the standardized patients' (SPs) role with the aim of improving the quality of the intervention protocol in terms of user acceptability, experience, and engagement. The accuracy of users' role-playing is further analyzed. Methods: This preliminary study is based on the Obesity-Related Behavioral Intervention Trial model, with a specific focus on its early phases. The healthy coping intervention protocol was initially designed together with a team of psychologists following the main guidelines and recommendations for psychoeducational interventions for healthy coping in the context of DM. The protocol was refined with the support of 3 experts in the design of behavioral intervention technologies for mental health and well-being, who role-played 3 SPs' profiles receiving the virtual coaching intervention in a Wizard of Oz setting via WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 university students (mean age 23.61, SD 1.975 years) in a slightly different Wizard of Oz evaluation setting. Participants provided quantitative and qualitative postintervention feedback by reporting their experiences with the VC. Clustering techniques on the logged interactions and dialogs between the VC and users were collected and analyzed to identify additional refinements for future VC development. Results: Both quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies. Analyses of the logged dialogs showed that most of the participants accurately played the SPs' profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols. Conclusions: This study outlined an original approach to the early development and iterative testing of digital healthy coping interventions for type 2 DM. Indeed, the intervention was well-accepted and proved its effectiveness in the definition and refinement of the initial protocol and of the user experience with a VC before directly involving real patients in its subsequent use and testing. ",
doi="10.2196/27500",
url="https://formative.jmir.org/2022/2/e27500",
url="http://www.ncbi.nlm.nih.gov/pubmed/35147505"
}


@Article{info:doi/10.2196/34656,
author="Cosimini, Joseph Michael
and Watsjold, Bjorn
and Chan, M. Teresa",
title="Serious Games Without Screens. Comment on ``Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review''",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="9",
volume="10",
number="1",
pages="e34656",
keywords="game-based learning",
keywords="health professions education",
keywords="participatory design",
keywords="systematic review",
keywords="user-centered design",
keywords="serious games",
keywords="game development",
keywords="end users",
keywords="education",
doi="10.2196/34656",
url="https://games.jmir.org/2022/1/e34656",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138255"
}


@Article{info:doi/10.2196/29973,
author="Shields, Cathy
and Cunningham, G. Scott
and Wake, J. Deborah
and Fioratou, Evridiki
and Brodie, Doogie
and Philip, Sam
and Conway, T. Nicholas",
title="User-Centered Design of A Novel Risk Prediction Behavior Change Tool Augmented With an Artificial Intelligence Engine (MyDiabetesIQ): A Sociotechnical Systems Approach",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="8",
volume="9",
number="1",
pages="e29973",
keywords="diabetes mellitus",
keywords="digital health intervention",
keywords="eHealth",
keywords="artificial intelligence",
keywords="user-centred design",
keywords="human factors",
keywords="think aloud",
abstract="Background: Diabetes and its complications account for 10\% of annual health care spending in the United Kingdom. Digital health care interventions (DHIs) can provide scalable care, fostering diabetes self-management and reducing the risk of complications. Tailorability (providing personalized interventions) and usability are key to DHI engagement/effectiveness. User-centered design of DHIs (aligning features to end users' needs) can generate more usable interventions, avoiding unintended consequences and improving user engagement. Objective: MyDiabetesIQ (MDIQ) is an artificial intelligence engine intended to predict users' diabetes complications risk. It will underpin a user interface in which users will alter lifestyle parameters to see the impact on their future risks. MDIQ will link to an existing DHI, My Diabetes My Way (MDMW). We describe the user-centered design of the user interface of MDIQ as informed by human factors engineering. Methods: Current users of MDMW were invited to take part in focus groups to gather their insights about users being shown their likelihood of developing diabetes-related complications and any risks they perceived from using MDIQ. Findings from focus groups informed the development of a prototype MDIQ interface, which was then user-tested through the ``think aloud'' method, in which users speak aloud about their thoughts/impressions while performing prescribed tasks. Focus group and think aloud transcripts were analyzed thematically, using a combination of inductive and deductive analysis. For think aloud data, a sociotechnical model was used as a framework for thematic analysis. Results: Focus group participants (n=8) felt that some users could become anxious when shown their future complications risks. They highlighted the importance of easy navigation, jargon avoidance, and the use of positive/encouraging language. User testing of the prototype site through think aloud sessions (n=7) highlighted several usability issues. Issues included confusing visual cues and confusion over whether user-updated information fed back to health care teams. Some issues could be compounded for users with limited digital skills. Results from the focus groups and think aloud workshops were used in the development of a live MDIQ platform. Conclusions: Acting on the input of end users at each iterative stage of a digital tool's development can help to prioritize users throughout the design process, ensuring the alignment of DHI features with user needs. The use of the sociotechnical framework encouraged the consideration of interactions between different sociotechnical dimensions in finding solutions to issues, for example, avoiding the exclusion of users with limited digital skills. Based on user feedback, the tool could scaffold good goal setting, allowing users to balance their palatable future complications risk against acceptable lifestyle changes. Optimal control of diabetes relies heavily on self-management. Tools such as MDMW/ MDIQ can offer personalized support for self-management alongside access to users' electronic health records, potentially helping to delay or reduce long-term complications, thereby providing significant reductions in health care costs. ",
doi="10.2196/29973",
url="https://humanfactors.jmir.org/2022/1/e29973",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133280"
}


@Article{info:doi/10.2196/31263,
author="Zhang, Yan
and Yi, Siqi
and Trace, B. Ciaran
and Williams-Brown, Yvette Marian",
title="Understanding the Information Needs of Patients With Ovarian Cancer Regarding Genetic Testing to Inform Intervention Design: Interview Study",
journal="JMIR Cancer",
year="2022",
month="Feb",
day="8",
volume="8",
number="1",
pages="e31263",
keywords="patient information needs",
keywords="consumer health informatics",
keywords="ovarian cancer",
keywords="genetic testing",
keywords="genetic counseling",
keywords="mobile phone",
abstract="Background: Experts in gynecological cancer care recommend that all patients with invasive or high-grade ovarian cancer (OC) undergo genetic testing. However, even patients who intend to take or have taken genetic tests have many unaddressed information needs regarding genetic testing. Existing genetic counseling falls short of adequately addressing this challenge. Objective: This study aims to investigate the genetic testing--related information needs of patients with OC to inform the design of interactive technology-based interventions that can enhance communication of genetic testing information to patients. Methods: We interviewed 20 patients with OC who had taken genetic tests and gathered genetic testing--related messages from an active OC web-based community. The interview transcripts and web-based community messages were analyzed using the qualitative content analysis method. Results: Data analyses produced a comprehensive taxonomy of the genetic testing--related information needs of patients with OC, which included five major topic clusters: knowledge of genetic testing as a medical test, genetic testing process, genetic testing implications for patients, implications for family members, and medical terminology. Findings indicated that patients wanted to receive information that was relevant, understandable, concise, usable, appropriate, sympathetic, and available when needed. They also preferred various channels to receive information, including internet-based technologies, print, and conversations with health care providers. Conclusions: Patients with OC need a range of information to address the uncertainties and challenges that they encounter while taking genetic tests. Their preferences for channels to receive information vary widely. A multichannel information delivery solution that combines both provider-led and peer-to-peer education models is needed to supplement existing genetic counseling to effectively meet the genetic testing--related information needs of patients with OC. ",
doi="10.2196/31263",
url="https://cancer.jmir.org/2022/1/e31263",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133282"
}


@Article{info:doi/10.2196/30989,
author="Jaffar, Aida
and Mohd-Sidik, Sherina
and Foo, Nien Chai
and Admodisastro, Novia
and Abdul Salam, Nur Sobihatun
and Ismail, Diana Noor",
title="Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="3",
volume="9",
number="1",
pages="e30989",
keywords="User-centered design",
keywords="mHealth app",
keywords="Digital intervention",
keywords="mHealth Development and Evaluation Framework",
keywords="Usability",
keywords="Acceptability",
keywords="Pelvic Floor Muscle Training",
keywords="Urinary incontinence",
keywords="Pregnancy",
abstract="Background: Mobile health apps, for example, the T{\"a}t, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9\% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design--11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. ",
doi="10.2196/30989",
url="https://humanfactors.jmir.org/2022/1/e30989",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113025"
}


@Article{info:doi/10.2196/27887,
author="Khanbhai, Mustafa
and Symons, Joshua
and Flott, Kelsey
and Harrison-White, Stephanie
and Spofforth, Jamie
and Klaber, Robert
and Manton, David
and Darzi, Ara
and Mayer, Erik",
title="Enriching the Value of Patient Experience Feedback: Web-Based Dashboard Development Using Co-design and Heuristic Evaluation",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="3",
volume="9",
number="1",
pages="e27887",
keywords="patient experience",
keywords="friends and family test",
keywords="quality dashboard",
keywords="co-design",
keywords="heuristic evaluation",
keywords="usability",
abstract="Background: There is an abundance of patient experience data held within health care organizations, but stakeholders and staff are often unable to use the output in a meaningful and timely way to improve care delivery. Dashboards, which use visualized data to summarize key patient experience feedback, have the potential to address these issues. Objective: The aim of this study is to develop a patient experience dashboard with an emphasis on Friends and Family Test (FFT) reporting, as per the national policy drive. Methods: A 2-stage approach was used---participatory co-design involving 20 co-designers to develop a dashboard prototype, followed by iterative dashboard testing. Language analysis was performed on free-text patient experience data from the FFT, and the themes and sentiments generated were used to populate the dashboard with associated FFT metrics. Heuristic evaluation and usability testing were conducted to refine the dashboard and assess user satisfaction using the system usability score. Results: The qualitative analysis from the co-design process informed the development of the dashboard prototype with key dashboard requirements and a significant preference for bubble chart display. The heuristic evaluation revealed that most cumulative scores had no usability problems (18/20, 90\%), had cosmetic problems only (7/20, 35\%), or had minor usability problems (5/20, 25\%). The mean System Usability Scale score was 89.7 (SD 7.9), suggesting an excellent rating. Conclusions: The growing capacity to collect and process patient experience data suggests that data visualization will be increasingly important in turning feedback into improvements to care. Through heuristic usability, we demonstrated that very large FFT data can be presented in a thematically driven, simple visual display without the loss of the nuances and still allow for the exploration of the original free-text comments. This study establishes guidance for optimizing the design of patient experience dashboards that health care providers find meaningful, which in turn drives patient-centered care. ",
doi="10.2196/27887",
url="https://humanfactors.jmir.org/2022/1/e27887",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113022"
}


@Article{info:doi/10.2196/32360,
author="Kulkarni, Anagha
and Wong, Mike
and Belsare, Tejasvi
and Shah, Risha
and Yu Yu, Diana
and Coskun, Bera
and Holschuh, Carrie
and Kakar, Venoo
and Modrek, Sepideh
and Smirnova, Anastasia",
title="Quantifying the Quality of Web-Based Health Information on Student Health Center Websites Using a Software Tool: Design and Development Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="2",
volume="6",
number="2",
pages="e32360",
keywords="online health information quality",
keywords="information quality metrics",
keywords="automated quantification tool",
keywords="student health center websites",
keywords="digital health",
keywords="health information",
keywords="health information websites",
keywords="adolescents",
keywords="online health",
keywords="infodemiology",
keywords="public health",
keywords="health websites",
abstract="Background: The internet has become a major source of health information, especially for adolescents and young adults. Unfortunately, inaccurate, incomplete, or outdated health information is widespread on the web. Often adolescents and young adults turn to authoritative websites such as the student health center (SHC) website of the university they attend to obtain reliable health information. Although most on-campus SHC clinics comply with the American College Health Association standards, their websites are not subject to any standards or code of conduct. In the absence of quality standards or guidelines, monitoring and compliance processes do not exist for SHC websites. Thus, there is no oversight of the health information published on SHC websites by any central governing body. Objective: The aim of this study is to develop, describe, and validate an open-source software that can effectively and efficiently assess the quality of health information on SHC websites in the United States. Methods: Our cross-functional team designed and developed an open-source software, QMOHI (Quantitative Measures of Online Health Information), that assesses information quality for a specified health topic from all SHC websites belonging to a predetermined list of universities. The tool was designed to compute 8 different quality metrics that quantify various aspects of information quality based on the retrieved text. We conducted and reported results from 3 experiments that assessed the QMOHI tool in terms of its scalability, generalizability in health topics, and robustness to changes in universities' website structure. Results: Empirical evaluation has shown the QMOHI tool to be highly scalable and substantially more efficient than manually assessing web-based information quality. The tool's runtime was dominated by network-related tasks (98\%), whereas the metric computations take <2 seconds. QMOHI demonstrated topical versatility, evaluating SHC website information quality for four disparate and broad health topics (COVID, cancer, long-acting reversible contraceptives, and condoms) and two narrowly focused topics (hormonal intrauterine device and copper intrauterine device). The tool exhibited robustness, correctly measuring information quality despite changes in SHC website structure. QMOHI can support longitudinal studies by being robust to such website changes. Conclusions: QMOHI allows public health researchers and practitioners to conduct large-scale studies of SHC websites that were previously too time- and cost-intensive. The capability to generalize broadly or focus narrowly allows a wide range of applications of QMOHI, allowing researchers to study both mainstream and underexplored health topics. QMOHI's ability to robustly analyze SHC websites periodically promotes longitudinal investigations and allows QMOHI to be used as a monitoring tool. QMOHI serves as a launching pad for our future work that aims to develop a broadly applicable public health tool for web-based health information studies with potential applications far beyond SHC websites. ",
doi="10.2196/32360",
url="https://formative.jmir.org/2022/2/e32360",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107423"
}


@Article{info:doi/10.2196/31858,
author="Kip, Hanneke
and Keizer, Julia
and da Silva, C. Marcia
and Beerlage-de Jong, Nienke
and K{\"o}hle, Nadine
and Kelders, M. Saskia",
title="Methods for Human-Centered eHealth Development: Narrative Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="27",
volume="24",
number="1",
pages="e31858",
keywords="eHealth",
keywords="community-based participatory research",
keywords="human-centered design",
keywords="CeHRes Roadmap",
keywords="internet-based intervention",
keywords="technological innovations",
abstract="Background: Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective: The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods: We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results: In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions: This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process. ",
doi="10.2196/31858",
url="https://www.jmir.org/2022/1/e31858",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084359"
}


@Article{info:doi/10.2196/28701,
author="Gagnon-Roy, Mireille
and Pinard, St{\'e}phanie
and Bottari, Carolina
and Le Morellec, Fanny
and Lalibert{\'e}, Catherine
and Ben Lagha, Rym
and Yaddaden, Amel
and Pigot, H{\'e}l{\`e}ne
and Giroux, Sylvain
and Bier, Nathalie",
title="Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Jan",
day="26",
volume="9",
number="1",
pages="e28701",
keywords="usability testing and evaluation",
keywords="user experience",
keywords="qualitative methods",
keywords="assistive technologies",
keywords="rehabilitation",
keywords="patient safety",
abstract="Background: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. Objective: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. Methods: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. Results: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). Conclusions: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology. ",
doi="10.2196/28701",
url="https://rehab.jmir.org/2022/1/e28701",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080496"
}


@Article{info:doi/10.2196/31471,
author="Ingadottir, Brynja
and Laitonen, Elina
and Stefansdottir, Adalheidur
and Sigurdardottir, Olafia Anna
and Brynjolfsdottir, Berglind
and Parisod, Heidi
and Nyman, Johanna
and Gunnarsdottir, Karitas
and J{\'o}nsd{\'o}ttir, Katr{\'i}n
and Salanter{\"a}, Sanna
and Pakarinen, Anni",
title="Developing a Health Game to Prepare Preschool Children for Anesthesia: Formative Study Using a Child-Centered Approach",
journal="JMIR Serious Games",
year="2022",
month="Jan",
day="20",
volume="10",
number="1",
pages="e31471",
keywords="anesthesia",
keywords="child-centred design",
keywords="children",
keywords="digital health",
keywords="educational games",
keywords="health games",
keywords="hospital",
keywords="patient education",
keywords="serious games",
keywords="surgery",
keywords="user-centred design",
keywords="video games",
abstract="Background: Every year, millions of children undergo medical procedures that require anesthesia. Fear and anxiety are common among young children undergoing such procedures and can interfere with the child's recovery and well-being. Relaxation, distraction, and education are methods that can be used to prepare children and help them cope with fear and anxiety, and serious games may be a suitable medium for these purposes. User-centered design emphasizes the involvement of end users during the development and testing of products, but involving young, preschool children may be challenging. Objective: One objective of this study was to describe the development and usability of a computer-based educational health game intended for preschool children to prepare them for upcoming anesthesia. A further objective was to describe the lessons learned from using a child-centered approach with the young target group. Methods: A formative mixed methods child (user)-centered study design was used to develop and test the usability of the game. Preschool children (4-6 years old) informed the game design through playful workshops (n=26), and usability testing was conducted through game-playing and interviews (n=16). Data were collected in Iceland and Finland with video-recorded direct observation and interviews, as well as children's drawings, and analyzed with content analysis and descriptive statistics. Results: The children shared their knowledge and ideas about hospitals, different emotions, and their preferences concerning game elements. Testing revealed the high usability of the game and provided important information that was used to modify the game before publishing and that will be used in its further development. Conclusions: Preschool children can inform game design through playful workshops about health-related subjects that they are not necessarily familiar with but that are relevant for them. The game's usability was improved with the participation of the target group, and the game is now ready for clinical testing. ",
doi="10.2196/31471",
url="https://games.jmir.org/2022/1/e31471",
url="http://www.ncbi.nlm.nih.gov/pubmed/35049507"
}


@Article{info:doi/10.2196/33716,
author="Hogan, P. Timothy
and Etingen, Bella
and McMahon, Nicholas
and Bixler, R. Felicia
and Am, Linda
and Wacks, E. Rachel
and Shimada, L. Stephanie
and Reilly, D. Erin
and Frisbee, L. Kathleen
and Smith, M. Bridget",
title="Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="20",
volume="6",
number="1",
pages="e33716",
keywords="mobile health applications",
keywords="pain",
keywords="veterans",
keywords="usability",
abstract="Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1\%). These veterans received our outreach program; 236 (236/393, 60.1\%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2\% (24/236) used Pain Coach, and 58\% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3\%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. ",
doi="10.2196/33716",
url="https://formative.jmir.org/2022/1/e33716",
url="http://www.ncbi.nlm.nih.gov/pubmed/35049515"
}


@Article{info:doi/10.2196/28659,
author="Hwang, Jeonghwan
and Lee, Taeheon
and Lee, Honggu
and Byun, Seonjeong",
title="A Clinical Decision Support System for Sleep Staging Tasks With Explanations From Artificial Intelligence: User-Centered Design and Evaluation Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="19",
volume="24",
number="1",
pages="e28659",
keywords="sleep staging",
keywords="clinical decision support",
keywords="user-centered design",
keywords="medical artificial intelligence",
abstract="Background: Despite the unprecedented performance of deep learning algorithms in clinical domains, full reviews of algorithmic predictions by human experts remain mandatory. Under these circumstances, artificial intelligence (AI) models are primarily designed as clinical decision support systems (CDSSs). However, from the perspective of clinical practitioners, the lack of clinical interpretability and user-centered interfaces hinders the adoption of these AI systems in practice. Objective: This study aims to develop an AI-based CDSS for assisting polysomnographic technicians in reviewing AI-predicted sleep staging results. This study proposed and evaluated a CDSS that provides clinically sound explanations for AI predictions in a user-centered manner. Methods: Our study is based on a user-centered design framework for developing explanations in a CDSS that identifies why explanations are needed, what information should be contained in explanations, and how explanations can be provided in the CDSS. We conducted user interviews, user observation sessions, and an iterative design process to identify three key aspects for designing explanations in the CDSS. After constructing the CDSS, the tool was evaluated to investigate how the CDSS explanations helped technicians. We measured the accuracy of sleep staging and interrater reliability with macro-F1 and Cohen $\kappa$ scores to assess quantitative improvements after our tool was adopted. We assessed qualitative improvements through participant interviews that established how participants perceived and used the tool. Results: The user study revealed that technicians desire explanations that are relevant to key electroencephalogram (EEG) patterns for sleep staging when assessing the correctness of AI predictions. Here, technicians wanted explanations that could be used to evaluate whether the AI models properly locate and use these patterns during prediction. On the basis of this, information that is closely related to sleep EEG patterns was formulated for the AI models. In the iterative design phase, we developed a different visualization strategy for each pattern based on how technicians interpreted the EEG recordings with these patterns during their workflows. Our evaluation study on 9 polysomnographic technicians quantitatively and qualitatively investigated the helpfulness of the tool. For technicians with <5 years of work experience, their quantitative sleep staging performance improved significantly from 56.75 to 60.59 with a P value of .05. Qualitatively, participants reported that the information provided effectively supported them, and they could develop notable adoption strategies for the tool. Conclusions: Our findings indicate that formulating clinical explanations for automated predictions using the information in the AI with a user-centered design process is an effective strategy for developing a CDSS for sleep staging. ",
doi="10.2196/28659",
url="https://www.jmir.org/2022/1/e28659",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044311"
}


@Article{info:doi/10.2196/28300,
author="Moltrecht, Bettina
and Patalay, Praveetha
and Bear, Alice Holly
and Deighton, Jessica
and Edbrooke-Childs, Julian",
title="A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="19",
volume="6",
number="1",
pages="e28300",
keywords="mHealth",
keywords="participatory design",
keywords="emotion regulation",
keywords="interdisciplinary development",
keywords="child mental health",
abstract="Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient--clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children's mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. ",
doi="10.2196/28300",
url="https://formative.jmir.org/2022/1/e28300",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044312"
}


@Article{info:doi/10.2196/33470,
author="Larsen, Kevin
and Akindele, Bilikis
and Head, Henry
and Evans, Rick
and Mehta, Purvi
and Hlatky, Quinn
and Krause, Brendan
and Chen, Sydney
and King, Dominic",
title="Developing a User-Centered Digital Clinical Decision Support App for Evidence-Based Medication Recommendations for Type 2 Diabetes Mellitus: Prototype User Testing and Validation Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="18",
volume="9",
number="1",
pages="e33470",
keywords="clinical decision support",
keywords="user-centered design",
keywords="user testing",
keywords="type 2 diabetes mellitus",
keywords="evidence-based guidelines",
keywords="validation",
keywords="workflows",
keywords="electronic health record",
keywords="decision support",
keywords="design",
keywords="diabetes",
abstract="Background: Closing the gap between care recommended by evidence-based guidelines and care delivered in practice is an ongoing challenge across systems and delivery models. Clinical decision support systems (CDSSs) are widely deployed to augment clinicians in their complex decision-making processes. Despite published success stories, the poor usability of many CDSSs has contributed to fragmented workflows and alert fatigue. Objective: This study aimed to validate the application of a user-centered design (UCD) process in the development of a standards-based medication recommender for type 2 diabetes mellitus in a simulated setting. The prototype app was evaluated for effectiveness, efficiency, and user satisfaction. Methods: We conducted interviews with 8 clinical leaders with 8 rounds of iterative user testing with 2-8 prescribers in each round to inform app development. With the resulting prototype app, we conducted a validation study with 43 participants. The participants were assigned to one of two groups and completed a 2-hour remote user testing session. Both groups reviewed mock patient facts and ordered diabetes medications for the patients. The Traditional group used a mock electronic health record (EHR) for the review in Period 1 and used the prototype app in Period 2, while the Tool group used the prototype app during both time periods. The perceived cognitive load associated with task performance during each period was assessed with the National Aeronautics and Space Administration Task Load Index. Participants also completed the System Usability Scale (SUS) questionnaire and Kano Survey. Results: Average SUS scores from the questionnaire, taken at the end of 5 of the 8 user testing sessions, ranged from 68-86. The results of the validation study are as follows: percent adherence to evidence-based guidelines was greater with the use of the prototype app than with the EHR across time periods with the Traditional group (prototype app mean 96.2 vs EHR mean 72.0, P<.001) and between groups during Period 1 (Tool group mean 92.6 vs Traditional group mean 72.0, P<.001). Task completion times did not differ between groups (P=.23), but the Tool group completed medication ordering more quickly in Period 2 (Period 1 mean 130.7 seconds vs Period 2 mean 107.7 seconds, P<.001). Based on an adjusted $\alpha$ level owing to violation of the assumption of homogeneity of variance (Ps>.03), there was no effect on screens viewed and on perceived cognitive load (all Ps>.14). Conclusions: Through deployment of the UCD process, a point-of-care medication recommender app holds promise of improving adherence to evidence-based guidelines; in this case, those from the American Diabetes Association. Task-time performance suggests that with practice the T2DM app may support a more efficient ordering process for providers, and SUS scores indicate provider satisfaction with the app. ",
doi="10.2196/33470",
url="https://humanfactors.jmir.org/2022/1/e33470",
url="http://www.ncbi.nlm.nih.gov/pubmed/34784293"
}


@Article{info:doi/10.2196/29889,
author="Doyle, Sarah
and Pavlos, Rebecca
and Carlson, J. Samantha
and Barton, Katherine
and Bhuiyan, Mejbah
and Boeing, Bernadett
and Borland, L. Meredith
and Hoober, Steven
and Blyth, C. Christopher",
title="Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="17",
volume="6",
number="1",
pages="e29889",
keywords="usability testing",
keywords="REDCap",
keywords="discharge instructions",
keywords="acute respiratory infection",
keywords="digital health technology",
keywords="mobile technology",
keywords="semistructured interview",
keywords="pediatric acute respiratory infection",
keywords="mobile phone",
abstract="Background: Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools---a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform---into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective: The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods: Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results: Most parents (9/11, 82\%) indicated that they usually received verbal discharge advice, with some (5/11, 45\%) recalling receiving preprinted resources from their physician. Most (8/11, 73\%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88\%) described their usual practice as verbal discharge instructions, with some (3/8, 38\%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73\%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions: Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting. ",
doi="10.2196/29889",
url="https://formative.jmir.org/2022/1/e29889",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037889"
}


@Article{info:doi/10.2196/24483,
author="Fox, Sarah
and Brown, E. Laura J.
and Antrobus, Steven
and Brough, David
and Drake, J. Richard
and Jury, Francine
and Leroi, Iracema
and Parry-Jones, R. Adrian
and Machin, Matthew",
title="Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="14",
volume="10",
number="1",
pages="e24483",
keywords="agile",
keywords="dementia",
keywords="co-design",
keywords="cognition",
keywords="mHealth",
keywords="patient public involvement",
keywords="software development",
keywords="mobile phone",
abstract="Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner--led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. ",
doi="10.2196/24483",
url="https://mhealth.jmir.org/2022/1/e24483",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029539"
}


@Article{info:doi/10.2196/29512,
author="Nimmanterdwong, Zethapong
and Boonviriya, Suchaya
and Tangkijvanich, Pisit",
title="Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="14",
volume="10",
number="1",
pages="e29512",
keywords="connected health",
keywords="development",
keywords="elderly",
keywords="HCD",
keywords="mHealth",
keywords="older adults",
keywords="review",
keywords="telehealth",
keywords="UCD",
keywords="usability",
keywords="design",
keywords="human-centered",
keywords="app",
abstract="Background: The world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality. Objective: This systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population. Methods: We conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies' qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed. Results: Eight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210. Conclusions: Findings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted. ",
doi="10.2196/29512",
url="https://mhealth.jmir.org/2022/1/e29512",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029535"
}


@Article{info:doi/10.2196/31567,
author="Poduval, Shoba
and Ross, Jamie
and Pal, Kingshuk
and Newhouse, Nikki
and Hamilton, Fiona
and Murray, Elizabeth",
title="Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="14",
volume="9",
number="1",
pages="e31567",
keywords="type 2 diabetes",
keywords="patient self-management",
keywords="diabetes education",
keywords="primary care",
keywords="digital health",
abstract="Background: Digital health research encompasses methods from human-computer interaction and health research. Objective: This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. Methods: The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. Results: The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. Conclusions: The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs. ",
doi="10.2196/31567",
url="https://humanfactors.jmir.org/2022/1/e31567",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029531"
}


@Article{info:doi/10.2196/32610,
author="Sanchez Antelo, Victoria
and Szwarc, Lucila
and Paolino, Melisa
and Saimovici, Diana
and Massaccesi, Silvia
and Viswanath, Kasisomayajula
and Arrossi, Silvina",
title="A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="13",
volume="6",
number="1",
pages="e32610",
keywords="mHealth",
keywords="mobile application",
keywords="counseling",
keywords="HPV test",
keywords="cervical cancer",
keywords="health belief model",
keywords="integrated behavioral model",
keywords="patient education",
keywords="Argentina",
abstract="Background: Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective: This study aims to understand HPV-tested women's perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results: We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users' needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions: Providing information that meets women's needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women. ",
doi="10.2196/32610",
url="https://formative.jmir.org/2022/1/e32610",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023843"
}


@Article{info:doi/10.2196/32273,
author="Feldman, G. Amy
and Moore, Susan
and Bull, Sheana
and Morris, A. Megan
and Wilson, Kumanan
and Bell, Cameron
and Collins, M. Margaret
and Denize, M. Kathryn
and Kempe, Allison",
title="A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="13",
volume="6",
number="1",
pages="e32273",
keywords="vaccinations",
keywords="transplantation",
keywords="mobile app",
keywords="agile development",
keywords="immunization",
keywords="mHealth",
keywords="mobile health",
keywords="children",
keywords="transplant recipients",
keywords="pediatric transplant recipients",
keywords="pediatrics",
abstract="Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20\% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87\% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. ",
doi="10.2196/32273",
url="https://formative.jmir.org/2022/1/e32273",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023840"
}


@Article{info:doi/10.2196/25444,
author="Clifford, Gari
and Nguyen, Tony
and Shaw, Corey
and Newton, Brittney
and Francis, Sherilyn
and Salari, Mohsen
and Evans, Chad
and Jones, Camara
and Akintobi, Henry Tabia
and Taylor Jr, Herman",
title="An Open-Source Privacy-Preserving Large-Scale Mobile Framework for Cardiovascular Health Monitoring and Intervention Planning With an Urban African American Population of Young Adults: User-Centered Design Approach",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="11",
volume="6",
number="1",
pages="e25444",
keywords="agile design",
keywords="cardiovascular disease",
keywords="community-based participatory research",
keywords="exposome",
keywords="user-centered design",
keywords="minority health",
keywords="African American",
keywords="mobile phone",
abstract="Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide and are increasingly affecting younger populations, particularly African Americans in the southern United States. Access to preventive and therapeutic services, biological factors, and social determinants of health (ie, structural racism, resource limitation, residential segregation, and discriminatory practices) all combine to exacerbate health inequities and their resultant disparities in morbidity and mortality. These factors manifest early in life and have been shown to impact health trajectories into adulthood. Early detection of and intervention in emerging risk offers the best hope for preventing race-based differences in adult diseases. However, young-adult populations are notoriously difficult to recruit and retain, often because of a lack of knowledge of personal risk and a low level of concern for long-term health outcomes. Objective: This study aims to develop a system design for the MOYO mobile platform. Further, we seek to addresses the challenge of primordial prevention in a young, at-risk population (ie, Southern-urban African Americans). Methods: Urban African Americans, aged 18 to 29 years (n=505), participated in a series of co-design sessions to develop MOYO prototypes (ie, HealthTech Events). During the sessions, participants were orientated to the issues of CVD risk health disparities and then tasked with wireframing prototype screens depicting app features that they considered desirable. All 297 prototype screens were subsequently analyzed using NVivo 12 (QSR International), a qualitative analysis software. Using the grounded theory approach, an open-coding method was applied to a subset of data, approximately 20\% (5/25), or 5 complete prototypes, to identify the dominant themes among the prototypes. To ensure intercoder reliability, 2 research team members analyzed the same subset of data. Results: Overall, 9 dominant design requirements emerged from the qualitative analysis: customization, incentive motivation, social engagement, awareness, education, or recommendations, behavior tracking, location services, access to health professionals, data user agreements, and health assessment. This led to the development of a cross-platform app through an agile design process to collect standardized health surveys, narratives, geolocated pollution, weather, food desert exposure data, physical activity, social networks, and physiology through point-of-care devices. A Health Insurance Portability and Accountability Act--compliant cloud infrastructure was developed to collect, process, and review data, as well as generate alerts to allow automated signal processing and machine learning on the data to produce critical alerts. Integration with wearables and electronic health records via fast health care interoperability resources was implemented. Conclusions: The MOYO mobile platform provides a comprehensive health and exposure monitoring system that allows for a broad range of compliance, from passive background monitoring to active self-reporting. These study findings support the notion that African Americans should be meaningfully involved in designing technologies that are developed to improve CVD outcomes in African American communities. ",
doi="10.2196/25444",
url="https://formative.jmir.org/2022/1/e25444",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014970"
}


@Article{info:doi/10.2196/30565,
author="Burn, Anne-Marie
and Ford, J. Tamsin
and Stochl, Jan
and Jones, B. Peter
and Perez, Jesus
and Anderson, K. Joanna",
title="Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="10",
volume="6",
number="1",
pages="e30565",
keywords="mental health",
keywords="assessment",
keywords="young people",
keywords="youth",
keywords="schools",
keywords="computerized adaptive testing",
keywords="mobile apps",
keywords="user-centered design",
keywords="coproduction",
keywords="qualitative study",
abstract="Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles---an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. ",
doi="10.2196/30565",
url="https://formative.jmir.org/2022/1/e30565",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006079"
}


@Article{info:doi/10.2196/27689,
author="Rao, Nema
and Perdomo, Sophy
and Jonassaint, Charles",
title="A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="7",
volume="9",
number="1",
pages="e27689",
keywords="pain",
keywords="pain measurement",
keywords="chronic pain",
keywords="animations",
keywords="mobile apps",
keywords="human-centered design",
abstract="Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. ",
doi="10.2196/27689",
url="https://humanfactors.jmir.org/2022/1/e27689",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994697"
}


@Article{info:doi/10.2196/31679,
author="Maramba, Daniel Inocencio
and Chatterjee, Arunangsu",
title="Continuous User Experience Monitoring of a Patient-Completed Preoperative Assessment System in the United Kingdom: Cross-sectional Study",
journal="JMIRx Med",
year="2022",
month="Jan",
day="6",
volume="3",
number="1",
pages="e31679",
keywords="preoperative assessment",
keywords="self-completed patient questionnaires",
keywords="digital health",
keywords="usability",
keywords="user experience",
keywords="web-based",
abstract="Background: Anesthetic preoperative assessment (POA) is now a common part of the surgical care pathway, and guidelines support its routine use. MyPreOp (Ultramed Ltd) is a web-based POA system that enables remote assessments. Usability is a key factor in the success of digital health solutions. Objective: This study aims to assess the usability of the MyPreOp system through patient feedback, investigate the amount of time it took for patients to complete the POA questionnaire and the factors that influenced completion time, and explore the effect on completion times of implementing a validated eHealth usability scale, as compared to using a simple but unvalidated usability evaluation scale, and to test the feasibility of administering a more detailed usability evaluation scale in a staggered manner so as not to unduly increase completion times. Methods: In this cross-sectional study, anonymized data sets were extracted from the MyPreOp system. The participants were adults (aged ?18 years), scheduled for nonurgent surgical procedures performed in hospitals in the United Kingdom, who gave consent for their anonymized data to be analyzed. Data collected included age, gender, American Society of Anesthesiology (ASA) physical classification status, and completion time. Two user experience evaluations were used: in Phase 1, 2 questions asking about overall experience and ease of use, and in Phase 2, a previously validated usability questionnaire, with its 20 questions equally distributed among 5 succeeding patient cohorts. There were 2593 respondents in total (Phase 1: n=1193; Phase 2: n=1400). The median age of the participants was 46 years, and 1520 (58.62\%) of the 2593 respondents were female. End points measured were the median completion times in Phase I and Phase II. The data were collected by extracting a subset of records from the database and exported to a spreadsheet for analysis (Excel, Microsoft Corporation). The data were analyzed for differences in completion times between Phase I and Phase II, as well as for differences between age groups, genders, and ASA classifications. Results: MyPreOp scored well in usability in both phases. In Phase 1, 81.64\% (974/1193) of respondents had a good or better experience, and 93.8\% (1119/1193) found it easy to use. The usability rating in Phase 2 was 4.13 out of a maximum of 5, indicating high usability. The median completion time was 40.4 minutes. The implementation of the longer usability evaluation scale in Phase 2 did not negatively impact the completion times. Age and ASA physical status were found to be moderately associated with increased completion times. Conclusions: MyPreOp rates high in both user experience and usability. The method of dividing the questionnaire into 5 blocks is valid and does not negatively affect completion times. Further research into the factors affecting completion time is recommended. ",
doi="10.2196/31679",
url="https://med.jmirx.org/2022/1/e31679",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725545"
}


@Article{info:doi/10.2196/29743,
author="Teleman, Britta
and Svedberg, Petra
and Larsson, Ingrid
and Karlsson, Caroline
and Nygren, M. Jens",
title="A Norm-Creative Method for Co-constructing Personas With Children With Disabilities: Multiphase Design Study",
journal="J Particip Med",
year="2022",
month="Jan",
day="6",
volume="14",
number="1",
pages="e29743",
keywords="disability",
keywords="children",
keywords="norm-critical",
keywords="participatory design",
keywords="personas",
keywords="co-produced care",
keywords="health care",
abstract="Background: An increase in the demand for child participation in health care requires tools that enable and empower children to be involved in the co-production of their own care. The development of such tools should involve children, but participatory design and research with children have challenges, in particular, when involving children with disabilities where a low level of participation is the norm. Norm-creative and participatory approaches may bring more effective design solutions for this group. ``Personas'' is a methodology for increasing user perspectives in design and offers representation when users are absent. However, research on participatory persona generation in this context is limited. Objective: The objective of this study was to investigate how norm-creative and participatory design approaches can be integrated in a persona generation method to suit children with disabilities in the design of games for health that target this group. Methods: The method development involved interview transcripts and image-based workshops. Sixteen children with various disabilities participated in persona generation through co-creation of characters and scenarios. The results from the workshops were validated together with 8 children without disabilities, 1 young adult with a disability, and 1 rehabilitation professional. A qualitative thematic design analysis was iterated throughout the process. Results: The results consisted of an image-based and iterative co-construction method. It was accompanied by examples of personas that were generated and validated within a games for health case. The method showed effectiveness in enabling flexible co-construction and communication. The data resonated with social model perspectives, and the development is discussed in terms of participation levels, salutogenic descriptions of barriers, and norm-creative tradeoffs. Conclusions: The resulting method may influence future design projects toward more inclusiveness and enable increased representation for children with disabilities in research and design. Using this method to its full potential requires a norm-critical awareness as well as extensive facilitation. Suggestions for further research include the application of the method to design processes in similar contexts or user groups. ",
doi="10.2196/29743",
url="https://jopm.jmir.org/2022/1/e29743",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989695"
}


@Article{info:doi/10.2196/30408,
author="Wray, B. Tyler
and Chan, A. Philip
and Guigayoma, P. John
and Kahler, W. Christopher",
title="Game Plan---a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="5",
volume="6",
number="1",
pages="e30408",
keywords="HIV",
keywords="pre-exposure prophylaxis",
keywords="alcohol use",
keywords="mHealth",
keywords="eHealth",
keywords="intervention",
keywords="mobile phone",
abstract="Background: HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP's effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective: We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods: Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results: In addition to Game Plan's pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions: Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult. ",
doi="10.2196/30408",
url="https://formative.jmir.org/2022/1/e30408",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989679"
}


@Article{info:doi/10.2196/28895,
author="Tennant, Ryan
and Allana, Sana
and Mercer, Kate
and Burns, M. Catherine",
title="Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="5",
volume="6",
number="1",
pages="e28895",
keywords="children",
keywords="caregiver",
keywords="digital health",
keywords="home care",
keywords="qualitative research",
keywords="technology",
abstract="Background: Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their child's health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their child's health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. Objective: The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. Methods: This research is part of a broader study to explore caregivers' perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. Results: We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their child's status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their children's educators. Beyond the scope of managing their child's health information, family caregivers also navigated bureaucratic processes for their child's home care. Conclusions: Family caregivers' experiences of caring for CSHCN differ contextually and evolve as their child's condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their child's health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings. ",
doi="10.2196/28895",
url="https://formative.jmir.org/2022/1/e28895",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989692"
}


@Article{info:doi/10.2196/29494,
author="Thirumalai, Mohanraj
and Brown, Nashira
and Niranjan, Soumya
and Townsend, Sh'Nese
and Powell, Anne Mary
and Neal, Whitney
and Schleicher, Erica
and Raparla, Venkatadri
and Oster, Robert
and Demark-Wahnefried, Wendy
and Pekmezi, Dori",
title="An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="4",
volume="9",
number="1",
pages="e29494",
keywords="interactive voice response systems",
keywords="usability",
keywords="exercise",
keywords="physical activity",
keywords="rural health",
keywords="telehealth",
abstract="Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. ",
doi="10.2196/29494",
url="https://humanfactors.jmir.org/2022/1/e29494",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982714"
}


@Article{info:doi/10.2196/32785,
author="Adib, Riddhiman
and Das, Dipranjan
and Ahamed, Iqbal Sheikh
and Lerret, Marie Stacee",
title="An mHealth App-Based Self-management Intervention for Family Members of Pediatric Transplant Recipients (myFAMI): Framework Design and Development Study",
journal="JMIR Nursing",
year="2022",
month="Jan",
day="4",
volume="5",
number="1",
pages="e32785",
keywords="pediatric patients",
keywords="transplant",
keywords="mobile health",
keywords="mHealth",
keywords="family self-management",
keywords="smartphone",
abstract="Background: Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients' families. Objective: This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods: The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results: Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses' and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members' response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions: The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22010 ",
doi="10.2196/32785",
url="https://nursing.jmir.org/2022/1/e32785",
url="http://www.ncbi.nlm.nih.gov/pubmed/34780344"
}


@Article{info:doi/10.2196/23236,
author="Ogundaini, Oluwamayowa
and de la Harpe, Retha",
title="The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="4",
volume="6",
number="1",
pages="e23236",
keywords="agency",
keywords="health care professionals",
keywords="technology performativity",
keywords="sub-Saharan Africa",
keywords="service design",
keywords="work activities",
keywords="mobile phone",
abstract="Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants' data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. ",
doi="10.2196/23236",
url="https://formative.jmir.org/2022/1/e23236",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982713"
}


@Article{info:doi/10.2196/30474,
author="Mariakakis, Alex
and Karkar, Ravi
and Patel, N. Shwetak
and Kientz, A. Julie
and Fogarty, James
and Munson, A. Sean",
title="Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="3",
volume="9",
number="1",
pages="e30474",
keywords="mobile health",
keywords="survey instrument",
keywords="health screening",
keywords="health belief model",
keywords="path analysis",
keywords="user design",
keywords="health technology",
keywords="health intervention technology",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people's decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. ",
doi="10.2196/30474",
url="https://humanfactors.jmir.org/2022/1/e30474",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982038"
}


@Article{info:doi/10.2196/27033,
author="Shorey, Shefaly
and Tan, Chye Thiam
and 
and Mathews, Jancy
and Yu, Yan Chun
and Lim, Hoon Siew
and Shi, Luming
and Ng, Debby Esperanza
and Chan, Huak Yiong
and Law, Evelyn
and Chee, Cornelia
and Chong, Seng Yap",
title="Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="24",
volume="23",
number="12",
pages="e27033",
keywords="depression",
keywords="development",
keywords="education",
keywords="parent",
keywords="perinatal",
keywords="support",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child's development. Given the rise in technology and parents' preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles---the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. ",
doi="10.2196/27033",
url="https://www.jmir.org/2021/12/e27033",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260376"
}


@Article{info:doi/10.2196/31367,
author="Kruzan, Payne Kaylee
and Meyerhoff, Jonah
and Biernesser, Candice
and Goldstein, Tina
and Reddy, Madhu
and Mohr, C. David",
title="Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="24",
volume="8",
number="12",
pages="e31367",
keywords="user-centered design",
keywords="intervention",
keywords="suicide",
keywords="nonsuicidal self-injury",
keywords="lived experience",
keywords="technology-enabled services",
keywords="digital intervention",
keywords="engagement",
keywords="mobile phone",
abstract="Background: The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. Objective: We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). Methods: We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. Results: In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. Conclusions: UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions. ",
doi="10.2196/31367",
url="https://mental.jmir.org/2021/12/e31367",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951602"
}


@Article{info:doi/10.2196/30268,
author="Adams, Zachary
and Grant, Miyah
and Hupp, Samantha
and Scott, Taylor
and Feagans, Amanda
and Phillips, Lois Meredith
and Bixler, Kristina
and Nallam, Teja Phani
and La Putt, Dorothy",
title="Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="24",
volume="5",
number="12",
pages="e30268",
keywords="mobile health",
keywords="user-centered design",
keywords="adolescents",
keywords="substance use disorders",
keywords="mental health",
keywords="mHealth",
keywords="cognitive behavioral therapy",
keywords="homework",
keywords="technology acceptance model",
keywords="trauma",
keywords="mobile phone",
abstract="Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. ",
doi="10.2196/30268",
url="https://formative.jmir.org/2021/12/e30268",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951593"
}


@Article{info:doi/10.2196/24114,
author="O'Campo, Patricia
and Velonis, Alisa
and Buhariwala, Pearl
and Kamalanathan, Janisha
and Hassan, Awaiz Maha
and Metheny, Nicholas",
title="Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="21",
volume="23",
number="12",
pages="e24114",
keywords="intimate partner violence",
keywords="web-based applications",
keywords="women",
keywords="user-centered design",
abstract="Background: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions. ",
doi="10.2196/24114",
url="https://www.jmir.org/2021/12/e24114",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931998"
}


@Article{info:doi/10.2196/27991,
author="Majid, Shazmin
and Reeves, Stuart
and Figueredo, Grazziela
and Brown, Susan
and Lang, Alexandra
and Moore, Matthew
and Morriss, Richard",
title="The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="20",
volume="8",
number="12",
pages="e27991",
keywords="user-centered design",
keywords="participatory design",
keywords="human-computer interaction",
keywords="patient and public involvement",
keywords="self-monitoring technology",
keywords="bipolar disorder",
keywords="mobile phone",
abstract="Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36\%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9\%) self-monitoring app was classified as having low user involvement, 4 (36\%) self-monitoring apps were classified as having medium user involvement, and 2 (18\%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care--based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. ",
doi="10.2196/27991",
url="https://mental.jmir.org/2021/12/e27991",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931992"
}


@Article{info:doi/10.2196/29731,
author="Cooray, Nipuna
and Sun, Louise Si
and Ho, Catherine
and Adams, Susan
and Keay, Lisa
and Nassar, Natasha
and Brown, Julie",
title="Toward a Behavior Theory--Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="20",
volume="4",
number="4",
pages="e29731",
keywords="child injury",
keywords="Behaviour Change Wheel",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Falls account for approximately 50\% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory--informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory-- and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn's mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory--informed mobile intervention for injury prevention refined using the person-based approach. ",
doi="10.2196/29731",
url="https://pediatrics.jmir.org/2021/4/e29731",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932004"
}


@Article{info:doi/10.2196/30603,
author="Alvarez-Perez, Yolanda
and Perestelo-Perez, Lilisbeth
and Rivero-Santana, Amado
and Wagner, M. Ana
and Torres-Casta{\~n}o, Alezandra
and Toledo-Ch{\'a}varri, Ana
and Duarte-D{\'i}az, Andrea
and Alvarado-Martel, D{\'a}cil
and Piccini, Barbara
and Van den Broucke, Stephan
and Vandenbosch, Jessica
and Gonz{\'a}lez-Gonz{\'a}lez, Carina
and Perello, Michelle
and Serrano-Aguilar, Pedro
and ",
title="Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study",
journal="JMIR Diabetes",
year="2021",
month="Dec",
day="13",
volume="6",
number="4",
pages="e30603",
keywords="diabetes",
keywords="digital health literacy",
keywords="health education",
keywords="MOOC",
abstract="Background: Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources---that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective: We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods: The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results: A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001). Conclusions: Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population. ",
doi="10.2196/30603",
url="https://diabetes.jmir.org/2021/4/e30603",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898453"
}


@Article{info:doi/10.2196/34652,
author="Castro, R. Aimee
and Arnaert, Antonia
and Moffatt, Karyn
and Kildea, John
and Bitzas, Vasiliki
and Tsimicalis, Argerie",
title="Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="13",
volume="10",
number="12",
pages="e34652",
keywords="respite care",
keywords="caregivers",
keywords="cancer",
keywords="neoplasms",
keywords="user-centered design",
keywords="mobile applications",
keywords="palliative care",
keywords="home care services",
keywords="information systems research framework",
keywords="hospice and palliative care nursing",
abstract="Background: Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer. Objective: The aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Qu{\'e}bec, Canada. Methods: This user-centered design research comprises the core component of the iRespite Services iR{\'e}pit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. Results: We anticipate that preliminary results will be available by Spring 2022. Conclusions: An app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Qu{\'e}bec, supporting death at home, which is where most patients and their families wish to be. International Registered Report Identifier (IRRID): PRR1-10.2196/34652 ",
doi="10.2196/34652",
url="https://www.researchprotocols.org/2021/12/e34652",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898464"
}


@Article{info:doi/10.2196/19230,
author="Thomas, Sarah
and Pulman, Andy
and Dogan, Huseyin
and Jiang, Nan
and Passmore, David
and Pretty, Keith
and Fairbanks, Beth
and Davies Smith, Angela
and Thomas, W. Peter",
title="Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="9",
volume="5",
number="12",
pages="e19230",
keywords="multiple sclerosis",
keywords="fatigue",
keywords="self-management",
keywords="cognitive behavioral",
keywords="digital health",
keywords="mHealth",
keywords="eHealth",
keywords="development",
keywords="participatory design",
keywords="usability testing",
abstract="Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80\% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective: The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users' unique requirements throughout the design, build, prototyping, and testing stages. Methods: Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results: The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95\% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users' needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions: This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue. ",
doi="10.2196/19230",
url="https://formative.jmir.org/2021/12/e19230",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889744"
}


@Article{info:doi/10.2196/23285,
author="Choi, Yeon Jah
and Kim, Bak Ji
and Lee, Sunki
and Lee, Seo-Joon
and Shin, Eon Seung
and Park, Hyun Se
and Park, Jin Eun
and Kim, Woohyeun
and Na, Oh Jin
and Choi, Ung Cheol
and Rha, Seung-Woon
and Park, Gyu Chang
and Seo, Seog Hong
and Ahn, Jeonghoon
and Jeong, Hyun-Ghang
and Kim, Ju Eung",
title="A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study",
journal="JMIR Med Inform",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e23285",
keywords="cardiac rehabilitation",
keywords="smartphone app",
keywords="coronary heart disease",
abstract="Background: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research. ",
doi="10.2196/23285",
url="https://medinform.jmir.org/2021/12/e23285",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878987"
}


@Article{info:doi/10.2196/28102,
author="G{\"o}ttgens, Irene
and Oertelt-Prigione, Sabine",
title="The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="6",
volume="9",
number="12",
pages="e28102",
keywords="human-centered design",
keywords="design thinking",
keywords="user-centered design",
keywords="design-based research",
keywords="methodology",
keywords="review",
keywords="mobile phone",
abstract="Background: Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations. Objective: This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research. Methods: A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users. Results: This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user's needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners. Conclusions: We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups. ",
doi="10.2196/28102",
url="https://mhealth.jmir.org/2021/12/e28102",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874893"
}


@Article{info:doi/10.2196/29687,
author="Petrenko, McGee Christie Lynn
and Kautz-Turnbull, Christine Carson
and Roth, Rose Alicia
and Parr, Elizabeth Jennifer
and Tapparello, Cristiano
and Demir, Utku
and Olson, Carmichael Heather",
title="Initial Feasibility of the ``Families Moving Forward Connect'' Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="2",
volume="5",
number="12",
pages="e29687",
keywords="fetal alcohol spectrum disorders",
keywords="fetal alcohol syndrome",
keywords="intervention",
keywords="mobile health",
keywords="mHealth",
keywords="parenting",
keywords="children",
keywords="prenatal alcohol",
keywords="digital health",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84\% (38/45) of caregivers and 94\% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67\% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers' stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. ",
doi="10.2196/29687",
url="https://formative.jmir.org/2021/12/e29687",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860661"
}


@Article{info:doi/10.2196/26370,
author="Counson, Isabelle
and Bartholomew, Alexandra
and Crawford, Joanna
and Petrie, Katherine
and Basarkod, Geetanjali
and Moynihan, Victoria
and Pires, Josie
and Cohen, Rachel
and Glozier, Nicholas
and Harvey, Samuel
and Sanatkar, Samineh",
title="Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="2",
volume="5",
number="12",
pages="e26370",
keywords="digital mental health",
keywords="mHealth apps",
keywords="help-seeking",
keywords="junior physicians",
keywords="co-design",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were---needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians' needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. ",
doi="10.2196/26370",
url="https://formative.jmir.org/2021/12/e26370",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860662"
}


@Article{info:doi/10.2196/25071,
author="Petracca, Francesco
and Tempre, Rosaria
and Cucciniello, Maria
and Ciani, Oriana
and Pompeo, Elena
and Sannino, Luigi
and Lovato, Valeria
and Castaman, Giancarlo
and Ghirardini, Alessandra
and Tarricone, Rosanna",
title="An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="1",
volume="5",
number="12",
pages="e25071",
keywords="mobile apps",
keywords="mHealth",
keywords="hemophilia A",
keywords="rare diseases",
keywords="usability",
keywords="user-centered design",
keywords="design science",
keywords="mobile phone",
abstract="Background: There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective: The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods: We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app's improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results: The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app's layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions: The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app's users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration: ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135 ",
doi="10.2196/25071",
url="https://formative.jmir.org/2021/12/e25071",
url="http://www.ncbi.nlm.nih.gov/pubmed/34855619"
}


@Article{info:doi/10.2196/30053,
author="Danieli, Morena
and Ciulli, Tommaso
and Mousavi, Mahed Seyed
and Riccardi, Giuseppe",
title="A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="1",
volume="5",
number="12",
pages="e30053",
keywords="mental health care",
keywords="conversational AI",
keywords="mHealth",
keywords="personal health care agents",
keywords="participatory design",
keywords="psychotherapy",
abstract="Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists' acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants' levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. ",
doi="10.2196/30053",
url="https://formative.jmir.org/2021/12/e30053",
url="http://www.ncbi.nlm.nih.gov/pubmed/34855607"
}


@Article{info:doi/10.2196/26597,
author="Chudyk, M. Anna
and Ragheb, Sandra
and Kent, David
and Duhamel, A. Todd
and Hyra, Carole
and Dave, G. Mudra
and Arora, C. Rakesh
and Schultz, SH Annette",
title="Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study",
journal="JMIR Perioper Med",
year="2021",
month="Nov",
day="30",
volume="4",
number="2",
pages="e26597",
keywords="cardiac surgery",
keywords="perioperative care",
keywords="enhanced recovery protocols",
keywords="mobile app",
keywords="smartphone app",
keywords="mHealth",
keywords="development",
keywords="patient and public involvement",
keywords="patient engagement in research",
abstract="Background: Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective: The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods: Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results: The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions: Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users. ",
doi="10.2196/26597",
url="https://periop.jmir.org/2021/2/e26597",
url="http://www.ncbi.nlm.nih.gov/pubmed/34851299"
}


@Article{info:doi/10.2196/26017,
author="Zhang, Zhan
and Kmoth, Lukas
and Luo, Xiao
and He, Zhe",
title="User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="25",
volume="8",
number="4",
pages="e26017",
keywords="clinical laboratory results",
keywords="patient-centered care",
keywords="patient portal",
keywords="health communication",
abstract="Background: Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results. Objective: The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers. Methods: We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results. Results: The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions. Conclusions: We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic. ",
doi="10.2196/26017",
url="https://humanfactors.jmir.org/2021/4/e26017",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842529"
}


@Article{info:doi/10.2196/27323,
author="Sandb{\ae}k, Amanda
and Christensen, Due Line
and Larsen, Lykke Lotte
and Primholdt Christensen, Nina
and Kofod, Greek Frida
and Guassora, Dorrit Ann
and Merrild, Hoffmann Camilla
and Assing Hvidt, Elisabeth",
title="Guidance for Implementing Video Consultations in Danish General Practice: Rapid Cycle Coproduction Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="24",
volume="5",
number="11",
pages="e27323",
keywords="general practice",
keywords="remote consultation",
keywords="implementation science",
keywords="resource guide",
keywords="communication",
keywords="video consultation",
keywords="coproduction",
keywords="rapid analysis",
keywords="workshop",
keywords="intervention development",
abstract="Background: The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. Objective: The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. Methods: The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. Results: A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients' use of VCs, the performance of VCs, and the arrangements for booking a VC. Conclusions: The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period. ",
doi="10.2196/27323",
url="https://formative.jmir.org/2021/11/e27323",
url="http://www.ncbi.nlm.nih.gov/pubmed/34821560"
}


@Article{info:doi/10.2196/29945,
author="Cartujano-Barrera, Francisco
and Azogini, Chiamaka
and McIntosh, Scott
and Bansal-Travers, Maansi
and Ossip, J. Deborah
and Cupertino, Paula Ana",
title="Developing Graphic Messages for Vaping Prevention Among Black and Latino Adolescents: Participatory Research Approach",
journal="J Particip Med",
year="2021",
month="Nov",
day="23",
volume="13",
number="3",
pages="e29945",
keywords="vaping",
keywords="electronic cigarettes",
keywords="adolescents",
keywords="Latino",
keywords="Black",
abstract="Background: As an important transition stage in human development, adolescence is a critical window for vaping prevention. There is a substantial gap in communication research on vaping prevention among racial and ethnic minority groups. Their representation is essential to develop, implement, and disseminate innovative and effective interventions for vaping prevention. Objective: The aim of this study is to describe the participatory research (PR) procedures used with Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. Methods: This PR study used a qualitative, user-centered design method. We conducted a series of focus groups with 16 Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. The biobehavioral model of nicotine addiction provided a framework for the development of the graphic messages. Participants met 4 times to provide iterative feedback on the graphic messages until they reached a consensus on overall quality and content. Results: At baseline, the participants' mean age was 15.4 years (SD 1.4). Of the participants, 50\% (8/16) were female, 88\% (14/16) were heterosexual, 56\% (9/16) were Black/African American, and 44\% (7/16) were Hispanic/Latino. A total of 12 of the 16 participants (75\%) chose to participate in the English sessions. Participants decided to create four types of graphic messages: (1) financial reward, (2) health reward, (3) social norms, and (4) self-efficacy. Meeting 4 times with the 4 groups provided sufficient opportunities for iterative feedback on the graphic messages to reach a consensus on overall quality and content. Conclusions: It is feasible and practical to build PR among Black and Latino adolescents focused on vaping prevention. Adolescents added innovation and creativity to the development of culturally and linguistically appropriate graphic messages for vaping prevention. Appropriate staffing, funding, and approaches are key for successful PR efforts among Black and Latino adolescents. Future research is needed to evaluate the impact of the graphic messages on vaping prevention. ",
doi="10.2196/29945",
url="https://jopm.jmir.org/2021/3/e29945",
url="http://www.ncbi.nlm.nih.gov/pubmed/34812734"
}


@Article{info:doi/10.2196/25192,
author="Amin, Shiraz
and Gupta, Vedant
and Du, Gaixin
and McMullen, Colleen
and Sirrine, Matthew
and Williams, V. Mark
and Smyth, S. Susan
and Chadha, Romil
and Stearley, Seth
and Li, Jing",
title="Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="16",
volume="23",
number="11",
pages="e25192",
keywords="cardiology",
keywords="medical diagnosis",
keywords="medicine",
keywords="mobile applications",
keywords="prognostics and health",
keywords="syncope",
abstract="Background: Syncope evaluation and management is associated with testing overuse and unnecessary hospitalizations. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Syncope Guideline aims to standardize clinical practice and reduce unnecessary services. The use of clinical decision support (CDS) tools offers the potential to successfully implement evidence-based clinical guidelines. However, CDS tools that provide an evidence-based differential diagnosis (DDx) of syncope at the point of care are currently lacking. Objective: With input from diverse health systems, we developed and demonstrated the viability of a mobile app, the Multilevel Implementation Strategy for Syncope optImal care thrOugh eNgagement (MISSION) Syncope, as a CDS tool for syncope diagnosis and prognosis. Methods: Development of the app had three main goals: (1) reliable generation of an accurate DDx, (2) incorporation of an evidence-based clinical risk tool for prognosis, and (3) user-based design and technical development. To generate a DDx that incorporated assessment recommendations, we reviewed guidelines and the literature to determine clinical assessment questions (variables) and likelihood ratios (LHRs) for each variable in predicting etiology. The creation and validation of the app diagnosis occurred through an iterative clinician review and application to actual clinical cases. The review of available risk score calculators focused on identifying an easily applied and valid evidence-based clinical risk stratification tool. The review and decision-making factors included characteristics of the original study, clinical variables, and validation studies. App design and development relied on user-centered design principles. We used observations of the emergency department workflow, storyboard demonstration, multiple mock review sessions, and beta-testing to optimize functionality and usability. Results: The MISSION Syncope app is consistent with guideline recommendations on evidence-based practice (EBP), and its user interface (UI) reflects steps in a real-world patient evaluation: assessment, DDx, risk stratification, and recommendations. The app provides flexible clinical decision making, while emphasizing a care continuum; it generates recommendations for diagnosis and prognosis based on user input. The DDx in the app is deemed a pragmatic model that more closely aligns with real-world clinical practice and was validated using actual clinical cases. The beta-testing of the app demonstrated well-accepted functionality and usability of this syncope CDS tool. Conclusions: The MISSION Syncope app development integrated the current literature and clinical expertise to provide an evidence-based DDx, a prognosis using a validated scoring system, and recommendations based on clinical guidelines. This app demonstrates the importance of using research literature in the development of a CDS tool and applying clinical experience to fill the gaps in available research. It is essential for a successful app to be deliberate in pursuing a practical clinical model instead of striving for a perfect mathematical model, given available published evidence. This hybrid methodology can be applied to similar CDS tool development. ",
doi="10.2196/25192",
url="https://www.jmir.org/2021/11/e25192",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783669"
}


@Article{info:doi/10.2196/26212,
author="Whale, Katie
and Beasant, Lucy
and Wright, J. Anne
and Yardley, Lucy
and Wallace, M. Louise
and Moody, Louise
and Joinson, Carol",
title="A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="15",
volume="4",
number="4",
pages="e26212",
keywords="incontinence",
keywords="urinary incontinence",
keywords="digital intervention",
keywords="child health",
keywords="pediatric",
keywords="pediatric incontinence",
keywords="smartphone",
keywords="intervention development",
keywords="mobile phone",
abstract="Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. ",
doi="10.2196/26212",
url="https://pediatrics.jmir.org/2021/4/e26212",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779780"
}


@Article{info:doi/10.2196/27896,
author="Noorbergen, J. Tyler
and Adam, P. Marc T.
and Teubner, Timm
and Collins, E. Clare",
title="Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="10",
volume="9",
number="11",
pages="e27896",
keywords="co-design",
keywords="mHealth",
keywords="guidelines",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research. ",
doi="10.2196/27896",
url="https://mhealth.jmir.org/2021/11/e27896",
url="http://www.ncbi.nlm.nih.gov/pubmed/34757323"
}


@Article{info:doi/10.2196/29815,
author="Lazard, J. Allison
and Babwah Brennen, Scott J.
and Belina, P. Stephanie",
title="App Designs and Interactive Features to Increase mHealth Adoption: User Expectation Survey and Experiment",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="4",
volume="9",
number="11",
pages="e29815",
keywords="smartphone",
keywords="interactive design",
keywords="mobile apps",
keywords="preventive health",
keywords="mental models",
keywords="prototypicality",
keywords="attention",
keywords="affordances",
abstract="Background: Despite the ubiquity of smartphones, there is little guidance for how to design mobile health apps to increase use. Specifically, knowing what features users expect, grab their attention, encourage use (via predicted use or through positive app evaluations), and signal beneficial action possibilities can guide and focus app development efforts. Objective: We investigated what features users expect and how the design (prototypicality) impacts app adoption. Methods: In a web-based survey, we elicited expectations, including presence and placement, for 12 app features. Thereafter, participants (n=462) viewed 2 health apps (high prototypicality similar to top downloaded apps vs low prototypicality similar to research interventions) and reported willingness to download, attention, and predicted use of app features. Participants rated both apps (high and low) for aesthetics, ease of use, usefulness, perceived affordances, and intentions to use. Results: Most participants (425/462, 92\%) expected features for navigation or personal settings (eg, menu) in specific regions (eg, top corners). Features with summary graphs or statics were also expected by many (395-396 of 462, 86\%), with a center placement expectation. A feature to ``share with friends'' was least expected among participants (203/462, 44\%). Features fell into 4 unique categories based on attention and predicted use, including essential features with high (>50\% or >231 of 462) predicted use and attention (eg, calorie trackers), flashy features with high attention but lower predicted use (eg, links to specific diets), functional features with modest attention and low use (eg, settings), and mundane features with low attention and use (eg, discover tabs). When given a choice, 347 of 462 (75\%) participants would download the high-prototypicality app. High prototypicality apps (vs low) led to greater aesthetics, ease of use, usefulness, and intentions, (for all, P<.001). Participants thought that high prototypicality apps had more perceived affordances. Conclusions: Intervention designs that fail to meet a threshold of mHealth expectations will be dismissed as less usable or beneficial. Individuals who download health apps have shared expectations for features that should be there, as well as where these features should appear. Meeting these expectations can improve app evaluations and encourage use. Our typology should guide presence and placement of expected app features to signal value and increase use to impact preventive health behaviors. Features that will likely be used and are attention-worthy---essential, flashy, and functional---should be prioritized during app development. ",
doi="10.2196/29815",
url="https://mhealth.jmir.org/2021/11/e29815",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734829"
}


@Article{info:doi/10.2196/31649,
author="Reichold, Michael
and He{\ss}, Miriam
and Kolominsky-Rabas, Peter
and Gr{\"a}{\ss}el, Elmar
and Prokosch, Hans-Ulrich",
title="Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="3",
volume="5",
number="11",
pages="e31649",
keywords="dementia",
keywords="usability",
keywords="evaluation",
keywords="mobile device",
keywords="registry",
keywords="electronic data collection",
keywords="offline",
keywords="mobile app",
keywords="digital health",
keywords="usability testing",
abstract="Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project ``Digital Dementia Registry Bavaria (digiDEM Bayern),'' interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the ``Thinking Aloud'' method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the ``Thinking Aloud'' method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents ``good'' usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry--based research project. ",
doi="10.2196/31649",
url="https://formative.jmir.org/2021/11/e31649",
url="http://www.ncbi.nlm.nih.gov/pubmed/34730543"
}


@Article{info:doi/10.2196/20739,
author="Chin, Yun Winnie Szu
and Kurowski, Alicia
and Gore, Rebecca
and Chen, Guanling
and Punnett, Laura
and ",
title="Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="28",
volume="5",
number="10",
pages="e20739",
keywords="mobile apps",
keywords="usability testing",
keywords="user experience design",
keywords="mobile phone",
keywords="mhealth",
keywords="iterative testing",
keywords="participatory research",
keywords="user demographics",
keywords="worker participation",
abstract="Background: Process evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers', developers', and users' mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics. Objective: This study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users. Methods: An app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app's 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics. Results: In stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility andefficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics. Conclusions: Occupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data. ",
doi="10.2196/20739",
url="https://formative.jmir.org/2021/10/e20739",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709186"
}


@Article{info:doi/10.2196/28618,
author="Reese, J. Thomas
and Del Fiol, Guilherme
and Morgan, Keaton
and Hurwitz, T. Jason
and Kawamoto, Kensaku
and Gomez-Lumbreras, Ainhoa
and Brown, L. Mary
and Thiess, Henrik
and Vazquez, R. Sara
and Nelson, D. Scott
and Boyce, Richard
and Malone, Daniel",
title="A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="Oct",
day="26",
volume="8",
number="4",
pages="e28618",
keywords="shared decision-making",
keywords="user-centered design",
keywords="drug interaction",
keywords="clinical decision support",
abstract="Background: Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. Objective: This study aims to design and study the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs. Methods: We used an SDM framework and user-centered design methods to guide the design and usability of DDInteract---an SDM electronic health record app to prevent harm from clinically significant DDIs. The design involved iterative prototypes, qualitative feedback from stakeholders, and a heuristic evaluation. The usability evaluation included patients and clinicians. Patients participated in a simulated SDM discussion using clinical vignettes. Clinicians were asked to complete eight tasks using DDInteract and to assess the tool using a survey adapted from the System Usability Scale. Results: The designed DDInteract prototype includes the following features: a patient-specific risk profile, dynamic risk icon array, patient education section, and treatment decision tree. A total of 4 patients and 11 clinicians participated in the usability study. After an SDM session where patients and clinicians review the tool concurrently, patients generally favored pain treatments with less risk of gastrointestinal bleeding. Clinicians successfully completed the tasks with a mean of 144 (SD 74) seconds and rated the usability of DDInteract as 4.32 (SD 0.52) of 5. Conclusions: This study expands the use of SDM to DDIs. The next steps are to determine if DDInteract can improve shared decision-making quality and to implement it across health systems using interoperable technology. ",
doi="10.2196/28618",
url="https://humanfactors.jmir.org/2021/4/e28618",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698649"
}


@Article{info:doi/10.2196/25512,
author="Barr, J. Paul
and Haslett, William
and Dannenberg, D. Michelle
and Oh, Lisa
and Elwyn, Glyn
and Hassanpour, Saeed
and Bonasia, L. Kyra
and Finora, C. James
and Schoonmaker, A. Jesse
and Onsando, Moraa W.
and Ryan, James
and Bruce, L. Martha
and Das, K. Amar
and Arend, Roger
and Piper, Sheryl
and Ganoe, H. Craig",
title="An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="22",
volume="23",
number="10",
pages="e25512",
keywords="patient-centered care",
keywords="health communication",
keywords="audiovisual aids",
keywords="user-centered design",
keywords="software",
keywords="natural language processing",
keywords="patients",
keywords="caregivers",
abstract="Background: Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective: This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods: Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients' primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results: We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63\%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one's own recordings and others' recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions: To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans. ",
doi="10.2196/25512",
url="https://www.jmir.org/2021/10/e25512",
url="http://www.ncbi.nlm.nih.gov/pubmed/34677131"
}


@Article{info:doi/10.2196/32921,
author="Xiao, Jin
and Luo, Jiebo
and Ly-Mapes, Oriana
and Wu, Tong Tong
and Dye, Timothy
and Al Jallad, Nisreen
and Hao, Peirong
and Ruan, Jinlong
and Bullock, Sherita
and Fiscella, Kevin",
title="Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="22",
volume="10",
number="10",
pages="e32921",
keywords="artificial intelligence",
keywords="smartphone app",
keywords="mDentistry",
keywords="dental caries",
keywords="underserved population",
keywords="mobile dentistry",
abstract="Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55\% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85\% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence--powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence--powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 ",
doi="10.2196/32921",
url="https://www.researchprotocols.org/2021/10/e32921",
url="http://www.ncbi.nlm.nih.gov/pubmed/34529582"
}


@Article{info:doi/10.2196/23204,
author="Mauka, Wilhellmuss
and Mbotwa, Christopher
and Moen, K{\aa}re
and Lichtwarck, Ochieng Hanne
and Haaland, Inga
and Kazaura, Method
and Leyna, H. Germana
and Leshabari, T. Melkizedeck
and Mmbaga, J. Elia",
title="Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="7",
volume="5",
number="10",
pages="e23204",
keywords="mHealth application",
keywords="participatory design",
keywords="HIV",
keywords="pre-exposure prophylaxis",
keywords="Africa",
keywords="female sex workers",
keywords="sex and gender minorities",
abstract="Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app's design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 ",
doi="10.2196/23204",
url="https://formative.jmir.org/2021/10/e23204",
url="http://www.ncbi.nlm.nih.gov/pubmed/34617904"
}


@Article{info:doi/10.2196/26125,
author="Tobias, Guy
and Sgan-Cohen, Harold
and Spanier, B. Assaf
and Mann, Jonathan",
title="Perceptions and Attitudes Toward the Use of a Mobile Health App for Remote Monitoring of Gingivitis and Willingness to Pay for Mobile Health Apps (Part 3): Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="5",
volume="5",
number="10",
pages="e26125",
keywords="mHealth",
keywords="public health",
keywords="oral health promotion",
keywords="gum health",
keywords="willingness to pay",
keywords="willingness to use",
keywords="willingness",
keywords="perception",
keywords="attitude",
keywords="mouth",
keywords="oral health",
keywords="dentist",
keywords="app",
keywords="monitoring",
keywords="mixed method",
abstract="Background: Gum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting. Objective: The aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app. Methods: The first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires. Results: There was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t119=?2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04). Conclusions: Potential mHealth users will be willing to pay for app use depending on their perception of the app's ability to help them personally, provided they define themselves as currently unhealthy. ",
doi="10.2196/26125",
url="https://formative.jmir.org/2021/10/e26125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609320"
}


@Article{info:doi/10.2196/27358,
author="Egan, J. Kieren
and Hodgson, William
and Dunlop, D. Mark
and Imperatore, Gennaro
and Kirk, Alison
and Maguire, Roma",
title="A Novel Mobile App (``CareFit'') to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="1",
volume="5",
number="10",
pages="e27358",
keywords="physical activity",
keywords="Android",
keywords="COVID-19",
keywords="intervention",
keywords="co-design",
keywords="exercise",
keywords="app",
keywords="development",
keywords="support",
keywords="caregiver",
abstract="Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, ``CareFit,'' by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. ",
doi="10.2196/27358",
url="https://formative.jmir.org/2021/10/e27358",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406969"
}


@Article{info:doi/10.2196/31185,
author="Snow-Hill, L. Nyssa
and Donenberg, Geri
and Feil, G. Edward
and Smith, R. David
and Floyd, R. Brenikki
and Leve, Craig",
title="A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="30",
volume="5",
number="9",
pages="e31185",
keywords="health education",
keywords="sexual behavior",
keywords="juvenile delinquency",
keywords="feasibility studies",
keywords="evidence-based practice",
keywords="adolescent health services",
keywords="inservice training",
keywords="implementation science",
keywords="organizational innovation",
keywords="technology",
keywords="risk reduction behavior",
keywords="mobile phone",
keywords="health technology",
keywords="health promotion",
keywords="sexual health",
abstract="Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth---PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. ",
doi="10.2196/31185",
url="https://formative.jmir.org/2021/9/e31185",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591028"
}


@Article{info:doi/10.2196/19794,
author="Toonders, Johanna Suze Adriana
and van Westrienen, Elisabeth Paula
and Konings, Sophie
and Nieboer, E. Marianne
and Veenhof, Cindy
and Pisters, F. Martijn",
title="Patients' Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e19794",
keywords="usability",
keywords="medically unexplained physical symptoms",
keywords="blended care",
abstract="Background: Medically unexplained physical symptoms are physical symptoms, such as pain, fatigue, and dizziness, that persist for more than a few weeks and cannot be explained after adequate medical examination. Treatment for preventing the chronicity of symptoms is recommended. A promising approach is identifying patients who are at risk and subsequently offering a blended care intervention that focuses on promoting self-management while using eHealth as a supportive tool. When these interventions match with a patient's expectations, their effectiveness grows. Objective: This study aimed to obtain more insights into usability from the patient perspective to improve future interventions. Methods: A mixed methods design (ie, the use of qualitative and quantitative data) was used. Through semistructured interviews, in-depth insights were gained into patients' perspectives on usability. The analysis process was continuous and iterative. Data were synthesized and categorized into different themes. The System Usability Scale, which measures the usability of a system, was used to compare participants that found usability to be low, medium, or high. This study was approved by the Medical Ethical Committee Utrecht (approval number: 17-391/C). Results: Saturation was reached after interviewing 13 participants. The following four themes emerged from the interviews: motivations and expectations prior to participating in the program, the applicability of e-coaching, the role of health care professionals, and the integrated design of the blended approach. Conclusions: The successful implementation of integrated blended care interventions based on patients' perspectives requires matching treatments to patients' individual situations and motivations. Furthermore, personalizing the relative frequency of face-to-face appointments and e-coaching can improve usability. ",
doi="10.2196/19794",
url="https://www.jmir.org/2021/9/e19794",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581674"
}


@Article{info:doi/10.2196/28698,
author="Myhre, Leren Enid
and Garnweidner-Holme, Lisa
and Dahl, Bente
and Reigstad, Myhre Marte
and Lukasse, Mirjam",
title="Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="27",
volume="5",
number="9",
pages="e28698",
keywords="early labor",
keywords="latent phase",
keywords="think aloud",
keywords="usability",
keywords="website",
keywords="labor",
keywords="pregnancy",
keywords="user-friendliness",
keywords="eHealth",
keywords="user satisfaction",
abstract="Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users' experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website's user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants' feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants' experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website's design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. ",
doi="10.2196/28698",
url="https://formative.jmir.org/2021/9/e28698",
url="http://www.ncbi.nlm.nih.gov/pubmed/34569940"
}


@Article{info:doi/10.2196/27447,
author="Kim, Sunyoung
and Park, Yunoh
and Ackerman, K. Matthew",
title="Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="22",
volume="5",
number="9",
pages="e27447",
keywords="asthma",
keywords="children",
keywords="indoor air quality",
keywords="mobile app",
keywords="smartphone",
keywords="user-centered design",
abstract="Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. ",
doi="10.2196/27447",
url="https://formative.jmir.org/2021/9/e27447",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550080"
}


@Article{info:doi/10.2196/25294,
author="Mauriello, Louis Matthew
and Tantivasadakarn, Nantanick
and Mora-Mendoza, Antonio Marco
and Lincoln, Thierry Emmanuel
and Hon, Grace
and Nowruzi, Parsa
and Simon, Dorien
and Hansen, Luke
and Goenawan, H. Nathaniel
and Kim, Joshua
and Gowda, Nikhil
and Jurafsky, Dan
and Paredes, Enrique Pablo",
title="A Suite of Mobile Conversational Agents for Daily Stress Management (Popbots): Mixed Methods Exploratory Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="14",
volume="5",
number="9",
pages="e25294",
keywords="conversational agents",
keywords="virtual agent",
keywords="chatbot",
keywords="therapy",
keywords="stress relief",
keywords="stress management",
keywords="mental health",
keywords="stress",
keywords="exploratory",
keywords="support",
keywords="mobile phone",
abstract="Background: Approximately 60\%-80\% of the primary care visits have a psychological stress component, but only 3\% of patients receive stress management advice during these visits. Given recent advances in natural language processing, there is renewed interest in mental health chatbots. Conversational agents that can understand a user's problems and deliver advice that mitigates the effects of daily stress could be an effective public health tool. However, such systems are complex to build and costly to develop. Objective: To address these challenges, our aim is to develop and evaluate a fully automated mobile suite of shallow chatbots---we call them Popbots---that may serve as a new species of chatbots and further complement human assistance in an ecosystem of stress management support. Methods: After conducting an exploratory Wizard of Oz study (N=14) to evaluate the feasibility of a suite of multiple chatbots, we conducted a web-based study (N=47) to evaluate the implementation of our prototype. Each participant was randomly assigned to a different chatbot designed on the basis of a proven cognitive or behavioral intervention method. To measure the effectiveness of the chatbots, the participants' stress levels were determined using self-reported psychometric evaluations (eg, web-based daily surveys and Patient Health Questionnaire-4). The participants in these studies were recruited through email and enrolled on the web, and some of them participated in follow-up interviews that were conducted in person or on the web (as necessary). Results: Of the 47 participants, 31 (66\%) completed the main study. The findings suggest that the users viewed the conversations with our chatbots as helpful or at least neutral and came away with increasingly positive sentiment toward the use of chatbots for proactive stress management. Moreover, those users who used the system more often (ie, they had more than or equal to the median number of conversations) noted a decrease in depression symptoms compared with those who used the system less often based on a Wilcoxon signed-rank test (W=91.50; Z=?2.54; P=.01; r=0.47). The follow-up interviews with a subset of the participants indicated that half of the common daily stressors could be discussed with chatbots, potentially reducing the burden on human coping resources. Conclusions: Our work suggests that suites of shallow chatbots may offer benefits for both users and designers. As a result, this study's contributions include the design and evaluation of a novel suite of shallow chatbots for daily stress management, a summary of benefits and challenges associated with random delivery of multiple conversational interventions, and design guidelines and directions for future research into similar systems, including authoring chatbot systems and artificial intelligence--enabled recommendation algorithms. ",
doi="10.2196/25294",
url="https://formative.jmir.org/2021/9/e25294",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519655"
}


@Article{info:doi/10.2196/26434,
author="Salim, Hani
and Lee, Yein Ping
and Sharif-Ghazali, Sazlina
and Cheong, Theng Ai
and Wong, Jasmine
and Young, Ingrid
and Pinnock, Hilary
and ",
title="Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="9",
volume="23",
number="9",
pages="e26434",
keywords="asthma",
keywords="self-management",
keywords="design sprint",
keywords="health literacy",
keywords="mobile phone",
abstract="Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing. ",
doi="10.2196/26434",
url="https://www.jmir.org/2021/9/e26434",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499039"
}


@Article{info:doi/10.2196/28356,
author="Karpathakis, Kassandra
and Libow, Gene
and Potts, W. Henry W.
and Dixon, Simon
and Greaves, Felix
and Murray, Elizabeth",
title="An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="8",
volume="23",
number="9",
pages="e28356",
keywords="digital health",
keywords="internet-based interventions",
keywords="mHealth",
keywords="evaluation studies",
keywords="public health",
keywords="human-centered design",
keywords="service design",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE's Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. ",
doi="10.2196/28356",
url="https://www.jmir.org/2021/9/e28356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34494965"
}


@Article{info:doi/10.2196/25168,
author="Hatzioannou, Anna
and Chatzittofis, Andreas
and Koutroubas, Sunday Virginia
and Papastavrou, Evridiki
and Karanikola, Maria",
title="Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="8",
volume="10",
number="9",
pages="e25168",
keywords="education",
keywords="empowerment",
keywords="bipolar disorders",
keywords="self-management",
keywords="bipolar",
keywords="mental health",
abstract="Background: Addressing the enhancement of ill health self-management skills in adults diagnosed with  bipolar disorder may be considered an important intervention for health care systems worldwide. Objective: This protocol describes the study ``Management of my Bipolarity'' (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with  bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants' knowledge of  their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. Methods: The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). Results: A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70\% of the visitors. Conclusions: Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. Trial Registration: ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210 International Registered Report Identifier (IRRID): DERR1-10.2196/25168 ",
doi="10.2196/25168",
url="https://www.researchprotocols.org/2021/9/e25168",
url="http://www.ncbi.nlm.nih.gov/pubmed/34494969"
}


@Article{info:doi/10.2196/21471,
author="Ntalindwa, Theoneste
and Nduwingoma, Mathias
and Karangwa, Evariste
and Rashid Soron, Tanjir
and Uworwabayeho, Alphonse
and Uwineza, Annette",
title="Development of a Mobile App to Improve Numeracy Skills of Children With Autism Spectrum Disorder: Participatory Design and Usability Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="31",
volume="4",
number="3",
pages="e21471",
keywords="autism spectrum disorder",
keywords="mobile app",
keywords="learning",
keywords="information and communication technologies",
keywords="education",
keywords="numeracy",
keywords="mathematics",
abstract="Background: The use of information and communication technologies is transforming the lives of millions of people including children with autism spectrum disorder (ASD). However, the process of developing a user-friendly and effective mobile app needs to follow a complex standard protocol and culture-sensitive customization, and involves multiple sectors. This complex work becomes even more challenging when considering children with ASD in low- and middle-income countries as the users. Objective: This study aimed to design and develop a more intuitive mobile app to improve numeracy skills of children with ASD in Rwanda and evaluate the usability of the app. Methods: A participatory design approach was utilized in this study in which 40 children with ASD, 5 teachers, and 10 parents of children with ASD participated in focus group discussions (FGDs) and usability testing. A narrative literature review was performed to explore existing mobile apps and compare previous studies to design the questions for FGD and facilitate a framework for designing the app. The agile methodology was used to develop the mobile app, and the heuristics evaluation method was used to test and evaluate the usability of the initial version of the app to improve its functionalities. The interviews were recorded, transcribed, and analyzed following the guidelines of the qualitative narrative analysis (QNA) method. Results: During the FGDs the respondents shared their need for a mobile app in teaching and learning numeracy for children with ASD and pointed to possibilities of integrating the mobile app into existing curriculum. Ten themes emerged from the FGDs and exercise of developing the mobile app. The themes were related to (1) teaching and learning numeracy for children with ASD, (2) planning and development of a mobile app for a person with ASD, (3) testing a mobile app, (4) strength of the developed app against the existing ones, (5) behavioral maintenance and relapse prevention, (6) possibilities to integrate the mobile app into the existing curriculum, (7) data protection for users, (8) social implications, (9) challenges in Rwanda, and (10) focus on future. Conclusions: The community plays an important role in the planning, development, and evaluation of a mobile app for children with ASD. In this study, inputs from teachers and parents resulted in an optimally designed mobile app that can improve numeracy skills in children diagnosed with ASD to support the implementation of competency-based curriculum in Rwanda. ",
doi="10.2196/21471",
url="https://pediatrics.jmir.org/2021/3/e21471",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463629"
}


@Article{info:doi/10.2196/26861,
author="Saberi, Parya
and Lisha, E. Nadra
and Erguera, A. Xavier
and Hudes, Sid Estie
and Johnson, O. Mallory
and Ruel, Theodore
and Neilands, B. Torsten",
title="A Mobile Health App (WYZ) for Engagement in Care and Antiretroviral Therapy Adherence Among Youth and Young Adults Living With HIV: Single-Arm Pilot Intervention Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="31",
volume="5",
number="8",
pages="e26861",
keywords="youth living with HIV",
keywords="mobile health",
keywords="mobile app",
keywords="engagement in care",
keywords="antiretroviral therapy adherence",
keywords="pilot",
abstract="Background: Youth are globally recognized as being vulnerable to HIV. Younger age has been correlated with worse health outcomes. Mobile health (mHealth) interventions have the potential to interact with youth where they are, using a device they already access. Objective: Using predefined benchmarks, we sought to evaluate the feasibility and acceptability of WYZ, an mHealth app, for improved engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV. WYZ was designed and developed with input from youth and young adults living with HIV using a human-centered design approach and was based on the information, motivation, and behavioral skills framework to address common barriers to care and ART adherence among youth and young adults living with HIV. Methods: We recruited youth and young adults living with HIV (18-29 years old) from the San Francisco Bay Area to take part in a 6-month pilot trial. Their participation included completing baseline and exit surveys, and participating in seven phone check-ins about their use of WYZ. Results: Youth and young adults living with HIV (N=79) reported high levels of feasibility and acceptability with WYZ use. We met predefined benchmarks for recruitment (79/84, 94\%), mean logins per week (5.3), tracking ART adherence (5442/9393, 57.9\%), posting chat topics per week (4.8), and app crashes reported per week (0.24). The ease of app download, install, and setup, and comfort with security, privacy, and anonymity were highly rated (all over 91\%). Additionally, participants reported high satisfaction for a research project that was remotely conducted. Participants used the app for shorter timeframes compared to the predefined benchmark. Conclusions: We noted high feasibility and acceptability with WYZ. Further research to examine the efficacy of WYZ will enable youth and young adults living with HIV and their providers to make informed decisions when using, recommending, and prescribing the app for improved engagement in HIV care and ART adherence. Trial Registration: ClinicalTrials.gov NCT03587857; https://clinicaltrials.gov/ct2/show/NCT03587857 ",
doi="10.2196/26861",
url="https://formative.jmir.org/2021/8/e26861",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463622"
}


@Article{info:doi/10.2196/28075,
author="Swanston, Emma
and Pulman, Andy
and Dogan, Huseyin
and Murphy, Jane
and Bitters, Fiona",
title="Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="31",
volume="5",
number="8",
pages="e28075",
keywords="nutrition",
keywords="food",
keywords="behavior change",
keywords="mobile health",
keywords="police",
keywords="lifestyle management",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift---an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users. ",
doi="10.2196/28075",
url="https://formative.jmir.org/2021/8/e28075",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463625"
}


@Article{info:doi/10.2196/27195,
author="McClincy, Michael
and Seabol, G. Liliana
and Riffitts, Michelle
and Ruh, Ethan
and Novak, E. Natalie
and Wasilko, Rachel
and Hamm, E. Megan
and Bell, M. Kevin",
title="Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="27",
volume="9",
number="3",
pages="e27195",
keywords="IHT",
keywords="pediatric",
keywords="sports medicine",
keywords="ACL",
keywords="orthopaedics",
keywords="rehabilitation",
keywords="health technology",
keywords="gamification",
abstract="Background: Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements.  Objective: This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods: In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post--ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70\% (7/10) were female. Most participants (7/10, 70\%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75\%-100\% in 40\% (4/10), 50\%-75\% in 40\% (4/10), and 25\%-50\% of prescribed exercises in 20\% (2/10) of the participants. Results: The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions: The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting. ",
doi="10.2196/27195",
url="https://games.jmir.org/2021/3/e27195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448715"
}


@Article{info:doi/10.2196/21186,
author="Wong, Cheong Kam
and Thiagalingam, Aravinda
and Kumar, Saurabh
and Marschner, Simone
and Kunwar, Ritu
and Bailey, Jannine
and Kok, Cindy
and Usherwood, Tim
and Chow, K. Clara",
title="User Perceptions and Experiences of a Handheld 12-Lead Electrocardiographic Device in a Clinical Setting: Usability Evaluation",
journal="JMIR Cardio",
year="2021",
month="Aug",
day="26",
volume="5",
number="2",
pages="e21186",
keywords="handheld",
keywords="electrocardiogram",
keywords="ECG",
keywords="acceptability",
keywords="usability",
keywords="user perception",
keywords="user experience",
keywords="atrial fibrillation",
keywords="long QT",
keywords="screening",
abstract="Background: Cardiac arrhythmias are a leading cause of death. The mainstay method for diagnosing arrhythmias (eg, atrial fibrillation) and cardiac conduction disorders (eg, prolonged corrected QT interval [QTc]) is by using 12-lead electrocardiography (ECG). Handheld 12-lead ECG devices are emerging in the market. In tandem with emerging technology options, evaluations of device usability should go beyond validation of the device in a controlled laboratory setting and assess user perceptions and experiences, which are crucial for successful implementation in clinical practice. Objective: This study aimed to evaluate clinician and patient perceptions and experiences, regarding the usability of a handheld 12-lead ECG device compared to a conventional 12-lead ECG machine, and generalizability of this user-centered approach. Methods: International Organization for Standardization Guidelines on Usability and the Technology Acceptance Model were integrated to form the framework for this study, which was conducted in outpatient clinics and cardiology wards at Westmead Hospital, New South Wales, Australia. Each patient underwent 2 ECGs (1 by each device) in 2 postures (supine and standing) acquired in random sequence. The times taken by clinicians to acquire the first ECG (efficiency) using the devices were analyzed using linear regression. Electrocardiographic parameters (QT interval, QTc interval, heart rate, PR interval, QRS interval) and participant satisfaction surveys were collected. Device reliability was assessed by evaluating the mean difference of QTc measurements within {\textpm}15 ms, intraclass correlation coefficient, and level of agreement of the devices in detecting atrial fibrillation and prolonged QTc. Clinicians' perceptions and feedback were assessed with semistructured interviews based on the Technology Acceptance Model. Results: A total of 100 patients (age: mean 57.9 years, SD 15.2; sex: male: n=64, female n=36) and 11 clinicians (experience acquiring ECGs daily or weekly 10/11, 91\%) participated, and 783 ECGs were acquired. Mean differences in QTc measurements of both handheld and conventional devices were within {\textpm}15 ms with high intraclass correlation coefficients (range 0.90-0.96), and the devices had a good level of agreement in diagnosing atrial fibrillation and prolonged QTc ($\kappa$=0.68-0.93). Regardless of device, QTc measurements when patients were standing were longer duration than QTc measurements when patients were supine. Clinicians' ECG acquisition times improved with usage (P<.001). Clinicians reported that device characteristics (small size, light weight, portability, and wireless ECG transmission) were highly desired features. Most clinicians agreed that the handheld device could be used for clinician-led mass screening with enhancement in efficiency by increasing user training. Regardless of device, patients reported that they felt comfortable when they were connected to the ECG devices. Conclusions: Reliability and usability of the handheld 12-lead ECG device were comparable to those of a conventional ECG machine. The user-centered evaluation approach helped us identify remediable action to improve the efficiency in using the device and identified highly desirable device features that could potentially help mass screening and remote assessment of patients. The approach could be applied to evaluate and better understand the acceptability and usability of new medical devices. ",
doi="10.2196/21186",
url="https://cardio.jmir.org/2021/2/e21186",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435958"
}


@Article{info:doi/10.2196/26930,
author="Ledermann, Katharina
and Abou Khaled, Omar
and Caon, Maurizio
and Berger, Thomas
and Chabwine, N. Joelle
and Wicht, Joachim
and Martin-Soelch, Chantal",
title="An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="26",
volume="10",
number="8",
pages="e26930",
keywords="chronic pain",
keywords="older adults",
keywords="mHealth",
keywords="online intervention",
keywords="self-management",
abstract="Background: Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population. Objective: To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults. Methods: The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app. Results: Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022. Conclusions: Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/26930 ",
doi="10.2196/26930",
url="https://www.researchprotocols.org/2021/8/e26930",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435969"
}


@Article{info:doi/10.2196/28650,
author="Maheu-Cadotte, Marc-Andr{\'e}
and Dub{\'e}, V{\'e}ronique
and Cossette, Sylvie
and Lapierre, Alexandra
and Fontaine, Guillaume
and Desch{\^e}nes, Marie-France
and Lavoie, Patrick",
title="Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="19",
volume="9",
number="3",
pages="e28650",
keywords="game-based learning",
keywords="health professions education",
keywords="participatory design",
keywords="systematic review",
keywords="user-centered design",
keywords="serious games",
keywords="game development",
keywords="end users",
keywords="education",
abstract="Background: On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users' involvement in SG development. Objective: The aim of this study is to describe how end users are involved in the development of SGs for health care professions education. Methods: We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages. Results: End users' involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7). Conclusions: Researchers mentioned end users' involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement. ",
doi="10.2196/28650",
url="https://games.jmir.org/2021/3/e28650",
url="http://www.ncbi.nlm.nih.gov/pubmed/34129514"
}


@Article{info:doi/10.2196/28878,
author="Katiri, Roulla
and Hall, A. Deborah
and Hoare, J. Derek
and Fackrell, Kathryn
and Horobin, Adele
and Buggy, N{\'o}ra
and Hogan, Nicholas
and Kitterick, T. P{\'a}draig
and ",
title="Redesigning a Web-Based Stakeholder Consensus Meeting About Core Outcomes for Clinical Trials: Formative Feedback Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="19",
volume="5",
number="8",
pages="e28878",
keywords="COVID-19",
keywords="nominal group technique",
keywords="formative research",
keywords="patient participation",
keywords="persons with hearing impairments",
keywords="mobile phone",
abstract="Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98\% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. ",
doi="10.2196/28878",
url="https://formative.jmir.org/2021/8/e28878",
url="http://www.ncbi.nlm.nih.gov/pubmed/34420915"
}


@Article{info:doi/10.2196/22608,
author="Oakley-Girvan, Ingrid
and Davis, Watkins Sharon
and Kurian, Allison
and Rosas, G. Lisa
and Daniels, Jena
and Palesh, Gronskaya Oxana
and Mesia, J. Rachel
and Kamal, H. Arif
and Longmire, Michelle
and Divi, Vasu",
title="Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="13",
volume="5",
number="8",
pages="e22608",
keywords="cancer",
keywords="oncology",
keywords="mHealth",
keywords="caregiver",
keywords="cancer survivor",
keywords="mobile app",
keywords="smartphone",
keywords="feasibility",
keywords="caregiver burden",
keywords="symptom reporting",
abstract="Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 ",
doi="10.2196/22608",
url="https://formative.jmir.org/2021/8/e22608",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398787"
}


@Article{info:doi/10.2196/27047,
author="Tiersen, Federico
and Batey, Philippa
and Harrison, C. Matthew J.
and Naar, Lenny
and Serban, Alina-Irina
and Daniels, C. Sarah J.
and Calvo, A. Rafael",
title="Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach",
journal="JMIR Aging",
year="2021",
month="Aug",
day="11",
volume="4",
number="3",
pages="e27047",
keywords="assistive technology",
keywords="independent living",
keywords="internet of things",
keywords="remote monitoring",
keywords="dementia",
keywords="human centered design",
keywords="user-centered design",
keywords="patient-centered care",
keywords="smart home",
keywords="digital health",
abstract="Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users' safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient--caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. ",
doi="10.2196/27047",
url="https://aging.jmir.org/2021/3/e27047",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383672"
}


@Article{info:doi/10.2196/22784,
author="Siedlikowski, Maia
and Curiale, Lianna
and Rauch, Frank
and Tsimicalis, Argerie",
title="Experiences of Children With Osteogenesis Imperfecta in the Co-design of the Interactive Assessment and Communication Tool Sisom OI: Secondary Analysis of Qualitative Design Sessions",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="10",
volume="4",
number="3",
pages="e22784",
keywords="child health",
keywords="symptom assessment",
keywords="communication",
keywords="mobile applications",
keywords="software",
abstract="Background: Children with osteogenesis imperfecta (OI) experience a diversity of symptoms that expose them to difficult physical, mental, and social challenges. Sisom (DHealth) is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic conditions express their symptoms. Recently, the co-design of the Sisom OI paper prototype was launched by seeking the perspectives of end users, including children with OI and their clinicians. Objective: The aim of this study is to describe the experiences that children with OI were prompted to share with researchers during the co-design of the Sisom OI paper prototype. Methods: A secondary analysis of qualitative data was conducted at a university-affiliated, pediatric, orthopedic hospital. The data sources consisted of interview transcripts, drawings, field notes, and observations derived from interviewing 12 children with OI who participated in the co-design of the Sisom OI paper prototype. The themes and subthemes identified from the data sources were generated using qualitative description. Results: Three themes were identified. The first, Relating to Others, described the balance between feeling different versus feeling similar to other children. The subthemes were Common OI Experience, Feeling Different, and Feeling Just Like Others. The second, Relating to Their Condition, described children's positive and negative interactions with their own condition and health care. The subthemes were Understanding Their Condition, Special Relationship with the Hospital, and Difficult Treatments and Procedures. The third, Reflecting on Capabilities, described children's recognition of their strengths and limitations. The subthemes were Perceiving Limitations, Overcoming Isolation, and Celebrating Strengths. Conclusions: This co-design process provided children with OI the space to not only contribute to the development of the end product but also eloquently describe their experiences. These findings, based on the descriptions given by the children themselves, offer us a unique understanding of what it means to grow up with OI. ",
doi="10.2196/22784",
url="https://pediatrics.jmir.org/2021/3/e22784",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383677"
}


@Article{info:doi/10.2196/27452,
author="Rogers, C. Courtney
and Moutinho Jr, J. Thomas
and Liu, Xiaoyue
and Valdez, S. Rupa",
title="Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work",
journal="JMIR Hum Factors",
year="2021",
month="Aug",
day="10",
volume="8",
number="3",
pages="e27452",
keywords="Crohn disease",
keywords="inflammatory bowel diseases",
keywords="chronic disease",
keywords="self-management",
keywords="consumer health information technology",
keywords="qualitative research",
keywords="user-centered design",
keywords="patient work",
keywords="context",
keywords="articulation work",
keywords="diet",
keywords="nutrition",
abstract="Background: Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. Objective: The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. Methods: We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. Results: Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. Conclusions: This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time. ",
doi="10.2196/27452",
url="https://humanfactors.jmir.org/2021/3/e27452",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383664"
}


@Article{info:doi/10.2196/24909,
author="Hoevenaars, Dirk
and Holla, M. Jasmijn F.
and te Loo, Leonie
and Koedijker, M. Johan
and Dankers, Sarah
and Houdijk, Han
and Visser, Bart
and Janssen, J. Thomas W.
and de Groot, Sonja
and Deutekom, Marije
and ",
title="Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="9",
volume="5",
number="8",
pages="e24909",
keywords="mHealth",
keywords="mobile app",
keywords="lifestyle",
keywords="usability",
keywords="feasibility",
keywords="wheelchair users",
keywords="spinal cord injury",
keywords="lower limb amputation",
abstract="Background: Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. ",
doi="10.2196/24909",
url="https://formative.jmir.org/2021/8/e24909",
url="http://www.ncbi.nlm.nih.gov/pubmed/34379056"
}


@Article{info:doi/10.2196/25568,
author="Rankine, Jacquelin
and Yeramosu, Deepika
and Matheo, Loreta
and Sequeira, M. Gina
and Miller, Elizabeth
and Ray, N. Kristin",
title="Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design",
journal="JMIR Hum Factors",
year="2021",
month="Aug",
day="5",
volume="8",
number="3",
pages="e25568",
keywords="referral",
keywords="consultation",
keywords="telemedicine",
keywords="telehealth",
keywords="adolescents",
keywords="child health",
keywords="child health services",
keywords="confidentiality",
keywords="access to health care",
abstract="Background: e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. Objective: This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. Methods: We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. Results: Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. Conclusions: Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs. ",
doi="10.2196/25568",
url="https://humanfactors.jmir.org/2021/3/e25568",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383665"
}


@Article{info:doi/10.2196/24112,
author="Derksen, E. Marloes
and Jaspers, WM Monique
and van Strijp, Sander
and Fransen, P. Mirjam",
title="Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="4",
volume="5",
number="8",
pages="e24112",
keywords="think aloud",
keywords="heuristic evaluation",
keywords="usability",
keywords="mHealth",
keywords="game elements",
keywords="smoking prevention",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. ",
doi="10.2196/24112",
url="https://formative.jmir.org/2021/8/e24112",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346895"
}


@Article{info:doi/10.2196/30241,
author="Heffner, L. Jaimee
and Watson, L. Noreen
and Serfozo, Edit
and Kelly, M. Megan
and Reilly, D. Erin
and Kim, Daniella
and Baker, Kelsey
and Scout, N. N. F.
and Karekla, Maria",
title="An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot Trial",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="30",
volume="5",
number="7",
pages="e30241",
keywords="LGBT",
keywords="embodied agent",
keywords="tobacco cessation",
keywords="nicotine dependence",
keywords="user-centered design",
keywords="avatar",
keywords="digital health",
keywords="minority",
keywords="young adult",
keywords="teenager",
keywords="smoking",
keywords="cessation",
keywords="intervention",
keywords="development",
keywords="pilot trial",
abstract="Background: Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. Objective: To address these challenges as well as their preferences for sexual and gender minority--targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy--based digital program called Empowered, Queer, Quitting, and Living (EQQUAL). Methods: Participants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco. Results: For young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39\% (7/18) completed all 6 sessions. Overall, 93\% of participants (14/15) were satisfied with the EQQUAL program, 100\% (15/15) found it easy to use, and 100\% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23\% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar's appearance and movements. Conclusions: Treatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar's movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers. ",
doi="10.2196/30241",
url="https://formative.jmir.org/2021/7/e30241",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328430"
}


@Article{info:doi/10.2196/30450,
author="Weber, J. Summer
and Shearer, Elyse
and Mulvaney, A. Shelagh
and Schmidt, Douglas
and Thompson, Chris
and Jones, Jessica
and Ahmad, Haseeb
and Coe, Martina
and Hull, C. Pamela",
title="Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="30",
volume="5",
number="7",
pages="e30450",
keywords="WIC",
keywords="mobile technology",
keywords="maternal-child health",
keywords="childhood obesity",
keywords="nutrition",
keywords="government programs",
keywords="mobile app",
keywords="user-centered design",
keywords="low income",
keywords="women",
keywords="infant",
keywords="child",
keywords="formative",
keywords="development",
abstract="Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. ",
doi="10.2196/30450",
url="https://formative.jmir.org/2021/7/e30450",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328432"
}


@Article{info:doi/10.2196/24927,
author="H{\"a}gglund, Maria
and Scandurra, Isabella",
title="User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="27",
volume="8",
number="3",
pages="e24927",
keywords="usability",
keywords="system usability scale",
keywords="evaluation",
keywords="patient accessible electronic health records",
keywords="open notes",
keywords="patient portals",
abstract="Background: Transparency is increasingly called for in health care, especially, when it comes to patients' access to their electronic health records. In Sweden, the e-service Journalen is a national patient accessible electronic health record (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefits of using a PAEHR influence behavioral intention for use and adoption, but poor usability that increases the effort expectancy can have a negative impact. It is, therefore, of interest to explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective: The aim of this study was to explore how the users of the Swedish PAEHR experience the usability of the system and to identify differences in these experiences based on the level of transparency of the region. Methods: A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data were collected from June to October 2016. The questionnaire included questions regarding the usability of the system from the System Usability Scale (SUS). The SUS analysis was the focus of this paper. Analysis was performed on different levels: nationally looking at the whole data set and breaking it down by focusing on 2 different regions to explore differences in experienced usability based on the level of transparency. Results: During the survey period, 423,141 users logged into Journalen, of which 2587 unique users completed the survey (response rate 0.61\%). The total mean score for all respondents to the SUS items was 79.81 (SD 14.25), which corresponds to a system with good usability. To further explore whether the level of transparency in a region would affect the user's experience of the usability of the system, we analyzed the 2 regions with the most respondents: Region Uppsala (the first to launch, with a high level of transparency), and Region Sk{\aa}ne (an early implementer, with a low level of transparency at the time of the survey). Of the participants who responded to at least 1 SUS statement, 520 stated that they had received care in Region Sk{\aa}ne, whereas 331 participants had received care in Region Uppsala. Uppsala's mean SUS score was 80.71 (SD 13.41), compared with Sk{\aa}ne's mean of 79.37 (SD 13.78). Conclusions: The Swedish national PAEHR Journalen has a reasonably good usability (mean SUS score 79.81, SD 14.25); however, further research into more specific usability areas are needed to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared with the region with low transparency could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required. ",
doi="10.2196/24927",
url="https://humanfactors.jmir.org/2021/3/e24927",
url="http://www.ncbi.nlm.nih.gov/pubmed/34313596"
}


@Article{info:doi/10.2196/25531,
author="Sch{\"u}ttler, Christina
and Prokosch, Hans-Ulrich
and Sedlmayr, Martin
and Sedlmayr, Brita",
title="Evaluation of Three Feasibility Tools for Identifying Patient Data and Biospecimen Availability: Comparative Usability Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="21",
volume="9",
number="7",
pages="e25531",
keywords="software tools",
keywords="user interface",
keywords="feasibility",
keywords="evaluation",
keywords="research",
abstract="Background: To meet the growing importance of real-word data analysis, clinical data and biosamples must be timely made available. Feasibility platforms are often the first contact point for determining the availability of such data for specific research questions. Therefore, a user-friendly interface should be provided to enable access to this information easily. The German Medical Informatics Initiative also aims to establish such a platform for its infrastructure. Although some of these platforms are actively used, their tools still have limitations. Consequently, the Medical Informatics Initiative consortium MIRACUM (Medical Informatics in Research and Care in University Medicine) committed itself to analyzing the pros and cons of existing solutions and to designing an optimized graphical feasibility user interface. Objective: The aim of this study is to identify the system that is most user-friendly and thus forms the best basis for developing a harmonized tool. To achieve this goal, we carried out a comparative usability evaluation of existing tools used by researchers acting as end users. Methods: The evaluation included three preselected search tools and was conducted as a qualitative exploratory study with a randomized design over a period of 6 weeks. The tools in question were the MIRACUM i2b2 (Informatics for Integrating Biology and the Bedside) feasibility platform, OHDSI's (Observational Health Data Sciences and Informatics) ATLAS, and the Sample Locator of the German Biobank Alliance. The evaluation was conducted in the form of a web-based usability test (usability walkthrough combined with a web-based questionnaire) with participants aged between 26 and 63 years who work as medical doctors. Results: In total, 17 study participants evaluated the three tools. The overall evaluation of usability, which was based on the System Usability Scale, showed that the Sample Locator, with a mean System Usability Scale score of 77.03 (SD 20.62), was significantly superior to the other two tools (Wilcoxon test; Sample Locator vs i2b2: P=.047; Sample Locator vs ATLAS: P=.001). i2b2, with a score of 59.83 (SD 25.36), performed significantly better than ATLAS, which had a score of 27.81 (SD 21.79; Wilcoxon test; i2b2 vs ATLAS: P=.005). The analysis of the material generated by the usability walkthrough method confirmed these findings. ATLAS caused the most usability problems (n=66), followed by i2b2 (n=48) and the Sample Locator (n=22). Moreover, the Sample Locator achieved the highest ratings with respect to additional questions regarding satisfaction with the tools. Conclusions: This study provides data to develop a suitable basis for the selection of a harmonized tool for feasibility studies via concrete evaluation and a comparison of the usability of three different types of query builders. The feedback obtained from the participants during the usability test made it possible to identify user problems and positive design aspects of the individual tools and compare them qualitatively. ",
doi="10.2196/25531",
url="https://medinform.jmir.org/2021/7/e25531",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287211"
}


@Article{info:doi/10.2196/27321,
author="Dinesen, Birthe
and Dam Gade, Josefine
and Skov Schacksen, Cathrine
and Spindler, Helle
and Eie Albertsen, Andi
and Dittmann, Lars
and Jochumsen, Mads
and Svenstrup M{\o}ller, Dorthe",
title="The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses",
journal="JMIR Cardio",
year="2021",
month="Jul",
day="19",
volume="5",
number="2",
pages="e27321",
keywords="atrial fibrillation",
keywords="cardiac rehabilitation",
keywords="telerehabilitation",
keywords="patient education",
abstract="Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients' perspectives. Secondary outcomes were the development of patients' knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient--TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437. ",
doi="10.2196/27321",
url="https://cardio.jmir.org/2021/2/e27321",
url="http://www.ncbi.nlm.nih.gov/pubmed/34279239"
}


@Article{info:doi/10.2196/29689,
author="Lau, Nancy
and O'Daffer, Alison
and Yi-Frazier, P. Joyce
and Rosenberg, R. Abby",
title="Popular Evidence-Based Commercial Mental Health Apps: Analysis of Engagement, Functionality, Aesthetics, and Information Quality",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="14",
volume="9",
number="7",
pages="e29689",
keywords="mobile health",
keywords="mental health",
keywords="behavioral health",
keywords="user-centered design",
keywords="evidence-based health management",
keywords="smartphones",
keywords="mobile phones",
abstract="Background: There is a robust market for mobile health (mHealth) apps focused on self-guided interventions to address a high prevalence of mental health disorders and behavioral health needs in the general population. Disseminating mental health interventions via mHealth technologies may help overcome barriers in access to care and has broad consumer appeal. However, development and testing of mental health apps in formal research settings are limited and far outpaced by everyday consumer use. In addition to prioritizing efficacy and effectiveness testing, researchers should examine and test app design elements that impact the user experience, increase engagement, and lead to sustained use over time. Objective: The aim of this study was to evaluate the objective and subjective quality of apps that are successful across both research and consumer sectors, and the relationships between objective app quality, subjective user ratings, and evidence-based behavior change techniques. This will help inform user-centered design considerations for mHealth researchers to maximize design elements and features associated with consumer appeal, engagement, and sustainability. Methods: We conducted a user-centered design analysis of popular consumer apps with scientific backing utilizing the well-validated Mobile Application Rating Scale (MARS). Popular consumer apps with research support were identified via a systematic search of the App Store iOS (Apple Inc) and Google Play (Google LLC) and literature review. We evaluated the quality metrics of 19 mental health apps along 4 MARS subscales, namely, Engagement, Functionality, Aesthetics, and Information Quality. MARS total and subscale scores range from 1 to 5, with higher scores representing better quality. We then extracted user ratings from app download platforms and coded apps for evidence-based treatment components. We calculated Pearson correlation coefficients to identify associations between MARS scores, App Store iOS/Google Play consumer ratings, and number of evidence-based treatment components. Results: The mean MARS score was 3.52 (SD 0.71), consumer rating was 4.22 (SD 0.54), and number of evidence-based treatment components was 2.32 (SD 1.42). Consumer ratings were significantly correlated with the MARS Functionality subscale (r=0.74, P<.001), Aesthetics subscale (r=0.70, P<.01), and total score (r=0.58, P=.01). Number of evidence-based intervention components was not associated with MARS scores (r=0.085, P=.73) or consumer ratings (r=--0.329, P=.16). Conclusions: In our analysis of popular research-supported consumer apps, objective app quality and subjective consumer ratings were generally high. App functionality and aesthetics were highly consistent with consumer appeal, whereas evidence-based components were not. In addition to designing treatments that work, we recommend that researchers prioritize aspects of app design that impact the user experience for engagement and sustainability (eg, ease of use, navigation, visual appeal). This will help translate evidence-based interventions to the competitive consumer app market, thus bridging the gap between research development and real-world implementation. ",
doi="10.2196/29689",
url="https://mhealth.jmir.org/2021/7/e29689",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259639"
}


@Article{info:doi/10.2196/25866,
author="Glass, E. Joseph
and Matson, E. Theresa
and Lim, Catherine
and Hartzler, L. Andrea
and Kimbel, Kilian
and Lee, K. Amy
and Beatty, Tara
and Parrish, Rebecca
and Caldeiro, M. Ryan
and Garza McWethy, Angela
and Curran, M. Geoffrey
and Bradley, A. Katharine",
title="Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="6",
volume="23",
number="7",
pages="e25866",
keywords="user-centered design",
keywords="qualitative",
keywords="drug use disorders",
keywords="stimulants",
keywords="cannabis",
keywords="opioids",
keywords="primary care",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective: This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods: The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results: Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions: A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients' needs for structure, support in and outside of visits, and desire for convenience. ",
doi="10.2196/25866",
url="https://www.jmir.org/2021/7/e25866",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255666"
}


@Article{info:doi/10.2196/28526,
author="Ben-Zeev, Dror
and Meller, Suzanne
and Snyder, Jaime
and Attah, A. Dzifa
and Albright, Liam
and Le, Hoa
and Asafo, M. Seth
and Collins, Y. Pamela
and Ofori-Atta, Angela",
title="A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study",
journal="JMIR Ment Health",
year="2021",
month="Jul",
day="2",
volume="8",
number="7",
pages="e28526",
keywords="mobile phone",
keywords="low- and middle-income country",
keywords="schizophrenia",
keywords="bipolar disorder",
abstract="Background: The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. Objective: The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. Results: A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67\%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable. Conclusions: This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses. ",
doi="10.2196/28526",
url="https://mental.jmir.org/2021/7/e28526",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255712"
}


@Article{info:doi/10.2196/30621,
author="Kim, S. Esther
and Laird, Laura
and Wilson, Carlee
and Bieg, Till
and Mildner, Philip
and M{\"o}ller, Sebastian
and Schatz, Raimund
and Schwarz, Stephanie
and Spang, Robert
and Voigt-Antons, Jan-Niklas
and Rochon, Elizabeth",
title="Implementation and Effects of an Information Technology--Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="2",
volume="10",
number="7",
pages="e30621",
keywords="aphasia",
keywords="rehabilitation",
keywords="speech-language pathology",
keywords="app-based therapy",
keywords="user-centered design",
keywords="mHealth",
keywords="adaptive software",
abstract="Background: Mobile app--based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. Objective: VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods: A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. Results: Recruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. Conclusions: The results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. Trial Registration: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364 International Registered Report Identifier (IRRID): DERR1-10.2196/30621 ",
doi="10.2196/30621",
url="https://www.researchprotocols.org/2021/7/e30621",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255727"
}


@Article{info:doi/10.2196/24659,
author="Hoogsteder, H. Mariette H.
and Douma, N. Linda
and Eskens, A. Charlotte G.
and Berendsen, L. Renske
and Vanneste, M. Yvonne T.
and Schaafsma, G. Frederieke",
title="Professionals' and Students' Perceived Needs for an Online Supportive Application for Reducing School Absence and Stimulating Reintegration: Concept Mapping Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="21",
volume="5",
number="6",
pages="e24659",
keywords="medical absenteeism",
keywords="secondary education",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="students",
keywords="schools, health occupations",
keywords="youth health physicians",
keywords="concept mapping",
abstract="Background: To limit students' medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students' autonomy regarding their situation. Objective: This study aimed to identify professionals' and students' perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. Methods: Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. Results: Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. Conclusions: Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism. ",
doi="10.2196/24659",
url="https://formative.jmir.org/2021/6/e24659",
url="http://www.ncbi.nlm.nih.gov/pubmed/34152275"
}


@Article{info:doi/10.2196/26195,
author="Larsen, Britta
and Greenstadt, D. Emily
and Olesen, L. Brittany
and Marcus, H. Bess
and Godino, Job
and Zive, M. Michelle",
title="An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="15",
volume="5",
number="6",
pages="e26195",
keywords="mobile health",
keywords="human-centered design",
keywords="qualitative research",
keywords="adolescent health",
keywords="health disparities",
keywords="mobile phone",
abstract="Background: Only 3\% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population.  Objective: This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework.  Methods: On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process. Results: The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96\%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases.  Conclusions: Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product. ",
doi="10.2196/26195",
url="https://formative.jmir.org/2021/6/e26195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128823"
}


@Article{info:doi/10.2196/26012,
author="Willis, Matthew
and Brand Hein, Leah
and Hu, Zhaoxian
and Saran, Rajiv
and Argentina, Marissa
and Bragg-Gresham, Jennifer
and Krein, L. Sarah
and Gillespie, Brenda
and Zheng, Kai
and Veinot, C. Tiffany",
title="Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Jun",
day="14",
volume="8",
number="2",
pages="e26012",
keywords="user interaction",
keywords="dialysis",
keywords="usability",
keywords="informatics intervention",
abstract="Background: Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)---low blood pressure during hemodialysis---is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based interventions hold promise as a platform for patient activation. However, little is known about the usability challenges that patients undergoing hemodialysis may face when using tablet-based informatics interventions, especially while dialyzing. Objective: This study aims to test the usability of a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing--based mentoring from patient peers via videoconferencing. Methods: We conducted a cross-sectional, mixed methods usability evaluation of the tablet-based intervention by using think-aloud methods, field notes, and structured observations. These qualitative data were evaluated by trained researchers using a structured data collection instrument to capture objective observational data. We calculated descriptive statistics for the quantitative data and conducted inductive content analysis using the qualitative data. Results: Findings from 14 patients cluster around general constraints such as the use of one arm, dexterity issues, impaired vision, and lack of experience with touch screen devices. Our task-by-task usability results showed that specific sections with the greatest difficulty for users were logging into the intervention (difficulty score: 2.08), interacting with the quizzes (difficulty score: 1.92), goal setting (difficulty score: 2.28), and entering and exiting videoconference rooms (difficulty score: 2.07) that are used to engage with peers during motivational interviewing sessions. Conclusions: In this paper, we present implications for designing informatics interventions for patients on dialysis and detail resulting changes to be implemented in the next version of this intervention. We frame these implications first through the context of the role the patients' physical body plays when interacting with the intervention and then through the digital considerations for software and interface interaction. ",
doi="10.2196/26012",
url="https://humanfactors.jmir.org/2021/2/e26012",
url="http://www.ncbi.nlm.nih.gov/pubmed/34121664"
}


@Article{info:doi/10.2196/25741,
author="Madar, Ronni
and Ugon, Adrien
and Ivankovi{\'c}, Damir
and Tsopra, Rosy",
title="A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="11",
volume="23",
number="6",
pages="e25741",
keywords="clinical decision support system",
keywords="visualization",
keywords="usability",
keywords="clinical practice guidelines",
keywords="antibiotic",
keywords="primary care",
abstract="Background: Antibiotic misuse is a serious public health problem worldwide. National health authorities release clinical practice guidelines (CPGs) to guide general practitioners (GPs) in their choice of antibiotics. However, despite the large-scale dissemination of CPGs, GPs continue to prescribe antibiotics that are not recommended as first-line treatments. This nonadherence to recommendations may be due to GPs misunderstanding the CPGs. A web interface displaying antibiotic prescription recommendations and their justifications could help to improve the comprehensibility and readability of CPGs, thereby increasing the adoption of recommendations regarding antibiotic treatment. Objective: This study aims to design and evaluate a web interface for antibiotic prescription displaying both the recommended antibiotics and their justifications in the form of antibiotic properties. Methods: A web interface was designed according to the same principles as e-commerce interfaces and was assessed by 117 GPs. These GPs were asked to answer 17 questions relating to the usefulness, user-friendliness, and comprehensibility and readability of the interface, and their satisfaction with it. Responses were recorded on a 4-point Likert scale (ranging from ``absolutely disagree'' to ``absolutely agree''). At the end of the evaluation, the GPs were allowed to provide optional, additional free comments. Results: The antibiotic prescription web interface consists of three main sections: a clinical summary section, a filter section, and a recommended antibiotics section. The majority of GPs appreciated the clinical summary (90/117, 76.9\%) and filter (98/117, 83.8\%) sections, whereas 48.7\% (57/117) of them reported difficulty reading some of the icons in the recommended antibiotics section. Overall, 82.9\% (97/117) of GPs found the display of drug properties useful, and 65.8\% (77/117) reported that the web interface improved their understanding of CPG recommendations. Conclusions: The web interface displaying antibiotic recommendations and their properties can help doctors understand the rationale underlying CPG recommendations regarding antibiotic treatment, but further improvements are required before its implementation into a clinical decision support system. ",
doi="10.2196/25741",
url="https://www.jmir.org/2021/6/e25741",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114958"
}


@Article{info:doi/10.2196/27526,
author="Lester, Gabriel Ethan
and Hopkins, Whitall Sarah
and Popok, Jean Paula
and Vranceanu, Ana-Maria",
title="Adaptation of a Live Video Mind--Body Program to a Web-Based Platform for English-Speaking Adults With Neurofibromatosis: Protocol for the NF-Web Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="10",
volume="10",
number="6",
pages="e27526",
keywords="neurofibromatosis",
keywords="quality of life",
keywords="stress management",
keywords="mind--body",
keywords="asynchronous delivery",
keywords="resiliency",
keywords="mobile phone",
abstract="Background: Neurofibromatosis (NF) is a rare genetic condition associated with lower but modifiable quality of life (QoL). Although a virtual live video program (Relaxation Response Resiliency Program for Neurofibromatosis [3RP-NF]; efficacy randomized controlled trial underway) that we created has been made available, ongoing barriers impede some patients from engaging in this intervention. A necessary next step is to develop a stand-alone web-based intervention that reduces barriers to accessing NF-specific psychosocial care. Objective: First, we aim to develop a web-based platform (Neurofibromatosis-Web [NF-Web]) of our mind--body resiliency program (3RP-NF) through qualitative interviews with participants from an adult efficacy randomized controlled trial. Second, we aim to iteratively optimize the feasibility, acceptability, credibility, and satisfaction of the NF-Web platform through open pilot trials with participant exit interviews and explore quantitative outcomes within this sample. Here, we describe the protocol and study design, intervention, and analysis plan. Methods: For aim 1, we will invite completers from our efficacy trial to participate in qualitative interviews. We will use data from these interviews to adapt the content of the live video program for asynchronous delivery and understand how to create a user-friendly format for an engaging web platform. For aim 2, we will enroll eligible participants recruited for the efficacy trial who could not enroll because of treatment barriers. Eligible participants will complete QoL, depression, anxiety, pain, treatment satisfaction, and program credibility measures at baseline and posttest. Inclusion criteria are identical to those for the efficacy trial, including stress and coping difficulties (self-report), no change in antidepressant medication in the past 3 months, no psychotherapy in the past 3 months, no major upcoming surgeries in the next 12 months, English speaking, ability to complete questionnaires on the web and participate in live video interventions, and consent before participation. The primary outcomes are feasibility, treatment satisfaction, and credibility. The secondary outcomes include physical, psychological, social, and environmental QoL; depression; anxiety; pain intensity; and pain interference. We will enroll at least two group cohorts and iteratively refine the program based on participant feedback after each cohort completes the open pilot trial. Results: This trial is ongoing. We have completed the interviews (n=23) and analyzed the data to construct the website. Afterward, we will recruit our cohorts for the trial (approximately n=15/cohort; total=30). Recruitment will end by May 2021, with plans to analyze the data by October 2021. Conclusions: We will develop the first web platform for people with NF with difficulties managing stress and NF symptoms and report on feasibility and preliminary effects in improving QoL and psychosocial functioning. NF-Web has potential to extend the reach of our 3RP-NF intervention by removing barriers to care, including lack of trained providers, scheduling difficulties, and appearance concerns. International Registered Report Identifier (IRRID): DERR1-10.2196/27526 ",
doi="10.2196/27526",
url="https://www.researchprotocols.org/2021/6/e27526",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110294"
}


@Article{info:doi/10.2196/16304,
author="Mascheroni, Alessandro
and Choe, Kyoung Eun
and Luo, Yuhan
and Marazza, Michele
and Ferlito, Clara
and Caverzasio, Serena
and Mezzanotte, Francesco
and Kaelin-Lang, Alain
and Faraci, Francesca
and Puiatti, Alessandro
and Ratti, Luca Pietro",
title="The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="8",
volume="9",
number="6",
pages="e16304",
keywords="Parkinson disease",
keywords="ecological momentary assessment",
keywords="finger-tapping test",
keywords="subjective scales",
keywords="sleep diaries",
keywords="tablet application",
keywords="home-based system",
abstract="Background: Parkinson disease (PD) is a common, multifaceted neurodegenerative disorder profoundly impacting patients' autonomy and quality of life. Assessment in real-life conditions of subjective symptoms and objective metrics of mobility and nonmotor symptoms such as sleep disturbance is strongly advocated. This information would critically guide the adaptation of antiparkinsonian medications and nonpharmacological interventions. Moreover, since the spread of the COVID-19 pandemic, health care practices are being reshaped toward a more home-based care. New technologies could play a pivotal role in this new approach to clinical care. Nevertheless, devices and information technology tools might be unhandy for PD patients, thus dramatically limiting their widespread employment. Objective: The goals of the research were development and usability evaluation of an application, SleepFit, for ecological momentary assessment of objective and subjective clinical metrics at PD patients' homes, and as a remote tool for researchers to monitor patients and integrate and manage data. Methods: An iterative and user-centric strategy was employed for the development of SleepFit. The core structure of SleepFit consists of (1) an electronic finger-tapping test; (2) motor, sleepiness, and emotional subjective scales; and (3) a sleep diary. Applicable design, ergonomic, and navigation principles have been applied while tailoring the application to the specific patient population. Three progressively enhanced versions of the application (alpha, v1.0, v2.0) were tested by a total of 56 patients with PD who were asked to perform multiple home assessments 4 times per day for 2 weeks. Patient compliance was calculated as the proportion of completed tasks out of the total number of expected tasks. Satisfaction on the latest version (v2.0) was evaluated as potential willingness to use SleepFit again after the end of the study. Results: From alpha to v1.0, SleepFit was improved in graphics, ergonomics, and navigation, with automated flows guiding the patients in performing tasks throughout the 24 hours, and real-time data collection and consultation were made possible thanks to a remote web portal. In v2.0, the kiosk-mode feature restricts the use of the tablet to the SleepFit application only, thus preventing users from accidentally exiting the application. A total of 52 (4 dropouts) patients were included in the analyses. Overall compliance (all versions) was 88.89\% (5707/6420). SleepFit was progressively enhanced and compliance increased from 87.86\% (2070/2356) to 89.92\% (2899/3224; P=.04). Among the patients who used v2.0, 96\% (25/26) declared they would use SleepFit again. Conclusions: SleepFit can be considered a state-of-the-art home-based system that increases compliance in PD patients, ensures high-quality data collection, and works as a handy tool for remote monitoring and data management in clinical research. Thanks to its user-friendliness and modular structure, it could be employed in other clinical studies with minimum adaptation efforts. Trial Registration: ClinicalTrials.gov NCT02723396; https://clinicaltrials.gov/ct2/show/NCT02723396 ",
doi="10.2196/16304",
url="https://mhealth.jmir.org/2021/6/e16304",
url="http://www.ncbi.nlm.nih.gov/pubmed/34100767"
}


@Article{info:doi/10.2196/18167,
author="Salari, Raheleh
and R Niakan Kalhori, Sharareh
and GhaziSaeedi, Marjan
and Jeddi, Marjan
and Nazari, Mahin
and Fatehi, Farhad",
title="Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="2",
volume="23",
number="6",
pages="e18167",
keywords="type 2 diabetes",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app, self-management",
keywords="behavior change",
abstract="Background: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. Objective: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. Methods: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. Results: The developed mobile app includes modules that support several features. A person's data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician's portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. Conclusions: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up. ",
doi="10.2196/18167",
url="https://www.jmir.org/2021/6/e18167",
url="http://www.ncbi.nlm.nih.gov/pubmed/34076579"
}


@Article{info:doi/10.2196/19941,
author="Sun, Ruo-Ting
and Han, Wencui
and Chang, Hsin-Lu
and Shaw, J. Michael",
title="Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="2",
volume="9",
number="6",
pages="e19941",
keywords="adherence",
keywords="mobile health",
keywords="motivation",
keywords="personality",
keywords="MBTI",
keywords="action design research",
keywords="mobile phone",
abstract="Background: Physical inactivity is a global issue that affects people's health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective: This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods: This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2{\texttimes}3{\texttimes}2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants' adherence level to exercise plans. By analyzing users' usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results: In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15\% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34\% (P<.001). Conclusions: This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research. ",
doi="10.2196/19941",
url="https://mhealth.jmir.org/2021/6/e19941",
url="http://www.ncbi.nlm.nih.gov/pubmed/34076580"
}


@Article{info:doi/10.2196/25997,
author="Yildirim, Oguzcan
and Surer, Elif",
title="Developing Adaptive Serious Games for Children With Specific Learning Difficulties: A Two-phase Usability and Technology Acceptance Study",
journal="JMIR Serious Games",
year="2021",
month="May",
day="31",
volume="9",
number="2",
pages="e25997",
keywords="serious games",
keywords="adaptive games",
keywords="specific learning difficulty",
keywords="usability",
keywords="system usability scale",
keywords="technology acceptance model",
keywords="training",
keywords="development",
keywords="adaptation",
keywords="gaming",
keywords="learning disability",
keywords="children",
keywords="education",
keywords="teacher",
abstract="Background: Specific learning difficulties (SpLD) include several disorders such as dyslexia, dyscalculia, and dysgraphia, and the children with these SpLD receive special education. However, the studies and the educational material so far focus mainly on one specific disorder. Objective: This study's primary goal is to develop comprehensive training material for different types of SpLD, with five serious games addressing different aspects of the SpLD. The second focus is measuring the impact of adaptive difficulty level adjustment in the children's and their educators' usability and technology acceptance perception. Receiving feedback from the children and their educators, and refining the games according to their suggestions have also been essential in this two-phase study. Methods: A total of 10 SpLD educators and 23 children with different types of SpLD tested the prototypes of the five serious games (ie, Word game, Memory game, Category game, Space game, and Math game), gave detailed feedback, answered the System Usability Scale and Technology Acceptance Model (TAM) questionnaires, and applied think-aloud protocols during game play. Results: The games' standard and adaptive versions were analyzed in terms of average playtime and the number of false answers. Detailed analyses of the interviews, with word clouds and player performances, were also provided. The TAM questionnaires' average and mean values and box plots of each data acquisition session for the children and the educators were also reported via System Usability Scale and TAM questionnaires. The TAM results of the educators had an average of 8.41 (SD 0.87) out of 10 in the first interview and an average of 8.71 (SD 0.64) out of 10 in the second interview. The children had an average of 9.07 (SD 0.56) out of 10 in the first interview. Conclusions: Both the educators and the children with SpLD enjoyed playing the games, gave positive feedback, and suggested new ways for improvement. The results showed that these games provide thorough training material for different types of SpLD with personalized and tailored difficulty systems. The final version of the proposed games will become a part of the special education centers' supplementary curriculum and training materials, making new enhancements and improvements possible in the future. ",
doi="10.2196/25997",
url="https://games.jmir.org/2021/2/e25997",
url="http://www.ncbi.nlm.nih.gov/pubmed/34057415"
}


@Article{info:doi/10.2196/25705,
author="Wang, Gubing
and Albayrak, Armagan
and Kortuem, Gerd
and van der Cammen, JM Tischa",
title="A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="28",
volume="5",
number="5",
pages="e25705",
keywords="human-centered design",
keywords="data visualizations",
keywords="person-centered care",
keywords="people with dementia",
keywords="assistive technology",
keywords="health care design",
keywords="care management",
keywords="internet of things",
keywords="data-driven design",
keywords="data-enabled design",
abstract="Background: Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms. Objective: This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team. Methods: The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see. Results: The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into ``client level,'' ``ward level,'' and ``team level.'' The corresponding actions taken by the care team were classified into ``investigation'' and ``implementation.'' User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified. Conclusions: By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context. ",
doi="10.2196/25705",
url="https://formative.jmir.org/2021/5/e25705",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047703"
}


@Article{info:doi/10.2196/25281,
author="Paton, Chris
and Kushniruk, W. Andre
and Borycki, M. Elizabeth
and English, Mike
and Warren, Jim",
title="Improving the Usability and Safety of Digital Health Systems: The Role of Predictive Human-Computer Interaction Modeling",
journal="J Med Internet Res",
year="2021",
month="May",
day="27",
volume="23",
number="5",
pages="e25281",
keywords="digital health",
keywords="human-centered design",
keywords="usability",
keywords="human-computer interaction",
keywords="predictive modeling",
doi="10.2196/25281",
url="https://www.jmir.org/2021/5/e25281",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042590"
}


@Article{info:doi/10.2196/22513,
author="Fonner, A. Virginia
and Kennedy, Samuel
and Desai, Rohan
and Eichberg, Christie
and Martin, Lisa
and Meissner, G. Eric",
title="Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="27",
volume="5",
number="5",
pages="e22513",
keywords="HIV",
keywords="mHealth",
keywords="text messaging",
keywords="video calling",
keywords="implementation science",
keywords="mobile phone",
abstract="Background: Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective: The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods: We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results: Most patients (11/12, 92\%) and providers (12/14, 86\%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions: Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients' needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health--based communication, especially as implementation requires active participation from providers and patients. ",
doi="10.2196/22513",
url="https://formative.jmir.org/2021/5/e22513",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042596"
}


@Article{info:doi/10.2196/22915,
author="McMaughan, Jones Darcy
and Lin, Sherry
and Ozmetin, Jennifer
and Beverly, Gayle Judith
and Brog, Joshua
and Naiser, Emily",
title="A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="25",
volume="5",
number="5",
pages="e22915",
keywords="youth with special health care needs",
keywords="health care transitions",
keywords="eHealth",
keywords="usability",
keywords="concurrent think aloud method",
abstract="Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92\%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3\% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92\% (1065/1300) with a cutoff score of 73.33\% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76\%) and navigation (ease of use: 114/150, 76\%; hyperlinks: 163/200, 81.5\%; structure: 159/200, 79.5\%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68\%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75\%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. ",
doi="10.2196/22915",
url="https://formative.jmir.org/2021/5/e22915",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032579"
}


@Article{info:doi/10.2196/24449,
author="Lee, Seyeon
and Oh, Hyunyoung
and Shi, Chung-Kon
and Doh, Yim Young",
title="Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach",
journal="JMIR Serious Games",
year="2021",
month="May",
day="20",
volume="9",
number="2",
pages="e24449",
keywords="mobile games",
keywords="older adults",
keywords="middle-aged adults",
keywords="design guideline",
keywords="gaming experience",
abstract="Background: The number of older adult gamers who play mobile games is growing worldwide. Earlier studies have reported that digital games provide cognitive, physical, and socioemotional benefits for older adults. However, current mobile games that understand older adults' gameplay experience and reflect their needs are very scarce. Furthermore, studies that have analyzed older adults' game experience in a holistic manner are rare. Objective: The purpose of this study was to suggest mobile game design guidelines for adults older than 50 years from a holistic gaming experience perspective. Adopting a human-centric approach, this study analyzes middle-aged and older adults' gameplay experience and suggests practical design guides to increase accessibility and satisfaction. Methods: We organized a living laboratory project called the ``Intergenerational Play Workshop.'' In this workshop, 40 middle-aged and older adults (mean age 66.75 years, age range 50-85 years) played commercial mobile games of various genres with young adult partners for 1 month (8 sessions). Using a convergent parallel mixed-method design, we conducted a qualitative analysis of dialogue, game diaries, and behavioral observations during the workshop and a quantitative analysis of the satisfaction level of the game elements for the mobile games that they played. Results: This project was active from April 2019 to December 2021, and the data were collected at the workshops from July 1 to August 28, 2019. Based on the identified themes of positive and negative experiences from the qualitative data, we proposed 45 design guides under 3 categories: (1) cognitive and physical elements, (2) psychological and socioemotional elements, and (3) consumption contextual elements. Our empirical research could reaffirm the proposals from previous studies and provide new guidelines for improving the game design. In addition, we demonstrate how existing commercial games can be evaluated quantitatively by using the satisfaction level of each game's elements and overall satisfaction level. Conclusions: The final guidelines were presented to game designers to easily find related information and enhance the overall understanding of the game experience of middle-aged and older adults. ",
doi="10.2196/24449",
url="https://games.jmir.org/2021/2/e24449",
url="http://www.ncbi.nlm.nih.gov/pubmed/34014175"
}


@Article{info:doi/10.2196/21177,
author="Pathak, Elizabeth Laura
and Aguilera, Adrian
and Williams, Jay Joseph
and Lyles, Rees Courtney
and Hernandez-Ramos, Rosa
and Miramontes, Jose
and Cemballi, Gunshekar Anupama
and Figueroa, Astrid Caroline",
title="Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="19",
volume="9",
number="5",
pages="e21177",
keywords="user centered design",
keywords="mHealth",
keywords="text messaging",
keywords="crowdsourcing",
keywords="mobile phone",
abstract="Background: Text messaging interventions can be an effective and efficient way to improve health behavioral changes. However, most texting interventions are neither tested nor designed with diverse end users, which could reduce their impact, and there is limited evidence regarding the optimal design methodology of health text messages tailored to low-income, low--health literacy populations and non-English speakers. Objective: This study aims to combine participant feedback, crowdsourced data, and researcher expertise to develop motivational text messages in English and Spanish that will be used in a smartphone app--based texting intervention that seeks to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms. Methods: The design process consisted of 5 phases and was iterative in nature, given that the findings from each step informed the subsequent steps. First, we designed messages to increase physical activity based on the behavior change theory and knowledge from the available evidence. Second, using user-centered design methods, we refined these messages after a card sorting task and semistructured interviews (N=10) and evaluated their likeability during a usability testing phase of the app prototype (N=8). Third, the messages were tested by English- and Spanish-speaking participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform (N=134). Participants on MTurk were asked to categorize the messages into overarching theoretical categories based on the capability, opportunity, motivation, and behavior framework. Finally, each coauthor rated the messages for their overall quality from 1 to 5. All messages were written at a sixth-grade or lower reading level and culturally adapted and translated into neutral Spanish by bilingual research staff. Results: A total of 200 messages were iteratively refined according to the feedback from target users gathered through user-centered design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged to discard unappealing messages and edit the thematic aspects of messages that did not resonate well with the target users. Overall, 54 messages were sorted into the correct theoretical categories at least 50\% of the time in the MTurk categorization tasks and were rated 3.5 or higher by the research team members. These were included in the final text message bank, resulting in 18 messages per motivational category. Conclusions: By using an iterative process of expert opinion, feedback from participants that were reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable inputs for the design of motivational text messages developed in English and Spanish with a low literacy level to increase physical activity. We describe the design considerations and lessons learned for the text messaging development process and provide a novel, integrative framework for future developers of health text messaging interventions. ",
doi="10.2196/21177",
url="https://mhealth.jmir.org/2021/5/e21177",
url="http://www.ncbi.nlm.nih.gov/pubmed/34009130"
}


@Article{info:doi/10.2196/27205,
author="Lowe, Cabella
and Hanuman Sing, Harry
and Browne, Mitchell
and Alwashmi, F. Meshari
and Marsh, William
and Morrissey, Dylan",
title="Usability Testing of a Digital Assessment Routing Tool: Protocol for an Iterative Convergent Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="18",
volume="10",
number="5",
pages="e27205",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="digital health",
keywords="digital technology",
keywords="musculoskeletal injury",
keywords="musculoskeletal conditions",
keywords="triage",
keywords="physiotherapy triage",
keywords="usability",
keywords="acceptability",
abstract="Background: Musculoskeletal conditions account for 16\% of global disability, resulting in a negative effect on millions of patients and an increasing burden on health care utilization. Digital technologies that improve health care outcomes and efficiency are considered a priority; however, innovations are often inadequately developed and poorly adopted. Further, they are rarely tested with sufficient rigor in clinical trials---the gold standard for clinical proof of efficacy. We have developed a new musculoskeletal Digital Assessment Routing Tool (DART) that allows users to self-assess and be directed to the right care. DART requires usability testing in preparation for clinical trials. Objective: This study will use the iterative convergent mixed methods design to assess and mitigate all serious usability issues to optimize user experience and adoption. Using this methodology, we will provide justifiable confidence to progress to full-scale randomized controlled trials when DART is integrated into clinical management pathways. This study protocol will provide a blueprint for future usability studies of mobile health solutions. Methods: We will collect qualitative and quantitative data from 20-30 participants aged 18 years and older for 4 months. The exact number of participants recruited will be dependent on the number of iterative cycles required to reach the study end points. Building on previous internal testing and stakeholder involvement, quantitative data collection is defined by the constructs within the ISO 9241-210-2019 standard and the system usability scale, providing a usability score for DART. Guided by the participant responses to quantitative questioning, the researcher will focus the qualitative data collection on specific usability problems. These will then be graded to provide the rationale for further DART system improvements throughout the iterative cycles. Results: This study received approval from the Queen Mary University of London Ethics of Research Committee (QMREC2018/48/048) on June 4, 2020. At manuscript submission, study recruitment was on-going, with data collection to be completed and results published in 2021. Conclusions: This study will provide evidence concerning mobile health DART system usability and acceptance determining system improvements required to support user adoption and minimize suboptimal system usability as a potential confounder within subsequent noninferiority clinical trials. Success should produce a safe effective system with excellent usability, facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This deliberately rigorous approach to mobile health innovation could be used as a guide for other developers of similar apps. International Registered Report Identifier (IRRID): DERR1-10.2196/27205 ",
doi="10.2196/27205",
url="https://www.researchprotocols.org/2021/5/e27205",
url="http://www.ncbi.nlm.nih.gov/pubmed/34003135"
}


@Article{info:doi/10.2196/25316,
author="Lopes, Filipa
and Rodrigues, M{\'a}rio
and Silva, G. Anabela",
title="User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="14",
volume="9",
number="5",
pages="e25316",
keywords="pain assessment",
keywords="mobile app",
keywords="validity",
keywords="reliability",
keywords="usability",
keywords="mHealth",
keywords="pain",
keywords="user-centered design",
abstract="Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1---development of the AvaliaDor app; and phase 2---assessment of the apps' usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. ",
doi="10.2196/25316",
url="https://mhealth.jmir.org/2021/5/e25316",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988515"
}


@Article{info:doi/10.2196/24669,
author="Guay, Manon
and Labb{\'e}, Mathieu
and S{\'e}guin-Tremblay, No{\'e}mie
and Auger, Claudine
and Goyer, Genevi{\`e}ve
and Veloza, Emily
and Chevalier, Natalie
and Polgar, Jan
and Michaud, Fran{\c{c}}ois",
title="Adapting a Person's Home in 3D Using a Mobile App (MapIt): Participatory Design Framework Investigating the App's Acceptability",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="May",
day="11",
volume="8",
number="2",
pages="e24669",
keywords="occupational therapy",
keywords="mobile phone",
keywords="aging",
keywords="disability",
keywords="telehealth",
keywords="3D visualization",
keywords="universal design",
keywords="built environment",
keywords="camera",
keywords="remote assessment",
keywords="assistive technology",
abstract="Background: Home adaptation processes enhancing occupational engagement rely on identifying environmental barriers, generally during time-consuming home visits performed by occupational therapists (OTs). Relevance of a 3D model to the OT's work has been attested, but a convenient and consumer-available technology to map the home environment in 3D is currently lacking. For instance, such a technology would support the exploration of home adaptations for a person with disability, with or without an OT visit. Objective: The aim of this study was to document the development and acceptability of a 3D mapping eHealth technology, optimizing its contribution to the OT's work when conducting assessments in which home representations are essential to fit a person's needs. Methods: A user-centered perspective, embedded in a participatory design framework where users are considered as research partners (not as just study participants), is reported. OTs, engineers, clinicians, researchers, and students, as well as the relatives of older adults contributed by providing ongoing feedback (eg, demonstrations, brainstorming, usability testing, questionnaires, prototyping). System acceptability, as per the Nielsen model, is documented by deductively integrating the data. Results: A total of 24 stakeholders contributed significantly to MapIt technology's co-design over a span of 4 years. Fueled by the objective to enhance MapIt's acceptability, 11 iterations lead to a mobile app to scan a room and produce its 3D model in less than 5 minutes. The app is available for smartphones and paired with computer software. Scanning, visualization, and automatic measurements are done on a smartphone equipped with a motion sensor and a camera with depth perception, and the computer software facilitates visualization, while allowing custom measurement of architectural elements directly on the 3D model. Stakeholders' perception was favorable regarding MapIt's acceptability, testifying to its usefulness (ie, usability and utility). Residual usability issues as well as concerns about accessibility and scan rendering still need to be addressed to foster its integration to a clinical context. Conclusions: MapIt allows to scan a room quickly and simply, providing a 3D model from images taken in real-world settings and to remotely but jointly explore home adaptations to enhance a person's occupational engagement. ",
doi="10.2196/24669",
url="https://rehab.jmir.org/2021/2/e24669",
url="http://www.ncbi.nlm.nih.gov/pubmed/33973867"
}


@Article{info:doi/10.2196/26673,
author="Trettin, Bettina
and Danbj{\o}rg, Boe Dorthe
and Andersen, Flemming
and Feldman, Steven
and Agerskov, Hanne",
title="Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study",
journal="JMIR Dermatol",
year="2021",
month="May",
day="10",
volume="4",
number="1",
pages="e26673",
keywords="mHealth",
keywords="psoriasis",
keywords="biologics",
keywords="participatory design",
keywords="teledermatology",
keywords="mobile phone",
abstract="Background: In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients' needs. Objective: This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design. Methods: Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps---plan, act, observe, and reflect---in the methodology of participatory design. Results: Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app. Conclusions: Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions. ",
doi="10.2196/26673",
url="https://derma.jmir.org/2021/1/e26673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632817"
}


@Article{info:doi/10.2196/23809,
author="Graham, K. Andrea
and Munson, A. Sean
and Reddy, Madhu
and Neubert, W. Sarah
and Green, A. Emilie
and Chang, Angela
and Spring, Bonnie
and Mohr, C. David
and Wildes, E. Jennifer",
title="Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis",
journal="JMIR Form Res",
year="2021",
month="May",
day="10",
volume="5",
number="5",
pages="e23809",
keywords="obesity",
keywords="binge eating",
keywords="user-centered design",
keywords="mobile intervention",
keywords="engagement",
keywords="experimental therapeutics",
abstract="Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32\% non-Hispanic White; 8/22, 36\% male) with self-reported obesity and recurrent binge eating (?12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82\% (18/22) struggled with implementation, and 23\% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82\% (18/22) indicated the strategy was helpful, and 86\% (19/22) planned to continue use. One-week average within-subject changes in weight (--2.2 [SD --5.0] pounds) and binge eating (--1.6 [SD --1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. ",
doi="10.2196/23809",
url="https://formative.jmir.org/2021/5/e23809",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970114"
}


@Article{info:doi/10.2196/22826,
author="Sch{\"a}ttin, Alexandra
and H{\"a}fliger, Stephan
and Meyer, Alain
and Fr{\"u}h, Barbara
and B{\"o}ckler, Sonja
and Hungerb{\"u}hler, Yannic
and de Bruin, D. Eling
and Frese, Sebastian
and Steinlin Egli, Regula
and G{\"o}tz, Ulrich
and Bauer, Ren{\'e}
and Martin-Niedecken, Lisa Anna",
title="Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies",
journal="JMIR Serious Games",
year="2021",
month="May",
day="7",
volume="9",
number="2",
pages="e22826",
keywords="multiple sclerosis",
keywords="exergame",
keywords="motor",
keywords="physical",
keywords="cognition",
keywords="usability",
keywords="feasibility",
abstract="Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game--based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. Objective: The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. Methods: Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience--related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. Results: In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=?2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=?2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. Conclusions: The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS. ",
doi="10.2196/22826",
url="https://games.jmir.org/2021/2/e22826",
url="http://www.ncbi.nlm.nih.gov/pubmed/33960956"
}


@Article{info:doi/10.2196/24038,
author="Keniston, Angela
and McBeth, Lauren
and Pell Sr, Jonathan
and Bowden, Kasey
and Ball, Stephen
and Stoebner, Kristin
and Scherzberg, Elaina
and Moore, L. Susan
and Nordhagen, Jamie
and Anthony, Amanda
and Burden, Marisha",
title="Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2021",
month="Apr",
day="23",
volume="8",
number="2",
pages="e24038",
keywords="user-centered design",
keywords="stakeholder engagement",
keywords="health information technology",
keywords="implementation science",
keywords="interdisciplinary",
keywords="teamwork",
keywords="discharge planning",
keywords="discharge readiness tool",
abstract="Background: Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams. Objective: Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings. Methods: We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys. Results: We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54\%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88\%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness. Conclusions: Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool. ",
doi="10.2196/24038",
url="https://humanfactors.jmir.org/2021/2/e24038",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890860"
}


@Article{info:doi/10.2196/21251,
author="Mano, Rita",
title="Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis",
journal="JMIR Hum Factors",
year="2021",
month="Apr",
day="22",
volume="8",
number="2",
pages="e21251",
keywords="mobile health apps",
keywords="health empowerment",
keywords="health management behaviors",
keywords="costs-benefits",
keywords="mobile phone",
abstract="Background: Rising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors. Objective: We introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users. Methods: The analysis is based on individuals' reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96\% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics. Results: The findings indicate that the proposed models were reasonably adequate. In all, 88.76\% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97\% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95\% (1016/1495) of the users for consultation and 71.97\% (1076/1495) of the users for decision making. The model was effective for 88.76\% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97\% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective. Conclusions: The use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use. ",
doi="10.2196/21251",
url="https://humanfactors.jmir.org/2021/2/e21251",
url="http://www.ncbi.nlm.nih.gov/pubmed/33885372"
}


@Article{info:doi/10.2196/25928,
author="LaMonica, M. Haley
and Roberts, E. Anna
and Davenport, A. Tracey
and Hickie, B. Ian",
title="Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study",
journal="JMIR Aging",
year="2021",
month="Apr",
day="21",
volume="4",
number="2",
pages="e25928",
keywords="older adults",
keywords="mental health",
keywords="technology",
keywords="community-based participatory research",
keywords="stakeholder participation",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective: This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods: Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results: A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions: HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need. ",
doi="10.2196/25928",
url="https://aging.jmir.org/2021/2/e25928",
url="http://www.ncbi.nlm.nih.gov/pubmed/33881410"
}


@Article{info:doi/10.2196/19564,
author="Palotai, Miklos
and Wallack, Max
and Kujbus, Gergo
and Dalnoki, Adam
and Guttmann, Charles",
title="Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="16",
volume="9",
number="4",
pages="e19564",
keywords="multiple sclerosis",
keywords="fatigue",
keywords="depression",
keywords="mobile application",
keywords="mobile phone",
keywords="real-time assessment",
abstract="Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88\%) used the app, of which 51 (91\%) completed all one-time questionnaires and 47 (84\%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. ",
doi="10.2196/19564",
url="https://mhealth.jmir.org/2021/4/e19564",
url="http://www.ncbi.nlm.nih.gov/pubmed/33861208"
}


@Article{info:doi/10.2196/17503,
author="Asensio-Cuesta, Sabina
and Blanes-Selva, Vicent
and Conejero, Alberto J.
and Frigola, Ana
and Portol{\'e}s, G. Manuel
and Merino-Torres, Francisco Juan
and Rubio Almanza, Matilde
and Syed-Abdul, Shabbir
and Li, (Jack) Yu-Chuan
and Vilar-Mateo, Ruth
and Fernandez-Luque, Luis
and Garc{\'i}a-G{\'o}mez, M. Juan",
title="A User-Centered Chatbot (Wakamola) to Collect Linked Data in Population Networks to Support Studies of Overweight and Obesity Causes: Design and Pilot Study",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="14",
volume="9",
number="4",
pages="e17503",
keywords="mHealth",
keywords="obesity",
keywords="overweight",
keywords="chatbot",
keywords="assessment",
keywords="public health",
keywords="Telegram",
keywords="user-centered design",
keywords="Social Network Analysis",
abstract="Background: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. Objective: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. Methods: We first studied the users' needs and gathered users' graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. Results: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11\%), 5 overweight people (7\%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. Conclusions: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives. ",
doi="10.2196/17503",
url="https://medinform.jmir.org/2021/4/e17503",
url="http://www.ncbi.nlm.nih.gov/pubmed/33851934"
}


@Article{info:doi/10.2196/22822,
author="Milton, C. Alyssa
and Stewart, Elizabeth
and Ospina-Pinillos, Laura
and Davenport, Tracey
and Hickie, B. Ian",
title="Participatory Design of an Activities-Based Collective Mentoring Program in After-School Care Settings: Connect, Promote, and Protect Program",
journal="JMIR Pediatr Parent",
year="2021",
month="Apr",
day="12",
volume="4",
number="2",
pages="e22822",
keywords="participatory design",
keywords="children",
keywords="after school care",
keywords="health",
keywords="well-being",
keywords="program development",
keywords="community consultation",
abstract="Background: Out of school hours care (OSHC) services provide a unique opportunity to deliver early intervention programs to enhance primary school--aged children's social, emotional, physical, and cognitive well-being; however, such programs are currently lacking. Objective: This study aims to address the lack of well-being programs for children accessing OSHC services in the research literature by using participatory design (PD) to collaboratively develop and test an OSHC well-being program---the connect, promote, and protect program (CP3). Methods: The study employed methods of PD, user (acceptance) testing, and iterative knowledge translation to develop a novel well-being program framework---CP3---with key stakeholders (eg, children, OSHC staff, volunteers, families, clinicians, educators, and researchers). Thematic techniques were used to interpret and translate the qualitative information obtained during the research and design cycles. Results: The co-design process generated the CP3 model, which comprises a group-based mentoring approach to facilitate enhanced activities in OSHC settings. Activities are underpinned by 4 key principles of program delivery: build well-being and resilience, broaden horizons, inspire and engage, and connect communities. Conclusions: To our knowledge, the CP3 program is the first co-designed well-being program developed specifically for OSHC services. This co-design process is key to ensuring local community needs---particularly those of young people accessing OSHC---are met and that these individuals are meaningfully and actively involved in all stages of the research and design process, from conception to implementation, evaluation, and continuous improvement. ",
doi="10.2196/22822",
url="https://pediatrics.jmir.org/2021/2/e22822",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843603"
}


@Article{info:doi/10.2196/25513,
author="Thornton, Louise
and Gardner, Anne Lauren
and Osman, Bridie
and Green, Olivia
and Champion, Elizabeth Katrina
and Bryant, Zachary
and Teesson, Maree
and Kay-Lambkin, Frances
and Chapman, Cath
and ",
title="A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="12",
volume="5",
number="4",
pages="e25513",
keywords="mHealth",
keywords="mobile phone",
keywords="chronic disease",
keywords="adolescents",
keywords="health promotion",
abstract="Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. ",
doi="10.2196/25513",
url="https://formative.jmir.org/2021/4/e25513",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843590"
}


@Article{info:doi/10.2196/20424,
author="Jonathan, K. Geneva
and Dopke, A. Cynthia
and Michaels, Tania
and Bank, Andrew
and Martin, R. Clair
and Adhikari, Krina
and Krakauer, L. Rachel
and Ryan, Chloe
and McBride, Alyssa
and Babington, Pamela
and Frauenhofer, Ella
and Silver, Jamilah
and Capra, Courtney
and Simon, Melanie
and Begale, Mark
and Mohr, C. David
and Goulding, H. Evan",
title="A Smartphone-Based Self-management Intervention for Bipolar Disorder (LiveWell): User-Centered Development Approach",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="12",
volume="8",
number="4",
pages="e20424",
keywords="behavioral intervention technology",
keywords="mHealth",
keywords="bipolar disorder",
keywords="depression",
keywords="illness management",
keywords="smartphone",
keywords="behavior change",
keywords="early warning signs",
keywords="self-management",
keywords="qualitative",
abstract="Background: Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. Objective: This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. Methods: Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. Results: The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40\%), followed by cognitive (25\%), mood (15\%), physical (10\%), and motivational (7\%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. Conclusions: User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development. ",
doi="10.2196/20424",
url="https://mental.jmir.org/2021/4/e20424",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843607"
}


@Article{info:doi/10.2196/26554,
author="Coulter, S. Robert W.
and Mitchell, Shannon
and Prangley, Kelly
and Smallwood, Seth
and Bonanno, Leyna
and Foster, N. Elizabeth
and Wilson, Abby
and Miller, Elizabeth
and Chugani, D. Carla",
title="Generating Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities Among Sexual and Gender Minority Youth: Protocol for a Web-Based, Longitudinal, Human-Centered Design Study",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="12",
volume="10",
number="4",
pages="e26554",
keywords="sexual and gender minorities",
keywords="adolescent",
keywords="psychosocial intervention",
keywords="internet-based intervention",
keywords="intimate partner violence",
abstract="Background: Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective: This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods: We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results: This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions: Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/26554 ",
doi="10.2196/26554",
url="https://www.researchprotocols.org/2021/4/e26554",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843601"
}


@Article{info:doi/10.2196/24565,
author="Tanner, E. Amanda
and Dowshen, Nadia
and Philbin, M. Morgan
and Rulison, L. Kelly
and Camacho-Gonzalez, Andres
and Lee, Susan
and Moore, J. Shamia
and Fortenberry, Dennis J.
and Hussen, A. Sophia",
title="An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="7",
volume="10",
number="4",
pages="e24565",
keywords="HIV",
keywords="mHealth",
keywords="transition to adult care",
keywords="young adult",
keywords="feasibility studies",
keywords="retention in care",
keywords="control groups",
keywords="United States",
keywords="telemedicine",
keywords="HIV infections",
keywords="mobile phone",
abstract="Background: In the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths' care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV. Objective: There are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory--based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition's feasibility and acceptability and to establish preliminary efficacy among youth and provider participants. Methods: The iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability. Results: Phase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023. Conclusions: The development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV. International Registered Report Identifier (IRRID): DERR1-10.2196/24565 ",
doi="10.2196/24565",
url="https://www.researchprotocols.org/2021/4/e24565",
url="http://www.ncbi.nlm.nih.gov/pubmed/33825691"
}


@Article{info:doi/10.2196/20986,
author="Marlin, Nadine
and Rivas, Carol
and Allotey, John
and Dodds, Julie
and Horne, Andrew
and Ball, Elizabeth",
title="Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="5",
volume="10",
number="4",
pages="e20986",
keywords="endometriosis",
keywords="algorithm",
keywords="laparoscopy",
keywords="pain",
keywords="therapeutic",
abstract="Background: Endometriosis is a chronic inflammatory condition affecting 6\%-10\% of women of reproductive age and is defined by the presence of endometrial-like tissue outside the uterus (lesions), commonly affecting the pelvis and ovaries. It is associated with debilitating pelvic pain, infertility, and fatigue and often has devastating effects on the quality of life (QoL). Although it is as common as back pain, it is poorly understood, and treatment and diagnosis are often delayed, leading to unnecessary suffering. Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. Objective: This study aims to determine which women with confirmed endometriosis benefit from surgical improvement in pain and QoL and whether these women could be identified from clinical symptoms measured before laparoscopy. Methods: First, we will carry out a systematic search and review and, if appropriate, meta-analysis of observational cohort and case-control studies reporting one or more risk factors for endometriosis and postsurgical treatment success. We will search PubMed, Embase, and Cochrane databases from inception without language restrictions and supplement the reference lists by manual searches. Second, we will develop separate clinical prediction models for women with confirmed and suspected diagnoses of endometriosis. A total of three suitable databases have been identified for development and external validation (the MEDAL [ISRCTN13028601] and LUNA [ISRCTN41196151] studies, and the BSGE database), and access has been guaranteed. The models will be developed using a linear regression approach that links candidate factors to outcomes. Third, we will hold 2 stakeholder co-design workshops involving eight clinicians and eight women with endometriosis separately and then bring all 16 participants together. Participants will discuss the implementation, delivery, usefulness, and sustainability of the prediction models. Clinicians will also focus on the ease of use and access to clinical prediction tools. Results: This project was funded in March 2018 and approved by the Institutional Research Ethics Board in December 2019. At the time of writing, this study was in the data analysis phase, and the results are expected to be available in April 2021. Conclusions: This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. International Registered Report Identifier (IRRID): DERR1-10.2196/20986 ",
doi="10.2196/20986",
url="https://www.researchprotocols.org/2021/4/e20986",
url="http://www.ncbi.nlm.nih.gov/pubmed/33818394"
}


@Article{info:doi/10.2196/23447,
author="Wong, W. Howard
and Lo, Brian
and Shi, Jenny
and Hollenberg, Elisa
and Abi-Jaoude, Alexxa
and Johnson, Andrew
and Chaim, Gloria
and Cleverley, Kristin
and Henderson, Joanna
and Levinson, Andrea
and Robb, Janine
and Voineskos, Aristotle
and Wiljer, David",
title="Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="2",
volume="8",
number="4",
pages="e23447",
keywords="transition-aged youth",
keywords="qualitative study",
keywords="user experience",
keywords="help-seeking",
keywords="mental health",
keywords="postsecondary",
keywords="mobile apps",
keywords="adolescent",
abstract="Background: There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students. Objective: This study focuses on understanding postsecondary students' attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience. Methods: Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants' overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts. Results: User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time. Conclusions: Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 ",
doi="10.2196/23447",
url="https://mental.jmir.org/2021/4/e23447",
url="http://www.ncbi.nlm.nih.gov/pubmed/33797395"
}


@Article{info:doi/10.2196/22099,
author="Hwang, Youjin
and Shin, Donghoon
and Eun, Jinsu
and Suh, Bongwon
and Lee, Joonhwan",
title="Design Guidelines of a Computer-Based Intervention for Computer Vision Syndrome: Focus Group Study and Real-World Deployment",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="29",
volume="23",
number="3",
pages="e22099",
keywords="computer-based intervention",
keywords="computer vision syndrome",
keywords="system interface",
keywords="deployment study",
abstract="Background: Prolonged time of computer use increases the prevalence of ocular problems, including eye strain, tired eyes, irritation, redness, blurred vision, and double vision, which are collectively referred to as computer vision syndrome (CVS). Approximately 70\% of computer users have vision-related problems. For these reasons, properly designed interventions for users with CVS are required. To design an effective screen intervention for preventing or improving CVS, we must understand the effective interfaces of computer-based interventions. Objective: In this study, we aimed to explore the interface elements of computer-based interventions for CVS to set design guidelines based on the pros and cons of each interface element. Methods: We conducted an iterative user study to achieve our research objective. First, we conducted a workshop to evaluate the overall interface elements that were included in previous systems for CVS (n=7). Through the workshop, participants evaluated existing interface elements. Based on the evaluation results, we eliminated the elements that negatively affect intervention outcomes. Second, we designed our prototype system LiquidEye that includes multiple interface options (n=11). Interface options included interface elements that were positively evaluated in the workshop study. Lastly, we deployed LiquidEye in the real world to see how the included elements affected the intervention outcomes. Participants used LiquidEye for 14 days, and during this period, we collected participants' daily logs (n=680). Additionally, we conducted prestudy and poststudy surveys, and poststudy interviews to explore how each interface element affects participation in the system. Results: User data logs collected from the 14 days of deployment were analyzed with multiple regression analysis to explore the interface elements affecting user participation in the intervention (LiquidEye). Statistically significant elements were the instruction page of the eye resting strategy (P=.01), goal setting of the resting period (P=.009), compliment feedback after completing resting (P<.001), a mid-size popup window (P=.02), and CVS symptom-like effects (P=.004). Conclusions: Based on the study results, we suggested design implications to consider when designing computer-based interventions for CVS. The sophisticated design of the customization interface can make it possible for users to use the system more interactively, which can result in higher engagement in managing eye conditions. There are important technical challenges that still need to be addressed, but given the fact that this study was able to clarify the various factors related to computer-based interventions, the findings are expected to contribute greatly to the research of various computer-based intervention designs in the future. ",
doi="10.2196/22099",
url="https://www.jmir.org/2021/3/e22099",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779568"
}


@Article{info:doi/10.2196/22695,
author="Radu, Roxana
and Hern{\'a}ndez-Ortega, Sara
and Borrega, Oriol
and Palmeri, Avril
and Athanasiou, Dimitrios
and Brooke, Nicholas
and Chap{\'i}, Inma
and Le Corvec, Ana{\"i}s
and Guglieri, Michela
and Perera-Lluna, Alexandre
and Garrido-Aguirre, Jon
and Ryll, Bettina
and Nafria Escalera, Begonya",
title="Global Collaborative Social Network (Share4Rare) to Promote Citizen Science in Rare Disease Research: Platform Development Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="29",
volume="5",
number="3",
pages="e22695",
keywords="Share4Rare",
keywords="rare disease",
keywords="citizen science",
keywords="participatory medicine",
keywords="natural history",
keywords="genotype",
keywords="phenotype",
abstract="Background: Rare disease communities are spread around the globe and segmented by their condition. Little research has been performed on the majority of rare diseases. Most patients who are affected by a rare disease have no research on their condition because of a lack of knowledge due to absence of common groups in the research community. Objective: We aimed to develop a safe and secure community of rare disease patients, without geographic or language barriers, to promote research. Methods: Cocreation design methodology was applied to build Share4Rare, with consultation and input through workshops from a variety of stakeholders (patients, caregivers, clinicians, and researchers). Results: The workshops allowed us to develop a layered version of the platform based on educating patients and caregivers with publicly accessible information, a secure community for the patients and caregivers, and a research section with the purpose of collecting patient information for analysis, which was the core and final value of the platform. Conclusions: Rare disease research requires global collaboration in which patients and caregivers have key roles. Collective intelligence methods implemented in digital platforms reduce geographic and language boundaries and involve patients in a unique and universal project. Their contributions are essential to increase the amount of scientific knowledge that experts have on rare diseases. Share4Rare has been designed as a global platform to facilitate the donation of clinical information to foster research that matters to patients with rare conditions. The codesign methods with patients have been essential to create a patient-centric design. ",
doi="10.2196/22695",
url="https://formative.jmir.org/2021/3/e22695",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779572"
}


@Article{info:doi/10.2196/18079,
author="Saparamadu, Samandika Amarasinghe Arachchige Don Nalin
and Fernando, Piyum
and Zeng, Peizi
and Teo, Henry
and Goh, Andrew
and Lee, Yin Joanne Mee
and Lam, Leslie Choong Weng",
title="User-Centered Design Process of an mHealth App for Health Professionals: Case Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="26",
volume="9",
number="3",
pages="e18079",
keywords="user-centered design",
keywords="participatory design",
keywords="mobile health applications",
keywords="mHealth",
keywords="smartphones",
keywords="health professionals",
keywords="healthcare",
keywords="human-computer interaction",
keywords="mobile phones",
abstract="Background: User-centered design processes are infrequently employed and not fully explored for building mobile health (mHealth) apps that are particularly targeted to health professionals as end users. The authors have used a user-centered design--based approach to build an mHealth app for health professionals, tasked to deliver medical laboratory-related information on a daily basis. Objective: Our objective is to generate a simple and functional user-centered design process for mHealth apps for health professionals. This paper presents the key learnings from design activities. Methods: A stratified random sample of doctors and nurses was recruited for the study. The design activities were planned in the following sequence: focus group discussion for situation analysis and information architecture, design activity 1 for wireframe designing, design activity 2 for wireframe testing, and user testing sessions 1 and 2. Results: The final design and functions of the app, information architecture, and interactive elements were largely influenced by the participatory design--based user-centered design activities. As a result of the design process, we could identify the mental models of processing requests for information and personal preferences based on the experience. These findings were directly or indirectly incorporated into the app design. Furthermore, finding alternative ways of working within time constraints and cultural barriers and the methods employed to manage the challenges of interdisciplinary discourse stood out among the lessons learned. Conclusions: We recommend a user-centered design process based on a participatory design approach in mHealth app design, enriched with focus group discussions where possible. ",
doi="10.2196/18079",
url="https://mhealth.jmir.org/2021/3/e18079",
url="http://www.ncbi.nlm.nih.gov/pubmed/33769297"
}


@Article{info:doi/10.2196/24652,
author="Horsham, Caitlin
and Dutton-Regester, Ken
and Antrobus, Jodie
and Goldston, Andrew
and Price, Harley
and Ford, Helen
and Hacker, Elke",
title="A Virtual Reality Game to Change Sun Protection Behavior and Prevent Cancer: User-Centered Design Approach",
journal="JMIR Serious Games",
year="2021",
month="Mar",
day="25",
volume="9",
number="1",
pages="e24652",
keywords="virtual reality",
keywords="gamification",
keywords="primary prevention",
keywords="health promotion",
keywords="skin cancer",
keywords="mobile phone",
abstract="Background: Public health sun safety campaigns introduced during the 1980s have successfully reduced skin cancer rates in Australia. Despite this success, high rates of sunburn continue to be reported by youth and young adults. As such, new strategies to reinforce sun protection approaches in this demographic are needed. Objective: This study aims to develop a virtual reality (VR) game containing preventive skin cancer messaging and to assess the safety and satisfaction of the design based on end user feedback. Methods: Using a two-phase design approach, we created a prototype VR game that immersed the player inside the human body while being confronted with growing cancer cells. The first design phase involved defining the problem, identifying stakeholders, choosing the technology platform, brainstorming, and designing esthetic elements. In the second design phase, we tested the prototype VR experience with stakeholders and end users in focus groups and interviews, with feedback incorporated into refining and improving the design. Results: The focus groups and interviews were conducted with 18 participants. Qualitative feedback indicated high levels of satisfaction, with all participants reporting the VR game as engaging. A total of 11\% (2/8) of participants reported a side effect of feeling nauseous during the experience. The end user feedback identified game improvements, suggesting an extended multistage experience with visual transitions to other environments and interactions involving cancer causation. The implementation of the VR game identified challenges in sharing VR equipment and hygiene issues. Conclusions: This study presents key findings highlighting the design and implementation approaches for a VR health intervention primarily aimed at improving sun protection behaviors. This design approach can be applied to other health prevention programs in the future. ",
doi="10.2196/24652",
url="https://games.jmir.org/2021/1/e24652",
url="http://www.ncbi.nlm.nih.gov/pubmed/33764308"
}


@Article{info:doi/10.2196/26355,
author="Zucchelli, Fabio
and Donnelly, Olivia
and Rush, Emma
and Smith, Harriet
and Williamson, Heidi
and ",
title="Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders' Input",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="24",
volume="5",
number="3",
pages="e26355",
keywords="mobile health",
keywords="acceptance and commitment therapy",
keywords="appearance",
keywords="qualitative",
keywords="participatory design",
keywords="mobile phone",
abstract="Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention's design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders' design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords. ",
doi="10.2196/26355",
url="https://formative.jmir.org/2021/3/e26355",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759791"
}


@Article{info:doi/10.2196/24062,
author="Morse, S. Robert
and Lambden, Kaley
and Quinn, Erin
and Ngoma, Twalib
and Mushi, Beatrice
and Ho, Xian Yun
and Ngoma, Mamsau
and Mahuna, Habiba
and Sagan, B. Sarah
and Mmari, Joshua
and Miesfeldt, Susan",
title="A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="23",
volume="7",
number="1",
pages="e24062",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="palliative care",
keywords="pain",
keywords="cancer",
keywords="sub-Saharan Africa",
keywords="mobile phone",
abstract="Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life--focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users---patients or caregivers, LHWs, and members of the palliative care team---and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. ",
doi="10.2196/24062",
url="https://cancer.jmir.org/2021/1/e24062",
url="http://www.ncbi.nlm.nih.gov/pubmed/33755022"
}


@Article{info:doi/10.2196/21312,
author="Bhattacharjya, Sutanuka
and Cavuoto, Anne Lora
and Reilly, Brandon
and Xu, Wenyao
and Subryan, Heamchand
and Langan, Jeanne",
title="Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Mar",
day="22",
volume="8",
number="1",
pages="e21312",
keywords="stroke",
keywords="rehabilitation",
keywords="smart technology",
keywords="3-dimensional printing",
keywords="usability",
abstract="Background: Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. Objective: This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. Methods: A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants' qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. Results: Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. Conclusions: Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users' needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. Trial Registration: ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944 ",
doi="10.2196/21312",
url="https://humanfactors.jmir.org/2021/1/e21312",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749608"
}


@Article{info:doi/10.2196/25604,
author="Hsieh, Katherine
and Fanning, Jason
and Frechette, Mikaela
and Sosnoff, Jacob",
title="Usability of a Fall Risk mHealth App for People With Multiple Sclerosis: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Mar",
day="22",
volume="8",
number="1",
pages="e25604",
keywords="smartphone",
keywords="user center design",
keywords="falls",
keywords="mobile phone",
abstract="Background: Multiple sclerosis (MS) is a chronic, neurodegenerative disease that causes a range of motor, sensory, and cognitive symptoms. Due to these symptoms, people with MS are at a high risk for falls, fall-related injuries, and reductions in quality of life. There is no cure for MS, and managing symptoms and disease progression is important to maintain a high quality of life. Mobile health (mHealth) apps are commonly used by people with MS to help manage their health. However, there are limited health apps for people with MS designed to evaluate fall risk. A fall risk app can increase access to fall risk assessments and improve self-management. When designing mHealth apps, a user-centered approach is critical for improving use and adoption. Objective: The purpose of this study is to undergo a user-centered approach to test and refine the usability of the app through an iterative design process. Methods: The fall risk app Steady-MS is an extension of Steady, a fall risk app for older adults. Steady-MS consists of 2 components: a 25-item questionnaire about demographics and MS symptoms and 5 standing balance tasks. Data from the questionnaire and balance tasks were inputted into an algorithm to compute a fall risk score. Two iterations of semistructured interviews (n=5 participants per iteration) were performed to evaluate usability. People with MS used Steady-MS on a smartphone, thinking out loud. Interviews were recorded, transcribed, and developed into codes and themes. People with MS also completed the System Usability Scale. Results: A total of 3 themes were identified: intuitive navigation, efficiency of use, and perceived value. Overall, the participants found Steady-MS efficient to use and useful to learn their fall risk score. There were challenges related to cognitive overload during the balance tasks. Modifications were made, and after the second iteration, people with MS reported that the app was intuitive and efficient. Average System Usability Scale scores were 95.5 in both iterations, representing excellent usability. Conclusions: Steady-MS is the first mHealth app for people with MS to assess their overall risk of falling and is usable by a subset of people with MS. People with MS found Steady-MS to be usable and useful for understanding their risk of falling. When developing future mHealth apps for people with MS, it is important to prevent cognitive overload through simple and clear instructions and present scores that are understood and interpreted correctly through visuals and text. These findings underscore the importance of user-centered design and provide a foundation for the future development of tools to assess and prevent scalable falls for people with MS. Future steps include understanding the validity of the fall risk algorithm and evaluating the clinical utility of the app. ",
doi="10.2196/25604",
url="https://humanfactors.jmir.org/2021/1/e25604",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749609"
}


@Article{info:doi/10.2196/24343,
author="Mariamo, Audrey
and Temcheff, Elizabeth Caroline
and L{\'e}ger, Pierre-Majorique
and Senecal, Sylvain
and Lau, Alexandra Marianne",
title="Emotional Reactions and Likelihood of Response to Questions Designed for a Mental Health Chatbot Among Adolescents: Experimental Study",
journal="JMIR Hum Factors",
year="2021",
month="Mar",
day="18",
volume="8",
number="1",
pages="e24343",
keywords="chatbots",
keywords="conversational agents",
keywords="mental health",
keywords="well-being",
keywords="adolescents",
keywords="user experience",
keywords="user preferences",
abstract="Background: Psychological distress increases across adolescence and has been associated with several important health outcomes with consequences that can extend into adulthood. One type of technological innovation that may serve as a unique intervention for youth experiencing psychological distress is the conversational agent, otherwise known as a chatbot. Further research is needed on the factors that may make mental health chatbots destined for adolescents more appealing and increase the likelihood that adolescents will use them. Objective: The aim of this study was to assess adolescents' emotional reactions and likelihood of responding to questions that could be posed by a mental health chatbot. Understanding adolescent preferences and factors that could increase adolescents' likelihood of responding to chatbot questions could assist in future mental health chatbot design destined for youth. Methods: We recruited 19 adolescents aged 14 to 17 years to participate in a study with a 2{\texttimes}2{\texttimes}3 within-subjects factorial design. Each participant was sequentially presented with 96 chatbot questions for a duration of 8 seconds per question. Following each presentation, participants were asked to indicate how likely they were to respond to the question, as well as their perceived affective reaction to the question. Demographic data were collected, and an informal debriefing was conducted with each participant. Results: Participants were an average of 15.3 years old (SD 1.00) and mostly female (11/19, 58\%). Logistic regressions showed that the presence of GIFs predicted perceived emotional valence ($\beta$=--.40, P<.001), such that questions without GIFs were associated with a negative perceived emotional valence. Question type predicted emotional valence, such that yes/no questions ($\beta$=--.23, P=.03) and open-ended questions ($\beta$=--.26, P=.01) were associated with a negative perceived emotional valence compared to multiple response choice questions. Question type also predicted the likelihood of response, such that yes/no questions were associated with a lower likelihood of response compared to multiple response choice questions ($\beta$=--.24, P=.03) and a higher likelihood of response compared to open-ended questions ($\beta$=.54, P<.001). Conclusions: The findings of this study add to the rapidly growing field of teen-computer interaction and contribute to our understanding of adolescent user experience in their interactions with a mental health chatbot. The insights gained from this study may be of assistance to developers and designers of mental health chatbots. ",
doi="10.2196/24343",
url="https://humanfactors.jmir.org/2021/1/e24343",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734089"
}


@Article{info:doi/10.2196/19519,
author="Richardson, Julie
and Letts, Lori
and Sinclair, Susanne
and Chan, David
and Miller, Jordan
and Donnelly, Catherine
and Smith-Turchyn, Jenna
and Wojkowski, Sarah
and Gravesande, Janelle
and Loyola S{\'a}nchez, Adalberto",
title="Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Mar",
day="18",
volume="8",
number="1",
pages="e19519",
keywords="rehabilitation",
keywords="physiotherapy",
keywords="occupational therapy",
keywords="self-management",
keywords="function",
keywords="web-based application",
keywords="usability",
keywords="user-centered design",
abstract="Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ?45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. ",
doi="10.2196/19519",
url="https://rehab.jmir.org/2021/1/e19519",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734090"
}


@Article{info:doi/10.2196/24846,
author="Chaniaud, No{\'e}mie
and Megalakaki, Olga
and Capo, Sophie
and Loup-Escande, Emilie",
title="Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="Mar",
day="17",
volume="8",
number="1",
pages="e24846",
keywords="user characteristics",
keywords="health literacy",
keywords="home medical devices",
keywords="usability study",
keywords="remote health",
keywords="home health",
abstract="Background: The Smart Angel home medical device allows ambulatory surgery patients to monitor their own health by taking their blood pressure and oxygen levels and answering a health questionnaire from home. Currently, this device is a prototype in the design phase, and no usability evaluation has been performed.  This preventive device must be usable by patients with different profiles; however, it is important to select patients carefully to ensure their safety when using the device. As such, it would be interesting to know how to select or exclude patients. However, the links between user characteristics and the usability of this home medical device remain unclear. Objective: This study aims to better understand the links between certain characteristics of potential patients (ie, age, education, technophilia, and health literacy) and the usability (ie, effectiveness, efficiency, and satisfaction) of Smart Angel, as defined by the ISO 9241-11. Methods: We conducted an experimental study involving 36 participants investigating the effects of 4 patient characteristics (ie, age, education, technophilia, and health literacy) on usability, measured in terms of effectiveness, efficiency, and satisfaction. A mixed methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). First, to help participants project themselves into the real use of the Smart Angel device, they watched a scenario in a video. Second, the participants completed a set of questionnaires to show the extent of their health literacy level (Newest Vital Sign [NVS] and the Health Literacy Survey [HLS]) and then operated Smart Angel devices. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (System Usability Scale [SUS]). The qualitative observational data were coded using inductive analysis by 2 independent researchers specialized in cognitive psychology and cognitive ergonomics. Results: The results show a moderate and positive correlation between age and effectiveness (r=0.359; P=.03) and efficiency (r=0.357; P=.03). There is strong correlation between health literacy scored by the NVS and effectiveness (r=0.417; P=.01), efficiency (r=-0.38; P=.02), and satisfaction (r=0.45; P=.006). However, there is a weak correlation between technophilia and usability and no relationship between education level and usability. Conclusions: Our results show that literacy level and age are 2 important factors to consider when selecting future users of the Smart Angel device to ensure patient safety. This study also serves as an example promoting mixed methodologies in assessments of medical device usability that cannot be performed under real-world conditions. ",
doi="10.2196/24846",
url="https://humanfactors.jmir.org/2021/1/e24846",
url="http://www.ncbi.nlm.nih.gov/pubmed/33729161"
}


@Article{info:doi/10.2196/15032,
author="Witteman, O. Holly
and Vaisson, Gratianne
and Provencher, Thierry
and Chipenda Dansokho, Selma
and Colquhoun, Heather
and Dugas, Michele
and Fagerlin, Angela
and Giguere, MC Anik
and Haslett, Lynne
and Hoffman, Aubri
and Ivers, M. Noah
and L{\'e}gar{\'e}, France
and Trottier, Marie-Eve
and Stacey, Dawn
and Volk, J. Robert
and Renaud, Jean-S{\'e}bastien",
title="An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="16",
volume="23",
number="3",
pages="e15032",
keywords="patient-centered care",
keywords="patient participation",
keywords="health services research",
keywords="validation studies as topic",
keywords="surveys and questionnaires",
keywords="humans",
keywords="user-centred design, human-centred design",
keywords="user-centered design",
keywords="human-centered design",
keywords="co-design",
keywords="instrument",
keywords="scale",
keywords="index",
keywords="patient and public involvement",
abstract="Background: Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. Objective: The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. Methods: We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. Results: We retained 11 items in a 3-factor structure explaining 68\% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. Conclusions: The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools. ",
doi="10.2196/15032",
url="https://www.jmir.org/2021/3/e15032",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724194"
}


@Article{info:doi/10.2196/24738,
author="Ammar, Nariman
and Bailey, E. James
and Davis, L. Robert
and Shaban-Nejad, Arash",
title="Using a Personal Health Library--Enabled mHealth Recommender System for Self-Management of Diabetes Among Underserved Populations: Use Case for Knowledge Graphs and Linked Data",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="16",
volume="5",
number="3",
pages="e24738",
keywords="personal health library",
keywords="mobile health",
keywords="personal health knowledge graph",
keywords="patient-centered design",
keywords="personalized health",
keywords="recommender system",
keywords="observations of daily living",
keywords="Semantic Web",
keywords="privacy",
abstract="Background: Traditionally, digital health data management has been based on electronic health record (EHR) systems and has been handled primarily by centralized health providers. New mechanisms are needed to give patients more control over their digital health data. Personal health libraries (PHLs) provide a single point of secure access to patients' digital health data and enable the integration of knowledge stored in their digital health profiles with other sources of global knowledge. PHLs can help empower caregivers and health care providers to make informed decisions about patients' health by understanding medical events in the context of their lives. Objective: This paper reports the implementation of a mobile health digital intervention that incorporates both digital health data stored in patients' PHLs and other sources of contextual knowledge to deliver tailored recommendations for improving self-care behaviors in diabetic adults. Methods: We conducted a thematic assessment of patient functional and nonfunctional requirements that are missing from current EHRs based on evidence from the literature. We used the results to identify the technologies needed to address those requirements. We describe the technological infrastructures used to construct, manage, and integrate the types of knowledge stored in the PHL. We leverage the Social Linked Data (Solid) platform to design a fully decentralized and privacy-aware platform that supports interoperability and care integration. We provided an initial prototype design of a PHL and drafted a use case scenario that involves four actors to demonstrate how the proposed prototype can be used to address user requirements, including the construction and management of the PHL and its utilization for developing a mobile app that queries the knowledge stored and integrated into the PHL in a private and fully decentralized manner to provide better recommendations. Results: To showcase the main features of the mobile health app and the PHL, we mapped those features onto a framework comprising the user requirements identified in a use case scenario that features a preventive intervention from the diabetes self-management domain. Ongoing development of the app requires a formative evaluation study and a clinical trial to assess the impact of the digital intervention on patient-users. We provide synopses of both study protocols. Conclusions: The proposed PHL helps patients and their caregivers take a central role in making decisions regarding their health and equips their health care providers with informatics tools that support the collection and interpretation of the collected knowledge. By exposing the PHL functionality as an open service, we foster the development of third-party applications or services and provide motivational technological support in several projects crossing different domains of interest. ",
doi="10.2196/24738",
url="https://formative.jmir.org/2021/3/e24738",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724197"
}


@Article{info:doi/10.2196/25148,
author="Otokiti, Umar Ahmed
and Craven, K. Catherine
and Shetreat-Klein, Avniel
and Cohen, Stacey
and Darrow, Bruce",
title="Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="16",
volume="10",
number="3",
pages="e25148",
keywords="electronic health records",
keywords="burnout, psychological",
keywords="user-centered design",
keywords="usability",
keywords="EHR optimization",
abstract="Background: Up to 60\% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective: This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods: Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results: The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6--month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions: The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID): PRR1-10.2196/25148 ",
doi="10.2196/25148",
url="https://www.researchprotocols.org/2021/3/e25148",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724202"
}


@Article{info:doi/10.2196/23568,
author="Lindsay, Sally
and Kolne, Kendall
and Barker, J. Donna
and Colantonio, Angela
and Stinson, Jennifer
and Moll, Sandra
and Thomson, Nicole",
title="Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="15",
volume="5",
number="3",
pages="e23568",
keywords="continuing education",
keywords="gender-identity",
keywords="gender-sensitive care",
keywords="rehabilitation",
abstract="Background: Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective: This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods: We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results: Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions: Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities. ",
doi="10.2196/23568",
url="https://formative.jmir.org/2021/3/e23568",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720023"
}


@Article{info:doi/10.2196/24006,
author="Biehl, Verena
and Becker, Heidrun
and Ogrin, Alenka
and Reissner, Alenka
and Burger, Johannes
and Glaessel, Andrea",
title="User-Centered Development of a Web Platform Supporting Community-Based Health Care Organizations for Older Persons in Need of Support: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="10",
volume="23",
number="3",
pages="e24006",
keywords="community-based health care services",
keywords="older persons in need of support",
keywords="user-centered design",
keywords="focus groups",
keywords="qualitative research",
keywords="web platform",
abstract="Background: The ongoing changes in population demographics increase the relevance of dignified aging across Europe. Community-based health care (CBHC) organizations are necessary to provide sustainable strategies for organizing care for older persons in need of support. To support the digitalization of these organizations, new business models and suitable web platforms are necessary. Objective: This study, which is part of the European Active and Assisted Living (AAL) project called ``ICareCoops'', aimed to explore concepts, approaches, and workflows of CBHC organizations to achieve a comprehensive understanding of extant services offered and relevant requirements to support these services with information and computer technology (ICT) solutions. Methods: A qualitative study with six focus groups (FGs) with 40 participants was conducted in Switzerland and Slovenia to identify potential stakeholders' needs and requirements for the user-centered development of a web platform. Data were collected from three different stakeholder groups: (1) older persons in need of support as care receivers, (2) significant others of older persons in need of support, and (3) managers or care providers of CBHC organizations. A semistructured interview guide with open questions was used for data collection. FG sessions were audio-recorded and transcribed verbatim. Thematic content analysis was used to analyze the content of the FG sessions. To assist with further web platform development, the responses of the FG participants were translated into user stories to describe technical requirements. Results: By analyzing the transcripts, five main categories were identified: (1) ICT usage behavior of users, (2) challenges of web platform usage, (3) content and technical requirements for the web platform, (4) form and services of CBHC organizations, and (5) rationales of CBHC organizations. The main issues identified were the need for seniors to have individual contact with the CBHC organization and the possibility to coordinate routine services via the web platform, such as ordering meals-on-wheels or booking a caregiver to accompany an older person to the doctor. Conclusions: The majority of participants showed a lack of familiarity with the usage of ICT. Nevertheless, they were open-minded regarding web platform usage to facilitate workflows and to benefit CBHC organizations. Cooperatives as an organizational model demonstrate a high potential to address users' needs. Therefore, the web platform offers an essential tool for innovative health care models in the future. Searching for care services, contacting care providers, and communicating with care providers was preferred via personal contact and seemed to be the key element for user acceptance and for the successful implementation of a web platform like ``ICareCoops'' to support CBHC organizations. ",
doi="10.2196/24006",
url="https://www.jmir.org/2021/3/e24006",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688837"
}


@Article{info:doi/10.2196/25617,
author="Thilsing, Trine
and Larsen, Bruun Lars
and Sonderlund, Larrabee Anders
and Andreassen, Skaarup Signe
and Christensen, Reffstrup Jeanette
and Svensson, Herning Nanna
and Dahl, Marie
and Sondergaard, Jens",
title="Effects of a Co-Design--Based Invitation Strategy on Participation in a Preventive Health Check Program: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2021",
month="Mar",
day="10",
volume="7",
number="3",
pages="e25617",
keywords="participation rate",
keywords="prenotification",
keywords="invitation letter",
keywords="co-design",
keywords="preventive health checks",
keywords="primary care",
abstract="Background: Preventive primary care programs that aim to reduce morbidity and mortality from lifestyle-related diseases are often affected by low-to-moderate participation rates. Improving participation rates is essential for clinical effectiveness and cost-effectiveness. In 2016-2017, we conducted a pilot study (TOF pilot1) for a preventive primary care intervention (TOF is the Danish abbreviation for ``Early Detection and Prevention''). Among 8814 invited patients, 3545 (40.22\%) consented to participate, with the highest participation rates among women and patients with higher income, education, and employment. Objective: The aim of this study was to evaluate the effects of a revised invitation strategy on invitation comprehensibility, the overall participation rate, and participant demography. The new strategy specifically targeted men and patients of low educational attainment. Methods: This study was embedded in the second TOF pilot study (TOF pilot2, initiated in October 2018) that tested an adjusted intervention. The revised invitation strategy comprised a prenotification postcard and a new invitation that specifically targeted men and patients of low educational attainment. The new invitation was developed in a co-design process that included communication professionals and target-group representatives. The study sample consisted of 4633 patients aged between 29 and 59 years, who resided in one of two municipalities in the Region of Southern Denmark. Eligible patients were randomly assigned to one of four invitation groups. The control group (Group 1) received the original invitation used in TOF pilot1. The intervention groups received the original invitation and the prenotification postcard (Group 2), the new revised invitation and the prenotification postcard (Group 3), or the new invitation but no prenotification postcard (Group 4). Results: Overall, 2171 (46.86\%) patients consented to participate. Compared to the control group, participation rates increased significantly in all three intervention groups (all P<.001). Participation across the three intervention groups increased for women and men, as well as for patients with high and low educational attainment and high and low family income. The largest relative increase in participation rates occurred among men, patients with low educational attainment, and patients with low family income. No  increase in participation was detected for unemployed patients or patients of non-Danish origin. Most participants found the original (813/987, 82.37\%) and new (965/1133, 85.17\%) invitations easy to understand with no significant difference (P=.08) in comprehensibility between invitations. Conclusions: The results suggest that participation in preventive primary care interventions can be greatly increased by implementing a co-design--based invitation strategy that includes prenotification postcards and targeted invitations. Although firm conclusions cannot be made from this study, the observed increased participation rates for men and patients of low socioeconomic status may be relevant in programs that aim to reduce social inequality in health. Trial Registration: ClinicalTrials.gov NCT03913585; https://clinicaltrials.gov/ct2/show/NCT03913585 ",
doi="10.2196/25617",
url="https://publichealth.jmir.org/2021/3/e25617",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688836"
}


@Article{info:doi/10.2196/18325,
author="Wolbers, Roos
and Bode, Christina
and Siemerink, Ester
and Siesling, Sabine
and Pieterse, Marcel",
title="Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="10",
volume="5",
number="3",
pages="e18325",
keywords="breast cancer",
keywords="cognitive bias modification",
keywords="eHealth",
keywords="fatigue",
keywords="oncology",
keywords="psychology",
keywords="vitality",
abstract="Background: More than 50\% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients. ",
doi="10.2196/18325",
url="https://formative.jmir.org/2021/3/e18325",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688833"
}


@Article{info:doi/10.2196/22370,
author="Chu, H. Charlene
and Biss, K. Ren{\'e}e
and Cooper, Lara
and Quan, Linh Amanda My
and Matulis, Henrique",
title="Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study",
journal="JMIR Serious Games",
year="2021",
month="Mar",
day="9",
volume="9",
number="1",
pages="e22370",
keywords="user-centered design",
keywords="aged",
keywords="long-term care",
keywords="nursing homes",
abstract="Background: Older adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments.  Objective: This study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input. Methods: This study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat.  Results: A total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat's ability to increase residents' autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants.  Conclusions: This study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents' physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials. ",
doi="10.2196/22370",
url="https://games.jmir.org/2021/1/e22370",
url="http://www.ncbi.nlm.nih.gov/pubmed/33687337"
}


@Article{info:doi/10.2196/26168,
author="Lewis, Matthew
and Palmer, J. Victoria
and Kotevski, Aneta
and Densley, Konstancja
and O'Donnell, L. Meaghan
and Johnson, Caroline
and Wohlgezogen, Franz
and Gray, Kathleen
and Robins-Browne, Kate
and Burchill, Luke",
title="Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="9",
volume="10",
number="3",
pages="e26168",
keywords="mental health",
keywords="mobile applications",
keywords="COVID-19",
keywords="health personnel",
keywords="experience-based co-design",
keywords="impact",
keywords="evaluation",
keywords="digital interventions",
keywords="app",
keywords="intervention",
keywords="health care worker",
keywords="design",
keywords="delivery",
keywords="support",
abstract="Background: The COVID-19 pandemic has highlighted the importance of health care workers' mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 ",
doi="10.2196/26168",
url="https://www.researchprotocols.org/2021/3/e26168",
url="http://www.ncbi.nlm.nih.gov/pubmed/33635823"
}


@Article{info:doi/10.2196/24501,
author="Lu{\vs}trek, Mitja
and Bohanec, Marko
and Cavero Barca, Carlos
and Ciancarelli, Costanza Maria
and Clays, Els
and Dawodu, Adeyemo Amos
and Derboven, Jan
and De Smedt, Delphine
and Dovgan, Erik
and Lampe, Jure
and Marino, Flavia
and Mlakar, Miha
and Pioggia, Giovanni
and Puddu, Emilio Paolo
and Rodr{\'i}guez, Mario Juan
and Schiariti, Michele
and Slapni{\v c}ar, Ga{\vs}per
and Slegers, Karin
and Tartarisco, Gennaro
and Vali{\v c}, Jakob
and Vodopija, Aljo{\vs}a",
title="A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="5",
volume="9",
number="3",
pages="e24501",
keywords="congestive heart failure",
keywords="personal health system",
keywords="mobile application",
keywords="mobile phone",
keywords="wearable electronic devices",
keywords="decision support techniques",
keywords="psychological support",
keywords="human centered design",
abstract="Background: Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated. Objective: The HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions. Methods: A mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psychological profile recognition. These methods feed a decision support system that provides recommendations on physical health and psychological support. The system was designed using a human-centered methodology involving the patients throughout development. It was evaluated in a proof-of-concept trial with 56 patients. Results: Fairly high accuracy of the patient-monitoring methods was observed. The mean absolute error of BP estimation was 9.0 mm Hg for systolic BP and 7.0 mm Hg for diastolic BP. The accuracy of psychological profile detection was 88.6\%. The F-measure for physical activity recognition was 71\%. The proof-of-concept clinical trial in 56 patients showed that the HeartMan system significantly improved self-care behavior (P=.02), whereas depression and anxiety rates were significantly reduced (P<.001), as were perceived sexual problems (P=.01). According to the Unified Theory of Acceptance and Use of Technology questionnaire, a positive attitude toward HeartMan was seen among end users, resulting in increased awareness, self-monitoring, and empowerment. Conclusions: The HeartMan project combined a range of advanced technologies with human-centered design to develop a complex system that was shown to help patients with CHF. More psychological than physical benefits were observed. Trial Registration: ClinicalTrials.gov NCT03497871; https://clinicaltrials.gov/ct2/history/NCT03497871. International Registered Report Identifier (IRRID): RR2-10.1186/s12872-018-0921-2 ",
doi="10.2196/24501",
url="https://medinform.jmir.org/2021/3/e24501",
url="http://www.ncbi.nlm.nih.gov/pubmed/33666562"
}


@Article{info:doi/10.2196/24302,
author="Godfrey, M. Emily
and Kazmerski, M. Traci
and Brown, Georgia
and Thayer, K. Erin
and Mentch, Laura
and Pam, Molly
and Al Achkar, Morhaf",
title="Educational Needs and Preferences for Patient-Centered Outcomes Research in the Cystic Fibrosis Community: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="4",
volume="5",
number="3",
pages="e24302",
keywords="cystic fibrosis",
keywords="needs assessment",
keywords="patient-centered outcomes research",
keywords="training",
keywords="education",
keywords="team building",
keywords="patient engagement",
abstract="Background: Cystic fibrosis (CF) is a rare, life-shortening, multiorgan disease, the treatment of which has seen significant increases in the life expectancy of those with CF. Many advances in CF care are thanks to the dedicated and active participation of people with CF as research participants. Unfortunately, most CF research teams still do not fully partner with people with CF or their caregivers. Objective: The aim of this study was to determine the interest, knowledge gaps, and desired format for patient-centered outcomes research (PCOR) training in the CF community. Methods: We surveyed patients, caregivers, researchers, research staff, and diverse health care providers via list servers and social media outreach about their knowledge of, experience with, and preferences for PCOR training components. We followed the survey with 3 small-group discussion sessions with 22 participants who completed the survey to establish consensus and prioritize key learning components of a PCOR training program. We summarized results using descriptive statistics. Results: A total of 170 participants completed the survey (patients/caregivers: 96/170, 56.5\%; researchers/health care providers: 74/170, 43.5\%). Among providers, 26\% (19/74) were physicians/advanced practice providers, 20\% (15/74) were nurses, and 54\% (40/74) were from other disciplines. Among all participants, 86.5\% (147/170) expressed interest in learning about PCOR, although training topics and training format differed between the patient/caregiver and researcher/health care provider groups. Before participating in PCOR, patients/caregivers wanted to understand more about expectations of them as partners on PCOR research teams (82/96, 85\%). Meanwhile, researchers/health care providers desired information on how to include outcomes important to patients/caregivers (55/74, 74\%) and the quality and impact of PCOR research (52/74, 70\% and 51/74, 69\%, respectively). Patients/caregivers were most interested in learning about the time commitment as a PCOR team member (75/96, 78\%). Researchers/health care providers wanted to receive training about how to establish trust (47/74, 64\%) and maintain confidentiality (47/74, 64\%) when including patient or caregiver partners on the PCOR team. During follow-up discussions, participants emphasized the importance of addressing the traditional patient/caregiver and researchers/health care provider hierarchy by teaching about transparency, appreciation, creating a common language between the groups, and providing specific training on ``how'' to do PCOR. Conclusions: Our findings suggest CF community members are interested in PCOR. A high-quality training program would fill a current deficit in methodological research. This assessment identified the topics and formats desired and can be used to develop targeted training to enhance meaningful PCOR in CF. ",
doi="10.2196/24302",
url="https://formative.jmir.org/2021/3/e24302",
url="http://www.ncbi.nlm.nih.gov/pubmed/33661127"
}


@Article{info:doi/10.2196/15846,
author="Dekkers, Tessa
and Melles, Marijke
and Vehmeijer, W. Stephan B.
and de Ridder, Huib",
title="Effects of Information Architecture on the Effectiveness and User Experience of Web-Based Patient Education in Middle-Aged and Older Adults: Online Randomized Experiment",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="3",
volume="23",
number="3",
pages="e15846",
keywords="user-computer interface",
keywords="total joint replacement",
keywords="user-centered design",
keywords="health education",
keywords="mobile phone",
keywords="computer-assisted instruction",
keywords="patient education as topic",
keywords="models, theoretical",
keywords="middle aged",
keywords="aged",
keywords="humans",
keywords="internet",
abstract="Background: Web-based patient education is increasingly offered to improve patients' ability to learn, remember, and apply health information. Efficient organization, display, and structural design, that is, information architecture (IA), can support patients' ability to independently use web-based patient education. However, the role of IA in the context of web-based patient education has not been examined systematically. Objective: To support intervention designers in making informed choices that enhance patients' learning, this paper describes a randomized experiment on the effects of IA on the effectiveness, use, and user experience of a patient education website and examines the theoretical mechanisms that explain these effects. Methods: Middle-aged and older adults with self-reported hip or knee joint complaints were recruited to use and evaluate 1 of 3 patient education websites containing information on total joint replacement surgery. Each website contained the same textual content based on an existing leaflet but differed in the employed IA design (tunnel, hierarchical, or matrix design). Participants rated the websites on satisfaction, engagement, control, relevance, trust, and novelty and completed an objective knowledge test. Analyses of variance and structural equation modeling were used to examine the effects of IA and construct a theoretical model. Results: We included 215 participants in our analysis. IA did not affect knowledge gain (P=.36) or overall satisfaction (P=.07) directly. However, tunnel (mean 3.22, SD 0.67) and matrix (mean 3.17, SD 0.69) architectures were found to provide more emotional support compared with hierarchical architectures (mean 2.86, SD 0.60; P=.002). Furthermore, increased perceptions of personal relevance in the tunnel IA ($\beta$=.18) were found to improve satisfaction ($\beta$=.17) indirectly. Increased perceptions of active control in the matrix IA ($\beta$=.11) also improved satisfaction ($\beta$=.27) indirectly. The final model of the IA effects explained 74.3\% of the variance in satisfaction and 6.8\% of the variance in knowledge and achieved excellent fit ($\chi$217,215=14.7; P=.62; root mean square error of approximation=0.000; 95\% CI [0.000-0.053]; comparative fit index=1.00; standardized root mean square residual=0.044). Conclusions: IA has small but notable effects on users' experiences with web-based health education interventions. Web-based patient education designers can employ tunnel IA designs to guide users through sequentially ordered content or matrix IA to offer users more control over navigation. Both improve user satisfaction by increasing user perceptions of relevance (tunnel) and active control (matrix). Although additional research is needed, hierarchical IA designs are currently not recommended, as hierarchical content is perceived as less supportive, engaging, and relevant, which may diminish the use and, in turn, the effect of the educational intervention. ",
doi="10.2196/15846",
url="https://www.jmir.org/2021/3/e15846",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656446"
}


@Article{info:doi/10.2196/19309,
author="Sesel, Amy-Lee
and Sharpe, Louise
and Beadnall, N. Heidi
and Barnett, H. Michael
and Szabo, Marianna
and Naismith, L. Sharon",
title="Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="2",
volume="23",
number="3",
pages="e19309",
keywords="multiple sclerosis",
keywords="mindfulness",
keywords="depression",
keywords="program development",
keywords="internet intervention",
keywords="qualitative research",
abstract="Background: Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision. Objective: This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. Methods: We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8). Results: We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. Conclusions: The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program. ",
doi="10.2196/19309",
url="https://www.jmir.org/2021/3/e19309",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650980"
}


@Article{info:doi/10.2196/18164,
author="Abrantes, Diogo
and Teles, Soraia
and Tavares de Sousa, Rita
and Freitas, Alberto
and Vieira-Marques, Pedro
and Ferreira, Ana",
title="A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study",
journal="JMIR Aging",
year="2021",
month="Mar",
day="1",
volume="4",
number="1",
pages="e18164",
keywords="aging",
keywords="ambient assisted living",
keywords="elderly",
keywords="usability testing",
keywords="user-centered design",
abstract="Background: Aging of the global population is slowly paving the way for new markets for care products and services. The desire of older people to maintain their independence while remaining at home is boosting the development of ambient assisted living (AAL) solutions. Lack of user awareness of AAL solutions paired with an insufficient use of user-centered and participatory design approaches in the development of these products has hindered the uptake of these solutions by end users. Objective: This study aims to describe the usability and users' experiences within a novel platform, ActiveAdvice, aimed at offering advice and a holistic market overview of AAL products and services. Methods: Usability tests were performed on the developed platform among identified prospective end users, with 32 older adults and informal carers from 4 European countries being part of the user tests. The usability and appeal of the web interface design, information flow, and information architecture were analyzed by collecting both objective and subjective measures. These would include pretest and posttest surveys, along with a series of think-aloud tasks to be performed within the platform. Results: The outcomes suggest that the ActiveAdvice platform's objectives and functionalities are mostly aligned with the needs and expectations of end users, who demonstrated interest in using it, stressing its purpose along with its simple and intuitive interaction. Task completion rates were high, and participants had good satisfaction rates when navigating the platform. However, the tests still advocate for an improved design at some points and better disclosure of information. Conclusions: Our findings shed light on a few peculiarities of interface design, information architecture, user needs, and preferred functionalities, which should be applied to future developments of similar platforms with related services. The AAL field could benefit from tools supporting the dissemination of available AAL solutions and how they can improve one's quality of life. These tools may benefit not only older adults but also caregivers, business owners, and governmental employees. ",
doi="10.2196/18164",
url="https://aging.jmir.org/2021/1/e18164",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646134"
}


@Article{info:doi/10.2196/18172,
author="Alqahtani, Felwah
and Winn, Andrea
and Orji, Rita",
title="Co-Designing a Mobile App to Improve Mental Health and Well-Being: Focus Group Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="26",
volume="5",
number="2",
pages="e18172",
keywords="mental health",
keywords="mobile app",
keywords="focus groups",
keywords="design recommendation",
keywords="mobile phone",
abstract="Background: Recent advances in mobile technology have created opportunities to develop mobile apps to aid and assist people in achieving various health and wellness goals. Mental health apps hold significant potential to assist people affected by various mental health issues at any time they may need it, considering the ubiquitous nature of mobile phones. However, there is a need for research to explore and understand end users' perceptions, needs, and concerns with respect to such technologies. Objective: The aim of this paper is to explore the opinions, perceptions, preferences, and experiences of people who have experienced some form of mental health issues based on self-diagnosis to inform the design of a next-generation mental health app that would be substantially more engaging and effective than the currently available apps to improve mental health and well-being. Methods: We conducted six focus group sessions with people who had experienced mental health issues based on self-diagnosis (average age 26.7 years, SD 23.63; 16/32, 50\% male; 16/32, 50\% female). We asked participants about their experiences with mental health issues and their viewpoints regarding two existing mental health apps (the Happify app and the Self-Help Anxiety Management app). Finally, participants were engaged in a design session where they each sketched a design for their ideal mental health and well-being mobile app. Results: Our findings revealed that participants used strategies to deal with their mental health issues: doing something to distract themselves from their current negative mood, using relaxation exercises and methods to relieve symptoms, interacting with others to share their issues, looking for an external source to solve their problems, and motivating themselves by repeating motivational sentences to support themselves or by following inspirational people. Moreover, regarding the design of mental health apps, participants identified that general design characteristics; personalization of the app, including tracking and feedback, live support, and social community; and providing motivational content and relaxation exercises are the most important features that users want in a mental health app. In contrast, games, relaxation audio, the Google map function, personal assistance to provide suggestions, goal setting, and privacy preservation were surprisingly the least requested features. Conclusions: Understanding end users' needs and concerns about mental health apps will inform the future design of mental health apps that are useful to and used by many people. ",
doi="10.2196/18172",
url="https://formative.jmir.org/2021/2/e18172",
url="http://www.ncbi.nlm.nih.gov/pubmed/33635281"
}


@Article{info:doi/10.2196/18815,
author="Bierbooms, A. Joyce J. P.
and Sluis-Thiescheffer, W. Wouter R. J.
and Feijt, A. Milou
and IJsselsteijn, A. Wijnand
and Bongers, B. Inge M.",
title="Design of a Game-Based Training Environment to Enhance Health Care Professionals' E--Mental Health Skills: Protocol for a User Requirements Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="17",
volume="10",
number="2",
pages="e18815",
keywords="mental health",
keywords="skill development",
keywords="eHealth",
keywords="games",
keywords="user-centered design",
abstract="Background: E--mental health (EMH) offers various possibilities for mental health care delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental health care professionals remains to be low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has been shown to be effective in other areas but has not yet been applied to the development of EMH skills of mental health care professionals. Objective: The aim of this paper is to describe a study protocol for the user requirements analysis for the design of a game-based training environment for mental health care professionals to enhance their skills in EMH. Methods: The user requirements are formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). We collected the data using a questionnaire, co-design sessions, and interviews. The questionnaire was used to determine mental health care professionals' characteristics, attitudes, and skill levels regarding EMH and was distributed among mental health care professionals in the Netherlands. This led to a number of recognizable subuser groups as the basis for personas. Co-design sessions with mental health care professionals resulted in further specification of the personas and an identification of different user scenarios for the game-based training environment. Interviews with mental health care professionals helped to determine the preferences of mental health care professionals regarding training in EMH and the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirement elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) and an in-depth understanding of specific design requirements (through interviews and co-design). Results: The questionnaire was filled by 432 respondents; three co-design sessions with mental health care professionals and 17 interviews were conducted. The data have been analyzed, and a full paper on the results is expected to be submitted in the first half of 2021. Conclusions: To develop an environment that can effectively support professionals' EMH skill development, it is important to offer training possibilities that address the specific needs of mental health care professionals. The approach described in this protocol incorporates elements that enable the design of a playful training environment that is user driven and flexible and considers the technical and organizational prerequisites that influence its implementation in practice. It describes a protocol that is replicable and provides a methodology for user requirements analyses in other projects and health care areas. International Registered Report Identifier (IRRID): RR1-10.2196/18815 ",
doi="10.2196/18815",
url="http://www.researchprotocols.org/2021/2/e18815/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595453"
}


@Article{info:doi/10.2196/25037,
author="Williams, James Andrew
and Menneer, Tamaryn
and Sidana, Mansi
and Walker, Tim
and Maguire, Kath
and Mueller, Markus
and Paterson, Cheryl
and Leyshon, Michael
and Leyshon, Catherine
and Seymour, Emma
and Howard, Zo{\"e}
and Bland, Emma
and Morrissey, Karyn
and Taylor, J. Timothy",
title="Fostering Engagement With Health and Housing Innovation: Development of Participant Personas in a Social Housing Cohort",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="16",
volume="7",
number="2",
pages="e25037",
keywords="user-centered design",
keywords="community",
keywords="social network analysis",
keywords="United Kingdom",
keywords="mobile phone",
abstract="Background: Personas, based on customer or population data, are widely used to inform design decisions in the commercial sector. The variety of methods available means that personas can be produced from projects of different types and scale. Objective: This study aims to experiment with the use of personas that bring together data from a survey, household air measurements and electricity usage sensors, and an interview within a research and innovation project, with the aim of supporting eHealth and eWell-being product, process, and service development through broadening the engagement with and understanding of the data about the local community. Methods: The project participants were social housing residents (adults only) living in central Cornwall, a rural unitary authority in the United Kingdom. A total of 329 households were recruited between September 2017 and November 2018, with 235 (71.4\%) providing complete baseline survey data on demographics, socioeconomic position, household composition, home environment, technology ownership, pet ownership, smoking, social cohesion, volunteering, caring, mental well-being, physical and mental health--related quality of life, and activity. K-prototype cluster analysis was used to identify 8 clusters among the baseline survey responses. The sensor and interview data were subsequently analyzed by cluster and the insights from all 3 data sources were brought together to produce the personas, known as the Smartline Archetypes. Results: The Smartline Archetypes proved to be an engaging way of presenting data, accessible to a broader group of stakeholders than those who accessed the raw anonymized data, thereby providing a vehicle for greater research engagement, innovation, and impact. Conclusions: Through the adoption of a tool widely used in practice, research projects could generate greater policy and practical impact, while also becoming more transparent and open to the public. ",
doi="10.2196/25037",
url="http://publichealth.jmir.org/2021/2/e25037/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591284"
}


@Article{info:doi/10.2196/23502,
author="Cheng, Sze Vanessa Wan
and Piper, E. Sarah
and Ottavio, Antonia
and Davenport, A. Tracey
and Hickie, B. Ian",
title="Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="10",
volume="23",
number="2",
pages="e23502",
keywords="mental health",
keywords="health information technologies",
keywords="self-determination theory",
keywords="eHealth",
keywords="internet",
keywords="digital health",
keywords="adolescent",
keywords="mental health services",
keywords="young adult",
keywords="LGBTQ persons",
keywords="mobile phone",
keywords="rural health",
abstract="Background: Culturally diverse populations (including Aboriginal and Torres Strait Islander people, people of diverse genders and sexualities, and culturally and linguistically diverse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers. Objective: This study aims to identify how best to improve a mental health and well-being HIT for culturally diverse Australians in nonurban areas. Methods: We conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally diverse groups. Results: We identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to design an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to use an HIT. Conclusions: Although culturally diverse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete examples of design features recommended by participants. ",
doi="10.2196/23502",
url="https://www.jmir.org/2021/2/e23502",
url="http://www.ncbi.nlm.nih.gov/pubmed/33565985"
}


@Article{info:doi/10.2196/26750,
author="Lawrence, Katharine
and Rodriguez, V. Danissa
and Feldthouse, M. Dawn
and Shelley, Donna
and Yu, L. Jonathan
and Belli, M. Hayley
and Gonzalez, Javier
and Tasneem, Sumaiya
and Fontaine, Jerlisa
and Groom, L. Lisa
and Luu, Son
and Wu, Yinxiang
and McTigue, M. Kathleen
and Rockette-Wagner, Bonny
and Mann, M. Devin",
title="Effectiveness of an Integrated Engagement Support System to Facilitate Patient Use of Digital Diabetes Prevention Programs: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="9",
volume="10",
number="2",
pages="e26750",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="diabetes prevention",
keywords="type 2 diabetes mellitus",
keywords="mobile phone",
abstract="Background: Digital diabetes prevention programs (dDPPs) are effective behavior change tools to prevent disease progression in patients at risk for diabetes. At present, these programs are poorly integrated into existing health information technology infrastructure and clinical workflows, resulting in barriers to provider-level knowledge of, interaction with, and support of patients who use dDPPs. Tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient engagement and adherence to these programs and improved health outcomes. Objective: This study aims to use a rigorous, user-centered design (UCD) methodology to develop a theory-driven system that supports patient engagement with dDPPs and their primary care providers with their care. Methods: This study will be conducted in 3 phases. In phase 1, we will use systematic UCD, Agile software development, and qualitative research methods to identify key user (patients, providers, clinical staff, digital health technologists, and content experts) requirements, constraints, and prioritization of high-impact features to design, develop, and refine a viable intervention prototype for the engagement system. In phase 2, we will conduct a single-arm feasibility pilot of the engagement system among patients with prediabetes and their primary care providers. In phase 3, we will conduct a 2-arm randomized controlled trial using the engagement system. Primary outcomes will be weight, BMI, and A1c at 6 and 12 months. Secondary outcomes will be patient engagement (use and activity) in the dDPP. The mediator variables (self-efficacy, digital health literacy, and patient-provider relationship) will be measured. Results: The project was initiated in 2018 and funded in September 2019. Enrollment and data collection for phase 1 began in September 2019 under an Institutional Review Board quality improvement waiver granted in July 2019. As of December 2020, 27 patients have been enrolled and first results are expected to be submitted for publication in early 2021. The study received Institutional Review Board approval for phases 2 and 3 in December 2020, and phase 2 enrollment is expected to begin in early 2021. Conclusions: Our findings will provide guidance for the design and development of technology to integrate dDPP platforms into existing clinical workflows. This will facilitate patient engagement in digital behavior change interventions and provider engagement in patients' use of dDPPs. Integrated clinical tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient adherence to these programs and improved health outcomes by addressing barriers faced by both patients and providers. Further evaluation with pilot testing and a clinical trial will assess the effectiveness and implementation of these tools. Trial Registration: ClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500 International Registered Report Identifier (IRRID): DERR1-10.2196/26750 ",
doi="10.2196/26750",
url="http://www.researchprotocols.org/2021/2/e26750/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33560240"
}


@Article{info:doi/10.2196/22220,
author="Donald, Maoliosa
and Beanlands, Heather
and Straus, E. Sharon
and Smekal, Michelle
and Gil, Sarah
and Elliott, J. Meghan
and Herrington, Gwen
and Harwood, Lori
and Waldvogel, Blair
and Delgado, Maria
and Sparkes, Dwight
and Tong, Allison
and Grill, Allan
and Novak, Marta
and James, Thomas Matthew
and Brimble, Scott K.
and Samuel, Susan
and Tu, Karen
and Farragher, Janine
and Hemmelgarn, R. Brenda",
title="A Web-Based Self-Management Support Prototype for Adults With Chronic Kidney Disease (My Kidneys My Health): Co-Design and Usability Testing",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="9",
volume="5",
number="2",
pages="e22220",
keywords="chronic kidney disease",
keywords="knowledge-to-action framework",
keywords="integrated knowledge translation",
keywords="patient engagement",
keywords="patient-oriented research",
keywords="self-management",
keywords="web-based intervention",
abstract="Background: Supporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those who care for them. Self-management has been shown to slow CKD progression and improve the quality of life of individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed, web-based tool for CKD self-management that can be individualized to a patient's unique situation, priorities, and preferences. We addressed this gap using an integrated knowledge translation method and patient engagement principles. Objective: The aim of this study is to conduct systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (nondialysis and nontransplant) and their caregivers to enhance self-management support. Methods: A multistep, iterative system development cycle was used to co-design and test the My Kidneys My Health prototype. The 3-step process included creating website features and content using 2 sequential focus groups with patients with CKD and caregivers, heuristic testing using the 10 heuristic principles by Nielsen, and usability testing through in-person 60-minute interviews with patients with CKD and their caregivers. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. Results: In step 1, 18 participants (14 patients and 4 caregivers) attended one of the 2 sequential focus groups. The participants provided specific suggestions for simplifying navigation as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. A total of 5 reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Furthermore, 5 participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean system usability score of 90 out of 100. Conclusions: The My Kidneys My Health prototype is a systematically developed, multifaceted, web-based CKD self-management support tool guided by the theory and preferences of patients with CKD and their caregivers. The website is user friendly and provides features that improve user experience by tailoring the content and resources to their needs. A feasibility study will provide insights into the acceptability of and engagement with the prototype and identify preliminary patient-reported outcomes (eg, self-efficacy) as well as potential factors related to implementation. This work is relevant given the shift to virtual care during the current pandemic times and provides patients with support when in-person care is restricted. ",
doi="10.2196/22220",
url="https://formative.jmir.org/2021/2/e22220",
url="http://www.ncbi.nlm.nih.gov/pubmed/33560245"
}


@Article{info:doi/10.2196/20213,
author="Easton, Katherine
and Kellett, Stephen
and Cooper, Martin
and Millings, Abigail
and Varela, Jo
and Parry, Glenys",
title="Blending Cognitive Analytic Therapy With a Digital Support Tool: Mixed Methods Study Involving a User-Centered Design of a Prototype App",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="1",
volume="8",
number="2",
pages="e20213",
keywords="cognitive analytic therapy",
keywords="digital app",
keywords="relational awareness",
keywords="user-centered design",
keywords="acceptability",
keywords="user testing",
abstract="Background: Patients can struggle to make good use of psychotherapy owing to deficits in awareness, and digital technologies that support awareness are at a premium. Currently, when patients participate in cognitive analytic therapy (CAT), the technology supporting relational awareness work involves completion of paper-based worksheets as between-session tasks. Objective: We aimed to design, with therapists and patients, a prototype digital mobile app. This was to help patients better engage in the ``recognition'' phase of the CAT treatment model by providing an unobtrusive means for practicing relational awareness with dynamic feedback on progress. Methods: A national online survey was conducted with CAT therapists (n=50) to determine readiness for adoption of a mobile app in clinical practice and to identify core content, functionality, and potential barriers to adoption. A prototype mobile app based on data and existing paper-based worksheets was built. Initial face-to-face user testing of the prototype system was completed with three therapists and three CAT expatients. Results: Among the therapists surveyed, 72\% (36/50) reported not currently using any digital tools during CAT. However, the potential value of a mobile app to support patient awareness was widely endorsed. Areas of therapist concern were data security, data governance, and equality of access. These concerns were mirrored during subsequent user testing by CAT therapists. Expatients generated additional user specifications on the design, functionality, and usability of the app. Results from both streams were integrated to produce five key changes for the reiteration of the app. Conclusions: The user-centered design process has enabled a prototype CAT-App to be developed to enhance the relational awareness work of CAT. This means that patients can now practice relational awareness in a much more unobtrusive manner and with ongoing dynamic feedback of progress. Testing the acceptability and feasibility of this technological innovation in clinical practice is the next stage in the research process, which has since been conducted and has been submitted. The important challenges of data protection and governance must be navigated in order to ensure implementation and adoption if the CAT-App is found to be acceptable and clinically effective. ",
doi="10.2196/20213",
url="https://mental.jmir.org/2021/2/e20213",
url="http://www.ncbi.nlm.nih.gov/pubmed/33522979"
}


@Article{info:doi/10.2196/23423,
author="Da Silva J{\'u}nior, Andrade Jorge Luiz
and Biduski, Daiana
and Bellei, Andrei Ericles
and Becker, Cemin Osvaldo Henrique
and Daroit, Luciane
and Pasqualotti, Adriano
and Tourinho Filho, Hugo
and De Marchi, Bertoletti Ana Carolina",
title="A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="29",
volume="9",
number="1",
pages="e23423",
keywords="functional status",
keywords="elderly",
keywords="virtual reality therapy",
keywords="user-centered design",
keywords="software design",
keywords="video games",
abstract="Background: Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people. Objective: In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants' adherence to and enjoyment of exercise; (2) test the participants' functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers. Methods: We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants' General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers. Results: We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame. Conclusions: The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants. ",
doi="10.2196/23423",
url="http://games.jmir.org/2021/1/e23423/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33512319"
}


@Article{info:doi/10.2196/14781,
author="Stanyon, Miriam
and Streater, Amy
and Coleston-Shields, Maria Donna
and Yates, Jennifer
and Challis, David
and Dening, Tom
and Hoe, Juanita
and Lloyd-Evans, Brynmor
and Mitchell, Shirley
and Moniz-Cook, Esme
and Poland, Fiona
and Prothero, David
and Orrell, Martin",
title="Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="27",
volume="10",
number="1",
pages="e14781",
keywords="dementia",
keywords="caregivers",
keywords="crisis",
keywords="mental health",
keywords="home management",
abstract="Background: Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams. Objective: The aim of this study is to develop a ``best practice model'' for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a ``best practice model.'' Methods: Participants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit. Results: Data were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice. Conclusions: This is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers. International Registered Report Identifier (IRRID): RR1-10.2196/14781 ",
doi="10.2196/14781",
url="http://www.researchprotocols.org/2021/1/e14781/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502333"
}


@Article{info:doi/10.2196/20841,
author="Benedict, Catherine
and Dauber-Decker, L. Katherine
and King, D'Arcy
and Hahn, Alexandria
and Ford, S. Jennifer
and Diefenbach, Michael",
title="A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="22",
volume="5",
number="1",
pages="e20841",
keywords="patient-centered care",
keywords="user-centered design",
keywords="decision support techniques",
keywords="decision aid",
keywords="cancer",
keywords="fertility",
keywords="internet-based intervention",
keywords="web-based intervention",
keywords="mobile phone",
keywords="psychosocial intervention",
abstract="Background: An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients' needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users' needs, values, abilities, and limitations. Objective: This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building. Methods: User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed. Results: The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process. Conclusions: The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement. ",
doi="10.2196/20841",
url="http://formative.jmir.org/2021/1/e20841/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33480848"
}


@Article{info:doi/10.2196/25746,
author="Greenberg, Jonathan
and Singh, Tanya
and Iverson, L. Grant
and Silverberg, D. Noah
and Macklin, A. Eric
and Parker, A. Robert
and Giacino, T. Joseph
and Yeh, Y. Gloria
and Vranceanu, Ana-Maria",
title="A Live Video Mind-Body Treatment to Prevent Persistent Symptoms Following Mild Traumatic Brain Injury: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="14",
volume="10",
number="1",
pages="e25746",
keywords="mild traumatic brain injury",
keywords="anxiety",
keywords="mixed methods",
keywords="intervention development",
abstract="Background: Every year, approximately 42 million people sustain a mild traumatic brain injury (mTBI, also known as concussion), with particularly high rates among college-aged individuals. A substantial proportion of these people (44\%-64\%) develop persistent symptoms that are challenging to treat, costly, and associated with significant disability. Anxiety has emerged as a risk factor for progression from acute to persistent mTBI symptoms. Objective: This study aims to develop, adapt, and establish the feasibility of the Toolkit for Optimal Recovery after Concussions (TOR-C), an innovative mind-body program aimed at preventing persistent symptoms among young adults with mTBI and comorbid anxiety. Here, we describe the proposed study design, methodology, measurement, and treatment manuals. Methods: In phase 1, we will conduct individual, live video qualitative interviews (up to n=20) with college-aged individuals with mTBI and comorbid anxiety to inform adaptation of the intervention and study procedures. In phase 2, an open pilot of the live video TOR-C (n=5) with exit interviews will be conducted to explore the initial feasibility, acceptability, and credibility of the program and to refine the study procedures. Phase 3 will involve conducting a feasibility randomized controlled trial (N=50) of the TOR-C versus a health education control (Health Enhancement for Concussions; HE-C), both delivered via live video, to establish feasibility of recruitment procedures (screening, eligibility, and enrollment) and data collection; feasibility, credibility, and acceptability of the live video TOR-C and HE-C (adherence, retention, fidelity, and satisfaction) following prespecified benchmarks; and a signal of improvement in outcomes. Results: Phase 1 of the study has been approved by the Massachusetts General Hospital Institutional Review Board. Study completion is anticipated by early 2025. Conclusions: We will develop and test the first mind-body intervention focused on prevention of persistent symptoms following mTBI in young adults with comorbid anxiety problems. This will allow us to establish feasibility markers in postconcussive symptoms, anxiety, disability, and fear avoidance to inform a future efficacy trial of the TOR-C versus HE-C. International Registered Report Identifier (IRRID): PRR1-10.2196/25746 ",
doi="10.2196/25746",
url="https://www.researchprotocols.org/2021/1/e25746",
url="http://www.ncbi.nlm.nih.gov/pubmed/33443484"
}


@Article{info:doi/10.2196/18587,
author="Ferrucci, Francesca
and Jorio, Manuele
and Marci, Stefano
and Bezenchek, Antonia
and Diella, Giulia
and Nulli, Cinzia
and Miranda, Ferdinando
and Castelli-Gattinara, Guido",
title="A Web-Based Application for Complex Health Care Populations: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2021",
month="Jan",
day="13",
volume="8",
number="1",
pages="e18587",
keywords="patient",
keywords="community participation",
keywords="eHealth",
keywords="patient-centered care",
keywords="user-centered design, comorbidity",
abstract="Background: Although eHealth technology makes it possible to improve the management of complex health care systems and follow up on chronic patients, it is not without challenges, thus requiring the development of efficient programs and graphic user interface (GUI) features. Similar information technology tools are crucial, as health care populations are going to have to endure social distancing measures in the forthcoming months and years. Objective: This study aims to provide adequate and personalized support to complex health care populations by developing a specific web-based mobile app. The app is designed around the patient and adapted to specific groups, for example, people with complex or rare diseases, autism, or disabilities (especially among children) as well as Alzheimer or senile dementia. The app's core features include the collection, labeling, analysis, and sorting of clinical data. Furthermore, it authorizes a network of people around the patient to securely access the data contained in his or her electronic health record. Methods: The application was designed according to the paradigms of patient-centered care and user-centered design (UCD). It considers the patient as the main empowered and motivating factor in the management of his or her well-being. Implementation was informed through a family needs and technology perception assessment. We used 3 interdisciplinary focus groups and 2 assessment surveys to study the contexts of app use, subpopulation management, and preferred functions. Finally, we developed an observational study involving 116 enrolled patients and 253 system users, followed by 2 feedback surveys to evaluate the performance and impact of the app. Results: In the validated general GUI, we developed 10 user profiles with different privacy settings. We tested 81 functions and studied a modular structure based on disease or medical area. This allowed us to identify replicable methods to be applied to module design. The observational study not only showed good family and community engagement but also revealed some limitations that need to be addressed. In total, 42 of 51 (82\%) patients described themselves as satisfied or very satisfied. Health care providers reported facilitated communication with colleagues and the need to support data quality. Conclusions: The experimented solution addressed some of the health system challenges mentioned by the World Health Organization: usability appears to be significantly improved when the GUI is designed according to patients' UCD mental models and when new media and medical literacy are promoted. This makes it possible to maximize the impact of eHealth products, thereby overcoming some crucial gaps reported in the literature. Two main features seemed to have potential benefit compared with other eHealth products: the modeling, within the app, of both the formal and informal health care support networks and the modular structure allowing for comorbidity management, both of which require further implementation. ",
doi="10.2196/18587",
url="http://humanfactors.jmir.org/2021/1/e18587/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439146"
}


@Article{info:doi/10.2196/22463,
author="Ahmed, Mona
and Mar{\'i}n, Mayca
and Bou{\c{c}}a-Machado, Raquel
and How, Daniella
and Judica, Elda
and Tropea, Peppino
and Bentlage, Ellen
and Brach, Michael",
title="Investigating Users' and Other Stakeholders' Needs in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People with Dementia or Parkinson Disease: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="12",
volume="10",
number="1",
pages="e22463",
keywords="dementia",
keywords="older adults",
keywords="neurodegenerative diseases",
keywords="integrated care",
keywords="health care technologies",
keywords="user-centered design",
abstract="Background: Dementias---including Alzheimer disease---and Parkinson disease profoundly impact the quality of life of older population members and their families. PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older Adults) is a European project that recognizes the benefit of technology-based integrated care models in improving the care coordination and the quality of life of these target groups. This project proposes an integrated, scalable, and interactive care platform targeting older people suffering from neurodegenerative diseases, their caregivers, and socio-health professionals. PROCare4Life adopts a user-centered design approach from the early stage and throughout platform development and implementation, during which the platform is designed and adapted to the needs and requirements of all the involved users. Objective: This paper presents the study protocol for investigating users' needs and requirements regarding the design of the proposed PROCare4Life platform. Methods: A mixed qualitative and quantitative study design is utilized, including online surveys, interviews, and workshops. The study aimed to recruit approximately 200 participants, including patients diagnosed with dementia or Parkinson disease, caregivers, socio-health professionals, and other stakeholders, from five different European countries: Germany, Italy, Portugal, Romania, and Spain. Results: The study took place between April and September 2020. Recruitment is now closed, and all the data have been collected and analyzed in order to be used in shaping the large-scale pilot phase of the PROCare4Life project. Results of the study are expected to be published in spring 2021. Conclusions: This paper charts the protocol for a user-centered design approach at the early stage of the PROCare4Life project in order to shape and influence an integrated health platform suitable for its intended target group and purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/22463 ",
doi="10.2196/22463",
url="https://www.researchprotocols.org/2021/1/e22463",
url="http://www.ncbi.nlm.nih.gov/pubmed/33433394"
}


@Article{info:doi/10.2196/20463,
author="Lindsay, Sally
and Kosareva, Polina
and Sukhai, Mahadeo
and Thomson, Nicole
and Stinson, Jennifer",
title="Online Self-Determination Toolkit for Youth With Disabilities: Protocol for a Mixed Methods Evaluation Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="11",
volume="10",
number="1",
pages="e20463",
keywords="disability",
keywords="involvement",
keywords="occupational therapy",
keywords="rehabilitation",
keywords="youth",
abstract="Background: Youth with disabilities encounter many challenges during their transition to adulthood including finding employment. Jobs are often inaccessible, and youth often face a lack of support, discriminatory attitudes, and sometimes low self-confidence. Therefore, it is critical to help youth enhance their self-determination skills to advocate for their needs in the workplace. Objective: The aim of this paper is to describe how an online toolkit aimed to improve self-determination in advocating for needs, including disability disclosure and accommodation requests to employers, was co-created with youth with disabilities. Methods: We will use a mixed method design in which qualitative data (ie, focus groups and mentored discussion forum) are collected to understand the contextual factors during the intervention that could affect outcomes or explain results through the pre-post questionnaires. Fifty youths with disabilities aged 15 to 24 years will be recruited. Results: Data collection is in progress. Planned analyses include focus groups and pre-post surveys to determine the impact of the intervention on self-determination. A qualitative content analysis of the focus groups and all open-ended survey questions will be conducted to understand the impact of the toolkit. Conclusions: Our online toolkit includes evidence-informed content that was co-created with youth who have a disability. It has potential for educational and vocational programming for youth with disabilities. International Registered Report Identifier (IRRID): PRR1-10.2196/20463 ",
doi="10.2196/20463",
url="http://www.researchprotocols.org/2021/1/e20463/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427688"
}


@Article{info:doi/10.2196/20061,
author="Reven{\"a}s, {\AA}sa
and Johansson, Ann-Christin
and Ehn, Maria",
title="Integrating Key User Characteristics in User-Centered Design of Digital Support Systems for Seniors' Physical Activity Interventions to Prevent Falls: Protocol for a Usability Study",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="21",
volume="9",
number="12",
pages="e20061",
keywords="eHealth",
keywords="mobile health",
keywords="internet-based interventions",
keywords="physical activity",
keywords="exercise",
keywords="older adults",
keywords="gender",
keywords="user feedback",
keywords="user involvement",
keywords="user-centered design",
abstract="Background: The goal of user-centered design (UCD) is to understand the users' perspective and to use that knowledge to shape more effective solutions. The UCD approach provides insight into users' needs and requirements and thereby improves the design of the developed services. However, involving users in the development process does not guarantee that feedback from different subgroups of users will shape the development in ways that will make the solutions more useful for the entire target user population. Objective: The aim of this study was to describe a protocol for systematic analysis and prioritization of feedback from user subgroups in the usability testing of a digital motivation support for fall-preventive physical activity (PA) interventions in seniors (aged 65 years and older). This protocol can help researchers and developers to systematically exploit feedback from relevant user subgroups in UCD. Methods: Gender, PA level, and level of technology experience have been identified in the literature to influence users' experience and use of digital support systems for fall-preventive PA interventions in seniors. These 3 key user characteristics were dichotomized and used to define 8 (ie, 23) possible user subgroups. The presented method enables systematic tracking of the user subgroups' contributions in iterative development. The method comprises (1) compilation of difficulties and deficiencies in the digital applications identified in usability testing, (2) clustering of the identified difficulties and deficiencies, and (3) prioritization of deficiencies to be rectified. Tracking user subgroup representation in the user feedback ensures that the development process is prioritized according to the needs of different subgroups. Mainly qualitative data collection methods are used. Results: A protocol was developed to ensure that feedback from users representing all possible variants of 3 selected key user characteristics (gender, PA level, and level of technology experience) is considered in the iterative usability testing of a digital support for seniors' PA. The method was applied in iterative usability testing of two digital applications during spring/summer 2018. Results from the study on the users' experiences and the iterative modification of the digital applications are expected to be published during 2021. Conclusions: Methods for systematic collection, analysis, and prioritization of feedback from user subgroups might be particularly important in heterogenous user groups (eg, seniors). This study can contribute to identifying and improving the understanding of potential differences between user subgroups of seniors in their use and experiences of digital support for fall-preventive PA interventions. This knowledge may be relevant for developing digital support systems that are appropriate, useful, and attractive to users and for enabling the design of digital support systems that target specific user subgroups (ie, tailoring of the support). The protocol needs to be further used and investigated in order to validate its potential value. International Registered Report Identifier (IRRID): RR1-10.2196/20061 ",
doi="10.2196/20061",
url="http://www.researchprotocols.org/2020/12/e20061/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33346732"
}


@Article{info:doi/10.2196/24960,
author="Mukaino, Masahiko
and Tatemoto, Tsuyoshi
and Kumazawa, Nobuhiro
and Tanabe, Shigeo
and Katoh, Masaki
and Saitoh, Eiichi
and Otaka, Yohei",
title="An Affordable, User-friendly Telerehabilitation System Assembled Using Existing Technologies for Individuals Isolated With COVID-19: Development and Feasibility Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Dec",
day="10",
volume="7",
number="2",
pages="e24960",
keywords="telerehabilitation",
keywords="COVID-19",
keywords="telemedicine",
keywords="isolation",
keywords="user-friendly",
keywords="feasibility",
keywords="rehabilitation",
keywords="eHealth",
abstract="Background: Isolation due to a COVID-19 infection can limit activities and cause physical and mental decline, especially in older adults and people with disabilities. However, due to limited contact, adequate rehabilitation is difficult to provide for quarantined patients. Telerehabilitation technology could be a solution; however, issues specific to COVID-19 should be taken into consideration, such as strict quarantine and respiratory symptoms, as well as accessibility to deal with rapid increases in need due to the pandemic. Objective: This study aims to develop and to investigate the feasibility of a telerehabilitation system for patients who are quarantined due to COVID-19 by combining existing commercial devices and computer applications. Methods: A multidisciplinary team has identified the requirements for a telerehabilitation system for COVID-19 and developed the system to satisfy those requirements. In the subsequent feasibility study, patients diagnosed with COVID-19 (N=10; mean age 60 years, SD 18 years) were included. A single session of telerehabilitation consisted of stretching exercises, a 15-minute exercise program, and a video exercise program conducted under real-time guidance by a physical therapist through a video call. The system included a tablet computer, a pulse oximeter, videoconferencing software, and remote control software. The feasibility of the system was evaluated using the Telemedicine Satisfaction Questionnaire (TSQ; 14 items) and an additional questionnaire on the telerehabilitation system (5 items). Each item was rated from ``1 = strongly disagree'' to ``5 = strongly agree.'' Results: The telerehabilitation system was developed by combining existing devices and applications, including a pulse oximeter and remote control mechanism, to achieve user-friendliness, affordability, and safety, which were determined as the system requirements. In the feasibility study, 9 out of 10 patients were able to use the telerehabilitation system without any on-site help. On the TSQ, the mean score for each item was 4.7 (SD 0.7), and in the additional items regarding telerehabilitation, the mean score for each item was 4.3 (SD 1.0). Conclusions: These findings support the feasibility of this simple telerehabilitation system in quarantined patients with COVID-19, encouraging further investigation on the merit of the system's use in clinical practice. ",
doi="10.2196/24960",
url="http://rehab.jmir.org/2020/2/e24960/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33279877"
}


@Article{info:doi/10.2196/18439,
author="Newton, Amanda
and Bagnell, Alexa
and Rosychuk, Rhonda
and Duguay, Janelle
and Wozney, Lori
and Huguet, Anna
and Henderson, Joanna
and Curran, Janet",
title="A Mobile Phone--Based App for Use During Cognitive Behavioral Therapy for Adolescents With Anxiety (MindClimb): User-Centered Design and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="8",
volume="8",
number="12",
pages="e18439",
keywords="anxiety disorders",
keywords="mobile apps",
keywords="adolescents",
keywords="usability testing",
keywords="development",
keywords="design",
keywords="anxiety",
abstract="Background: Mobile device--based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective: This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods: This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen's usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. Results: Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. Conclusions: The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes. ",
doi="10.2196/18439",
url="https://mhealth.jmir.org/2020/12/e18439",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289671"
}


@Article{info:doi/10.2196/17531,
author="Rai, Kaur Harleen
and Cavalcanti Barroso, Aline
and Yates, Lauren
and Schneider, Justine
and Orrell, Martin",
title="Involvement of People With Dementia in the Development of Technology-Based Interventions: Narrative Synthesis Review and Best Practice Guidelines",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="3",
volume="22",
number="12",
pages="e17531",
keywords="dementia",
keywords="technology",
keywords="co-production",
keywords="participation",
keywords="development",
abstract="Background: Technology can be helpful in supporting people with dementia in their daily lives. However, people with dementia are often not fully involved in the development process of new technology. This lack of involvement of people with dementia in developing technology-based interventions can lead to the implementation of faulty and less suitable technology. Objective: This systematic review aims to evaluate current approaches and create best practice guidelines for involving people with dementia in developing technology-based interventions. Methods: A systematic search was conducted in January 2019 in the following databases: EMBASE (Excerpta Medica database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulated Index to Nursing and Allied Health Literature), and Web of Science. The search strategy included search terms in 3 categories: dementia, technology, and involvement in development. Narrative synthesis wove the evidence together in a structured approach. Results: A total of 21 studies met the inclusion criteria. Most studies involved people with dementia in a single phase, such as development (n=10), feasibility and piloting (n=7), or evaluation (n=1). Only 3 studies described involvement in multiple phases. Frequently used methods for assessing involvement included focus groups, interviews, observations, and user tests. Conclusions: Most studies concluded that it was both necessary and feasible to involve people with dementia, which can be optimized by having the right prerequisites in place, ensuring that technology meets standards of reliability and stability, and providing a positive research experience for participants. Best practice guidelines for the involvement of people with dementia in developing technology-based interventions are described. ",
doi="10.2196/17531",
url="https://www.jmir.org/2020/12/e17531",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270034"
}


@Article{info:doi/10.2196/20360,
author="Strong, Carol
and Wu, Huei-Jiuan
and Tseng, Yuan-Chi
and Yuan, Chien-Wen
and Yu, Yi-Fang
and Liao, Chiehen Jay
and Chen, Yi-Wen
and Hung, Yi-Chen
and Li, Chia-Wen
and Huang, Po-Hsien
and Ko, Nai-Ying
and Ku, Wen-Wei Stephane",
title="Mobile App (UPrEPU) to Monitor Adherence to Pre-exposure Prophylaxis in Men Who Have Sex With Men: Protocol for a User-Centered Approach to Mobile App Design and Development",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="1",
volume="9",
number="12",
pages="e20360",
keywords="mobile apps",
keywords="pre-exposure prophylaxis",
keywords="event-driven",
keywords="sexual behavior",
keywords="men who have sex with men",
keywords="user-centered design approach",
abstract="Background: Daily and on-demand pre-exposure prophylaxis (PrEP) has been well demonstrated to effectively prevent HIV acquisition for men who have sex with men (MSM). More than half of the MSM PrEP users in Taiwan prefer on-demand PrEP; however, on-demand PrEP involves a complicated dosing regimen because it requires precoital and postcoital dosing and sex events are hard to anticipate. Although there are a growing number of mobile apps designed to improve access to HIV prevention services and HIV medication adherence, few mobile apps focus on adherence to PrEP or are designed to accommodate a complicated, on-demand PrEP dosing schedule. Objective: The aim of this project is to evaluate the usability of a newly developed mobile app (UPrEPU) to assist MSM PrEP users to self-monitor their adherence to either daily or on-demand PrEP using a user-centered scheme. Methods: This research will be conducted in 2 phases: app development and usability study. In the app development phase, we will first conduct formative research with end users and stakeholders through in-depth interviews; the results will provide PrEP users' and PrEP navigators' personas as material used in the app conceptualization stage. PrEP navigators are individuals in the health care system that help HIV-negative individuals who need assistance in accessing PrEP care. A low-fidelity prototype of the app feature will be formatted by applying a participatory design approach to engage PrEP users, designers, and app developers in the design process of the app. Then, a high-fidelity prototype of the app will be developed for the usability study and refined iteratively by the multidisciplinary team and new internal testers. Internal testers include the research team consisting of experts in public health, infectious disease, and industrial design and a close network of the research team that is taking PrEP. In the usability study phase, we will enroll 70 MSM PrEP users and follow them up for 4 months. Usability, feasibility, and effectiveness of adherence monitoring will be evaluated. Results: Refinement of the UPrEPU app is currently ongoing. The usability study commenced in May 2020. Conclusions: The UPrEPU app is one of the first apps designed to help MSM PrEP users to self-manage their PrEP schedule better regardless of dosing modes. With a design-thinking approach and adapting to the cultural context in Taiwan's MSM population, this novel app will have substantial potential to be acceptable and feasible and contribute to the reduction of new HIV infections. Trial Registration: ClinicalTrials.gov NCT04248790; https://clinicaltrials.gov/ct2/show/NCT04248790 International Registered Report Identifier (IRRID): PRR1-10.2196/20360 ",
doi="10.2196/20360",
url="https://www.researchprotocols.org/2020/12/e20360",
url="http://www.ncbi.nlm.nih.gov/pubmed/33258793"
}


@Article{info:doi/10.2196/18982,
author="Biran, Noa
and Anthony Kouyat{\'e}, Robin
and Yucel, Emre
and McGovern, E. Gillian
and Schoenthaler, M. Antoinette
and Durling, G. Olivia
and Unawane, Rashmi
and Schutt, Andrew
and Panjabi, Sumeet",
title="Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="17",
volume="4",
number="11",
pages="e18982",
keywords="mHealth",
keywords="digital health",
keywords="electronic patient-reported outcome",
keywords="ePRO",
keywords="patient-reported outcome",
keywords="PRO",
keywords="mobile",
keywords="app",
keywords="implementation science",
keywords="multiple myeloma",
keywords="relapsed refractory multiple myeloma",
abstract="Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83\% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. ",
doi="10.2196/18982",
url="http://formative.jmir.org/2020/11/e18982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200997"
}


@Article{info:doi/10.2196/19000,
author="Geelen, G. Sven J.
and Giele, M. Boukje
and Nollet, Frans
and Engelbert, H. Raoul H.
and van der Schaaf, Marike",
title="Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="13",
volume="9",
number="11",
pages="e19000",
keywords="implementation science",
keywords="quality improvement",
keywords="physical activity",
keywords="mobility",
keywords="outcome and process assessment",
keywords="health care",
abstract="Background: Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective: This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods: The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results: This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions: This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration: Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID): DERR1-10.2196/19000 ",
doi="10.2196/19000",
url="http://www.researchprotocols.org/2020/11/e19000/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33185561"
}


@Article{info:doi/10.2196/23337,
author="Stratton, Elizabeth
and Choi, Isabella
and Peters, Dorian
and Calvo, A. Rafael
and Harvey, B. Samuel
and Glozier, Nicholas",
title="Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="6",
volume="4",
number="11",
pages="e23337",
keywords="employee disclosure",
keywords="decision aid tool",
keywords="mental health",
keywords="web-based",
abstract="Background: Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. Objective: This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. Methods: A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. Results: A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69\%), male (8/13, 62\%), and employed full time (11/13, 85\%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. Conclusions: The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld. ",
doi="10.2196/23337",
url="https://formative.jmir.org/2020/11/e23337",
url="http://www.ncbi.nlm.nih.gov/pubmed/33155982"
}


@Article{info:doi/10.2196/23893,
author="Bostr{\o}m, Katrine
and B{\o}r{\o}sund, Elin
and Varsi, Cecilie
and Eide, Hilde
and Flakk Nordang, Elise
and Schreurs, MG Karlein
and Waxenberg, B. Lori
and Weiss, E. Karen
and Morrison, J. Eleshia
and Cvancarova Sm{\aa}stuen, Milada
and Stubhaug, Audun
and Solberg Nes, Lise",
title="Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Oct",
day="23",
volume="4",
number="10",
pages="e23893",
keywords="chronic pain",
keywords="feasibility",
keywords="acceptability",
keywords="self-management",
keywords="eHealth",
keywords="digital",
keywords="cognitive-behavioral pain",
keywords="usability",
keywords="user centered",
abstract="Background: Chronic pain can be complex and taxing to live with, and treatment and support require a multicomponent approach, which may not always be offered or available. Smartphones, tablets, and personal computers are already incorporated into patients' daily lives, and therefore, they can be used to communicate, educate, and support self-management. Although some web-based self-management interventions exist, research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is limited, findings are inconclusive, and new innovative ideas and solutions are needed. Objective: This feasibility pilot study aimed to explore the system use, perceived usefulness, ease of use, and preliminary effects of EPIO, an app-based cognitive-behavioral pain self-management intervention program for patients living with chronic pain. Methods: The EPIO intervention was delivered in a blended-care model containing (1) one face-to-face introduction session, (2) nine cognitive behavior--based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (3) one follow-up phone call at 2 to 3 weeks after the introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and 3 months after the introduction session, with registration of system use (ie, log data) until 6 months. The use, perceived usefulness, and ease of use of the EPIO program were examined through system use data, as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effects included the Brief Pain Inventory, health-related quality of life (HRQoL) scale, Hospital Anxiety and Depression Scale, Self-Regulatory Fatigue scale, Pain Catastrophizing Scale, and Chronic Pain Acceptance Questionnaire. Results: Participants (N=50) had a median age of 52 years (range 29-74 years) at inclusion and were mainly female (40/50, 80\%). Thirty-one participants completed at least six of the nine modules within the 3-month study period (62\% completion rate). Forty-five participants completed outcome measures at 3 months, and the EPIO program was rated as useful (ie, ``totally agree'' or ``agree''; 39/45, 87\%) and easy to use (42/45, 93\%), and as having easily understandable exercises (44/45, 98\%). The average overall system usability (SUS) score was 85.7, indicating grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily nonsignificant pre-post intervention improvements at 3 months, but with significant positive effects related to some aspects of HRQoL (bodily pain, P=.02 and change, P=.049). Conclusions: ?Digital self-management intervention programs may be of use and support for patients living with chronic pain. In this feasibility study, EPIO showed an acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large-scale randomized controlled trial are warranted and in progress. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 ",
doi="10.2196/23893",
url="http://formative.jmir.org/2020/10/e23893/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33094734"
}


@Article{info:doi/10.2196/21639,
author="Khalil, Carine
and Van Deen, Welmoed
and Dupuy, Taylor
and Bonthala, Nirupama
and Almario, Christopher
and Spiegel, Brennan",
title="Developing Patient-Centered Inflammatory Bowel Disease--Related Educational Videos Optimized for Social Media: Qualitative Research Study",
journal="JMIR Med Educ",
year="2020",
month="Oct",
day="20",
volume="6",
number="2",
pages="e21639",
keywords="inflammatory bowel disease",
keywords="educational videos",
keywords="patient education",
keywords="design thinking",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Important knowledge gaps have been identified related to the causes and symptoms of inflammatory bowel disease (IBD) and medical treatments and their side effects. Patients with IBD turn to social media to learn more about their disease. However, such information found on the web is misleading and often of low quality. Objective: This study aims to gain an in-depth understanding of the unmet educational needs of patients with IBD and to use the resulting insights to develop a collection of freely available, evidence-based educational videos optimized for dissemination through social media. Methods: We used design thinking, a human-centered approach, to guide our qualitative research methodology. We performed focus groups and interviews with a diverse sample of 29 patients with IBD. Data collection was performed in 3 phases (inspiration, ideation, and implementation) based on IDEO design thinking. Phase 1 offered insights into the needs of patients with IBD, whereas phases 2 and 3 involved ideation, prototyping, and video testing. A thematic analysis was performed to analyze the resulting data. Results: Patients emphasized the need for educational videos that address their challenges, needs, and expectations. From the data analysis, 5 video topics and their content emerged: IBD treatments' risks and benefits; how to be a self-advocate; how to stay healthy with IBD; how to cope with IBD; and educating families, friends, and colleagues about experiences of patients with IBD. Conclusions: Design thinking offers a deep understanding and recognition of the unmet educational needs of patients with IBD; this approach informed the development of 5 evidence-based educational videos. Future research will formally test and disseminate these freely available videos through social media. ",
doi="10.2196/21639",
url="http://mededu.jmir.org/2020/2/e21639/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33079065"
}


@Article{info:doi/10.2196/22485,
author="Davis, Teaniese
and DiClemente, Joseph Ralph
and Prietula, Michael",
title="Using ADAPT-ITT to Modify a Telephone-Based HIV Prevention Intervention for SMS Delivery: Formative Study",
journal="JMIR Form Res",
year="2020",
month="Oct",
day="6",
volume="4",
number="10",
pages="e22485",
keywords="short message service",
keywords="HIV",
keywords="African Americans",
keywords="adolescent",
keywords="female",
keywords="texting",
keywords="mHealth",
keywords="ADAPT-ITT framework",
keywords="intervention study",
keywords="health status disparities",
keywords="young adult",
keywords="risk reduction behavior",
abstract="Background: African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. Objective: This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator--led phone calling to text-based communication. Methods: The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board's request, this phase included an optional, additional week of text-based PMI messages. Results: The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. Conclusions: The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives. ",
doi="10.2196/22485",
url="https://formative.jmir.org/2020/10/e22485",
url="http://www.ncbi.nlm.nih.gov/pubmed/32831178"
}


@Article{info:doi/10.2196/19880,
author="Frost, Emily
and Porat, Talya
and Malhotra, Paresh
and Picinali, Lorenzo",
title="A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders",
journal="JMIR Hum Factors",
year="2020",
month="Sep",
day="30",
volume="7",
number="3",
pages="e19880",
keywords="cognitive decline",
keywords="mobile phone",
keywords="hearing loss",
abstract="Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. ",
doi="10.2196/19880",
url="http://humanfactors.jmir.org/2020/3/e19880/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32996884"
}


@Article{info:doi/10.2196/15460,
author="Hawley-Hague, Helen
and Tacconi, Carlo
and Mellone, Sabato
and Martinez, Ellen
and Ford, Claire
and Chiari, Lorenzo
and Helbostad, Jorunn
and Todd, Chris",
title="Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="28",
volume="8",
number="9",
pages="e15460",
keywords="aged",
keywords="postural balance",
keywords="telerehabilitation",
keywords="patient compliance",
keywords="accidental falls",
abstract="Background: Falls have implications for older adults' health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps' usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of ``Motivate Me'' and ``My Activity Programme.'' Key changes from the workshops included being able to add more details about the patients' exercise program and a wider selection of goals within ``Motivate Me.'' The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. ",
doi="10.2196/15460",
url="http://mhealth.jmir.org/2020/9/e15460/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985992"
}


@Article{info:doi/10.2196/17947,
author="Siedlikowski, Maia
and Rauch, Frank
and Tsimicalis, Argerie",
title="Giving Children With Osteogenesis Imperfecta a Voice: Participatory Approach for the Development of the Interactive Assessment and Communication Tool Sisom OI",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="22",
volume="22",
number="9",
pages="e17947",
keywords="child health",
keywords="symptom assessment, communication, mobile apps, software",
abstract="Background: Children with osteogenesis imperfecta (OI) experience acute and chronic symptoms that expose them to physical, mental, and social challenges. Empowering these children by involving them in their care can help them to cope with OI. Sisom is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic illnesses express their symptoms. This tool has not yet been adapted to the unique needs of OI. Objective: The aim of this study was to develop a Sisom OI paper prototype by seeking the perspectives of end users. Methods: A participatory approach was adopted to develop the prototype overseen by an expert panel of 9 clinicians at a university-affiliated pediatric hospital. Purposive sampling was used to recruit 12 children with OI who were aged 6-12 years. The study was carried out over the course of 3 feedback cycles. Data were deductively interpreted using content analysis techniques. Results: Overall, 64\% (57/89) of the Sisom symptoms were deemed relevant for inclusion in Sisom OI, with 42\% (37/89) directly incorporated and 22\% (20/89) incorporated with changes. In total, 114 symptoms were used to create the prototype, of which 57 were newly generated. The relevant symptoms addressed children's thoughts and feelings about hospitalization and their wishes for participation in their own care. The new symptoms addressed fractures, body image, and social isolation related to difficulties with accessibility and intimidation. Conclusions: Once developed, Sisom OI will offer clinicians an innovative and child-centered approach to capture children's perspectives on their condition. ",
doi="10.2196/17947",
url="http://www.jmir.org/2020/9/e17947/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32960176"
}


@Article{info:doi/10.2196/19195,
author="Wannheden, Carolina
and Reven{\"a}s, {\AA}sa",
title="How People with Parkinson's Disease and Health Care Professionals Wish to Partner in Care Using eHealth: Co-Design Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="21",
volume="22",
number="9",
pages="e19195",
keywords="chronic care",
keywords="Parkinson's disease",
keywords="co-creation",
keywords="co-design",
keywords="participatory design",
keywords="eHealth",
keywords="mHealth",
keywords="clinical decision support",
abstract="Background: Worldwide, the number of people with Parkinson's disease (PD) is predicted to double between the years 2005 and 2030. Chronic care management requires active collaboration and knowledge exchange between patients and health care professionals (HCPs) for best possible health outcomes, which we describe as co-care. eHealth services have the potential to support the realization of co-care between people with PD (PwP) and HCPs. Objective: This study aimed to explore how co-care could be operationalized in PD care, supported by eHealth. More specifically, this study explores PwP's and HCPs' expectations and desired eHealth functionalities to achieve co-care. Methods: Principles of participatory design were used to enable the identification of co-care needs and design ideas, in a series of 4 half-day co-design workshops. The sample included 7 (4 women) PwP and 9 (4 women) HCPs, including 4 neurologists, 3 nurses, and 2 physiotherapists. The co-design process resulted in a functional prototype that was evaluated by the co-design participants in the last workshop. Data were collected through note cards produced by the participants during the first 3 workshops and focus group discussions during the 3rd and 4th workshops. The data were analyzed using qualitative thematic analysis. After the workshop series, the prototype was demonstrated at a Mini Fair for ongoing PD research and evaluated using a self-developed questionnaire with 37 respondents: 31 PwP (14 women) and 6 informal caregivers (3 women). Descriptive statistics are reported. Results: The qualitative analysis of data resulted in 2 main themes. The first theme, core eHealth functionalities and their expected values, describes 6 desired eHealth functionalities for supporting PD co-care between PwP and HCPs: (1) self-tracking, (2) previsit forms, (3) graphical visualization, (4) clinical decision support, (5) self-care recommendations, and (6) asynchronous communication. The second theme, individual and organizational constraints, describes constraints that need to be addressed to succeed with an eHealth service for co-care. Individual constraints include eHealth literacy and acceptance; organizational constraints include teamwork and administrative workload. The majority of the questionnaire respondents (31/37, 84\%) perceived that they would benefit from an eHealth service similar to the demonstrated prototype. All prototype functionalities were rated as very important or important by the majority of respondents (ranging from 86\% to 97\% per functionality). Conclusions: This study adds to our knowledge on how PD co-care could be operationalized. Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by the mutual needs of patients and HCPs and supported by active information exchange between them, as well as automated information processing to generate patient-specific advice. More research is needed to further explore the concept of co-care in chronic care management and what it means for self-care and health care. International Registered Report Identifier (IRRID): RR2-10.2196/11278 ",
doi="10.2196/19195",
url="http://www.jmir.org/2020/9/e19195/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955448"
}


@Article{info:doi/10.2196/19066,
author="Humphries, Monica Sophia
and Rondung, Elisabet
and Norlund, Fredrika
and Sundin, {\"O}rjan
and Tornvall, Per
and Held, Claes
and Spaak, Jonas
and Lyng{\aa}, Patrik
and Olsson, G. Erik M.",
title="Designing a Web-Based Psychological Intervention for Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: User-Centered Design Approach",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="17",
volume="22",
number="9",
pages="e19066",
keywords="web-based intervention",
keywords="iCBT",
keywords="myocardial infarction",
keywords="nonobstructive coronary arteries",
keywords="patient involvement",
keywords="psychological treatment",
keywords="MINOCA",
keywords="takotsubo cardiomyopathy",
abstract="Background: The involvement of patient research partners (PRPs) in research aims to safeguard the needs of patient groups and produce new interventions that are developed based on patient input. Myocardial infarction with nonobstructive coronary arteries (MINOCA), unlike acute myocardial infarction (MI) with obstructive coronary arteries, is presented with no significant obstructive coronary artery disease. Patients with this diagnosis are a subset of those diagnosed with traditional MI and often need more psychological support, something that is presently not established in the current treatment scheme in Swedish health care or elsewhere, to our knowledge. An internet-delivered intervention might offer patients with MINOCA the opportunity to access a psychological treatment that is tailored to their specific needs after MINOCA and could therefore supplement the existing medical care in an easily accessible format. Objective: This paper aims to describe the development of a therapist-guided, internet-delivered psychological intervention designed specifically for patients with MINOCA. Methods: The study used a participatory design that involved 7 PRPs diagnosed with MINOCA who collaborated with a team consisting of researchers, cardiologists, and psychologists. Intervention content was developed iteratively and presented to the PRPs across several prototypes, each continually adjusted and redesigned according to the feedback received. The intervention and experience of it were discussed by PRPs in a final meeting and then presented to a panel of 2 clinical psychologists and a cardiologist for further input. Results: The outcome of the collaboration between PRPs and the research group produced a web-based psychological 9-step program focusing on stress, worry, and valued action. The input from PRPs contributed substantially to the therapy content, homework tasks, interactive activities, multimedia, and design presentation. Conclusions: Working with PRPs to develop an intervention for people with MINOCA produced a web-based intervention that can be further evaluated with the goal of offering a new psychological treatment option to a patient group currently without one. Direct contribution from PRPs enabled us to obtain relevant, insightful, and valuable feedback that was put towards the overall design and content of the intervention. ",
doi="10.2196/19066",
url="http://www.jmir.org/2020/9/e19066/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32940615"
}


@Article{info:doi/10.2196/19100,
author="Prinsenberg, Tamara
and Zantkuijl, Paul
and Zuilhof, Wim
and Davidovich, Udi
and Schinkel, Janke
and Prins, Maria
and van der Valk, Marc",
title="Design and Implementation of a Multilevel Intervention to Reduce Hepatitis C Transmission Among Men Who Have Sex With Men in Amsterdam: Co-Creation and Usability Study",
journal="JMIR Form Res",
year="2020",
month="Sep",
day="11",
volume="4",
number="9",
pages="e19100",
keywords="co-creation",
keywords="mHealth",
keywords="intervention",
keywords="hepatitis C",
keywords="prevention",
keywords="risk reduction",
keywords="MSM",
keywords="HCV",
abstract="Background: In the Netherlands, transmission of hepatitis C virus (HCV) occurs primarily among men who have sex with men (MSM). Early HCV testing of at-risk MSM and immediate initiation of treatment will prevent onward transmission, but this may not be sufficient to eliminate HCV in a population with ongoing risk behaviors. Therefore, targeted socioculturally acceptable preventive measures, including behavioral interventions, are urgently needed. Currently, little contextually appropriate information about HCV or risk reduction interventions is available. Objective: The objective of this project was to develop an intervention to reduce HCV transmission among MSM in Amsterdam through a co-creation process, with the input of men from the targeted community directly impacting intervention content, design, and implementation. Methods: We developed a multilevel intervention targeting 6 levels: individual, community, professional, context, patient, and network. The intervention was developed in close cooperation between health professionals, gay community members, commercial stakeholders, and stakeholders from within the gay community. The co-creation process had 4 phases: a needs assessment, stakeholder engagement, co-creation, and implementation. The co-creation phase continued until consensus was reached between the researchers and community members on the intervention content and design. The final intervention, NoMoreC, was completed within 2 years, and implementation started in February 2018. Results: NoMoreC includes web-based and face-to-face components as well as an anonymous HCV testing service. The NoMoreC website provides information about hepatitis C, HCV transmission routes, risk reduction strategies, testing and treatment options, and partner notification. The face-to-face component comprises a risk reduction toolbox, training for health professionals, and providing tailored advice to sex on premises venues. NoMoreC is promoted by an active voluntary campaign team. Conclusions: Involving the community and stakeholders in the creation of NoMoreC has been the main strength of this project. It has resulted in an intervention with various components that resonates with the gay community at risk of HCV infection. The uptake and acceptability of the described intervention will be evaluated in the future. The description of the co-creation process and implementation of the project may serve as a rich and useful source for others who want to develop culturally and context appropriate HCV interventions. ",
doi="10.2196/19100",
url="http://formative.jmir.org/2020/9/e19100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915157"
}


@Article{info:doi/10.2196/18427,
author="Schiro, Jessica
and Pelayo, Sylvia
and Martinot, Alain
and Dubos, Fran{\c{c}}ois
and Beuscart-Z{\'e}phir, Marie-Catherine
and Marcilly, Romaric",
title="Applying a Human-Centered Design to Develop a Patient Prioritization Tool for a Pediatric Emergency Department: Detailed Case Study of First Iterations",
journal="JMIR Hum Factors",
year="2020",
month="Sep",
day="4",
volume="7",
number="3",
pages="e18427",
keywords="emergency department",
keywords="triage systems",
keywords="ergonomics",
keywords="design",
keywords="human-centered design",
keywords="patients",
abstract="Background: Overcrowding in the emergency departments has become an increasingly significant problem. Patient triage strategies are acknowledged to help clinicians manage patient flow and reduce patients' waiting time. However, electronic patient triage systems are not developed so that they comply with clinicians' workflow. Objective: This case study presents the development of a patient prioritization tool (PPT) and of the related patient prioritization algorithm (PPA) for a pediatric emergency department (PED), relying on a human-centered design process. Methods: We followed a human-centered design process, wherein we (1) performed a work system analysis through observations and interviews in an academic hospital's PED; (2) deduced design specifications; (3) designed a mock PPT and the related PPA; and (4) performed user testing to assess the intuitiveness of the icons, the effectiveness in communicating patient priority, the fit between the prioritization model implemented and the participants' prioritization rules, and the participants' satisfaction. Results: The workflow analysis identified that the PPT interface should meet the needs of physicians and nurses, represent the stages of patient care, and contain patient information such as waiting time, test status (eg, prescribed, in progress), age, and a suggestion for prioritization. The mock-up developed gives the status of patients progressing through the PED; a strip represents the patient and the patient's characteristics, including a delay indicator that compares the patient's waiting time to the average waiting time of patients with a comparable reason for emergency. User tests revealed issues with icon intuitiveness, information gaps, and possible refinements in the prioritization algorithm. Conclusions: The results of the user tests have led to modifications to improve the usability and usefulness of the PPT and its PPA. We discuss the value of integrating human factors into the design process for a PPT for PED. The PPT/PPA has been developed and installed in Lille University Hospital's PED. Studies are carried out to evaluate the use and impact of this tool on clinicians' situation awareness and prioritization-related cognitive load, prioritization of patients, waiting time, and patients' experience. ",
doi="10.2196/18427",
url="http://humanfactors.jmir.org/2020/3/e18427/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32886071"
}


@Article{info:doi/10.2196/15972,
author="Stawarz, Katarzyna
and Preist, Chris
and Tallon, Debbie
and Wiles, Nicola
and Kessler, David
and Turner, Katrina
and Shafran, Roz
and Coyle, David",
title="Design Considerations for the Integrated Delivery of Cognitive Behavioral Therapy for Depression: User-Centered Design Study",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="3",
volume="7",
number="9",
pages="e15972",
keywords="cognitive behavioral therapy",
keywords="depression",
keywords="mental health",
keywords="blended therapy",
keywords="integrated therapy",
keywords="user-centered design",
keywords="qualitative research",
abstract="Background: Adherence to computerized cognitive behavioral therapy (cCBT) programs in real-world settings can be poor, and in the absence of therapist support, effects are modest and short term. Moreover, because cCBT systems tend toward limited support and thus low-intensity treatment, they are typically most appropriate for people experiencing mild to moderate mental health difficulties. Blended therapy, that is, combining direct therapist contact with cCBT or psychoeducational materials, has been identified as one possible approach to address these limitations and widen access to individual CBT for depression. Building on the initial success of blended therapy, we explore an integrated approach that seeks to seamlessly combine face-to-face contact, electronic contact, and between-session activities. Integration also considers how the technology can support therapists' workflow and integrate with broader health care systems. The ultimate aim is to provide a structure within which therapists can deliver high-intensity treatments, while also greatly reducing face-to-face contact. Objective: The research aimed to explore patients' and therapists' views on using a system for the delivery of individual treatment for depression that integrates face-to-face therapist contact with access to online resources and with synchronous online therapy sessions that allow collaborative exercises, and to establish design requirements and thus key design considerations for integrated systems that more seamlessly combine different modes of communication. Methods: We conducted a series of four user-centered design studies. This included four design workshops and seven prototype testing sessions with 18 people who had received CBT for depression in the past, and 11 qualitative interviews and three role-play sessions with 12 CBT therapists experienced in the treatment of depression. Studies took place between July and December 2017 in Bristol, United Kingdom. Results: Workshops and prototyping sessions with people who had received CBT identified three important requirements for integrated platforms delivering CBT therapy for depression as follows: (1) features that help to overcome depression-related barriers, (2) features that support engagement, and (3) features that reinforce learning and support the development of new skills. Research with therapists highlighted the importance of the therapist and client working together, the impact of technology on therapists' workflow and workload, challenges and opportunities related to the use of online resources, and the potential of technology to support patient engagement. We use these findings to inform 12 design considerations for developing integrated therapy systems. Conclusions: To meet clients' and therapists' needs, integrated systems need to help retain the personal connection, support both therapist- and patient-led activities, and provide access to materials and the ability to monitor progress. However, developers of such systems should be mindful of their capacity to disrupt current work practices and increase therapists' workload. Future research should evaluate the impact of integrated systems on patients and therapists in a real-world context. ",
doi="10.2196/15972",
url="https://mental.jmir.org/2020/9/e15972",
url="http://www.ncbi.nlm.nih.gov/pubmed/32880580"
}


@Article{info:doi/10.2196/18554,
author="Schoenthaler, Antoinette
and Cruz, Jocelyn
and Payano, Leydi
and Rosado, Marina
and Labbe, Kristen
and Johnson, Chrystal
and Gonzalez, Javier
and Patxot, Melissa
and Patel, Smit
and Leven, Eric
and Mann, Devin",
title="Investigation of a Mobile Health Texting Tool for Embedding Patient-Reported Data Into Diabetes Management (i-Matter): Development and Usability Study",
journal="JMIR Form Res",
year="2020",
month="Aug",
day="31",
volume="4",
number="8",
pages="e18554",
keywords="patient-reported outcome measures",
keywords="mobile health",
keywords="type 2 diabetes",
abstract="Background: Patient-reported outcomes (PROs) are increasingly being used in the management of type 2 diabetes (T2D) to integrate data from patients' perspective into clinical care. To date, the majority of PRO tools have lacked patient and provider involvement in their development, thus failing to meet the unique needs of end users, and lack the technical infrastructure to be integrated into the clinic workflow. Objective: This study aims to apply a systematic, user-centered design approach to develop i-Matter (investigating a mobile health [mHealth] texting tool for embedding patient-reported data into diabetes management), a theory-driven, mobile PRO system for patients with T2D and their primary care providers. Methods: i-Matter combines text messaging with dynamic data visualizations that can be integrated into electronic health records (EHRs) and personalized patient reports. To build i-Matter, we conducted semistructured group and individual interviews with patients with T2D and providers, a design thinking workshop to refine initial ideas and design the prototype, and user testing sessions of prototypes using a rapid-cycle design (ie, design-test-modify-retest). Results: Using an iterative user-centered process resulted in the identification of 6 PRO messages that were relevant to patients and providers: medication adherence, dietary behaviors, physical activity, sleep quality, quality of life, and healthy living goals. In user testing, patients recommended improvements to the wording and timing of the PRO text messages to increase clarity and response rates. Patients also recommended including motivational text messages to help sustain engagement with the program. The personalized report was regarded as a key tool for diabetes self-management by patients and providers because it aided in the identification of longitudinal patterns in the PRO data, which increased patient awareness of their need to adopt healthier behaviors. Patients recommended adding individualized tips to the journal on how they can improve their behaviors. Providers preferred having a separate tab built into the EHR that included the personalized report and highlighted key trends in patients' PRO data over the past 3 months. Conclusions: PRO tools that capture patients' well-being and the behavioral aspects of T2D management are important to patients and providers. A clinical trial will test the efficacy of i-Matter in 282 patients with uncontrolled T2D. Trial Registration: ClinicalTrials.gov NCT03652389; https://clinicaltrials.gov/ct2/show/NCT03652389 ",
doi="10.2196/18554",
url="https://formative.jmir.org/2020/8/e18554",
url="http://www.ncbi.nlm.nih.gov/pubmed/32865505"
}


@Article{info:doi/10.2196/15866,
author="Patel, Devika
and Sarlati, Siavash
and Martin-Tuite, Patrick
and Feler, Joshua
and Chehab, Lara
and Texada, Michael
and Marquez, Ruben
and Orellana, Julia F.
and Henderson, L. Terrell
and Nwabuo, Adaobi
and Plevin, Rebecca
and Dicker, Ami Rochelle
and Juillard, Catherine
and Sammann, Amanda",
title="Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="24",
volume="8",
number="8",
pages="e15866",
keywords="human-centered design",
keywords="violence intervention",
keywords="information and communications technology",
abstract="Background: Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective: Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods: We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results: Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions: Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community. ",
doi="10.2196/15866",
url="http://mhealth.jmir.org/2020/8/e15866/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32831179"
}


@Article{info:doi/10.2196/17406,
author="Bogza, Laura-Mihaela
and Patry-Lebeau, Cassandra
and Farmanova, Elina
and Witteman, O. Holly
and Elliott, Jacobi
and Stolee, Paul
and Hudon, Carol
and Giguere, C. Anik M.",
title="User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="19",
volume="22",
number="8",
pages="e17406",
keywords="decision aid",
keywords="mild cognitive impairment",
keywords="elderly",
keywords="decision support technique",
keywords="aging",
abstract="Background: Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. Objective: This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. Methods: We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users' knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. Results: A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (?60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users' priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. Conclusions: This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings. ",
doi="10.2196/17406",
url="https://www.jmir.org/2020/8/e17406",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442151"
}


@Article{info:doi/10.2196/19433,
author="Tobias, Guy
and Spanier, B. Assaf",
title="Developing a Mobile App (iGAM) to Promote Gingival Health by Professional Monitoring of Dental Selfies: User-Centered Design Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="14",
volume="8",
number="8",
pages="e19433",
keywords="mHealth",
keywords="telemedicine",
keywords="public health",
keywords="oral health promotion",
keywords="gum health",
keywords="flow of information",
keywords="COVID-19",
abstract="Background: Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis. Objective: This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients. Methods: A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections.  We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks. Results: All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) ``what's in it for me?'' and (2) the need for a take-home message.  The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction. Conclusions: iGAM is the first mHealth app for monitoring gingivitis using self-photography.  iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic). ",
doi="10.2196/19433",
url="http://mhealth.jmir.org/2020/8/e19433/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32795985"
}


@Article{info:doi/10.2196/16862,
author="Petersen, Lee Curtis
and Halter, Ryan
and Kotz, David
and Loeb, Lorie
and Cook, Summer
and Pidgeon, Dawna
and Christensen, C. Brock
and Batsis, A. John",
title="Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="7",
volume="8",
number="8",
pages="e16862",
keywords="aged adults",
keywords="sarcopenia",
keywords="remote sensing technology",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40\% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process. Objective: This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in NLP and sentiment analysis Methods: Through a user-centered design process, we conducted semistructured interviews during the development of a geriatric-friendly Bluetooth-connected resistance exercise band app. We interviewed patients and clinicians at weeks 0, 5, and 10 of the app development. Each semistructured interview consisted of heuristic evaluations, cognitive walkthroughs, and observations. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. Sentiment was defined as the sum of positive and negative words (each word with a +1 or ?1 value). To assess utility, we used quantitative assessment questionnaires---System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). Finally, we used multivariate linear models---adjusting for age, sex, subject group (clinician vs patient), and development---to explore the association between sentiment analysis and SUS and USE outcomes. Results: The mean age of the 22 participants was 68 (SD 14) years, and 17 (77\%) were female. The overall mean SUS and USE scores were 66.4 (SD 13.6) and 41.3 (SD 15.2), respectively. Both patients and clinicians provided valuable insights into the needs of older adults when designing and building an app. The mean positive-negative sentiment per sentence was 0.19 (SD 0.21) and 0.47 (SD 0.21) for patient and clinician interviews, respectively. We found a positive association with positive sentiment in an interview and SUS score ({\ss}=1.38; 95\% CI 0.37 to 2.39; P=.01). There was no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Conclusions: Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults. ",
doi="10.2196/16862",
url="https://mhealth.jmir.org/2020/8/e16862",
url="http://www.ncbi.nlm.nih.gov/pubmed/32540843"
}


@Article{info:doi/10.2196/17481,
author="O'Grady, Conor
and Melia, Ruth
and Bogue, John
and O'Sullivan, Mary
and Young, Karen
and Duggan, Jim",
title="A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan)",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="30",
volume="22",
number="7",
pages="e17481",
keywords="mobile apps",
keywords="suicide",
keywords="mHealth",
abstract="Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users' access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app's core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. ",
doi="10.2196/17481",
url="http://www.jmir.org/2020/7/e17481/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32729845"
}


@Article{info:doi/10.2196/19721,
author="Brennan, Louise
and Kessie, Threase
and Caulfield, Brian",
title="Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="29",
volume="8",
number="7",
pages="e19721",
keywords="breast cancer",
keywords="physiotherapy",
keywords="rehabilitation",
keywords="mHealth",
keywords="biofeedback",
keywords="user-centred design",
keywords="cancer",
abstract="Background: Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective: The aims of this study were to explore patients' rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods: This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of ``Rehabilitation'' and ``Technology'' and performed a thematic analysis on the interview data. Results: Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer--specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions: There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance. ",
doi="10.2196/19721",
url="http://mhealth.jmir.org/2020/7/e19721/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32687476"
}


@Article{info:doi/10.2196/12655,
author="Arevian, C. Armen
and O'Hora, Jennifer
and Rosser, James
and Mango, D. Joseph
and Miklowitz, J. David
and Wells, B. Kenneth",
title="Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="29",
volume="8",
number="7",
pages="e12655",
keywords="mobile health",
keywords="community-based participatory research",
keywords="app development",
keywords="technology platforms",
keywords="personalized medicine",
keywords="behavioral health",
keywords="mobile phone",
abstract="Background: Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective: We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods: In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results: Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90\%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80\%) agreed that the messages were effective at helping complete treatment plans. Conclusions: Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies. ",
doi="10.2196/12655",
url="http://mhealth.jmir.org/2020/7/e12655/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723714"
}


@Article{info:doi/10.2196/19485,
author="Champion, Elizabeth Katrina
and Gardner, Anne Lauren
and McGowan, Cyanna
and Chapman, Cath
and Thornton, Louise
and Parmenter, Belinda
and McBride, Nyanda
and Lubans, R. David
and McCann, Karrah
and Spring, Bonnie
and Teesson, Maree
and 
and Newton, Clare Nicola",
title="A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="28",
volume="4",
number="7",
pages="e19485",
keywords="primary prevention",
keywords="schools",
keywords="eHealth",
keywords="chronic disease",
keywords="mobile phone",
keywords="health promotion",
abstract="Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. ",
doi="10.2196/19485",
url="http://formative.jmir.org/2020/7/e19485/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720898"
}


@Article{info:doi/10.2196/17703,
author="Cornet, Philip Victor
and Toscos, Tammy
and Bolchini, Davide
and Rohani Ghahari, Romisa
and Ahmed, Ryan
and Daley, Carly
and Mirro, J. Michael
and Holden, J. Richard",
title="Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="21",
volume="8",
number="7",
pages="e17703",
keywords="user-centered design",
keywords="research methods",
keywords="mobile health",
keywords="digital health",
keywords="mobile apps",
keywords="usability",
keywords="technology",
keywords="evaluation",
keywords="human-computer interaction",
keywords="mobile phone",
abstract="Background: User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective: This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods: Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results: We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers' assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions: UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories. ",
doi="10.2196/17703",
url="http://mhealth.jmir.org/2020/7/e17703/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706745"
}


@Article{info:doi/10.2196/17893,
author="Mrklas, J. Kelly
and Barber, Tanya
and Campbell-Scherer, Denise
and Green, A. Lee
and Li, C. Linda
and Marlett, Nancy
and Miller, Jean
and Shewchuk, Brittany
and Teare, Sylvia
and Wasylak, Tracy
and Marshall, A. Deborah",
title="Co-Design in the Development of a Mobile Health App for the Management of Knee Osteoarthritis by Patients and Physicians: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="10",
volume="8",
number="7",
pages="e17893",
keywords="health services research",
keywords="app",
keywords="knee osteoarthritis",
keywords="community-based participatory research",
abstract="Background: Despite a doubling of osteoarthritis-targeted mobile health (mHealth) apps and high user interest and demand for health apps, their impact on patients, patient outcomes, and providers has not met expectations. Most health and medical apps fail to retain users longer than 90 days, and their potential for facilitating disease management, data sharing, and patient-provider communication is untapped. An important, recurrent criticism of app technology development is low user integration design. User integration ensures user needs, desires, functional requirements, and app aesthetics are responsive and reflect target user preferences. Objective: This study aims to describe the co-design process for developing a knee osteoarthritis minimum viable product (MVP) mHealth app with patients, family physicians, and researchers that facilitates guided, evidence-based self-management and patient-physician communication. Methods: Our qualitative co-design approach involved focus groups, prioritization activities, and a pre-post quality and satisfaction Kano survey. Study participants included family physicians, patient researchers and patients with knee osteoarthritis (including previous participants of related collaborative research), researchers, key stakeholders, and industry partners. The study setting was an academic health center in Southern Alberta. Results: Distinct differences exist between what patients, physicians, and researchers perceive are the most important, convenient, desirable, and actionable app functional requirements. Despite differences, study participants agreed that the MVP should be electronic, should track patient symptoms and activities, and include features customized for patient- and physician-identified factors and international guideline-based self-management strategies. Through the research process, participants negotiated consensus on their respective priority functional requirements. The highest priorities were a visual symptom graph, setting goals, exercise planning and daily tracking, and self-management strategies. The structured co-design with patients, physicians, and researchers established multiple collaborative processes, grounded in shared concepts, language, power, rationale, mutual learning, and respect for diversity and differing opinions. These shared team principles fostered an open and inclusive environment that allowed for effective conceptualization, negotiation, and group reflection, aided by the provision of tangible and ongoing support throughout the research process, which encouraged team members to question conventional thinking. Group-, subgroup-, and individual-level data helped the team reveal how and for whom perspectives about individual functional requirements changed or remained stable over the course of the study. This provided valuable insight into how and why consensus emerged, despite the presence of multiple and differing underlying rationales for functional requirement prioritization. Conclusions: It is feasible to preserve the diversity of perspectives while negotiating a consensus on the core functional requirements of an mHealth prototype app for knee osteoarthritis management. Our study sample was purposely constructed to facilitate high co-design interactivity. This study revealed important differences between the patient, physician, and researcher preferences for functional requirements of an mHealth app that did not preclude the development of consensus. ",
doi="10.2196/17893",
url="http://mhealth.jmir.org/2020/7/e17893/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673245"
}


@Article{info:doi/10.2196/19713,
author="Miller, Stephen
and Gilbert, Stephen
and Virani, Vishaal
and Wicks, Paul",
title="Patients' Utilization and Perception of an Artificial Intelligence--Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study",
journal="JMIR Hum Factors",
year="2020",
month="Jul",
day="10",
volume="7",
number="3",
pages="e19713",
keywords="human-centered design",
keywords="innovative",
keywords="health care apps",
keywords="eHealth",
keywords="symptom checker",
keywords="primary care",
keywords="general practice",
keywords="app",
keywords="usability",
keywords="acceptability",
keywords="utility",
abstract="Background: When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies. Objective: We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting. Methods: Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment. Results: Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1\%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6\%) of working-age individuals (aged 15-64) than the general population (66.0\%). Participants rated Ada's ease of use highly, with most (511/522, 97.8\%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1\%) and agreed they would recommend it to a friend or relative (444/520, 85.3\%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93\%, 18-24-year olds reported helpful) than older respondents (19/32, 59\%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0\%), a sizable minority (63/494, 12.8\%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22\%) than aged 70+ (0/28, 0\%). Conclusions: In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups. ",
doi="10.2196/19713",
url="https://humanfactors.jmir.org/2020/3/e19713",
url="http://www.ncbi.nlm.nih.gov/pubmed/32540836"
}


@Article{info:doi/10.2196/18018,
author="Amann, Julia
and Fiordelli, Maddalena
and Brach, Mirjam
and Bertschy, Sue
and Scheel-Sailer, Anke
and Rubinelli, Sara",
title="Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="9",
volume="8",
number="7",
pages="e18018",
keywords="co-design",
keywords="mHealth",
keywords="eHealth",
keywords="self-management",
keywords="spinal cord injury",
keywords="pressure injury",
abstract="Background: Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries. Objective: The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app. Methods: We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods. Results: The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function). Conclusions: Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions. ",
doi="10.2196/18018",
url="https://mhealth.jmir.org/2020/7/e18018",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673241"
}


@Article{info:doi/10.2196/19771,
author="Vandekerckhove, Pieter
and Vandekerckhove, Yves
and Tavernier, Rene
and De Jaegher, Kelly
and de Mul, Marleen",
title="Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="25",
volume="22",
number="6",
pages="e19771",
keywords="telemedicine",
keywords="design thinking",
keywords="cardiology",
keywords="patient",
keywords="COVID-19",
keywords="user experience",
doi="10.2196/19771",
url="http://www.jmir.org/2020/6/e19771/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32519964"
}


@Article{info:doi/10.2196/17147,
author="Hilt, D. Alexander
and Mamaqi Kapllani, Kevin
and Hierck, P. Beerend
and Kemp, C. Anne
and Albayrak, Armagan
and Melles, Marijke
and Schalij, J. Martin
and Scherptong, C. Roderick W.",
title="Perspectives of Patients and Professionals on Information and Education After Myocardial Infarction With Insight for Mixed Reality Implementation: Cross-Sectional Interview Study",
journal="JMIR Hum Factors",
year="2020",
month="Jun",
day="23",
volume="7",
number="2",
pages="e17147",
keywords="human factors",
keywords="myocardial infarction",
keywords="mixed reality",
keywords="patient education",
keywords="patient experience",
keywords="PROM",
abstract="Background: Patient education is crucial in the secondary prevention of cardiovascular disease. Novel technologies such as augmented reality or mixed reality expand the possibilities for providing visual support in this process. Mixed reality creates interactive digital three-dimensional (3D) projections overlaying virtual objects on the real-world environment. While augmented reality only overlays objects, mixed reality not just overlays but anchors virtual objects to the real world. However, research on this technology in the patient domain is scarce. Objective: The aim of this study was to understand how patients perceive information provided after myocardial infarction and examine if mixed reality can be supportive in this process. Methods: In total, 12 patients that experienced myocardial infarction and 6 health care professionals were enrolled in the study. Clinical, demographic, and qualitative data were obtained through semistructured interviews, with a main focus on patient experiences within the hospital and the knowledge they gained about their disease. These data were then used to map a susceptible timeframe to identify how mixed reality can contribute to patient information and education. Results: Knowledge transfer after myocardial infarction was perceived by patients as too extensive, not personal, and inconsistent. Notably, knowledge on anatomy and medication was minimal and was not recognized as crucial by patients, whereas professionals stated the opposite. Patient journey analysis indicated the following four critical phases of knowledge transfer: at hospital discharge, at the first outpatient visit, during rehabilitation, and during all follow-up outpatient visits. Important patient goals were understanding the event in relation to daily life and its implications on resuming daily life. During follow-up, understanding physical limitations and coping with the condition and medication side effects in daily life emerged as the most important patient goals. The professionals' goals were to improve recovery, enhance medication adherence, and offer coping support. Conclusions: There is a remarkable difference between patients' and professionals' goals regarding information and education after myocardial infarction. Mixed reality may be a practical tool to unite perspectives of patients and professionals on the disease in a more even manner, and thus optimize knowledge transfer after myocardial infarction. Improving medication knowledge seems to be a feasible target for mixed reality. However, further research is needed to create durable methods for education on medication through mixed reality interventions. ",
doi="10.2196/17147",
url="http://humanfactors.jmir.org/2020/2/e17147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32573464"
}


@Article{info:doi/10.2196/15449,
author="Korpershoek, G. Yvonne J.
and Hermsen, Sander
and Schoonhoven, Lisette
and Schuurmans, J. Marieke
and Trappenburg, A. Jaap C.",
title="User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="15",
volume="22",
number="6",
pages="e15449",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="behavior change",
keywords="COPD",
keywords="exacerbation",
keywords="self-management",
keywords="self-care",
keywords="mobile phone",
abstract="Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention---Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions. ",
doi="10.2196/15449",
url="https://www.jmir.org/2020/6/e15449",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538793"
}


@Article{info:doi/10.2196/16165,
author="Giorgi Rossi, Paolo
and Ferrari, Francesca
and Amarri, Sergio
and Bassi, Andrea
and Bonvicini, Laura
and Dall'Aglio, Luca
and Della Giustina, Claudia
and Fabbri, Alessandra
and Ferrari, Maria Anna
and Ferrari, Elena
and Fontana, Marta
and Foracchia, Marco
and Gallelli, Teresa
and Ganugi, Giulia
and Ilari, Barbara
and Lo Scocco, Sara
and Maestri, Gianluca
and Moretti, Veronica
and Panza, Costantino
and Pinotti, Mirco
and Prandini, Riccardo
and Storani, Simone
and Street, Elisabeth Maria
and Tamelli, Marco
and Trowbridge, Hayley
and Venturelli, Francesco
and Volta, Alessandro
and Davoli, Maria Anna
and ",
title="Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="8",
volume="8",
number="6",
pages="e16165",
keywords="childhood obesity",
keywords="health promotion",
keywords="mHealth",
keywords="cocreation",
keywords="mobile app",
abstract="Background: Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective: The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents' phones aimed at promoting child health and preventing obesity. Methods: After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results: Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children's need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions: The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project. ",
doi="10.2196/16165",
url="https://mhealth.jmir.org/2020/6/e16165",
url="http://www.ncbi.nlm.nih.gov/pubmed/32357123"
}


@Article{info:doi/10.2196/14973,
author="Moore, M. Courtney
and Wiehe, E. Sarah
and Lynch, O. Dustin
and Claxton, EM Gina
and Landman, P. Matthew
and Carroll, E. Aaron
and Musey, I. Paul",
title="Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 2): Patient- and Parent-Centered Outcomes of Decolonization",
journal="J Participat Med",
year="2020",
month="May",
day="20",
volume="12",
number="2",
pages="e14973",
keywords="patient-centered outcomes",
keywords="Staphylococcus aureus",
keywords="abscess",
keywords="decolonization",
keywords="human-centered design",
abstract="Background: Skin and soft tissue infections (SSTIs) due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) can lead to a number of significant known medical outcomes including hospitalization, surgical procedures such as incision and drainage (I\&D), and the need for decolonization procedures to remove the bacteria from the skin and nose and prevent recurrent infection. Little research has been done to understand patient and caregiver-centered outcomes associated with the successful treatment of MRSA infection. Objective: This study aimed to uncover MRSA decolonization outcomes that are important to patients and their parents in order to create a set of prototype measures for use in the MRSA Eradication and Decolonization in Children (MEDiC) study. Methods: A 4-hour, human-centered design (HCD) workshop was held with 5 adolescents (aged 10-18 years) who had experienced an I\&D procedure and 11 parents of children who had experienced an I\&D procedure. The workshop explored the patient and family experience with skin infection to uncover patient-centered outcomes of MRSA treatment. The research team analyzed the audio and artifacts created during the workshop and coded for thematic similarity. The final themes represent patient-centered outcome domains to be measured in the MEDiC comparative effectiveness trial. Results: The workshop identified 9 outcomes of importance to patients and their parents: fewer MRSA outbreaks, improved emotional health, improved self-perception, decreased social stigma, increased amount of free time, increased control over free time, fewer days of school or work missed, decreased physical pain and discomfort, and decreased financial burden. Conclusions: This study represents an innovative HCD approach to engaging patients and families with lived experience with MRSA SSTIs in the study design and trial development to determine meaningful patient-centered outcomes. We were able to identify 9 major recurrent themes. These themes were used to develop the primary and secondary outcome measures for MEDiC, a prospectively enrolling comparative effectiveness trial. Trial Registration: ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658 ",
doi="10.2196/14973",
url="http://jopm.jmir.org/2020/2/e14973/"
}


@Article{info:doi/10.2196/14974,
author="Moore, M. Courtney
and Wiehe, E. Sarah
and Lynch, O. Dustin
and Claxton, EM Gina
and Landman, P. Matthew
and Carroll, E. Aaron
and Musey, I. Paul",
title="Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 1): Development of a Decolonization Toolkit With Patient and Parent Advisors",
journal="J Participat Med",
year="2020",
month="May",
day="20",
volume="12",
number="2",
pages="e14974",
keywords="Staphylococcus aureus",
keywords="MRSA",
keywords="abscess",
keywords="decolonization",
keywords="human-centered design",
keywords="communication design",
abstract="Background: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections affect many healthy children. A significant number of these children are hospitalized and require surgical incision and drainage (I\&D). Once sent home, these children and families are asked to complete burdensome home decolonization and hygiene procedures in an effort to prevent the high rate of recurrent infections. Objective: This component of the Methicillin-resistant Staphylococcus aureus Eradication and Decolonization in Children (MEDiC) study aimed to develop a toolkit to assist MEDiC study participants in completing MRSA decolonization and hygiene procedures at home (the MEDiC kit). Methods: In all, 5 adolescents (aged 10-18 years) who had undergone an I\&D procedure for a skin infection and 11 parents of children who had undergone an I\&D procedure for a skin infection were engaged in a 4-hour group workshop using a human-centered design approach. The topics covered in this workshop and analyzed for this paper were (1) attitudes about MRSA decolonization procedures and (2) barriers to the implementation of MRSA decolonization and hygiene procedures. The team analyzed the audio and artifacts created during the workshop and synthesized their findings to inform the creation of the MEDiC kit. Results: The workshop activities uncovered barriers to successful completion of the decolonization and hygiene procedures: lack of step-by-step instruction, lack of proper tools in the home, concerns about adverse events, lack of control over some aspects of the hygiene procedures, and general difficulty coordinating all the procedures. Many of these could be addressed as part of the MEDiC kit. In addition, the workshop revealed that effective communication about decolonization would have to address concerns about the effects of bleach, provide detailed information, give reasons for the specific decolonization and hygiene protocol steps, and include step-by-step instructions (preferably through video). Conclusions: Through direct engagement with patients and families, we were able to better understand how to support families in implementing MRSA decolonization and hygiene protocols. In addition, we were able to better understand how to communicate about MRSA decolonization and hygiene protocols. With this knowledge, we created a robust toolkit that uses patient-driven language and visuals to help support patients and families through the implementation of these protocols. Trial Registration: ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658 ",
doi="10.2196/14974",
url="http://jopm.jmir.org/2020/2/e14974/"
}


@Article{info:doi/10.2196/15895,
author="Ector, ICG Genevi{\`e}ve
and Westerweel, E. Peter
and Hermens, PMG Rosella
and Braspenning, AE Karin
and Heeren, CM Barend
and Vinck, MF Oscar
and de Jong, JM Jan
and Janssen, JWM Jeroen
and Blijlevens, MA Nicole",
title="The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach",
journal="J Med Internet Res",
year="2020",
month="May",
day="15",
volume="22",
number="5",
pages="e15895",
keywords="eHealth",
keywords="chronic myeloid leukemia",
keywords="patient participation",
keywords="mobile apps",
abstract="Background: With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective: The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods: The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results: The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients' symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions: The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves. ",
doi="10.2196/15895",
url="https://www.jmir.org/2020/5/e15895",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412424"
}


@Article{info:doi/10.2196/16861,
author="Greenhalgh, Trisha
and Maylor, Harvey
and Shaw, Sara
and Wherton, Joseph
and Papoutsi, Chrysanthi
and Betton, Victoria
and Nelissen, Natalie
and Gremyr, Andreas
and Rushforth, Alexander
and Koshkouei, Mona
and Taylor, John",
title="The NASSS-CAT Tools for Understanding, Guiding, Monitoring, and Researching Technology Implementation Projects in Health and Social Care: Protocol for an Evaluation Study in Real-World Settings",
journal="JMIR Res Protoc",
year="2020",
month="May",
day="13",
volume="9",
number="5",
pages="e16861",
keywords="evaluation",
keywords="complexity",
keywords="theory-driven evaluation",
keywords="diffusion of innovation",
keywords="scale-up",
keywords="sustainability",
keywords="implementation",
keywords="NASSS (nonadoption, abandonment, scale-up, spread, sustainability) framework",
keywords="innovation adoption",
keywords="project management",
abstract="Background: Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al's nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects. Objective: We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings. Methods: Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals. Results: The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects' progress. Conclusions: The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. International Registered Report Identifier (IRRID): DERR1-10.2196/16861 ",
doi="10.2196/16861",
url="https://www.researchprotocols.org/2020/5/e16861",
url="http://www.ncbi.nlm.nih.gov/pubmed/32401224"
}


@Article{info:doi/10.2196/17520,
author="Thorn, Pinar
and Hill, TM Nicole
and Lamblin, Michelle
and Teh, Zoe
and Battersby-Coulter, Rikki
and Rice, Simon
and Bendall, Sarah
and Gibson, L. Kerry
and Finlay, May Summer
and Blandon, Ryan
and de Souza, Libby
and West, Ashlee
and Cooksey, Anita
and Sciglitano, Joe
and Goodrich, Simon
and Robinson, Jo",
title="Developing a Suicide Prevention Social Media Campaign With Young People (The \#Chatsafe Project): Co-Design Approach",
journal="JMIR Ment Health",
year="2020",
month="May",
day="11",
volume="7",
number="5",
pages="e17520",
keywords="suicide",
keywords="social media",
keywords="health promotion",
keywords="co-design",
keywords="adolescent",
keywords="young adult",
keywords="\#chatsafe",
abstract="Background: Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the \#chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions. Objective: This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the \#chatsafe suicide prevention social media campaign. Methods: In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators. Results: The majority of young people reported that the workshops were both safe (116/131, 88.5\%) and enjoyable (126/131, 96.2\%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services. Conclusions: This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web. ",
doi="10.2196/17520",
url="https://mental.jmir.org/2020/5/e17520",
url="http://www.ncbi.nlm.nih.gov/pubmed/32391800"
}


@Article{info:doi/10.2196/14884,
author="Alberts, M. Nicole
and Badawy, M. Sherif
and Hodges, Jason
and Estepp, H. Jeremie
and Nwosu, Chinonyelum
and Khan, Hamda
and Smeltzer, P. Matthew
and Homayouni, Ramin
and Norell, Sarah
and Klesges, Lisa
and Porter, S. Jerlym
and Hankins, S. Jane",
title="Development of the InCharge Health Mobile App to Improve Adherence to Hydroxyurea in Patients With Sickle Cell Disease: User-Centered Design Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="8",
volume="8",
number="5",
pages="e14884",
keywords="sickle cell anemia",
keywords="hydroxyurea",
keywords="hydroxycarbamide",
keywords="medication adherence",
keywords="self-management",
keywords="mobile health",
keywords="internet",
abstract="Background: Sickle cell disease (SCD) is an inherited blood disorder causing acute complications and chronic progressive end organ damage. SCD is associated with significant morbidity, early mortality, impaired health-related quality of life, and increased acute health care utilization. Hydroxyurea is a US Food and Drug Administration--approved medication that reduces disease complications, acute health care utilization, and costs. However, adherence to hydroxyurea is suboptimal. Mobile health (mHealth) interventions have the potential to improve hydroxyurea adherence, but few examples exist that are specific to the SCD population. Objective: This study aimed to design a mHealth intervention for individuals with SCD to improve adherence to hydroxyurea, using a user-centered design that was informed by specific barriers to hydroxyurea adherence and utilization in this population. Methods: This study consisted of 4 phases. In phase 1, individuals with SCD and health care providers participated in an optimization digital workshop. In phase 2, patients completed surveys pertaining to their interest in mHealth use, barriers and facilitators to hydroxyurea use, and health literacy. Phases 3 and 4 involved semistructured interviews and focus groups, respectively, and used the Health Belief Model (HBM) as the framework to investigate drivers of poor hydroxyurea adherence and to inform the development of an app prototype. In addition, in phase 4, we have incorporated the patients' feedback on the preliminary app prototype and its features. Results: Barriers to hydroxyurea adherence were consistent with the literature and included forgetfulness and several specific thoughts and emotions associated with hydroxyurea use (eg, fear of side effects, depression, stigma, and hopelessness). In addition, more than half of the participants reported potentially low health literacy. Preferred patient app features included 7 key components, namely (1) medication reminders and tracker, (2) disease education, (3) communication, (4) personalization, (5) motivation, (6) support during pain episodes, and (7) social support. Utilizing a user-centered design approach, data obtained from patients and providers were translated into features within the app, mapping to components of the HBM and the specific drivers of hydroxyurea adherence and matching the literacy level of the population, resulting in the development of a novel mobile app called InCharge Health. Conclusions: The InCharge Health app is an mHealth intervention developed with substantial input from users and by mapping the HBM as the framework that guided the choice for its components. InCharge Health is a customized product for the SCD population aimed at optimizing medication adherence, with the end goal of improving quality of life and health outcomes among patients with SCD. The efficacy and implementation of the InCharge Health app as an mHealth intervention to promote hydroxyurea adherence will be tested in a future stepped-wedge multicenter trial for adolescents and adults with SCD. ",
doi="10.2196/14884",
url="https://mhealth.jmir.org/2020/5/e14884",
url="http://www.ncbi.nlm.nih.gov/pubmed/32383683"
}


@Article{info:doi/10.2196/18400,
author="Fedele, A. David
and Cushing, C. Christopher
and Koskela-Staples, Natalie
and Patton, R. Susana
and McQuaid, L. Elizabeth
and Smyth, M. Joshua
and Prabhakaran, Sreekala
and Gierer, Selina
and Nezu, M. Arthur",
title="Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="6",
volume="8",
number="5",
pages="e18400",
keywords="asthma",
keywords="mobile health",
keywords="adherence",
keywords="adolescence",
keywords="self-regulation",
keywords="problem-solving",
keywords="adolescent",
keywords="youth",
abstract="Background: Adolescents diagnosed with persistent asthma commonly take less than 50\% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents' objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17--year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93\%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT's emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process. ",
doi="10.2196/18400",
url="https://mhealth.jmir.org/2020/5/e18400",
url="http://www.ncbi.nlm.nih.gov/pubmed/32374273"
}


@Article{info:doi/10.2196/15083,
author="Haque, Sanaul Md
and Kangas, Maarit
and J{\"a}ms{\"a}, Timo",
title="A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2020",
month="May",
day="4",
volume="4",
number="5",
pages="e15083",
keywords="mHealth behavioral change intervention",
keywords="persuasive app",
keywords="UCD",
keywords="game elements",
keywords="physical activity",
keywords="SDT",
abstract="Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. ",
doi="10.2196/15083",
url="https://formative.jmir.org/2020/5/e15083",
url="http://www.ncbi.nlm.nih.gov/pubmed/32364506"
}


@Article{info:doi/10.2196/14376,
author="Molina-Recio, Guillermo
and Molina-Luque, Rafael
and Jim{\'e}nez-Garc{\'i}a, M. Ana
and Ventura-Puertos, E. Pedro
and Hern{\'a}ndez-Reyes, Alberto
and Romero-Salda{\~n}a, Manuel",
title="Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e14376",
keywords="mHealth",
keywords="user-centered development",
keywords="focus groups",
keywords="discussion groups",
keywords="interdisciplinarity",
abstract="Background: Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention. Objective: The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves. Methods: An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: ``mHealth AND apps AND focus group OR discussion group.'' A total of 69 papers were included in the review. Results: A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing---keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented. Conclusions: These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users. ",
doi="10.2196/14376",
url="http://mhealth.jmir.org/2020/4/e14376/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319965"
}


@Article{info:doi/10.2196/14874,
author="Marier-Desch{\^e}nes, Pascale
and Gagnon, Marie-Pierre
and D{\'e}ry, Julien
and Lamontagne, Marie-Eve",
title="Traumatic Brain Injury and Sexuality: User Experience Study of an Information Toolkit",
journal="J Participat Med",
year="2020",
month="Mar",
day="18",
volume="12",
number="1",
pages="e14874",
keywords="user-centered design",
keywords="user experience",
keywords="traumatic brain injury",
keywords="sexuality",
keywords="health information",
abstract="Background: After having sustained a traumatic brain injury (TBI), individuals are at risk of functional impairments in information processing, abstract reasoning, executive functioning, attention, and memory. This affects different aspects of communicative functioning. Specific strategies can be adopted to improve the provision of health information to individuals with TBI, including the development of written materials and nonwritten media. Objective: A user-centered design was adopted to codevelop four audiovisual presentations, a double-sided information sheet, and a checklist aimed at informing individuals about post-TBI sexuality. The last phase of the project was the assessment of the user experience of the information toolkit, based on the User Experience Honeycomb model. Methods: Overall, two small group discussions and one individual semistructured interview were conducted with individuals with moderate to severe TBI. Results: The participants mentioned that the toolkit was easily usable and would have fulfilled a need for information on post-TBI sexuality during or after rehabilitation. They mostly agreed that the minimalist visual content was well-organized, attractive, and relevant. The information was easily located, the tools were accessible in terms of reading and visibility, and the content was also considered credible. Conclusions: Aspects such as usability, usefulness, desirability, accessibility, credibility, and findability of information were viewed positively by the participants. Further piloting of the toolkit is recommended to explore its effects on the awareness of the potential sexual repercussions of TBI in individuals and partners. ",
doi="10.2196/14874",
url="https://jopm.jmir.org/2020/1/e14874"
}


@Article{info:doi/10.2196/15914,
author="Ospina-Pinillos, Laura
and Davenport, A. Tracey
and Navarro-Mancilla, Andres Alvaro
and Cheng, Sze Vanessa Wan
and Cardozo Alarc{\'o}n, Camilo Andr{\'e}s
and Rangel, M. Andres
and Rueda-Jaimes, Eduardo German
and Gomez-Restrepo, Carlos
and Hickie, B. Ian",
title="Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies",
journal="JMIR Ment Health",
year="2020",
month="Feb",
day="6",
volume="7",
number="2",
pages="e15914",
keywords="Colombia",
keywords="telemedicine",
keywords="medical informatics",
keywords="eHealth",
keywords="mental health",
keywords="cultural characteristics",
keywords="cultural competency",
keywords="ethnic groups",
keywords="quality of health care",
keywords="community-based participatory research",
keywords="primary health care",
keywords="patient participation",
keywords="patient preference",
keywords="patient satisfaction",
keywords="consumer health information",
keywords="methods",
keywords="research design",
abstract="Background: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. Objective: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods: This study involved the utilization of a research and development (R\&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. Results: A total of 2 co-design workshops were held with 18 users---young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions---young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. Conclusions: The application of an R\&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R\&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C---a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time. ",
doi="10.2196/15914",
url="https://mental.jmir.org/2020/2/e15914"
}


@Article{info:doi/10.2196/15889,
author="Ledel Solem, Konstanse Ingrid
and Varsi, Cecilie
and Eide, Hilde
and Kristjansdottir, Birna Ol{\"o}f
and B{\o}r{\o}sund, Elin
and Schreurs, G. Karlein M.
and Waxenberg, B. Lori
and Weiss, E. Karen
and Morrison, J. Eleshia
and Haaland-{\O}verby, Mette
and Bevan, Katherine
and Zangi, Andersen Heidi
and Stubhaug, Audun
and Solberg Nes, Lise",
title="A User-Centered Approach to an Evidence-Based Electronic Health Pain Management Intervention for People With Chronic Pain: Design and Development of EPIO",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="21",
volume="22",
number="1",
pages="e15889",
keywords="Web-based interventions",
keywords="eHealth",
keywords="mobile apps",
keywords="evidence-based, user-centered design approach",
keywords="service design",
keywords="chronic pain",
keywords="cognitive behavioral therapy",
keywords="acceptance and commitment therapy",
abstract="Background: Chronic pain conditions are complicated and challenging to live with. Electronic health (eHealth) interventions show promise in helping people cope with chronic illness, including pain. The success of these interventions depends not only on the technology and intervention content but also on the users' acceptance and adherence. Involving all stakeholders (eg, patients, spouses, health care providers, designers, software developers, and researchers) and exploring their input and preferences in the design and development process is an important step toward developing meaningful interventions and possibly strengthening treatment outcomes. Objective: The aim of this study was to design and develop a user-centered, evidence-based eHealth self-management intervention for people with chronic pain. Methods: The study employed a multidisciplinary and user-centered design approach. Overall, 20 stakeholders from the project team (ie, 7 researchers, 5 editors, 7 software developers, and 1 user representative), together with 33 external stakeholders (ie, 12 health care providers, 1 health care manger, 1 eHealth research psychologist, and 17 patients with chronic pain and 2 of their spouses) participated in a user-centered development process that included workshops, intervention content development, and usability testing. Intervention content was developed and finalized based on existing evidence, stakeholder input, and user testing. Stakeholder input was examined through qualitative analyses with rapid and in-depth analysis approaches. Results: Analyses from stakeholder input identified themes including a need for reliable, trustworthy, and evidence-based content, personalization, options for feedback, behavioral tracking, and self-assessment/registration as factors to include in the intervention. Evidence-based intervention content development resulted in one face-to-face introduction session and 9 app-based educational and exercise-based modules. Usability testing provided further insight into how to optimize the design of the intervention to the user group, identifying accessibility and a simple design to be essential. Conclusions: The design and development process of eHealth interventions should strive to combine well-known evidence-based concepts with stakeholder input. This study, designing and developing the pain management intervention EPIO, illustrates how a stakeholder-centered design approach can provide essential input in the development of an eHealth self-management intervention for people with chronic pain. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 ",
doi="10.2196/15889",
url="http://www.jmir.org/2020/1/e15889/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31961331"
}


@Article{info:doi/10.2196/14424,
author="ten Klooster, Iris
and Noordzij, Leendert Matthijs
and Kelders, Marion Saskia",
title="Exploring How Professionals Within Agile Health Care Informatics Perceive Visualizations of Log File Analyses: Observational Study Followed by a Focus Group Interview",
journal="JMIR Hum Factors",
year="2020",
month="Jan",
day="21",
volume="7",
number="1",
pages="e14424",
keywords="log file analyses",
keywords="user-centered design",
keywords="agile",
keywords="Markov Chains",
keywords="health care systems",
abstract="Background: An increasing number of software companies work according to the agile software development method, which is difficult to integrate with user-centered design (UCD) practices. Log file analysis may provide opportunities for integrating UCD practices in the agile process. However, research within health care information technology mostly has a theoretical approach and is often focused on the researcher's interpretation of log file analyses. Objective: We aimed to propose a systematic approach to log file analysis in this study and present this to developers to explore how they react and interpret this approach in the context of a real-world health care information system, in an attempt to answer the following question: How may log file analyses contribute to increasing the match between the health care system and its users, within the agile development method, according to agile team members? Methods: This study comprised 2 phases to answer the research question. In the first phase, log files were collected from a health care information system and subsequently analyzed (summarizing sequential patterns, heat mapping, and clustering). In the second phase, the results of these analyses are presented to agile professionals during a focus group interview. The interpretations of the agile professionals are analyzed by open axial coding. Results: Log file data of 17,924 user sessions and, in total, 176,678 activities were collected. We found that the Patient Timeline is mainly visited, with 23,707 (23,707/176,678; 13.42\%) visits in total. The main unique user session occurred in 5.99\% (1074/17,924) of all user sessions, and this comprised Insert Measurement Values for Patient and Patient Timeline, followed by the page Patient Settings and, finally, Patient Treatment Plan. In the heat map, we found that users often navigated to the pages Insert Measurement Values and Load Messages Collaborate. Finally, in the cluster analysis, we found 5 clusters, namely, the Information-seeking cluster, the Collaborative cluster, the Mixed cluster, the Administrative cluster, and the Patient-oriented cluster. We found that the interpretations of these results by agile professionals are related to stating hypotheses (n=34), comparing paths (n=31), benchmarking (n=22), and prioritizing (n=17). Conclusions: We found that analyzing log files provides agile professionals valuable insights into users' behavior. Therefore, we argue that log file analyses should be used within agile development to inform professionals about users' behavior. In this way, further UCD research can be informed by these results, making the methods less labor intensive. Moreover, we argue that these translations to an approach for further UCD research will be carried out by UCD specialists, as they are able to infer which goals the user had when going through these paths when looking at the log data. ",
doi="10.2196/14424",
url="https://humanfactors.jmir.org/2020/1/e14424",
url="http://www.ncbi.nlm.nih.gov/pubmed/31961325"
}


@Article{info:doi/10.2196/13695,
author="Hemingway, Charlotte
and Baja, S. Emmanuel
and Dalmacion, V. Godafreda
and Medina, B. Paul Mark
and Guevara, Genesis Ernest
and Sy, Reden Tyrone
and Dacombe, Russell
and Dormann, Claire
and Taegtmeyer, Miriam",
title="Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process",
journal="JMIR Serious Games",
year="2019",
month="Dec",
day="20",
volume="7",
number="4",
pages="e13695",
keywords="HIV",
keywords="video games",
keywords="health communication",
keywords="persuasive communication",
keywords="games",
keywords="experimental",
keywords="user-centered design",
abstract="Background: Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user's subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective: This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods: Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results: Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game's narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions: User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures. ",
doi="10.2196/13695",
url="http://games.jmir.org/2019/4/e13695/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31859673"
}


@Article{info:doi/10.2196/15618,
author="Klamerus, L. Mandi
and Damschroder, J. Laura
and Sparks, B. Jordan
and Skurla, E. Sarah
and Kerr, A. Eve
and Hofer, P. Timothy
and Caverly, J. Tanner",
title="Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes",
journal="JMIR Res Protoc",
year="2019",
month="Nov",
day="26",
volume="8",
number="11",
pages="e15618",
keywords="quality of health care",
keywords="user-centered design",
keywords="design thinking",
keywords="overtesting",
keywords="medical overuse",
keywords="overtreatment",
abstract="Background: Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. Objective: This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. Methods: We engaged stakeholders in design charrettes---intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem---focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (WhoDo). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. Results: A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. Conclusions: Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services. International Registered Report Identifier (IRRID): RR1-10.2196/15618 ",
doi="10.2196/15618",
url="http://www.researchprotocols.org/2019/11/e15618/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31769764"
}


@Article{info:doi/10.2196/15368,
author="O'Donnell, Shane
and Lewis, Dana
and Marchante Fern{\'a}ndez, Mar{\'i}a
and W{\"a}ldchen, Mandy
and Cleal, Bryan
and Skinner, Timothy
and Raile, Klemens
and Tappe, Adrian
and Ubben, Tebbe
and Willaing, Ingrid
and Hauck, Bastian
and Wolf, Saskia
and Braune, Katarina",
title="Evidence on User-Led Innovation in Diabetes Technology (The OPEN Project): Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2019",
month="Nov",
day="19",
volume="8",
number="11",
pages="e15368",
keywords="diabetes",
keywords="digital health",
keywords="open source",
keywords="closed-loop insulin delivery systems",
keywords="automated insulin delivery systems",
keywords="\#WeAreNotWaiting",
abstract="Background: Digital innovations in health care have traditionally followed a top-down pathway, with manufacturers leading the design and production of technology-enabled solutions and those living with chronic conditions involved only as passive recipients of the end product. However, user-driven open-source initiatives in health care are becoming increasingly popular. An example is the growing movement of people with diabetes, who create their own ``Do-It-Yourself Artificial Pancreas Systems'' (DIYAPS). Objective: The overall aim of this study is to establish the empirical evidence base for the clinical effectiveness and quality-of-life benefits of DIYAPS and identify the challenges and possible solutions to enable their wider diffusion. Methods: A research program comprising 5 work packages will examine the outcomes and potential for scaling up DIYAPS solutions. Quantitative and qualitative methodologies will be used to examine clinical and self-reported outcome measures of DIYAPS users. The majority of members of the research team live with type 1 diabetes and are active DIYAPS users, making Outcomes of Patients' Evidence With Novel, Do-It-Yourself Artificial Pancreas Technology (OPEN) a unique, user-driven research project. Results: This project has received funding from the European Commission's Horizon 2020 Research and Innovation Program, under the Marie Sk?odowska-Curie Action Research and Innovation Staff Exchange. Researchers with both academic and nonacademic backgrounds have been recruited to formulate research questions, drive the research process, and disseminate ongoing findings back to the DIYAPS community and other stakeholders. Conclusions: The OPEN project is unique in that it is a truly patient- and user-led research project, which brings together an international, interdisciplinary, and intersectoral research group, comprising health care professionals, technical developers, biomedical and social scientists, the majority of whom are also living with diabetes. Thus, it directly addresses the core research and user needs of the DIYAPS movement. As a new model of cooperation, it will highlight how researchers in academia, industry, and the patient community can create patient-centric innovation and reduce disease burden together. International Registered Report Identifier (IRRID): PRR1-10.2196/15368 ",
doi="10.2196/15368",
url="http://www.researchprotocols.org/2019/11/e15368/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31742563"
}


@Article{info:doi/10.2196/14558,
author="Gill, Kaur Roopan
and Ogilvie, Gina
and Norman, V. Wendy
and Fitzsimmons, Brian
and Maher, Ciana
and Renner, Regina",
title="Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion: User-Centered Design",
journal="JMIR Hum Factors",
year="2019",
month="Oct",
day="10",
volume="6",
number="4",
pages="e14558",
keywords="mHealth",
keywords="abortion",
keywords="digital health",
keywords="human centered design",
keywords="knowledge translation",
keywords="women's health",
keywords="sexual health",
abstract="Background: Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. Objective: The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. Methods: The study design was based on the ``development-evaluation-implementation'' process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. Results: We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. Conclusions: This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care. ",
doi="10.2196/14558",
url="https://humanfactors.jmir.org/2019/4/e14558",
url="http://www.ncbi.nlm.nih.gov/pubmed/31603429"
}


@Article{info:doi/10.2196/14990,
author="Lyon, R. Aaron
and Munson, A. Sean
and Renn, N. Brenna
and Atkins, C. David
and Pullmann, D. Michael
and Friedman, Emily
and Are{\'a}n, A. Patricia",
title="Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability?",
journal="JMIR Res Protoc",
year="2019",
month="Oct",
day="9",
volume="8",
number="10",
pages="e14990",
keywords="implementation science",
keywords="human-centered design",
keywords="evidence-based psychosocial interventions",
abstract="Background: This paper presents the protocol for the National Institute of Mental Health (NIMH)--funded University of Washington's ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center (UWAC), which uses human-centered design (HCD) methods to improve the implementation of evidence-based psychosocial interventions (EBPIs). We propose that usability---the degree to which interventions and implementation strategies can be used with ease, efficiency, effectiveness, and satisfaction---is a fundamental, yet poorly understood determinant of implementation. Objective: We present a novel Discover, Design/Build, and Test (DDBT) framework to study usability as an implementation determinant. DDBT will be applied across Center projects to develop scalable and efficient implementation strategies (eg, training tools), modify existing EBPIs to enhance usability, and create usable and nonburdensome decision support tools for quality delivery of EBPIs. Methods: Stakeholder participants will be implementation practitioners/intermediaries, mental health clinicians, and patients with mental illness in nonspecialty mental health settings in underresourced communities. Three preplanned projects and 12 pilot studies will employ the DDBT model to (1) identify usability challenges in implementing EBPIs in underresourced settings; (2) iteratively design solutions to overcome these challenges; and (3) compare the solution to the original version of the EPBI or implementation strategy on usability, quality of care, and patient-reported outcomes. The final products from the center will be a streamlined modification and redesign model that will improve the usability of EBPIs and implementation strategies (eg, tools to support EBPI education and decision making); a matrix of modification targets (ie, usability issues) that are both common and unique to EBPIs, strategies, settings, and patient populations; and a compilation of redesign strategies and the relative effectiveness of the redesigned solution compared to the original EBPI or strategy. Results: The UWAC received institutional review board approval for the three separate studies in March 2018 and was funded in May 2018. Conclusions: The outcomes from this center will inform the implementation of EBPIs by identifying cross-cutting features of EBPIs and implementation strategies that influence the use and acceptability of these interventions, actively involving stakeholder clinicians and implementation practitioners in the design of the EBPI modification or implementation strategy solution and identifying the impact of HCD-informed modifications and solutions on intervention effectiveness and quality. Trial Registration: ClinicalTrials.gov NCT03515226 (https://clinicaltrials.gov/ct2/show/NCT03515226), NCT03514394 (https://clinicaltrials.gov/ct2/show/NCT03514394), and NCT03516513 (https://clinicaltrials.gov/ct2/show/NCT03516513). International Registered Report Identifier (IRRID): DERR1-10.2196/14990 ",
doi="10.2196/14990",
url="https://www.researchprotocols.org/2019/10/e14990",
url="http://www.ncbi.nlm.nih.gov/pubmed/31599736"
}


@Article{info:doi/10.2196/15871,
author="Zhang, Melvyn
and Heng, Sandor
and Song, Guo
and Fung, SS Daniel
and Smith, E. Helen",
title="Co-designing a Mobile Gamified Attention Bias Modification Intervention for Substance Use Disorders: Participatory Research Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="3",
volume="7",
number="10",
pages="e15871",
keywords="attention bias",
keywords="cognitive bias",
keywords="gamification",
keywords="participatory design research",
keywords="psychiatry",
keywords="apps",
keywords="mobile intervention",
abstract="Background: Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective: The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders. Methods: The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype. Results: Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation. Conclusions: The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm. \emspace ",
doi="10.2196/15871",
url="https://mhealth.jmir.org/2019/10/e15871",
url="http://www.ncbi.nlm.nih.gov/pubmed/31584003"
}


@Article{info:doi/10.2196/14633,
author="Woods, Leanna
and Duff, Jed
and Roehrer, Erin
and Walker, Kim
and Cummings, Elizabeth",
title="Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart",
journal="JMIR Nursing",
year="2019",
month="Sep",
day="23",
volume="2",
number="1",
pages="e14633",
keywords="heart failure",
keywords="mobile health (mHealth)",
keywords="mobile apps",
keywords="self-management",
keywords="mobile phone",
keywords="patient involvement",
abstract="Background: Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management. Objective: The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart. Methods: Seven patients, four family caregivers, and seven multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor. Results: The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member's contact details, schedule medical appointments, and store documents. The My Plan section contains nine important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development. Conclusions: We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use. ",
doi="10.2196/14633",
url="https://nursing.jmir.org/2019/1/e14633",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345774"
}


@Article{info:doi/10.2196/10702,
author="Schimmer, Robyn
and Orre, Carljohan
and {\"O}berg, Ulrika
and Danielsson, Karin
and H{\"o}rnsten, {\AA}sa",
title="Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges",
journal="JMIR Diabetes",
year="2019",
month="Sep",
day="19",
volume="4",
number="3",
pages="e10702",
keywords="eHealth",
keywords="diabetes mellitus, type 2",
keywords="informatics",
keywords="nursing",
keywords="patient-centered care",
keywords="self-management",
abstract="Background: Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. Objective: The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. Methods: A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. Results: Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. Conclusions: A total of three overarching challenges---flexible access, reducing administrative tasks, and patient empowerment---each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus. ",
doi="10.2196/10702",
url="http://diabetes.jmir.org/2019/3/e10702/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31538941"
}


@Article{info:doi/10.2196/14002,
author="Giordanengo, Alain
and {\AA}rsand, Eirik
and Woldaregay, Zebene Ashenafi
and Bradway, Meghan
and Grottland, Astrid
and Hartvigsen, Gunnar
and Granja, Concei{\c{c}}{\~a}o
and Torsvik, Torbj{\o}rn
and Hansen, Helen Anne",
title="Design and Prestudy Assessment of a Dashboard for Presenting Self-Collected Health Data of Patients With Diabetes to Clinicians: Iterative Approach and Qualitative Case Study",
journal="JMIR Diabetes",
year="2019",
month="Jul",
day="09",
volume="4",
number="3",
pages="e14002",
keywords="dashboard",
keywords="self-collected health data",
keywords="diabetes",
keywords="mHealth",
keywords="decision support system",
abstract="Background: Introducing self-collected health data from patients with diabetes into consultation can be beneficial for both patients and clinicians. Such an initiative can allow patients to be more proactive in their disease management and clinicians to provide more tailored medical services. Optimally, electronic health record systems (EHRs) should be able to receive self-collected health data in a standard representation of medical data such as Fast Healthcare Interoperability Resources (FHIR), from patients systems like mobile health apps and display the data directly to their users---the clinicians. However, although Norwegian EHRs are working on implementing FHIR, no solution or graphical interface is available today to display self-collected health data. Objective: The objective of this study was to design and assess a dashboard for displaying relevant self-collected health data from patients with diabetes to clinicians. Methods: The design relied on an iterative participatory process involving workshops with patients, clinicians, and researchers to define which information should be available and how it should be displayed. The assessment is based on a case study, presenting an instance of the dashboard populated with data collected from one patient with diabetes type 1 (in-house researcher) face-to-face by 14 clinicians. We performed a qualitative analysis based on usability, functionality, and expectation by using responses to questionnaires that were distributed to the 14 clinicians at the end of the workshops and collected before the participants left. The qualitative assessment was guided by the Standards for Reporting Qualitative Research. Results: We created a dashboard permitting clinicians to assess the reliability of self-collected health data, list all collected data including medical calculations, and highlight medical situations that need to be investigated to improve the situation of the patients. The dashboard uses a combination of tables, graphs, and other visual representations to display the relevant information. Clinicians think that this type of solution will be useful during consultations every day, especially for patients living in remote areas or those who are technologically interested. Conclusions: Displaying self-collected health data during consultations is not enough for clinicians; the data reliability has to be assured and the relevant information needs to be extracted and displayed along with the data to ease the introduction during a medical encounter. The prestudy assessment showed that the system provides relevant information to meet clinicians' need and that clinicians were eager to start using it during consultations. The system has been under testing in a medical trial since November 2018, and the first results of its assessment in a real-life situation are expected in the beginning of next year (2020). ",
doi="10.2196/14002",
url="http://diabetes.jmir.org/2019/3/e14002/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31290396"
}


@Article{info:doi/10.2196/12055,
author="Pickup, Laura
and Lang, Alexandra
and Shipley, Lara
and Henry, Caroline
and Carpenter, James
and McCartney, Damon
and Butler, Matthew
and Hayes-Gill, Barrie
and Sharkey, Don",
title="Development of a Clinical Interface for a Novel Newborn Resuscitation Device: Human Factors Approach to Understanding Cognitive User Requirements",
journal="JMIR Hum Factors",
year="2019",
month="Jun",
day="8",
volume="6",
number="2",
pages="e12055",
keywords="neonatal resuscitation",
keywords="medical device",
keywords="human factors",
keywords="user-centred design",
keywords="applied cognitive task analysis",
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. ",
doi="10.2196/12055",
url="http://humanfactors.jmir.org/2019/2/e12055/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199321"
}


@Article{info:doi/10.2196/12327,
author="Tremblay, M{\'e}lanie
and Latulippe, Karine
and Giguere, MC Anik
and Provencher, V{\'e}ronique
and Poulin, Val{\'e}rie
and Dub{\'e}, V{\'e}ronique
and Guay, Manon
and Ethier, Sophie
and S{\'e}vigny, Andr{\'e}e
and Carignan, Maude
and Giroux, Dominique",
title="Requirements for an Electronic Health Tool to Support the Process of Help Seeking by Caregivers of Functionally Impaired Older Adults: Co-Design Approach",
journal="JMIR Aging",
year="2019",
month="Jun",
day="07",
volume="2",
number="1",
pages="e12327",
keywords="functionally-impaired elderly",
keywords="caregivers",
keywords="co-design",
keywords="eHealth",
keywords="telemedicine",
keywords="help-seeking behavior",
abstract="Background: In Quebec, Canada, many public, community, and private organizations provide resources to caregivers of functionally impaired older adults. Nevertheless, these resources may be difficult for caregivers to find. A co-design study was conducted to address the gap between caregivers and access to resources. The purpose of this study was to support the process of help seeking by caregivers of functionally impaired older adults through electronic health (eHealth). Objective: The purpose of this study was to focus on the identification of functional and content requirements for an eHealth tool to support the help-seeking process of caregivers of functionally impaired older adults. Methods: This study uses a co-design process based on qualitative action research approach to develop an eHealth tool with health and social service professionals (HSSPs), community workers, and caregivers. The participants acted as co-designers in identifying requirements for the tool. A total of 4 design workshops and 1 advisory committee session were held in different locations in Quebec, Canada. Activities were videotaped and analyzed with a conceptual framework of user experience. Results: A total of 11 caregivers, 16 community workers, and 11 HSSPs participated in identifying the requirements for the eHealth tool. Several functional and content requirements were identified for each user need (19). Content requirements differed depending on the category of participant, corresponding to the concept of user segmentation in the design of information and communication technology. Nevertheless, there were disagreements among co-designers about specific functionalities, which included (1) functionalities related to the social Web, (2) functionalities related to the evaluation of resources for caregivers, and (3) functionalities related to the emerging technologies. Several co-design sessions were required to resolve disagreements. Conclusions: Co-designers (participants) were able to identify functional and content requirements for each of the previously identified needs; however, several discussions were required to achieve consensus. Decision making was influenced by identity, social context, and participants' knowledge, and it is a challenge to reconcile the different perspectives. The findings stressed the importance of allowing more time to deal with the iterative aspect of the design activity, especially during the identification of requirements of an eHealth tool. International Registered Report Identifier (IRRID): RR2-10.2196/11634 ",
doi="10.2196/12327",
url="http://aging.jmir.org/2019/1/e12327/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518279"
}


@Article{info:doi/10.2196/humanfactors.9481,
author="Jalil, Sakib
and Myers, Trina
and Atkinson, Ian
and Soden, Muriel",
title="Complementing a Clinical Trial With Human-Computer Interaction: Patients' User Experience With Telehealth",
journal="JMIR Hum Factors",
year="2019",
month="Jun",
day="06",
volume="6",
number="2",
pages="e9481",
keywords="clinical user-experience evaluation",
keywords="telehealth",
keywords="type 2 diabetes",
keywords="user experience",
keywords="human-computer interaction",
keywords="patient-centered",
keywords="patient-technology interaction",
keywords="eHealth",
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. ",
doi="10.2196/humanfactors.9481",
url="http://humanfactors.jmir.org/2019/2/e9481/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31172958"
}


@Article{info:doi/10.2196/13365,
author="Castro-S{\'a}nchez, Enrique
and Sood, Anuj
and Rawson, Miles Timothy
and Firth, Jamie
and Holmes, Helen Alison",
title="Forecasting Implementation, Adoption, and Evaluation Challenges for an Electronic Game--Based Antimicrobial Stewardship Intervention: Co-Design Workshop With Multidisciplinary Stakeholders",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="04",
volume="21",
number="6",
pages="e13365",
keywords="serious games",
keywords="antimicrobial stewardship",
keywords="medical education",
abstract="Background: Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescribers. Objective: The goal of the research was to forecast gaps in implementation, adoption and evaluation of game-based interventions, and co-design solutions with antimicrobial clinicians and digital and behavioral researchers. Methods: A co-development workshop with clinicians and academics in serious games, antimicrobials, and behavioral sciences was organized to open the International Summit on Serious Health Games in London, United Kingdom, in March 2018. The workshop was announced on social media and online platforms. Attendees were asked to work in small groups provided with a laptop/tablet and the latest version of the game On call: Antibiotics. A workshop leader guided open group discussions around implementation, adoption, and evaluation threats and potential solutions. Workshop summary notes were collated by an observer. Results: There were 29 participants attending the workshop. Anticipated challenges to resolve reflected implementation threats such as an inadequate organizational arrangement to scale and sustain the use of the game, requiring sufficient technical and educational support and a streamlined feedback mechanism that made best use of data arriving from the game. Adoption threats included collective perceptions that a game would be a ludic rather than professional tool and demanding efforts to integrate all available educational solutions so none are seen as inferior. Evaluation threats included the need to combine game metrics with organizational indicators such as antibiotic use, which may be difficult to enable. Conclusions: As with other technology-based interventions, deploying game-based solutions requires careful planning on how to engage and support clinicians in their use and how best to integrate the game and game outputs onto existing workflows. The ludic characteristics of the game may foster perceptions of unprofessionalism among gamers, which would need buffering from the organization. ",
doi="10.2196/13365",
url="https://www.jmir.org/2019/6/e13365/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31165712"
}


@Article{info:doi/10.2196/12135,
author="Sandhu, Harminder
and Wilson, Katherine
and Reed, Nick
and Mihailidis, Alex",
title="A Mobile Phone App for the Self-Management of Pediatric Concussion: Development and Usability Testing",
journal="JMIR Hum Factors",
year="2019",
month="May",
day="31",
volume="6",
number="2",
pages="e12135",
keywords="brain concussion",
keywords="safety",
keywords="pediatrics",
keywords="youth",
keywords="children",
keywords="self-management",
keywords="mild traumatic brain injury",
keywords="mobile apps",
keywords="mobile health",
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. ",
doi="10.2196/12135",
url="http://humanfactors.jmir.org/2019/2/e12135/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31152527"
}


@Article{info:doi/10.2196/10465,
author="Haldane, Victoria
and Koh, Kai Joel Jun
and Srivastava, Aastha
and Teo, Qi Krichelle Wei
and Tan, Guo Yao
and Cheng, Xiang Rui
and Yap, Cheng Yi
and Ong, Pei-Shi
and Van Dam, M. Rob
and Foo, Min Jie
and M{\"u}ller-Riemenschneider, Falk
and Koh, Choon-Huat Gerald
and Foong, Sym Pin
and Perel, Pablo
and Legido-Quigley, Helena",
title="User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="28",
volume="7",
number="5",
pages="e10465",
keywords="personas",
keywords="biopsychosocial personas",
keywords="qualitative",
keywords="ASCVD",
keywords="adherence",
keywords="patient perspectives",
abstract="Background: The use of mobile health (mHealth) has gained popularity globally, including for its use in a variety of health interventions, particularly through short message service (SMS) text messaging. However, there are challenges to the use of mHealth, particularly among older users who have a large heterogeneity in usability and accessibility barriers when using technology. Objective: In order to better understand and conceptualize the diversity of users and give insight into their particular needs, we turned to persona creation. Personas are user archetypes created through data generated from multi-method inquiry with actual target users. Personas are an appropriate yet largely underutilized component of current mHealth research. Methods: Leveraging data from a multi-method study conducted in Singapore with an ethnically diverse population including Chinese, Malay, and Indian participants, we used a proforma to analyze data from the qualitative component (ie, 20 in-depth interviews) and quantitative component (ie, 100 interviewer-guided surveys). We then identified key characteristics, including technology use and preferences as well as adherence factors, to synthesize five personas reflective of persons over the age of 40 years in Singapore with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, such as hypertension. Results: We present five personas typologized as (1) The Quiet Analog, (2) The Busy Grandparent, (3) The Socializer, (4) The Newly Diagnosed, and (5) The Hard-to-Reach. We report on four key characteristics: health care access, medication adherence, mobile phone technology usage (ie, ownership, access, and utilization), and interest in mHealth. Finally, we provide insights into how these personas may be used in the design and implementation of an mHealth intervention. Our work demonstrates how multi-method data can create biopsychosocial personas that can be used to explore and address the diversity in behaviors, preferences, and needs in user groups. Conclusions: With wider adoption of mHealth, it is important that we consider user-centered design techniques and design thinking in order to create meaningful, patient-centered interventions for adherence to medications. Future research in this area should include greater exploration of how these five personas can be used to better understand how and when is best to deliver mHealth interventions in Singapore and beyond. ",
doi="10.2196/10465",
url="http://mhealth.jmir.org/2019/5/e10465/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31140445"
}


@Article{info:doi/10.2196/10318,
author="Bhattacharyya, Onil
and Mossman, Kathryn
and Gustafsson, Lovisa
and Schneider, C. Eric",
title="Using Human-Centered Design to Build a Digital Health Advisor for Patients With Complex Needs: Persona and Prototype Development",
journal="J Med Internet Res",
year="2019",
month="May",
day="09",
volume="21",
number="5",
pages="e10318",
keywords="chronic disease",
keywords="user-centered design",
keywords="medical applications",
abstract="Background: Twenty years ago, a ``Guardian Angel'' or comprehensive digital health advisor was proposed to empower patients to better manage their own health. This is now technically feasible, but most digital applications have narrow functions and target the relatively healthy, with few designed for those with the greatest needs. Objective: The goal of the research was to identify unmet needs and key features of a general digital health advisor for frail elderly and people with multiple chronic conditions and their caregivers. Methods: In-depth interviews were used to develop personas and use cases, and iterative feedback from participants informed the creation of a low-fidelity prototype of a digital health advisor. Results were shared with developers, investors, regulators, and health system leaders for suggestions on how this could be developed and disseminated. Results: Patients highlighted the following goals: ``live my life,'' ``love my life,'' ``manage my health,'' and ``feel understood.'' Patients and caregivers reported interest in four functions to address these goals: tracking and insights, advice and information, providing a holistic picture of the patient, and coordination and communication. Experts and system stakeholders felt the prototype was technically feasible, and that while health care delivery organizations could help disseminate such a tool, it should be done in partnership with consumer-focused organizations. Conclusions: This study describes the key features of a comprehensive digital health advisor, but to spur its development, we need to clarify the business case and address the policy, organizational, and cultural barriers to creating tools that put patients and their goals at the center of the health system. ",
doi="10.2196/10318",
url="https://www.jmir.org/2019/5/e10318/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094334"
}


@Article{info:doi/10.2196/12656,
author="Fleming, Theresa
and Merry, Sally
and Stasiak, Karolina
and Hopkins, Sarah
and Patolo, Tony
and Ruru, Stacey
and Latu, Manusiu
and Shepherd, Matthew
and Christie, Grant
and Goodyear-Smith, Felicity",
title="The Importance of User Segmentation for Designing Digital Therapy for Adolescent Mental Health: Findings From Scoping Processes",
journal="JMIR Ment Health",
year="2019",
month="May",
day="08",
volume="6",
number="5",
pages="e12656",
keywords="gamification",
keywords="computerized therapy",
keywords="mental health",
keywords="adolescent",
keywords="mobile apps",
keywords="internet",
abstract="Background: New Zealand youth, especially those of M?ori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement. Objective: We aimed to carry out preliminary scoping to understand adolescents' current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers. Methods: Interactive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach. Results: Participants (N=58) engaged in 2 wh?nau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face. Conclusions: Defining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health--need groups. This study demonstrates the importance of scoping possible user needs to inform design processes. ",
doi="10.2196/12656",
url="https://mental.jmir.org/2019/5/e12656/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066705"
}


@Article{info:doi/10.2196/12700,
author="Griffin, Lauren
and Lee, Donghee
and Jaisle, Alyssa
and Carek, Peter
and George, Thomas
and Laber, Eric
and Lok, Benjamin
and Modave, Fran{\c{c}}ois
and Paskett, Electra
and Krieger, Janice",
title="Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2019",
month="May",
day="08",
volume="6",
number="2",
pages="e12700",
keywords="communication",
keywords="cell phone",
keywords="mobile phone",
keywords="culturally appropriate technology",
keywords="interdisciplinary research",
keywords="colon cancer",
keywords="cancer screening",
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. ",
doi="10.2196/12700",
url="http://humanfactors.jmir.org/2019/2/e12700/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066688"
}


@Article{info:doi/10.2196/11833,
author="Marko-Holguin, Monika
and Cordel, Luz Stephanie
and Van Voorhees, William Benjamin
and Fogel, Joshua
and Sykes, Emily
and Fitzgibbon, Marian
and Glassgow, Elizabeth Anne",
title="A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="01",
volume="7",
number="5",
pages="e11833",
keywords="mobile applications",
keywords="telemedicine",
keywords="patient participation",
keywords="patient acceptance of health care",
keywords="delivery of health care",
keywords="family health",
keywords="community health services",
keywords="healthcare disparities",
keywords="information technology",
keywords="cell phone use",
abstract="Background: Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective: The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods: We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results: The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients' ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions: Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff. ",
doi="10.2196/11833",
url="https://mhealth.jmir.org/2019/5/e11833/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31042152"
}


@Article{info:doi/10.2196/12028,
author="Birnie, A. Kathryn
and Campbell, Fiona
and Nguyen, Cynthia
and Lalloo, Chitra
and Tsimicalis, Argerie
and Matava, Clyde
and Cafazzo, Joseph
and Stinson, Jennifer",
title="iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="22",
volume="3",
number="2",
pages="e12028",
keywords="postoperative pain",
keywords="smartphone",
keywords="mobile applications",
keywords="mHealth",
keywords="pain management",
keywords="self-management",
keywords="adolescent",
abstract="Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. ",
doi="10.2196/12028",
url="http://formative.jmir.org/2019/2/e12028/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008704"
}


@Article{info:doi/10.2196/11965,
author="Buus, Niels
and Juel, Anette
and Haskelberg, Hila
and Frandsen, Hanne
and Larsen, Skovgaard Jette Louise
and River, Jo
and Andreasson, Kate
and Nordentoft, Merete
and Davenport, Tracey
and Erlangsen, Annette",
title="User Involvement in Developing the MYPLAN Mobile Phone Safety Plan App for People in Suicidal Crisis: Case Study",
journal="JMIR Ment Health",
year="2019",
month="Apr",
day="16",
volume="6",
number="4",
pages="e11965",
keywords="mobile apps",
keywords="patient participation",
keywords="primary prevention",
keywords="self-injurious behavior",
keywords="suicide, attempted",
abstract="Background: The effect of safety planning for people in suicidal crisis is not yet determined, but using safety plans to mitigate acute psychological crisis is regarded as best practice. Between 2016 and 2017, Australian and Danish stakeholders were involved in revising and updating the Danish MYPLAN mobile phone safety plan and translating the app into a culturally appropriate version for Australia. Objective: The objective of this study was to examine the negotiation of stakeholders' suggestions and contributions to the design, function, and content of the MYPLAN app and to characterize significant developments in the emerging user-involving processes. Methods: We utilized a case study design where 4 focus groups and 5 user-involving workshops in Denmark and Australia were subjected to thematic analysis. Results: The analyses identified 3 consecutive phases in the extensive development of the app: from phase 1, Suggesting core functions, through phase 2, Refining functions, to phase 3, Negotiating the finish. The user-involving processes continued to prevent closure and challenged researchers and software developers to repeatedly reconsider the app's basic user interface and functionality. It was a limitation that the analysis did not include potentially determinative backstage dimensions of the decision-making process. Conclusions: The extended user involvement prolonged the development process, but it also allowed for an extensive exploration of different user perspectives and needs. ",
doi="10.2196/11965",
url="http://mental.jmir.org/2019/4/e11965/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30990456"
}


@Article{info:doi/10.2196/10894,
author="Srinivas, Preethi
and Bodke, Kunal
and Ofner, Susan
and Keith, R. NiCole
and Tu, Wanzhu
and Clark, O. Daniel",
title="Context-Sensitive Ecological Momentary Assessment: Application of User-Centered Design for Improving User Satisfaction and Engagement During Self-Report",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="03",
volume="7",
number="4",
pages="e10894",
keywords="mhealth",
keywords="health status",
keywords="obesity",
keywords="ecological momentary assessment",
abstract="Background: Ecological momentary assessment (EMA) can be a useful tool for collecting real-time behavioral data in studies of health and health behavior. However, EMA administered through mobile technology can be burdensome, and it tends to suffer from suboptimal user engagement, particularly in low health-literacy populations. Objective: This study aimed to report a case study involving the design and evaluation of a mobile EMA tool that supports context-sensitive EMA-reporting of location and social situations accompanying eating and sedentary behavior. Methods: An iterative, user-centered design process with obese, middle-aged women seeking care in a safety-net health system was used to identify the preferred format of self-report measures and the look, feel, and interaction of the mobile EMA tool. A single-arm feasibility field trial with 21 participants receiving 12 prompts each day for momentary self-reports over a 4-week period (336 total prompts per participant) was used to determine user satisfaction with interface quality and user engagement, operationalized as response rate. A second trial among 38 different participants randomized to receive or not to receive a feature designed to improve engagement was conducted. Results: The feasibility trial results showed high interface satisfaction and engagement, with an average response rate of 50\% over 4 weeks. Qualitative feedback pointed to the need for auditory alerts. We settled on 3 alerts at 10-min intervals to accompany each EMA-reporting prompt. The second trial testing this feature showed a statistically significant increase in the response rate between participants randomized to receive repeat auditory alerts versus those who were not (60\% vs 40\%). Conclusions: This paper reviews the design research and a set of design constraints that may be considered in the creation of mobile EMA interfaces personalized to users' preferences. Novel aspects of the study include the involvement of low health-literacy adults in design research, the capture of data on time, place, and social context of eating and sedentary behavior, and reporting prompts tailored to an individual's location and schedule. Trial Registration: ClinicalTrials.gov NCT03083964;?https://clinicaltrials.gov/ct2/show/NCT03083964 ",
doi="10.2196/10894",
url="http://mhealth.jmir.org/2019/4/e10894/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30942698"
}


@Article{info:doi/10.2196/13205,
author="Ledel Solem, Konstanse Ingrid
and Varsi, Cecilie
and Eide, Hilde
and Kristjansdottir, Birna Ol{\"o}f
and Mirkovic, Jelena
and B{\o}r{\o}sund, Elin
and Haaland-{\O}verby, Mette
and Heldal, Karina
and Schreurs, MG Karlein
and Waxenberg, B. Lori
and Weiss, Elizabeth Karen
and Morrison, J. Eleshia
and Solberg Nes, Lise",
title="Patients' Needs and Requirements for eHealth Pain Management Interventions: Qualitative Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="01",
volume="21",
number="4",
pages="e13205",
keywords="chronic pain",
keywords="eHealth",
keywords="self-management",
keywords="qualitative methods",
keywords="intervention development",
keywords="user-centered design",
abstract="Background: A growing body of evidence supports the potential effectiveness of electronic health (eHealth) interventions in managing chronic pain. However, research on the needs and preferences of patients with chronic pain in relation to eHealth interventions is scarce. Eliciting user input in the development of eHealth interventions may be a crucial step toward developing meaningful interventions for patients for potentially improving treatment outcomes. Objective: This study aimed to explore the experiences of patients with chronic pain with regard to information and communication technology, understand how an eHealth intervention can support the everyday needs and challenges of patients with chronic pain, and identify possible facilitators and barriers for patients' use of an eHealth pain management intervention. Methods: Twenty patients living with chronic pain and five spouses participated in individual interviews. Semistructured interview guides were used to explore participants' needs, experiences, and challenges in daily life as well as their information and communication technology experiences and preferences for eHealth support interventions. Spouses were recruited and interviewed to gain additional insight into the patients' needs. The study used qualitative thematic analysis. Results: The participants were generally experienced technology users and reported using apps regularly. They were mainly in favor of using an eHealth self-management intervention for chronic pain and considered it a potentially acceptable way of gathering knowledge and support for pain management. The participants expressed the need for obtaining more information and knowledge, establishing a better balance in everyday life, and receiving support for improving communication and social participation. They provided suggestions for the eHealth intervention content and functionality to address these needs. Accessibility, personalization, and usability were emphasized as important elements for an eHealth support tool. The participants described an ideal eHealth intervention as one that could be used for support and distraction from pain, at any time or in any situation, regardless of varying pain intensity and concentration capacity. Conclusions: This study provides insight into user preferences for eHealth interventions aiming to address self-management for chronic pain. Participants highlighted important factors to be considered when designing and developing eHealth interventions for self-management of chronic pain, illustrating the importance and benefit of including users in the development of eHealth interventions. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104. ",
doi="10.2196/13205",
url="https://www.jmir.org/2019/4/e13205/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30877780"
}


@Article{info:doi/10.2196/12378,
author="Buitenweg, C. David
and Bongers, L. Ilja
and van de Mheen, Dike
and van Oers, AM Hans
and van Nieuwenhuizen, Chijs",
title="Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems",
journal="JMIR Ment Health",
year="2019",
month="Mar",
day="28",
volume="6",
number="3",
pages="e12378",
keywords="mobile app",
keywords="quality of life",
keywords="mental health",
keywords="homeless persons",
keywords="medical informatics",
abstract="Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language?based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. ",
doi="10.2196/12378",
url="http://mental.jmir.org/2019/3/e12378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920381"
}


@Article{info:doi/10.2196/jmir.9958,
author="Prince, M. Rebecca
and Soung Yee, Anthony
and Parente, Laura
and Enright, A. Katherine
and Grunfeld, Eva
and Powis, Melanie
and Husain, Amna
and Gandhi, Sonal
and Krzyzanowska, K. Monika",
title="User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="28",
volume="21",
number="3",
pages="e9958",
keywords="prototype",
keywords="Web-based tool",
keywords="toxicity management",
keywords="chemotherapy",
keywords="self-management",
abstract="Background: Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population. Objective: This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities. Methods: User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users. Results: Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information. Conclusions: Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption. ",
doi="10.2196/jmir.9958",
url="http://www.jmir.org/2019/3/e9958/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920373"
}


@Article{info:doi/10.2196/11374,
author="Moraes Carrilho, Juliana
and Oliveira, Ramos Isaias Jos{\'e}
and Santos, Dimitri
and Osanan, Costa Gabriel
and Cruz-Correia, Jo{\~a}o Ricardo
and Reis, Nogueira Zilma Silveira",
title="Pregnant Users' Perceptions of the Birth Plan Interface in the ``My Prenatal Care'' App: Observational Validation Study",
journal="JMIR Form Res",
year="2019",
month="Mar",
day="28",
volume="3",
number="1",
pages="e11374",
keywords="birth plan",
keywords="perinatal care",
keywords="usability, mobile health",
keywords="mobile app",
keywords="pregnancy",
keywords="prenatal care",
keywords="mobile phone",
abstract="Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users' positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women's perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user's perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users' performance in accomplishing previously prepared tasks, we found that 10 of 11 (91\%) women were capable of completing at least 6 of 8 (75\%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. ",
doi="10.2196/11374",
url="http://formative.jmir.org/2019/1/e11374/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920372"
}


@Article{info:doi/10.2196/11224,
author="Smail-Crevier, Rachel
and Powers, Gabrielle
and Noel, Chelsea
and Wang, JianLi",
title="Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="18",
volume="21",
number="3",
pages="e11224",
keywords="occupational health",
keywords="workplace",
keywords="mental health",
keywords="preventive health program",
keywords="depression",
keywords="internet",
abstract="Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers' health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4\%) and women (211/500, 42.2\%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8\%), women (408/479, 85.2\%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7\%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8\%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9\%), and to receive printed materials by mail (215/500, 43.4\%). Men preferred to receive information in a video game format (156/511, 30.7\%). Younger men (46/73, 63\%) and younger women (49/60, 81\%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. ",
doi="10.2196/11224",
url="http://www.jmir.org/2019/3/e11224/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30882361"
}


@Article{info:doi/10.2196/13121,
author="Ray, M. Jessica
and Ahmed, M. Osama
and Solad, Yauheni
and Maleska, Matthew
and Martel, Shara
and Jeffery, M. Molly
and Platts-Mills, F. Timothy
and Hess, P. Erik
and D'Onofrio, Gail
and Melnick, R. Edward",
title="Computerized Clinical Decision Support System for Emergency Department--Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design",
journal="JMIR Hum Factors",
year="2019",
month="Feb",
day="27",
volume="6",
number="1",
pages="e13121",
keywords="user-centered design",
keywords="decision support systems, clinical",
keywords="opioid-related disorders",
keywords="opiate substitution treatment",
keywords="health information technology",
abstract="Background: Emergency departments (EDs) frequently care for individuals with opioid use disorder (OUD). Buprenorphine (BUP) is an effective treatment option for patients with OUD that can safely be initiated in the ED. At present, BUP is rarely initiated as a part of routine ED care. Clinical decision support (CDS) could accelerate adoption of ED-initiated BUP into routine emergency care. Objective: This study aimed to design and formatively evaluate a user-centered decision support tool for ED initiation of BUP for patients with OUD. Methods: User-centered design with iterative prototype development was used. Initial observations and interviews identified workflows and information needs. The design team and key stakeholders reviewed prototype designs to ensure accuracy. A total of 5 prototypes were evaluated and iteratively refined based on input from 26 attending and resident physicians. Results: Early feedback identified concerns with the initial CDS design: an alert with several screens. The timing of the alert led to quick dismissal without using the tool. User feedback on subsequent iterations informed the development of a flexible tool to support clinicians with varied levels of experience with the intervention by providing both one-click options for direct activation of care pathways and user-activated support for critical decision points. The final design resolved challenging navigation issues through targeted placement, color, and design of the decision support modules and care pathways. In final testing, users expressed that the tool could be easily learned without training and was reasonable for use during routine emergency care. Conclusions: A user-centered design process helped designers to better understand users' needs for a Web-based clinical decision tool to support ED initiation of BUP for OUD. The process identified varying needs across user experience and familiarity with the protocol, leading to a flexible design supporting both direct care pathways and user-initiated decision support. ",
doi="10.2196/13121",
url="http://humanfactors.jmir.org/2019/1/e13121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30810531"
}


@Article{info:doi/10.2196/11714,
author="Zibrowski, Elaine
and Shepherd, Lisa
and Booth, Richard
and Sedig, Kamran
and Gibson, Candace",
title="A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting",
journal="JMIR Hum Factors",
year="2019",
month="Feb",
day="06",
volume="6",
number="1",
pages="e11714",
keywords="Lean health care",
keywords="emergency medicine",
keywords="privacy and confidentiality",
keywords="work intensification",
keywords="qualitative research",
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. ",
doi="10.2196/11714",
url="http://humanfactors.jmir.org/2019/1/e11714/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30724743"
}


@Article{info:doi/10.2196/12128,
author="Adam, Maya
and McMahon, A. Shannon
and Prober, Charles
and B{\"a}rnighausen, Till",
title="Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="30",
volume="21",
number="1",
pages="e12128",
keywords="human-centered design",
keywords="health promotion",
keywords="health behavior",
keywords="health knowledge, attitudes, practice",
keywords="community health workers",
keywords="telemedicine",
keywords="eHealth",
keywords="mHealth",
doi="10.2196/12128",
url="http://www.jmir.org/2019/1/e12128/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30698531"
}


@Article{info:doi/10.2196/jmir.9711,
author="Weichelt, Bryan
and Bendixsen, Casper
and Keifer, Matthew",
title="Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="29",
volume="21",
number="1",
pages="e9711",
keywords="agriculture",
keywords="farmworkers",
keywords="injuries",
keywords="occupational medicine",
keywords="return to work",
keywords="software application",
abstract="Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers' compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners' and managers' attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company's human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software's impact on patients and employers. ",
doi="10.2196/jmir.9711",
url="https://www.jmir.org/2019/1/e9711/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30694202"
}


@Article{info:doi/10.2196/10956,
author="Morita, Pelegrini Plinio
and Yeung, S. Melanie
and Ferrone, Madonna
and Taite, K. Ann
and Madeley, Carole
and Stevens Lavigne, Andrea
and To, Teresa
and Lougheed, Diane M.
and Gupta, Samir
and Day, G. Andrew
and Cafazzo, A. Joseph
and Licskai, Christopher",
title="A Patient-Centered Mobile Health System That Supports Asthma Self-Management (breathe): Design, Development, and Utilization",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="28",
volume="7",
number="1",
pages="e10956",
keywords="smartphone",
keywords="asthma",
keywords="self report",
keywords="self-management",
keywords="patient compliance",
keywords="telemedicine",
keywords="risk reduction behavior",
keywords="internet",
keywords="monitoring, physiologic",
keywords="mobile applications",
abstract="Background: Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes. Objective: The aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM) platform (breathe) using content based on international evidence-based clinical guidelines. Methods: We designed and developed breathe as a Web-based mobile health (mHealth) platform accessible on smartphones, tablets, or desktop with user-centered design methods and International Organization for Standardization--certified quality development processes. Moreover, breathe was envisioned as a multifunctional, CSM mHealth platform, with content based on international clinical practice guidelines and compliant with national privacy and security specifications. The system enabled CSM (patient, provider, and breathe) and self-monitoring of asthma patients through (1) assessment of asthma control, (2) real-time access to a dynamic asthma action plan, (3) access to real-time environmental conditions, and (4) risk-reduction messaging. The data collection protocol collected user data for 12 months, with clinic visits at baseline and 6 and 12 months. Utilization outcomes included user interactions with the platform, user impressions, self-reported medication use, asthma symptom profile, reported peak flow measurement, and the delivery and impact of email reminders. Results: We enrolled 138 patients with a mean age of 45.3 years to receive the breathe intervention. Majority were female (100/138, 72.5\%), had a smartphone (92/138, 66.7\%), and had a mean Asthma Control Test score of 18.3 (SD 4.9). A majority reported that breathe helped in the management of their asthma. Moreover, breathe scored 71.1 (SD 18.9) on the System Usability Scale. Overall, 123 patients had complete usage analytics datasets. The platform sent 7.96 reminder emails per patient per week (pppw), patients accessed breathe 3.08 times, journaled symptoms 2.56 times, reported medication usage 0.30 times, and reported peak flow measurements 0.92 times pppw. Furthermore, breathe calculated patients' action plan zone of control 2.72 times pppw, with patients being in the green (well-controlled) zone in 47.71\% (8300/17,396) of the total calculations. Usage analysis showed that 67.5\% (83/123) of the participants used the app at week 4 and only 57.7\% (71/123) by week 45. Physician visits, email reminders, and aged 50 years and above were associated with higher utilization. Conclusions: Individuals with asthma reported good usability and high satisfaction levels, reacted to breathe notifications, and had confidence in the platform's assessment of asthma control. Strong utilization was seen at the intervention's initiation, followed by a rapid reduction in use. Patient reminders, physician visits, and being aged 50 years and above were associated with higher utilization. Trial Registration: ClinicalTrials.gov NCT01964469;?https://clinicaltrials.gov/ct2/show/NCT01964469 ",
doi="10.2196/10956",
url="http://mhealth.jmir.org/2019/1/e10956/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30688654"
}


@Article{info:doi/10.2196/11447,
author="Pham, Quynh
and Graham, Gary
and Lalloo, Chitra
and Morita, P. Plinio
and Seto, Emily
and Stinson, N. Jennifer
and Cafazzo, A. Joseph",
title="An Analytics Platform to Evaluate Effective Engagement With Pediatric Mobile Health Apps: Design, Development, and Formative Evaluation",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="21",
volume="6",
number="12",
pages="e11447",
keywords="analytics",
keywords="engagement",
keywords="log data",
keywords="mobile health",
keywords="mobile apps",
keywords="chronic disease",
abstract="Background: Mobile health (mHealth) apps for pediatric chronic conditions are growing in availability and challenge investigators to conduct rigorous evaluations that keep pace with mHealth innovation. Traditional research methods are poorly suited to operationalize the agile, iterative trials required to evidence and optimize these digitally mediated interventions. Objective: We sought to contribute a resource to support the quantification, analysis, and visualization of analytic indicators of effective engagement with mHealth apps for chronic conditions. Methods: We applied user-centered design methods to design and develop an Analytics Platform to Evaluate Effective Engagement (APEEE) with consumer mHealth apps for chronic conditions and implemented the platform to analyze both retrospective and prospective data generated from a smartphone-based pain self-management app called iCanCope for young people with chronic pain. Results: Through APEEE, we were able to automate the process of defining, operationalizing, and evaluating effective engagement with iCanCope. Configuring the platform to integrate with the app was feasible and provided investigators with a resource to consolidate, analyze, and visualize engagement data generated by participants in real time. Preliminary efforts to evaluate APEEE showed that investigators perceived the platform to be an acceptable evaluative resource and were satisfied with its design, functionality, and performance. Investigators saw potential in APEEE to accelerate and augment evidence generation and expressed enthusiasm for adopting the platform to support their evaluative practice once fully implemented. Conclusions: Dynamic, real-time analytic platforms may provide investigators with a powerful means to characterize the breadth and depth of mHealth app engagement required to achieve intended health outcomes. Successful implementation of APEEE into evaluative practice may contribute to the realization of effective and evidence-based mHealth care. ",
doi="10.2196/11447",
url="http://mhealth.jmir.org/2018/12/e11447/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578179"
}


@Article{info:doi/10.2196/11048,
author="Chokshi, Kuppin Sara
and Mann, M. Devin",
title="Innovating From Within: A Process Model for User-Centered Digital Development in Academic Medical Centers",
journal="JMIR Hum Factors",
year="2018",
month="Dec",
day="19",
volume="5",
number="4",
pages="e11048",
keywords="academic medical centers",
keywords="digital health",
keywords="heath information technology",
keywords="innovation",
keywords="process model",
keywords="user-centered design",
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. ",
doi="10.2196/11048",
url="http://humanfactors.jmir.org/2018/4/e11048/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30567688"
}


@Article{info:doi/10.2196/diabetes.9926,
author="Wysocki, Tim
and Pierce, Jessica
and Caldwell, Cindy
and Aroian, Karen
and Miller, Louis
and Farless, Rebecca
and Hafezzadeh, Ivy
and McAninch, Terri
and Lee, M. Joyce",
title="A Web-Based Coping Intervention by and for Parents of Very Young Children With Type 1 Diabetes: User-Centered Design",
journal="JMIR Diabetes",
year="2018",
month="Dec",
day="17",
volume="3",
number="4",
pages="e16",
keywords="coping",
keywords="mobile phone",
keywords="parenting",
keywords="social media",
keywords="type 1 diabetes",
abstract="Background: Management of type 1 diabetes (T1D) among children aged <6 years is exceptionally challenging for parents and caregivers. Metabolic and psychosocial outcomes among very young children with T1D (YC-T1D) are tightly associated with their parents' ability to meet these challenges. There is scant research testing interventions targeting these issues and few resources to equip health care providers with feasible and effective coping strategies for these parents. User-centered design (UCD) of a continuously accessible Web-based resource could be a mechanism for helping parents of YC-T1D cope more effectively with the complex challenges they face by providing them with information, solutions, and emotional support. Objective: The objectives of this paper are to (1) describe the application of UCD principles to the development of a Web-based coping intervention designed by and for parents of very young children (<6 years old) with T1D; (2) illustrate the use of crowdsourcing methods in obtaining the perspectives of parents, health care providers, and Web development professionals in designing and creating this resource; and (3) summarize the design of an ongoing randomized controlled trial (RCT) that is evaluating the effects of parental access to this resource on pertinent child and parent outcomes. Methods: This paper illustrates the application of UCD principles to create a Web-based coping resource designed by and for parents of YC-T1D. A Web-based Parent Crowd, a Health Care Provider Crowd, and a Focus Group of minority parents provided input throughout the design process. A formal usability testing session and design webinars yielded additional stakeholder input to further refine the end product. Results: This paper describes the completed website and the ongoing RCT to evaluate the effects of using this Web-based resource on pertinent parent and child outcomes. Conclusions: UCD principles and the targeted application of crowdsourcing methods provided the foundation for the development, construction, and evaluation of a continuously accessible, archived, user-responsive coping resource designed by and for parents of YC-T1D. The process described here could be a template for the development of similar resources for other special populations that are enduring specific medical or psychosocial distress. The ongoing RCT is the final step in the UCD process and is designed to validate its merits. ",
doi="10.2196/diabetes.9926",
url="http://diabetes.jmir.org/2018/4/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30559089"
}


@Article{info:doi/10.2196/11473,
author="Honary, Mahsa
and Fisher, Ruth Naomi
and McNaney, Roisin
and Lobban, Fiona",
title="A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach",
journal="JMIR Ment Health",
year="2018",
month="Dec",
day="07",
volume="5",
number="4",
pages="e11473",
keywords="mental health",
keywords="Web-based intervention",
keywords="user-centered design",
keywords="caregivers",
keywords="bipolar disorder",
keywords="psychosis",
abstract="Background: Relatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs. Objective: The aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder. Methods: We engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives' views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives' views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit. Results: Our findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner. Conclusions: Our study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support. ",
doi="10.2196/11473",
url="http://mental.jmir.org/2018/4/e11473/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30530457"
}


@Article{info:doi/10.2196/10128,
author="Shtrichman, Ronit
and Conrad, Stefan
and Schimo, Kai
and Shachar, Ran
and Machluf, Ehud
and Mindal, Enrique
and Epstein, Howard
and Epstein, Shirli
and Paz, Alan",
title="Use of a Digital Medication Management System for Effective Assessment and Enhancement of Patient Adherence to Therapy (ReX): Feasibility Study",
journal="JMIR Hum Factors",
year="2018",
month="Nov",
day="26",
volume="5",
number="4",
pages="e10128",
keywords="medication adherence",
keywords="medication nonadherence",
keywords="personalized medicine",
keywords="therapy management",
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. ",
doi="10.2196/10128",
url="http://humanfactors.jmir.org/2018/4/e10128/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30478020"
}


@Article{info:doi/10.2196/11131,
author="Tunnell, Harry
and Faiola, Anthony
and Bolchini, Davide
and Bartlett Ellis, Rebecca",
title="Simulated Clinical Encounters Using Patient-Operated mHealth: Experimental Study to Investigate Patient-Provider Communication",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="01",
volume="6",
number="11",
pages="e11131",
keywords="medical informatics",
keywords="personal health record",
keywords="medication reconciliation",
abstract="Background: This study investigates patient-centered mobile health (mHealth) technology in terms of the secondary user experience (UX). Specifically, it examines how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient's health care during their first visit to a provider. Common ground, a theory about language use, is used as the theoretical basis to examine interactions. A novel concept of this study is that it is one of the first empirical studies to explore the relative meaningfulness of a secondary UX for specific health care tasks. Objective: The objective of this study was to investigate the extent that patient-operated mHealth technology can be designed to improve the communication between the patient and provider during an initial face-to-face encounter. Methods: The experimental study was conducted in 2 large Midwestern cities from February 2016 to May 2016. A custom-designed smartphone app prototype was used as the study treatment. The experimental design was posttest-only control group and included video-recorded simulated face-to-face clinical encounters in which an actor role-played a patient. Experienced clinicians consisting of doctors (n=4) and nurses (n=8) were the study participants. A thematic analysis of qualitative data was performed. Quantitative data collected from time on task measurements were analyzed using descriptive statistics. Results: Three themes that represent how grounding manifested during the encounter, what it meant for communication during the encounter, and how it influenced the provider's perception of the patient emerged from the qualitative analysis. The descriptive statistics were important for inferring evidence of efficiency and effectiveness of communication for providers. Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit. Conclusions: Combining the notions of common ground, human-computer interaction design, and smartphone technology resulted in a prototype that improved the efficiency and effectiveness of face-to-face collaboration for secondary users. The experimental study is one of the first studies to demonstrate that an investment in the secondary UX for high payoff tasks has value but that not all secondary UXs are meaningful for design. This observation is useful for prioritizing how resources should be applied when considering the secondary UX. ",
doi="10.2196/11131",
url="https://mhealth.jmir.org/2018/11/e11131/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30389652"
}


@Article{info:doi/10.2196/mhealth.9856,
author="Marent, Benjamin
and Henwood, Flis
and Darking, Mary
and ",
title="Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="19",
volume="6",
number="10",
pages="e184",
keywords="mHealth",
keywords="mobile applications",
keywords="telemedicine",
keywords="information technology",
keywords="sexual health",
keywords="HIV",
keywords="self-management",
keywords="patient participation",
keywords="sociology, medical",
keywords="community-based participatory research",
keywords="health services",
abstract="Background: Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective: The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods: Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results: Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform's implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions: Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process. ",
doi="10.2196/mhealth.9856",
url="http://mhealth.jmir.org/2018/10/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30339132"
}


@Article{info:doi/10.2196/11027,
author="Scherer, M. Aaron
and Witteman, O. Holly
and Solomon, Jacob
and Exe, L. Nicole
and Fagerlin, Angela
and Zikmund-Fisher, J. Brian",
title="Improving the Understanding of Test Results by Substituting (Not Adding) Goal Ranges: Web-Based Between-Subjects Experiment",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="19",
volume="20",
number="10",
pages="e11027",
keywords="decision making, education of patients, electronic health record, computer graphics, clinical laboratory information systems",
abstract="Background: Most displays of laboratory test results include a standard reference range. For some patients (eg, those with chronic conditions), however, getting a result within the standard range may be unachievable, inappropriate, or even harmful. Objective: The objective of our study was to test the impact of including clinically appropriate goal ranges outside the standard range in the visual displays of laboratory test results. Methods: Participants (N=6776) from a demographically diverse Web-based panel viewed hypothetical glycated hemoglobin (HbA1c) test results (HbA1c either 6.2\% or 8.2\%) as part of a type 2 diabetes management scenario. Test result visual displays included either a standard range (4.5\%-5.7\%) only, a goal range (6.5\%-7.5\%) added to the standard range, or the goal range only. The results were displayed in 1 of the following 3 display formats: (1) a table; (2) a simple, two-colored number line (simple line); or (3) a number line with diagnostic categories indicated via colored blocks (block line). Primary outcome measures were comprehension of and negative reactions to test results. Results: While goal range information did not influence the understanding of HbA1c=8.2\% results, the goal range only display produced higher levels of comprehension and decreased negative reactions to HbA1c=6.2\% test results compared with the no goal range and goal range added conditions. Goal range information was less helpful in the block line condition versus the other formats. Conclusions: Replacing the standard range with a clinically appropriate goal range could help patients better understand how their test results relate to their personal targets. ",
doi="10.2196/11027",
url="http://www.jmir.org/2018/10/e11027/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30341053"
}


@Article{info:doi/10.2196/11826,
author="Backonja, Uba
and Haynes, C. Sarah
and Kim, K. Katherine",
title="Data Visualizations to Support Health Practitioners' Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study",
journal="JMIR Hum Factors",
year="2018",
month="Oct",
day="16",
volume="5",
number="4",
pages="e11826",
keywords="cancer care facilities",
keywords="informatics",
keywords="patient-centered care",
keywords="patient-generated health data",
keywords="precision medicine",
keywords="visualization",
abstract="Background: There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. Objective: The aim of the study was to assess the health care practitioners' perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care. Methods: Medical doctors (n=4) and registered nurses (n=4) providing cancer care at an academic medical center in the western United States provided feedback on visualization mock-ups. Mock-up designs were guided by current health informatics and visualization literature and the Munzner Nested Model for Visualization Design. User-centered design methods, a mock patient persona, and a scenario were used to elicit insights from participants. Directed content analysis was used to identify themes from session transcripts. Means and SDs were calculated for health care practitioners' rankings of overview visualizations. Results: Themes identified were data elements, supportive elements, confusing elements, interpretation, and use of visualization. Overall, participants found the visualizations useful and with the potential to provide personalized care. Use of color, reference lines, and familiar visual presentations (calendars, line graphs) were noted as helpful in interpreting data. Conclusions: Visualizations guided by a framework and literature can support health care practitioners' understanding of data for individuals with multiple chronic conditions engaged in cancer care. This understanding has the potential to support the provision of personalized care. ",
doi="10.2196/11826",
url="http://humanfactors.jmir.org/2018/4/e11826/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30327290"
}


@Article{info:doi/10.2196/mhealth.9811,
author="Nguyen, D. Amy
and Frensham, J. Lauren
and Wong, XC Michael
and Meslin, MM Sylvain
and Martin, Paige
and Lau, YS Annie
and Baysari, T. Melissa
and Day, O. Richard",
title="mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="15",
volume="6",
number="10",
pages="e182",
keywords="mobile apps",
keywords="gout",
keywords="self-management",
keywords="chronic disease",
keywords="uric acid",
abstract="Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app's presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. ",
doi="10.2196/mhealth.9811",
url="http://mhealth.jmir.org/2018/10/e182/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30322835"
}


@Article{info:doi/10.2196/10105,
author="Ploderer, Bernd
and Brown, Ross
and Seng, Da Leonard Si
and Lazzarini, A. Peter
and van Netten, J. Jaap",
title="Promoting Self-Care of Diabetic Foot Ulcers Through a Mobile Phone App: User-Centered Design and Evaluation",
journal="JMIR Diabetes",
year="2018",
month="Oct",
day="10",
volume="3",
number="4",
pages="e10105",
keywords="mobile apps",
keywords="foot ulcer, diabetic",
keywords="self-care (rehabilitation)",
keywords="therapeutic adherence and compliance",
keywords="patient engagement",
keywords="podiatry",
abstract="Background: Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs. Objective: This study aimed to evaluate the usability and potential usefulness of a new mobile phone app to engage people with DFUs in self-care. Methods: We developed a new mobile phone app, MyFootCare, to engage people with DFUs through goals, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extract and monitor DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centered design process with 11 participants with DFUs. Data were collected through semistructured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analyzed qualitatively through thematic analysis. Results: Key themes were as follows: (1) participants already used mobile phone photos to monitor their DFU progress; (2) participants had limited experience with using mobile phone apps; (3) participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress; (4) participants were ambivalent about the MyFootCare goal image and diary features, commenting that these features were useful but also that it was unlikely that they would use them; and (5) participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress. Conclusions: MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data are useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, that is, by refining the process of taking and analyzing photos of DFUs and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions and to test it with people with DFUs and their carers. ",
doi="10.2196/10105",
url="https://diabetes.jmir.org/2018/4/e10105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30305266"
}


@Article{info:doi/10.2196/humanfactors.9569,
author="Martinez, William
and Threatt, L. Anthony
and Rosenbloom, Trent S.
and Wallston, A. Kenneth
and Hickson, B. Gerald
and Elasy, A. Tom",
title="A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing",
journal="JMIR Hum Factors",
year="2018",
month="Sep",
day="24",
volume="5",
number="3",
pages="e26",
keywords="diabetes mellitus, type 2",
keywords="patient portals",
keywords="qualitative research",
keywords="consumer health informatics",
abstract="Background: Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use. Objective: The aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record. Methods: We applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met). Results: The sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants' mean age was 63 years (range 45-78 years), 57\% (8/14) were female, and 50\% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients' diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80\% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5). Conclusions: Our results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use. ",
doi="10.2196/humanfactors.9569",
url="http://humanfactors.jmir.org/2018/3/e26/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249579"
}


@Article{info:doi/10.2196/formative.9954,
author="B{\o}r{\o}sund, Elin
and Mirkovic, Jelena
and Clark, M. Matthew
and Ehlers, L. Shawna
and Andrykowski, A. Michael
and Bergland, Anne
and Westeng, Marianne
and Solberg Nes, Lise",
title="A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing",
journal="JMIR Formativ Res",
year="2018",
month="Sep",
day="06",
volume="2",
number="2",
pages="e19",
keywords="stress management",
keywords="mindfulness",
keywords="cancer",
keywords="eHealth",
keywords="mHealth",
keywords="mobile apps",
keywords="development",
keywords="usability",
keywords="user-centered design",
keywords="mobile phones",
abstract="Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) ",
doi="10.2196/formative.9954",
url="http://formative.jmir.org/2018/2/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684438"
}


@Article{info:doi/10.2196/mental.9445,
author="Fuller-Tyszkiewicz, Matthew
and Richardson, Ben
and Klein, Britt
and Skouteris, Helen
and Christensen, Helen
and Austin, David
and Castle, David
and Mihalopoulos, Cathrine
and O'Donnell, Renee
and Arulkadacham, Lilani
and Shatte, Adrian
and Ware, Anna",
title="A Mobile App--Based Intervention for Depression: End-User and Expert Usability Testing Study",
journal="JMIR Ment Health",
year="2018",
month="Aug",
day="23",
volume="5",
number="3",
pages="e54",
keywords="depression",
keywords="eHealth",
keywords="mHealth",
keywords="young adult",
abstract="Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. ",
doi="10.2196/mental.9445",
url="http://mental.jmir.org/2018/3/e54/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30139722"
}


@Article{info:doi/10.2196/10206,
author="Wang, Jing
and Chu, Chin-Fun
and Li, Chengdong
and Hayes, Laura
and Siminerio, Linda",
title="Diabetes Educators' Insights Regarding Connecting Mobile Phone-- and Wearable Tracker--Collected Self-Monitoring Information to a Nationally-Used Electronic Health Record System for Diabetes Education: Descriptive Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jul",
day="26",
volume="6",
number="7",
pages="e10206",
keywords="wearable",
keywords="connected health",
keywords="mHealth",
keywords="diabetes",
keywords="self-management",
keywords="lifestyle intervention",
keywords="electronic health record",
keywords="self-monitoring",
keywords="behavior modification",
keywords="usability",
abstract="Background: Diabetes educators are integral to a clinical team in providing diabetes self-management education and support; however, current mobile and Web-based self-management tools are not integrated into clinical diabetes care to support diabetes educators' education efforts. Objective: The objective of our study was to seek diabetes educators' insights regarding the development of an interface within the Chronicle Diabetes system, a nationally used electronic health record (EHR) system for diabetes education documentation with behavioral goal-setting functions, to transfer mobile phone- and wearable tracker-collected self-monitoring information from patients to diabetes educators to facilitate behavioral goal monitoring. Methods: A descriptive qualitative study was conducted to seek educators' perspectives on usability and interface development preferences in developing a connected system. Educators can use the Chronicle Diabetes system to set behavioral goals with their patients. Individual and group interviews were used to seek educators' preferences for viewing mobile phone- and wearable tracker-collected information on diet, physical activity, and sleep in the Chronicle Diabetes system using open-ended questions. Interview data were transcribed verbatim and analyzed for common themes. Results: Five common themes emerged from the discussion. First, educators expressed enthusiasm for and concerns about viewing diet and physical activity data in Chronicle Diabetes system. Second, educators valued viewing detailed dietary macronutrients and activity data; however, they preferred different kinds of details depending on patients' needs, conditions, and behavioral goals and educators' training background. Third, all educators liked the integration of mobile phone-collected data into Chronicle Diabetes system and preferably with current EHR systems. Fourth, a need for a health care team and a central EHR system to be formed was realized for educators to share summaries of self-monitoring data with other providers. Fifth, educators desired advanced features for the mobile app and the connected interface that can show self-monitoring data. Conclusions: Flexibility is needed for educators to track the details of mobile phone- and wearable tracker-collected diet and activity information, and the integration of such data into Chronicle Diabetes and EHR systems is valuable for educators to track patients' behavioral goals, provide diabetes self-management education and support, and share data with other health care team members to faciliate team-based care in clinical practice. ",
doi="10.2196/10206",
url="http://mhealth.jmir.org/2018/7/e10206/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30049667"
}


@Article{info:doi/10.2196/rehab.9009,
author="Wang, Erh-Hsuan
and Zhou, Leming
and Chen, Kay Szu-Han
and Hill, Katya
and Parmanto, Bambang",
title="An mHealth Platform for Supporting Clinical Data Integration into Augmentative and Alternative Communication Service Delivery: User-Centered Design and Usability Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Jul",
day="24",
volume="5",
number="2",
pages="e14",
keywords="Web-based portal",
keywords="data integration",
keywords="Augmentative and Alternative Communication",
keywords="service delivery",
abstract="Background: The recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence. Objective: The objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery. Methods: A questionnaire and interviews were used to collect clinicians' ideas regarding what constitutes their desired ``clinically relevant'' data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals. Results: A Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal. Conclusions: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery. ",
doi="10.2196/rehab.9009",
url="http://rehab.jmir.org/2018/2/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30042092"
}


@Article{info:doi/10.2196/10070,
author="Schoen, W. Martin
and Basch, Ethan
and Hudson, L. Lori
and Chung, E. Arlene
and Mendoza, R. Tito
and Mitchell, A. Sandra
and St. Germain, Diane
and Baumgartner, Paul
and Sit, Laura
and Rogak, J. Lauren
and Shouery, Marwan
and Shalley, Eve
and Reeve, B. Bryce
and Fawzy, R. Maria
and Bhavsar, A. Nrupen
and Cleeland, Charles
and Schrag, Deborah
and Dueck, C. Amylou
and Abernethy, P. Amy",
title="Software for Administering the National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study",
journal="JMIR Hum Factors",
year="2018",
month="Jul",
day="16",
volume="5",
number="3",
pages="e10070",
keywords="usability",
keywords="patient-reported outcomes",
keywords="symptoms",
keywords="adverse events",
keywords="PRO-CTCAE",
keywords="cancer clinical trials",
abstract="Background: The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). Objective: The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. Methods: Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. Results: Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02; P=.001). Conclusions: Software modifications, informed by rigorous assessment, rendered a usable system, which is currently used in multiple NCI-sponsored multicenter cancer clinical trials. Trial Registration: ClinicalTrials.gov NCT01031641; https://clinicaltrials.gov/ct2/show/NCT01031641 (Archived by WebCite at http://www.webcitation.org/708hTjlTl) ",
doi="10.2196/10070",
url="http://humanfactors.jmir.org/2018/3/e10070/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30012546"
}


@Article{info:doi/10.2196/10413,
author="Nazi, M. Kim
and Turvey, L. Carolyn
and Klein, M. Dawn
and Hogan, P. Timothy",
title="A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="10",
volume="20",
number="7",
pages="e10413",
keywords="patient portal",
keywords="user-centered design",
keywords="eHealth",
keywords="veteran",
abstract="Background: Health care systems have entered a new era focused on patient engagement. Patient portals linked to electronic health records are recognized as a promising multifaceted tool to help achieve patient engagement goals. Achieving significant growth in adoption and use requires agile evaluation methods to complement periodic formal research efforts. Objective: This paper describes one of the implementation strategies that the Department of Veterans Affairs (VA) has used to foster the adoption and sustained use of its patient portal, My HealtheVet, over the last decade: an ongoing focus on user-centered design (UCD). This strategy entails understanding the users and their tasks and goals and optimizing portal design and functionality accordingly. Using a case study approach, we present a comparison of early user demographics and preferences with more recent data and several examples to illustrate how a UCD can serve as an effective implementation strategy for a patient portal within a large integrated health care system. Methods: VA has employed a customer experience analytics (CXA) survey on its patient portal since 2007 to enable ongoing direct user feedback. In a continuous cycle, a random sample of site visitors is invited to participate in the Web-based survey. CXA model questions are used to track and trend satisfaction, while custom questions collect data about users' characteristics, needs, and preferences. In this case study, we performed analyses of descriptive statistics comparing user characteristics and preferences from FY2008 (wherein ``FY'' means ``fiscal year'') to FY2017 and user trends regarding satisfaction with and utilization of specific portal functions over the last decade, as well as qualitative content analysis of user's open-ended survey comments. Results: User feedback has guided the development of enhancements to core components of the My HealtheVet portal including available features, content, interface design, prospective functional design, and related policies. Ten-year data regarding user characteristics and portal utilization demonstrate trends toward greater patient engagement and satisfaction. Administration of a continuous voluntary Web-based survey is an efficient and effective way to capture veterans' voices about who they are, how they use the patient portal, needed system improvements, and desired additional services. Conclusions: Leveraging ``voice-of-the-customer'' techniques as part of patient portal implementation can ensure that such systems meet users' needs in ways that are agile and most effective. Through this strategy, VA has fostered significant adoption and use of My HealtheVet to engage patients in managing their health. ",
doi="10.2196/10413",
url="http://www.jmir.org/2018/7/e10413/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29991468"
}


@Article{info:doi/10.2196/10507,
author="Bian, Jiantao
and Weir, Charlene
and Unni, Prasad
and Borbolla, Damian
and Reese, Thomas
and Wan, Jacob Yik-Ki
and Del Fiol, Guilherme",
title="Interactive Visual Displays for Interpreting the Results of Clinical Trials: Formative Evaluation With Case Vignettes",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="25",
volume="20",
number="6",
pages="e10507",
keywords="clinical decision-making",
keywords="clinician information needs",
keywords="information display",
keywords="information foraging theory",
keywords="information seeking behavior",
abstract="Background: At the point of care, evidence from randomized controlled trials (RCTs) is underutilized in helping clinicians meet their information needs. Objective: To design interactive visual displays to help clinicians interpret and compare the results of relevant RCTs for the management of a specific patient, and to conduct a formative evaluation with physicians comparing interactive visual versus narrative displays. Methods: We followed a user-centered and iterative design process succeeded by development of information display prototypes as a Web-based application. We then used a within-subjects design with 20 participants (8 attendings and 12 residents) to evaluate the usability and problem-solving impact of the information displays. We compared subjects' perceptions of the interactive visual displays versus narrative abstracts. Results: The resulting interactive visual displays present RCT results side-by-side according to the Population, Intervention, Comparison, and Outcome (PICO) framework. Study participants completed 19 usability tasks in 3 to 11 seconds with a success rate of 78\% to 100\%. Participants favored the interactive visual displays over narrative abstracts according to perceived efficiency, effectiveness, effort, user experience and preference (all P values <.001). Conclusions: When interpreting and applying RCT findings to case vignettes, physicians preferred interactive graphical and PICO-framework-based information displays that enable direct comparison of the results from multiple RCTs compared to the traditional narrative and study-centered format. Future studies should investigate the use of interactive visual displays to support clinical decision making in care settings and their effect on clinician and patient outcomes. ",
doi="10.2196/10507",
url="http://www.jmir.org/2018/6/e10507/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29941416"
}


@Article{info:doi/10.2196/resprot.9589,
author="Kotz, David
and Lord, E. Sarah
and O'Malley, James A.
and Stark, Luke
and Marsch, A. Lisa",
title="Workshop on Emerging Technology and Data Analytics for Behavioral Health",
journal="JMIR Res Protoc",
year="2018",
month="Jun",
day="20",
volume="7",
number="6",
pages="e158",
keywords="behavioral health",
keywords="mobile technology",
keywords="wearable devices",
keywords="data analytics",
keywords="mHealth",
doi="10.2196/resprot.9589",
url="http://www.researchprotocols.org/2018/6/e158/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925493"
}


@Article{info:doi/10.2196/10474,
author="van Velsen, Lex
and Evers, Mirka
and Bara, Cristian-Dan
and Op den Akker, Harm
and Boerema, Simone
and Hermens, Hermie",
title="Understanding the Acceptance of an eHealth Technology in the Early Stages of Development: An End-User Walkthrough Approach and Two Case Studies",
journal="JMIR Formativ Res",
year="2018",
month="Jun",
day="15",
volume="2",
number="1",
pages="e10474",
keywords="eHealth",
keywords="acceptance",
keywords="design",
keywords="walkthrough",
keywords="agile design",
abstract="Background: Studies that focus on the acceptance of an electronic health (eHealth) technology generally make use of surveys. However, results of such studies hold little value for a redesign, as they focus only on quantifying end-user appreciation of general factors (eg, perceived usefulness). Objective: We present a method for understanding end-user acceptance of an eHealth technology, early in the development process: The eHealth End-User Walkthrough. Methods: During a walkthrough, a participant is guided by using the technology via a scenario, a persona, and a low-fidelity protoype. A participant is questioned about factors that may affect acceptance during and after the demonstration. We show the value of the method via two case studies. Results: During the case studies, participants commented on whether they intend to use a technology and why they would (not) use its main features. They also provided redesign advice or input for additional functions. Finally, the sessions provide guidance for the generation of business models and implementation plans. Conclusions: The eHealth End-User Walkthrough can aid design teams in understanding the acceptance of their eHealth application in a very early stage of the design process. Consequently, it can prevent a mismatch between technology and end-users' needs, wishes and context. ",
doi="10.2196/10474",
url="http://formative.jmir.org/2018/1/e10474/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684434"
}


@Article{info:doi/10.2196/10181,
author="Thirumalai, Mohanraj
and Rimmer, H. James
and Johnson, George
and Wilroy, Jereme
and Young, Hui-Ju
and Mehta, Tapan
and Lai, Byron",
title="TEAMS (Tele-Exercise and Multiple Sclerosis), a Tailored Telerehabilitation mHealth App: Participant-Centered Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="24",
volume="6",
number="5",
pages="e10181",
keywords="multiple sclerosis",
keywords="exercise",
keywords="therapy",
keywords="mHealth",
keywords="user-centered design",
abstract="Background: People with multiple sclerosis face varying levels of disability and symptoms, thus requiring highly trained therapists and/or exercise trainers to design personalized exercise programs. However, for people living in geographically isolated communities, access to such trained professionals can be challenging due to a number of barriers associated with cost, access to transportation, and travel distance. Generic mobile health exercise apps often fall short of what people with multiple sclerosis need to become physically active (ie, exercise content that has been adapted to accommodate a wide range of functional limitations). Objective: This usability study describes the development process of the TEAMS (Tele-Exercise and Multiple Sclerosis) app, which is being used by people with multiple sclerosis in a large randomized controlled trial to engage in home-based telerehabilitation. Methods: Twenty-one participants with disabilities (10 people with multiple sclerosis) were involved in the double iterative design, which included the simultaneous development of the app features and exercise content (exercise videos and articles). Framed within a user-centered design approach, the development process included 2 stages: ground-level creation (focus group followed by early stage evaluations and developments), and proof of concept through 2 usability tests. Usability (effectiveness, usefulness, and satisfaction) was evaluated using a mixed-methods approach. Results: During testing of the app's effectiveness, the second usability test resulted in an average of 1 problem per participant, a decrease of 53\% compared to the initial usability test. Five themes were constructed from the qualitative data that related to app usefulness and satisfaction, namely: high perceived confidence for app usability, positive perceptions of exercise videos, viable exercise option at home, orientation and familiarity required for successful participation, and app issues. Participants acknowledged that the final app was ready to be delivered to the public after minor revisions. After including these revisions, the project team released the final app that is being used in the randomized controlled trial. Conclusions: A multi-level user-centered development process resulted in the development of an inclusive exercise program for people with multiple sclerosis operated through an easy-to-use app. The promotion of exercise through self-regulated mHealth programs requires a stakeholder-driven approach to app development. This ensures that app and content match the preferences and functional abilities of the end user (ie, people with varying levels of multiple sclerosis). ",
doi="10.2196/10181",
url="http://mhealth.jmir.org/2018/5/e10181/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29798832"
}


@Article{info:doi/10.2196/jopm.9877,
author="Basile, Melissa
and Andrews, Johanna
and Jacome, Sonia
and Zhang, Meng
and Kozikowski, Andrzej
and Hajizadeh, Negin",
title="A Decision Aid to Support Shared Decision Making About Mechanical Ventilation in Severe Chronic Obstructive Pulmonary Disease Patients (InformedTogether): Feasibility Study",
journal="J Participat Med",
year="2018",
month="May",
day="14",
volume="10",
number="2",
pages="e7",
keywords="Chronic Obstructive Pulmonary Disease",
keywords="COPD",
keywords="shared decision making",
keywords="life support",
abstract="Background: Severe Chronic Obstructive Pulmonary Disease patients are often unprepared to make decisions about accepting intubation for respiratory failure. We developed a Web-based decision aid, InformedTogether, to facilitate severe Chronic Obstructive Pulmonary Disease patients' preparation for decision making about whether to accept invasive mechanical ventilation for respiratory failure. Objective: We describe feasibility testing of the InformedTogether decision aid. Methods: Mixed methods, pre- and postintervention feasibility study in outpatient pulmonary and geriatric clinics. Clinicians used InformedTogether with severe Chronic Obstructive Pulmonary Disease patients. Patient-participants completed pre- and postassessments about InformedTogether use. The outcomes measured were the following: feasibility/acceptability, communication (Combined Outcome Measure for Risk Communication [COMRADE], Medical Communication Competency Scale [MCCS], Observing Patient Involvement [OPTION] scales), and effectiveness of InformedTogether on changing patients' knowledge, Decisional Conflict Scale, and motivation. Results: We enrolled 11 clinicians and 38 Chronic Obstructive Pulmonary Disease patients at six sites. Feasibility/acceptability: Clinicians and patients gave positive responses to acceptability questions (mean 74.1/89 max [SD 7.24] and mean 59.63/61 [SD 4.49], respectively). Communication: 96\% of clinicians stated InformedTogether improved communication (modified MCCS mean 44.54/49 [SD 2.97]; mean OPTION score 32.03/48 [SD 9.27]; mean COMRADE Satisfaction 4.31/5.0 [SD 0.58]; and COMRADE Confidence 4.18/5.0 [SD 0.56]). Preference: Eighty percent of patients discussed preferences with their surrogates by 1-month. Effectiveness: Knowledge scores increased significantly after using InformedTogether (mean difference 3.61 [SD 3. 44], P=.001) and Decisional Conflict decreased (mean difference Decisional Conflict Scale pre/post -13.76 [SD 20.39], P=.006). Motivation increased after viewing the decision aid. Conclusions: InformedTogether supports high-quality communication and shared decision making among Chronic Obstructive Pulmonary Disease patients, clinicians, and surrogates. The increased knowledge and opportunity to deliberate and discuss treatment choices after using InformedTogether should lead to improved decision making at the time of critical illness. ",
doi="10.2196/jopm.9877",
url="http://jopm.jmir.org/2018/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32461812"
}


@Article{info:doi/10.2196/games.8902,
author="Pramana, Gede
and Parmanto, Bambang
and Lomas, James
and Lindhiem, Oliver
and Kendall, C. Philip
and Silk, Jennifer",
title="Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial",
journal="JMIR Serious Games",
year="2018",
month="May",
day="10",
volume="6",
number="2",
pages="e9",
keywords="gamification",
keywords="mobile health",
keywords="ecological momentary intervention",
keywords="cognitive behavioral therapy",
keywords="child anxiety treatment",
keywords="SmartCAT",
keywords="childhood anxiety disorders",
abstract="Background: Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40\%-50\%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). Objective: The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. Methods: We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. Results: Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). Conclusions: The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment. ",
doi="10.2196/games.8902",
url="http://games.jmir.org/2018/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29748165"
}


@Article{info:doi/10.2196/jopm.9652,
author="Hannon, S. Tamara
and Moore, M. Courtney
and Cheng, R. Erika
and Lynch, O. Dustin
and Yazel-Smith, G. Lisa
and Claxton, EM Gina
and Carroll, E. Aaron
and Wiehe, E. Sarah",
title="Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test",
journal="J Participat Med",
year="2018",
month="May",
day="10",
volume="10",
number="2",
pages="e8",
keywords="adolescent health services",
keywords="patient-centered care",
keywords="research design",
keywords="diabetes mellitus, type 1",
keywords="self-management",
abstract="Background: Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents' thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective: The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods: The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution's Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results: Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions: Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus. ",
doi="10.2196/jopm.9652",
url="http://jopm.jmir.org/2018/2/e8/"
}


@Article{info:doi/10.2196/humanfactors.8568,
author="Zheng, Hua
and Rosal, C. Milagros
and Li, Wenjun
and Borg, Amy
and Yang, Wenyun
and Ayers, C. David
and Franklin, D. Patricia",
title="A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design",
journal="JMIR Hum Factors",
year="2018",
month="Apr",
day="30",
volume="5",
number="2",
pages="e17",
keywords="usability evaluation",
keywords="patient decision support",
keywords="knee osteoarthritis",
keywords="total knee replacement",
keywords="outcome prediction",
abstract="Background: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results: Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra ``next page'' click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions: We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients' use. ",
doi="10.2196/humanfactors.8568",
url="http://humanfactors.jmir.org/2018/2/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29712620"
}


@Article{info:doi/10.2196/formative.9550,
author="Duff, Orlaith
and Walsh, Deirdre
and Malone, Shauna
and McDermott, Lauri
and Furlong, Brona
and O'Connor, Noel
and Moran, Kieran
and Woods, Catherine",
title="MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development",
journal="JMIR Formativ Res",
year="2018",
month="Apr",
day="27",
volume="2",
number="1",
pages="e8",
keywords="app development",
keywords="cardiac rehabilitation",
keywords="telemedicine",
keywords="exercise",
keywords="mHealth",
keywords="focus groups",
keywords="usability testing",
abstract="Background: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach. ",
doi="10.2196/formative.9550",
url="http://formative.jmir.org/2018/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684426"
}


@Article{info:doi/10.2196/humanfactors.9030,
author="DeJonckheere, Melissa
and Robinson, H. Claire
and Evans, Lindsey
and Lowery, Julie
and Youles, Bradley
and Tremblay, Adam
and Kelley, Caitlin
and Sussman, B. Jeremy",
title="Designing for Clinical Change: Creating an Intervention to Implement New Statin Guidelines in a Primary Care Clinic",
journal="JMIR Hum Factors",
year="2018",
month="Apr",
day="24",
volume="5",
number="2",
pages="e19",
keywords="cardiovascular disease",
keywords="preventative medicine",
keywords="clinical decision support",
keywords="user-centered design",
keywords="qualitative research",
keywords="implementation",
abstract="Background: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user centered and specifically chosen to address identified barriers. Objective: The objectives of this study were to identify potential determinants of provider uptake of the new statin guidelines and to use that information to tailor a coordinated and streamlined local quality improvement intervention focused on prescribing appropriate statins. Methods: We employed user-centered design principles to guide the development and testing of a multicomponent guideline implementation intervention to improve statin prescribing. This paper describes the intervention development process whereby semistructured qualitative interviews with providers were conducted to (1) illuminate the knowledge, attitudes, and behaviors of providers and (2) elicit feedback on intervention prototypes developed to align with and support the use of the VA/DoD guidelines. Our aim was to use this information to design a local quality improvement intervention focused on statin prescribing that was tailored to the needs of primary care providers at our facility. Cabana's Clinical Practice Guidelines Framework for Improvement and Nielsen's Usability Heuristics were used to guide the analysis of data obtained in the intervention development process. Results: Semistructured qualitative interviews were conducted with 15 primary care Patient Aligned Care Team professionals (13 physicians and 2 clinical pharmacists) at a single VA medical center. Findings highlight that providers were generally comfortable with the paradigm shift to risk-based guidelines but less clear on the need for the VA/DoD guidelines in specific. Providers preferred a clinical decision support tool that helped them calculate patient risk and guide their care without limiting autonomy. They were less comfortable with risk communication and performance measurement systems that do not account for shared decision making. When possible, we incorporated their recommendations into the intervention. Conclusions: By combining qualitative methods and user-centered design principles, we could inform the design of a multicomponent guideline implementation intervention to better address the needs and preferences of providers, including clear and direct language, logical decision prompts with an option to dismiss a clinical decision support tool, and logical ordering of feedback information. Additionally, this process allowed us to identify future design considerations for quality improvement interventions. ",
doi="10.2196/humanfactors.9030",
url="http://humanfactors.jmir.org/2018/2/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29691206"
}


@Article{info:doi/10.2196/resprot.9116,
author="Jordan, Scott
and McSwiggan, Jane
and Parker, Joanne
and Halas, A. Gayle
and Friesen, Marcia",
title="An mHealth App for Decision-Making Support in Wound Dressing Selection (WounDS): Protocol for a User-Centered Feasibility Study",
journal="JMIR Res Protoc",
year="2018",
month="Apr",
day="24",
volume="7",
number="4",
pages="e108",
keywords="mHealth",
keywords="wounds",
keywords="wound dressing",
keywords="wound management",
abstract="Background: Primary care health professionals, especially family physicians, see a variety of wounds, and yet---despite the frequency of providing wound care---many family physicians do not feel confident in wound care management. This is partly due to a lack of formal wound education in Family Medicine programs. While there are numerous electronic wound care resources available in the UK and North America, none were identified that address the specific need in supporting clinical decision-making in wound dressing selection. At the same time, healthcare providers are increasingly using technology in personal and professional contexts, and a logical extension is to use technology for knowledge translation strategies. Objective: This work developed a prototype mobile health software application named WounDS, designed to support clinical decision-making in selecting wound dressings. This article presents the development and evaluation plan for the WounDS app. Methods: WounDS has been developed on the iOS platform. The primary specification included ease of use, in that one of the primary influences in user adoption would be the ability to receive a wound dressing recommendation in under 30 seconds and under 5 taps on the screen. The WounDS app guides users through a series of binary decisions for assessing the wound and provides a wound dressing recommendation. The selection algorithm is based in best practices using the Wound Bed Preparation Paradigm. Results: Current work is underway to examine the implementation needs for WounDS to be most effectively utilized and to pilot test its feasibility and use in clinical care. Data will be collected through user trials, focus groups, and user metadata will be collected within the app. Optimizing these preconditions will enable a subsequent phase of study to determine effects on clinical decision-making and clinical outcomes. Conclusions: WounDS is designed for knowledge translation, use of technology in clinical decision-making, and continuity of care. The benefits of WounDS include the potential to improve healthcare providers' competency in wound management and to improve wound healing through better alignment with evidence-based best practices in wound dressing selection, consistency in care from primary to community care, and subsequent downstream impacts in quality of life for patients. ",
doi="10.2196/resprot.9116",
url="http://www.researchprotocols.org/2018/4/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29691213"
}


@Article{info:doi/10.2196/mhealth.8778,
author="Webb, Julie Marianne
and Wadley, Greg
and Sanci, Amanda Lena",
title="Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="24",
volume="6",
number="4",
pages="e105",
keywords="adolescent",
keywords="primary health care",
keywords="primary prevention",
keywords="health behavior",
keywords="quality improvement",
keywords="telemedicine",
abstract="Background: Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. Objective: The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. Methods: We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. Results: A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app's administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84\%) completed Check Up GP in the waiting room, with less than half (35/80, 44\%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. Conclusions: The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings. ",
doi="10.2196/mhealth.8778",
url="http://mhealth.jmir.org/2018/4/e105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29691209"
}


@Article{info:doi/10.2196/jmir.7940,
author="Welbie, Marlies
and Wittink, Harriet
and Westerman, J. Marjan
and Topper, Ilse
and Snoei, Josca
and Devill{\'e}, LJM Walter",
title="Using Plain Language and Adding Communication Technology to an Existing Health-Related Questionnaire to Help Generate Accurate Information: Qualitative Study",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="23",
volume="20",
number="4",
pages="e140",
keywords="educational status",
keywords="surveys and questionnaires",
keywords="physical therapy specialty",
keywords="qualitative research",
abstract="Background: Low-educated patients are disadvantaged in using questionnaires within the health care setting because most health-related questionnaires do not take the educational background of patients into account. The Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in an attempt to meet the needs of low-educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure, it needs to generate accurate information from all of their patients, independent of educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three-Step Test-Interview method was used to collect observational data on actual response behavior of 24 physical therapy patients with diverse levels of education. The interviews included both think-aloud and retrospective probing techniques. Results: Of the 24 respondents, 20 encountered one or more problems during their response process. The use of plain language and information and communication technology (ICT) appeared to have a positive effect on the comprehensibility of the DTTSQ. However, it also had some negative effects on the interpretation, retrieval, judgment, and response selection within the response processes of the participants in this study. No educational group in this research population stood out from the rest in the kind or number of problems that arose. All respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The use of plain language and ICT within the DTTSQ had both positive and negative effects on the response processes of its target population. The results of this study emphasize the importance of earlier recommendations to accompany any adaption of any questionnaire to a new mode of delivery by demonstrating the difference and equivalence between the two different modes and to scientifically evaluate the applicability of the newly developed mode of the questionnaire in its intended setting. This is especially important in a digital era in which the use of plain language within health care is increasingly being advocated. ",
doi="10.2196/jmir.7940",
url="http://www.jmir.org/2018/4/e140/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29685873"
}


@Article{info:doi/10.2196/games.8609,
author="Vervaeke, Jasmien
and Van Looy, Jan
and Hoorelbeke, Kristof
and Baeken, Chris
and Koster, HW Ernst",
title="Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis",
journal="JMIR Serious Games",
year="2018",
month="Apr",
day="05",
volume="6",
number="2",
pages="e6",
keywords="depression",
keywords="cognitive dysfunction",
keywords="cognitive remediation",
keywords="relapse prevention",
keywords="qualitative research",
keywords="secondary prevention",
abstract="Background: The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. Objective: The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. Methods: We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. Results: Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. Conclusions: The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression. ",
doi="10.2196/games.8609",
url="http://games.jmir.org/2018/2/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29622525"
}


@Article{info:doi/10.2196/formative.8248,
author="Rivera, Jordan
and McPherson, C. Amy
and Hamilton, Jill
and Birken, Catherine
and Coons, Michael
and Peters, Michelle
and Iyer, Sindoora
and George, Tessy
and Nguyen, Cynthia
and Stinson, Jennifer",
title="User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study",
journal="JMIR Formativ Res",
year="2018",
month="Apr",
day="04",
volume="2",
number="1",
pages="e7",
keywords="obesity",
keywords="weight loss",
keywords="adolescent",
keywords="mobile apps",
abstract="Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents' views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs. ",
doi="10.2196/formative.8248",
url="http://formative.jmir.org/2018/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684409"
}


@Article{info:doi/10.2196/mhealth.8849,
author="McWilliams, Andrew
and Reeves, Kelly
and Shade, Lindsay
and Burton, Elizabeth
and Tapp, Hazel
and Courtlandt, Cheryl
and Gunter, Andrew
and Dulin, F. Michael",
title="Patient and Family Engagement in the Design of a Mobile Health Solution for Pediatric Asthma: Development and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="22",
volume="6",
number="3",
pages="e68",
keywords="engagement",
keywords="pediatric asthma",
keywords="shared decision-making",
keywords="health information technology",
abstract="Background: Asthma is a highly prevalent, chronic disease with significant morbidity, cost, and disparities in health outcomes. While adherence to asthma treatment guidelines can improve symptoms and decrease exacerbations, most patients receive care that is not guideline-based. New approaches that incorporate shared decision-making (SDM) and health information technology (IT) are needed to positively impact asthma management. Despite the promise of health IT to improve efficiency and outcomes in health care, new IT solutions frequently suffer from a lack of widespread adoption and do not achieve desired results, as a consequence of not involving end-users in design. Objective: To describe a case study of a pediatric asthma SDM health IT solution's development and demonstrate a methodology for engaging actual patients and families in IT development. Perspectives are shared from the vantage point of the research team and a parent of a child with asthma, who participated on the development team. Methods: We adapted user-centric design principles to engage actual users across three main development phases: project initiation, ideation, and usability testing. To facilitate the necessary level of user engagement, our approach included: (1) a Development Workgroup consisting of patients, caregivers, and providers who met regularly with the research team; and (2) ``real-world users'' consisting of patients, caregivers, and providers recruited from a variety of care locations, including safety-net clinics. Results: Using this methodology, we successful partnered with asthma patients and families to create an interactive, digital solution called Carolinas Asthma Coach. Carolinas Asthma Coach incorporates SDM principles to elicit patient information, including goals and preferences, and provides health-literate, tailored education with specific guideline-based recommendations for patients and their providers. Of the patients, caregivers, and providers surveyed, 100\% (n=60) said they would recommend Carolinas Asthma Coach to a friend or colleague. Qualitative feedback from users provided support for the usability and engaging nature of the app. Conclusions: This project demonstrates the feasibility and benefits of deploying user-centric design methods that engage real patients and caregivers throughout the health IT design process. ",
doi="10.2196/mhealth.8849",
url="http://mhealth.jmir.org/2018/3/e68/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29567637"
}


@Article{info:doi/10.2196/rehab.8158,
author="Allin, Sonya
and Shepherd, John
and Tomasone, Jennifer
and Munce, Sarah
and Linassi, Gary
and Hossain, Noreen Saima
and Jaglal, Susan",
title="Participatory Design of an Online Self-Management Tool for Users With Spinal Cord Injury: Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Mar",
day="21",
volume="5",
number="1",
pages="e6",
keywords="health education",
keywords="internet",
keywords="spinal cord injuries",
keywords="self-management",
abstract="Background: Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. Objective: The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI \& U) and illustrate how it has been used to define design constraints and solutions. Methods: Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers were recruited from consumer advocacy groups and worked with a core development team. Key informants were recruited from geographically distributed advocacy groups to form a product advisory council that met regularly with the core team. During meetings, codesigners and informants walked through stages of work that typify PD processes such as exploration, discovery, and prototyping. This paper details the process by analyzing 10 meetings that took place between August 2015 and May 2016. Meetings were recorded, transcribed, and subjected to an inductive thematic analysis; resulting themes were organized according to their relationship to PD stages. Results: A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Themes of trust, expertise, and community emerged in every group discussion. The exploration stage revealed interest in online self-management resources coupled with concerns about information credibility. In general, participants indicated that they felt more confident with information received from trusted, in-person sources (eg, peers or health care professionals) than information found online. The discovery stage saw participants propose and discuss concepts to filter credible information and highlight community expertise, namely (1) a community-curated resource database, (2) online information navigators, and (3) group chats with peers. Several tools and techniques were collectively prototyped in an effort to foster trust and community; these are illustrated in the Results section. Conclusions: A PD process engaging users as codesigners, codevelopers, and informants can be used to identify design concerns and prototype online solutions to promote self-management after SCI. Future work will assess the usability of the collectively designed tools among a broad population of Canadians with SCI and the tools' impact on self-efficacy and health. ",
doi="10.2196/rehab.8158",
url="http://rehab.jmir.org/2018/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29563075"
}


@Article{info:doi/10.2196/mental.8891,
author="Champion, Elizabeth Katrina
and Chapman, Cath
and Newton, Clare Nicola
and Brierley, Mary-Ellen
and Stapinski, Lexine
and Kay-Lambkin, Frances
and Nagle, Jack
and Teesson, Maree",
title="A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice",
journal="JMIR Ment Health",
year="2018",
month="Mar",
day="20",
volume="5",
number="1",
pages="e21",
keywords="methamphetamine",
keywords="substance-related disorders",
keywords="internet",
keywords="preventive psychiatry",
keywords="health education",
abstract="Background: The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. Objective: This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Methods: Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit's acceptability, relevance, and appeal. Results: Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were ``to get information for myself'' (185/451, 41.0\%) and ``to find out how to help a friend or a family member'' (136/451, 30.2\%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a ``low prevalence of use, yet high impact'' message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93\% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07\% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. Conclusions: The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities. ",
doi="10.2196/mental.8891",
url="http://mental.jmir.org/2018/1/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29559427"
}


@Article{info:doi/10.2196/humanfactors.8319,
author="Dijkstra, Elske Nienke
and Sino, Maria Carolina Geertruida
and Heerdink, Rob Eibert
and Schuurmans, Joanna Marieke",
title="Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study",
journal="JMIR Hum Factors",
year="2018",
month="Mar",
day="07",
volume="5",
number="1",
pages="e10",
keywords="primary care",
keywords="home care",
keywords="eHealth",
keywords="mHealth",
abstract="Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice--based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. ",
doi="10.2196/humanfactors.8319",
url="http://humanfactors.jmir.org/2018/1/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29514771"
}


@Article{info:doi/10.2196/mhealth.9437,
author="Giunti, Guido
and Mylonopoulou, Vasiliki
and Rivera Romero, Octavio",
title="More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="02",
volume="6",
number="3",
pages="e51",
keywords="multiple sclerosis",
keywords="telemedicine",
keywords="fatigue",
keywords="mobile applications",
keywords="video games",
keywords="qualitative research",
keywords="exercise",
keywords="chronic disease",
keywords="user-computer interface",
keywords="software design",
abstract="Background: Multiple sclerosis (MS) is one of the world's most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users' needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen's heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. ",
doi="10.2196/mhealth.9437",
url="http://mhealth.jmir.org/2018/3/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29500159"
}


@Article{info:doi/10.2196/aging.9025,
author="Dale, Jeremy
and Loew, Joelle
and Nanton, Veronica
and Grason Smith, Gillian",
title="Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study",
journal="JMIR Aging",
year="2018",
month="Feb",
day="28",
volume="1",
number="1",
pages="e1",
keywords="family caregivers",
keywords="caregivers",
keywords="self efficacy",
keywords="information technology",
keywords="frailty",
keywords="Internet",
abstract="Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers' well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers' coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. Objective: This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. Methods: The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. Results: Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. Conclusions: The person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway. ",
doi="10.2196/aging.9025",
url="http://aging.jmir.org/2018/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518238"
}


@Article{info:doi/10.2196/humanfactors.8083,
author="Seid, Michael
and Dellal, George
and Peterson, E. Laura
and Provost, Lloyd
and Gloor, A. Peter
and Fore, Livingstone David
and Margolis, A. Peter",
title="Co-Designing a Collaborative Chronic Care Network (C3N) for Inflammatory Bowel Disease: Development of Methods",
journal="JMIR Hum Factors",
year="2018",
month="Feb",
day="22",
volume="5",
number="1",
pages="e8",
keywords="chronic disease",
keywords="pediatrics",
keywords="health care delivery",
keywords="quality improvement",
abstract="Background: Our health care system fails to deliver necessary results, and incremental system improvements will not deliver needed change. Learning health systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research; yet, few such systems exist. We describe the process of codesigning, with all relevant stakeholders, an approach for creating a collaborative chronic care network (C3N), a peer-produced networked LHS. Objective: The objective of this study was to report the methods used, with a diverse group of stakeholders, to translate the idea of a C3N to a set of actionable next steps. Methods: The setting was ImproveCareNow, an improvement network for pediatric inflammatory bowel disease. In collaboration with patients and families, clinicians, researchers, social scientists, technologists, and designers, C3N leaders used a modified idealized design process to develop a design for a C3N. Results: Over 100 people participated in the design process that resulted in (1) an overall concept design for the ImproveCareNow C3N, (2) a logic model for bringing about this system, and (3) 13 potential innovations likely to increase awareness and agency, make it easier to collect and share information, and to enhance collaboration that could be tested collectively to bring about the C3N. Conclusions: We demonstrate methods that resulted in a design that has the potential to transform the chronic care system into an LHS. ",
doi="10.2196/humanfactors.8083",
url="http://humanfactors.jmir.org/2018/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29472173"
}


@Article{info:doi/10.2196/humanfactors.8948,
author="Thomson, Karen
and Brouwers, Corline
and Damman, C. Olga
and de Bruijne, C. Martine
and Timmermans, RM Danielle
and Melles, Marijke",
title="How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study",
journal="JMIR Hum Factors",
year="2018",
month="Feb",
day="20",
volume="5",
number="1",
pages="e7",
keywords="medication adherence",
keywords="eHealth",
keywords="shared decision making",
keywords="self-management",
keywords="patient engagement",
abstract="Background: Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence. Objective: The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods: A Web-based prototype of the eHealth app---MIK---was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians' evaluations. Results: On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient's understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow. Conclusions: The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM. ",
doi="10.2196/humanfactors.8948",
url="http://humanfactors.jmir.org/2018/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29463494"
}


@Article{info:doi/10.2196/mhealth.8287,
author="Simons, Dorien
and De Bourdeaudhuij, Ilse
and Clarys, Peter
and De Cocker, Katrien
and Vandelanotte, Corneel
and Deforche, Benedicte",
title="A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="20",
volume="6",
number="2",
pages="e44",
keywords="mHealth",
keywords="young adult",
keywords="mobile applications",
keywords="physical activity",
keywords="active transport",
keywords="health promotion",
abstract="Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. ",
doi="10.2196/mhealth.8287",
url="http://mhealth.jmir.org/2018/2/e44/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29463491"
}


@Article{info:doi/10.2196/humanfactors.7856,
author="Daneshvar, Hadi
and Anderson, Stuart
and Williams, Robin
and Mozaffar, Hajar",
title="How Can Social Media Lead to Co-Production (Co-Delivery) of New Services for the Elderly Population? A Qualitative Study",
journal="JMIR Hum Factors",
year="2018",
month="Feb",
day="12",
volume="5",
number="1",
pages="e5",
keywords="social media",
keywords="eHealth",
keywords="mHealth",
keywords="social networking",
keywords="Web 2.0",
keywords="health informatics",
abstract="Background: The future of health care services in the European Union faces the triple challenges of aging, fiscal restriction, and inclusion. Co-production offers ways to manage informal care resources to help them cater for the growing needs of elderly people. Social media (SM) is seen as a critical enabler for co-production. Objective: The objective of this study was to investigate how SM---private Facebook groups, forums, Twitter, and blogging---acts as an enabler of co-production in health and care by facilitating its four underlying principles: equality, diversity, accessibility, and reciprocity. Methods: We used normalization process theory as our theoretical framework to design this study. We conducted a qualitative study and collected data through 20 semistructured interviews and observation of the activities of 10 online groups and individuals. We then used thematic analysis and drew on principles of co-production (equality, diversity, accessibility, and reciprocity) as a deductive coding framework to analyze our findings. Results: Our findings point to distinct patterns of feature use by different people involved in care of elderly people. This diversity makes possible the principles of co-production by offering equality among users, enabling diversity of use, making experiences accessible, and encouraging reciprocity in the sharing of knowledge and mutual support. We also identified that explication of common resources may lead to new forms of competition and conflicts. These conflicts require better management to enhance the coordination of the common pool of resources. Conclusions: SM uses afford new forms of organizing and collective engagement between patients, carers, and professionals, which leads to change in health and care communication and coordination. ",
doi="10.2196/humanfactors.7856",
url="http://humanfactors.jmir.org/2018/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29434014"
}


@Article{info:doi/10.2196/cardio.9000,
author="Baek, Hyunyoung
and Suh, Jung-Won
and Kang, Si-Hyuck
and Kang, Seungjin
and Lim, Ho Tae
and Hwang, Hee
and Yoo, Sooyoung",
title="Enhancing User Experience Through User Study: Design of an mHealth Tool for Self-Management and Care Engagement of Cardiovascular Disease Patients",
journal="JMIR Cardio",
year="2018",
month="Feb",
day="09",
volume="2",
number="1",
pages="e3",
keywords="cardiovascular disease",
keywords="mHealth",
keywords="mobile application",
keywords="app",
keywords="user-centered design",
abstract="Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the app can be used continuously. Objective: The purpose of the study was to provide insightful information for developing mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: To drive the mobile functions and services needed to manage diseases in CVD patients, user research was conducted on patients and doctors at a tertiary general university hospital located in the Seoul metropolitan area of South Korea. Interviews and a survey were performed on patients (35 participants) and a focus group interview was conducted with doctors (5 participants). A mock-up mobile app was developed based on the user survey results, and a usability test was then conducted (8 participants) to identify factors that should be considered to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Functional features, such as communication with doctors, self-risk assessment, exercise, tailored education, blood pressure management, and health status recording had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were perceived to be useful to patients. The results of the mock-up usability test showed that inputting and visualizing blood pressure and other health conditions was required to be easier. The doctors requested a function that offered a comprehensive view of the patient's daily health status by linking the mHealth app data with the hospital's electronic health record system. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel between patients and doctors, may be helpful to improve patient engagement in care. ",
doi="10.2196/cardio.9000",
url="http://cardio.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758783"
}


@Article{info:doi/10.2196/mhealth.8996,
author="Giunti, Guido
and Kool, Jan
and Rivera Romero, Octavio
and Dorronzoro Zubiete, Enrique",
title="Exploring the Specific Needs of Persons with Multiple Sclerosis for mHealth Solutions for Physical Activity: Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="09",
volume="6",
number="2",
pages="e37",
keywords="multiple sclerosis",
keywords="telemedicine",
keywords="fatigue",
keywords="mobile applications",
keywords="video games",
keywords="qualitative research",
keywords="exercise",
keywords="chronic disease",
abstract="Background: Multiple sclerosis (MS) is one of the world's most common neurologic disorders, with symptoms such as fatigue, cognitive problems, and issues with mobility. Evidence suggests that physical activity (PA) helps people with MS reduce fatigue and improve quality of life. The use of mobile technologies for health has grown in recent years with little involvement from relevant stakeholders. User-centered design (UCD) is a design philosophy with the goal of creating solutions specific to the needs and tasks of the intended users. UCD involves stakeholders early and often in the design process. In a preliminary study, we assessed the landscape of commercially available MS mobile health (mHealth) apps; to our knowledge, no study has explored what persons with MS and their formal care providers think of mHealth solutions for PA. Objective: The aim of this study was to (1) explore MS-specific needs for MS mHealth solutions for PA, (2) detect perceived obstacles and facilitators for mHealth solutions from persons with MS and health care professionals, and (3) understand the motivational aspects behind adoption of mHealth solutions for MS. Methods: A mixed-methods design study was conducted in Kliniken Valens, Switzerland, a clinic specializing in neurological rehabilitation. We explored persons with MS and health care professionals who work with them separately. The study had a qualitative part comprising focus groups and interviews, and a quantitative part with standardized tools such as satisfaction with life scale and electronic health (eHealth) literacy. Results: A total of 12 persons with relapsing-remitting MS and 12 health care professionals from different backgrounds participated in the study. Participants were well-educated with an even distribution between genders. Themes identified during analysis were MS-related barriers and facilitators, mHealth design considerations, and general motivational aspects. The insights generated were used to create MS personas for design purposes. Desired mHealth features were as follows: (1) activity tracking, (2) incentives for completing tasks and objectives, (3) customizable goal setting, (4) optional sociability, and (5) game-like attitude among others. Potential barriers to mHealth apps adoption were as follows: (1) rough on-boarding experiences, (2) lack of clear use benefits, and (3) disruption of the health care provider-patient relationship. Potential facilitators were identified: (1) endorsements from experts, (2) playfulness, and (3) tailored to specific persons with MS needs. A total of 4 MS personas were developed to provide designers and computer scientists means to help in the creation of future mHealth solutions for MS. Conclusions: mHealth solutions for increasing PA in persons with MS hold promise. Allowing for realistic goal setting and positive feedback, while minimizing usability burdens, seems to be critical for the adoption of such apps. Fatigue management is especially important in this population; more attention should be brought to this area. ",
doi="10.2196/mhealth.8996",
url="http://mhealth.jmir.org/2018/2/e37/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29426814"
}


@Article{info:doi/10.2196/mental.9041,
author="Hetrick, Elisabeth Sarah
and Robinson, Jo
and Burge, Eloise
and Blandon, Ryan
and Mobilio, Bianca
and Rice, M. Simon
and Simmons, B. Magenta
and Alvarez-Jimenez, Mario
and Goodrich, Simon
and Davey, G. Christopher",
title="Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm",
journal="JMIR Ment Health",
year="2018",
month="Jan",
day="23",
volume="5",
number="1",
pages="e9",
keywords="depression",
keywords="suicidal ideation",
keywords="suicide, attempted",
keywords="self-injurious behavior",
keywords="adolescent",
keywords="young adult",
keywords="cell phone",
abstract="Background: Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. Objective: The objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. Methods: We engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups. Results: The app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a ``well-being tracker'' in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services. Conclusions: The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians. ",
doi="10.2196/mental.9041",
url="http://mental.jmir.org/2018/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29362208"
}


@Article{info:doi/10.2196/mhealth.9179,
author="Waite-Jones, M. Jennifer
and Majeed-Ariss, Rabiya
and Smith, Joanna
and Stones, R. Simon
and Van Rooyen, Vanessa
and Swallow, Veronica",
title="Young People's, Parents', and Professionals' Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jan",
day="19",
volume="6",
number="1",
pages="e25",
keywords="Adolescent",
keywords="young people",
keywords="juvenile arthritis",
keywords="mobile apps",
keywords="self-management",
keywords="qualitative research",
abstract="Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people's self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people's self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants' views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications. ",
doi="10.2196/mhealth.9179",
url="http://mhealth.jmir.org/2018/1/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29351898"
}


@Article{info:doi/10.2196/games.8881,
author="Vilardaga, Roger
and Rizo, Javier
and Zeng, Emily
and Kientz, A. Julie
and Ries, Richard
and Otis, Chad
and Hernandez, Kayla",
title="User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness",
journal="JMIR Serious Games",
year="2018",
month="Jan",
day="16",
volume="6",
number="1",
pages="e2",
keywords="smoking cessation",
keywords="mHealth",
keywords="serious mental illness",
keywords="user-centered design",
keywords="gamification",
keywords="acceptance and commitment therapy",
abstract="Background: Smoking rates in the United States have been reduced in the past decades to 15\% of the general population. However, up to 88\% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective: The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods: We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app's core vision and design specification, and collaboration with a software development company. Results: We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions: Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content. ",
doi="10.2196/games.8881",
url="http://games.jmir.org/2018/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29339346"
}


@Article{info:doi/10.2196/mhealth.7734,
author="Danbj{\o}rg, Boe Dorthe
and Villadsen, Allan
and Gill, Ester
and Rothmann, Juel Mette
and Clemensen, Jane",
title="Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jan",
day="11",
volume="6",
number="1",
pages="e11",
keywords="arthritis",
keywords="rehabilitation",
keywords="telemedicine",
abstract="Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users' needs, including motivational and other behavioral factors. ",
doi="10.2196/mhealth.7734",
url="https://mhealth.jmir.org/2018/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29326092"
}


@Article{info:doi/10.2196/formative.8032,
author="Freyne, Jill
and Bradford, Dana
and Pocock, Courtney
and Silvera-Tawil, David
and Harrap, Karen
and Brinkmann, Sally",
title="Developing Digital Facilitation of Assessments in the Absence of an Interpreter: Participatory Design and Feasibility Evaluation With Allied Health Groups",
journal="JMIR Formativ Res",
year="2018",
month="Jan",
day="09",
volume="2",
number="1",
pages="e1",
keywords="mobile apps",
keywords="cultural diversity",
keywords="culturally appropriate technology",
keywords="cross-cultural care",
keywords="language barriers",
keywords="health care delivery",
keywords="ehealth allied health",
abstract="Background: To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians' inability to communicate directly with them. Objective: The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment. Methods: CALD Assist's design, functionality, and content were determined through focus groups with clinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campuses of a hospital in Victoria, Australia. Results: A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during their initial assessment. Evaluation results show that clinicians' confidence in their assessment increased with use of the CALD Assist app: clinicians' reports of ``complete confidence'' increased from 10\% (3/30) to 42\% (5/12), and assessment reports of ``no confidence'' decreased from 57\% (17/30) to 17\% (2/12). Average time required to complete an assessment with patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. Conclusions: Through the use of CALD Assist, clinician confidence in communicating with patients from non-English speaking backgrounds in the absence of an interpreter increased, providing patients from non-English speaking backgrounds with timely initial assessments and subsequent care in line with their English speaking peers. Additionally, the inclusion of images and video demonstrations in CALD Assist increased the ability to communicate with patients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app is now available in the Apple App Store. ",
doi="10.2196/formative.8032",
url="http://formative.jmir.org/2018/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684405"
}


@Article{info:doi/10.2196/mhealth.8791,
author="Frie, Kerstin
and Hartmann-Boyce, Jamie
and Jebb, Susan
and Albury, Charlotte
and Nourse, Rebecca
and Aveyard, Paul",
title="Insights From Google Play Store User Reviews for the Development of Weight Loss Apps: Mixed-Method Analysis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="22",
volume="5",
number="12",
pages="e203",
keywords="weight loss",
keywords="mobile applications",
keywords="telemedicine",
keywords="consumer behavior",
abstract="Background: Significant weight loss takes several months to achieve, and behavioral support can enhance weight loss success. Weight loss apps could provide ongoing support and deliver innovative interventions, but to do so, developers must ensure user satisfaction. Objective: The aim of this study was to conduct a review of Google Play Store apps to explore what users like and dislike about weight loss and weight-tracking apps and to examine qualitative feedback through analysis of user reviews. Methods: The Google Play Store was searched and screened for weight loss apps using the search terms weight loss and weight track*, resulting in 179 mobile apps. A content analysis was conducted based on the Oxford Food and Activity Behaviors taxonomy. Correlational analyses were used to assess the association between complexity of mobile health (mHealth) apps and popularity indicators. The sample was then screened for popular apps that primarily focus on weight-tracking. For the resulting subset of 15 weight-tracking apps, 569 user reviews were sampled from the Google Play Store. Framework and thematic analysis of user reviews was conducted to assess which features users valued and how design influenced users' responses. Results: The complexity (number of components) of weight loss apps was significantly positively correlated with the rating (r=.25; P=.001), number of reviews (r=.28; P<.001), and number of downloads (r=.48; P<.001) of the app. In contrast, in the qualitative analysis of weight-tracking apps, users expressed preference for simplicity and ease of use. In addition, we found that positive reinforcement through detailed feedback fostered users' motivation for further weight loss. Smooth functioning and reliable data storage emerged as critical prerequisites for long-term app usage. Conclusions: Users of weight-tracking apps valued simplicity, whereas users of comprehensive weight loss apps appreciated availability of more features, indicating that complexity demands are specific to different target populations. The provision of feedback on progress can motivate users to continue their weight loss attempts. Users value seamless functioning and reliable data storage. ",
doi="10.2196/mhealth.8791",
url="http://mhealth.jmir.org/2017/12/e203/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29273575"
}


@Article{info:doi/10.2196/mhealth.6969,
author="Eckersberger, Elisabeth
and Pearson, Erin
and Andersen, Kathryn
and Hossain, Altaf
and Footman, Katharine
and Biswas, Kanti Kamal
and Nuremowla, Sadid
and Reiss, Kate",
title="Developing mHealth Messages to Promote Postmenstrual Regulation Contraceptive Use in Bangladesh: Participatory Interview Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="14",
volume="5",
number="12",
pages="e174",
keywords="abortion",
keywords="reproductive health services",
keywords="contraception",
keywords="family planning",
keywords="mHealth",
keywords="Bangladesh",
abstract="Background: Abortions are restricted in Bangladesh, but menstrual regulation is an approved alternative, defined as a procedure of regulating the menstrual cycle when menstruation is absent for a short duration. Use of contraception after menstrual regulation can reduce subsequent unintended pregnancy, but in Bangladesh, the contraceptive method mix is dominated by short-term methods, which have higher discontinuation and failure rates. Mobile phones are a channel via which menstrual regulation clients could be offered contraceptive support after leaving the clinic. Objective: This study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. Methods: We conducted participatory interviews with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh. Women were recruited from facilities in urban and peri-urban areas, which included public sector clinics supported by Ipas, an international nongovernmental organization (NGO), and NGO clinics run by Marie Stopes. Main themes covered in the interviews were factors affecting the use of contraception, what information and support women want after their menstrual regulation procedure, how respondents would prefer to receive information about contraception, and other key issues for mobile health (mHealth) interventions, such as language and privacy. As part of the in-depth interviews, women were shown and played 6 different messages about contraception on the research assistant's phone, which they were given to operate, and were then asked to give feedback. Results: Women were open to both receiving messages about family planning methods on their mobile phones and talking to a counselor about family planning methods over the phone after their menstrual regulation. Women most commonly wanted information about the contraceptive method they were currently using and wanted this information to be tailored to their particular needs. Women preferred voice messages to text and liked the interactive voice message format. When asked to repeat and identify the main points of the messages, women demonstrated good understanding of the content. Women did not seem too concerned with privacy or with others reading the messages and welcomed including their husbands in speaking to a counselor. Conclusions: This study found that menstrual regulation clients are very interested in receiving information on their phones to support family planning use and wanted more information about the method of contraception they were using. Participatory voicemail was the preferred modality. ",
doi="10.2196/mhealth.6969",
url="http://mhealth.jmir.org/2017/12/e174/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29242175"
}


@Article{info:doi/10.2196/jmir.8877,
author="Reid, Kathy
and Hartling, Lisa
and Ali, Samina
and Le, Anne
and Norris, Allison
and Scott, D. Shannon",
title="Development and Usability Evaluation of an Art and Narrative-Based Knowledge Translation Tool for Parents With a Child With Pediatric Chronic Pain: Multi-Method Study",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="14",
volume="19",
number="12",
pages="e412",
keywords="pain",
keywords="child health",
keywords="parents",
keywords="art",
abstract="Background: Chronic pain in childhood is increasingly being recognized as a significant clinical problem for children and their families. Previous research has identified that families want information about the causes of their child's chronic pain, treatment options, and effective strategies to help their child cope with the pain. Unfortunately, parents have reported that finding this information can be challenging. Objective: The aim of this study was to actively work together with children attending a pediatric chronic pain clinic and their parents to develop, refine, and evaluate the usability of an art and narrative-based electronic book (e-book) for pediatric chronic pain. Methods: A multiphase, multi-method research design employing patient engagement techniques was used to develop, refine, and evaluate the usability of an art and narrative based e-book for pediatric chronic pain management to facilitate knowledge translation for parents with a child with chronic pain. The multiple phases included the following: (1) qualitative interviews to compile parents' narratives using qualitative interviews; (2) qualitative data analysis; (3) development of an e-book prototype; (4) expert clinician feedback; (5) parent usability evaluation, knowledge change, and confidence in knowledge responses using an electronic survey; (6) e-book refinement; and (7) dissemination of the e-book. Results: A 48-page e-book was developed to characterize the experiences of a family living with a child with chronic pain. The e-book was a composite narrative of the parent interviews and encompassed descriptions of the effects the condition has on each member of the family. This was merged with the best available research evidence on the day-to-day management of pediatric chronic pain. The e-book was vetted for clinical accuracy by expert pediatric pain clinicians. All parents that participated in the usability evaluation (N=14) agreed or strongly agreed the content of the e-book was easy to understand and stated that they would recommend the e-book to other families who have children with chronic pain. Our research identified up to a 21.4\% increase in knowledge after using the e-book, and paired t tests demonstrated a statistically significant difference in confidence in answering two of the five knowledge questions (chronic pain is a disease involving changes in the nervous system; the use of ibuprofen is usually effective at controlling chronic pain); t13=0.165, P=.001 and t13=0.336, P=.002, respectively, after being exposed to the e-book. Conclusions: Our results demonstrate that parents positively rated an e-book developed for parents with a child with chronic pain. Our results also identify that overall, parents' knowledge increased after using the e-book, and confidence in their knowledge about chronic pain and its management increased in two aspects after e-book exposure. These results suggest that art and narrative-based knowledge translation interventions may be useful in transferring complex health information to parents. ",
doi="10.2196/jmir.8877",
url="http://www.jmir.org/2017/12/e412/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29242180"
}


@Article{info:doi/10.2196/cancer.8150,
author="Galpin, Adam
and Meredith, Joanne
and Ure, Cathy
and Robinson, Leslie",
title="``Thanks for Letting Us All Share Your Mammogram Experience Virtually'': Developing a Web-Based Hub for Breast Cancer Screening",
journal="JMIR Cancer",
year="2017",
month="Oct",
day="27",
volume="3",
number="2",
pages="e17",
keywords="decision making",
keywords="eHealth",
keywords="cancer screening",
keywords="qualitative research",
keywords="social media",
keywords="mammography",
abstract="Background: The decision around whether to attend breast cancer screening can often involve making sense of confusing and contradictory information on its risks and benefits. The Word of Mouth Mammogram e-Network (WoMMeN) project was established to create a Web-based resource to support decision making regarding breast cancer screening. This paper presents data from our user-centered approach in engaging stakeholders (both health professionals and service users) in the design of this Web-based resource. Our novel approach involved creating a user design group within Facebook to allow them access to ongoing discussion between researchers, radiographers, and existing and potential service users. Objective: This study had two objectives. The first was to examine the utility of an online user design group for generating insight for the creation of Web-based health resources. We sought to explore the advantages and limitations of this approach. The second objective was to analyze what women want from a Web-based resource for breast cancer screening. Methods: We recruited a user design group on Facebook and conducted a survey within the group, asking questions about design considerations for a Web-based breast cancer screening hub. Although the membership of the Facebook group varied over time, there were 71 members in the Facebook group at the end point of analysis. We next conducted a framework analysis on 70 threads from Facebook and a thematic analysis on the 23 survey responses. We focused additionally on how the themes were discussed by the different stakeholders within the context of the design group. Results: Two major themes were found across both the Facebook discussion and the survey data: (1) the power of information and (2) the hub as a place for communication and support. Information was considered as empowering but also recognized as threatening. Communication and the sharing of experiences were deemed important, but there was also recognition of potential miscommunication within online discussion. Health professionals and service users expressed the same broad concerns, but there were subtle differences in their opinions. Importantly, the themes were triangulated between the Facebook discussions and the survey data, supporting the validity of an online user design group. Conclusions: Online user design groups afford a useful method for understanding stakeholder needs. In contrast to focus groups, they afford access to users from diverse geographical locations and traverse time constraints, allowing more follow-ups to responses. The use of Facebook provides a familiar and naturalistic setting for discussion. Although we acknowledge the limitations in the sample, this approach has allowed us to understand the views of stakeholders in the user-centered design of the WoMMeN hub for breast cancer screening. ",
doi="10.2196/cancer.8150",
url="http://cancer.jmir.org/2017/2/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29079555"
}


@Article{info:doi/10.2196/jmir.8614,
author="Haun, N. Jolie
and Chavez, Margeaux
and Nazi, Kim
and Antinori, Nicole
and Melillo, Christine
and Cotner, A. Bridget
and Hathaway, Wendy
and Cook, Ashley
and Wilck, Nancy
and Noonan, Abigail",
title="Veterans' Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="23",
volume="19",
number="10",
pages="e359",
keywords="communication",
keywords="patient participation",
keywords="quality improvement",
keywords="health information technology",
keywords="medical informatics",
keywords="patient portal",
keywords="personal health record",
keywords="telehealth",
keywords="kiosk",
keywords="mhealth",
abstract="Background: The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. Objective: This study aimed to describe veterans' experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Methods: Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Results: Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Conclusions: Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated, and synchronized user-friendly interface designs. ",
doi="10.2196/jmir.8614",
url="http://www.jmir.org/2017/10/e359/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29061553"
}


@Article{info:doi/10.2196/mhealth.7136,
author="Bendixen, M. Roxanna
and Fairman, D. Andrea
and Karavolis, Meredith
and Sullivan, Carly
and Parmanto, Bambang",
title="A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Sep",
day="26",
volume="5",
number="9",
pages="e141",
keywords="mobile health",
keywords="telemedicine",
keywords="self-care",
keywords="adolescence",
keywords="spina bifida",
keywords="cerebral palsy",
keywords="spinal cord injury",
abstract="Background: Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. Objective: Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. Methods: Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. Results: A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. Conclusions: Our findings suggest that most individuals keep their mobile phones with them at all times and typically use a mobile phone for social media, music, photos, and texting. Our qualitative analysis indicates that youth and young adults with BSA, as well as their caregivers, acknowledge the importance of being actively engaged in developing and using mHealth apps that monitor and manage their health care needs. Information gleaned from these focus group sessions and surveys have provided data to refine the iMHere 2.0 mHealth prototype platform that we have developed. ",
doi="10.2196/mhealth.7136",
url="http://mhealth.jmir.org/2017/9/e141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28951378"
}


@Article{info:doi/10.2196/humanfactors.7845,
author="Reblin, Maija
and Wu, P. Yelena
and Pok, Justin
and Kane, Lauren
and Colman, Howard
and Cohen, L. Adam
and Mendivil, Eduardo
and Warner, L. Echo
and Meyer, Miriah
and Agutter, James",
title="Development of the Electronic Social Network Assessment Program Using the Center for eHealth and Wellbeing Research Roadmap",
journal="JMIR Hum Factors",
year="2017",
month="Aug",
day="30",
volume="4",
number="3",
pages="e23",
keywords="intervention development",
keywords="user-centered design",
keywords="oncology",
keywords="caregiver",
abstract="Background: The number of Web-based psychological and behavioral interventions is growing. Beyond their theoretical underpinnings, a key factor to the success of these interventions is how they are designed and developed to ensure usability over a new method of delivery. Our team has adapted ecomapping, a tool for visualizing family caregiver social network resources, for the Web. Here, we describe how we designed and developed the electronic Social Network Assessment Program (eSNAP) Web-based tool using a framework of the Center for eHealth and Wellbeing Research (CeHRes) Roadmap for Web-based intervention development. The CeHRes Roadmap is still new in terms of tool development and we showcase an example of its application. Objective: The aim of our study was to provide an example of the application of the Web-based intervention development process using the CeHRes Roadmap for other research teams to follow. In doing so, we are also sharing our pilot work to enhance eSNAP's acceptance and usability for users and the feasibility of its implementation. Methods: We describe the development of the eSNAP app to support family caregivers of neuro-oncology patients. This development is based on the 5 iterative stages of the CeHRes Roadmap: contextual inquiry, value specification, design, operationalization, and summative evaluation. Research activities to support eSNAP development prior to implementation included literature review, focus groups, and iterative rounds of interviews. Results: Key lessons learned in developing the eSNAP app broadly fell under a theme of translating theoretical needs and ideas to the real world. This included how to prioritize needs to be addressed at one time, how the modality of delivery may change design requirements, and how to develop a tool to fit within the context it will be used. Conclusions: Using the CeHRes Roadmap to develop Web-based interventions such as eSNAP helps to address potential issues by outlining important intervention development milestones. In addition, by encouraging inclusion of users and other stakeholders in the process, Web-based intervention developers using the Roadmap can identify what will work in the real world and increase feasibility and effectiveness. ",
doi="10.2196/humanfactors.7845",
url="http://humanfactors.jmir.org/2017/3/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28855149"
}


@Article{info:doi/10.2196/resprot.8113,
author="Pope, Lizzy
and Garnett, Bernice
and Dibble, Marguerite",
title="Engaging Adolescents to Inform the Development of a Mobile Gaming App to Incentivize Physical Activity",
journal="JMIR Res Protoc",
year="2017",
month="Aug",
day="29",
volume="6",
number="8",
pages="e161",
keywords="adolescents",
keywords="qualitative research",
keywords="mHealth",
keywords="physical activity",
abstract="Background: Involving youth in the development of a mobile game designed to increase physical activity may increase relevancy and adoption. Objective: To share the development process used to create a gaming app aimed at incentivizing physical activity in high school students. Methods: Five focus groups were conducted with high school students (N=50) to understand gaming behaviors. A subset of students from the focus groups chose to complete a Web-based survey (N=10). Four different versions of gaming artwork and concept design based on student input were pilot tested (N=35), and group consensus building determined the direction of the game. The 4 game versions differed in their artwork style and gaming concept with some requiring competition versus cooperation, or being more individual versus team based. Group consensus building meant that all artwork and game concept options were displayed at the front of a classroom. Students could then vote for their top artwork and concept choices by putting stickers on the top 1 or 2 artwork and concept options that they liked best. Once all votes were cast, investigators discussed the voting results with students, and brainstormed ways to incorporate popular aspects of the 3 ``losing'' artwork and game concepts into the winning ideas. Results: Focus group transcripts were analyzed for common themes. Artwork and gaming concept-voting data was tallied at the time of voting to share with students in real time. Focus groups and survey results revealed important themes for a successful gaming app: (1) competition, (2) balanced in-game rewards, (3) accessibility, and (4) aesthetic features. Consensus voting indicated the popularity of a collaborative competitive content design (35/66, 53\%) and playful art (27/71, 38\%). Conclusions: To ensure saliency and effectiveness of game-based physical activity interventions, youth need to be included in design and implementation. Furthermore, the unique preferences and social constructs of high school students need to be considered during intervention development. ",
doi="10.2196/resprot.8113",
url="http://www.researchprotocols.org/2017/8/e161/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28851676"
}


@Article{info:doi/10.2196/humanfactors.7078,
author="Liu, Na
and Kim, Jinman
and Jung, Younhyun
and Arisy, Adani
and Nicdao, Ann Mary
and Mikaheal, Mary
and Baldacchino, Tanya
and Khadra, Mohamed
and Sud, Kamal",
title="Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design",
journal="JMIR Hum Factors",
year="2017",
month="Aug",
day="29",
volume="4",
number="3",
pages="e21",
keywords="remote-monitoring",
keywords="home hemodialysis",
keywords="co-presence enhancement",
keywords="design",
abstract="Background: Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the ``presence'' of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. Objective: This study presents an HHD system design for hemodialysis patients with features to enhance patient's perceived ``copresence'' with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. Methods: A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Results: Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with ``Very Happy'' as the emotional status, 2167 entries with a ``Happy'' status, 56 entries with a ``Neutral'' status, 18 entries with an ``Unhappy'' status, and 24 entries with a ``Very unhappy'' status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients' change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients' feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients' status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses. Conclusions: The copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems. ",
doi="10.2196/humanfactors.7078",
url="http://humanfactors.jmir.org/2017/3/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28851680"
}


@Article{info:doi/10.2196/mhealth.7229,
author="Cai, A. Ran
and Beste, Dominik
and Chaplin, Hema
and Varakliotis, Socrates
and Suffield, Linda
and Josephs, Francesca
and Sen, Debajit
and Wedderburn, R. Lucy
and Ioannou, Yiannakis
and Hailes, Stephen
and Eleftheriou, Despina",
title="Developing and Evaluating JIApp: Acceptability and Usability of a Smartphone App System to Improve Self-Management in Young People With Juvenile Idiopathic Arthritis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="15",
volume="5",
number="8",
pages="e121",
keywords="juvenile idiopathic arthritis",
keywords="self-management",
keywords="adolescent",
keywords="young adult",
keywords="mobile applications",
keywords="qualitative research",
keywords="smartphone",
abstract="Background: Flare-ups in juvenile idiopathic arthritis (JIA) are characterized by joint pain and swelling and often accompanied with fatigue, negative emotions, and reduced participation in activities. To minimize the impact of JIA on the physical and psychosocial development and well-being of young people (YP), it is essential to regularly monitor disease activity and side effects, as well as to support self-management such as adherence to treatment plans and engagement in general health-promoting behaviors. Smartphone technology has the potential to engage YP with their health care through convenient self-monitoring and easy access to information. In addition, having a more accurate summary of self-reported fluctuations in symptoms, behaviors, and psychosocial problems can help both YP and health care professionals (HCPs) better understand the patient's condition, identify barriers to self-management, and assess treatment effectiveness and additional health care needs. No comprehensive smartphone app has yet been developed in collaboration with YP with JIA, their parents, and HCPs involved in their care. Objectives: The objective of this study was to design, develop, and evaluate the acceptability and usability of JIApp, a self-management smartphone app system for YP with JIA and HCPs. Methods: We used a qualitative, user-centered design approach involving YP, parents, and HCPs from the rheumatology team. The study was conducted in three phases: (1) phase I focused on developing consensus on the features, content, and design of the app; (2) phase II was used for further refining and evaluating the app prototype; and (3) phase III focused on usability testing of the app. The interview transcripts were analyzed using qualitative content analysis. Results: A total of 29 YP (aged 10-23, median age 17) with JIA, 7 parents, and 21 HCPs were interviewed. Major themes identified as the ones that helped inform app development in phase I were: (1) remote monitoring of symptoms, well-being, and activities; (2) treatment adherence; and (3) education and support. During phase II, three more themes emerged that informed further refinement of the app prototype. These included (4) adapting a reward system to motivate end users for using the app; (5) design of the app interface; and (6) clinical practice integration. The usability testing during phase III demonstrated high rates of overall satisfaction and further affirmed the content validity of the app. Conclusions: We present the development and evaluation of a smartphone app to encourage self-management and engagement with health care for YP with JIA. The app was found to have high levels of acceptability and usability among YP and HCPs and has the potential to improve health care and outcomes for this age group. Future feasibility testing in a prospective study will firmly establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with arthritis. ",
doi="10.2196/mhealth.7229",
url="http://mhealth.jmir.org/2017/8/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28811270"
}


@Article{info:doi/10.2196/mhealth.7816,
author="Webb, Julie Marianne
and Wadley, Greg
and Sanci, Amanda Lena",
title="Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="11",
volume="5",
number="8",
pages="e118",
keywords="adolescent",
keywords="needs assessment",
keywords="general practice",
keywords="primary prevention",
keywords="health behavior",
keywords="health information technology",
keywords="patient-centered care",
abstract="Background: Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people's routine health care. Objective: The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people's assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people's acceptance and experience of using a screening app during regular health care. Methods: This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey. Results: The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86\% (73/85) of young people felt the app was a ``good idea'' and only 1\% (1/85) thought it a ``bad idea.'' Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration. Conclusions: Integrating a health and lifestyle-screening app into face-to-face care can enrich young people's experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth. ",
doi="10.2196/mhealth.7816",
url="http://mhealth.jmir.org/2017/8/e118/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28801302"
}


@Article{info:doi/10.2196/mhealth.7046,
author="Harte, Richard
and Quinlan, R. Leo
and Glynn, Liam
and Rodr{\'i}guez-Molinero, Alejandro
and Baker, MA Paul
and Scharf, Thomas
and {\'O}Laighin, Gear{\'o}id",
title="Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="30",
volume="5",
number="5",
pages="e71",
keywords="human-centered design",
keywords="user-centered design",
keywords="human-computer interface",
keywords="human factors engineering",
keywords="eHealth",
keywords="engineering psychology",
keywords="mHealth",
abstract="Background: Design processes such as human-centered design (HCD), which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of HCD can often conflict with the necessary rapid product development life-cycles associated with the competitive connected health industry. Objective: The aim of this study was to apply a structured HCD methodology to the development of a smartphone app that was to be used within a connected health fall risk detection system. Our methodology utilizes so called discount usability engineering techniques to minimize the burden on resources during development and maintain a rapid pace of development. This study will provide prospective designers a detailed description of the application of a HCD methodology. Methods: A 3-phase methodology was applied. In the first phase, a descriptive ``use case'' was developed by the system designers and analyzed by both expert stakeholders and end users. The use case described the use of the app and how various actors would interact with it and in what context. A working app prototype and a user manual were then developed based on this feedback and were subjected to a rigorous usability inspection. Further changes were made both to the interface and support documentation. The now advanced prototype was exposed to user testing by end users where further design recommendations were made. Results: With combined expert and end-user analysis of a comprehensive use case having originally identified 21 problems with the system interface, we have only seen and observed 3 of these problems in user testing, implying that 18 problems were eliminated between phase 1 and 3. Satisfactory ratings were obtained during validation testing by both experts and end users, and final testing by users shows the system requires low mental, physical, and temporal demands according to the NASA Task Load Index (NASA-TLX). Conclusions: From our observation of older adults' interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials. ",
doi="10.2196/mhealth.7046",
url="http://mhealth.jmir.org/2017/5/e71/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28559227"
}


@Article{info:doi/10.2196/humanfactors.7240,
author="Ray, Pradeep
and Li, Junhua
and Ariani, Arni
and Kapadia, Vasvi",
title="Tablet-Based Well-Being Check for the Elderly: Development and Evaluation of Usability and Acceptability",
journal="JMIR Hum Factors",
year="2017",
month="May",
day="12",
volume="4",
number="2",
pages="e12",
keywords="agile methodology",
keywords="elderly people",
keywords="information and communications technology application",
keywords="silvercare model",
keywords="tablet-based well-being system",
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. ",
doi="10.2196/humanfactors.7240",
url="http://humanfactors.jmir.org/2017/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28500017"
}


@Article{info:doi/10.2196/resprot.6831,
author="Slomian, Justine
and Emonts, Patrick
and Vigneron, Lara
and Acconcia, Alessandro
and Reginster, Jean-Yves
and Oumourgh, Mina
and Bruy{\`e}re, Olivier",
title="Meeting the Needs of Mothers During the Postpartum Period: Using Co-Creation Workshops to Find Technological Solutions",
journal="JMIR Res Protoc",
year="2017",
month="May",
day="03",
volume="6",
number="5",
pages="e76",
keywords="mothers' needs",
keywords="technological solutions",
keywords="co-creating workshop",
keywords="co-creation",
keywords="postpartum needs",
abstract="Background: The postnatal period is associated with many new needs for mothers. Objective: The aim of this study was to find technological solutions that meet the needs of mothers during the year following childbirth. Methods: Two co-creation workshops were undertaken with parents and professionals. The aim of the first workshop was to create a list of all the criteria the proposed solution would have to address to meet the needs of mothers after childbirth. The aim of the second workshop was to create solutions in response to the criteria selected during the first workshop. Results: Parents and health professionals want solutions that include empathy (ie, to help fight against the feelings of abnormality and loneliness), that help mothers in daily life, that are personalized and adapted to different situations, that are educational, and that assures some continuity in their contact with health professionals. In practice, we found that parents and professionals think the solution should be accessible to everyone and available at all times. To address these criteria, technology experts proposed different solutions, such as a forum dedicated to the postpartum period that is supervised by professionals, a centralized website, a system of videoconferencing, an online exchange group, a ``gift voucher'' system, a virtual reality app, or a companion robot. Conclusions: The human component seems to be very important during the postnatal period. Nevertheless, technology could be a great ally in helping mothers during the postpartum period. Technology can help reliably inform parents and may also give them the right tools to find supportive people. However, these technologies should be tested in clinical trials. ",
doi="10.2196/resprot.6831",
url="http://www.researchprotocols.org/2017/5/e76/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28468746"
}


@Article{info:doi/10.2196/mhealth.6666,
author="Horner, N. Gabrielle
and Agboola, Stephen
and Jethwani, Kamal
and Tan-McGrory, Aswita
and Lopez, Lenny",
title="Designing Patient-Centered Text Messaging Interventions for Increasing Physical Activity Among Participants With Type 2 Diabetes: Qualitative Results From the Text to Move Intervention",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Apr",
day="24",
volume="5",
number="4",
pages="e54",
keywords="diabetes mellitus, type 2",
keywords="text messaging",
keywords="exercise",
keywords="qualitative research",
abstract="Background: Type 2 diabetes mellitus (T2DM) is a disease affecting approximately 29.1 million people in the United States, and an additional 86 million adults have prediabetes. Diabetes self-management education, a complex health intervention composed of 7 behaviors, is effective at improving self-care behaviors and glycemic control. Studies have employed text messages for education, reminders, and motivational messaging that can serve as ``cues to action,'' aiming to improve glucose monitoring, self-care behaviors, appointment attendance, and medication adherence. Objectives: The Text to Move (TTM) study was a 6-month 2-parallel group randomized controlled trial of individuals with T2DM to increase physical activity, measured by a pedometer. The intervention arm received text messages twice daily for 6 months that were tailored to the participant's stage of behavior change as defined by the transtheoretical model of behavior change. Methods: We assessed participants' attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audiorecorded, transcribed verbatim, coded, and analyzed using a grounded theory approach. Results: The response rate was 67\% (31/46 participants). The average age was 51.4 years and 61\% (19/31 participants) were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of the participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their health care center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants. Conclusions: Participants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes. Trial Registration: Clinicaltrials.gov NCT01569243; http://clinicaltrials.gov/ct2/show/NCT01569243 (Archived by Webcite at http://www.webcitation.org/6pfH6yXag) ",
doi="10.2196/mhealth.6666",
url="http://mhealth.jmir.org/2017/4/e54/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28438728"
}


@Article{info:doi/10.2196/mhealth.6654,
author="Holtz, E. Bree
and Murray, M. Katharine
and Hershey, D. Denise
and Dunneback, K. Julie
and Cotten, R. Shelia
and Holmstrom, J. Amanda
and Vyas, Arpita
and Kaiser, K. Molly
and Wood, A. Michael",
title="Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Apr",
day="19",
volume="5",
number="4",
pages="e53",
keywords="mHealth",
keywords="qualitative research",
keywords="type 1 diabetes",
keywords="family",
abstract="Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan's family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents. ",
doi="10.2196/mhealth.6654",
url="http://mhealth.jmir.org/2017/4/e53/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28428167"
}


@Article{info:doi/10.2196/jmir.6994,
author="Peters, Dorian
and Davis, Sharon
and Calvo, Alejandro Rafael
and Sawyer, M. Susan
and Smith, Lorraine
and Foster, M. Juliet",
title="Young People's Preferences for an Asthma Self-Management App Highlight Psychological Needs: A Participatory Study",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="11",
volume="19",
number="4",
pages="e113",
keywords="asthma",
keywords="mobile applications",
keywords="quality of life",
keywords="mental health",
keywords="adolescents",
keywords="chronic disease",
keywords="mhealth",
keywords="participatory design",
abstract="Background: Although the prevalence of mental illness among young people with asthma is known to be twice the rate of the wider population, none of the asthma apps reported have acknowledged or attempted to include psychological support features. This is perhaps because user involvement in the development of asthma apps has been scarce. User involvement, facilitated by participatory design methods, can begin to address these issues while contributing insights to our understanding of the psychological experience associated with asthma and how technology might improve quality of life. Objective: The goal of this participatory user research study was to explore the experience, needs, and ideas of young people with asthma while allowing them to define requirements for an asthma app that would be engaging and effective at improving their well-being. Methods: Young people aged 15-24 years with doctor-diagnosed asthma were invited to participate in a participatory workshop and to complete a workbook designed to elicit their thoughts and ideas about living with asthma, technology use, and the design of an app. Participants generated a number of artifacts (including collages, concept maps, and paper prototypes) designed to reify their ideas, tacit knowledge, and experience. Results: A total of 20 participants (mean age 17.8 years; 60\%, 12/20 female) representing a range from inadequately to well-controlled asthma completed a workbook and 13 of these also took part in a workshop (four workshops were held in total), resulting in 102 participant-generated artifacts. Theoretical thematic analysis resulted in a set of personal needs, feature ideas, and app characteristics considered relevant by young people for an asthma support app. The data revealed that psychological factors such as anxiety, and impediments to autonomy, competence, and relatedness (as consistent with self-determination theory [SDT]), were considered major influences on quality of life by young people with asthma. Furthermore, the incorporation of features pertaining to psychological experience was particularly valued by participants. Conclusions: In addition to practical features for asthma management, an app for young people with asthma should include support for the mental health factors associated with lived experience (ie, anxiety, lack of autonomy, and social disconnectedness). We show how support for these factors can be translated into design features of an app for asthma. In addition to informing the development of asthma-support technologies for young people, these findings could have implications for technologies designed to support people with chronic illness more generally. ",
doi="10.2196/jmir.6994",
url="http://www.jmir.org/2017/4/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28400353"
}


@Article{info:doi/10.2196/humanfactors.6502,
author="Witteman, O. Holly
and Presseau, Justin
and Nicholas Angl, Emily
and Jokhio, Iffat
and Schwalm, JD
and Grimshaw, M. Jeremy
and Bosiak, Beth
and Natarajan, K. Madhu
and Ivers, M. Noah",
title="Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome",
journal="JMIR Hum Factors",
year="2017",
month="Mar",
day="01",
volume="4",
number="1",
pages="e6",
keywords="user-centered design",
keywords="codesign",
keywords="medication adherence",
keywords="health behavior",
keywords="health education",
keywords="myocardial infarction",
keywords="secondary prevention",
keywords="stents",
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. ",
doi="10.2196/humanfactors.6502",
url="http://humanfactors.jmir.org/2017/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28249831"
}


@Article{info:doi/10.2196/rehab.6761,
author="Rothgangel, Andreas
and Braun, Susy
and Smeets, Rob
and Beurskens, Anna",
title="Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Feb",
day="15",
volume="4",
number="1",
pages="e2",
keywords="telerehabilitation",
keywords="telemedicine",
keywords="self care",
keywords="software design",
keywords="phantom limb",
keywords="imagery (psychotherapy)",
abstract="Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients' adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain. Objective: The main aim of this study was to describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain. We addressed 3 research questions: (1) Which requirements are defined by patients and therapists for the content and functions of a telerehabilitation platform and how can these requirements be prioritized to develop a first prototype of the platform? (2) How can the user interface of the telerehabilitation platform be designed so as to match the predefined critical user requirements and how can this interface be translated into a medium-fidelity prototype of the platform? (3) How do patients with phantom limb pain and their treating therapists judge the usability of the medium-fidelity prototype of the telerehabilitation platform in routine care and how can the platform be redesigned based on their feedback to achieve a high-fidelity prototype? Methods: The telerehabilitation platform was developed using an iterative user-centered design process. In the first phase, a questionnaire followed by a semistructured interview was used to identify the user requirements of both the patients and their physical and occupational therapists, which were then prioritized using a decision matrix. The second phase involved designing the interface of the telerehabilitation platform using design sketches, wireframes, and interface mock-ups to develop a low-fidelity prototype. Heuristic evaluation resulted in a medium-fidelity prototype whose usability was tested in routine care in the final phase, leading to the development of a high-fidelity prototype. Results: A total of 7 categories of patient requirements were identified: monitoring, exercise programs, communication, settings, background information, log-in, and general requirements. One additional category emerged for therapists: patient management. Based on these requirements, patient and therapist interfaces for the telerehabilitation platform were developed and redesigned by the software development team in an iterative process, addressing the usability problems that were reported by the users during 4 weeks of field testing in routine care. Conclusions: Our findings underline the importance of involving the users and other stakeholders early and continuously in an iterative design process, as well as the need for clear criteria to identify critical user requirements. A decision matrix is presented that incorporates the views of various stakeholders in systematically rating and prioritizing user requirements. The findings and lessons learned might help health care providers, researchers, software designers, and other stakeholders in designing and evaluating new teletreatments, and hopefully increase the likelihood of user acceptance. ",
doi="10.2196/rehab.6761",
url="http://rehab.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582249"
}


@Article{info:doi/10.2196/jmir.5951,
author="Cranen, Karlijn
and Groothuis-Oudshoorn, GM Catharina
and Vollenbroek-Hutten, MR Miriam
and IJzerman, J. Maarten",
title="Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients' Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment",
journal="J Med Internet Res",
year="2017",
month="Jan",
day="20",
volume="19",
number="1",
pages="e26",
keywords="patient preference",
keywords="patient acceptance of health care",
keywords="telerehabilitation",
keywords="choice behavior",
keywords="decision making",
keywords="decision support techniques",
keywords="patient compliance",
keywords="chronic disease",
keywords="exercise therapy",
keywords="chronic pain",
abstract="Background: Patient-centered design that addresses patients' preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients' preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients' perspective. In addition, limited evidence is available about the best way to explore patients' preferences. Therefore, the assessment of patients' preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients' treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: ``Intermediate'' telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment. ",
doi="10.2196/jmir.5951",
url="http://www.jmir.org/2017/1/e26/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28108429"
}


@Article{info:doi/10.2196/humanfactors.6778,
author="Iwamoto, Rikako
and Rodrigues Santos, Laura Ana
and Chavannes, Niels
and Reis, Ria
and Diehl, Carel Jan",
title="Considerations for an Access-Centered Design of the Fever Thermometer in Low-Resource Settings: A Literature Review",
journal="JMIR Hum Factors",
year="2017",
month="Jan",
day="18",
volume="4",
number="1",
pages="e3",
keywords="fever diagnostics",
keywords="sub-Saharan Africa",
keywords="thermometer",
keywords="low-resource settings",
keywords="design",
keywords="patient journey",
keywords="product-service system",
abstract="Background: The lack of adequate information about fever in low-resource settings, its unreliable self-assessment, and poor diagnostic practices may result in delayed care and under-or-overdiagnosis of diseases such as malaria. The mismatches of existing fever thermometers in the context of use imply that the diagnostic tools and connected services need to be studied further to address the challenges of fever-related illnesses and their diagnostics. Objective: This study aims to inform a product-service system approach to design a reliable and accessible fever thermometer and connected services, as well as contribute to the identification of innovative opportunities to improve health care in low-resource settings. Methods: To determine what factors impede febrile people seeking health care to access adequate fever diagnostics, a literature search was conducted in Google Scholar and PubMed with relevant keywords. Next, these factors were combined with a patient journey model to design a new product-service system for fever diagnostics in low-resource settings. Results: In total, 37 articles were reviewed. The five As framework was used to categorize the identified barriers. The results indicate that there is a poor distribution of reliable fever diagnostic practices among remote communities. This paper speaks to the global public health and design communities. Three complementary considerations are discussed that support the idea of a more holistic approach to the design of fever diagnostics: (1) understanding of the fever diagnostics patient journey, (2) identifying user groups of the thermometers in a specific health care system, and (3) assessing different needs and interests of the different users. Conclusions: Access to basic, primary health care may be enhanced with better information and technology design made through the involvement of system users. ",
doi="10.2196/humanfactors.6778",
url="http://humanfactors.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28100439"
}


@Article{info:doi/10.2196/games.6254,
author="Brox, Ellen
and Konstantinidis, Th Stathis
and Evertsen, Gunn",
title="User-Centered Design of Serious Games for Older Adults Following 3 Years of Experience With Exergames for Seniors: A Study Design",
journal="JMIR Serious Games",
year="2017",
month="Jan",
day="11",
volume="5",
number="1",
pages="e2",
keywords="user studies",
keywords="usability testing",
keywords="gestural input",
keywords="user-centred design",
keywords="accessibility",
keywords="consumer health",
keywords="exergames",
keywords="participatory design",
keywords="lessons learned",
abstract="Background: Seniors need sufficient balance and strength to manage in daily life, and sufficient physical activity is required to achieve and maintain these abilities. This can be a challenge, but fun and motivational exergames can be of help. However, most commercial games are not suited for this age group for several reasons. Many usability studies and user-centered design (UCD) protocols have been developed and applied, but to the best of our knowledge none of them are focusing on seniors' use of games for physical activity. In GameUp, a European cofunded project, some prototype Kinect exergames to enhance the mobility of seniors were developed in a user-centered approach. Objective: In this paper we aim to record lessons learned in 3 years of experience with exergames for seniors, considering both the needs of older adults regarding user-centered development of exergames and participation in UCD. We also provide a UCD protocol for exergames tailored to senior needs. Methods: An initial UCD protocol was formed based on literature of previous research outcomes. Senior users participated in UCD following the initial protocol. The users formed a steady group that met every second week for 3 years to play exergames and participate in the UCD during the 4 phases of the protocol. Several methods were applied in the 4 different phases of the UCD protocol; the most important methods were structured and semistructured interviews, observations, and group discussions. Results: A total of 16 seniors with an average age above 80 years participated for 3 years in UCD in order to develop the GameUp exergames. As a result of the lessons learned by applying the different methodologies of the UCD protocol, we propose an adjusted UCD protocol providing explanations on how it should be applied for seniors as users. Questionnaires should be turned into semistructured and structured interviews while user consultation sessions should be repeated with the same theme to ensure that the UCD methods produce a valid outcome. By first following the initial and gradually the adjusted UCD protocol, the project resulted in exergame functionalities and interface features for seniors. Conclusions: The main lessons learned during 3 years of experience with exergames for seniors applying UCD are that devoting time to seniors is a key element of success so that trust can be gained, communication can be established, and users' opinions can be recorded. All different game elements should be taken into consideration during the design of exergames for seniors even if they seem obvious. Despite the limitations of this study, one might argue that it provides a best practice guide to the development of serious games for physical activity targeting seniors. ",
doi="10.2196/games.6254",
url="http://games.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28077348"
}


@Article{info:doi/10.2196/mental.5878,
author="Sundram, Frederick
and Hawken, J. Susan
and Stasiak, Karolina
and Lucassen, FG Mathijs
and Fleming, Theresa
and Shepherd, Matthew
and Greenwood, Andrea
and Osborne, Raechel
and Merry, N. Sally",
title="Tips and Traps: Lessons From Codesigning a Clinician E-Monitoring Tool for Computerized Cognitive Behavioral Therapy",
journal="JMIR Ment Health",
year="2017",
month="Jan",
day="11",
volume="4",
number="1",
pages="e3",
keywords="e-therapy",
keywords="psychotherapy",
keywords="cognitive therapy",
keywords="depression",
keywords="psychology, adolescent",
keywords="primary health care",
abstract="Background: Computerized cognitive behavioral therapy (cCBT) is an acceptable and promising treatment modality for adolescents with mild-to-moderate depression. Many cCBT programs are standalone packages with no way for clinicians to monitor progress or outcomes. We sought to develop an electronic monitoring (e-monitoring) tool in consultation with clinicians and adolescents to allow clinicians to monitor mood, risk, and treatment adherence of adolescents completing a cCBT program called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts). Objective: The objectives of our study were as follows: (1) assess clinicians' and adolescents' views on using an e-monitoring tool and to use this information to help shape the development of the tool and (2) assess clinician experiences with a fully developed version of the tool that was implemented in their clinical service. Methods: A descriptive qualitative study using semistructured focus groups was conducted in New Zealand. In total, 7 focus groups included clinicians (n=50) who worked in primary care, and 3 separate groups included adolescents (n=29). Clinicians were general practitioners (GPs), school guidance counselors, clinical psychologists, youth workers, and nurses. Adolescents were recruited from health services and a high school. Focus groups were run to enable feedback at 3 phases that corresponded to the consultation, development, and postimplementation stages. Thematic analysis was applied to transcribed responses. Results: Focus groups during the consultation and development phases revealed the need for a simple e-monitoring registration process with guides for end users. Common concerns were raised in relation to clinical burden, monitoring risk (and effects on the therapeutic relationship), alongside confidentiality or privacy and technical considerations. Adolescents did not want to use their social media login credentials for e-monitoring, as they valued their privacy. However, adolescents did want information on seeking help and personalized monitoring and communication arrangements. Postimplementation, clinicians who had used the tool in practice revealed no adverse impact on the therapeutic relationship, and adolescents were not concerned about being e-monitored. Clinicians did need additional time to monitor adolescents, and the e-monitoring tool was used in a different way than was originally anticipated. Also, it was suggested that the registration process could be further streamlined and integrated with existing clinical data management systems, and the use of clinician alerts could be expanded beyond the scope of simply flagging adolescents of concern. Conclusions: An e-monitoring tool was developed in consultation with clinicians and adolescents. However, the study revealed the complexity of implementing the tool in clinical practice. Of salience were privacy, parallel monitoring systems, integration with existing electronic medical record systems, customization of the e-monitor, and preagreed monitoring arrangements between clinicians and adolescents. ",
doi="10.2196/mental.5878",
url="http://mental.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28077345"
}


@Article{info:doi/10.2196/resprot.5932,
author="Geryk, L. Lorie
and Roberts, A. Courtney
and Sage, J. Adam
and Coyne-Beasley, Tamera
and Sleath, L. Betsy
and Carpenter, M. Delesha",
title="Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study",
journal="JMIR Res Protoc",
year="2016",
month="Dec",
day="06",
volume="5",
number="4",
pages="e229",
keywords="asthma",
keywords="self-management",
keywords="social support",
keywords="mHealth",
keywords="mobile apps",
keywords="adolescents",
keywords="parents",
keywords="clinicians",
abstract="Background: Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input. Objective: This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills. Methods: We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful). Results: All parents were female (n=20), 45\% were black, 20\% had an income ?US \$50,000, and 45\% had a bachelor's degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided. Conclusions: Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps. ",
doi="10.2196/resprot.5932",
url="http://www.researchprotocols.org/2016/4/e229/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27923777"
}


@Article{info:doi/10.2196/mental.6202,
author="Rickard, Nikki
and Arjmand, Hussain-Abdulah
and Bakker, David
and Seabrook, Elizabeth",
title="Development of a Mobile Phone App to Support Self-Monitoring of Emotional Well-Being: A Mental Health Digital Innovation",
journal="JMIR Ment Health",
year="2016",
month="Nov",
day="23",
volume="3",
number="4",
pages="e49",
keywords="eHealth",
keywords="emotions",
keywords="mental health",
keywords="mobile phone",
keywords="feedback",
abstract="Background: Emotional well-being is a primary component of mental health and well-being. Monitoring changes in emotional state daily over extended periods is, however, difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Mobile phone technology offers a sustainable means of enhancing self-management of emotional well-being. Objective: This paper aims to describe the development of a mobile phone tool designed to monitor emotional changes in a natural everyday context and in real time. Methods: This evidence-informed mobile phone app monitors emotional mental health and well-being, and it provides links to mental health organization websites and resources. The app obtains data via self-report psychological questionnaires, experience sampling methodology (ESM), and automated behavioral data collection. Results: Feedback from 11 individuals (age range 16-52 years; 4 males, 7 females), who tested the app over 30 days, confirmed via survey and focus group methods that the app was functional and usable. Conclusions: Recommendations for future researchers and developers of mental health apps to be used for research are also presented. The methodology described in this paper offers a powerful tool for a range of potential mental health research studies and provides a valuable standard against which development of future mental health apps should be considered. ",
doi="10.2196/mental.6202",
url="http://mental.jmir.org/2016/4/e49/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27881358"
}


@Article{info:doi/10.2196/humanfactors.6653,
author="Chininthorn, Prangnat
and Glaser, Meryl
and Tucker, David William
and Diehl, Carel Jan",
title="Exploration of Deaf People's Health Information Sources and Techniques for Information Delivery in Cape Town: A Qualitative Study for the Design and Development of a Mobile Health App",
journal="JMIR Hum Factors",
year="2016",
month="Nov",
day="11",
volume="3",
number="2",
pages="e28",
keywords="Deafness",
keywords="sign language",
keywords="South Africa",
keywords="mHealth",
keywords="health",
keywords="qualitative research",
keywords="co-creation",
keywords="community-based co-design",
abstract="Background: Many cultural and linguistic Deaf people in South Africa face disparity when accessing health information because of social and language barriers. The number of certified South African Sign Language interpreters (SASLIs) is also insufficient to meet the demand of the Deaf population in the country. Our research team, in collaboration with the Deaf communities in Cape Town, devised a mobile health app called SignSupport to bridge the communication gaps in health care contexts. We consequently plan to extend our work with a Health Knowledge Transfer System (HKTS) to provide Deaf people with accessible, understandable, and accurate health information. We conducted an explorative study to prepare the groundwork for the design and development of the system. Objectives: To investigate the current modes of health information distributed to Deaf people in Cape Town, identify the health information sources Deaf people prefer and their reasons, and define effective techniques for delivering understandable information to generate the groundwork for the mobile health app development with and for Deaf people. Methods: A qualitative methodology using semistructured interviews with sensitizing tools was used in a community-based codesign setting. A total of 23 Deaf people and 10 health professionals participated in this study. Inductive and deductive coding was used for the analysis. Results: Deaf people currently have access to 4 modes of health information distribution through: Deaf and other relevant organizations, hearing health professionals, personal interactions, and the mass media. Their preferred and accessible sources are those delivering information in signed language and with communication techniques that match Deaf people's communication needs. Accessible and accurate health information can be delivered to Deaf people by 3 effective techniques: using signed language including its dialects, through health drama with its combined techniques, and accompanying the information with pictures in combination with simple text descriptions. Conclusions: We can apply the knowledge gained from this exploration to build the groundwork of the mobile health information system. We see an opportunity to design an HKTS to assist the information delivery during the patient-health professional interactions in primary health care settings. Deaf people want to understand the information relevant to their diagnosed disease and its self-management. The 3 identified effective techniques will be applied to deliver health information through the mobile health app. ",
doi="10.2196/humanfactors.6653",
url="http://humanfactors.jmir.org/2016/2/e28/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27836819"
}


@Article{info:doi/10.2196/rehab.6182,
author="Ploderer, Bernd
and Fong, Justin
and Klaic, Marlena
and Nair, Siddharth
and Vetere, Frank
and Cofr{\'e} Lizama, Eduardo L.
and Galea, Pauline Mary",
title="How Therapists Use Visualizations of Upper Limb Movement Information From Stroke Patients: A Qualitative Study With Simulated Information",
journal="JMIR Rehabil Assist Technol",
year="2016",
month="Oct",
day="05",
volume="3",
number="2",
pages="e9",
keywords="stroke",
keywords="upper-limb rehabilitation",
keywords="therapy",
keywords="information visualization",
keywords="dashboard",
keywords="wearable technology",
abstract="Background: Stroke is a leading cause of disability worldwide, with upper limb deficits affecting an estimated 30\% to 60\% of survivors. The effectiveness of upper limb rehabilitation relies on numerous factors, particularly patient compliance to home programs and exercises set by therapists. However, therapists lack objective information about their patients' adherence to rehabilitation exercises as well as other uses of the affected arm and hand in everyday life outside the clinic. We developed a system that consists of wearable sensor technology to monitor a patient's arm movement and a Web-based dashboard to visualize this information for therapists. Objective: The aim of our study was to evaluate how therapists use upper limb movement information visualized on a dashboard to support the rehabilitation process. Methods: An interactive dashboard prototype with simulated movement information was created and evaluated through a user-centered design process with therapists (N=8) at a rehabilitation clinic. Data were collected through observations of therapists interacting with an interactive dashboard prototype, think-aloud data, and interviews. Data were analyzed qualitatively through thematic analysis. Results: Therapists use visualizations of upper limb information in the following ways: (1) to obtain objective data of patients' activity levels, exercise, and neglect outside the clinic, (2) to engage patients in the rehabilitation process through education, motivation, and discussion of experiences with activities of daily living, and (3) to engage with other clinicians and researchers based on objective data. A major limitation is the lack of contextual data, which is needed by therapists to discern how movement data visualized on the dashboard relate to activities of daily living. Conclusions: Upper limb information captured through wearable devices provides novel insights for therapists and helps to engage patients and other clinicians in therapy. Consideration needs to be given to the collection and visualization of contextual information to provide meaningful insights into patient engagement in activities of daily living. These findings open the door for further work to develop a fully functioning system and to trial it with patients and clinicians during therapy. ",
doi="10.2196/rehab.6182",
url="http://rehab.jmir.org/2016/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582257"
}


@Article{info:doi/10.2196/mhealth.6187,
author="Lyles, R. Courtney
and Altschuler, Andrea
and Chawla, Neetu
and Kowalski, Christine
and McQuillan, Deanna
and Bayliss, Elizabeth
and Heisler, Michele
and Grant, W. Richard",
title="User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="14",
volume="4",
number="3",
pages="e108",
keywords="primary health care",
keywords="chronic disease",
keywords="computers, handheld",
keywords="mobile applications",
keywords="medical informatics",
keywords="health communication",
abstract="Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective: Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results: Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and to reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (eg, the ability to raise private or sensitive concerns) and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match sex and race/ethnicity of the actors with patients. Conclusions: User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities. ",
doi="10.2196/mhealth.6187",
url="http://mhealth.jmir.org/2016/3/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27627965"
}


@Article{info:doi/10.2196/humanfactors.6029,
author="Nelson, A. Lyndsay
and Mayberry, S. Lindsay
and Wallston, Kenneth
and Kripalani, Sunil
and Bergner, M. Erin
and Osborn, Y. Chandra",
title="Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes",
journal="JMIR Hum Factors",
year="2016",
month="Sep",
day="08",
volume="3",
number="2",
pages="e23",
keywords="mobile health",
keywords="patient adherence",
keywords="type 2 diabetes mellitus",
keywords="text messaging",
keywords="health status disparities",
abstract="Background: Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of adults with T2DM, but few have been tested with disadvantaged populations. Objective: To develop Rapid Education/Encouragement And Communications for Health (REACH), a tailored, text messaging intervention to support the self-care adherence of disadvantaged patients with T2DM, based on the Information-Motivation-Behavioral skills model. We then tested REACH's usability to make improvements before evaluating its effects. Methods: We developed REACH's content and functionality using an empirical and theory-based approach, findings from a previously pilot-tested intervention, and the expertise of our interdisciplinary research team. We recruited 36 adults with T2DM from Federally Qualified Health Centers to participate in 1 of 3 rounds of usability testing. For 2 weeks, participants received daily text messages assessing and promoting self-care, including tailored messages addressing users' unique barriers to adherence, and weekly text messages with adherence feedback. We analyzed quantitative and qualitative user feedback and system-collected data to improve REACH. Results: Participants were, on average, 52.4 (SD 9.5) years old, 56\% (20/36) female, 63\% (22/35) were a racial or ethnic minority, and 67\% (22/33) had an income less than US \$35,000. About half were taking insulin, and average hemoglobin A1c level was 8.2\% (SD 2.2\%). We identified issues (eg, user concerns with message phrasing, technical restrictions with responding to assessment messages) and made improvements between testing rounds. Overall, participants favorably rated the ease of understanding (mean 9.6, SD 0.7) and helpfulness (mean 9.3, SD 1.4) of self-care promoting text messages on a scale of 1-10, responded to 96\% of assessment text messages, and rated the helpfulness of feedback text messages 8.5 (SD 2.7) on a scale of 1-10. User feedback led to refining our study enrollment process so that users understood the flexibility in message timing and that computers, not people, send the messages. Furthermore, research assistants' feedback on the enrollment process helped improve participants' engagement with study procedures. Conclusions: Testing technology-delivered interventions with disadvantaged adults revealed preferences and concerns unique to this population. Through iterative testing and multiple data sources, we identified and responded to users' intervention preferences, technical issues, and shortcomings in our research procedures. ",
doi="10.2196/humanfactors.6029",
url="http://humanfactors.jmir.org/2016/2/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27609738"
}


@Article{info:doi/10.2196/resprot.5906,
author="Mirkovic, Jelena
and Kristjansdottir, Birna Ol{\"o}f
and Stenberg, Una
and Krogseth, Tonje
and Stange, C. Kurt
and Ruland, M. Cornelia",
title="Patient Insights Into the Design of Technology to Support a Strengths-Based Approach to Health Care",
journal="JMIR Res Protoc",
year="2016",
month="Aug",
day="24",
volume="5",
number="3",
pages="e175",
keywords="patient strengths",
keywords="resilience",
keywords="patient participation",
keywords="patient-centered care",
keywords="patient--provider collaboration",
keywords="user-computer interface",
keywords="participatory design",
keywords="chronic disease",
keywords="patient requirement",
abstract="Background: An increasing number of research studies in the psychological and biobehavioral sciences support incorporating patients' personal strengths into illness management as a way to empower and activate the patients, thus improving their health and well-being. However, lack of attention to patients' personal strengths is still reported in patient--provider communication. Information technology (IT) has great potential to support strengths-based patient--provider communication and collaboration, but knowledge about the users' requirements and preferences is inadequate. Objective: This study explored the aspirations and requirements of patients with chronic conditions concerning IT tools that could help increase their awareness of their own personal strengths and resources, and support discussion of these assets in consultations with health care providers. Methods: We included patients with different chronic conditions (chronic pain, morbid obesity, and chronic obstructive pulmonary disease) and used various participatory research methods to gain insight into the participants' needs, values, and opinions, and the contexts in which they felt strengths-based IT tools could be used. Results: Participants were positive toward using technology to support them in identifying and discussing their personal strengths in clinical consultation, but also underlined the importance of fitting it to their specific requirements and the right contexts of use. Participants recommended that technology be designed for use in preconsultation settings (eg, at home) and felt that it should support them in both identifying strengths and in finding out new ways how strengths can be used to attain personal health-related goals. Participants advocated use of technology to support advance preparation for consultations and empower them to take a more active role. IT tools were suggested to be potentially useful in specific contexts, including individual or group consultations with health care providers (physician, nurse, specialist, care team) in clinical consultations but also outside health care settings (eg, as a part of a self-management program). Participants' requirements for functionality and design include, among others: providing examples of strengths reported by other patients with chronic conditions, along with an option to extend the list with personal examples; giving an option to briefly summarize health-related history; using intuitive, easy-to-use but also engaging user interface design. Additionally, the findings are exemplified with a description of a low-fidelity paper prototype of a strengths-based tool, developed with participants in this study. Conclusions: Users requirements for IT support of a strengths-based approach to health care appear feasible. The presented findings reflect patients' values and lists potential contexts where they feel that technology could facilitate meaningful patient--provider communication that focuses not just on symptoms and problems, but also takes into account patients' strengths and resources. The findings can be used to inform further development of IT tools for use in clinical consultations. ",
doi="10.2196/resprot.5906",
url="http://www.researchprotocols.org/2016/3/e175/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27558951"
}


@Article{info:doi/10.2196/jmir.5790,
author="O'Brien, Nicola
and Heaven, Ben
and Teal, Gemma
and Evans, H. Elizabeth
and Cleland, Claire
and Moffatt, Suzanne
and Sniehotta, F. Falko
and White, Martin
and Mathers, C. John
and Moynihan, Paula",
title="Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition",
journal="J Med Internet Res",
year="2016",
month="Aug",
day="03",
volume="18",
number="8",
pages="e210",
keywords="intervention studies",
keywords="health behavior",
keywords="retirement",
keywords="Internet",
abstract="Background: Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective: The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods: Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results: The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions: Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible. ",
doi="10.2196/jmir.5790",
url="http://www.jmir.org/2016/8/e210/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27489143"
}


@Article{info:doi/10.2196/humanfactors.5820,
author="Press, Anne
and DeStio, Catherine
and McCullagh, Lauren
and Kapoor, Sandeep
and Morley, Jeanne
and 
and Conigliaro, Joseph",
title="Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records",
journal="JMIR Hum Factors",
year="2016",
month="Jul",
day="08",
volume="3",
number="2",
pages="e18",
keywords="clinical decision support",
keywords="adoption",
keywords="primary care",
keywords="usability",
keywords="SBIRT",
abstract="Background: Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods. Objective: The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home. Methods: Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version. Results: Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient's visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade ``1'' for the statement, ``I would like to use this system frequently'' during the first round of testing but a ``5'' during the second round of analysis. Conclusions: The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers' perceptions of the SBIRT tool and their specific clinical workflow. ",
doi="10.2196/humanfactors.5820",
url="http://humanfactors.jmir.org/2016/2/e18/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27393643"
}


@Article{info:doi/10.2196/mhealth.5715,
author="Arvidsson, Susann
and Gilljam, Britt-Mari
and Nygren, Jens
and Ruland, Maria Cornelia
and Nordby-B{\o}e, Trude
and Svedberg, Petra",
title="Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jun",
day="24",
volume="4",
number="2",
pages="e76",
keywords="cancer",
keywords="children",
keywords="communication",
keywords="mobile app",
keywords="participation",
keywords="validation",
abstract="Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a ``traditional'' conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym ``Si det som det er'' or ``Tell it how it is'') is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a ``voice'' in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children's views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. ",
doi="10.2196/mhealth.5715",
url="http://mhealth.jmir.org/2016/2/e76/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27343004"
}


@Article{info:doi/10.2196/jmir.5661,
author="Pang, Cheong-Iao Patrick
and Chang, Shanton
and Verspoor, Karin
and Pearce, Jon",
title="Designing Health Websites Based on Users' Web-Based Information-Seeking Behaviors: A Mixed-Method Observational Study",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="06",
volume="18",
number="6",
pages="e145",
keywords="consumer health information",
keywords="public health informatics",
keywords="exploratory behavior",
keywords="hypermedia",
abstract="Background: Laypeople increasingly use the Internet as a source of health information, but finding and discovering the right information remains problematic. These issues are partially due to the mismatch between the design of consumer health websites and the needs of health information seekers, particularly the lack of support for ``exploring'' health information. Objective: The aim of this research was to create a design for consumer health websites by supporting different health information--seeking behaviors. We created a website called Better Health Explorer with the new design. Through the evaluation of this new design, we derive design implications for future implementations. Methods: Better Health Explorer was designed using a user-centered approach. The design was implemented and assessed through a laboratory-based observational study. Participants tried to use Better Health Explorer and another live health website. Both websites contained the same content. A mixed-method approach was adopted to analyze multiple types of data collected in the experiment, including screen recordings, activity logs, Web browsing histories, and audiotaped interviews. Results: Overall, 31 participants took part in the observational study. Our new design showed a positive result for improving the experience of health information seeking, by providing a wide range of information and an engaging environment. The results showed better knowledge acquisition, a higher number of page reads, and more query reformulations in both focused and exploratory search tasks. In addition, participants spent more time to discover health information with our design in exploratory search tasks, indicating higher engagement with the website. Finally, we identify 4 design considerations for designing consumer health websites and health information--seeking apps: (1) providing a dynamic information scope; (2) supporting serendipity; (3) considering trust implications; and (4) enhancing interactivity. Conclusions: Better Health Explorer provides strong support for the heterogeneous and shifting behaviors of health information seekers and eases the health information--seeking process. Our findings show the importance of understanding different health information--seeking behaviors and highlight the implications for designers of consumer health websites and health information--seeking apps. ",
doi="10.2196/jmir.5661",
url="http://www.jmir.org/2016/6/e145/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27267955"
}


@Article{info:doi/10.2196/humanfactors.4800,
author="Barbara, M. Angela
and Dobbins, Maureen
and Haynes, Brian R.
and Iorio, Alfonso
and Lavis, N. John
and Raina, Parminder
and Levinson, J. Anthony",
title="The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website",
journal="JMIR Human Factors",
year="2016",
month="May",
day="11",
volume="3",
number="1",
pages="e14",
keywords="online health information",
keywords="health informatics",
keywords="elderly",
keywords="consumer health information",
keywords="qualitative research",
keywords="usability testing",
keywords="Internet",
keywords="evidence-based medicine",
keywords="knowledge translation",
keywords="aging",
keywords="website",
abstract="Background: Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Objective: Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Methods: Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. Results: A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal's strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. Conclusions: The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites. ",
doi="10.2196/humanfactors.4800",
url="http://humanfactors.jmir.org/2016/1/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27170443"
}


@Article{info:doi/10.2196/resprot.5450,
author="Schlosser, Danielle
and Campellone, Timothy
and Kim, Daniel
and Truong, Brandy
and Vergani, Silvia
and Ward, Charlie
and Vinogradov, Sophia",
title="Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia",
journal="JMIR Res Protoc",
year="2016",
month="Apr",
day="28",
volume="5",
number="2",
pages="e77",
keywords="schizophrenia",
keywords="mobile app",
keywords="smartphone",
keywords="motivation",
keywords="technology-based intervention",
keywords="social networking",
keywords="coaching",
keywords="negative symptoms",
keywords="quality of life",
abstract="Background: Despite improvements in treating psychosis, schizophrenia remains a chronic and debilitating disorder that affects approximately 1\% of the US population and costs society more than depression, dementia, and other medical illnesses across most of the lifespan. Improving functioning early in the course of illness could have significant implications for long-term outcome of individuals with schizophrenia. Yet, current gold-standard treatments do not lead to clinically meaningful improvements in outcome, partly due to the inherent challenges of treating a population with significant cognitive and motivational impairments. The rise of technology presents an opportunity to develop novel treatments that may circumvent the motivational and cognitive challenges observed in schizophrenia. Objective: The purpose of this study was two-fold: (1) to evaluate the feasibility and acceptability of implementing a Personalized Real-Time Intervention for Motivation Enhancement (PRIME), a mobile app intervention designed to target reward-processing impairments, enhance motivation, and thereby improve quality of life in recent onset schizophrenia, and (2) evaluate the empirical benefits of using an iterative, user-centered design (UCD) process. Methods: We conducted two design workshops with 15 key stakeholders, followed by a series of in-depth interviews in collaboration with IDEO, a design and innovation firm. The UCD approach ultimately resulted in the first iteration of PRIME, which was evaluated by 10 RO participants. Results from the Stage 1 participants were then used to guide the next iteration that is currently being evaluated in an ongoing RCT. Participants in both phases were encouraged to use the app daily with a minimum frequency of 1/week over a 12-week period. Results: The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community ``moments feed'' to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100\% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform. Conclusions: These results indicate that the neuroscience-informed mobile app, PRIME, is a feasible and acceptable intervention for young people with schizophrenia. ",
doi="10.2196/resprot.5450",
url="http://www.researchprotocols.org/2016/2/e77/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27125771"
}


@Article{info:doi/10.2196/publichealth.5285,
author="Israni, Ajay
and Dean, Carl
and Kasel, Brian
and Berndt, Lisa
and Wildebush, Winston
and Wang, Jason C.",
title="Why do Patients Forget to Take Immunosuppression Medications and Miss Appointments: Can a Mobile Phone App Help?",
journal="JMIR Public Health Surveill",
year="2016",
month="Apr",
day="04",
volume="2",
number="1",
pages="e15",
keywords="adherence",
keywords="immunosuppressive medications",
keywords="appointments",
keywords="mobile phone",
abstract="Background: Kidney transplant recipients must adhere to their immunosuppressive medication regimen. However, non-adherence remains a major problem. Objective: The aim of this paper is to determine how kidney transplant recipients remember to take their medications, and assess their perception and beliefs about adherence to immunosuppressive medications and barriers to medication adherence. In addition, we aim to assess perception and beliefs about willingness to use a hypothetical, mobile phone app to improve adherence. Methods: We conducted a qualitative study that included an average of three home or workplace visits of kidney transplant recipients (N=16) from a single urban transplant center. Results: The qualitative study revealed that transplant recipients understood the importance of taking their immunosuppressive medications and this motivated them to take their medications. The visits showed that most participants have incorporated medication use into their daily lives and that any minor deviation from daily routines could result in non-adherence. Participants also reported other barriers to adherence. All participants were interested in using an app to remind them to take their medication; however, they reported potential barriers to using the app. Conclusions: Although kidney transplant recipients understood the importance of medication adherence, there were significant barriers to maintaining adherence. Participants also reported interest in using a mobile phone app. ",
doi="10.2196/publichealth.5285",
url="http://publichealth.jmir.org/2016/1/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27227150"
}


@Article{info:doi/10.2196/humanfactors.4996,
author="Kurahashi, M. Allison
and Weinstein, B. Peter
and Jamieson, Trevor
and Stinson, N. Jennifer
and Cafazzo, A. Joseph
and Lokuge, Bhadra
and Morita, P. Plinio
and Cohen, Eyal
and Rapoport, Adam
and Bezjak, Andrea
and Husain, Amna",
title="In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System",
journal="JMIR Human Factors",
year="2016",
month="Mar",
day="24",
volume="3",
number="1",
pages="e12",
keywords="collaborative care",
keywords="patient-centered care",
keywords="patient engagement",
keywords="chronic disease",
keywords="communication",
keywords="Internet communication tools",
keywords="Internet communication technologies",
abstract="Background: We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space. Objective: The objectives of this paper are to present the iterative design of the separate views for health care providers (HCPs) within each patient's secure space and examine patients', caregivers', and HCPs' perspectives on this separate view for HCP-only communication. Methods: The overall research program includes cycles of ethnography, prototyping, usability testing, and pilot testing. This paper describes the usability testing phase that directly informed development. A descriptive qualitative approach was used to analyze participant perspectives that emerged during usability testing. Results: During usability testing, we sampled 89 participants from three user groups: 23 patients, 19 caregivers, and 47 HCPs. Almost all perspectives from the three user groups supported the need for an HCP-only communication view. In an earlier prototype, the visual presentation caused confusion among HCPs when reading and composing messages about whether a message was visible to the patient. Usability testing guided us to design a more deliberate distinction between posting in the Patient and Team view and the Health Care Provider Only view at the time of composing a message, which once posted is distinguished by an icon. Conclusions: The team made a decision to incorporate an HCP-only communication view based on findings during earlier phases of work. During usability testing we tested the separate communication views, and all groups supported this partition. We spent considerable effort designing the partition; however, preliminary findings from the next phase of evaluation, pilot testing, show that the Patient and Team communication is predominantly being used. This demonstrates the importance of a subsequent phase of the clinical trial of Loop to validate the concept and design. ",
doi="10.2196/humanfactors.4996",
url="http://humanfactors.jmir.org/2016/1/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025912"
}


@Article{info:doi/10.2196/resprot.5204,
author="Steele Gray, Carolyn
and Khan, Irfan Anum
and Kuluski, Kerry
and McKillop, Ian
and Sharpe, Sarah
and Bierman, S. Arlene
and Lyons, F. Renee
and Cott, Cheryl",
title="Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach",
journal="JMIR Res Protoc",
year="2016",
month="Feb",
day="18",
volume="5",
number="1",
pages="e28",
keywords="eHealth development",
keywords="mobile apps",
keywords="multi-morbidity",
keywords="complex patients",
keywords="primary care",
abstract="Background: Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD. Objective: This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool.  Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers. Methods: Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool. Results: Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis---Possible, Implementable, (to be) Challenged, (to be) Killed---guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5).  Working group findings were broken down into categories of what works and what does not work to inform modifications to the prototype. This latter phase led to a major shift in the purpose and design of the prototype, validating the importance of using iterative codesign processes. Conclusions: Interpretive descriptive methods allow for an understanding of user experiences of patients with CCDD, their carers, and primary care providers. Qualitative methods help to capture and interpret user needs, and identify contextual barriers and enablers to tool adoption, informing a redesign to better suit the needs of this diverse user group. This study illustrates the value of adopting interpretive descriptive methods into user-centered mHealth tool design and can also serve to inform the design of other eHealth technologies. Our approach is particularly useful in requirements determination when developing for a complex user group and their health care providers. ",
doi="10.2196/resprot.5204",
url="http://www.researchprotocols.org/2016/1/e28/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26892952"
}


@Article{info:doi/10.2196/mhealth.5181,
author="McClure, B. Jennifer
and Hartzler, L. Andrea
and Catz, L. Sheryl",
title="Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers",
journal="JMIR mHealth uHealth",
year="2016",
month="Feb",
day="12",
volume="4",
number="1",
pages="e17",
keywords="tobacco use cessation",
keywords="smoking",
keywords="mobile health",
keywords="smartphone",
abstract="Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9\%) and would recommend them to their clients/patients (201/264, 76.1\%), especially if the app were empirically validated (236/264, 89.4\%). Few providers believe effective cessation apps currently exist (112/264, 42.4\%). Few smokers (5/40, 13\%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83\%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one's needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. ",
doi="10.2196/mhealth.5181",
url="http://mhealth.jmir.org/2016/1/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26872940"
}


@Article{info:doi/10.2196/humanfactors.4853,
author="Gustafson Jr, H. David
and Maus, Adam
and Judkins, Julianne
and Dinauer, Susan
and Isham, Andrew
and Johnson, Roberta
and Landucci, Gina
and Atwood, K. Amy",
title="Using the NIATx Model to Implement User-Centered Design of Technology for Older Adults",
journal="JMIR Human Factors",
year="2016",
month="Jan",
day="14",
volume="3",
number="1",
pages="e2",
keywords="eHealth",
keywords="user-centered design",
keywords="technology",
keywords="aging in place",
keywords="independent living",
keywords="consumer participation",
keywords="accessibility",
doi="10.2196/humanfactors.4853",
url="http://humanfactors.jmir.org/2016/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025985"
}


@Article{info:doi/10.2196/jmir.4999,
author="Rowsell, Alison
and Muller, Ingrid
and Murray, Elizabeth
and Little, Paul
and Byrne, D. Christopher
and Ganahl, Kristin
and M{\"u}ller, Gabriele
and Gibney, Sarah
and Lyles, R. Courtney
and Lucas, Antonia
and Nutbeam, Don
and Yardley, Lucy",
title="Views of People With High and Low Levels of Health Literacy About a Digital Intervention to Promote Physical Activity for Diabetes: A Qualitative Study in Five Countries",
journal="J Med Internet Res",
year="2015",
month="Oct",
day="12",
volume="17",
number="10",
pages="e230",
keywords="health literacy, digital intervention, diabetes, qualitative, physical activity",
abstract="Background: Low health literacy is associated with poor health-related knowledge, illness self-management, health service use, health, and survival, and thus addressing issues related to low health literacy has been highlighted as a pressing international priority. Objective: To explore views of a digital health promotion intervention designed to be accessible to people with lower levels of health literacy, in particular examining reactions to the interactive and audiovisual elements of the intervention. Methods: Qualitative think-aloud interviews were carried out with 65 adults with type 2 diabetes in the UK, Ireland, USA, Germany, and Austria, with purposive sampling to ensure representation of people with lower levels of health literacy. Inductive thematic analysis was used to identify common themes. We then systematically compared views in subgroups based on country, health literacy level, age, gender, and time since diagnosis. Results: Most participants from the chosen countries expressed positive views of most elements and features of the intervention. Some interactive and audiovisual elements required modification to increase their usability and perceived credibility and relevance. There were some differences in views based on age and gender, but very few differences relating to health literacy level or time since diagnosis. Conclusions: In general, participants found the intervention content and format accessible, appropriate, engaging, and motivating. Digital interventions can and should be designed to be accessible and engaging for people with a wide range of health literacy levels. ",
doi="10.2196/jmir.4999",
url="http://www.jmir.org/2015/10/e230/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26459743"
}


@Article{info:doi/10.2196/mhealth.4300,
author="Mann, Davina
and Riddell, Lynn
and Lim, Karen
and Byrne, K. Linda
and Nowson, Caryl
and Rigo, Manuela
and Szymlek-Gay, A. Ewa
and Booth, O. Alison",
title="Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="28",
volume="3",
number="3",
pages="e92",
keywords="cell phones",
keywords="telemedicine",
keywords="mobile apps",
keywords="iron",
keywords="behavior therapy",
keywords="focus groups",
keywords="goals",
abstract="Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app's functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app's components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. ",
doi="10.2196/mhealth.4300",
url="http://mhealth.jmir.org/2015/3/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26416479"
}


@Article{info:doi/10.2196/mhealth.4882,
author="Schnall, Rebecca
and Mosley, Patterson Jocelyn
and Iribarren, J. Sarah
and Bakken, Suzanne
and Carballo-Di{\'e}guez, Alex
and Brown III, William",
title="Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="18",
volume="3",
number="3",
pages="e91",
keywords="mHealth",
keywords="HIV",
keywords="mobile apps",
keywords="user-centered design",
abstract="Background: There is preliminary evidence that mobile health (mHealth) apps are feasible, attractive, and an effective platform for the creation of self-management tools for persons living with HIV (PLWH). As a foundation for the current study, we conducted formative research using focus groups, participatory design sessions, and usability evaluation methods to inform the development of a health management app for PLWH. The formative research resulted in identification of the following functional requirements of a mHealth app for self-management: (1) communication between providers and peers, (2) medication reminders, (3) medication log, (4) lab reports, (5) pharmacy information, (6) nutrition and fitness, (7) resources (eg, social services, substance use, video testimonials), (8) settings, and (9) search function. Objective: The purpose of this study was to conduct an ecological review of the existing apps for PLWH and to compare the functionality of existing apps with the app specifications identified in our formative work. Methods: We searched two mobile app stores (Google Play and iTunes) and found a total of 5606 apps. We reviewed the apps, narrowed our search terms, and found a total of 112 apps. Of these, we excluded 97 (86.6\%) apps that were either not in English (10/112, 8.9\%), not HIV focused (32/112, 28.9\%), or focused only on HIV prevention (2/112, 7.8\%); targeted health care providers (26/112, 23.2\%); provided information only on conference schedules and events (7/112, 6.3\%), fundraisers (7/112, 6.3\%), specific clinics (7/112, 6.3\%),  international or narrow local resources (3/112, 2.7\%); or were identified in the first search but were no longer on the market at the next review (4/112, 3.6\%). The 15 apps meeting inclusion criteria were then evaluated for inclusion of the nine functionalities identified in our earlier work. Results: Of the 15 apps that we included in our final review, none had all of the functionalities that were identified in our formative work. The apps that we identified included the following functionalities: communication with providers and/or peers (4/15, 27\%), medication reminders (6/15, 40\%), medication logs (7/15, 47\%), lab reports (5/15, 33\%), pharmacy information (4/15, 27\%), resources (7/15, 47\%), settings (11/15, 73\%), and search function (6/15, 40\%). No apps included nutrition or fitness information. Conclusions: Currently, there are only a small number of apps that have been designed for PLWH to manage their health.  Of the apps that are currently available, none have all of the desired functionalities identified by PLWH and experts in our formative research. Findings from this work elucidate the need to develop and evaluate mobile apps that meet PLWH's desired functional specifications. ",
doi="10.2196/mhealth.4882",
url="http://mhealth.jmir.org/2015/3/e91/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26385783"
}


@Article{info:doi/10.2196/humanfactors.4452,
author="Davies, Louise Emma
and Martin, Jilly
and Foxcroft, R. David",
title="Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study",
journal="JMIR Human Factors",
year="2015",
month="Jul",
day="29",
volume="2",
number="2",
pages="e13",
keywords="adolescents",
keywords="alcohol",
keywords="intervention development",
keywords="prevention",
keywords="think aloud",
abstract="Background: The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM. Objective: This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version. Methods: A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50\%). Transcripts were analyzed using thematic analysis. Results: The following 3 main themes relating the acceptability of the intervention were identified: ``challenging expectations of alcohol education''; ``motivations for drinking or not drinking,'' and ``the inevitability of drinking.'' Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. Conclusions: An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people. ",
doi="10.2196/humanfactors.4452",
url="http://humanfactors.jmir.org/2015/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025403"
}


@Article{info:doi/10.2196/jmir.4201,
author="Ludden, DS Geke
and van Rompay, JL Thomas
and Kelders, M. Saskia
and van Gemert-Pijnen, EWC Julia",
title="How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint",
journal="J Med Internet Res",
year="2015",
month="Jul",
day="10",
volume="17",
number="7",
pages="e172",
keywords="Web-based interventions",
keywords="adherence",
keywords="design for well-being",
keywords="metaphors",
keywords="personalization",
keywords="ambient information",
doi="10.2196/jmir.4201",
url="http://www.jmir.org/2015/7/e172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26163456"
}


@Article{info:doi/10.2196/humanfactors.4125,
author="Payne, YM Ada
and Surikova, Jelena
and Liu, Sam
and Ross, Heather
and Mechetiuc, Teodora
and Nolan, P. Robert",
title="Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure",
journal="JMIR Human Factors",
year="2015",
month="May",
day="08",
volume="2",
number="1",
pages="e7",
keywords="chronic heart failure",
keywords="self-care behaviors",
keywords="e-counseling",
keywords="usability assessment",
abstract="Background: Chronic heart failure (CHF) is a major cause of hospitalization and mortality. In order to maintain heart function and quality of life, patients with CHF need to follow recommended self-care guidelines (ie, eating a heart healthy diet, exercising regularly, taking medications as prescribed, monitoring their symptoms, and living a smoke-free life). Yet, adherence to self-care is poor. We have developed an Internet-based e-Counseling platform, Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT), that aims to improve self-care adherence and quality of life in people with CHF. Before assessing the efficacy of this e-platform in a multisite, double-blind, randomized controlled trial, we evaluated the usability of the prototype website. Objective: The objective of the study was to assess the usability of the CHF-CePPORT e-Counseling platform in terms of navigation, content, and layout. Methods: CHF patients were purposively sampled from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network, to participate in this study. We asked the consented participants to perform specific tasks on the website. These tasks included watching self-help videos and reviewing content as directed. Their interactions with the website were captured using the ``think aloud'' protocol. After completing the tasks, research personnel conducted a semi-structured interview with each participant to assess their experience with the website. Content analysis of the transcripts from the ``think aloud'' sessions and the interviews was conducted to identify themes related to navigation, content, and layout of the website. Descriptive statistics were used to summarize the satisfaction data. Results: A total of 7 men and women (ages 39-77) participated in 2 iterative rounds of testing. Overall, all participants were very satisfied with the content and layout of the website. They reported that the content was helpful to their management of CHF and that it reflected their experiences in coping with CHF. The layout was professional and friendly. The use of videos made the learning process entertaining. However, they experienced many navigation errors in the first round of testing. For example, some participants were not sure how to navigate across a series of Web pages. Based on the experiences that were reported in the first round, we made several changes to the navigation structure. This included using large navigation buttons to direct users to each section and providing tutorial videos to familiarize users with our website. We assessed whether these changes improved user navigation in the second round of testing. The major finding is that participants made fewer navigation errors and they did not identify any new problems. Conclusions: We found evidence to support the usability of our CHF-CePPORT e-Counseling platform. Our findings highlight the importance of a clear and easy-to-follow navigation structure on user experience. ",
doi="10.2196/humanfactors.4125",
url="http://humanfactors.jmir.org/2015/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27026267"
}


@Article{info:doi/10.2196/mhealth.3942,
author="Lim, Joanne
and Cloete, Garth
and Dunsmuir, T. Dustin
and Payne, A. Beth
and Scheffer, Cornie
and von Dadelszen, Peter
and Dumont, A. Guy
and Ansermino, Mark J.",
title="Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage",
journal="JMIR mHealth uHealth",
year="2015",
month="Apr",
day="17",
volume="3",
number="2",
pages="e37",
keywords="pulse oximetry",
keywords="mHealth app",
keywords="predictive model",
keywords="usability analysis",
keywords="design methodology",
abstract="Background: Pre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter. Objective: The aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system. Methods: Development of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town. Results: After ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7).To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec). Conclusions: By including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway. ",
doi="10.2196/mhealth.3942",
url="http://mhealth.jmir.org/2015/2/e37/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25887292"
}


@Article{info:doi/10.2196/resprot.3795,
author="Reven{\"a}s, {\AA}sa
and Opava, H. Christina
and Martin, Cathrin
and Demmelmaier, Ingrid
and Keller, Christina
and {\AA}senl{\"o}f, Pernilla",
title="Development of a Web-Based and Mobile App to Support Physical Activity in Individuals With Rheumatoid Arthritis: Results From the Second Step of a Co-Design Process",
journal="JMIR Res Protoc",
year="2015",
month="Feb",
day="09",
volume="4",
number="1",
pages="e22",
keywords="eHealth",
keywords="Internet intervention",
keywords="physical activity",
keywords="rheumatoid arthritis",
keywords="behavior change techniques",
keywords="participatory design",
abstract="Background: Long-term adherence to physical activity recommendations remains challenging for most individuals with rheumatoid arthritis (RA) despite evidence for its health benefits. Objective: The aim of this study was to provide basic data on system requirement specifications for a Web-based and mobile app to self-manage physical activity. More specifically, we explored the target user group, features of the future app, and correlations between the system requirements and the established behavior change techniques (BCTs). Methods: We used a participatory action research design. Qualitative data were collected using multiple methods in four workshops. Participants were 5 individuals with RA, a clinical physiotherapist, an officer from the Swedish Rheumatism Association, a Web designer, and 2 physiotherapy researchers. A taxonomy was used to determine the degree of correlation between the system requirements and established BCTs. Results: Participants agreed that the future Web-based and mobile app should be based on two major components important for maintaining physical activity: (1) a calendar feature for goal setting, planning, and recording of physical activity performance and progress, and (2) a small community feature for positive feedback and support from peers. All system requirements correlated with established BCTs, which were coded as 24 different BCTs. Conclusions: To our knowledge, this study is the first to involve individuals with RA as co-designers, in collaboration with clinicians, researchers, and Web designers, to produce basic data to generate system requirement specifications for an eHealth service. The system requirements correlated to the BCTs, making specifications of content and future evaluation of effectiveness possible. ",
doi="10.2196/resprot.3795",
url="http://www.researchprotocols.org/2015/1/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25665589"
}


@Article{info:doi/10.2196/jmir.4055,
author="Yardley, Lucy
and Morrison, Leanne
and Bradbury, Katherine
and Muller, Ingrid",
title="The Person-Based Approach to Intervention Development: Application to Digital Health-Related Behavior Change Interventions",
journal="J Med Internet Res",
year="2015",
month="Jan",
day="30",
volume="17",
number="1",
pages="e30",
keywords="person-based approach",
keywords="Internet",
keywords="qualitative research",
keywords="evaluation studies",
keywords="feasibility studies",
keywords="health promotion",
keywords="patient education",
keywords="professional education",
keywords="behavior change.",
doi="10.2196/jmir.4055",
url="http://www.jmir.org/2015/1/e30/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25639757"
}


@Article{info:doi/10.2196/resprot.3796,
author="Kuijpers, Wilma
and Groen, G. Wim
and Oldenburg, SA Hester
and Wouters, WJM Michel
and Aaronson, K. Neil
and van Harten, H. Wim",
title="Development of MijnAVL, an Interactive Portal to Empower Breast and Lung Cancer Survivors: An Iterative, Multi-Stakeholder Approach",
journal="JMIR Res Protoc",
year="2015",
month="Jan",
day="22",
volume="4",
number="1",
pages="e14",
keywords="cancer survivors",
keywords="interactive portal",
keywords="development",
keywords="usability testing",
keywords="empowerment",
abstract="Background: MijnAVL (MyAVL) is an interactive portal being developed to empower cancer survivors. Literature review and focus groups yielded the selection of features such as access to the electronic medical record (EMR), patient reported outcomes (PROs) and related feedback, and a physical activity support program. Objective: Our aim was to present a final design of MijnAVL based on (1) health professionals' evaluation of proposed features, (2) cancer survivors' evaluation of a first draft, and (3) cancer survivors' evaluation of a functional online prototype. Methods: Professionals from various disciplines gave input to the content of and procedures related to MijnAVL. Subsequently, 16 cancer survivors participated in an interview to evaluate content and graphic design of a first draft (shown with screenshots). Finally, 7 survivors participated in a usability test with a fully functional prototype. They performed predefined tasks (eg, logging in, finding a test result, completing a questionnaire) while thinking aloud. Descriptive statistics and simple content analysis were used to analyze the data of both the interviews and the usability tests. Results: Professionals supported access to the EMR (eg, histology reports, lab results, and their letters to general practitioners). They also informed the development of PROs and the physical activity support program. Based on the first draft, survivors selected the preferred graphic design, approved the features and provided suggestions for the content (eg, explanation of medical jargon, more concise texts, notification by emails). Usability tests revealed that it was relatively easy to navigate the website and use the different features. Recommendations included, among others, a frequently asked questions section and the use of hyperlinks between different parts of the website. Conclusions: The development of MijnAVL, an interactive portal to empower breast and lung cancer survivors, was performed iteratively and involved multiple groups of end-users. This approach resulted in a usable and understandable final version. Its effectiveness should be determined in further research. ",
doi="10.2196/resprot.3796",
url="http://www.researchprotocols.org/2015/1/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25614924"
}


@Article{info:doi/10.2196/humanfactors.3302,
author="Fledderus, Martine
and Schreurs, MG Karlein
and Bohlmeijer, T. Ernst
and Vollenbroek-Hutten, MR Miriam",
title="Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients",
journal="JMIR Human Factors",
year="2015",
month="Jan",
day="05",
volume="2",
number="1",
pages="e1",
keywords="chronic pain",
keywords="eHealth",
keywords="acceptance and commitment therapy",
keywords="relapse prevention",
keywords="aftercare",
abstract="Background: A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed. Objective: In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)---both as a website and as a mobile app---was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs. Methods: In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors. Results: The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users. Conclusions: This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors. Trial Registration: Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D). ",
doi="10.2196/humanfactors.3302",
url="http://humanfactors.jmir.org/2015/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025550"
}


@Article{info:doi/10.2196/med20.3032,
author="Ashurst, J. Emily
and Jones, B. Ray
and Abraham, Charles
and Jenner, Martin
and Boddy, Kate
and Besser, EJ Rachel
and Hammersley, Suzanne
and Pinkney, Jonathan",
title="The Diabetes App Challenge: User-Led Development and Piloting of Internet Applications Enabling Young People With Diabetes to Set the Focus for Their Diabetes Consultations",
journal="Med 2.0",
year="2014",
month="Nov",
day="07",
volume="3",
number="2",
pages="e5",
keywords="Type 1 diabetes",
keywords="adolescents",
keywords="mobile technology",
keywords="clinic appointment",
keywords="user-innovation",
keywords="self-care",
keywords="user-centered design",
abstract="Background: Traditionally, some teenagers and young adults with diabetes have not engaged well at diabetes appointments, giving rise to concerns about long-term health risks. We considered that apps might help this group of patients to improve preparation for, and therefore engagement at their appointments. Although there are already many apps for young people with type 1 diabetes (YPD), we thought that by supporting YPD themselves to develop apps, the resulting products would have greater ``authenticity'' and relevance. Objective: To test the feasibility of an online competition to (1) recruit and support YPD to develop apps (mobile or Internet based) to help prepare for clinic appointments, and (2) for these apps to be tested and rated by YPD. Methods: The ``Diabetes App Challenge'' was a United Kingdom (UK) national competition, run between June and October 2012 for teams including at least one YPD (aged 16-25) to pilot the design and development of apps for use by other YPD prior to clinic appointments. The competition was advertised by social media, email, AdWords and postings on the Diabetes UK website. Registrants for the competition were supported via email and discussion forum. After app development, other YPD were invited (November 2012-February 2013) to trial the apps, choose and use one prior to a clinic appointment, and review their experiences. Results: Of 56 people (including 28 YPD) who expressed interest in the competition, 6 teams (14 people) developed and submitted an app. Two apps aimed to facilitate agenda setting in clinic consultations, 2 enabled data logging and 2 helped insulin dose calculation. Of 135 YPD who registered to trial the apps, 83 (61.5\%) took part (mean age 18.98, 37/83 male). Agenda setting apps were considered most useful for preparing for and setting the focus of clinic appointments (P=.02). Just over half (46/83, 55\%) said they would use their chosen app again and 4/5 (67/83, 81\%) would recommend it to a friend. Conclusions: This competition to engage YPD in developing and reviewing apps proved successful. App designers and testers saw a need for a range of functions. However, this may, in part, reflect a lack of detailed knowledge of all existing apps and be limited by the technical skills of YPD. App competitions appear worth applying to other patient groups, but future competitions should include a review stage and perhaps focus on ideas for app design for subsequent professional implementation. ",
doi="10.2196/med20.3032",
url="http://www.medicine20.com/2014/2/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25654312"
}


@Article{info:doi/10.2196/resprot.3695,
author="van Bruinessen, Renske Inge
and van Weel-Baumgarten, M. Evelyn
and Snippe, Wouter Harm
and Gouw, Hans
and Zijlstra, M. Jos{\'e}e
and van Dulmen, Sandra",
title="Active Patient Participation in the Development of an Online Intervention",
journal="JMIR Res Protoc",
year="2014",
month="Nov",
day="06",
volume="3",
number="4",
pages="e59",
keywords="communication",
keywords="malignant lymphoma",
keywords="online intervention",
keywords="self-help application",
keywords="patient participation",
keywords="intervention development",
abstract="Background: An important and challenging part of living with cancer relates to the repeated visits to the hospital. Since how patients cope between these post-diagnostic visits depends partly on the information and support received from their physician during the visits, it is important to make the most of them. Recent findings reinforce the importance of training not only the health care professionals in communication skills, but providing patients with support in communication as well. Delivering such supportive interventions online can have potential benefits in terms of accessibility, cost-effectiveness, and ability to tailor information to personal needs. However, problems with attrition (dropout, non-usage) during the test phase and poor uptake after implementation are frequently reported. The marginal level of engagement of the patient as end user seems to play a role in this. Therefore, recent research suggests integrating theory-based development methods with methods that promote involvement of the patient at an early stage. This paper describes a participatory protocol, used to let patients guide a theory-informed development process. Objective: The objective of this project was to apply a bottom-up inspired procedure to develop a patient-centered intervention with corresponding evaluation and implementation plan. Methods: The applied development protocol was based on the intervention mapping framework, combined with patient participatory methods that were inspired by the participation ladder and user-centred design methods. Results: The applied protocol led to a self-directed online communication intervention aimed at helping patients gain control during their communications with health care professionals. It also led to an evaluation plan and an implementation plan. The protocol enabled the continuous involvement of patient research partners and the partial involvement of patient service users, which led to valuable insights and improvements. Conclusions: The applied protocol realized patient participation on different levels throughout the entire project. Early involvement, involvement on different levels, and flexibility in terms of planning and setup seem to be preconditions to creating a bottom-up inspired development procedure with (seriously ill) patients. Further research is necessary to find out if a more patient-centered approach improves the implementation and uptake of eHealth interventions. Trial Registration: Netherlands National Trial Register ID number: NTR3779; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3779 (Archived by WebCite at http://www.webcitation.org/6TdfALKxV). ",
doi="10.2196/resprot.3695",
url="http://www.researchprotocols.org/2014/4/e59/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25379679"
}


@Article{info:doi/10.2196/humanfactors.3787,
author="Hong, Yan
and Goldberg, Daniel
and Dahlke, Vollmer Deborah
and Ory, G. Marcia
and Cargill, S. Jessica
and Coughlin, Rachel
and Hernandez, Edgar
and Kellstedt, K. Debra
and Peres, Camille S.",
title="Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults",
journal="JMIR Human Factors",
year="2014",
month="Oct",
day="13",
volume="1",
number="1",
pages="e2",
keywords="physical activity",
keywords="mobile health, older adults",
keywords="usability testing",
keywords="user experience",
abstract="Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants' comments were addressed to improve the site's senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56\% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users' experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway. ",
doi="10.2196/humanfactors.3787",
url="http://humanfactors.jmir.org/2014/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025254"
}


@Article{info:doi/10.2196/resprot.3607,
author="Cristancho-Lacroix, Victoria
and Moulin, Florence
and Wrobel, J{\'e}r{\'e}my
and Batrancourt, B{\'e}n{\'e}dicte
and Plichart, Matthieu
and De Rotrou, Jocelyne
and Cantegreil-Kallen, Inge
and Rigaud, Anne-Sophie",
title="A Web-Based Program for Informal Caregivers of Persons With Alzheimer's Disease: An Iterative User-Centered Design",
journal="JMIR Res Protoc",
year="2014",
month="Sep",
day="15",
volume="3",
number="3",
pages="e46",
keywords="usability",
keywords="caregivers",
keywords="Alzheimer's disease",
keywords="psychoeducational program",
keywords="psychological stress inclusive design",
abstract="Background: Web-based programs have been developed for informal caregivers of people with Alzheimer's disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers' correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial. Objective: The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers' stress, and based on the user-centered design approach. Methods: There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire. Results: The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis. Conclusions: Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs. ",
doi="10.2196/resprot.3607",
url="http://www.researchprotocols.org/2014/3/e46/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25263541"
}


@Article{info:doi/10.2196/mhealth.3250,
author="Grindrod, Anne Kelly
and Gates, Allison
and Dolovich, Lisa
and Slavcev, Roderick
and Drimmie, Rob
and Aghaei, Behzad
and Poon, Calvin
and Khan, Shamroz{\'e}
and Leat, J. Susan",
title="ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels",
journal="JMIR mHealth uHealth",
year="2014",
month="Aug",
day="15",
volume="2",
number="3",
pages="e35",
keywords="low vision",
keywords="legibility",
keywords="prescription labelling",
keywords="medication labels",
keywords="usability",
keywords="cognitive impairment",
keywords="visual impairment",
abstract="Background: In order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels. Objective: The aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition. Methods: This pilot study enrolled adults (?55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes. Results: The 47 participants had a mean age of 76 (SD 11) years and 60\% (28/47) were female. Of the participants, 32\% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72\% (5/7) of participants with functional reading difficulty, and 63\% (5/8) who failed a real-life pill-sorting task, but only 21\% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the ``drag and drop'' function. Conclusions: ClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow. ",
doi="10.2196/mhealth.3250",
url="http://mhealth.jmir.org/2014/3/e35/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25131813"
}


@Article{info:doi/10.2196/mhealth.3359,
author="Mirkovic, Jelena
and Kaufman, R. David
and Ruland, M. Cornelia",
title="Supporting Cancer Patients in Illness Management: Usability Evaluation of a Mobile App",
journal="JMIR mHealth uHealth",
year="2014",
month="Aug",
day="13",
volume="2",
number="3",
pages="e33",
keywords="mobile applications",
keywords="patients",
keywords="cell phone",
keywords="smartphone",
keywords="symptom assessment",
keywords="self-care",
keywords="user-computer interface",
abstract="Background: Mobile phones and tablets currently represent a significant presence in people's everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers significant potential in different app areas including health care. Objective: Our goal was to evaluate the usability of the Connect Mobile app. The mobile app enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptom management, the system promotes better patient-provider communication, collaboration, and shared decision making. The Connect Mobile app enables access to the Connect system over both mobile phones and tablets. Methods: The study consisted of usability tests of a high fidelity prototype with 7 cancer patients where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semistructured interviews to obtain participants' feedback about app usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile app and its features within everyday health management. Results: The study revealed a total of 27 design issues (13 for mobile apps and 14 for tablet apps), which were mapped to source events (ie, errors, requests for help, participants' concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues), as well as supporting an appropriate match between systems and the real world (7 issues) and consistent mapping of system functions and interactions (4 issues). Feedback from participants also showed the cancer patients' requirements for support systems and how these needs are influenced by different context-related factors, such as type of access terminal (eg, desktop computer, tablet, mobile phone) and phases of illness. Based on the observed results, we proposed design and functionality recommendations that can be used for the development of mobile apps for cancer patients to support their health management process. Conclusions: Understanding and addressing users' requirements is one of the main prerequisites for developing useful and effective technology-based health interventions. The results of this study outline different user requirements related to the design of the mobile patient support app for cancer patients. The results will be used in the iterative development of the Connect Mobile app and can also inform other developers and researchers in development, integration, and evaluation of mobile health apps and services that support cancer patients in managing their health-related issues. ",
doi="10.2196/mhealth.3359",
url="http://mhealth.jmir.org/2014/3/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25119490"
}


@Article{info:doi/10.2196/jmir.3195,
author="Vermeulen, Joan
and Verwey, Ren{\'e}e
and Hochstenbach, MJ Laura
and van der Weegen, Sanne
and Man, Ping Yan
and de Witte, P. Luc",
title="Experiences of Multidisciplinary Development Team Members During User-Centered Design of Telecare Products and Services: A Qualitative Study",
journal="J Med Internet Res",
year="2014",
month="May",
day="19",
volume="16",
number="5",
pages="e124",
keywords="user-centered design",
keywords="telecare",
keywords="eHealth",
keywords="participation",
keywords="multidisciplinary team",
keywords="barriers and facilitators",
abstract="Background: User-centered design (UCD) methodologies can help take the needs and requirements of potential end-users into account during the development of innovative telecare products and services. Understanding how members of multidisciplinary development teams experience the UCD process might help to gain insight into factors that members with different backgrounds consider critical during the development of telecare products and services. Objective: The primary objective of this study was to explore how members of multidisciplinary development teams experienced the UCD process of telecare products and services. The secondary objective was to identify differences and similarities in the barriers and facilitators they experienced. Methods: Twenty-five members of multidisciplinary development teams of four Research and Development (R\&D) projects participated in this study. The R\&D projects aimed to develop telecare products and services that can support self-management in elderly people or patients with chronic conditions. Seven participants were representatives of end-users (elderly persons or patients with chronic conditions), three were professional end-users (geriatrician and nurses), five were engineers, four were managers (of R\&D companies or engineering teams), and six were researchers. All participants were interviewed by a researcher who was not part of their own development team. The following topics were discussed during the interviews: (1) aim of the project, (2) role of the participant, (3) experiences during the development process, (4) points of improvement, and (5) what the project meant to the participant. Results: Experiences of participants related to the following themes: (1) creating a development team, (2) expectations regarding responsibilities and roles, (3) translating user requirements into technical requirements, (4) technical challenges, (5) evaluation of developed products and services, and (6) valorization. Multidisciplinary team members from different backgrounds often reported similar experienced barriers (eg, different members of the development team speak a ``different language'') and facilitators (eg, team members should voice expectations at the start of the project to prevent miscommunication at a later stage). However, some experienced barriers and facilitators were reported only by certain groups of participants. For example, only managers reported the experience that having different ideas about what a good business case is within one development team was a barrier, whereas only end-users emphasized the facilitating role of project management in end-user participation and the importance of continuous feedback from researchers on input of end-users. Conclusions: Many similarities seem to exist between the experienced barriers and facilitators of members of multidisciplinary development teams during UCD of telecare products and services. However, differences in experiences between team members from various backgrounds exist as well. Insights into these similarities and differences can improve understanding between team members from different backgrounds, which can optimize collaboration during the development of telecare products and services. ",
doi="10.2196/jmir.3195",
url="http://www.jmir.org/2014/5/e124/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24840245"
}


@Article{info:doi/10.2196/resprot.2897,
author="de Graaf, Marlies
and Totte, Joan
and Breugem, Corstiaan
and van Os-Medendorp, Harmieke
and Pasmans, Suzanne",
title="Evaluation of the Compliance, Acceptance, and Usability of a Web-Based eHealth Intervention for Parents of Children With Infantile Hemangiomas: Usability Study",
journal="JMIR Res Protoc",
year="2013",
month="Dec",
day="17",
volume="2",
number="2",
pages="e54",
keywords="eHealth",
keywords="e-learning",
keywords="Internet",
keywords="compliance",
keywords="acceptance",
keywords="usability",
keywords="dermatology",
keywords="optimizing care",
keywords="infantile hemangioma",
keywords="child",
abstract="Background: Infantile hemangiomas (IH) are common benign vascular tumors in children. Recognition and timely referral of high risk IH to specialized centers is important. This might be achieved by involving parents in the care for IH by means of an eHealth intervention. Objective: The objective of our study was to evaluate parent compliance, acceptance, and usability of an open access, Web-based eHealth intervention (including e-learning and e-consult) designed to increase parents' knowledge and (risk) evaluation of IH. Methods: A cross-sectional study of parents who completed the eHealth intervention between October 2010 and November 2012 was carried out. All parents were sent a study questionnaire. Questions to evaluate compliance (to the advice given by a dermatologist during e-consultation) were asked. Acceptance and usability were evaluated by using the modified Technology Acceptance Model. Results: A total of 224 parents completed the eHealth intervention and received the questionnaire, 135/224 parents responded (response rate was 60.3\%). There were 128/135 questionnaires that were completed and included. A total of 110/128 (85.9\%) parents were compliant to the advice of the dermatologist. There were 116.8/128 (91.3\%) that perceived the eHealth intervention as useful and almost all parents (98.4\%, 126/128) found the information in the e-learning clear. There were 29/128 (22.7\%) that experienced technical problems. The majority of the parents (94.5\%, 121/128) found the eHealth intervention reliable and most of them (98.4\%, 126/128) would recommend the eHealth intervention to other parents. Noncompliant parents judged the eHealth intervention significantly less reliable compared to compliant parents (71\%, 10/14 versus 97.3\%, 107/110; P=.003). Conclusions: Parents of children with an IH showed a high compliance (85.9\%, 110/128) to the advice of the dermatologist given via our Web-based eHealth intervention. This high compliance might be positively influenced by the good acceptance and usability of the eHealth intervention and might result in timely presentation and treatment of children with high risk IH in specialized centers. ",
doi="10.2196/resprot.2897",
url="http://www.researchprotocols.org/2013/2/e54/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24345450"
}


@Article{info:doi/10.2196/resprot.2899,
author="Cruz, Tedim V{\'i}tor
and Pais, Joana
and Bento, Virg{\'i}lio
and Mateus, C{\'a}tia
and Colunas, M{\'a}rcio
and Alves, Iv{\^a}nia
and Coutinho, Paula
and Rocha, Pacheco Nelson",
title="A Rehabilitation Tool Designed for Intensive Web-Based Cognitive Training: Description and Usability Study",
journal="JMIR Res Protoc",
year="2013",
month="Dec",
day="13",
volume="2",
number="2",
pages="e59",
keywords="cognitive training",
keywords="cognitive deficits",
keywords="neurorehabilitation",
keywords="Web-based applications",
keywords="eHealth systems",
keywords="usability test",
abstract="Background: Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients. Objective: The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs. Methods: From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient's home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer's disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire. Results: A total of 48/80 patients (60\%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66\%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4\%) were not interested in performing the exercises at home; 19/48 patients (39\%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier. Conclusions: This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs. ",
doi="10.2196/resprot.2899",
url="http://www.researchprotocols.org/2013/2/e59/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24334248"
}


@Article{info:doi/10.2196/resprot.2872,
author="Joshi, Ashish
and Wilhelm, Susan
and Aguirre, Trina
and Trout, Kate
and Amadi, Chioma",
title="An Interactive, Bilingual Touch Screen Program to Promote Breastfeeding Among Hispanic Rural Women: Usability Study",
journal="JMIR Res Protoc",
year="2013",
month="Nov",
day="07",
volume="2",
number="2",
pages="e47",
keywords="usability",
keywords="breastfeeding",
keywords="education",
keywords="evaluation",
keywords="computer",
abstract="Background: Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior.  Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful. Objective: The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings. Methods: A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed.  Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS). Results: The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90\%, 9/10), and 60\% (6/10) had breastfed less than 6 months. There were 90\% (9/10) of the study participants that had no prior history of taking prenatal classes and 80\% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks. Conclusions: The study participants were able to navigate through the multimedia program with ease and obtain relevant breastfeeding related health information. The interactive, touch screen computer-based breastfeeding program had high acceptance among 10 Hispanic women living in rural settings. ",
doi="10.2196/resprot.2872",
url="http://www.researchprotocols.org/2013/2/e47/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24200498"
}


@Article{info:doi/10.2196/resprot.2547,
author="Van Velsen, Lex
and Wentzel, Jobke
and Van Gemert-Pijnen, EWC Julia",
title="Designing eHealth that Matters via a Multidisciplinary Requirements Development Approach",
journal="JMIR Res Protoc",
year="2013",
month="Jun",
day="24",
volume="2",
number="1",
pages="e21",
keywords="health care information systems",
keywords="health informatics",
keywords="requirements analysis",
keywords="software design techniques",
keywords="user-centered design",
abstract="Background: Requirements development is a crucial part of eHealth design. It entails all the activities devoted to requirements identification, the communication of requirements to other developers, and their evaluation. Currently, a requirements development approach geared towards the specifics of the eHealth domain is lacking. This is likely to result in a mismatch between the developed technology and end user characteristics, physical surroundings, and the organizational context of use. It also makes it hard to judge the quality of eHealth design, since it makes it difficult to gear evaluations of eHealth to the main goals it is supposed to serve. Objective: In order to facilitate the creation of eHealth that matters, we present a practical, multidisciplinary requirements development approach which is embedded in a holistic design approach for eHealth (the Center for eHealth Research roadmap) that incorporates both human-centered design and business modeling. Methods: Our requirements development approach consists of five phases. In the first, preparatory, phase the project team is composed and the overall goal(s) of the eHealth intervention are decided upon. Second, primary end users and other stakeholders are identified by means of audience segmentation techniques and our stakeholder identification method. Third, the designated context of use is mapped and end users are profiled by means of requirements elicitation methods (eg, interviews, focus groups, or observations). Fourth, stakeholder values and eHealth intervention requirements are distilled from data transcripts, which leads to phase five, in which requirements are communicated to other developers using a requirements notation template we developed specifically for the context of eHealth technologies. Results: The end result of our requirements development approach for eHealth interventions is a design document which includes functional and non-functional requirements, a list of stakeholder values, and end user profiles in the form of personas (fictitious end users, representative of a primary end user group). Conclusions: The requirements development approach presented in this article enables eHealth developers to apply a systematic and multi-disciplinary approach towards the creation of requirements. The cooperation between health, engineering, and social sciences creates a situation in which a mismatch between design, end users, and the organizational context can be avoided. Furthermore, we suggest to evaluate eHealth on a feature-specific level in order to learn exactly why such a technology does or does not live up to its expectations. ",
doi="10.2196/resprot.2547",
url="http://www.researchprotocols.org/2013/1/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23796508"
}


@Article{info:doi/10.2196/resprot.2410,
author="Riiser, Kirsti
and L{\o}ndal, Knut
and Ommundsen, Yngvar
and Sundar, Turid
and Helseth, S{\o}lvi",
title="Development and Usability Testing of an Internet Intervention to Increase Physical Activity in Overweight Adolescents",
journal="JMIR Res Protoc",
year="2013",
month="Jan",
day="28",
volume="2",
number="1",
pages="e7",
keywords="Internet",
keywords="intervention",
keywords="development",
keywords="usability testing",
keywords="adolescents",
keywords="physical activity",
keywords="overweight",
abstract="Background: Internet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity. Research shows that overweight and obese adolescents are less physically active than their peers of normal weight. There are good reasons to believe that Internet-based interventions may be particularly suitable for motivating adolescents to increase physical activity, but we need to gain further knowledge of what features are effective and how to design such interventions. Objective: To describe the process of development and evaluation of usability of a Web-based program for increasing physical activity in overweight adolescents. Methods: Informed by the self-determination theory, motivational interviewing, and perspectives on self-regulation, this intervention was developed in a stepwise process by an interdisciplinary team of researchers, designers, developers, and representatives from the target group. An iterative qualitative usability testing approach (observation, survey, and interview) was applied in 2 sequences, first in the lab and second in the field, to assess how adolescents (aged 12-16 years) used and experienced the program and to make adjustments to the program based on evaluation of their response. Results: The following components were included in the program: self-monitoring through planning and registration of physical activity and graphical response on progress, autonomy supportive individual Web-based counseling, forum for social support, and relevant age-adjusted information about physical activity. The first usability test resulted in adjustments related mainly to making the content and aim of the different features more visible and explicit. The second test evaluated the program with adjustments from the first test, revealing that the program was well accepted by the participants and only small aesthetic adjustments had to be made to complete the final version of the Internet program, Young \& Active. Conclusions: Thorough preparation, with clear theory foundation and close monitoring in the developmental phase, as well as contribution and iterative evaluation from the target group, is essential to create a user-friendly and engaging program. The efficacy of the program will be evaluated in a controlled trial. ",
doi="10.2196/resprot.2410",
url="http://www.researchprotocols.org/2013/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612506"
}


@Article{info:doi/10.2196/resprot.2246,
author="Voncken-Brewster, Viola
and Moser, Albine
and van der Weijden, Trudy
and Nagykaldi, Zsolt
and de Vries, Hein
and Tange, Huibert",
title="Usability Evaluation of an Online, Tailored Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients Incorporating Behavior Change Techniques",
journal="JMIR Res Protoc",
year="2013",
month="Jan",
day="16",
volume="2",
number="1",
pages="e3",
keywords="usability testing",
keywords="Internet intervention",
keywords="computer tailoring",
keywords="chronic obstructive pulmonary disease",
keywords="self-management",
abstract="Background: An eHealth intervention using computer tailored technology including several behavior change techniques was developed to support the self-management of chronic obstructive pulmonary disease patients. Objective: The goal of this study was to evaluate and improve the usability of the eHealth intervention. Methods: We conducted a usability evaluation with 8 chronic obstructive pulmonary disease patients, with a mixed methods design. We improved the usability through iterative cycles of evaluation and adaptation. Participants were asked to think aloud during the evaluation sessions. Participants then completed a semi-structured interview. The sessions were observed and recorded. Descriptive statistics and content analysis were used to uncover usability issues. Results: Areas for improvement were layout, navigation, and content. Most issues could be solved within 3 iterations of improvement. Overall, participants found the program easy to use. The length of the program urged us to further analyze the appreciation of behavior change techniques. Some were perceived as helpful and easy to use, while others evoked frustration. Conclusions: The usability study identified several issues for improvement, confirming the need for usability evaluation during the development of eHealth interventions. The uncovered strengths and limitations of behavior change techniques may lead to optimization of eHealth interventions, but further insight is needed. ",
doi="10.2196/resprot.2246",
url="http://www.researchprotocols.org/2013/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612363"
}