@Article{info:doi/10.2196/56860, author="Low, Yun Shi and Ko, Qianwen Stephanie and Ang, Han Ian Yi", title="Health Care Providers' Experiences and Perceptions With Telehealth Tools in a Hospital-at-Home Program: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="17", volume="12", pages="e56860", keywords="telehealth usability", keywords="hospital-at-home", keywords="health care provider experience", keywords="virtual consultation", keywords="vital signs monitoring", keywords="mixed-methods study", keywords="health care provider", keywords="experience", keywords="perception", keywords="telehealth tools", keywords="telehealth", keywords="e-consultations", keywords="teleconsultation", keywords="hospital-based", keywords="home-based", keywords="mobile phone", abstract="Background: The growing demand for hospital-based care, driven by aging populations and constrained resources, has accelerated the adoption of telehealth tools such as teleconsultations and remote monitoring in hospital-at-home (HaH) programs. Despite their increasing use in delivering acute care at home, studies exploring health care providers' experiences and perceptions of these tools within HaH settings remain limited. Objective: This study aimed to understand the experiences and perspectives of health care providers toward teleconsultations and vital signs monitoring systems within a HaH program in Singapore to optimize effectiveness and address challenges in future implementation. Methods: A convergent mixed methods approach that combines qualitative in-depth interviews with an electronic survey designed based on the 5 domains (usefulness, ease of use, effectiveness, reliability, and satisfaction) of the Telehealth Usability Questionnaire was used. Results: In total, 37 surveys and 20 interviews were completed. Participants responded positively to the use of both teleconsultation and vital signs monitoring with a mean total score of each method being 4.55 (SD 0.44) and 4.52 (SD 0.42), respectively. Significantly higher mean ratings were observed among doctors compared with other health care providers for usefulness (P=.03) and ease of use (P=.047) in teleconsultations. Health care providers with fewer years of clinical experience also perceived the use of vital signs monitoring to be more effective (P=.02) and more usable (P=.04) than those with more years of experience. Qualitative analysis identified four themes: (1) benefits of telehealth for health care providers such as improved work convenience, efficiency, and satisfaction; (2) challenges of telehealth implementation relating to communication and technology; (3) perspectives on telehealth impact; and (4) enablers for successful implementation. Comparing both datasets, qualitative findings were aligned with and confirmed quantitative results. Conclusion: This study highlighted the benefits and usability of telehealth among health care providers. However, challenges relating to patient communication, technological issues, and delivery of care were also discussed along with enablers for successful implementation. These insights can inform strategies to optimize future implementation of telehealth in HaH. ", doi="10.2196/56860", url="https://humanfactors.jmir.org/2025/1/e56860" } @Article{info:doi/10.2196/68233, author="Olimb Hillkirk, Anstein and Skavberg Roaldsen, Kirsti and Johnsen, Mari Hege", title="Physiotherapists' User Acceptance of a Lower Limb Robotic Exoskeleton in Specialized Rehabilitation: Qualitative Exploratory Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="16", volume="12", pages="e68233", keywords="assistive technology", keywords="clinical implementation", keywords="deductive analysis", keywords="robot-assisted gait training therapy", keywords="RAGT", keywords="user experiences", keywords="unified theory of acceptance and use of technology", keywords="UTAUT", keywords="rehabilitation", abstract="Background: Robotic lower limb exoskeletons have emerged as promising tools in the clinical rehabilitation of patients with lower limb paralysis due to neurological disease, stroke, or spinal cord injury. Identified benefits in gait function rehabilitation include improved gait function, cardiovascular effects, enhanced training quality, patient motivation, and reduced physical and psychological workload for therapists. Despite the identified benefits, the successful adoption of this technology largely depends on therapists' user acceptance. Objective: This study aims to explore physiotherapists' perceptions of using robot-assisted lower-limb gait training in specialized neurological rehabilitation using the unified theory of acceptance and use of technology framework. Methods: A qualitative, exploratory research design with a deductive approach was used. Semistructured interviews were conducted with 7 expert physiotherapists in a Norwegian specialized rehabilitation hospital. Data collection and analysis were guided by the unified theory of acceptance and use of technology framework. Results: The physiotherapists' use of lower limb exoskeletons was greatly influenced by perceived benefits for patients or challenges, such as usability issues, the time required for adjustment to each patient, and the lack of personnel resources to facilitate their use. Thus, perceived usefulness and facilitating conditions (or lack thereof) had a great influence on the physiotherapists' intentions to use and the actual use of the exoskeleton. Conclusions: This study identified several factors influencing the physiotherapists' acceptance and integration of the lower limb exoskeleton. Available resources, such as time and personnel, were emphasized as important factors to increase the use of the exoskeleton in specialized rehabilitation. Our findings may inform service providers and engineers in specialized neurological rehabilitation settings. ", doi="10.2196/68233", url="https://rehab.jmir.org/2025/1/e68233", url="http://www.ncbi.nlm.nih.gov/pubmed/40238235" } @Article{info:doi/10.2196/65357, author="Keinert, Marie and Schindler-Gmelch, Lena and Rupp, Helene Lydia and Sadeghi, Misha and Richer, Robert and Capito, Klara and Eskofier, M. Bjoern and Berking, Matthias", title="The EmpkinS-EKSpression Reappraisal Training Augmented With Kinesthesia in Depression: One-Armed Feasibility Study", journal="JMIR Form Res", year="2025", month="Apr", day="14", volume="9", pages="e65357", keywords="depression", keywords="cognitive reappraisal", keywords="facial expression", keywords="kinesthesia", keywords="smartphone-based intervention", keywords="mobile phone", abstract="Background: Harboring dysfunctional depressogenic cognitions contributes to the development and maintenance of depression. A central goal of cognitive behavioral therapy (CBT) for depression is to invalidate such cognitions via cognitive reappraisal (CR). However, relatively low remission rates and high dropout rates in CBT demonstrate the need for further improvement. Potentially, the effects of CBT could be enhanced by addressing not only dysfunctional depressogenic cognitions but also body states associated with depression. This may be done, for example, by systematically pairing the invalidation of depressogenic cognitions with the performance of antidepressive kinesthesia. Objective: This study aimed to examine the feasibility and clinical potential of a smartphone-based cognitive restructuring task that required users to deliberately perform antidepressive kinesthesia in conjunction with the rejection of depressogenic statements and the affirmation of antidepressive statements. This feasibility study was conducted as a precursor to a large-scale randomized controlled trial. Methods: In total, 10 healthy participants engaged in a single 90-120-minute session of smartphone-based CR training. During the training, they completed 2 phases in which they were required to reject 20 depressogenic and affirm 20 antidepressive statements, respectively. Diagnostic assessments were conducted 1 week (T1) before and directly prior (T2) to the training, and again directly posttraining (T3) and at a 2-week follow-up posttraining (T4). Feasibility outcomes assessed at T3 included intervention safety recorded by study therapists, compliance, technical feasibility, usability assessed using the Short Version of the User Experience Questionnaire (UEQ-S), and acceptability assessed using the UEQ-S and self-developed items. Preliminary clinical potential was evaluated via single-item ratings of current depressed and positive mood assessed continuously during the training. Feasibility outcomes were analyzed descriptively, and clinical potential was examined using paired-sample t tests of pre and post ratings of mood at each training phase. Results: Overall, the results indicated that the training was safe, feasible, and usable (UEQ-S pragmatic quality scale: mean 1.45, SD 0.71). However, acceptance was limited (UEQ-S hedonic quality scale: mean 1.05, SD 0.79). While 80\% (8/10) of the participants were generally satisfied with the training, 80\% (8/10) would recommend it to a friend, 90\% (9/10) found it interesting, and 80\% (8/10) rated it as ``leading edge,'' 40\% (4/10) to 70\% (7/10) did not consider it particularly helpful and 50\% (5/10) found it repetitive. Preliminary results regarding clinical potential were promising, with significant increases in positive mood (rejection: Hedges g=0.63; affirmation: Hedges g=0.25), whereas changes in depressed mood were not significant. Conclusions: This study evaluated the feasibility and acceptability of a smartphone-based CR training augmented with validating and invalidating kinesthesia. This provided valuable insights for further optimizing the intervention for the subsequent randomized controlled trial, but also potential similar interventions. If future studies confirm their clinical potential, such interventions offer a promising approach to enhancing CBT for depression. Trial Registration: OSF Registries pw6ma; https://osf.io/pw6ma/ ", doi="10.2196/65357", url="https://formative.jmir.org/2025/1/e65357" } @Article{info:doi/10.2196/58377, author="Alhumaid, Khadija and Ayoubi, Kevin and Khalifa, Maha and Salloum, Said", title="Factors Determining Acceptance of Internet of Things in Medical Education: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="10", volume="12", pages="e58377", keywords="collaborative learning", keywords="student", keywords="college", keywords="university", keywords="education", keywords="Internet of Things", keywords="IoT", keywords="technology acceptance model", keywords="technology optimism", keywords="TAM", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="acceptance", keywords="adoption", keywords="survey", keywords="questionnaire", keywords="ANN", keywords="deep learning", keywords="structural equation modeling", keywords="neural network", keywords="intent", keywords="use", keywords="medical education", keywords="artificial neural network", keywords="technology innovation", abstract="Background: The global increase in the Internet of Things (IoT) adoption has sparked interest in its application within the educational sector, particularly in colleges and universities. Previous studies have often focused on individual attitudes toward IoT without considering a multiperspective approach and have overlooked the impact of IoT on the technology acceptance model outside the educational domain. Objective: This study aims to bridge the research gap by investigating the factors influencing IoT adoption in educational settings, thereby enhancing the understanding of collaborative learning through technology. It seeks to elucidate how IoT can facilitate learning processes and technology acceptance among college and university students in the United Arab Emirates. Methods: A questionnaire was distributed to students across various colleges and universities in the United Arab Emirates, garnering 463 participants. The data collected were analyzed using a hybrid approach that integrates structural equation modeling (SEM) and artificial neural network (ANN), along with importance-performance map analysis to evaluate the significance and performance of each factor affecting IoT adoption. Results: The study, involving 463 participants, identifies 2 primary levels at which factors influence the intention to adopt IoT technologies. Initial influences include technology optimism (TOP), innovation, and learning motivation, crucial for application engagement. Advanced influences stem from technology acceptance model constructs, particularly perceived ease of use (PE) and perceived usefulness (PU), which directly enhance adoption intentions. Detailed statistical analysis using partial least squares--SEM reveals significant relationships: TOP and innovativeness impact PE ($\beta$=.412, P=.04; $\beta$=.608, P=.002, respectively), and PU significantly influences TOP ($\beta$=.381, P=.04), innovativeness ($\beta$=.557, P=.003), and learning motivation ($\beta$=.752, P<.001). These results support our hypotheses (H1, H2, H3, H4, and H5). Further, the intention to use IoT is significantly affected by PE and usefulness ($\beta$=.619, P<.001; $\beta$=.598, P<.001, respectively). ANN modeling enhances these findings, showing superior predictive power (R2=89.7\%) compared to partial least squares--SEM (R2=86.3\%), indicating a more effective identification of nonlinear associations. Importance-performance map analysis corroborates these results, demonstrating the importance and performance of PU as most critical, followed by technology innovativeness and optimism, in shaping behavioral intentions to use IoT. Conclusions: This research contributes methodologically by leveraging deep ANN architecture to explore nonlinear relationships among factors influencing IoT adoption in education. The study underscores the importance of both intrinsic motivational factors and perceived technological attributes in fostering IoT adoption, offering insights for educational institutions considering IoT integration into their learning environments. ", doi="10.2196/58377", url="https://humanfactors.jmir.org/2025/1/e58377" } @Article{info:doi/10.2196/66473, author="Coletta, Giulia and Noguchi, S. Kenneth and Beaudoin, Kayla and McQuarrie, Angelica and Tang, Ada and Ganann, Rebecca and Phillips, M. Stuart and Griffin, Meridith", title="Older Adults' Perspectives on Participating in a Synchronous Online Exercise Program: Qualitative Study", journal="JMIR Aging", year="2025", month="Apr", day="3", volume="8", pages="e66473", keywords="exercise", keywords="older adults", keywords="qualitative study", keywords="qualitative", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="interview", keywords="internet", keywords="kinesiology", keywords="physiotherapy", keywords="synchronous", keywords="online", keywords="home-based", keywords="gerontology", keywords="geriatric", keywords="older", keywords="aging", keywords="physical activity", abstract="Background: Older adults face several barriers to exercise participation, including transportation, lack of access, and poor weather conditions. Such barriers may influence whether older adults meet the Canadian 24-Hour Movement Guidelines. Recently, older adults have adopted technology for health care and are increasingly using digital health technologies to improve their access to care. Therefore, technology may be a valuable tool to reduce barriers to exercise and increase exercise participation rates within this population. Objective: This study aimed to explore older adults' perceptions and experiences of exercise, in general, and specifically related to our synchronous online exercise program for community-dwelling older adults. Methods: A total of 3 registered kinesiologists and 1 physiotherapist with experience working with older adults delivered an 8-week, thrice-weekly synchronous online group-based exercise program for older adults in 3 cohorts. The program focused on strength, balance, and aerobic activity. Following the program, a qualitative study with interpretive descriptive design was conducted to explore participants' perceptions and experiences. Participants were invited to take part in a 30-minute, one-on-one semistructured interview via Zoom with a research team member. Interview data were thematically analyzed to identify common themes. Results: A total of 22 older adults (16 women, 6 men; mean age 70, SD 4 years) participated in interviews. Three themes were identified as follows: (1) health, exercise, and aging beliefs; (2) the pandemic interruption and impacts; and (3) synchronous online exercise programs attenuate barriers to exercise. Participants discussed their exercise beliefs and behaviors and their desire to safely and correctly participate in exercise. Older adults found that their physical activity was curtailed, routines disrupted, and access to in-person exercise programs revoked due to the pandemic. However, many suggested that our synchronous online exercise program was motivational and attenuated commonly reported environmental barriers to participation, such as transportation concerns (eg, time spent traveling, driving, and parking), accessibility and convenience by participating at a location of their choice, and removing travel-related concerns during poor weather conditions. Conclusions: Given these reported experiences, we posit that synchronous online exercise programs may help motivate and maintain adherence to exercise programs for older adults. These findings may be leveraged to improve health outcomes in community-dwelling older adults. Trial Registration: ClinicalTrials.gov NCT04627493; https://clinicaltrials.gov/study/NCT04627493 ", doi="10.2196/66473", url="https://aging.jmir.org/2025/1/e66473" } @Article{info:doi/10.2196/53074, author="Spierings, Jelle and Willinge, Gijs and Kokke, Marike and Repping, Sjoerd and de Lange, Wendela and Geerdink, Thijs and van Veen, Ruben and van der Velde, Detlef and Goslings, Carel and Twigt, Bas and ", title="Patient Experiences With a Mobile Self-Care Solution for Low-Complex Orthopedic Injuries: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="14", volume="12", pages="e53074", keywords="self-care application", keywords="mHealth", keywords="experience", keywords="traumasurgery", keywords="orthopedic surgery", keywords="virtual fracture clinic", keywords="patient perspective", keywords="direct discharge", keywords="musculoskeletal injury", keywords="mobile self-care", keywords="method study", keywords="health care system", keywords="hospital", keywords="mobile health", keywords="app", keywords="smartphone", keywords="satisfactory", keywords="effectiveness", keywords="treatment", keywords="virtual clinic", keywords="virtual care", keywords="digital health", abstract="Background: The Dutch acute health care system faces challenges with limited resources and increasing patient numbers. To reduce outpatient follow-up, direct discharge (DD) has been implemented in over 30 out of 80 Dutch hospitals. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit for low-complex, isolated, and stable musculoskeletal injuries. This policy is supported by information leaflets, a smartphone app, and a telephone helpline with human support. Growing evidence shows that DD is satisfactory, safe, and effective in reducing secondary health care use, but thorough patient experiences are lacking. Objective: The aim of this study was to explore the experiences of patients with DD to ensure durable adoption and to improve the treatment protocol. Methods: A mixed method study was conducted parallel to the implementation of DD in 3 hospitals. Data were collected through a survey directly after the ED visit, a survey 3 months post injury, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data used thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptance, preliminary efficacy, and demand. All patients who consented to the study face-to-face with one of the 12 low-complex musculoskeletal injuries were included in the study during the implementation period. Results: Of the 429 patients who started the primary survey, 138 patients completed both surveys. A total of 18 semistructured interviews were conducted and analyzed. Patients reported a median treatment satisfaction score of 7.8 (IQR 6.6-8.8) on a 10-point scale of DD at the ED. Information quality was experienced as good (106/138, 77\%), and most preferred DD over face-to-face follow-up (79/138, 59\%). Patient information demands and app use varied among patients, with a median frequency of use of 4 times (ranging from 1 to 30). Conclusions: This study shows that patients consider DD a feasible and safe alternative to traditional treatment, with a favorable perception of its acceptability, efficacy, applicability, and demand. Nevertheless, response rates were relatively low, and personal nuances and preferences must be considered when implementing DD. Clinicians and policy makers can use the insights to improve DD and work towards the integration of DD into clinical practice and future guidelines. ", doi="10.2196/53074", url="https://humanfactors.jmir.org/2025/1/e53074" } @Article{info:doi/10.2196/60170, author="H{\"u}er, Theresa and Walendzik, Anke and Kleinschmidt, Lara and H{\"o}fer, Klemens and Nauendorf, Beatrice and Malsch, Juliane and Brittner, Matthias and Brandenburg, Paul and Aeustergerling, Andr{\'e} and Schneider, Udo and Wadeck, Anja and Liersch, Sebastian and Sehlen, Stephanie and Schwarze, Katharina and Wasem, J{\"u}rgen", title="Use of Video Consultation Between 2017 and 2020 in Outpatient Medical Care in Germany and Characteristics of Their User Groups: Analysis of Claims Data", journal="JMIR Form Res", year="2025", month="Mar", day="14", volume="9", pages="e60170", keywords="video consultation", keywords="outpatient medical care", keywords="user groups", keywords="claims data analysis", keywords="Germany", keywords="physician", keywords="psychotherapist", keywords="sociodemographic", keywords="healthcare", keywords="digital health", keywords="digital consultation", keywords="telehealth", keywords="telemonitoring", keywords="telemedicine", abstract="Background: Supplementing outpatient medical care with the use of video consultations could, among other benefits, improve access, especially in structurally disadvantaged areas. Objective: This claims data analysis, carried out as part of the German research project ``Preference-based use of video consultation in urban and rural regions,'' aimed to analyze the use of video consultations and the characteristics of its user groups. Methods: Claims data from 3 Statutory Health Insurance Funds (SHIFs) and 4 Associations of Statutory Health Insurance Physicians (ASHIPs) from the period April 2017 to the end of 2020 were used. Data from a sample of about 6.1 million insured and 33,100 physicians and psychotherapists were analyzed. In addition to data on the use of video consultations, patient data on sociodemographic characteristics, diagnoses, and place of residence were included. To analyze the physicians' perspectives, specialty groups, demographic characteristics, and the type of practice location were also included. In consideration of the principles of data economy and the fact that data analysis represents merely a preliminary phase within the broader project, the SHIFs and ASHIPs transmitted aggregated data (cross-tabulations per subgroup analysis) to the evaluator. For this reason, the analyses were constrained to a comparison of video consultation users versus nonusers, differentiated according to the aforementioned subgroups. Furthermore, the association between place of residence or type of region of the practice location and the use of video consultation was examined. A significance level of P<.05 was set for chi-square tests. Results: From 2017 to 2019, almost no video consultations were used in outpatient care in the German health care system. Although this changed considerably in relative terms with the start of the COVID-19 pandemic (but still at a very low absolute level), there was also a clear decline in the use of video consultations as the number of infections flattened out. Physicians working in psychotherapy and psychological psychotherapists used video consultations with around 16\% (44,808/282,530) of their treatment cases in the second quarter of 2020, followed by psychotherapists using video consultations for children (10,828/113,293, 10\%). Although the absolute number of treatment cases with video consultations among general practitioners was very high compared with other specialist groups, their share of video consultations in all treatment cases was very low at 0.3\% (29,600/9,837,118). Younger age groups and those located in urban areas used video consultations more frequently; this applies to both patients (age groups: $\chi$27=9903.2, P<.001; region types: $\chi$22=3746.2, P<.001) and service providers (age groups: $\chi$23=11,338.2, P<.001; region types: $\chi$22=8474.1, P<.001). Conclusions: The current use of video consultations is below its potential in terms of scope and user groups. The widespread and lasting use of video consultations will only succeed if the potential user groups accept this form of service provision and recognize its advantages. Further analyses (both qualitative, such as focus group discussions, and quantitative, such as preference surveys) should therefore investigate the preferences of user groups for the use of video consultations. International Registered Report Identifier (IRRID): RR2-10.2196/50932 ", doi="10.2196/60170", url="https://formative.jmir.org/2025/1/e60170", url="http://www.ncbi.nlm.nih.gov/pubmed/40085136" } @Article{info:doi/10.2196/63260, author="Hansson, Helena and Castor, Charlotte and Larsen, B{\ae}kgaard Hanne and Topperzer, Krogh Martha and Olesen, Linnet Mette", title="Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals", journal="JMIR Pediatr Parent", year="2025", month="Mar", day="13", volume="8", pages="e63260", keywords="pediatrics", keywords="digital", keywords="interventions", keywords="eHealth", keywords="home care", keywords="intravenous infusion", keywords="qualitative research", abstract="Background: With the provision of home infusion therapy in children with acute or long-term illness on the rise, eHealth technologies have the potential to bridge the transition between hospital and home. However, eHealth interventions intended to support parents in managing home infusion therapy are sparse. Gaining insight into the needs and experiences of parents and health care professionals is crucial to developing feasible and sustainable eHealth interventions that target their needs. This study describes the first phase of a research study designed to develop and evaluate an eHealth intervention to support home infusion therapy. Objective: This study aimed to identify the experiences and needs of parents and health care professionals during home infusion therapy and their preferences for digital features in a future eHealth intervention. Methods: A qualitative study was conducted at 3 pediatric departments at a university hospital in Denmark. We individually interviewed 17 parents of 14 children who had received home infusion therapy with a portable pump. In addition, 5 focus groups were conducted with 15 health care professionals. We conducted a qualitative content analysis of the data, which we collected from February to July 2020. Results: We identified 6 subthemes that we merged into 3 main themes: increasing safe self-management at home; adapting information and responsibility to individual changing needs; and requesting digital features to ensure skill level, safety, and quality of care. The analysis showed that parents and health care professionals had corresponding needs and preferences, for example, a need for a high sense of safety and easier ways to communicate during home infusion therapy. Both groups emphasized the need for digital features to improve problem-solving and communication as a supplement to existing care to promote a safe environment, self-management, and quality of care. A vital issue was that an eHealth intervention should be aligned with the workflow of health care professionals and comply with regulations regarding confidentiality in communication and data sharing. Conclusions: Our study highlights the needs that parents and health care professionals have for increased safety and easier access to communication when receiving and providing home infusion therapy. The findings will be used to help develop an eHealth intervention supporting home infusion therapy tailored to individual needs. ", doi="10.2196/63260", url="https://pediatrics.jmir.org/2025/1/e63260" } @Article{info:doi/10.2196/71439, author="Watanabe, Seiya and Kizaki, Hayato and Hori, Satoko", title="Development of a Patient-Centered Symptom-Reporting Application in Pharmacy Settings Using a Hierarchical Patient-Friendly Symptom List: Developmental and Usability Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="6", volume="12", pages="e71439", keywords="patient symptom monitoring", keywords="hierarchical symptom list", keywords="community pharmacy", keywords="interview survey", keywords="mobile application", abstract="Background: Effective symptom identification, a key responsibility for community pharmacists, requires patients to describe their symptoms accurately and comprehensively. However, current practices in pharmacies may be insufficient in capturing patient-reported symptoms comprehensively, potentially affecting the quality of pharmaceutical care and patient safety. Objective: This study aimed to construct a new, hierarchical symptom list derived from the Patient-Friendly Term List of the Medical Dictionary for Regulatory Activities (MedDRA) and to develop and evaluate a mobile app incorporating this list for facilitating symptom reporting by patients in pharmacy settings. The study also aimed to assess the usability and acceptance of this app among potential users. Methods: Subjective symptom-related terms were extracted from the Patient-Friendly Term List version 23.0 of the MedDRA. These terms were systematically consolidated and organized into a hierarchical, user-friendly symptom list. A mobile app incorporating this list was developed for pharmacy settings, featuring a symptom selection interface and a free-text input field for additional symptoms. The app included an instructional video explaining the importance of symptom reporting and guidance on navigation. Usability tests and semistructured interviews were conducted with participants aged >20 years. Interview transcripts were analyzed using the Unified Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors influencing the acceptance of technology. Results: From the initial 1440 terms in the Patient-Friendly Term List, 795 relevant terms were selected and organized into 40 site-specific subcategories, which were then grouped into broader site categories (mental, head, trunk, upper limb, lower limb, physical condition, and others). These terms were further consolidated into 211 patient-friendly symptom terms, forming a hierarchical symptom list. The app's interface design limited options to 10 items per screen to assist with decision-making. A total of 5 adults participated in the usability test. Participants found the interface intuitive and easy to use, requiring minimal effort, and provided positive feedback regarding the potential utility of the app in pharmacy settings. The UTAUT analysis identified several facilitating factors, including ease of use and the potential for enhanced pharmacist-patient communication. However, concerns were raised about usability for older adults and the need for simplified technical terminology. Conclusions: The user-friendly app with a hierarchically structured symptom list and complementary free-text entry has potential benefits for improving the accuracy and efficiency of symptom reporting in pharmacy settings. The positive user acceptance and identified areas for improvement provide a foundation for further development and implementation of this technology to enhance communication between patients and pharmacists. Future improvements should focus on addressing usability for older adults and simplifying technical terminology. ", doi="10.2196/71439", url="https://humanfactors.jmir.org/2025/1/e71439", url="http://www.ncbi.nlm.nih.gov/pubmed/40053749" } @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/10.2196/52358, author="Ejaz, Hamza and Tsui, Keith Hon Lung and Patel, Mehul and Ulloa Paredes, Rafael Luis and Knights, Ellen and Aftab, Bakht Shah and Subbe, Peter Christian", title="Comparison of a Novel Machine Learning--Based Clinical Query Platform With Traditional Guideline Searches for Hospital Emergencies: Prospective Pilot Study of User Experience and Time Efficiency", journal="JMIR Hum Factors", year="2025", month="Feb", day="25", volume="12", pages="e52358", keywords="artificial intelligence", keywords="machine learning", keywords="information search", keywords="emergency care", keywords="developing", keywords="testing", keywords="information retrieval", keywords="hospital care", keywords="training", keywords="clinical practice", keywords="clinical experience", keywords="user satisfaction", keywords="clinical impact", keywords="user group", keywords="users", keywords="study design", keywords="mobile phone", abstract="Background: Emergency and acute medicine doctors require easily accessible evidence-based information to safely manage a wide range of clinical presentations. The inability to find evidence-based local guidelines on the trust's intranet leads to information retrieval from the World Wide Web. Artificial intelligence (AI) has the potential to make evidence-based information retrieval faster and easier. Objective: The aim of the study is to conduct a time-motion analysis, comparing cohorts of junior doctors using (1) an AI-supported search engine versus (2) the traditional hospital intranet. The study also aims to examine the impact of the AI-supported search engine on the duration of searches and workflow when seeking answers to clinical queries at the point of care. Methods: This pre- and postobservational study was conducted in 2 phases. In the first phase, clinical information searches by 10 doctors caring for acutely unwell patients in acute medicine were observed during 10 working days. Based on these findings and input from a focus group of 14 clinicians, an AI-supported, context-sensitive search engine was implemented. In the second phase, clinical practice was observed for 10 doctors for an additional 10 working days using the new search engine. Results: The hospital intranet group (n=10) had a median of 23 months of clinical experience, while the AI-supported search engine group (n=10) had a median of 54 months. Participants using the AI-supported engine conducted fewer searches. User satisfaction and query resolution rates were similar between the 2 phases. Searches with the AI-supported engine took 43 seconds longer on average. Clinicians rated the new app with a favorable Net Promoter Score of 20. Conclusions: We report a successful feasibility pilot of an AI-driven search engine for clinical guidelines. Further development of the engine including the incorporation of large language models might improve accuracy and speed. More research is required to establish clinical impact in different user groups. Focusing on new staff at beginning of their post might be the most suitable study design. ", doi="10.2196/52358", url="https://humanfactors.jmir.org/2025/1/e52358" } @Article{info:doi/10.2196/55316, author="Dauber-Decker, L. Katherine and Feldstein, David and Hess, Rachel and Mann, Devin and Kim, Ji Eun and Gautam-Goyal, Pranisha and Solomon, Jeffrey and Khan, Sundas and Malik, Fatima and Xu, Lynn and Huffman, Ainsley and Smith, D. Paul and Halm, Wendy and Yuroff, Alice and Richardson, Safiya", title="Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study", journal="JMIR Form Res", year="2025", month="Feb", day="18", volume="9", pages="e55316", keywords="clinical decision support", keywords="CDS", keywords="decision aid", keywords="clinical aid", keywords="cough", keywords="sore throat", keywords="strep pharyngitis", keywords="snowball group usability testing", keywords="snowball group", keywords="usability testing", abstract="Background: Usability testing is valuable for assessing a new tool or system's usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. Objective: Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. Methods: We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. Results: The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites' sessions prior to conducting their own testing. Conclusions: Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized. Trial Registration: Clinicaltrials.gov NCT04255303; https://clinicaltrials.gov/study/NCT04255303 ", doi="10.2196/55316", url="https://formative.jmir.org/2025/1/e55316" } @Article{info:doi/10.2196/55720, author="Heuvelink, Annerieke and Saini, Privender and Ta?ar, {\"O}zg{\"u}r and Nauts, Sanne", title="Improving Pediatric Patients' Magnetic Resonance Imaging Experience With an In-Bore Solution: Design and Usability Study", journal="JMIR Serious Games", year="2025", month="Feb", day="13", volume="13", pages="e55720", keywords="MRI", keywords="magnetic resonance imaging", keywords="imaging", keywords="radiology", keywords="pediatrics", keywords="children", keywords="patient guidance", keywords="patient experience", keywords="design", keywords="usability", keywords="breath hold", abstract="Background: Annually, millions of children undergo a magnetic resonance imaging (MRI) examination. Hospitals increasingly aim to scan young children awake, as doing so benefits both patients and health care systems. To help hospitals reduce the need for anesthesia, we have developed solutions to prepare pediatric patients at home and in the hospital. Objective: The goal of our project was to design, develop, and test a solution that extends our preparation solutions by guiding and engaging children during their MRI examination. Methods: Pediatric In-bore was designed to deliver a familiar experience by reusing design elements from our preparation solutions. It offers child-friendly movies and auditory and visual guidance about examination progress and breath holding. To evaluate children's liking and understanding of the solution, we conducted a usability study. Ten healthy children participated in a mock MRI examination featuring pediatric In-bore. We observed task compliance (ability to lie still and hold one's breath) and conducted guided interviews to assess their experience and understanding of the guidance offered. Results: Participants (aged 5 to 10 years) were generally positive about pediatric In-bore. They liked the main character (Ollie the elephant) and her movie. Auditory and visual guidance were generally liked and understood. All but one participant successfully managed to lie still during the mock examination, and 6 (60\%) out of 10 participants successfully held their breath. Conclusions: Pediatric In-bore appears promising for engaging and guiding young children during awake MRI. It completes the Pediatric Coaching solution that now offers guidance throughout the MRI journey. Future research can expand on this work by evaluating the clinical impact of the Pediatric Coaching solution in a larger and more diverse sample of pediatric patients. ", doi="10.2196/55720", url="https://games.jmir.org/2025/1/e55720" } @Article{info:doi/10.2196/59961, author="Lu, An-Tai and Liou, Chong-Sin and Lai, Chia-Hsin and Shian, Bo-Tsz and Li, Ming-Ta and Sun, Chih-Yen and Kao, Hao-Yun and Dai, Hong-Jie and Tsai, Ming-Ju", title="Application of Clinical Department--Specific AI-Assisted Coding Using Taiwan Diagnosis-Related Groups: Retrospective Validation Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="12", volume="12", pages="e59961", keywords="diagnosis-related group", keywords="artificial intelligence coding", keywords="International Classification of Diseases, Tenth Revision, Clinical Modification", keywords="ICD-10-CM", keywords="coding professionals", abstract="Background: The accuracy of the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) procedure coding system (PCS) is crucial for generating correct Taiwan diagnosis-related groups (DRGs), as coding errors can lead to financial losses for hospitals. Objective: The study aimed to determine the consistency between an artificial intelligence (AI)-assisted coding module and manual coding, as well as to identify clinical specialties suitable for implementing the developed AI-assisted coding module. Methods: This study examined the AI-assisted coding module from the perspective of health care professionals. The research period started in February 2023. The study excluded cases outside of Taiwan DRGs, those with incomplete medical records, and cases with Taiwan DRG disposals ICD-10 (International Statistical Classification of Diseases, Tenth Revision) PCS. Data collection was conducted through retrospective medical record review. The AI-assisted module was constructed using a hierarchical attention network. The verification of the Taiwan DRGs results from the AI-assisted coding model focused on the major diagnostic categories (MDCs). Statistical computations were conducted using SPSS version 19. Research variables consisted of categorical variables represented by MDC, and continuous variables were represented by the relative weight of Taiwan DRGs. Results: A total of 2632 discharge records meeting the research criteria were collected from February to April 2023. In terms of inferential statistics, $\kappa$ statistics were used for MDC analysis. The infectious and parasitic diseases MDC, as well as the respiratory diseases MDC had $\kappa$ values exceeding 0.8. Clinical inpatient specialties were statistically analyzed using the Wilcoxon signed rank test. There was not a difference in coding results between the 23 clinical departments, such as the Division of Cardiology, the Division of Nephrology, and the Department of Urology. Conclusions: For human coders, with the assistance of the ICD-10-CM AI-assisted coding system, work time is reduced. Additionally, strengthening knowledge in clinical documentation enables human coders to maximize their role. This positions them to become clinical documentation experts, preparing them for further career development. Future research will apply the same method to validate the ICD-10 AI-assisted coding module. ", doi="10.2196/59961", url="https://humanfactors.jmir.org/2025/1/e59961" } @Article{info:doi/10.2196/67043, author="Jacob, Christine and M{\"u}ller, Roman and Sch{\"u}ler, Sonja and Rey, Alix and Rey, Guillaume and Armenian, Berj and Vonlaufen, Alain and Drepper, Michael and Zimmerli, Marius", title="Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="12", volume="12", pages="e67043", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="technology assessment", keywords="technology adoption", keywords="technology implementation", keywords="usability study", keywords="colonoscopy", keywords="app", keywords="application", keywords="examinations", keywords="smartphone", keywords="usability", abstract="Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25\% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100\% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. ", doi="10.2196/67043", url="https://humanfactors.jmir.org/2025/1/e67043" } @Article{info:doi/10.2196/62776, author="Klasen, Linda and Koch, Julia Stefanie Anna and Benz, Elena Maike and Conrad, Johanna and Alexy, Ute and Blaszkiewicz, Konrad and Andone, Ionut and N{\"o}thlings, Ute", title="NutriDiary, a Smartphone-Based Dietary Record App: Description and Usability Evaluation", journal="JMIR Hum Factors", year="2025", month="Feb", day="10", volume="12", pages="e62776", keywords="dietary assessment", keywords="food record", keywords="barcode scanning", keywords="app", keywords="mobile phone", abstract="Background: Repeated applications of short-term dietary assessment instruments are recommended for estimating usual dietary intake. For this purpose, NutriDiary, a smartphone app for collecting weighed dietary records (WDRs) in the German population, was developed. Objective: We aim to describe NutriDiary and evaluate its usability and acceptability. Methods: NutriDiary was developed as a WDR, allowing users to enter food items via text search, barcode scanning, or free text entry. The sample for the evaluation study included 74 participants (n=51, 69\% female, aged 18?64 years), including 27 (37.5\%) experts and 47 (63.5\%) laypersons (including n=22, 30\%, nutrition students). Participants completed a 1-day WDR and entered a predefined sample meal (n=17 foods) the following day by using NutriDiary. An evaluation questionnaire was answered from which the system usability scale (SUS) score (0?100) was calculated. A backward selection procedure (PROC REG in SAS; SAS Institute) was used to identify potential predictors for the SUS score (age, sex, status [expert or laypersons], and operating system [iOS or Android]). Results: The median SUS score of 75 (IQR 63?88) indicated good usability. Age was the only characteristic identified as a potential predictor for a lower SUS score (P<.001). The median completion time for an individual WDR was 35 (IQR 19?52) minutes. Older participants took longer to enter the data than younger ones (18?30 y: median 1.5, IQR 1.1?2.0 min/item vs 45?64 y: median 1.8, IQR 1.3?2.3 min/item). Most participants expressed a preference for NutriDiary over the traditional paper-based method. Conclusions: Good usability and acceptability make NutriDiary promising for use in epidemiological studies. ", doi="10.2196/62776", url="https://humanfactors.jmir.org/2025/1/e62776" } @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/10.2196/64210, author="{\AA}vik Persson, Helene and Castor, Charlotte and Andersson, Nilla and Hyl{\'e}n, Mia", title="Swedish Version of the System Usability Scale: Translation, Adaption, and Psychometric Evaluation", journal="JMIR Hum Factors", year="2025", month="Jan", day="16", volume="12", pages="e64210", keywords="application", keywords="Swedish", keywords="System Usability Scale", keywords="usability", keywords="validation", abstract="Background: The Swedish health care system is undergoing a transformation. eHealth technologies are increasingly being used. The System Usability Scale is a widely used tool, offering a standardized and reliable measure for assessing the usability of digital health solutions. However, despite the existence of several translations of the System Usability Scale into Swedish, none have undergone psychometric validation. This highlights the urgent need for a validated and standardized Swedish version of the System Usability Scale to ensure accurate and reliable usability evaluations. Objective: The aim of the study was to translate and psychometrically evaluate a Swedish version of the System Usability Scale. Methods: The study utilized a 2-phase design. The first phase translated the System Usability Scale into Swedish and the second phase tested the scale's psychometric properties. A total of 62 participants generated a total of 82 measurements. Descriptive statistics were used to visualize participants' characteristics. The psychometric evaluation consisted of data quality, scaling assumptions, and acceptability. Construct validity was evaluated by convergent validity, and reliability was evaluated by internal consistency. Results: The Swedish version of the System Usability Scale demonstrated high conformity with the original version. The scale showed high internal consistency with a Cronbach $\alpha$ of .852 and corrected item-total correlations ranging from 0.454 to 0.731. The construct validity was supported by a significant positive correlation between the System Usability Scale and domain 5 of the eHealth Literacy Questionnaire (P=.001). Conclusions: The Swedish version of the System Usability Scale demonstrated satisfactory psychometric properties. It can be recommended for use in a Swedish context. The positive correlation with domain 5 of the eHealth Literacy Questionnaire further supports the construct validity of the Swedish version of the System Usability Scale, affirming its suitability for evaluating digital health solutions. Additional tests of the Swedish version of the System Usability Scale, for example, in the evaluation of more complex eHealth technology, would further validate the scale. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/study/NCT04150120 ", doi="10.2196/64210", url="https://humanfactors.jmir.org/2025/1/e64210" } @Article{info:doi/10.2196/37083, author="Szinay, Dorothy and Cameron, A. Rory and Jones, Andy and Whitty, A. Jennifer and Chadborn, Tim and Brown, Jamie and Naughton, Felix", title="Eliciting Preferences for the Uptake of Smoking Cessation Apps: Discrete Choice Experiment", journal="J Med Internet Res", year="2025", month="Jan", day="14", volume="27", pages="e37083", keywords="discrete choice experiment", keywords="uptake, engagement", keywords="mHealth", keywords="smartphone app", keywords="smoking cessation", keywords="health app", keywords="behavior change", keywords="TDF", keywords="theoretical domains framework", keywords="mobile phone", abstract="Background: If the most evidence-based and effective smoking cessation apps are not selected by smokers wanting to quit, their potential to support cessation is limited. Objective: This study sought to determine the attributes that influence smoking cessation app uptake and understand their relative importance to support future efforts to present evidence-based apps more effectively to maximize uptake. Methods: Adult smokers from the United Kingdom were invited to participate in a discrete choice experiment. Participants made 12 choices between two hypothetical smoking cessation app alternatives, with five predefined attributes reflecting domains from the theoretical domains framework: (1) monthly price of the app (environmental resources), (2) credible source as app developer (social influence), (3) social proof as star rating (social influence), (4) app description type (beliefs about consequences), and (5) images shown (beliefs about consequences); or opting out (choosing neither app). Preferences and the relative importance of attributes were estimated using mixed logit modeling. Willingness to pay and predicted uptake of the most and least preferred app were also calculated. Results: A total of 337 adult smokers completed the survey (n=168, 49.8\% female; mean age 35, SD 11 years). Participants selected a smoking cessation app rather than opting out for 90\% of the choices. Relative to other attributes, a 4.8-star user rating, representing social proof, was the strongest driver of app selection (mean preference parameter 2.27, SD 1.55; 95\% CI 1.95-2.59). Participants preferred an app developed by health care--orientated trusted organization (credible source) over a hypothetical company (mean preference parameter 0.93, SD 1.23; 95\% CI 0.72-1.15), with a logo and screenshots over logo only (mean preference parameter 0.39, SD 0.96; 95\% CI 0.19-0.59), and with a lower monthly cost (mean preference parameter --0.38, SD 0.33; 95\% CI --0.44 to --0.32). App description did not influence preferences. The uptake estimate for the best hypothetical app was 93\% and for the worst, 3\%. Participants were willing to pay a single payment of up to an additional US \$6.96 (UK {\textsterling}5.49) for 4.8-star ratings, US \$3.58 (UK {\textsterling}2.82) for 4-star ratings, and US \$2.61(UK {\textsterling}2.06) for an app developed by a trusted organization. Conclusions: On average, social proof appeared to be the most influential factor in app uptake, followed by credible source, one perceived as most likely to provide evidence-based apps. These attributes may support the selection of evidence-based apps. ", doi="10.2196/37083", url="https://www.jmir.org/2025/1/e37083", url="http://www.ncbi.nlm.nih.gov/pubmed/39808479" } @Article{info:doi/10.2196/58479, author="Chen, Hui-Yu and Tu, Ming-Hsiang and Chen, Miao-Yen", title="Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="8", volume="12", pages="e58479", keywords="mobile health app", keywords="bowel preparation", keywords="nursing guidance", keywords="technology acceptance model", keywords="mHealth", keywords="mobile health", abstract="Background: Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25\%-30\% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the ``ColonClean'' mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users' attitudes and behaviors toward BP. Objective: This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance. Methods: This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users' attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean. Results: The results showed that 75\% (30/40) of participants achieved an ``excellent'' or ``good'' level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users' attitudes and behaviors (P<.05). Conclusions: The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP. ", doi="10.2196/58479", url="https://humanfactors.jmir.org/2025/1/e58479" } @Article{info:doi/10.2196/63653, author="Hartch, Christa and Dietrich, S. Mary and Lancaster, Jeanette B. and Mulvaney, A. Shelagh and Stolldorf, P. Deonni", title="Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="7", volume="12", pages="e63653", keywords="medication adherence", keywords="mHealth", keywords="mobile phone", keywords="app", keywords="medically underserved", keywords="chronic disease", keywords="satisfaction", keywords="usage", keywords="health disparities", abstract="Background: Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear. Objective: This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population. Methods: Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company. Results: The participants were very satisfied with the app, with all participants (30/30, 100\%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93\%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93\%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature. Conclusions: A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale. Trial Registration: ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743 ", doi="10.2196/63653", url="https://humanfactors.jmir.org/2025/1/e63653" } @Article{info:doi/10.2196/64121, author="Soulard, Julie and Kairy, Dahlia and Walha, Roua and Duclos, Cyril and Nadeau, Sylvie and Auger, Claudine", title="Professionals' Perspectives of Smart Stationary Bikes in Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="Dec", day="31", volume="11", pages="e64121", keywords="health professionals", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="cross-sectional", keywords="survey", keywords="questionnaire", keywords="technology", keywords="stationary bike", keywords="cycling", keywords="rehabilitation", keywords="physical activity", keywords="bike", keywords="bicycle", keywords="qualitative", keywords="content analysis", keywords="digital health", abstract="Background: Stationary bikes are used in numerous rehabilitation settings, with most offering limited functionalities and types of training. Smart technologies, such as artificial intelligence and robotics, bring new possibilities to achieve rehabilitation goals. However, it is important that these technologies meet the needs of users in order to improve their adoption in current practice. Objective: This study aimed to collect professionals' perspectives on the use of smart stationary bikes in rehabilitation. Methods: Twelve health professionals (age: mean 43.4, SD 10.1 years) completed an online questionnaire and participated in a semistructured interview regarding their needs and expectations before and after a 30-minute session with a smart bike prototype. Results: A content analysis was performed with inductive coding. Seven main themes emerged: (1) bike functionalities (cycling assistance, asymmetric resistance, and forward and backward cycling), (2) interface between bike and users (simple, user-friendly, personalized, with written reminders during training), (3) feedback to users (user and performance data), (4) training programs (preprogrammed and personalized, and algorithmic programs), (5) user engagement (telerehabilitation, group sessions, music, and automatic suggestion of training), (6) the bike as a physical device (dimensions, comfort, setup, screen, etc), and (7) business model (various pricing strategies, training for professionals, and after-sales service). Conclusions: This study provides an interpretive understanding of professionals' perspectives regarding smart stationary bikes and is the first to identify the expectations of health professionals regarding the development of future bikes in rehabilitation. ", doi="10.2196/64121", url="https://rehab.jmir.org/2024/1/e64121" } @Article{info:doi/10.2196/60767, author="Wang, Y. Ellen and Qian, Daniel and Zhang, Lijin and Li, S-K Brian and Ko, Brian and Khoury, Michael and Renavikar, Meghana and Ganesan, Avani and Caruso, J. Thomas", title="Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study", journal="JMIR Med Educ", year="2024", month="Dec", day="23", volume="10", pages="e60767", keywords="virtual reality", keywords="technology assessment", keywords="graduate medical education trainees", keywords="medical education", keywords="technology adoption", keywords="Technology Acceptance Model", keywords="factor analysis", keywords="VR", keywords="TAM", keywords="United Theory of Acceptance and Use of Technology", keywords="UTAUT", abstract="Background: Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption. Objective: The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT. Methods: Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies. Results: In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9\% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability. Conclusions: This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model's reliability within specialties in different geographic locations. ", doi="10.2196/60767", url="https://mededu.jmir.org/2024/1/e60767" } @Article{info:doi/10.2196/56567, author="Bunnell, E. Brian and Schuler, R. Kaitlyn and Ivanova, Julia and Flynn, Lea and Barrera, F. Janelle and Niazi, Jasmine and Turner, Dylan and Welch, M. Brandon", title="Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="12", volume="11", pages="e56567", keywords="mental health", keywords="mental illness", keywords="mental disease", keywords="mental disorder", keywords="homework", keywords="homework challenge", keywords="therapy", keywords="therapist", keywords="barriers", keywords="adult client", keywords="adult", keywords="technology-based solution", keywords="health technology", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="mobile phone", abstract="Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act--compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. ", doi="10.2196/56567", url="https://humanfactors.jmir.org/2024/1/e56567" } @Article{info:doi/10.2196/59426, author="Nuseibeh, Zenk Betsey and Johns, A. Shelley and Shih, C. Patrick and Lewis, F. Gregory and Gowan, M. Tayler and Jordan, J. Evan", title="Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach", journal="JMIR Form Res", year="2024", month="Dec", day="9", volume="8", pages="e59426", keywords="breast cancer survivors", keywords="acceptance and commitment therapy", keywords="mHealth app", keywords="user-centered design", keywords="depression", keywords="anxiety", keywords="therapy", keywords="app", keywords="breast cancer", keywords="expert", keywords="designer", keywords="psychosocial", keywords="need", keywords="co-design", keywords="MOSAIC", keywords="mobile acceptance and commitment therapy stress intervention", keywords="interviews", abstract="Background: Breast cancer is the world's most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91\%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer--specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. ", doi="10.2196/59426", url="https://formative.jmir.org/2024/1/e59426" } @Article{info:doi/10.2196/58014, author="Fox, S. Rina and Torres, K. Tara and Badger, A. Terry and Katsanis, Emmanuel and Yang, DerShung and Sanford, D. Stacy and Victorson, E. David and Yanez, Betina and Penedo, J. Frank and Antoni, H. Michael and Oswald, B. Laura", title="Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial", journal="JMIR Cancer", year="2024", month="Dec", day="4", volume="10", pages="e58014", keywords="cancer survivors", keywords="survivorship", keywords="clinical trials", keywords="psychosocial intervention", keywords="usability testing", keywords="digital therapeutics", keywords="young adults", keywords="nonrandomized", abstract="Background: Young adult (YA) cancer survivors frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). YAs also have expressed a desire that behavioral interventions be convenient. In response to this, our team has developed a 10-week, group-based, supportive care intervention titled TOGETHER to improve YA cancer survivors' HRQOL. TOGETHER is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. Objective: In an effort to increase convenience, the goal of this 2-part study was to design and test a website to host the TOGETHER intervention for YA cancer survivors aged 18?39 years at the time of participation and aged 15?39 years at the time of initial cancer diagnosis. Methods: In part 1, we leveraged an existing web-based platform and adapted it to meet the needs of TOGETHER. We conducted 3 iterative waves of usability testing with 3 YAs per wave to refine the website. In part 2, we conducted a single-group feasibility trial of TOGETHER using the website. Primary outcomes were feasibility (ie, recruitment, retention, and attendance) and acceptability (ie, satisfaction). Results: Usability testing participants (n=9) indicated that the TOGETHER website was easy to use (mean 5.9, SD 1.3) and easy to learn (mean 6.5, SD 0.9; possible ranges 1?7). Qualitative feedback identified needed revisions to the aesthetics (eg, images), content (eg, session titles), function (eg, clarity of functionality), and structure (eg, expandable sections), which were implemented. In the feasibility trial, participants (n=7) were an average of 25 (SD 4.7) years old and mostly non-Hispanic White (n=4, 57\%). Recruitment (58\%) and retention (71\%) rates and average session attendance (mean 7.1 , SD 4.2) supported feasibility. Participant agreement with positive statements about TOGETHER and average satisfaction ratings (mean 5.06, SD 1.64; possible range: 1?7) demonstrated acceptability. Conclusions: Results supported the usability, feasibility, and acceptability of the TOGETHER program and website. By providing the content digitally, the program effectively addresses YAs' expressed preference for convenience. Future studies are needed to increase TOGETHER's efficiency and explore its efficacy for improving targeted outcomes. Trial Registration: NCT05597228, October 24, 2022; https://clinicaltrials.gov/study/NCT05597228 ", doi="10.2196/58014", url="https://cancer.jmir.org/2024/1/e58014" } @Article{info:doi/10.2196/59630, author="Morrow, L. Emily and Nelson, A. Lyndsay and Duff, C. Melissa and Mayberry, S. Lindsay", title="An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention", journal="JMIR Rehabil Assist Technol", year="2024", month="Nov", day="26", volume="11", pages="e59630", keywords="chronic traumatic brain injury", keywords="rehabilitation", keywords="memory", keywords="ecological momentary intervention", keywords="text messaging", keywords="mobile health", keywords="mobile application", keywords="digital health", keywords="digital intervention", abstract="Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals' behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message--based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI's usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98\%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users' preferences and plan to test the efficacy of this tool in a future clinical trial. ", doi="10.2196/59630", url="https://rehab.jmir.org/2024/1/e59630" } @Article{info:doi/10.2196/57771, author="Zimmermann, Jannik and Morf, Harriet and Scharf, Florian and Knitza, Johannes and Moeller, Heidi and Muehlensiepen, Felix and Nathrath, Michaela and Orlemann, Till and Voelker, Thomas and Deckers, Merlin", title="German Version of the Telehealth Usability Questionnaire and Derived Short Questionnaires for Usability and Perceived Usefulness in Health Care Assessment in Telehealth and Digital Therapeutics: Instrument Validation Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="21", volume="11", pages="e57771", keywords="mHealth", keywords="mobile health", keywords="telehealth", keywords="usability", keywords="questionnaire validation", keywords="technology acceptance model", keywords="validity", keywords="questionnaire translation", keywords="Net Promoter Scale", keywords="NPS", keywords="usefulness", keywords="autoimmune chronic diseases", keywords="questionnaire", keywords="German", keywords="digital therapeutics", keywords="therapeutics", keywords="feasibility", abstract="Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the ``Telehealth Usability Questionnaire'' (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients---``Telehealth Usability and Perceived Usefulness Short Questionnaire for patients'' (TUUSQ). Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. Results: The analysis revealed that a parsimonious factor structure with 2 factors (``perceived usefulness in health care'' and ``usability'') is sufficient to describe the patient's perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors ``perceived usefulness in health care'' and ``usability'' in patients. Trial Registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546 ", doi="10.2196/57771", url="https://humanfactors.jmir.org/2024/1/e57771" } @Article{info:doi/10.2196/60049, author="Chien, Shih-Ying", title="Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="15", volume="11", pages="e60049", keywords="digital health", keywords="chronic obstructive pulmonary disease", keywords="COPD", keywords="usability", keywords="telerehabilitation", keywords="mobile health app", abstract="Background: Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. Objective: This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. Methods: This study used a mixed methods approach involving two key stakeholders---patients with chronic obstructive pulmonary disease and HCPs---across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Results: The research indicated a notable difference in app usability perceptions: 66\% (8/12) of HCPs found tasks ``very easy,'' compared to only 22\% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non--native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Conclusions: Most HCPs (11/12, 91\%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62\% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care. ", doi="10.2196/60049", url="https://humanfactors.jmir.org/2024/1/e60049" } @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/10.2196/54171, author="Larson, Elizabeth and Mattie, L. Rebecca and Riffkin, A. Sophia", title="Assessment of Acceptability, Usage, and Impact on Caregivers of Children With Autism's Stress and Mindfulness: Multiple-Method Feasibility Study of the 5Minutes4Myself App's Mindfulness Module", journal="JMIR Hum Factors", year="2024", month="Oct", day="31", volume="11", pages="e54171", keywords="autism", keywords="caregiver", keywords="activities", keywords="mindfulness", keywords="mobile application", keywords="stress", keywords="wellness", keywords="app", keywords="application", keywords="usage", keywords="children", keywords="developmental disability", keywords="usability", keywords="acceptability", keywords="meditation", keywords="wellness application", abstract="Background: Caregiver wellness programs need to be easily accessible to address caregivers' constraints to participation. Objective: We aimed to assess the feasibility of 5Minutes4Myself app's mindfulness module (usability, usage, and impact on caregivers' levels of mindfulness and perceived stress). Methods: Before and after participation in the 5Minutes4Myself program, 15 participants were asked to complete the Perceived Stress Scale (PSS) and Five Facet Mindfulness Questionnaire (FFMQ). Data on the usage of app-delivered meditations were collected electronically via the app, and app usability was rated on the Modified System Usability Scale. Analyses assessed participants' frequency of use of app-delivered meditations, app usability, and changes in participants' stress and mindfulness post intervention. Results: Overall, participants completed 10.9 minutes of mindfulness meditations per week and rated the app 76.7, indicating above-average usability. Related samples t tests (2-tailed) found that group PSS (t10=1.20, P=.26) and FFMQ (t10=?1.57, P=.15) pre- or postintervention mean scores were not significantly different. However, a visualization of pre- and post-PSS and mindfulness scores suggested there was a group of responders who had decreased stress with increased mindfulness. This was confirmed via an individual change analysis. The effect size of the FFMQ scores (d=0.47) suggests there may be treatment effects with a larger sample. A hierarchical multiple regression analysis examined the degree mindfulness impacted perceived stress; 20\% of the variance in participants' perceived stress could be attributed to increases in self-rated mindfulness (P=.04) when controlling for preintervention stress levels. Conclusions: Caregivers found the app highly usable and on average used low-dose levels of mindfulness meditations (10 min/wk). For responders, increased mindfulness was related to stress reduction to population-based levels. Trial Registration: ClinicalTrials.gov NCT03771001; https://clinicaltrials.gov/study/NCT03771001 ", doi="10.2196/54171", url="https://humanfactors.jmir.org/2024/1/e54171" } @Article{info:doi/10.2196/50457, author="Manning, B. Julia and Blandford, Ann and Edbrooke-Childs, Julian", title="Facilitators of and Barriers to Teachers' Engagement With Consumer Technologies for Stress Management: Qualitative Study", journal="J Med Internet Res", year="2024", month="Oct", day="22", volume="26", pages="e50457", keywords="teachers", keywords="stress", keywords="workplace", keywords="self-management", keywords="digital health", keywords="technology", keywords="qualitative", keywords="context", keywords="high schools", keywords="wearables", keywords="apps", keywords="human-computer interaction", keywords="HCI", keywords="personal informatics", abstract="Background: Consumer technology is increasingly being adopted to support personal stress management, including by teachers. Multidisciplinary research has contributed some knowledge of design and features that can help detect and manage workplace stress. However, there is less understanding of what facilitates engagement with ubiquitous ``off the shelf'' technologies, particularly in a specific occupational setting. An understanding of features that facilitate or inhibit technology use, and the influences of contexts on the manner of interaction, could improve teachers' stress-management opportunities. Objective: The aim of the study was to investigate the interaction features that facilitated or inhibited engagement with 4 consumer technologies chosen by teachers for stress management, as well as the influence of the educational contexts on their engagement. We also examined how use of well-being technology could be better supported in the school. Methods: The choice of consumer technologies was categorized in a taxonomy for English secondary school teachers according to stress-management strategies and digital features. Due to the COVID-19 pandemic, we adapted the study so that working from home in the summer could be contrasted with being back in school. Thus, a longitudinal study intended for 6 weeks in the summer term (in 2020) was extended into the autumn term, lasting up to 27 weeks. Teachers chose to use either a Withings smartwatch or Wysa, Daylio, or Teacher Tapp apps. Two semistructured interviews and web-based surveys were conducted with 8 teachers in England in the summer term, and 6 (75\%) of them took part in a third interview in the autumn term. Interviews were analyzed using reflexive thematic analysis informed by interpretive phenomenological analysis. Results: Technology elements and characteristics such as passive data collation, brevity of interaction, discreet appearance, reminders, and data visualization were described by teachers as facilitators. Lack of instructions and information on features, connectivity, extended interaction requirements, and nondifferentiation of activity and exercise data were described as barriers. Mesocontextual barriers to engagement were also reported, particularly when teachers were back on school premises, including temporal constraints, social stigma, and lack of private space to de-stress. Teachers had ideas for feature improvements and how educational leadership normalizing teachers' stress management with consumer technologies could benefit the school culture. Conclusions: Having preselected their stress-management strategies, teachers were able to harness design features to support themselves over an extended period. There could be an important role for digital interventions as part of teachers' stress management, which the school leadership would need to leverage to maximize their potential. The findings add to the holistic understanding of situated self-care and should inform developers' considerations for occupational digital stress support. ", doi="10.2196/50457", url="https://www.jmir.org/2024/1/e50457" } @Article{info:doi/10.2196/63823, author="Follong, Berit and Haliburton, Caitlin and Mackay, Sally and Maiquez, Maria and Grey, Jacqueline and Ni Mhurchu, Cliona", title="Evaluating User Experiences and Preferred Features of a Web-Based 24-Hour Dietary Assessment Tool: Usability Study", journal="JMIR Form Res", year="2024", month="Oct", day="18", volume="8", pages="e63823", keywords="public health", keywords="nutrition", keywords="dietary assessment methods", keywords="digital tools", keywords="user experience", keywords="qualitative data", keywords="survey", abstract="Background: Intake24, a web-based 24-hour dietary recall tool developed in the United Kingdom, was adapted for use in New Zealand (Intake24-NZ) through the addition of a New Zealand food list, portion size images, and food composition database. Owing to the customizations made, a thorough evaluation of the tool's usability was required. Detailed qualitative usability studies are well suited to investigate any challenges encountered while completing a web-based 24-hour recall and provide meaningful data to inform enhancements to the tool. Objective: This study aims to evaluate the usability of Intake24-NZ and identify improvements to enhance both the user experience and the quality of dietary intake data collected. Methods: We used a mixed methods approach comprising two components: (1) completion of a single 24-hour dietary recall using Intake24-NZ with both screen observation recordings and collation of verbal participant feedback on their experience and (2) a survey. Results: A total of 37 participants aged ?11 years self-completed the dietary recall and usability survey (men and boys: 14/37, 38\% and women and girls: 23/37, 62\%; M?ori: 10/37, 27\% and non-M?ori: 27/37, 73\%). Although most (31/37, 84\%) reported that Intake24-NZ was easy to use and navigate, data from the recorded observations and usability survey revealed challenges related to the correct use of search terms, search results obtained (eg, type and order of foods displayed), portion size estimation, and associated food prompts (eg, did you add milk to your tea?). Conclusions: This comprehensive usability study identified challenges experienced by users in completing a dietary recall in Intake24-NZ. The results informed a series of improvements to enhance user experience and the quality of dietary data collected with Intake24-NZ, including adding new foods to the food list, optimizing the search function and ordering of search results, creating new portion size images, and providing clearer instructions to the users. ", doi="10.2196/63823", url="https://formative.jmir.org/2024/1/e63823", url="http://www.ncbi.nlm.nih.gov/pubmed/39422998" } @Article{info:doi/10.2196/56549, author="Huang, Huei-Ling and Chao, Yi-Ping and Kuo, Chun-Yu and Sung, Ya-Li and Shyu, L. Yea-Ing and Hsu, Wen-Chuin", title="Development of a Dementia Case Management Information System App: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Sep", day="23", volume="7", pages="e56549", keywords="case management", keywords="dementia", keywords="health information systems", keywords="mobile apps", keywords="user needs", keywords="mobile phone", abstract="Background: Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care. Objective: This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app. Methods: Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience. Results: Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app. Conclusions: Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan. ", doi="10.2196/56549", url="https://aging.jmir.org/2024/1/e56549" } @Article{info:doi/10.2196/52363, author="Pusnik, Adrijana and Hartzler, Bryan and Vjorn, Olivia and Rutkowski, A. Beth and Chaple, Michael and Becker, Sara and Freese, Thomas and Nichols, Maureen and Molfenter, Todd", title="Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys", journal="JMIR Ment Health", year="2024", month="Aug", day="12", volume="11", pages="e52363", keywords="telehealth", keywords="COVID-19", keywords="substance use disorders", keywords="telephone counseling", keywords="video counseling", abstract="Background: The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was ``Will telehealth ever take hold for SUD services?'' Now that social distancing guidelines have been lifted, the question is ``Will telehealth remain a commonly used care modality?'' Objective: The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods: An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25?35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results: A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50\% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] ?0.23; P=.002), but not for video-based telehealth (MD ?0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD?0.35; P<.001), but no difference was found for phone-based telehealth (MD ?0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions: Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations. ", doi="10.2196/52363", url="https://mental.jmir.org/2024/1/e52363" } @Article{info:doi/10.2196/53108, author="Baghdadi, R. Leena and Mobeirek, A. Arwa and Alhudaithi, R. Dania and Albenmousa, A. Fatimah and Alhadlaq, S. Leen and Alaql, S. Maisa and Alhamlan, A. Sarah", title="Patients' Attitudes Toward the Use of Artificial Intelligence as a Diagnostic Tool in Radiology in Saudi Arabia: Cross-Sectional Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="7", volume="11", pages="e53108", keywords="artificial intelligence", keywords="diagnostic radiology", keywords="patients", keywords="attitudes", keywords="questionnaire", keywords="patient", keywords="attitude", keywords="diagnostic tool", keywords="diagnostic tools", keywords="AI", keywords="radiologists", keywords="prognosis", keywords="treatment", keywords="Saudi Arabia", keywords="sociodemographic factors", keywords="sociodemographic factor", keywords="sociodemographic", keywords="cross-sectional study", keywords="participant", keywords="men", keywords="women", keywords="analysis", keywords="distrust", keywords="trust", abstract="Background: Artificial intelligence (AI) is widely used in various medical fields, including diagnostic radiology as a tool for greater efficiency, precision, and accuracy. The integration of AI as a radiological diagnostic tool has the potential to mitigate delays in diagnosis, which could, in turn, impact patients' prognosis and treatment outcomes. The literature shows conflicting results regarding patients' attitudes to AI as a diagnostic tool. To the best of our knowledge, no similar study has been conducted in Saudi Arabia. Objective: The objectives of this study are to examine patients' attitudes toward the use of AI as a tool in diagnostic radiology at King Khalid University Hospital, Saudi Arabia. Additionally, we sought to explore potential associations between patients' attitudes and various sociodemographic factors. Methods: This descriptive-analytical cross-sectional study was conducted in a tertiary care hospital. Data were collected from patients scheduled for radiological imaging through a validated self-administered questionnaire. The main outcome was to measure patients' attitudes to the use of AI in radiology by calculating mean scores of 5 factors, distrust and accountability (factor 1), procedural knowledge (factor 2), personal interaction and communication (factor 3), efficiency (factor 4), and methods of providing information to patients (factor 5). Data were analyzed using the student t test, one-way analysis of variance followed by post hoc and multivariable analysis. Results: A total of 382 participants (n=273, 71.5\% women and n=109, 28.5\% men) completed the surveys and were included in the analysis. The mean age of the respondents was 39.51 (SD 13.26) years. Participants favored physicians over AI for procedural knowledge, personal interaction, and being informed. However, the participants demonstrated a neutral attitude for distrust and accountability and for efficiency. Marital status was found to be associated with distrust and accountability, procedural knowledge, and personal interaction. Associations were also found between self-reported health status and being informed and between the field of specialization and distrust and accountability. Conclusions: Patients were keen to understand the work of AI in radiology but favored personal interaction with a radiologist. Patients were impartial toward AI replacing radiologists and the efficiency of AI, which should be a consideration in future policy development and integration. Future research involving multicenter studies in different regions of Saudi Arabia is required. ", doi="10.2196/53108", url="https://humanfactors.jmir.org/2024/1/e53108" } @Article{info:doi/10.2196/54032, author="Engelsma, Thomas and Heijmink, Simone and Hendriksen, A. Heleen M. and Visser, C. Leonie N. and Lemstra, W. Afina and Jaspers, M. Monique W. and Peute, P. Linda W.", title="Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Jul", day="31", volume="11", pages="e54032", keywords="dementia", keywords="design principles", keywords="digital health", keywords="memory clinic", keywords="usability evaluation", keywords="mobile phone", abstract="Background: Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. Objective: This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. Methods: First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. Results: The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57\%) with SCD, 1 (14\%) with MCI, and 2 (29\%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6\%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4\%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user's expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. Conclusions: By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6\% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50\% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population. ", doi="10.2196/54032", url="https://humanfactors.jmir.org/2024/1/e54032" } @Article{info:doi/10.2196/47438, author="Aqib, Ayma and Fareez, Faiha and Assadpour, Elnaz and Babar, Tubba and Kokavec, Andrew and Wang, Edward and Lo, Thomas and Lam, Jean-Paul and Smith, Christopher", title="Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education", journal="JMIR Med Educ", year="2024", month="Jun", day="20", volume="10", pages="e47438", keywords="medical education", keywords="objective structured clinical examination", keywords="OSCE", keywords="e-OSCE", keywords="Medical Council of Canada", keywords="MCC", keywords="virtual health", keywords="exam", keywords="examination", keywords="utility", keywords="usability", keywords="online learning", keywords="e-learning", keywords="medical student", keywords="medical students", keywords="clinical practice", keywords="clinical skills", keywords="clinical skill", keywords="OSCE tool", doi="10.2196/47438", url="https://mededu.jmir.org/2024/1/e47438" } @Article{info:doi/10.2196/56074, author="Podda, Jessica and Tacchino, Andrea and Ponzio, Michela and Di Antonio, Federica and Susini, Alessia and Pedull{\`a}, Ludovico and Battaglia, Alberto Mario and Brichetto, Giampaolo", title="Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study", journal="JMIR Form Res", year="2024", month="Jun", day="20", volume="8", pages="e56074", keywords="cognitive assessment", keywords="cognitive impairment", keywords="digital health", keywords="mHealth app", keywords="multiple sclerosis", keywords="self-management", keywords="usability", abstract="Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43\% to 70\% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app's reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74\%), followed by secondary progressive (15/92, 16\%) and primary progressive (9/92, 10\%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. ", doi="10.2196/56074", url="https://formative.jmir.org/2024/1/e56074", url="http://www.ncbi.nlm.nih.gov/pubmed/38900535" } @Article{info:doi/10.2196/49992, author="Depauw, Tanguy and Boasen, Jared and L{\'e}ger, Pierre-Majorique and S{\'e}n{\'e}cal, Sylvain", title="Assessing the Relationship Between Digital Trail Making Test Performance and IT Task Performance: Empirical Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="14", volume="11", pages="e49992", keywords="Trail Making Test", keywords="user experience", keywords="cognitive profile", keywords="information technology", keywords="task performance", keywords="cognitive assessment", keywords="human factors", keywords="cognitive function", keywords="CAPTCHA", abstract="Background: Cognitive functional ability affects the accessibility of IT and is thus something that should be controlled for in user experience (UX) research. However, many cognitive function assessment batteries are long and complex, making them impractical for use in conventional experimental time frames. Therefore, there is a need for a short and reliable cognitive assessment that has discriminant validity for cognitive functions needed for general IT tasks. One potential candidate is the Trail Making Test (TMT). Objective: This study investigated the usefulness of a digital TMT as a cognitive profiling tool in IT-related UX research by assessing its predictive validity on general IT task performance and exploring its discriminant validity according to discrete cognitive functions required to perform the IT task. Methods: A digital TMT (parts A and B) named Axon was administered to 27 healthy participants, followed by administration of 5 IT tasks in the form of CAPTCHAs (Completely Automated Public Turing tests to Tell Computers and Humans Apart). The discrete cognitive functions required to perform each CAPTCHA were rated by trained evaluators. To further explain and cross-validate our results, the original TMT and 2 psychological assessments of visuomotor and short-term memory function were administered. Results: Axon A and B were administrable in less than 5 minutes, and overall performance was significantly predictive of general IT task performance (F5,19=6.352; P=.001; $\Lambda$=0.374). This result was driven by performance on Axon B (F5,19=3.382; P=.02; $\Lambda$=0.529), particularly for IT tasks involving the combination of executive processing with visual object and pattern recognition. Furthermore, Axon was cross-validated with the original TMT (Pcorr=.001 and Pcorr=.017 for A and B, respectively) and visuomotor and short-term memory tasks. Conclusions: The results demonstrate that variance in IT task performance among an age-homogenous neurotypical population can be related to intersubject variance in cognitive function as assessed by Axon. Although Axon's predictive validity seemed stronger for tasks involving the combination of executive function with visual object and pattern recognition, these cognitive functions are arguably relevant to the majority of IT interfaces. Considering its short administration time and remote implementability, the Axon digital TMT demonstrates the potential to be a useful cognitive profiling tool for IT-based UX research. ", doi="10.2196/49992", url="https://humanfactors.jmir.org/2024/1/e49992", url="http://www.ncbi.nlm.nih.gov/pubmed/38875007" } @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/10.2196/56653, author="Murabito, M. Joanne and Faro, M. Jamie and Zhang, Yuankai and DeMalia, Angelo and Hamel, Alexander and Agyapong, Nakesha and Liu, Hongshan and Schramm, Eric and McManus, D. David and Borrelli, Belinda", title="Smartphone App Designed to Collect Health Information in Older Adults: Usability Study", journal="JMIR Hum Factors", year="2024", month="May", day="30", volume="11", pages="e56653", keywords="mobile application surveys", keywords="mixed methods", keywords="electronic data collection", keywords="mHealth", keywords="mobile health", keywords="mobile application", keywords="mobile applications", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="smartphone", keywords="smartphones", keywords="usability", keywords="usable", keywords="usableness", keywords="usefulness", keywords="utility", keywords="health information", abstract="Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40\% women; 15/15, 100\% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47\% women; 3/15, 20\% Hispanic; and 8/15, 53\% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. ", doi="10.2196/56653", url="https://humanfactors.jmir.org/2024/1/e56653", url="http://www.ncbi.nlm.nih.gov/pubmed/38815261" } @Article{info:doi/10.2196/54699, author="Rony, Jahangir Rahat and Amir, Shajnush and Ahmed, Nova and Atiba, Samuelson and Verdezoto, Nervo and Sparkes, Valerie and Stawarz, Katarzyna", title="Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2024", month="May", day="28", volume="11", pages="e54699", keywords="rehabilitation", keywords="wearables", keywords="upper-limb rehabilitation", keywords="user-centered design", keywords="qualitative", keywords="interviews", keywords="experiences", keywords="attitudes", keywords="perceptions", keywords="digital health", keywords="health technology", keywords="wearable", keywords="user centered design", keywords="design", keywords="home", keywords="stroke", keywords="recovery", keywords="affordable", keywords="low income", keywords="low resource", keywords="Bangladesh", keywords="physiotherapy", abstract="Background: People who survive a stroke in many cases require upper-limb rehabilitation (ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible. For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors and patients' everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directed home-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global South countries due to potential costs and limited access to technology. Objective: Our goal was to better understand physiotherapists', patients', and caregivers' experiences of rehabilitation in Bangladesh, existing rehabilitation practices, and how they differ from the rehabilitation approach in the United Kingdom. Understanding these differences and experiences would help to identify opportunities and requirements for developing affordable wearable devices that could support ULR in home settings. Methods: We conducted an exploratory study with 14 participants representing key stakeholder groups. We interviewed physiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, and technology use in this context. We also interviewed UK physiotherapists to explore the similarities and differences between the 2 countries and identify specific contextual and design requirements for low-cost wearables for ULR. Overall, we remotely interviewed 8 physiotherapists (4 in the United Kingdom, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conducted via videoconference, except for 2 interviews, and audio was recorded with consent. A total of 10 hours of discussions were transcribed. The results were analyzed using thematic analysis. Results: We identified several sociocultural factors that affect ULR and should be taken into account when developing technologies for the home: the important role of family, who may influence the treatment based on social and cultural perceptions; the impact of gender norms and their influence on attitudes toward rehabilitation and physiotherapists; and differences in approach to rehabilitation between the United Kingdom and Bangladesh, with Bangladeshi physiotherapists focusing on individual movements that are necessary to build strength in the affected parts and their British counterparts favoring a more holistic approach. We propose practical considerations and design recommendations for developing ULR devices for low-resource settings. Conclusions: Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressing sociotechnical challenges. When developing new health technologies, it is imperative to not only understand how well they could fit into patients', caregivers', and physiotherapists' everyday lives, but also how they may influence any potential tensions concerning culture, religion, and the characteristics of the local health care system. ", doi="10.2196/54699", url="https://rehab.jmir.org/2024/1/e54699" } @Article{info:doi/10.2196/54010, author="Dinh, Mackenzie and Lin, Chieh Chun and Whitfield, Candace and Farhan, Zahera and Meurer, J. William and Bailey, Sarah and Skolarus, E. Lesli", title="Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial", journal="JMIR Form Res", year="2024", month="May", day="28", volume="8", pages="e54010", keywords="hypertension", keywords="cognition", keywords="mobile health", keywords="Bluetooth", keywords="remote", keywords="monitoring", keywords="monitor", keywords="low income", keywords="mHealth", keywords="hypertensive", keywords="cardiology", keywords="cardiovascular", keywords="feasibility", keywords="acceptability", keywords="satisfaction", keywords="RCT", keywords="randomized controlled trial", keywords="assessment", keywords="blood pressure", keywords="neurological", abstract="Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease--related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health--based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25\% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message--linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7\%) consented and 71 (33.6\%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4\% were female and 57.8\% identified as Black. Among the 71 participants, 51 (72\%) completed cognitive assessments at 3 months and 34 (48\%) completed these assessments at 6 months. BP assessments were completed by 37 (52\%) and 20 (28\%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 ", doi="10.2196/54010", url="https://formative.jmir.org/2024/1/e54010", url="http://www.ncbi.nlm.nih.gov/pubmed/38805251" } @Article{info:doi/10.2196/41202, author="Collins-Pisano, Caroline and Leggett, N. Amanda and Gambee, David and Fortuna, L. Karen", title="Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study", journal="JMIR Hum Factors", year="2024", month="May", day="27", volume="11", pages="e41202", keywords="family caregivers", keywords="dementia", keywords="peer support", keywords="technology", keywords="mobile phone", abstract="Background: Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. Objective: The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. Methods: A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. Results: The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non--statistically significant improvements in burden, stress, and strain levels. Conclusions: This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms. ", doi="10.2196/41202", url="https://humanfactors.jmir.org/2024/1/e41202", url="http://www.ncbi.nlm.nih.gov/pubmed/38801660" } @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/10.2196/51789, author="Washington, T. Karla and Oliver, Parker Debra and Donehower, K. Allison and White, Patrick and Benson, J. Jacquelyn and Lyons, G. Patrick and Demiris, George", title="Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment", journal="JMIR Hum Factors", year="2024", month="May", day="23", volume="11", pages="e51789", keywords="caregivers", keywords="home care services", keywords="hospice care", keywords="signs and symptoms", keywords="technology", keywords="mobile phone", abstract="Background: Early users found Engagement and Visualization to Improve Symptoms in Oncology Care (ENVISION), a web-based application designed to improve home management of hospice patients' symptoms and support patients' and family caregivers' well-being, to be generally useful and easy to use. However, they also raised concerns about potential challenges users with limited technological proficiency might experience. Objective: We sought to concurrently accomplish two interrelated study aims: (1) to develop a conceptual framework of digital inclusivity for health information systems and (2) to apply the framework in evaluating the digital inclusivity of the ENVISION application. Methods: We engaged ENVISION users (N=34) in a qualitative study in which data were collected via direct observation, think-aloud techniques, and responses to open-ended queries. Data were analyzed via theory elaboration and basic qualitative description. Results: Accessibility, relevance, and impact were identified as 3 essential considerations in evaluating a health system's digital inclusivity. Study findings generally supported ENVISION's digital inclusivity, particularly concerning its perceived relevance to the work of family caregivers and hospice clinicians and its potentially positive impact on symptom management and quality of life. Limitations to ENVISION's digital inclusivity centered around issues of accessibility, particularly operability among individuals with limited technological knowledge and skills. Conclusions: The Accessibility, Relevance, and Impact conceptual framework of digital inclusivity for health information systems can help identify opportunities to strengthen the digital inclusivity of tools, such as ENVISION, intended for use by a broad and diverse range of users. ", doi="10.2196/51789", url="https://humanfactors.jmir.org/2024/1/e51789", url="http://www.ncbi.nlm.nih.gov/pubmed/38781581" } @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/10.2196/50430, author="Papadopoulos, Petros and Soflano, Mario and Connolly, Thomas", title="A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study", journal="JMIR Hum Factors", year="2024", month="May", day="14", volume="11", pages="e50430", keywords="mobile health", keywords="mHealth", keywords="digital health intervention", keywords="total knee replacement", keywords="TKR", keywords="total hip replacement", keywords="THR", keywords="dynamic hip screw", keywords="DHS", keywords="rehabilitation", keywords="usability", keywords="mobile phone", abstract="Background: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. Objective: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Methods: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. Results: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range ?3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. Conclusions: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw. ", doi="10.2196/50430", url="https://humanfactors.jmir.org/2024/1/e50430", url="http://www.ncbi.nlm.nih.gov/pubmed/38743479" } @Article{info:doi/10.2196/50747, author="Marier-Deschenes, Pascale and Pinard, Marie Anne and Jalbert, Laura and LeBlanc, Annie", title="Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="May", day="3", volume="11", pages="e50747", keywords="persistent pain", keywords="eHealth", keywords="self-paced intervention", keywords="web-based program", keywords="evidence based", keywords="web based", keywords="self-management", keywords="pain", keywords="chronic pain", keywords="mixed methods study", keywords="pain treatment", keywords="pain education", abstract="Background: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. Objective: This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. Methods: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Results: Response rates were 70\% (44/63) at postintervention and 56\% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46\% (29/63) of the participants completed the program. We interviewed 24\% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. Conclusions: These ?ndings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. Trial Registration: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652 ", doi="10.2196/50747", url="https://humanfactors.jmir.org/2024/1/e50747", url="http://www.ncbi.nlm.nih.gov/pubmed/38701440" } @Article{info:doi/10.2196/52957, author="Innominato, F. Pasquale and Macdonald, H. Jamie and Saxton, Wendy and Longshaw, Laura and Granger, Rachel and Naja, Iman and Allocca, Carlo and Edwards, Ruth and Rasheed, Solah and Folkvord, Frans and de Batlle, Jordi and Ail, Rohit and Motta, Enrico and Bale, Catherine and Fuller, Claire and Mullard, P. Anna and Subbe, P. Christian and Griffiths, Dawn and Wreglesworth, I. Nicholas and Pecchia, Leandro and Fico, Giuseppe and Antonini, Alessio", title="Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="30", volume="13", pages="e52957", keywords="cancer", keywords="survivorship", keywords="artificial intelligence", keywords="remote monitoring", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="circadian", keywords="actigraphy", keywords="mobile phone", abstract="Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled ``GATEKEEPER,'' conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50\% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 ", doi="10.2196/52957", url="https://www.researchprotocols.org/2024/1/e52957", url="http://www.ncbi.nlm.nih.gov/pubmed/38687985" } @Article{info:doi/10.2196/51076, author="Chen, Han Tzu and Lee, Shin-Da and Ma, Wei-Fen", title="Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study", journal="JMIR Form Res", year="2024", month="Apr", day="29", volume="8", pages="e51076", keywords="app quality", keywords="caregiver", keywords="dementia", keywords="geriatrics", keywords="aging", keywords="technology", keywords="digital health", keywords="mHealth", keywords="mobile health", keywords="seniors", keywords="mobile app", keywords="patient", keywords="adoption", keywords="development", keywords="management", abstract="Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three-- and bottom three--rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app's perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. ", doi="10.2196/51076", url="https://formative.jmir.org/2024/1/e51076", url="http://www.ncbi.nlm.nih.gov/pubmed/38684083" } @Article{info:doi/10.2196/51612, author="Tremoulet, D. Patrice and Lobo, F. Andrea and Simmons, A. Christina and Baliga, Ganesh and Brady, Matthew", title="Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing", journal="JMIR Hum Factors", year="2024", month="Apr", day="25", volume="11", pages="e51612", keywords="technology prototype", keywords="data collection", keywords="documentation", keywords="direct support professionals", keywords="intellectual and developmental disabilities", keywords="pilot test", keywords="mobile phone", abstract="Background: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs' jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. Objective: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. Methods: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. Results: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. Conclusions: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful. ", doi="10.2196/51612", url="https://humanfactors.jmir.org/2024/1/e51612", url="http://www.ncbi.nlm.nih.gov/pubmed/38662420" } @Article{info:doi/10.2196/48173, author="Grove, Engelst Birgith and de Thurah, Annette and Ivarsen, Per and Kvisgaard, Katrine Ann and Hjollund, Henrik Niels and Grytnes, Regine and Schougaard, Valen Liv Marit", title="Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Apr", day="24", volume="8", pages="e48173", keywords="chronic kidney disease", keywords="pragmatic randomized controlled trial", keywords="process evaluation", keywords="patient-reported outcome measures", keywords="remote monitoring", keywords="monitoring", keywords="patient-reported outcome", keywords="chronic kidney", keywords="intervention", abstract="Background: In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. Objective: This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. Methods: A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Results: Of the 320 patients invited, 152 (47.5\%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82\% (95\% CI 76-87). The questionnaire response rate was 539/544 (99.1\%). A minority of 13 (12.9\%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5\%) of the questionnaires. Contact was established in 417/539 (77.4\%) of the cases, and 122/539 (22.6\%) of the patients did not have contact. Physicians initiated 288/417 (69.1\%) and patients requested 129/417 (30.9\%) of all the contacts. The primary causes of contact were clinical data (242/417, 58\%), PRO data (92/417, 22.1\%), and medication concerns and precautionary reasons (83/417, 19.9\%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient's health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. Conclusions: This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their ``clinical glance,'' posing a potential risk of overlooking crucial patients` symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. Trial Registration: ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766 ", doi="10.2196/48173", url="https://formative.jmir.org/2024/1/e48173", url="http://www.ncbi.nlm.nih.gov/pubmed/38656781" } @Article{info:doi/10.2196/56883, author="McMurray, Josephine and Levy, AnneMarie and Pang, Wei and Holyoke, Paul", title="Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="19", volume="26", pages="e56883", keywords="cognitive dysfunction", keywords="dementia neuropsychological tests", keywords="evaluation study", keywords="technology", keywords="aged", keywords="mobile phone", abstract="Background: With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. Objective: The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. Methods: A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ?55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale--10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. Results: The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach $\alpha$ of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate $\kappa$ (0.15) values. Sensitivity and specificity were consistent (63.25\% and 74.07\%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3\% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. Conclusions: The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. International Registered Report Identifier (IRRID): RR2-10.2196/25520 ", doi="10.2196/56883", url="https://www.jmir.org/2024/1/e56883", url="http://www.ncbi.nlm.nih.gov/pubmed/38640480" } @Article{info:doi/10.2196/46811, author="Medina-Garc{\'i}a, Rodrigo and L{\'o}pez-Rodr{\'i}guez, A. Juan and Lozano-Hern{\'a}ndez, Mar{\'i}a Cristina and Ruiz Bejerano, Ver{\'o}nica and Criscio, Paride and Del Cura-Gonz{\'a}lez, Isabel and ", title="A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="5", volume="11", pages="e46811", keywords="user-centered design", keywords="multimorbidity", keywords="comorbid", keywords="self-care", keywords="medical informatics", keywords="primary health care", keywords="chronic disease", keywords="chronic condition", keywords="chronic illness", keywords="primary care", keywords="usability", keywords="telemedicne", keywords="telehealth", keywords="information and communication technologies", keywords="ICT", keywords="digital health", keywords="eHealth", keywords="human-computer interaction", abstract="Background: Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between a patient and technology, known as usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure their relevant role in promoting self-care. Objective: The aim of this study was to analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. Methods: A descriptive observational cross-sectional usability study was performed framed in the clinical trial in the primary care health centers of Madrid Health Service of the TeNDER (Affective Based Integrated Care for Better Quality of Life) project. The TeNDER technological tool integrates sensors for monitoring physical and sleep activity along with a mobile app for consulting the data collected and working with self-management tools. This project included patients over 60 years of age who had one or more chronic diseases, at least one of which was mild-moderate cognitive impairment, Parkinson disease, or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate in the usability study. The usability variables investigated were effectiveness, which was determined by the degree of completion and the total number of errors per task; efficiency, evaluated as the average time to perform each task; and satisfaction, quantified by the System Usability Scale. Five tasks were evaluated based on real case scenarios. Usability variables were analyzed according to the sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for task completion. Results: The median age of the 38 participants was 75 (IQR 72.0-79.0) years. There was a slight majority of women (20/38, 52.6\%) and the participants had a median of 8 (IQR 7.0-11.0) chronic diseases. Thirty patients completed the usability study, with a usability effectiveness result of 89.3\% (134/150 tasks completed). Among the 30 patients, 66.7\% (n=20) completed all tasks and 56.7\% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level emerged as a facilitating factor for independent task completion (odds ratio 1.79, 95\% CI 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction score was 55 (IQR 45.0-62.5) out of 100. Conclusions: Although usability effectiveness was high, the poor efficiency and usability satisfaction scores suggest that there are other factors that may interfere with the results. Multimorbidity was not confirmed to be a key factor affecting the usability of the technological tool. Trial Registration: Clinicaltrials.gov NCT05681065; https://clinicaltrials.gov/study/NCT05681065 ", doi="10.2196/46811", url="https://humanfactors.jmir.org/2024/1/e46811", url="http://www.ncbi.nlm.nih.gov/pubmed/38578675" } @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/10.2196/54854, 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/10.2196/45275, author="Savolainen, Kaisa and Kujala, Sari", title="Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services", journal="JMIR Hum Factors", year="2024", month="Mar", day="8", volume="11", pages="e45275", keywords="eHealth", keywords="online symptom checkers", keywords="usability", keywords="cognitive accessibility", keywords="web accessibility", keywords="qualitative research", abstract="Background: The popularity of eHealth services has surged significantly, underscoring the importance of ensuring their usability and accessibility for users with diverse needs, characteristics, and capabilities. These services can pose cognitive demands, especially for individuals who are unwell, fatigued, or experiencing distress. Additionally, numerous potentially vulnerable groups, including older adults, are susceptible to digital exclusion and may encounter cognitive limitations related to perception, attention, memory, and language comprehension. Regrettably, many studies overlook the preferences and needs of user groups likely to encounter challenges associated with these cognitive aspects. Objective: This study primarily aims to gain a deeper understanding of cognitive accessibility in the practical context of eHealth services. Additionally, we aimed to identify the specific challenges that vulnerable groups encounter when using eHealth services and determine key considerations for testing these services with such groups. Methods: As a case study of eHealth services, we conducted qualitative usability testing on 2 online symptom checkers used in Finnish public primary care. A total of 13 participants from 3 distinct groups participated in the study: older adults, individuals with mild intellectual disabilities, and nonnative Finnish speakers. The primary research methods used were the thinking-aloud method, questionnaires, and semistructured interviews. Results: We found that potentially vulnerable groups encountered numerous issues with the tested services, with similar problems observed across all 3 groups. Specifically, clarity and the use of terminology posed significant challenges. The services overwhelmed users with excessive information and choices, while the terminology consisted of numerous complex medical terms that were difficult to understand. When conducting tests with vulnerable groups, it is crucial to carefully plan the sessions to avoid being overly lengthy, as these users often require more time to complete tasks. Additionally, testing with vulnerable groups proved to be quite efficient, with results likely to benefit a wider audience as well. Conclusions: Based on the findings of this study, it is evident that older adults, individuals with mild intellectual disability, and nonnative speakers may encounter cognitive challenges when using eHealth services, which can impede or slow down their use and make the services more difficult to navigate. In the worst-case scenario, these challenges may lead to errors in using the services. We recommend expanding the scope of testing to include a broader range of eHealth services with vulnerable groups, incorporating users with diverse characteristics and capabilities who are likely to encounter difficulties in cognitive accessibility. ", doi="10.2196/45275", url="https://humanfactors.jmir.org/2024/1/e45275", url="http://www.ncbi.nlm.nih.gov/pubmed/38457214" } @Article{info:doi/10.2196/52885, author="Rodriguez, V. Danissa and Lawrence, Katharine and Gonzalez, Javier and Brandfield-Harvey, Beatrix and Xu, Lynn and Tasneem, Sumaiya and Levine, L. Defne and Mann, Devin", title="Leveraging Generative AI Tools to Support the Development of Digital Solutions in Health Care Research: Case Study", journal="JMIR Hum Factors", year="2024", month="Mar", day="6", volume="11", pages="e52885", keywords="digital health", keywords="GenAI", keywords="generative", keywords="artificial intelligence", keywords="ChatGPT", keywords="software engineering", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="diabetes", keywords="diabetic", keywords="diabetes prevention", keywords="digital prescription", keywords="software", keywords="engagement", keywords="behaviour change", keywords="behavior change", keywords="developer", keywords="developers", keywords="LLM", keywords="LLMs", keywords="language model", keywords="language models", keywords="NLP", keywords="natural language processing", abstract="Background: Generative artificial intelligence has the potential to revolutionize health technology product development by improving coding quality, efficiency, documentation, quality assessment and review, and troubleshooting. Objective: This paper explores the application of a commercially available generative artificial intelligence tool (ChatGPT) to the development of a digital health behavior change intervention designed to support patient engagement in a commercial digital diabetes prevention program. Methods: We examined the capacity, advantages, and limitations of ChatGPT to support digital product idea conceptualization, intervention content development, and the software engineering process, including software requirement generation, software design, and code production. In total, 11 evaluators, each with at least 10 years of experience in fields of study ranging from medicine and implementation science to computer science, participated in the output review process (ChatGPT vs human-generated output). All had familiarity or prior exposure to the original personalized automatic messaging system intervention. The evaluators rated the ChatGPT-produced outputs in terms of understandability, usability, novelty, relevance, completeness, and efficiency. Results: Most metrics received positive scores. We identified that ChatGPT can (1) support developers to achieve high-quality products faster and (2) facilitate nontechnical communication and system understanding between technical and nontechnical team members around the development goal of rapid and easy-to-build computational solutions for medical technologies. Conclusions: ChatGPT can serve as a usable facilitator for researchers engaging in the software development life cycle, from product conceptualization to feature identification and user story development to code generation. Trial Registration: ClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500 ", doi="10.2196/52885", url="https://humanfactors.jmir.org/2024/1/e52885", url="http://www.ncbi.nlm.nih.gov/pubmed/38446539" } @Article{info:doi/10.2196/50926, author="Anders, Carolin and Moorthy, Preetha and Svensson, Laura and M{\"u}ller, Julia and Heinze, Oliver and Knaup, Petra and Wallwiener, Markus and Deutsch, M. Thomas and Le, Thao-Vy and Weinert, Lina", title="Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking", journal="JMIR Hum Factors", year="2024", month="Mar", day="5", volume="11", pages="e50926", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="breast cancer", keywords="eye tracking", keywords="user interface", keywords="mixed methods", keywords="mobile phone", abstract="Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app's content regularly, and self-administration. In contrast to the app's current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients' feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. ", doi="10.2196/50926", url="https://humanfactors.jmir.org/2024/1/e50926", url="http://www.ncbi.nlm.nih.gov/pubmed/38441959" } @Article{info:doi/10.2196/48445, author="{\O}stervang, Christina and Jensen, Myhre Charlotte and Coyne, Elisabeth and Dieperink, B. Karin and Lassen, Annmarie", title="Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Feb", day="21", volume="11", pages="e48445", keywords="consumer", keywords="eHealth", keywords="elderly", keywords="emergency department", keywords="emergency", keywords="family members", keywords="healthcare professionals", keywords="information system", keywords="mixed methods research: patients", keywords="qualitative interview", keywords="questionnaire", keywords="technology", keywords="usability", keywords="usable", abstract="Background: A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient. Objective: This study aimed to evaluate the usability and experience of a newly developed information system. The system was developed together with patients and their family members to help provide the information needed in the ED. Methods: We conducted a mixed methods study consisting of quantitative data obtained from the System Usability Scale questionnaire and qualitative interview data obtained from purposively selected participants included in the quantitative part of the study. Results: A total of 106 patients and 14 family members (N=120) answered the questionnaire. A total of 10 patients and 3 family members participated in the interviews. Based on the System Usability Scale score, the information system was rated close to excellent, with a mean score of 83.6 (SD 12.8). Most of the participants found the information system easy to use and would like to use it again. The participants reported that the system helped them feel in control, and the information was useful. Simplifications were needed to improve the user experience for the older individuals. Conclusions: This study demonstrates that the usability of the information system is rated close to excellent. It was perceived to be useful as it enabled understanding and predictability of the patient's trajectory in the ED. Areas for improvement include making the system more usable by older individuals. The study provides an example of how a technological solution can be used to diminish the information gap in an ED context. ", doi="10.2196/48445", url="https://humanfactors.jmir.org/2024/1/e48445", url="http://www.ncbi.nlm.nih.gov/pubmed/38381502" } @Article{info:doi/10.2196/45492, author="Elavsky, Steriani and Knapova, Lenka and Jani{\vs}, Kamil and Cimler, Richard and Kuhnova, Jitka and Cernicky, Tomas", title="Multiple Perspectives on the Adoption of SMART Technologies for Improving Care of Older People: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Feb", day="7", volume="26", pages="e45492", keywords="adults", keywords="older", keywords="technologies", keywords="technological", keywords="caregivers", keywords="SMART", keywords="mobile phone", abstract="Background: Despite the ever-increasing offering of SMART technologies (ie, computer-controlled devices acting intelligently and capable of monitoring, analyzing or reporting), a wide gap exists between the development of new technological innovations and their adoption in everyday care for older adults. Objective: This study aims to explore the barriers and concerns related to the adoption of SMART technologies among different groups of stakeholders. Methods: Data from 4 sources were used: semistructured in-person or internet-based interviews with professional caregivers (n=12), structured email interviews with experts in the area of aging (n=9), a web-based survey of older adults (>55 years) attending the Virtual University of the Third Age (n=369), and a case study on the adoption of new technology by an older adult care facility. Results: Although all stakeholders noted the potential of SMART technologies to improve older adult care, multiple barriers to their adoption were identified. Caregivers perceived older adults as disinterested or incompetent in using technology, reported preferring known strategies over new technologies, and noted own fears of using technology. Experts viewed technologies as essential but expressed concerns about cost, low digital competency of older adults, and lack of support or willingness to implement technologies in older adult care. Older adults reported few concerns overall, but among the mentioned concerns were lack of ability or interest, misuse of data, and limited usefulness (in specific subgroups or situations). In addition, older adults' ratings of the usefulness of different technologies correlated with their self-rating of digital competency (r=0.258; P<.001). Conclusions: Older adults appeared to have more positive views of various technologies than professional caregivers; however, their concerns varied by the type of technology. Lack of competence and lack of support were among the common themes, suggesting that educationally oriented programs for both older adults and their caregivers should be pursued. ", doi="10.2196/45492", url="https://www.jmir.org/2024/1/e45492", url="http://www.ncbi.nlm.nih.gov/pubmed/38324345" } @Article{info:doi/10.2196/45494, author="Fiorini, Laura and D'Onofrio, Grazia and Sorrentino, Alessandra and Cornacchia Loizzo, Gabriella Federica and Russo, Sergio and Ciccone, Filomena and Giuliani, Francesco and Sancarlo, Daniele and Cavallo, Filippo", title="The Role of Coherent Robot Behavior and Embodiment in Emotion Perception and Recognition During Human-Robot Interaction: Experimental Study", journal="JMIR Hum Factors", year="2024", month="Jan", day="26", volume="11", pages="e45494", keywords="social robot", keywords="emotion recognition", keywords="human emotion perception", keywords="human-robot interaction", keywords="robot cospeech gestures evaluation", abstract="Background: Social robots are becoming increasingly important as companions in our daily lives. Consequently, humans expect to interact with them using the same mental models applied to human-human interactions, including the use of cospeech gestures. Research efforts have been devoted to understanding users' needs and developing robot's behavioral models that can perceive the user state and properly plan a reaction. Despite the efforts made, some challenges regarding the effect of robot embodiment and behavior in the perception of emotions remain open. Objective: The aim of this study is dual. First, it aims to assess the role of the robot's cospeech gestures and embodiment in the user's perceived emotions in terms of valence (stimulus pleasantness), arousal (intensity of evoked emotion), and dominance (degree of control exerted by the stimulus). Second, it aims to evaluate the robot's accuracy in identifying positive, negative, and neutral emotions displayed by interacting humans using 3 supervised machine learning algorithms: support vector machine, random forest, and K-nearest neighbor. Methods: Pepper robot was used to elicit the 3 emotions in humans using a set of 60 images retrieved from a standardized database. In particular, 2 experimental conditions for emotion elicitation were performed with Pepper robot: with a static behavior or with a robot that expresses coherent (COH) cospeech behavior. Furthermore, to evaluate the role of the robot embodiment, the third elicitation was performed by asking the participant to interact with a PC, where a graphical interface showed the same images. Each participant was requested to undergo only 1 of the 3 experimental conditions. Results: A total of 60 participants were recruited for this study, 20 for each experimental condition for a total of 3600 interactions. The results showed significant differences (P<.05) in valence, arousal, and dominance when stimulated with the Pepper robot behaving COH with respect to the PC condition, thus underlying the importance of the robot's nonverbal communication and embodiment. A higher valence score was obtained for the elicitation of the robot (COH and robot with static behavior) with respect to the PC. For emotion recognition, the K-nearest neighbor classifiers achieved the best accuracy results. In particular, the COH modality achieved the highest level of accuracy (0.97) when compared with the static behavior and PC elicitations (0.88 and 0.94, respectively). Conclusions: The results suggest that the use of multimodal communication channels, such as cospeech and visual channels, as in the COH modality, may improve the recognition accuracy of the user's emotional state and can reinforce the perceived emotion. Future studies should investigate the effect of age, culture, and cognitive profile on the emotion perception and recognition going beyond the limitation of this work. ", doi="10.2196/45494", url="https://humanfactors.jmir.org/2024/1/e45494", url="http://www.ncbi.nlm.nih.gov/pubmed/38277201" } @Article{info:doi/10.2196/47755, author="Albrink, Klara and Schr{\"o}der, Dominik and Joos, Carla and M{\"u}ller, Frank and Noack, Maria Eva", title="Usability of an App for Medical History Taking in General Practice From the Patients' Perspective: Cross-Sectional Study", journal="JMIR Hum Factors", year="2024", month="Jan", day="5", volume="11", pages="e47755", keywords="digitization", keywords="application software", keywords="usability", keywords="mHealth", keywords="history of present illness", keywords="medical history taking", abstract="Background: A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients' medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice's electronic medical record, allowing for the general practitioner to review structured information of the patients' complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. Objective: The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients' perspective. Methods: Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. Results: We analyzed data from 397 patients (56.7\% female, 43.3\% male). The mean total SUS score was 77.8 points; 54.4\% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. Conclusions: Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. Trial Registration: German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659 ", doi="10.2196/47755", url="https://humanfactors.jmir.org/2024/1/e47755", url="http://www.ncbi.nlm.nih.gov/pubmed/38180798" } @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/10.2196/48609, author="Lindsay, Sally and Kosareva, Polina and Thomson, Nicole and Stinson, Jennifer", title="A Codeveloped Web-Based Disability Disclosure Toolkit for Youth With Disabilities: Mixed Methods Pilot Evaluation", journal="JMIR Form Res", year="2023", month="Dec", day="8", volume="7", pages="e48609", keywords="disability", keywords="disclosure", keywords="employment", keywords="vocational rehabilitation", keywords="youth and young adults", keywords="usability testing", keywords="qualitative", keywords="pilot study", keywords="co-design", abstract="Background: Youth and young adults with disabilities experience many barriers in securing employment such as discrimination, inaccessible environments, and lack of support. Youth often need to decide whether and how they should disclose their need for accommodations to employers, which can help them to do their best at work. However, few evidence-based toolkits focusing on disability disclosure exist for youth with various types of disabilities. Supporting youth to develop self-advocacy skills is salient because they are an underrepresented and marginalized group in the labor market. Objective: The objective of this study was to conduct a pilot evaluation of a web-based toolkit to enhance disability disclosure for youth and young adults helping to advocate for their needs and request workplace accommodations. Methods: We conducted 2 in-person focus groups to codevelop a web-based disability disclosure toolkit, which was followed by a pilot evaluation with a pre-post survey. Primary outcomes focused on the relevance of the toolkit content, preliminary perceived impact on knowledge and confidence, and open-ended feedback on the usefulness of the toolkit. Secondary outcomes focused on effectiveness (ie, measures of self-determination). Results: A total of 14 youths with various types of disabilities took part in the study (aged 20-25 years; n=11, 78\% female) including 3 who participated in the codevelopment focus group sessions and 11 youths who participated in the surveys. Our findings involved three main themes in the codevelopment sessions that included (1) disability disclosure and workplace accommodation experiences (ie, knowing when, whether, and how to disclose their disability and request workplace accommodations), (2) usefulness of the tool (ie, relatable content, format and design, and suggestions for further development), and (3) perceived impact of the toolkit (ie, navigating disclosure decisions and how to approach employers and develop other relevant employment skills). The survey findings showed that the majority of participants (10/11, 91\%) reported that the toolkit increased or changed their knowledge or understanding of disability disclosure. Most participants (8/11, 73\%) reported that the toolkit helped to increase their perceived confidence in their daily activities. The majority of participants (8/11, 73\%) agreed or strongly agreed that the toolkit was easy to understand and comprehensive. Regarding the preliminary impact of the toolkit, participants did not demonstrate any significant improvements in self-determination (all P>.05). Conclusions: Our findings emphasize the importance of codeveloping a disability disclosure toolkit with youth to enhance its relevance for their needs. Our toolkit indicates preliminary potential as an educational resource for youth and young adults with disabilities as they search for and secure employment. Further research is needed to assess the impact of the tool with larger samples to understand the impact of workplace disability disclosure decisions for youth with disabilities. ", doi="10.2196/48609", url="https://formative.jmir.org/2023/1/e48609", url="http://www.ncbi.nlm.nih.gov/pubmed/38064264" } @Article{info:doi/10.2196/50029, author="Ha, Sandeul and Ho, Hee Seung and Bae, Young-Hyeon and Lee, Minyoung and Kim, Hee Ju and Kim, Han Ju and Lee, Jisan", title="Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study", journal="J Med Internet Res", year="2023", month="Nov", day="28", volume="25", pages="e50029", keywords="digital health equity", keywords="digital health care service", keywords="COVID-19", keywords="mobile health", keywords="mHealth", keywords="mobile apps", keywords="needs assessments", keywords="heuristic", keywords="people with disability", keywords="caregivers", keywords="health personnel", keywords="mobile phone", abstract="Background: As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. Objective: This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. Methods: The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Results: Among the participants, ``disability welfare information and related institutional linkage'' was the highest priority. Three of the 14 user interface sketches the participants created were related to ``providing educational content.'' The 11 heuristic evaluation experts identified ``focusing on a single task'' as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. Conclusions: In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity. ", doi="10.2196/50029", url="https://www.jmir.org/2023/1/e50029", url="http://www.ncbi.nlm.nih.gov/pubmed/38015589" } @Article{info:doi/10.2196/47025, author="Hofstetter, Sebastian and Ritter-Herschbach, Madeleine and Behr, Dominik and Jahn, Patrick", title="Ultrasound-Assisted Continence Care Support in an Inpatient Care Setting: Protocol for a Pilot Implementation Study", journal="JMIR Res Protoc", year="2023", month="Jul", day="13", volume="12", pages="e47025", keywords="bladder control", keywords="bladder dysfunction", keywords="continence care", keywords="digitization", keywords="incontinence", keywords="nursing", keywords="selfmanagement", keywords="ultrasound", keywords="urology", keywords="user requirements", abstract="Background: This nonrandomized exploratory intervention and feasibility study examines how digital assistive technology (DAT), comprising a DFree ultrasound sensor, affects nursing care for continence support and evaluates nurses' willingness to incorporate DAT into the planning and practical implementation of care processes. Objective: The relief provided by DFree in the clinical care setting and the extent to which it supports nursing care for activities of daily living pertaining to ``micturition'' is unclear. DAT DFree is expected to reduce nurses' workload in clinical continence-care settings and was designed as a human-technology interaction that ensures a high level of usability for the subjects (ie, the nurses) and increases user acceptance by at least one level (eg, from average to slightly above average) during the study. Methods: Approximately 45 nurses from neurology, neurosurgery, and geriatric medicine clinics and polyclinics at the University Medicine Halle will be included in the 90-day (3-month) intervention on-site in the respective wards. After the wards are equipped with digital technologies, the participating nurses will be trained to use DFree and will be able to select DFree as a possible patient-care resource if the anamnesis includes bladder dysfunction among only patients who are willing to participate. The willingness of nurse participants to use DFree in planning their care process will be assessed using the Technology Usage Inventory at 3 measurement points. The primary target values include the results of the multidimensional Technology Usage Inventory assessment that will be processed using descriptive statistics. Ten participating nurses will be invited to conduct extensive guided interviews that are intended to provide information about the device's usefulness and feasibility in the specific field of continence care and possible improvements. Results: It is expected that the intention to use will be confirmed by nurses, and the number of nursing problems, such as bladder dysfunction-induced bedwetting, will be reduced with a high rating of DAT usability. Conclusions: First, this study aims to produce multilevel innovative impacts, including practical, scientific, and societal effects. The results will provide practical solutions for workload reduction in the field of nursing support for continence care, where digital assistive technologies are becoming increasingly important. The DFree ultrasonic sensor is a new technical tool for the treatment of bladder dysfunction. Generating feedback to improve technical applications can increase the user-friendliness and usefulness of the device. Trial Registration: Deutsches Register Klinischer Studien DRKS00031483; https://drks.de/search/en/trial/DRKS00031483 International Registered Report Identifier (IRRID): PRR1-10.2196/47025 ", doi="10.2196/47025", url="https://www.researchprotocols.org/2023/1/e47025", url="http://www.ncbi.nlm.nih.gov/pubmed/37317590" } @Article{info:doi/10.2196/44644, author="Jing, Xia and Patel, L. Vimla and Cimino, J. James and Shubrook, H. Jay and Zhou, Yuchun and Draghi, N. Brooke and Ernst, A. Mytchell and Liu, Chang and De Lacalle, Sonsoles", title="A Visual Analytic Tool (VIADS) to Assist the Hypothesis Generation Process in Clinical Research: Mixed Methods Usability Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="27", volume="10", pages="e44644", keywords="usability", keywords="VIADS", keywords="data-driven hypothesis generation", keywords="visualization", keywords="clinical research", keywords="SUS", keywords="mixed methods study", abstract="Background: Visualization can be a powerful tool to comprehend data sets, especially when they can be represented via hierarchical structures. Enhanced comprehension can facilitate the development of scientific hypotheses. However, the inclusion of excessive data can make visualizations overwhelming. Objective: We developed a visual interactive analytic tool for filtering and summarizing large health data sets coded with hierarchical terminologies (VIADS). In this study, we evaluated the usability of VIADS for visualizing data sets of patient diagnoses and procedures coded in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Methods: We used mixed methods in the study. A group of 12 clinical researchers participated in the generation of data-driven hypotheses using the same data sets and time frame (a 1-hour training session and a 2-hour study session) utilizing VIADS via the think-aloud protocol. The audio and screen activities were recorded remotely. A modified version of the System Usability Scale (SUS) survey and a brief survey with open-ended questions were administered after the study to assess the usability of VIADS and verify their intense usage experience with VIADS. Results: The range of SUS scores was 37.5 to 87.5. The mean SUS score for VIADS was 71.88 (out of a possible 100, SD 14.62), and the median SUS was 75. The participants unanimously agreed that VIADS offers new perspectives on data sets (12/12, 100\%), while 75\% (8/12) agreed that VIADS facilitates understanding, presentation, and interpretation of underlying data sets. The comments on the utility of VIADS were positive and aligned well with the design objectives of VIADS. The answers to the open-ended questions in the modified SUS provided specific suggestions regarding potential improvements for VIADS, and the identified problems with usability were used to update the tool. Conclusions: This usability study demonstrates that VIADS is a usable tool for analyzing secondary data sets with good average usability, good SUS score, and favorable utility. Currently, VIADS accepts data sets with hierarchical codes and their corresponding frequencies. Consequently, only specific types of use cases are supported by the analytical results. Participants agreed, however, that VIADS provides new perspectives on data sets and is relatively easy to use. The VIADS functionalities most appreciated by participants were the ability to filter, summarize, compare, and visualize data. International Registered Report Identifier (IRRID): RR2-10.2196/39414 ", doi="10.2196/44644", url="https://humanfactors.jmir.org/2023/1/e44644", url="http://www.ncbi.nlm.nih.gov/pubmed/37011112" } @Article{info:doi/10.2196/43861, author="Davoody, Nadia and Eghdam, Aboozar and Koch, Sabine and H{\"a}gglund, Maria", title="Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="17", volume="10", pages="e43861", keywords="usability testing", keywords="stroke", keywords="aphasia", keywords="eHealth", keywords="rehabilitation", keywords="co-design", keywords="evaluation", keywords="user-centered design", keywords="effectiveness", keywords="user satisfaction", keywords="mobile phone", abstract="Background: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. Objective: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. Methods: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. Results: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients' disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. Conclusions: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group. ", doi="10.2196/43861", url="https://humanfactors.jmir.org/2023/1/e43861", url="http://www.ncbi.nlm.nih.gov/pubmed/37067848" } @Article{info:doi/10.2196/42224, author="Dittrich, Florian and Albrecht, Urs-Vito and Scherer, Julian and Becker, L. S{\"o}ren and Landgraeber, Stefan and Back, Alexander David and Fessmann, Kai and Haversath, Marcel and Beck, Sascha and Abbara-Czardybon, Mona and Quitmann, Henning and Harren, Katharina Anna and Aitzetm{\"u}ller, Matthias and Klietz, Luise Marie", title="Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App", journal="JMIR Form Res", year="2023", month="Apr", day="13", volume="7", pages="e42224", keywords="smartphone", keywords="mHealth", keywords="backend", keywords="usability", keywords="UX", keywords="user experience", keywords="mobile health", keywords="health app", keywords="mobile app", keywords="app development", keywords="no-code", abstract="Background: Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector---the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. Objective: This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. Methods: An end user--operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Results: Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Conclusions: Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol. ", doi="10.2196/42224", url="https://formative.jmir.org/2023/1/e42224", url="http://www.ncbi.nlm.nih.gov/pubmed/37052998" } @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/10.2196/43729, author="Barton, J. Hanna and Salwei, E. Megan and Rutkowski, A. Rachel and Wust, Kathryn and Krause, Sheryl and Hoonakker, LT Peter and Dail, vW Paula and Buckley, M. Denise and Eastman, Alexis and Ehlenfeldt, Brad and Patterson, W. Brian and Shah, N. Manish and King, J. Barbara and Werner, E. Nicole and Carayon, Pascale", title="Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation", journal="JMIR Hum Factors", year="2023", month="Mar", day="9", volume="10", pages="e43729", keywords="patient safety", keywords="heuristic evaluation", keywords="usability", keywords="emergency medicine", keywords="safety", keywords="emergency", keywords="human factors engineering", keywords="discharge summary", keywords="documentation", keywords="heuristic", abstract="Background: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients---with the potential to prevent adverse outcomes---is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how to manage symptoms, medications, and follow-up care. Objective: This study aims to assess a multistage method for integrating diverse expertise (ie, clinical, an older adult care partner, and health IT) with human factors engineering (HFE) expertise in the usability evaluation of the patient-facing ED AVS. Methods: We conducted a three-staged heuristic evaluation of an ED AVS using heuristics developed for use in evaluating patient-facing documentation. In stage 1, HFE experts reviewed the AVS to identify usability issues. In stage 2, 6 experts of varying expertise (ie, emergency medicine physicians, ED nurses, geriatricians, transitional care nurses, and an older adult care partner) rated each previously identified usability issue on its potential impact on patient comprehension and patient safety. Finally, in stage 3, an IT expert reviewed each usability issue to identify the likelihood of successfully addressing the issue. Results: In stage 1, we identified 60 usability issues that violated a total of 108 heuristics. In stage 2, 18 additional usability issues that violated 27 heuristics were identified by the study experts. Impact ratings ranged from all experts rating the issue as ``no impact'' to 5 out of 6 experts rating the issue as having a ``large negative impact.'' On average, the older adult care partner representative rated usability issues as being more significant more of the time. In stage 3, 31 usability issues were rated by an IT professional as ``impossible to address,'' 21 as ``maybe,'' and 24 as ``can be addressed.'' Conclusions: Integrating diverse expertise when evaluating usability is important when patient safety is at stake. The non-HFE experts, included in stage 2 of our evaluation, identified 23\% (18/78) of all the usability issues and, depending on their expertise, rated those issues as having differing impacts on patient comprehension and safety. Our findings suggest that, to conduct a comprehensive heuristic evaluation, expertise from all the contexts in which the AVS is used must be considered. Combining those findings with ratings from an IT expert, usability issues can be strategically addressed through redesign. Thus, a 3-staged heuristic evaluation method offers a framework for integrating context-specific expertise efficiently, while providing practical insights to guide human-centered design. ", doi="10.2196/43729", url="https://humanfactors.jmir.org/2023/1/e43729", url="http://www.ncbi.nlm.nih.gov/pubmed/36892941" } @Article{info:doi/10.2196/42572, author="Christensen, R{\o}nn Oliver and Hedegaard, Leonora and Rask, Tr{\o}llund Mette and Clemensen, Jane and Frostholm, Lisbeth and Rosendal, Marianne", title="Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study", journal="JMIR Hum Factors", year="2023", month="Feb", day="8", volume="10", pages="e42572", keywords="eHealth", keywords="digital health", keywords="medically unexplained symptom", keywords="persistent physical symptom", keywords="self-management", keywords="usability", keywords="physical symptom", keywords="persistent symptom", keywords="unexplained symptom", keywords="symptom management", keywords="unguided", keywords="thinking aloud", keywords="think aloud", abstract="Background: Patients with persistent physical symptoms presenting in primary care are often affected by multiple symptoms and reduced functioning. The medical and societal costs of these patients are high, and there is a need for new interventions tailored to both the patients and health care system. Objective: This study aimed to examine the usability of an unguided, self-help treatment program, ``My Symptoms,'' developed to assist patients and general practitioners in symptom management. Methods: In all, 11 users (4 patients with persistent physical symptoms and 7 laypeople) participated in web-based thinking-aloud interviews involving the performance of predefined tasks in the program. Thematic analysis was used to categorize the severity of usability issues. General usability heuristics were cross-referenced with the usability issues. Results: The analysis identified important usability issues related to functionality, navigation, and content. The study shows how therapeutic knowledge in some cases was lost in the translation of face-to-face therapy to a digital format. The user testing helped uncover how the functionality of the digital elements and general navigation of the program played a huge part in locating and accessing the needed treatment. Examples of redesign to mediate the therapeutic value in the digital format involving health care professionals, web developers, and users are provided. The study also highlights the differences of involving patients and laypeople in the interviews. Conclusions: Taking the experience of common symptoms as a point of departure, patients and laypeople contributed to finding usability issues on program functionality, navigation, and content to improve the program and make the treatment more accessible to users. ", doi="10.2196/42572", url="https://humanfactors.jmir.org/2023/1/e42572", url="http://www.ncbi.nlm.nih.gov/pubmed/36753312" } @Article{info:doi/10.2196/39646, author="Rizvi, F. Rubina and VanHouten, B. Courtney and Willis, C. Van and Rosario, L. Bedda and South, R. Brett and Sands-Lincoln, Megan and Brotman, David and Lenert, Jeffery and Snowdon, L. Jane and Jackson, P. Gretchen", title="Understanding a Care Management System's Role in Influencing a Transitional-Aged Youth Program's Practice: Mixed Methods Study", journal="JMIR Hum Factors", year="2022", month="Dec", day="16", volume="9", number="4", pages="e39646", keywords="care management solution", keywords="foster care youth", keywords="mixed methods study", keywords="interviews", keywords="qualitative data", keywords="quantitative data", keywords="process improvement", abstract="Background: Extended foster care programs help prepare transitional-aged youth (TAY) to step into adulthood and live independent lives. Aspiranet, one of California's largest social service organizations, used a social care management solution (SCMS) to meet TAY's needs. Objective: We aimed to investigate the impact of an SCMS, IBM Watson Care Manager (WCM), in transforming foster program service delivery and improving TAY outcomes. Methods: We used a mixed methods study design by collecting primary data from stakeholders through semistructured interviews in 2021 and by pulling secondary data from annual reports, system use logs, and data repositories from 2014 to 2021. Thematic analysis based on grounded theory was used to analyze qualitative data using NVivo software. Descriptive analysis of aggregated outcome metrics in the quantitative data was performed and compared across 2 periods: pre-SCMS implementation (before October 31, 2016) and post-SCMS implementation (November 1, 2016, and March 31, 2021). Results: In total, 6 Aspiranet employees (4 leaders and 2 life coaches) were interviewed, with a median time of 56 (IQR 53-67) minutes. The majority (5/6, 83\%) were female, over 30 years of age (median 37, IQR 32-39) with a median of 6 (IQR 5-10) years of experience at Aspiranet and overall field experience of 10 (IQR 7-14) years. Most (4/6, 67\%) participants rated their technological skills as expert. Thematic analysis of participants' interview transcripts yielded 24 subthemes that were grouped into 6 superordinate themes: study context, the impact of the new tool, key strengths, commonly used features, expectations with WCM, and limitations and recommendations. The tool met users' initial expectations of streamlining tasks and adopting essential functionalities. Median satisfaction scores around pre- and post-WCM workflow processes remained constant between 2 life coaches (3.25, IQR 2.5-4); however, among leaders, post-WCM scores (median 4, IQR 4-5) were higher than pre-WCM scores (median 3, IQR 3-3). Across the 2 study phases, Aspiranet served 1641 TAY having consistent population demographics (median age of 18, IQR 18-19 years; female: 903/1641, 55.03\%; race and ethnicity: Hispanic or Latino: 621/1641, 37.84\%; Black: 470/1641, 28.64\%; White: 397/1641, 24.19\%; Other: 153/1641, 9.32\%). Between the pre- and post-WCM period, there was an increase in full-time school enrollment (359/531, 67.6\% to 833/1110, 75.04\%) and a reduction in part-time school enrollment (61/531, 11.5\% to 91/1110, 8.2\%). The median number of days spent in the foster care program remained the same (247, IQR 125-468 years); however, the number of incidents reported monthly per hundred youth showed a steady decline, even with an exponentially increasing number of enrolled youth and incidents. Conclusions: The SCMS for coordinating care and delivering tailored services to TAY streamlined Aspiranet's workflows and processes and positively impacted youth outcomes. Further enhancements are needed to better align with user and youth needs. ", doi="10.2196/39646", url="https://humanfactors.jmir.org/2022/4/e39646", url="http://www.ncbi.nlm.nih.gov/pubmed/36525294" } @Article{info:doi/10.2196/42057, author="Psavko, Simon and Katz, Noam and Mirchi, Tina and Green, R. Courtney", title="Usability and Teachability of Continuous Glucose Monitoring Devices in Older Adults and Diabetes Educators: Task Analysis and Ease-of-Use Survey", journal="JMIR Hum Factors", year="2022", month="Dec", day="15", volume="9", number="4", pages="e42057", keywords="medical devices", keywords="wearable devices", keywords="older adults", keywords="task analysis", keywords="usability testing", keywords="continuous glucose monitoring", keywords="glucose monitoring", keywords="glucose levels", keywords="diabetes", keywords="usability", abstract="Background: Continuous glucose monitoring (CGM) devices continuously sense and relay glucose concentration data from the interstitial fluid to a mobile phone or receiver. Older adults benefit from this continuous monitoring of glucose levels. Proper deployment of the sensing wire is facilitated by a specialized applicator. Objective: Our aim was to assess a new seventh-generation (G7) CGM device (Dexcom, Inc) for use by adults 65 years of age or older and certified diabetes care and education specialists (CDCESs). Ease of use related to intradermal insertion and mobile app setup will be assessed and compared to the fifth- and sixth-generation systems. Methods: Formal task analysis was conducted to enumerate the number and complexity of tasks associated with CGM deployment. We recruited 10 older adults with no prior CGM experience and 10 CDCESs to assess ease of use through hands-on insertion and initiation of a G7 system followed by a survey and, for older adults, a system usability scale survey. Results: About half as many tasks are needed to deploy G7 compared to G6. Older adults and CDCESs reported overall high usability of the G7 CGM device. CDCESs noted G7's easier setup compared to previous generations. The system usability scale score for the CGM system was 92.8, which reflects excellent usability. Conclusions: For CDCESs and for older adults using the G7 CGM system, cognitive burden is relatively low and reduced compared to previous CGM systems. Easing of this burden and simplification of the glucose monitoring aspect of proper diabetes management will likely contribute to improved outcomes in this population. ", doi="10.2196/42057", url="https://humanfactors.jmir.org/2022/4/e42057", url="http://www.ncbi.nlm.nih.gov/pubmed/36347498" } @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/10.2196/35592, author="Villalobos, Paola Jennifer and Bull, Salyers Sheana and Portz, Dickman Jennifer", title="Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study", journal="JMIR Aging", year="2022", month="Oct", day="6", volume="5", number="4", pages="e35592", keywords="mHealth", keywords="older adult", keywords="symptom", keywords="heart failure", keywords="palliative care", keywords="app", keywords="digital health", keywords="cardiology", keywords="heart", keywords="Convoy-Pal", keywords="mobile", keywords="tablet", keywords="smartwatch", keywords="adult", keywords="aging", abstract="Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients' caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. ", doi="10.2196/35592", url="https://aging.jmir.org/2022/4/e35592", url="http://www.ncbi.nlm.nih.gov/pubmed/36201402" } @Article{info:doi/10.2196/35381, author="Agbadje, Tatiana Titilayo and Pilon, Chantale and B{\'e}rub{\'e}, Pierre and Forest, Jean-Claude and Rousseau, Fran{\c{c}}ois and Rahimi, Abbasgholizadeh Samira and Gigu{\`e}re, Yves and L{\'e}gar{\'e}, France", title="User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study", journal="JMIR Pediatr Parent", year="2022", month="Sep", day="6", volume="5", number="3", pages="e35381", keywords="shared decision-making", keywords="computer-based decision aid", keywords="prenatal screening", keywords="trisomy", keywords="Down syndrome", keywords="mixed methods", abstract="Background: Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective: This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods: For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants' reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results: A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75\%) and White (42/45, 94\%). Most clinicians were aged between 35 and 44 years (5/14, 36\%) and women (11/14, 79\%), and all were White (14/14, 100\%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50\%), women (5/8, 62\%), and White (8/8, 100\%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79\%), balanced (58/66, 88\%), useful (38/66, 58\%), and sufficient (50/66, 76\%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions: Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice. ", doi="10.2196/35381", url="https://pediatrics.jmir.org/2022/3/e35381", url="http://www.ncbi.nlm.nih.gov/pubmed/35896164" } @Article{info:doi/10.2196/36861, author="Tung, S. Keith T. and Wong, S. Rosa and Ho, K. Frederick and Chan, Ling Ko and Wong, S. Wilfred H. and Leung, Hugo and Leung, Ming and Leung, K. Gilberto K. and Chow, Bong Chun and Ip, Patrick", title="Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="18", volume="8", number="8", pages="e36861", keywords="injury", keywords="indicators", keywords="modified Delphi research design", keywords="surveillance", abstract="Background: Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries. Objective: This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong. Methods: This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong. Results: We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries. Conclusions: This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong. ", doi="10.2196/36861", url="https://publichealth.jmir.org/2022/8/e36861", url="http://www.ncbi.nlm.nih.gov/pubmed/35980728" } @Article{info:doi/10.2196/36975, author="Boutilier, J. Justin and Loganathar, Priya and Linden, Anna and Scheer, Eleanore and Noejovich, Sofia and Elliott, Christian and Zuraw, Matthew and Werner, E. Nicole", title="A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study", journal="JMIR Aging", year="2022", month="Aug", day="4", volume="5", number="3", pages="e36975", keywords="Alzheimer disease and related dementias", keywords="mHealth", keywords="caregivers", keywords="dementia caregiving", keywords="eHealth", keywords="telehealth", abstract="Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue's feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75\%), White (44/51, 86\%), married (37/51, 73\%), college educated (36/51, 71\%), and were, on average, 60.3 (SD 9.8) years of age, with 18\% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72\% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating ``good'' usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95\% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US \$100K and mean 55.4 for those reporting