%0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e56860 %T Health Care Providers’ Experiences and Perceptions With Telehealth Tools in a Hospital-at-Home Program: Mixed Methods Study %A Low,Shi Yun %A Ko,Stephanie Qianwen %A Ang,Ian Yi Han %K telehealth usability %K hospital-at-home %K health care provider experience %K virtual consultation %K vital signs monitoring %K mixed-methods study %K health care provider %K experience %K perception %K telehealth tools %K telehealth %K e-consultations %K teleconsultation %K hospital-based %K home-based %K mobile phone %D 2025 %7 17.4.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/56860 %U https://humanfactors.jmir.org/2025/1/e56860 %U https://doi.org/10.2196/56860 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e68233 %T Physiotherapists’ User Acceptance of a Lower Limb Robotic Exoskeleton in Specialized Rehabilitation: Qualitative Exploratory Study %A Olimb Hillkirk,Anstein %A Skavberg Roaldsen,Kirsti %A Johnsen,Hege Mari %+ Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Jon Lilletuns vei 9, Grimstad, 4879, Norway, 47 97515773, hege.mari.johnsen@uia.no %K assistive technology %K clinical implementation %K deductive analysis %K robot-assisted gait training therapy %K RAGT %K user experiences %K unified theory of acceptance and use of technology %K UTAUT %K rehabilitation %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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. %M 40238235 %R 10.2196/68233 %U https://rehab.jmir.org/2025/1/e68233 %U https://doi.org/10.2196/68233 %U http://www.ncbi.nlm.nih.gov/pubmed/40238235 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65357 %T The EmpkinS-EKSpression Reappraisal Training Augmented With Kinesthesia in Depression: One-Armed Feasibility Study %A Keinert,Marie %A Schindler-Gmelch,Lena %A Rupp,Lydia Helene %A Sadeghi,Misha %A Richer,Robert %A Capito,Klara %A Eskofier,Bjoern M %A Berking,Matthias %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstraße 25a, Erlangen, 91052, Germany, 49 9131 8567563, marie.keinert@fau.de %K depression %K cognitive reappraisal %K facial expression %K kinesthesia %K smartphone-based intervention %K mobile phone %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Form Res %G English %X 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/ %M 40228242 %R 10.2196/65357 %U https://formative.jmir.org/2025/1/e65357 %U https://doi.org/10.2196/65357 %U http://www.ncbi.nlm.nih.gov/pubmed/40228242 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58377 %T Factors Determining Acceptance of Internet of Things in Medical Education: Mixed Methods Study %A Alhumaid,Khadija %A Ayoubi,Kevin %A Khalifa,Maha %A Salloum,Said %K collaborative learning %K student %K college %K university %K education %K Internet of Things %K IoT %K technology acceptance model %K technology optimism %K TAM %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K adoption %K survey %K questionnaire %K ANN %K deep learning %K structural equation modeling %K neural network %K intent %K use %K medical education %K artificial neural network %K technology innovation %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X 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 (β=.412, P=.04; β=.608, P=.002, respectively), and PU significantly influences TOP (β=.381, P=.04), innovativeness (β=.557, P=.003), and learning motivation (β=.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 (β=.619, P<.001; β=.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. %R 10.2196/58377 %U https://humanfactors.jmir.org/2025/1/e58377 %U https://doi.org/10.2196/58377 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e66473 %T Older Adults’ Perspectives on Participating in a Synchronous Online Exercise Program: Qualitative Study %A Coletta,Giulia %A Noguchi,Kenneth S %A Beaudoin,Kayla %A McQuarrie,Angelica %A Tang,Ada %A Ganann,Rebecca %A Phillips,Stuart M %A Griffin,Meridith %K exercise %K older adults %K qualitative study %K qualitative %K experience %K attitude %K opinion %K perception %K perspective %K interview %K internet %K kinesiology %K physiotherapy %K synchronous %K online %K home-based %K gerontology %K geriatric %K older %K aging %K physical activity %D 2025 %7 3.4.2025 %9 %J JMIR Aging %G English %X 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 %R 10.2196/66473 %U https://aging.jmir.org/2025/1/e66473 %U https://doi.org/10.2196/66473 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53074 %T Patient Experiences With a Mobile Self-Care Solution for Low-Complex Orthopedic Injuries: Mixed Methods Study %A Spierings,Jelle %A Willinge,Gijs %A Kokke,Marike %A Repping,Sjoerd %A de Lange,Wendela %A Geerdink,Thijs %A van Veen,Ruben %A van der Velde,Detlef %A Goslings,Carel %A Twigt,Bas %A , %K self-care application %K mHealth %K experience %K traumasurgery %K orthopedic surgery %K virtual fracture clinic %K patient perspective %K direct discharge %K musculoskeletal injury %K mobile self-care %K method study %K health care system %K hospital %K mobile health %K app %K smartphone %K satisfactory %K effectiveness %K treatment %K virtual clinic %K virtual care %K digital health %D 2025 %7 14.3.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/53074 %U https://humanfactors.jmir.org/2025/1/e53074 %U https://doi.org/10.2196/53074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60170 %T Use of Video Consultation Between 2017 and 2020 in Outpatient Medical Care in Germany and Characteristics of Their User Groups: Analysis of Claims Data %A Hüer,Theresa %A Walendzik,Anke %A Kleinschmidt,Lara %A Höfer,Klemens %A Nauendorf,Beatrice %A Malsch,Juliane %A Brittner,Matthias %A Brandenburg,Paul %A Aeustergerling,André %A Schneider,Udo %A Wadeck,Anja %A Liersch,Sebastian %A Sehlen,Stephanie %A Schwarze,Katharina %A Wasem,Jürgen %+ Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 201 183 2592, theresa.hueer@medman.uni-due.de %K video consultation %K outpatient medical care %K user groups %K claims data analysis %K Germany %K physician %K psychotherapist %K sociodemographic %K healthcare %K digital health %K digital consultation %K telehealth %K telemonitoring %K telemedicine %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Form Res %G English %X 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: χ27=9903.2, P<.001; region types: χ22=3746.2, P<.001) and service providers (age groups: χ23=11,338.2, P<.001; region types: χ22=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 %M 40085136 %R 10.2196/60170 %U https://formative.jmir.org/2025/1/e60170 %U https://doi.org/10.2196/60170 %U http://www.ncbi.nlm.nih.gov/pubmed/40085136 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e63260 %T Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals %A Hansson,Helena %A Castor,Charlotte %A Larsen,Hanne Bækgaard %A Topperzer,Martha Krogh %A Olesen,Mette Linnet %K pediatrics %K digital %K interventions %K eHealth %K home care %K intravenous infusion %K qualitative research %D 2025 %7 13.3.2025 %9 %J JMIR Pediatr Parent %G English %X 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. %R 10.2196/63260 %U https://pediatrics.jmir.org/2025/1/e63260 %U https://doi.org/10.2196/63260 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e71439 %T Development of a Patient-Centered Symptom-Reporting Application in Pharmacy Settings Using a Hierarchical Patient-Friendly Symptom List: Developmental and Usability Study %A Watanabe,Seiya %A Kizaki,Hayato %A Hori,Satoko %+ Division of Drug Informatics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan, 81 354002650, satokoh@keio.jp %K patient symptom monitoring %K hierarchical symptom list %K community pharmacy %K interview survey %K mobile application %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 40053749 %R 10.2196/71439 %U https://humanfactors.jmir.org/2025/1/e71439 %U https://doi.org/10.2196/71439 %U http://www.ncbi.nlm.nih.gov/pubmed/40053749 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58715 %T Preadolescent Children Using Real-Time Heart Rate During Moderate to Vigorous Physical Activity: A Feasibility Study %A Lu,Lincoln %A Jake-Schoffman,Danielle E %A Lavoie,Hannah A %A Agharazidermani,Maedeh %A Boyer,Kristy Elizabeth %+ LearnDialogue Lab, Computer and Information Science and Engineering, University of Florida, 1889 Museum Road, Gainesville, FL, 32611, United States, 1 352 392 1133, lincolnlu@ufl.edu %K smartphone app %K physical activity %K heart rate %K wearable sensors %K youth %K commercial wearable device %K Garmin %K mobile phone %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 40053729 %R 10.2196/58715 %U https://humanfactors.jmir.org/2025/1/e58715 %U https://doi.org/10.2196/58715 %U http://www.ncbi.nlm.nih.gov/pubmed/40053729 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59485 %T Building a Decentralized Biobanking App for Research Transparency and Patient Engagement: Participatory Design Study %A Dewan,Ananya %A Eifler,M %A Hood,Amelia %A Sanchez,William %A Gross,Marielle %+ Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD, 21205, United States, 1 8135416103, mariellesophiagross@gmail.com %K mobile health %K mHealth %K application %K smartphone %K digital health %K digital intervention %K participatory design %K biobanking %K research transparency %K donation %K patient-derived biospecimens %K plain language communications %K patient education %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 40053747 %R 10.2196/59485 %U https://humanfactors.jmir.org/2025/1/e59485 %U https://doi.org/10.2196/59485 %U http://www.ncbi.nlm.nih.gov/pubmed/40053747 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e52358 %T 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 %A Ejaz,Hamza %A Tsui,Hon Lung Keith %A Patel,Mehul %A Ulloa Paredes,Luis Rafael %A Knights,Ellen %A Aftab,Shah Bakht %A Subbe,Christian Peter %K artificial intelligence %K machine learning %K information search %K emergency care %K developing %K testing %K information retrieval %K hospital care %K training %K clinical practice %K clinical experience %K user satisfaction %K clinical impact %K user group %K users %K study design %K mobile phone %D 2025 %7 25.2.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/52358 %U https://humanfactors.jmir.org/2025/1/e52358 %U https://doi.org/10.2196/52358 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55316 %T Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study %A Dauber-Decker,Katherine L %A Feldstein,David %A Hess,Rachel %A Mann,Devin %A Kim,Eun Ji %A Gautam-Goyal,Pranisha %A Solomon,Jeffrey %A Khan,Sundas %A Malik,Fatima %A Xu,Lynn %A Huffman,Ainsley %A Smith,Paul D %A Halm,Wendy %A Yuroff,Alice %A Richardson,Safiya %K clinical decision support %K CDS %K decision aid %K clinical aid %K cough %K sore throat %K strep pharyngitis %K snowball group usability testing %K snowball group %K usability testing %D 2025 %7 18.2.2025 %9 %J JMIR Form Res %G English %X 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 %R 10.2196/55316 %U https://formative.jmir.org/2025/1/e55316 %U https://doi.org/10.2196/55316 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e55720 %T Improving Pediatric Patients’ Magnetic Resonance Imaging Experience With an In-Bore Solution: Design and Usability Study %A Heuvelink,Annerieke %A Saini,Privender %A Taşar,Özgür %A Nauts,Sanne %+ , Imaging Innovation, Philips Medical Systems, High Tech Campus 34, Eindhoven, 5656 AE, Netherlands, 31 639833471, Annerieke.Heuvelink@philips.com %K MRI %K magnetic resonance imaging %K imaging %K radiology %K pediatrics %K children %K patient guidance %K patient experience %K design %K usability %K breath hold %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 39946688 %R 10.2196/55720 %U https://games.jmir.org/2025/1/e55720 %U https://doi.org/10.2196/55720 %U http://www.ncbi.nlm.nih.gov/pubmed/39946688 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59961 %T Application of Clinical Department–Specific AI-Assisted Coding Using Taiwan Diagnosis-Related Groups: Retrospective Validation Study %A Lu,An-Tai %A Liou,Chong-Sin %A Lai,Chia-Hsin %A Shian,Bo-Tsz %A Li,Ming-Ta %A Sun,Chih-Yen %A Kao,Hao-Yun %A Dai,Hong-Jie %A Tsai,Ming-Ju %K diagnosis-related group %K artificial intelligence coding %K International Classification of Diseases, Tenth Revision, Clinical Modification %K ICD-10-CM %K coding professionals %D 2025 %7 12.2.2025 %9 %J JMIR Hum Factors %G English %X 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, κ statistics were used for MDC analysis. The infectious and parasitic diseases MDC, as well as the respiratory diseases MDC had κ 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. %R 10.2196/59961 %U https://humanfactors.jmir.org/2025/1/e59961 %U https://doi.org/10.2196/59961 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67043 %T Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study %A Jacob,Christine %A Müller,Roman %A Schüler,Sonja %A Rey,Alix %A Rey,Guillaume %A Armenian,Berj %A Vonlaufen,Alain %A Drepper,Michael %A Zimmerli,Marius %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %K usability study %K colonoscopy %K app %K application %K examinations %K smartphone %K usability %D 2025 %7 12.2.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/67043 %U https://humanfactors.jmir.org/2025/1/e67043 %U https://doi.org/10.2196/67043 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62776 %T NutriDiary, a Smartphone-Based Dietary Record App: Description and Usability Evaluation %A Klasen,Linda %A Koch,Stefanie Anna Julia %A Benz,Maike Elena %A Conrad,Johanna %A Alexy,Ute %A Blaszkiewicz,Konrad %A Andone,Ionut %A Nöthlings,Ute %K dietary assessment %K food record %K barcode scanning %K app %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/62776 %U https://humanfactors.jmir.org/2025/1/e62776 %U https://doi.org/10.2196/62776 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65022 %T A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study %A Zeiler,Michael %A Dietzel,Nikolas %A Haug,Fabian %A Haug,Julian %A Kammerer,Klaus %A Pryss,Rüdiger %A Heuschmann,Peter %A Graessel,Elmar %A Kolominsky-Rabas,Peter L %A Prokosch,Hans-Ulrich %K dementia %K usability %K development %K digiDEM %K cognitive impairment %K older adults %K aging %K mobile health %K mHealth %K design %K feedback %K screening %K user centred %K cognitive disorder %K user-centered %K mobile app %D 2025 %7 22.1.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/65022 %U https://humanfactors.jmir.org/2025/1/e65022 %U https://doi.org/10.2196/65022 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64210 %T Swedish Version of the System Usability Scale: Translation, Adaption, and Psychometric Evaluation %A Åvik Persson,Helene %A Castor,Charlotte %A Andersson,Nilla %A Hylén,Mia %K application %K Swedish %K System Usability Scale %K usability %K validation %D 2025 %7 16.1.2025 %9 %J JMIR Hum Factors %G English %X 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 α 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 %R 10.2196/64210 %U https://humanfactors.jmir.org/2025/1/e64210 %U https://doi.org/10.2196/64210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e37083 %T Eliciting Preferences for the Uptake of Smoking Cessation Apps: Discrete Choice Experiment %A Szinay,Dorothy %A Cameron,Rory A %A Jones,Andy %A Whitty,Jennifer A %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Research Park, Norwich, NR4 7TJ, United Kingdom, 44 01603456161, dorothy.szinay@uea.ac.uk %K discrete choice experiment %K uptake, engagement %K mHealth %K smartphone app %K smoking cessation %K health app %K behavior change %K TDF %K theoretical domains framework %K mobile phone %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 £5.49) for 4.8-star ratings, US $3.58 (UK £2.82) for 4-star ratings, and US $2.61(UK £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. %M 39808479 %R 10.2196/37083 %U https://www.jmir.org/2025/1/e37083 %U https://doi.org/10.2196/37083 %U http://www.ncbi.nlm.nih.gov/pubmed/39808479 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58479 %T Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study %A Chen,Hui-Yu %A Tu,Ming-Hsiang %A Chen,Miao-Yen %K mobile health app %K bowel preparation %K nursing guidance %K technology acceptance model %K mHealth %K mobile health %D 2025 %7 8.1.2025 %9 %J JMIR Hum Factors %G English %X 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. %R 10.2196/58479 %U https://humanfactors.jmir.org/2025/1/e58479 %U https://doi.org/10.2196/58479 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e63653 %T Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study %A Hartch,Christa %A Dietrich,Mary S %A Lancaster,B Jeanette %A Mulvaney,Shelagh A %A Stolldorf,Deonni P %+ School of Nursing and Health Sciences, Manhattanville University, 2900 Purchase Street, Purchase, NY, 10577, United States, 1 914 323 5365, christa.hartch@mville.edu %K medication adherence %K mHealth %K mobile phone %K app %K medically underserved %K chronic disease %K satisfaction %K usage %K health disparities %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 39773694 %R 10.2196/63653 %U https://humanfactors.jmir.org/2025/1/e63653 %U https://doi.org/10.2196/63653 %U http://www.ncbi.nlm.nih.gov/pubmed/39773694 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e64121 %T Professionals’ Perspectives of Smart Stationary Bikes in Rehabilitation: Qualitative Study %A Soulard,Julie %A Kairy,Dahlia %A Walha,Roua %A Duclos,Cyril %A Nadeau,Sylvie %A Auger,Claudine %K health professionals %K attitude %K opinion %K perception %K perspective %K cross-sectional %K survey %K questionnaire %K technology %K stationary bike %K cycling %K rehabilitation %K physical activity %K bike %K bicycle %K qualitative %K content analysis %K digital health %D 2024 %7 31.12.2024 %9 %J JMIR Rehabil Assist Technol %G English %X 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. %R 10.2196/64121 %U https://rehab.jmir.org/2024/1/e64121 %U https://doi.org/10.2196/64121 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e60767 %T Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study %A Wang,Ellen Y %A Qian,Daniel %A Zhang,Lijin %A Li,Brian S-K %A Ko,Brian %A Khoury,Michael %A Renavikar,Meghana %A Ganesan,Avani %A Caruso,Thomas J %K virtual reality %K technology assessment %K graduate medical education trainees %K medical education %K technology adoption %K Technology Acceptance Model %K factor analysis %K VR %K TAM %K United Theory of Acceptance and Use of Technology %K UTAUT %D 2024 %7 23.12.2024 %9 %J JMIR Med Educ %G English %X 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. %R 10.2196/60767 %U https://mededu.jmir.org/2024/1/e60767 %U https://doi.org/10.2196/60767 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56567 %T Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study %A Bunnell,Brian E %A Schuler,Kaitlyn R %A Ivanova,Julia %A Flynn,Lea %A Barrera,Janelle F %A Niazi,Jasmine %A Turner,Dylan %A Welch,Brandon M %+ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613-4706, United States, 1 8139748607, bbunnell@usf.edu %K mental health %K mental illness %K mental disease %K mental disorder %K homework %K homework challenge %K therapy %K therapist %K barriers %K adult client %K adult %K technology-based solution %K health technology %K digital health %K digital technology %K digital intervention %K mobile phone %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39665475 %R 10.2196/56567 %U https://humanfactors.jmir.org/2024/1/e56567 %U https://doi.org/10.2196/56567 %U http://www.ncbi.nlm.nih.gov/pubmed/39665475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59426 %T Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach %A Nuseibeh,Betsey Zenk %A Johns,Shelley A %A Shih,Patrick C %A Lewis,Gregory F %A Gowan,Tayler M %A Jordan,Evan J %+ School of Public Health, Indiana University, 1025 East Seventh Street, Bloomington, IN, 47405, United States, 1 5132255577, bznuseib@iu.edu %K breast cancer survivors %K acceptance and commitment therapy %K mHealth app %K user-centered design %K depression %K anxiety %K therapy %K app %K breast cancer %K expert %K designer %K psychosocial %K need %K co-design %K MOSAIC %K mobile acceptance and commitment therapy stress intervention %K interviews %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %R 10.2196/59426 %U https://formative.jmir.org/2024/1/e59426 %U https://doi.org/10.2196/59426 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e58014 %T Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial %A Fox,Rina S %A Torres,Tara K %A Badger,Terry A %A Katsanis,Emmanuel %A Yang,DerShung %A Sanford,Stacy D %A Victorson,David E %A Yanez,Betina %A Penedo,Frank J %A Antoni,Michael H %A Oswald,Laura B %K cancer survivors %K survivorship %K clinical trials %K psychosocial intervention %K usability testing %K digital therapeutics %K young adults %K nonrandomized %D 2024 %7 4.12.2024 %9 %J JMIR Cancer %G English %X 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 %R 10.2196/58014 %U https://cancer.jmir.org/2024/1/e58014 %U https://doi.org/10.2196/58014 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e59630 %T An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention %A Morrow,Emily L %A Nelson,Lyndsay A %A Duff,Melissa C %A Mayberry,Lindsay S %K chronic traumatic brain injury %K rehabilitation %K memory %K ecological momentary intervention %K text messaging %K mobile health %K mobile application %K digital health %K digital intervention %D 2024 %7 26.11.2024 %9 %J JMIR Rehabil Assist Technol %G English %X 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. %R 10.2196/59630 %U https://rehab.jmir.org/2024/1/e59630 %U https://doi.org/10.2196/59630 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57771 %T 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 %A Zimmermann,Jannik %A Morf,Harriet %A Scharf,Florian %A Knitza,Johannes %A Moeller,Heidi %A Muehlensiepen,Felix %A Nathrath,Michaela %A Orlemann,Till %A Voelker,Thomas %A Deckers,Merlin %+ Palliative Care Team for Children Kassel, Mönchebergstr. 41-43, Kassel, 34125, Germany, 49 56198017558, merlin.deckers@kleine-riesen-nordhessen.de %K mHealth %K mobile health %K telehealth %K usability %K questionnaire validation %K technology acceptance model %K validity %K questionnaire translation %K Net Promoter Scale %K NPS %K usefulness %K autoimmune chronic diseases %K questionnaire %K German %K digital therapeutics %K therapeutics %K feasibility %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 39571151 %R 10.2196/57771 %U https://humanfactors.jmir.org/2024/1/e57771 %U https://doi.org/10.2196/57771 %U http://www.ncbi.nlm.nih.gov/pubmed/39571151 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e60049 %T Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study %A Chien,Shih-Ying %+ Department of Industrial Design, Chang Gung University, No.259, Wen-Hwa 1st Rd, Kweishan, Taoyuan, Taiwan, R.O.C., Taoyuan, 333, Taiwan, 886 3 2118800 ext 5669, shihying@mail.cgu.edu.tw %K digital health %K chronic obstructive pulmonary disease %K COPD %K usability %K telerehabilitation %K mobile health app %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39546767 %R 10.2196/60049 %U https://humanfactors.jmir.org/2024/1/e60049 %U https://doi.org/10.2196/60049 %U http://www.ncbi.nlm.nih.gov/pubmed/39546767 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57873 %T An Exercise-Based Precision Medicine Tool and Smartphone App for Managing Achilles Tendinopathy (the 'PhysViz' System): User-Centered Development Study %A Merry,Kohle %A MacPherson,Megan M %A Whittaker,Jackie L %A Napier,Christopher %A Holsti,Liisa %A Scott,Alex %+ Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 (604) 822 8225, kohle.merry@hiphealth.ca %K exercise therapy %K physical therapy modalities %K rehabilitation %K tendons %K tendinopathy %K mobile health %K mHealth %K mobile phone %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39536312 %R 10.2196/57873 %U https://humanfactors.jmir.org/2024/1/e57873 %U https://doi.org/10.2196/57873 %U http://www.ncbi.nlm.nih.gov/pubmed/39536312 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54171 %T 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 %A Larson,Elizabeth %A Mattie,Rebecca L %A Riffkin,Sophia A %K autism %K caregiver %K activities %K mindfulness %K mobile application %K stress %K wellness %K app %K application %K usage %K children %K developmental disability %K usability %K acceptability %K meditation %K wellness application %D 2024 %7 31.10.2024 %9 %J JMIR Hum Factors %G English %X 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 %R 10.2196/54171 %U https://humanfactors.jmir.org/2024/1/e54171 %U https://doi.org/10.2196/54171 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50457 %T Facilitators of and Barriers to Teachers’ Engagement With Consumer Technologies for Stress Management: Qualitative Study %A Manning,Julia B %A Blandford,Ann %A Edbrooke-Childs,Julian %+ UCL Interaction Centre, Department of Computer Science, University College London, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 02076792000, julia.manning@ucl.ac.uk %K teachers %K stress %K workplace %K self-management %K digital health %K technology %K qualitative %K context %K high schools %K wearables %K apps %K human-computer interaction %K HCI %K personal informatics %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39437381 %R 10.2196/50457 %U https://www.jmir.org/2024/1/e50457 %U https://doi.org/10.2196/50457 %U http://www.ncbi.nlm.nih.gov/pubmed/39437381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63823 %T Evaluating User Experiences and Preferred Features of a Web-Based 24-Hour Dietary Assessment Tool: Usability Study %A Follong,Berit %A Haliburton,Caitlin %A Mackay,Sally %A Maiquez,Maria %A Grey,Jacqueline %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599, berit.follong@auckland.ac.nz %K public health %K nutrition %K dietary assessment methods %K digital tools %K user experience %K qualitative data %K survey %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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%; Māori: 10/37, 27% and non-Māori: 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. %M 39422998 %R 10.2196/63823 %U https://formative.jmir.org/2024/1/e63823 %U https://doi.org/10.2196/63823 %U http://www.ncbi.nlm.nih.gov/pubmed/39422998 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56549 %T Development of a Dementia Case Management Information System App: Mixed Methods Study %A Huang,Huei-Ling %A Chao,Yi-Ping %A Kuo,Chun-Yu %A Sung,Ya-Li %A Shyu,Yea-Ing L %A Hsu,Wen-Chuin %+ Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, No.261, Wenhua 1st Road, Guishan District, Taoyuan City, 33303, Taiwan, 886 32118999 ext 5803, hlhuang@gw.cgust.edu.tw %K case management %K dementia %K health information systems %K mobile apps %K user needs %K mobile phone %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Aging %G English %X 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. %M 39312770 %R 10.2196/56549 %U https://aging.jmir.org/2024/1/e56549 %U https://doi.org/10.2196/56549 %U http://www.ncbi.nlm.nih.gov/pubmed/39312770 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52363 %T Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys %A Pusnik,Adrijana %A Hartzler,Bryan %A Vjorn,Olivia %A Rutkowski,Beth A %A Chaple,Michael %A Becker,Sara %A Freese,Thomas %A Nichols,Maureen %A Molfenter,Todd %K telehealth %K COVID-19 %K substance use disorders %K telephone counseling %K video counseling %D 2024 %7 12.8.2024 %9 %J JMIR Ment Health %G English %X 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. %R 10.2196/52363 %U https://mental.jmir.org/2024/1/e52363 %U https://doi.org/10.2196/52363 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53108 %T Patients’ Attitudes Toward the Use of Artificial Intelligence as a Diagnostic Tool in Radiology in Saudi Arabia: Cross-Sectional Study %A Baghdadi,Leena R %A Mobeirek,Arwa A %A Alhudaithi,Dania R %A Albenmousa,Fatimah A %A Alhadlaq,Leen S %A Alaql,Maisa S %A Alhamlan,Sarah A %+ Department of Family and Community Medicine, College of Medicine, King Saud University, 3332 King Khalid Road, Riyadh, 12372, Saudi Arabia, 966 114670836, lbaghdadi@ksu.edu.sa %K artificial intelligence %K diagnostic radiology %K patients %K attitudes %K questionnaire %K patient %K attitude %K diagnostic tool %K diagnostic tools %K AI %K artificial intelligence %K radiologists %K prognosis %K treatment %K Saudi Arabia %K sociodemographic factors %K sociodemographic factor %K sociodemographic %K cross-sectional study %K participant %K men %K women %K analysis %K distrust %K trust %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39110973 %R 10.2196/53108 %U https://humanfactors.jmir.org/2024/1/e53108 %U https://doi.org/10.2196/53108 %U http://www.ncbi.nlm.nih.gov/pubmed/39110973 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54032 %T Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study %A Engelsma,Thomas %A Heijmink,Simone %A Hendriksen,Heleen M A %A Visser,Leonie N C %A Lemstra,Afina W %A Jaspers,Monique W M %A Peute,Linda W P %+ eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 657570009, t.engelsma@amsterdamumc.nl %K dementia %K design principles %K digital health %K memory clinic %K usability evaluation %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 39083790 %R 10.2196/54032 %U https://humanfactors.jmir.org/2024/1/e54032 %U https://doi.org/10.2196/54032 %U http://www.ncbi.nlm.nih.gov/pubmed/39083790 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e47438 %T Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education %A Aqib,Ayma %A Fareez,Faiha %A Assadpour,Elnaz %A Babar,Tubba %A Kokavec,Andrew %A Wang,Edward %A Lo,Thomas %A Lam,Jean-Paul %A Smith,Christopher %K medical education %K objective structured clinical examination %K OSCE %K e-OSCE %K Medical Council of Canada %K MCC %K virtual health %K exam %K examination %K utility %K usability %K online learning %K e-learning %K medical student %K medical students %K clinical practice %K clinical skills %K clinical skill %K OSCE tool %D 2024 %7 20.6.2024 %9 %J JMIR Med Educ %G English %X A significant component of Canadian medical education is the development of clinical skills. The medical educational curriculum assesses these skills through an objective structured clinical examination (OSCE). This OSCE assesses skills imperative to good clinical practice, such as patient communication, clinical decision-making, and medical knowledge. Despite the widespread implementation of this examination across all academic settings, few preparatory resources exist that cater specifically to Canadian medical students. MonkeyJacket is a novel, open-access, web-based application, built with the goal of providing medical students with an accessible and representative tool for clinical skill development for the OSCE and clinical settings. This viewpoint paper presents the development of the MonkeyJacket application and its potential to assist medical students in preparation for clinical examinations and practical settings. Limited resources exist that are web-based; accessible in terms of cost; specific to the Medical Council of Canada (MCC); and, most importantly, scalable in nature. The goal of this research study was to thoroughly describe the potential utility of the application, particularly its capacity to provide practice and scalable formative feedback to medical students. MonkeyJacket was developed to provide Canadian medical students with the opportunity to practice their clinical examination skills and receive peer feedback by using a centralized platform. The OSCE cases included in the application were developed by using the MCC guidelines to ensure their applicability to a Canadian setting. There are currently 75 cases covering 5 specialties, including cardiology, respirology, gastroenterology, neurology, and psychiatry. The MonkeyJacket application is a web-based platform that allows medical students to practice clinical decision-making skills in real time with their peers through a synchronous platform. Through this application, students can practice patient interviewing, clinical reasoning, developing differential diagnoses, and formulating a management plan, and they can receive both qualitative feedback and quantitative feedback. Each clinical case is associated with an assessment checklist that is accessible to students after practice sessions are complete; the checklist promotes personal improvement through peer feedback. This tool provides students with relevant case stems, follow-up questions that probe for differential diagnoses and management plans, assessment checklists, and the ability to review the trend in their performance. The MonkeyJacket application provides medical students with a valuable tool that promotes clinical skill development for OSCEs and clinical settings. MonkeyJacket introduces a way for medical learners to receive feedback regarding patient interviewing and clinical reasoning skills that is both formative and scalable in nature, in addition to promoting interinstitutional learning. The widespread use of this application can increase the practice of and feedback on clinical skills among medical learners. This will not only benefit the learner; more importantly, it can provide downstream benefits for the most valuable stakeholder in medicine—the patient. %R 10.2196/47438 %U https://mededu.jmir.org/2024/1/e47438 %U https://doi.org/10.2196/47438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56074 %T Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study %A Podda,Jessica %A Tacchino,Andrea %A Ponzio,Michela %A Di Antonio,Federica %A Susini,Alessia %A Pedullà,Ludovico %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713306, jessica.podda@aism.it %K cognitive assessment %K cognitive impairment %K digital health %K mHealth app %K multiple sclerosis %K self-management %K usability %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38900535 %R 10.2196/56074 %U https://formative.jmir.org/2024/1/e56074 %U https://doi.org/10.2196/56074 %U http://www.ncbi.nlm.nih.gov/pubmed/38900535 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49992 %T Assessing the Relationship Between Digital Trail Making Test Performance and IT Task Performance: Empirical Study %A Depauw,Tanguy %A Boasen,Jared %A Léger,Pierre-Majorique %A Sénécal,Sylvain %+ Tech3lab, HEC Montréal, 5540 Av Louis-Colin, Montréal, QC, H3T 1T7, Canada, 1 514 340 6000, jared.boasen@hec.ca %K Trail Making Test %K user experience %K cognitive profile %K information technology %K task performance %K cognitive assessment %K human factors %K cognitive function %K CAPTCHA %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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; Λ=0.374). This result was driven by performance on Axon B (F5,19=3.382; P=.02; Λ=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. %M 38875007 %R 10.2196/49992 %U https://humanfactors.jmir.org/2024/1/e49992 %U https://doi.org/10.2196/49992 %U http://www.ncbi.nlm.nih.gov/pubmed/38875007 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50939 %T Assessing the Utility, Impact, and Adoption Challenges of an Artificial Intelligence–Enabled Prescription Advisory Tool for Type 2 Diabetes Management: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Lee,Phong Ching %A Tan,Hong Chang %A Teh,Ming Ming %A Lim,Dawn Shao Ting %A Kwee,Ann %A Suresh,Chandran %A Carmody,David %A Swee,Du Soon %A Tan,Sarah Ying Tse %A Wong,Andy Jun-Wei %A Choo,Charlotte Hui-Min %A Wee,Zongwen %A Bee,Yong Mong %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K clinical decision support system %K artificial intelligence %K endocrinology %K diabetes management %K human factors %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38869934 %R 10.2196/50939 %U https://humanfactors.jmir.org/2024/1/e50939 %U https://doi.org/10.2196/50939 %U http://www.ncbi.nlm.nih.gov/pubmed/38869934 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56653 %T Smartphone App Designed to Collect Health Information in Older Adults: Usability Study %A Murabito,Joanne M %A Faro,Jamie M %A Zhang,Yuankai %A DeMalia,Angelo %A Hamel,Alexander %A Agyapong,Nakesha %A Liu,Hongshan %A Schramm,Eric %A McManus,David D %A Borrelli,Belinda %+ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St Suite L-516, Boston, MA, 02118, United States, 1 508 935 3500, murabito@bu.edu %K mobile application surveys %K mixed methods %K electronic data collection %K mHealth %K mobile health %K mobile application %K mobile applications %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K usability %K usable %K usableness %K usefulness %K utility %K health information %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38815261 %R 10.2196/56653 %U https://humanfactors.jmir.org/2024/1/e56653 %U https://doi.org/10.2196/56653 %U http://www.ncbi.nlm.nih.gov/pubmed/38815261 %0 Journal Article %@ 2369-2529 %I %V 11 %N %P e54699 %T Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study %A Rony,Rahat Jahangir %A Amir,Shajnush %A Ahmed,Nova %A Atiba,Samuelson %A Verdezoto,Nervo %A Sparkes,Valerie %A Stawarz,Katarzyna %K rehabilitation %K wearables %K upper-limb rehabilitation %K user-centered design %K qualitative %K interviews %K experiences %K attitudes %K perceptions %K digital health %K health technology %K wearable %K user centered design %K design %K home %K stroke %K recovery %K affordable %K low income %K low resource %K Bangladesh %K physiotherapy %D 2024 %7 28.5.2024 %9 %J JMIR Rehabil Assist Technol %G English %X 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. %R 10.2196/54699 %U https://rehab.jmir.org/2024/1/e54699 %U https://doi.org/10.2196/54699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54010 %T 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 %A Dinh,Mackenzie %A Lin,Chun Chieh %A Whitfield,Candace %A Farhan,Zahera %A Meurer,William J %A Bailey,Sarah %A Skolarus,Lesli E %+ Davee Department of Neurology, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, United States, 1 312 503 0399, lesli.skolarus@northwestern.edu %K hypertension %K cognition %K mobile health %K Bluetooth %K remote %K monitoring %K monitor %K low income %K mHealth %K hypertensive %K cardiology %K cardiovascular %K feasibility %K acceptability %K satisfaction %K RCT %K randomized controlled trial %K assessment %K blood pressure %K neurological %K mobile health %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 38805251 %R 10.2196/54010 %U https://formative.jmir.org/2024/1/e54010 %U https://doi.org/10.2196/54010 %U http://www.ncbi.nlm.nih.gov/pubmed/38805251 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e41202 %T 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 %A Collins-Pisano,Caroline %A Leggett,Amanda N %A Gambee,David %A Fortuna,Karen L %+ Department of Psychology, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO, 80918, United States, 1 (719) 255 8227, ccolli20@uccs.edu %K family caregivers %K dementia %K peer support %K technology %K mobile phone %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38801660 %R 10.2196/41202 %U https://humanfactors.jmir.org/2024/1/e41202 %U https://doi.org/10.2196/41202 %U http://www.ncbi.nlm.nih.gov/pubmed/38801660 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54145 %T Evaluation of the Parkinson’s Remote Interactive Monitoring System in a Clinical Setting: Usability Study %A Bridges,Bronwyn %A Taylor,Jake %A Weber,John Thomas %+ School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, 1 709 864 7261, jweber@mun.ca %K Parkinson disease %K usability %K remote monitoring %K motor examination %K movement disorders %K thematic analysis %K System Usability Scale %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38787603 %R 10.2196/54145 %U https://humanfactors.jmir.org/2024/1/e54145 %U https://doi.org/10.2196/54145 %U http://www.ncbi.nlm.nih.gov/pubmed/38787603 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51789 %T Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment %A Washington,Karla T %A Oliver,Debra Parker %A Donehower,Allison K %A White,Patrick %A Benson,Jacquelyn J %A Lyons,Patrick G %A Demiris,George %+ Department of Medicine, School of Medicine, Washington University in St. Louis, Mid Campus Center, 4590 Children's Place, Mailstop 90-29-931, St. Louis, MO, 63110, United States, 1 (314) 285 0905, kwashington@wustl.edu %K caregivers %K home care services %K hospice care %K signs and symptoms %K technology %K mobile phone %D 2024 %7 23.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38781581 %R 10.2196/51789 %U https://humanfactors.jmir.org/2024/1/e51789 %U https://doi.org/10.2196/51789 %U http://www.ncbi.nlm.nih.gov/pubmed/38781581 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53691 %T Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions %A Aspelund,Anna %A Valkonen,Paula %A Viitanen,Johanna %A Rauta,Virpi %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo, FI-00076, Finland, 358 504763381, anna.aspelund@aalto.fi %K usability %K UX %K user experience %K PX %K patient experience %K user-based evaluation %K patients %K eHealth %K digital health solution %K kidney disease %K home dialysis %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38743476 %R 10.2196/53691 %U https://humanfactors.jmir.org/2024/1/e53691 %U https://doi.org/10.2196/53691 %U http://www.ncbi.nlm.nih.gov/pubmed/38743476 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50430 %T A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study %A Papadopoulos,Petros %A Soflano,Mario %A Connolly,Thomas %+ University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 7920756076, petros.papadopoulos@gmail.com %K mobile health %K mHealth %K digital health intervention %K total knee replacement %K TKR %K total hip replacement %K THR %K dynamic hip screw %K DHS %K rehabilitation %K usability %K mobile phone %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38743479 %R 10.2196/50430 %U https://humanfactors.jmir.org/2024/1/e50430 %U https://doi.org/10.2196/50430 %U http://www.ncbi.nlm.nih.gov/pubmed/38743479 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50747 %T Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study %A Marier-Deschenes,Pascale %A Pinard,Anne Marie %A Jalbert,Laura %A LeBlanc,Annie %+ CIRRIS, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 525, boul. Wilfrid-Hamel Québec, Québec, QC, G1M 2S8, Canada, 1 418 649 3735, pascale.marier-deschenes.1@ulaval.ca %K persistent pain %K eHealth %K self-paced intervention %K web-based program %K evidence based %K web based %K self-management %K pain %K chronic pain %K mixed methods study %K pain treatment %K pain education %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 findings 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 %M 38701440 %R 10.2196/50747 %U https://humanfactors.jmir.org/2024/1/e50747 %U https://doi.org/10.2196/50747 %U http://www.ncbi.nlm.nih.gov/pubmed/38701440 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52957 %T Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study %A Innominato,Pasquale F %A Macdonald,Jamie H %A Saxton,Wendy %A Longshaw,Laura %A Granger,Rachel %A Naja,Iman %A Allocca,Carlo %A Edwards,Ruth %A Rasheed,Solah %A Folkvord,Frans %A de Batlle,Jordi %A Ail,Rohit %A Motta,Enrico %A Bale,Catherine %A Fuller,Claire %A Mullard,Anna P %A Subbe,Christian P %A Griffiths,Dawn %A Wreglesworth,Nicholas I %A Pecchia,Leandro %A Fico,Giuseppe %A Antonini,Alessio %+ Knowledge Media Institute, The Open University, Level 4, Room 4, Berrill Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908 654356, alessio.antonini@open.ac.uk %K cancer %K survivorship %K artificial intelligence %K remote monitoring %K mobile health %K mHealth %K digital health %K circadian %K actigraphy %K mobile phone %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 38687985 %R 10.2196/52957 %U https://www.researchprotocols.org/2024/1/e52957 %U https://doi.org/10.2196/52957 %U http://www.ncbi.nlm.nih.gov/pubmed/38687985 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51612 %T Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing %A Tremoulet,Patrice D %A Lobo,Andrea F %A Simmons,Christina A %A Baliga,Ganesh %A Brady,Matthew %+ Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall Room 115K, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53777, tremoulet@rowan.edu %K technology prototype %K data collection %K documentation %K direct support professionals %K intellectual and developmental disabilities %K pilot test %K mobile phone %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38662420 %R 10.2196/51612 %U https://humanfactors.jmir.org/2024/1/e51612 %U https://doi.org/10.2196/51612 %U http://www.ncbi.nlm.nih.gov/pubmed/38662420 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48173 %T Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial %A Grove,Birgith Engelst %A de Thurah,Annette %A Ivarsen,Per %A Kvisgaard,Ann Katrine %A Hjollund,Niels Henrik %A Grytnes,Regine %A Schougaard,Liv Marit Valen %+ AmbuFlex, Centre for Patient-Reported Outcomes, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark, 45 28904835, bigcri@rm.dk %K chronic kidney disease %K pragmatic randomized controlled trial %K process evaluation %K patient-reported outcome measures %K remote monitoring %K monitoring %K patient-reported outcome %K chronic kidney %K intervention %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 38656781 %R 10.2196/48173 %U https://formative.jmir.org/2024/1/e48173 %U https://doi.org/10.2196/48173 %U http://www.ncbi.nlm.nih.gov/pubmed/38656781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56883 %T Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Pang,Wei %A Holyoke,Paul %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 548 889 4492, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia neuropsychological tests %K evaluation study %K technology %K aged %K mobile phone %D 2024 %7 19.4.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (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 %M 38640480 %R 10.2196/56883 %U https://www.jmir.org/2024/1/e56883 %U https://doi.org/10.2196/56883 %U http://www.ncbi.nlm.nih.gov/pubmed/38640480 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e46811 %T A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study %A Medina-García,Rodrigo %A López-Rodríguez,Juan A %A Lozano-Hernández,Cristina María %A Ruiz Bejerano,Verónica %A Criscio,Paride %A Del Cura-González,Isabel %A , %+ General Ricardos Primary Health Care Centre, Madrid Health Service, Calle General Ricardos, 131, Madrid, 28019, Spain, 34 660802663, rodrigo.medina@salud.madrid.org %K user-centered design %K multimorbidity %K comorbid %K self-care %K medical informatics %K primary health care %K chronic disease %K chronic condition %K chronic illness %K primary care %K usability %K telemedicne %K telehealth %K information and communication technologies %K ICT %K digital health %K eHealth %K human-computer interaction %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 38578675 %R 10.2196/46811 %U https://humanfactors.jmir.org/2024/1/e46811 %U https://doi.org/10.2196/46811 %U http://www.ncbi.nlm.nih.gov/pubmed/38578675 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51522 %T Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing %A Adler,Rachel F %A Baez,Kevin %A Morales,Paulina %A Sotelo,Jocelyn %A Victorson,David %A Magasi,Susan %+ School of Information Sciences, University of Illinois Urbana-Champaign, 501 E. Daniel St., Champaign, IL, 61820, United States, 1 217 244 4192, radler@illinois.edu %K mobile health %K mHealth %K apps %K usability %K cancer survivors %K accessibility %K disabilities %K cancer %K oncology %K heuristics %K empowerment %K advocacy %K mindfulness %K problem-solving %D 2024 %7 2.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38564261 %R 10.2196/51522 %U https://humanfactors.jmir.org/2024/1/e51522 %U https://doi.org/10.2196/51522 %U http://www.ncbi.nlm.nih.gov/pubmed/38564261 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54854 %T Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation %A Haag,Susan %A Kepros,John %+ Scottsdale Osborn Medical Center, 7400 E Osborn Rd, Scottsdale, AZ, 85251, United States, 1 480 323 4018, susan.haag@ymail.com %K health care interventions and technologies %K user experience research %K usability %K brain injury %K ground-level fall (GLF) %K head protection device (HPD) %K fall risk %K patient compliance %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=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. %M 38502170 %R 10.2196/54854 %U https://humanfactors.jmir.org/2024/1/e54854 %U https://doi.org/10.2196/54854 %U http://www.ncbi.nlm.nih.gov/pubmed/38502170 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e45275 %T Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services %A Savolainen,Kaisa %A Kujala,Sari %+ Department of Computer Science, Aalto University School of Science, Konemiehentie 2, Espoo, 02150, Finland, 358 503101457, kaisa.savolainen@aalto.fi %K eHealth %K online symptom checkers %K usability %K cognitive accessibility %K web accessibility %K qualitative research %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38457214 %R 10.2196/45275 %U https://humanfactors.jmir.org/2024/1/e45275 %U https://doi.org/10.2196/45275 %U http://www.ncbi.nlm.nih.gov/pubmed/38457214 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52885 %T Leveraging Generative AI Tools to Support the Development of Digital Solutions in Health Care Research: Case Study %A Rodriguez,Danissa V %A Lawrence,Katharine %A Gonzalez,Javier %A Brandfield-Harvey,Beatrix %A Xu,Lynn %A Tasneem,Sumaiya %A Levine,Defne L %A Mann,Devin %+ Department of Population Health, New York University Grossman School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, United States, 1 646 501 2684, danissa.rodriguez@nyulangone.org %K digital health %K GenAI %K generative %K artificial intelligence %K ChatGPT %K software engineering %K mHealth %K mobile health %K app %K apps %K application %K applications %K diabetes %K diabetic %K diabetes prevention %K digital prescription %K software %K engagement %K behaviour change %K behavior change %K developer %K developers %K LLM %K LLMs %K language model %K language models %K NLP %K natural language processing %D 2024 %7 6.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 38446539 %R 10.2196/52885 %U https://humanfactors.jmir.org/2024/1/e52885 %U https://doi.org/10.2196/52885 %U http://www.ncbi.nlm.nih.gov/pubmed/38446539 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50926 %T Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking %A Anders,Carolin %A Moorthy,Preetha %A Svensson,Laura %A Müller,Julia %A Heinze,Oliver %A Knaup,Petra %A Wallwiener,Markus %A Deutsch,Thomas M %A Le,Thao-Vy %A Weinert,Lina %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34651, Carolin.Anders@med.uni-heidelberg.de %K mobile health %K mHealth %K usability %K breast cancer %K eye tracking %K user interface %K mixed methods %K mobile phone %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38441959 %R 10.2196/50926 %U https://humanfactors.jmir.org/2024/1/e50926 %U https://doi.org/10.2196/50926 %U http://www.ncbi.nlm.nih.gov/pubmed/38441959 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e48445 %T Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study %A Østervang,Christina %A Jensen,Charlotte Myhre %A Coyne,Elisabeth %A Dieperink,Karin B %A Lassen,Annmarie %+ Department of Emergency Medicine, Odense University Hospital, Kløvervænget 25, Odense, 5000, Denmark, 45 21757009, christina.oestervang@rsyd.dk %K consumer %K eHealth %K elderly %K emergency department %K emergency %K family members %K healthcare professionals %K information system %K mixed methods research: patients %K qualitative interview %K questionnaire %K technology %K usability %K usable %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38381502 %R 10.2196/48445 %U https://humanfactors.jmir.org/2024/1/e48445 %U https://doi.org/10.2196/48445 %U http://www.ncbi.nlm.nih.gov/pubmed/38381502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45492 %T Multiple Perspectives on the Adoption of SMART Technologies for Improving Care of Older People: Mixed Methods Study %A Elavsky,Steriani %A Knapova,Lenka %A Janiš,Kamil %A Cimler,Richard %A Kuhnova,Jitka %A Cernicky,Tomas %+ Department of Human Movement Studies, University of Ostrava, Varenska 40a, Ostrava, 70200, Czech Republic, 420 553 46 2588, steriani.elavsky@osu.cz %K adults %K older %K technologies %K technological %K caregivers %K SMART %K mobile phone %D 2024 %7 7.2.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38324345 %R 10.2196/45492 %U https://www.jmir.org/2024/1/e45492 %U https://doi.org/10.2196/45492 %U http://www.ncbi.nlm.nih.gov/pubmed/38324345 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e45494 %T The Role of Coherent Robot Behavior and Embodiment in Emotion Perception and Recognition During Human-Robot Interaction: Experimental Study %A Fiorini,Laura %A D'Onofrio,Grazia %A Sorrentino,Alessandra %A Cornacchia Loizzo,Federica Gabriella %A Russo,Sergio %A Ciccone,Filomena %A Giuliani,Francesco %A Sancarlo,Daniele %A Cavallo,Filippo %+ Department of Industrial Engineering, University of Florence, Via Santa Marta 3, Firenze, 50139, Italy, 39 0552758663, laura.fiorini@unifi.it %K social robot %K emotion recognition %K human emotion perception %K human-robot interaction %K robot cospeech gestures evaluation %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38277201 %R 10.2196/45494 %U https://humanfactors.jmir.org/2024/1/e45494 %U https://doi.org/10.2196/45494 %U http://www.ncbi.nlm.nih.gov/pubmed/38277201 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e47755 %T Usability of an App for Medical History Taking in General Practice From the Patients’ Perspective: Cross-Sectional Study %A Albrink,Klara %A Schröder,Dominik %A Joos,Carla %A Müller,Frank %A Noack,Eva Maria %+ Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany, 49 551 39 65745, evamaria.noack@med.uni-goettingen.de %K digitization %K application software %K usability %K mHealth %K history of present illness %K medical history taking %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 38180798 %R 10.2196/47755 %U https://humanfactors.jmir.org/2024/1/e47755 %U https://doi.org/10.2196/47755 %U http://www.ncbi.nlm.nih.gov/pubmed/38180798 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48677 %T An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing %A Huguet,Anna %A Rozario,Sharlene %A Wozney,Lori %A McGrath,Patrick J %+ Department of Psychology, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 977 55 80 96, anna.huguet@urv.cat %K adolescents %K cognitive-behavioral intervention %K design process %K end users %K headaches %K internet %K usability %K young adult %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38085567 %R 10.2196/48677 %U https://humanfactors.jmir.org/2023/1/e48677 %U https://doi.org/10.2196/48677 %U http://www.ncbi.nlm.nih.gov/pubmed/38085567 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e52088 %T Evaluating the Clinical Use and Utility of a Digital Support App for Employees With Chronic Pain Returning to Work (SWEPPE): Observational Study %A Turesson,Christina %A Liedberg,Gunilla %A Björk,Mathilda %+ Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Kåkenhus, Bredgatan 32, Linköping, 581 85, Sweden, 46 11363602, christina.turesson@liu.se %K chronic pain %K digital support %K eHealth %K return-to-work %K user data %K mobile phone %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 38079212 %R 10.2196/52088 %U https://humanfactors.jmir.org/2023/1/e52088 %U https://doi.org/10.2196/52088 %U http://www.ncbi.nlm.nih.gov/pubmed/38079212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48609 %T A Codeveloped Web-Based Disability Disclosure Toolkit for Youth With Disabilities: Mixed Methods Pilot Evaluation %A Lindsay,Sally %A Kosareva,Polina %A Thomson,Nicole %A Stinson,Jennifer %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220, slindsay@hollandbloorview.ca %K disability %K disclosure %K employment %K vocational rehabilitation %K youth and young adults %K usability testing %K qualitative %K pilot study %K co-design %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38064264 %R 10.2196/48609 %U https://formative.jmir.org/2023/1/e48609 %U https://doi.org/10.2196/48609 %U http://www.ncbi.nlm.nih.gov/pubmed/38064264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50029 %T Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study %A Ha,Sandeul %A Ho,Seung Hee %A Bae,Young-Hyeon %A Lee,Minyoung %A Kim,Ju Hee %A Kim,Ju Han %A Lee,Jisan %+ Department of Nursing, Gangneung-Wonju National University, 402 W5 Department of Nursing, Gangneung-Wonju National University,, 150 Namwon-ro, Heungeop-myeon, Wonju, Gangwon State, 26403, Republic of Korea, 82 33 760 8646, saan2mari@gmail.com %K digital health equity %K digital health care service %K COVID-19 %K mobile health %K mHealth %K mobile apps %K needs assessments %K heuristic %K people with disability %K caregivers %K health personnel %K mobile phone %D 2023 %7 28.11.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38015589 %R 10.2196/50029 %U https://www.jmir.org/2023/1/e50029 %U https://doi.org/10.2196/50029 %U http://www.ncbi.nlm.nih.gov/pubmed/38015589 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47025 %T Ultrasound-Assisted Continence Care Support in an Inpatient Care Setting: Protocol for a Pilot Implementation Study %A Hofstetter,Sebastian %A Ritter-Herschbach,Madeleine %A Behr,Dominik %A Jahn,Patrick %+ AG-Versorgungsforschung/Pflege im Krankenhaus, Departement of Internel Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, Halle (Saale), 06120, Germany, 49 +345557 ext 4244, sebastian.hofstetter@medizin.uni-halle.de %K bladder control %K bladder dysfunction %K continence care %K digitization %K incontinence %K nursing %K selfmanagement %K ultrasound %K urology %K user requirements %D 2023 %7 13.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37317590 %R 10.2196/47025 %U https://www.researchprotocols.org/2023/1/e47025 %U https://doi.org/10.2196/47025 %U http://www.ncbi.nlm.nih.gov/pubmed/37317590 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44644 %T A Visual Analytic Tool (VIADS) to Assist the Hypothesis Generation Process in Clinical Research: Mixed Methods Usability Study %A Jing,Xia %A Patel,Vimla L %A Cimino,James J %A Shubrook,Jay H %A Zhou,Yuchun %A Draghi,Brooke N %A Ernst,Mytchell A %A Liu,Chang %A De Lacalle,Sonsoles %+ Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, 519 Edwards Hall, Clemson, SC, 29634, United States, 1 8646563347, xia.xjing@gmail.com %K usability %K VIADS %K data-driven hypothesis generation %K visualization %K clinical research %K SUS %K mixed methods study %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 37011112 %R 10.2196/44644 %U https://humanfactors.jmir.org/2023/1/e44644 %U https://doi.org/10.2196/44644 %U http://www.ncbi.nlm.nih.gov/pubmed/37011112 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43861 %T Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study %A Davoody,Nadia %A Eghdam,Aboozar %A Koch,Sabine %A Hägglund,Maria %+ Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, , Sweden, 46 (0)8 524 864 86, nadia.davoody@ki.se %K usability testing %K stroke %K aphasia %K eHealth %K rehabilitation %K co-design %K evaluation %K user-centered design %K effectiveness %K user satisfaction %K mobile phone %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 37067848 %R 10.2196/43861 %U https://humanfactors.jmir.org/2023/1/e43861 %U https://doi.org/10.2196/43861 %U http://www.ncbi.nlm.nih.gov/pubmed/37067848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42224 %T Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App %A Dittrich,Florian %A Albrecht,Urs-Vito %A Scherer,Julian %A Becker,Sören L %A Landgraeber,Stefan %A Back,David Alexander %A Fessmann,Kai %A Haversath,Marcel %A Beck,Sascha %A Abbara-Czardybon,Mona %A Quitmann,Henning %A Harren,Anna Katharina %A Aitzetmüller,Matthias %A Klietz,Marie Luise %+ Department of Digital Medicine, Medical Faculty Ost-Westfalen-Lippe, Bielefeld University, Bielefeld, Germany, 49 521106867, urs-vito.albrecht@uni-bielefeld.de %K smartphone %K mHealth %K backend %K usability %K UX %K user experience %K mHealth %K mobile health %K health app %K mobile app %K app development %K no-code %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 37052998 %R 10.2196/42224 %U https://formative.jmir.org/2023/1/e42224 %U https://doi.org/10.2196/42224 %U http://www.ncbi.nlm.nih.gov/pubmed/37052998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41222 %T Usability Testing of a Web-Based Empathy Training Portal: Mixed Methods Study %A Lobchuk,Michelle %A Hoplock,Lisa %A Harder,Nicole %A Friesen,Marcia %A Rempel,Julie %A Bathi,Prachotan Reddy %+ College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Rm 315 - 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada, 1 2044747135, Michelle.Lobchuk@umanitoba.ca %K web application %K usability %K mixed design research %K internet %K empathy %K mobile phone %K mobile devices %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 37014693 %R 10.2196/41222 %U https://formative.jmir.org/2023/1/e41222 %U https://doi.org/10.2196/41222 %U http://www.ncbi.nlm.nih.gov/pubmed/37014693 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43729 %T Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation %A Barton,Hanna J %A Salwei,Megan E %A Rutkowski,Rachel A %A Wust,Kathryn %A Krause,Sheryl %A Hoonakker,Peter LT %A Dail,Paula vW %A Buckley,Denise M %A Eastman,Alexis %A Ehlenfeldt,Brad %A Patterson,Brian W %A Shah,Manish N %A King,Barbara J %A Werner,Nicole E %A Carayon,Pascale %+ Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, 3139 Engineering Centers Building, 1550 Engineering Drive, Madison, WI, 53706, United States, 1 6083586120, hbarton@wisc.edu %K patient safety %K heuristic evaluation %K usability %K emergency medicine %K safety %K emergency %K human factors engineering %K usability %K discharge summary %K documentation %K heuristic %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 36892941 %R 10.2196/43729 %U https://humanfactors.jmir.org/2023/1/e43729 %U https://doi.org/10.2196/43729 %U http://www.ncbi.nlm.nih.gov/pubmed/36892941 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42572 %T Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study %A Christensen,Oliver Rønn %A Hedegaard,Leonora %A Rask,Mette Trøllund %A Clemensen,Jane %A Frostholm,Lisbeth %A Rosendal,Marianne %+ Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, Aarhus N, 8200, Denmark, 45 26540918, oliver.ronn.christensen@gmail.com %K eHealth %K digital health %K medically unexplained symptom %K persistent physical symptom %K self-management %K usability %K physical symptom %K persistent symptom %K unexplained symptom %K symptom management %K unguided %K thinking aloud %K think aloud %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 36753312 %R 10.2196/42572 %U https://humanfactors.jmir.org/2023/1/e42572 %U https://doi.org/10.2196/42572 %U http://www.ncbi.nlm.nih.gov/pubmed/36753312 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39646 %T Understanding a Care Management System’s Role in Influencing a Transitional-Aged Youth Program’s Practice: Mixed Methods Study %A Rizvi,Rubina F %A VanHouten,Courtney B %A Willis,Van C %A Rosario,Bedda L %A South,Brett R %A Sands-Lincoln,Megan %A Brotman,David %A Lenert,Jeffery %A Snowdon,Jane L %A Jackson,Gretchen P %+ IBM Watson Health, 75 Binney St, Cambridge, MA, 02142, United States, 1 4432865723, david.brotman@ibm.com %K care management solution %K foster care youth %K mixed methods study %K interviews %K qualitative data %K quantitative data %K process improvement %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 36525294 %R 10.2196/39646 %U https://humanfactors.jmir.org/2022/4/e39646 %U https://doi.org/10.2196/39646 %U http://www.ncbi.nlm.nih.gov/pubmed/36525294 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e42057 %T Usability and Teachability of Continuous Glucose Monitoring Devices in Older Adults and Diabetes Educators: Task Analysis and Ease-of-Use Survey %A Psavko,Simon %A Katz,Noam %A Mirchi,Tina %A Green,Courtney R %+ Dexcom, Inc, 6340 Sequence Dr, San Diego, CA, 92121-4356, United States, 1 858 529 4128, courtney.green@dexcom.com %K medical devices %K wearable devices %K older adults %K task analysis %K usability testing %K continuous glucose monitoring %K glucose monitoring %K glucose levels %K diabetes %K usability %D 2022 %7 15.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 36347498 %R 10.2196/42057 %U https://humanfactors.jmir.org/2022/4/e42057 %U https://doi.org/10.2196/42057 %U http://www.ncbi.nlm.nih.gov/pubmed/36347498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e36949 %T Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study %A Jarvis,Tamika %A Mah,Allison M L %A Wang,Rosalie H %A Wilson,Michael G %+ McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, MML-417, Canada, 1 905 525 9140 ext 22121, wilsom2@mcmaster.ca %K assistive technology %K program funding %K usability testing %K internet %K web-based database %K health services %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36326813 %R 10.2196/36949 %U https://formative.jmir.org/2022/11/e36949 %U https://doi.org/10.2196/36949 %U http://www.ncbi.nlm.nih.gov/pubmed/36326813 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e35592 %T Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study %A Villalobos,Jennifer Paola %A Bull,Sheana Salyers %A Portz,Jennifer Dickman %+ Colorado School of Public Health, University of Colorado, 13055 E 17th Ave, Mail Stop #F802, Aurora, CO, 80045, United States, 1 303 551 3823, jennifer.p.villalobos@gmail.com %K mHealth %K older adult %K symptom %K heart failure %K palliative care %K app %K digital health %K cardiology %K heart %K Convoy-Pal %K mobile %K tablet %K smartwatch %K adult %K aging %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Aging %G English %X 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. %M 36201402 %R 10.2196/35592 %U https://aging.jmir.org/2022/4/e35592 %U https://doi.org/10.2196/35592 %U http://www.ncbi.nlm.nih.gov/pubmed/36201402 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e35381 %T User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study %A Agbadje,Titilayo Tatiana %A Pilon,Chantale %A Bérubé,Pierre %A Forest,Jean-Claude %A Rousseau,François %A Rahimi,Samira Abbasgholizadeh %A Giguère,Yves %A Légaré,France %+ VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec, QC, G1G 2G1, Canada, 1 418 663 5313, France.Legare@mfa.ulaval.ca %K shared decision-making %K computer-based decision aid %K prenatal screening %K trisomy %K Down syndrome %K mixed methods %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 35896164 %R 10.2196/35381 %U https://pediatrics.jmir.org/2022/3/e35381 %U https://doi.org/10.2196/35381 %U http://www.ncbi.nlm.nih.gov/pubmed/35896164 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e36861 %T Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study %A Tung,Keith T S %A Wong,Rosa S %A Ho,Frederick K %A Chan,Ko Ling %A Wong,Wilfred H S %A Leung,Hugo %A Leung,Ming %A Leung,Gilberto K K %A Chow,Chun Bong %A Ip,Patrick %+ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, NCB 123, Queen Mary Hospital, Hong Kong, Hong Kong, 852 22554090, patricip@hku.hk %K injury %K indicators %K modified Delphi research design %K surveillance %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35980728 %R 10.2196/36861 %U https://publichealth.jmir.org/2022/8/e36861 %U https://doi.org/10.2196/36861 %U http://www.ncbi.nlm.nih.gov/pubmed/35980728 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36975 %T A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study %A Boutilier,Justin J %A Loganathar,Priya %A Linden,Anna %A Scheer,Eleanore %A Noejovich,Sofia %A Elliott,Christian %A Zuraw,Matthew %A Werner,Nicole E %+ Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, 1025 E 7th St, Bloomington, IN, 47405, United States, 1 703 340 7177, newerner@iu.edu %K Alzheimer disease and related dementias %K mHealth %K caregivers %K dementia caregiving %K eHealth %K telehealth %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Aging %G English %X 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 4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. Conclusions: The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. Trial Registration: ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3726-4 %M 35230243 %R 10.2196/35399 %U https://humanfactors.jmir.org/2022/1/e35399 %U https://doi.org/10.2196/35399 %U http://www.ncbi.nlm.nih.gov/pubmed/35230243 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e23794 %T User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study %A Chowdhary,Kuntal %A Yu,Daihua Xie %A Pramana,Gede %A Mesoros,Matthew %A Fairman,Andrea %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6052 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K cellular phone %K mobile apps %K telemedicine %K adaptive mHealth %K rehabilitation %K self-care %K spinal cord injury %K spina bifida %K chronic disease %K persons with disability %K accessibility %K dexterity impairments %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules—MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants’ dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. %M 35200144 %R 10.2196/23794 %U https://humanfactors.jmir.org/2022/1/e23794 %U https://doi.org/10.2196/23794 %U http://www.ncbi.nlm.nih.gov/pubmed/35200144 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32815 %T Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study %A Blair,Rachel A %A Horn,Christine E %A Dias,Jennifer M %A McDonnell,Marie E %A Seely,Ellen W %+ Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, United States, 1 6177329479, rblair4@bwh.harvard.edu %K gestational diabetes mellitus %K SMS text messaging %K mobile phone %K mobile health %K pregnancy %K blood glucose self-monitoring %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective: This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods: An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results: Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions: Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed. %M 35191851 %R 10.2196/32815 %U https://humanfactors.jmir.org/2022/1/e32815 %U https://doi.org/10.2196/32815 %U http://www.ncbi.nlm.nih.gov/pubmed/35191851 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32568 %T Web-Based Tool (FH Family Share) to Increase Uptake of Cascade Testing for Familial Hypercholesterolemia: Development and Evaluation %A Bangash,Hana %A Makkawy,Ahmed %A Gundelach,Justin H %A Miller,Alexandra A %A Jacobson,Kimberly A %A Kullo,Iftikhar J %+ Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 5072845467, kullo.iftikhar@mayo.edu %K familial hypercholesterolemia %K cascade testing %K communication %K genetic counselors %K digital tools %K website %K usability %K user experience %K public health %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Familial hypercholesterolemia, a prevalent genetic disorder, remains significantly underdiagnosed in the United States. Cascade testing, wherein individuals diagnosed with familial hypercholesterolemia— probands—contact their family members to inform them of their risk for familial hypercholesterolemia, has low uptake in the United States. Digital tools are needed to facilitate communication between familial hypercholesterolemia probands and their family members and to promote sharing of familial hypercholesterolemia–related risk information. Objective: We aimed to create and evaluate a web-based tool designed to enhance familial communication and promote cascade testing for familial hypercholesterolemia. Methods: A hybrid type 1 implementation science framework and a user-centered design process were used to develop an interactive web-based tool—FH Family Share—that enables familial hypercholesterolemia probands to communicate information about their familial hypercholesterolemia diagnosis with at-risk relatives. Probands can also use the tool to draw a family pedigree and learn more about familial hypercholesterolemia through education modules and curated knowledge resources. Usability guidelines and standards were taken into account during the design and development of the tool. The initial prototype underwent a cognitive walkthrough, which was followed by usability testing with key stakeholders including genetic counselors and patients with familial hypercholesterolemia. Participants navigated the prototype using the think-aloud technique, and their feedback was used to refine features of the tool. Results: Key themes that emerged from the cognitive walkthrough were design, format, navigation, terminology, instructions, and learnability. Expert feedback from the cognitive walkthrough resulted in a rebuild of the web-based tool to align it with institutional standards. Usability testing with genetic counselors and patients with familial hypercholesterolemia provided insights on user experience, satisfaction and interface design and highlighted specific modifications that were made to refine the features of FH Family Share. Genetic counselors and patients with familial hypercholesterolemia suggested inclusion of the following features in the web-based tool: (1) a letter-to-family-member email template, (2) education modules, and (3) knowledge resources. Surveys revealed that 6 of 9 (67%) genetic counselors found information within FH Family Share very easy to find, and 5 of 9 (56%) genetic counselors found information very easy to understand; 5 of 9 (56%) patients found information very easy to find within the website, and 7 of 9 (78%) patients found information very easy to understand. All genetic counselors and patients indicated that FH Family Share was a resource worth returning to. Conclusions: FH Family Share facilitates communication between probands and their relatives. Once informed, at-risk family members have the option to seek testing and treatment for familial hypercholesterolemia. %M 35166678 %R 10.2196/32568 %U https://humanfactors.jmir.org/2022/1/e32568 %U https://doi.org/10.2196/32568 %U http://www.ncbi.nlm.nih.gov/pubmed/35166678 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e27887 %T Enriching the Value of Patient Experience Feedback: Web-Based Dashboard Development Using Co-design and Heuristic Evaluation %A Khanbhai,Mustafa %A Symons,Joshua %A Flott,Kelsey %A Harrison-White,Stephanie %A Spofforth,Jamie %A Klaber,Robert %A Manton,David %A Darzi,Ara %A Mayer,Erik %+ Patient Safety Translational Research Centre, Imperial College London, National Institute for Health Research/Institute of Global Health Innovation, Queen Elizabeth the Queen Mother Wing, St Mary's Campus, London, W2 1NY, United Kingdom, 44 02033126428, m.khanbhai@imperial.ac.uk %K patient experience %K friends and family test %K quality dashboard %K co-design %K heuristic evaluation %K usability %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: There is an abundance of patient experience data held within health care organizations, but stakeholders and staff are often unable to use the output in a meaningful and timely way to improve care delivery. Dashboards, which use visualized data to summarize key patient experience feedback, have the potential to address these issues. Objective: The aim of this study is to develop a patient experience dashboard with an emphasis on Friends and Family Test (FFT) reporting, as per the national policy drive. Methods: A 2-stage approach was used—participatory co-design involving 20 co-designers to develop a dashboard prototype, followed by iterative dashboard testing. Language analysis was performed on free-text patient experience data from the FFT, and the themes and sentiments generated were used to populate the dashboard with associated FFT metrics. Heuristic evaluation and usability testing were conducted to refine the dashboard and assess user satisfaction using the system usability score. Results: The qualitative analysis from the co-design process informed the development of the dashboard prototype with key dashboard requirements and a significant preference for bubble chart display. The heuristic evaluation revealed that most cumulative scores had no usability problems (18/20, 90%), had cosmetic problems only (7/20, 35%), or had minor usability problems (5/20, 25%). The mean System Usability Scale score was 89.7 (SD 7.9), suggesting an excellent rating. Conclusions: The growing capacity to collect and process patient experience data suggests that data visualization will be increasingly important in turning feedback into improvements to care. Through heuristic usability, we demonstrated that very large FFT data can be presented in a thematically driven, simple visual display without the loss of the nuances and still allow for the exploration of the original free-text comments. This study establishes guidance for optimizing the design of patient experience dashboards that health care providers find meaningful, which in turn drives patient-centered care. %M 35113022 %R 10.2196/27887 %U https://humanfactors.jmir.org/2022/1/e27887 %U https://doi.org/10.2196/27887 %U http://www.ncbi.nlm.nih.gov/pubmed/35113022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33716 %T Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation %A Hogan,Timothy P %A Etingen,Bella %A McMahon,Nicholas %A Bixler,Felicia R %A Am,Linda %A Wacks,Rachel E %A Shimada,Stephanie L %A Reilly,Erin D %A Frisbee,Kathleen L %A Smith,Bridget M %+ eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, United States, 1 781 687 3181, Timothy.Hogan@va.gov %K mobile health applications %K pain %K veterans %K usability %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. %M 35049515 %R 10.2196/33716 %U https://formative.jmir.org/2022/1/e33716 %U https://doi.org/10.2196/33716 %U http://www.ncbi.nlm.nih.gov/pubmed/35049515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28368 %T A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study %A Leong,Victoria %A Raheel,Kausar %A Sim,Jia Yi %A Kacker,Kriti %A Karlaftis,Vasilis M %A Vassiliu,Chrysoula %A Kalaivanan,Kastoori %A Chen,S H Annabel %A Robbins,Trevor W %A Sahakian,Barbara J %A Kourtzi,Zoe %+ Psychology, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, 639818, Singapore, 65 6514 1052, victorialeong@ntu.edu.sg %K web-based testing %K neurocognitive assessment %K COVID-19 %K executive functions %K learning %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The global COVID-19 pandemic has triggered a fundamental reexamination of how human psychological research can be conducted safely and robustly in a new era of digital working and physical distancing. Online web-based testing has risen to the forefront as a promising solution for the rapid mass collection of cognitive data without requiring human contact. However, a long-standing debate exists over the data quality and validity of web-based studies. This study examines the opportunities and challenges afforded by the societal shift toward web-based testing and highlights an urgent need to establish a standard data quality assurance framework for online studies. Objective: This study aims to develop and validate a new supervised online testing methodology, remote guided testing (RGT). Methods: A total of 85 healthy young adults were tested on 10 cognitive tasks assessing executive functioning (flexibility, memory, and inhibition) and learning. Tasks were administered either face-to-face in the laboratory (n=41) or online using remote guided testing (n=44) and delivered using identical web-based platforms (Cambridge Neuropsychological Test Automated Battery, Inquisit, and i-ABC). Data quality was assessed using detailed trial-level measures (missed trials, outlying and excluded responses, and response times) and overall task performance measures. Results: The results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab (P>.40 for all comparisons). Moreover, RGT participants out-performed the lab group on measured verbal intelligence (P<.001), which could reflect test environment differences, including possible effects of mask-wearing on communication. Conclusions: These data suggest that the RGT methodology could help ameliorate concerns regarding online data quality—particularly for studies involving high-risk or rare cohorts—and offer an alternative for collecting high-quality human cognitive data without requiring in-person physical attendance. %M 34989691 %R 10.2196/28368 %U https://www.jmir.org/2022/1/e28368 %U https://doi.org/10.2196/28368 %U http://www.ncbi.nlm.nih.gov/pubmed/34989691 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e31130 %T Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study %A Choemprayong,Songphan %A Charoenlap,Chris %A Piromsopa,Krerk %+ Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand, 66 081 552 4224, chris.cha@chula.ac.th %K teleconsultation %K remote consultation %K mobile applications %K usability %K orthopedics %K physician-to-physician consultation %K electronic medical records %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective: This study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated. %M 34931991 %R 10.2196/31130 %U https://humanfactors.jmir.org/2021/4/e31130 %U https://doi.org/10.2196/31130 %U http://www.ncbi.nlm.nih.gov/pubmed/34931991 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e29234 %T Usability of an At-Home Anterior Nares SARS-CoV-2 RT-PCR Sample Collection Kit: Human Factors Feasibility Study %A Strong,Laura E %A Middendorf,Irene %A Turner,Michelle %A Edwards V,David K %A Sama,Varun %A Mou,Joshua %A Adams,K Colleen %+ Exact Sciences Corporation, 5505 Endeavor Lane, Madison, WI, 53719, United States, 1 6088006531, cadams@exactsciences.com %K COVID-19 testing %K at-home collection kit %K SARS-CoV-2 %K feasibility studies %K self-collection %K usability study %K COVID-19 %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Readily available testing for SARS-CoV-2 is necessary to mitigate COVID-19 disease outbreaks. At-home collection kits, in which samples are self-collected without requiring a laboratory or clinic visit and sent to an external laboratory for testing, can provide convenient testing to those with barriers to access. They can prevent unnecessary exposure between patient and clinical staff, increase access for patients with disabilities or remote workers, and decrease burdens on health care resources, such as provider time and personal protective equipment. Exact Sciences developed an at-home collection kit for samples to be tested to detect SARS-CoV-2 that includes an Instructions for Use (IFU) document, which guides people without prior experience on collecting a nasal swab sample. Demonstrating successful sample collection and usability is critical to ensure that these samples meet the same high-quality sample collection standards as samples collected in clinics. Objective: The aim of this study was to determine the usability of a SARS-CoV-2 at-home nasal swab sample collection kit. Methods: A human factors usability study was conducted with 30 subjects without prior medical, laboratory, or health care training and without COVID-19 sample self-collection experience. Subjects were observed while they followed the IFU for the at-home sample collection portion of the SARS-CoV-2 test in a setting that simulated a home environment. IFU usability was further evaluated by requiring the subjects to complete a survey, answer comprehension questions, provide written feedback, and respond to questions from the observer about problems during use. Results: All 30 subjects successfully completed the sample collection process, and all 30 samples were determined by reverse transcription–polymerase chain reaction (RT-PCR) testing to meet quality standards for SARS-CoV-2 testing. The subjects’ written feedback and comments revealed several recommendations to improve the IFU. Conclusions: The study demonstrated the overall usability of an at-home SARS-CoV-2 collection kit. Various feedback mechanisms provided opportunities to improve the wording and graphics for some critical tasks, including placing the label correctly on the tube. A modified IFU was prepared based on study outcomes. %M 34609947 %R 10.2196/29234 %U https://humanfactors.jmir.org/2021/4/e29234 %U https://doi.org/10.2196/29234 %U http://www.ncbi.nlm.nih.gov/pubmed/34609947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29071 %T Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study %A Steele Gray,Carolyn %A Chau,Edward %A Tahsin,Farah %A Harvey,Sarah %A Loganathan,Mayura %A McKinstry,Brian %A Mercer,Stewart W %A Nie,Jason Xin %A Palen,Ted E %A Ramsay,Tim %A Thavorn,Kednapa %A Upshur,Ross %A Wodchis,Walter P %+ Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada, 1 4168047100, Carolyn.SteeleGray@sinaihealth.ca %K older adults %K goal-oriented care %K quality of life %K self-management %K primary care %K eHealth %K pragmatic trial %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective: This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods: A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results: Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=−1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals’ lives and work acted as a key driver of adoption and tool appraisal. Conclusions: This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 %M 34860675 %R 10.2196/29071 %U https://www.jmir.org/2021/12/e29071 %U https://doi.org/10.2196/29071 %U http://www.ncbi.nlm.nih.gov/pubmed/34860675 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30867 %T User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service %A Aminoff,Hedvig %A Meijer,Sebastiaan %A Groth,Kristina %A Arnelo,Urban %+ Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Hälsovägen 11 C, Huddinge, Stockholm, 14157, Sweden, 46 8 790 60 00, hedvigam@kth.se %K telemedicine %K user experience %K satisfaction %K technology acceptance %K usability %K perioperative %K surgery %K consultation %K surgeons %K performance %K evaluation %K teleguidance %K telehealth %K telemedicine implementation %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective: We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. Methods: We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. Results: In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%). Conclusions: Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes. %M 34851302 %R 10.2196/30867 %U https://humanfactors.jmir.org/2021/4/e30867 %U https://doi.org/10.2196/30867 %U http://www.ncbi.nlm.nih.gov/pubmed/34851302 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30308 %T The Collaborative Metadata Repository (CoMetaR) Web App: Quantitative and Qualitative Usability Evaluation %A Stöhr,Mark R %A Günther,Andreas %A Majeed,Raphael W %+ Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Klinikstraße 36, Gießen, 35392, Germany, 49 641 985 42117, mark.stoehr@innere.med.uni-giessen.de %K usability %K metadata %K data visualization %K semantic web %K data management %K data warehousing %K communication barriers %K quality improvement %K biological ontologies %K data curation %D 2021 %7 29.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the field of medicine and medical informatics, the importance of comprehensive metadata has long been recognized, and the composition of metadata has become its own field of profession and research. To ensure sustainable and meaningful metadata are maintained, standards and guidelines such as the FAIR (Findability, Accessibility, Interoperability, Reusability) principles have been published. The compilation and maintenance of metadata is performed by field experts supported by metadata management apps. The usability of these apps, for example, in terms of ease of use, efficiency, and error tolerance, crucially determines their benefit to those interested in the data. Objective: This study aims to provide a metadata management app with high usability that assists scientists in compiling and using rich metadata. We aim to evaluate our recently developed interactive web app for our collaborative metadata repository (CoMetaR). This study reflects how real users perceive the app by assessing usability scores and explicit usability issues. Methods: We evaluated the CoMetaR web app by measuring the usability of 3 modules: core module, provenance module, and data integration module. We defined 10 tasks in which users must acquire information specific to their user role. The participants were asked to complete the tasks in a live web meeting. We used the System Usability Scale questionnaire to measure the usability of the app. For qualitative analysis, we applied a modified think aloud method with the following thematic analysis and categorization into the ISO 9241-110 usability categories. Results: A total of 12 individuals participated in the study. We found that over 97% (85/88) of all the tasks were completed successfully. We measured usability scores of 81, 81, and 72 for the 3 evaluated modules. The qualitative analysis resulted in 24 issues with the app. Conclusions: A usability score of 81 implies very good usability for the 2 modules, whereas a usability score of 72 still indicates acceptable usability for the third module. We identified 24 issues that serve as starting points for further development. Our method proved to be effective and efficient in terms of effort and outcome. It can be adapted to evaluate apps within the medical informatics field and potentially beyond. %M 34847059 %R 10.2196/30308 %U https://medinform.jmir.org/2021/11/e30308 %U https://doi.org/10.2196/30308 %U http://www.ncbi.nlm.nih.gov/pubmed/34847059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31649 %T Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study %A Reichold,Michael %A Heß,Miriam %A Kolominsky-Rabas,Peter %A Gräßel,Elmar %A Prokosch,Hans-Ulrich %+ Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, Erlangen, 91058, Germany, 49 91318526720, michael.reichold@fau.de %K dementia %K usability %K evaluation %K mobile device %K registry %K electronic data collection %K offline %K mobile app %K digital health %K usability testing %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project “Digital Dementia Registry Bavaria (digiDEM Bayern),” interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the “Thinking Aloud” method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the “Thinking Aloud” method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents “good” usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry–based research project. %M 34730543 %R 10.2196/31649 %U https://formative.jmir.org/2021/11/e31649 %U https://doi.org/10.2196/31649 %U http://www.ncbi.nlm.nih.gov/pubmed/34730543 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30169 %T A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study %A Wong,Jill %A Foussat,Agathe C %A Ting,Steven %A Acerbi,Enzo %A van Elburg,Ruurd M %A Mei Chien,Chua %+ Department of Neonatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore, 65 6394 1240, chua.mei.chien@singhealth.com.sg %K chatbot %K parental stress %K parental sleep %K infant feeding %K preterm infants %K term infants %K sleep %K stress %K eHealth %K support %K anxiety %K usability %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as “easy” to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were “satisfied” (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to “discomfort” and “tiredness” were more prevalent in preterm group conversations, whereas the topic of “positive feelings” occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents’ ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 %M 34544679 %R 10.2196/30169 %U https://pediatrics.jmir.org/2021/4/e30169 %U https://doi.org/10.2196/30169 %U http://www.ncbi.nlm.nih.gov/pubmed/34544679 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e27628 %T User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews %A Giang,Wayne C W %A Bland,Emma %A Chen,Jeffrey %A Colón-Morales,Coralys M %A Alvarado,Michelle M %+ Department of Industrial and Systems Engineering, University of Florida, 303 Weil Hall, P.O. Box 116595, Gainesville, FL, 32611-6595, United States, 1 352 294 7729, wayne.giang@ise.ufl.edu %K insurance, health %K health benefits plans %K employee %K decision aids %K cognitive ergonomics %K human factors engineering %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. Objective: This study aims to examine how individuals interact with two different types of health insurance decision aids (guided VBCs that mimic conversations with a real HR counselor and self-directed HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. Methods: In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. Results: Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. Conclusions: This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats. %M 34698647 %R 10.2196/27628 %U https://humanfactors.jmir.org/2021/4/e27628 %U https://doi.org/10.2196/27628 %U http://www.ncbi.nlm.nih.gov/pubmed/34698647 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25646 %T Facilitators of and Barriers to Lifestyle Support and eHealth Solutions: Interview Study Among Health Care Professionals Working in Cardiac Care %A Cohen Rodrigues,Talia R %A de Buisonjé,David R %A Keesman,Mike %A Reijnders,Thomas %A van der Geer,Jessica E %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Atsma,Douwe E %A Evers,Andrea W M %+ Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 71 527 3627, t.r.cohen.rodrigues@fsw.leidenuniv.nl %K eHealth %K digital health %K cardiovascular disease %K cardiac care %K lifestyle change %K lifestyle support %K intervention %K health care professionals %K implementation %K interview %K facilitators %K barriers %D 2021 %7 15.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people’s life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers. Objective: This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD. Methods: In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care. Results: We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth. Conclusions: HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care. %M 34652280 %R 10.2196/25646 %U https://www.jmir.org/2021/10/e25646 %U https://doi.org/10.2196/25646 %U http://www.ncbi.nlm.nih.gov/pubmed/34652280 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28136 %T An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study %A Kruglova,Katya %A O'Connell,Siobhan Bernadette Laura %A Dawadi,Shrinkhala %A Gelgoot,Eden Noah %A Miner,Skye A %A Robins,Stephanie %A Schinazi,Joy %A Zelkowitz,Phyllis %+ Lady Davis Institute for Medical Research, Jewish General Hospital, Ludmer Research & Training Bldg, Montreal, QC, H3A 1A1, Canada, 1 514 340 8222, phyllis.zelkowitz@mcgill.ca %K mHealth app %K mHealth development process %K infertility %K intervention design %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. %M 34636741 %R 10.2196/28136 %U https://formative.jmir.org/2021/10/e28136 %U https://doi.org/10.2196/28136 %U http://www.ncbi.nlm.nih.gov/pubmed/34636741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25837 %T Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study %A Boustani,Maya %A Lunn,Stephanie %A Visser,Ubbo %A Lisetti,Christine %+ Department of Psychology, Loma Linda University, 11130 Anderson St, Suite 117, Loma Linda, CA, 92350, United States, 1 909 558 7680, mboustani@llu.edu %K digital health agent %K virtual health assistant %K online intervention %K alcohol abuse %K brief intervention %K motivational interviewing %K intelligent virtual agent %K embodied conversational agent %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health agents — embodied conversational agents designed specifically for health interventions — provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care. Objective: Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users. Methods: We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility. Results: The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care. Conclusions: Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages. %M 34586074 %R 10.2196/25837 %U https://www.jmir.org/2021/9/e25837 %U https://doi.org/10.2196/25837 %U http://www.ncbi.nlm.nih.gov/pubmed/34586074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28796 %T A Computer-Based Interactive Narrative and a Serious Game for Children With Asthma: Development and Content Validity Analysis %A Sarasmita,Made Ary %A Larasanty,Luh Putu Febryana %A Kuo,Li-Na %A Cheng,Kuei-Ju %A Chen,Hsiang-Yin %+ Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Health and Science Building, 7th Floor, 250 Wuxing Street, Taipei, 110, Taiwan, 886 02 2736 1661 ext 6175, shawn@tmu.edu.tw %K asthma %K computer %K children %K interactive narrative %K serious game %K digital education %K mobile phone %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonadherence to medications, failure to prevent exposure to asthma triggers, lack of knowledge about using medications, and fixed mindsets contribute to poor asthma control in children. Digital learning could provide a new strategy for improving health-related outcomes in children with asthma. Objective: The aim of this study is to develop and design a digital educational program, titled Module of Inhaler and Asthma Triggers for Children (MIRACLE), for Indonesian children with asthma. The program comprises an interactive narrative and a serious game. It was proposed to increase the understanding of asthma self-management, instruct on proper inhaler techniques, improve asthma control, and promote a growth mindset for children with asthma. Methods: Two phases of research were conducted to develop the program. In the first phase, a literature search and two rounds of the Delphi technique were conducted to obtain agreement from an expert panel regarding elements of asthma self-management and the design of interactive narratives and a serious game. The expert panel item statements were evaluated using the content validity index (CVI). In the second phase, the SERES framework, Norma Engaging Multimedia Design, and Psychological Theory of Growth Mindset were applied to create a storyline, learn objectives, and game challenges. Results: In the first phase, 40 experts were invited to participate in Delphi round 1. Forty responses were collected to generate 38 item statements that consisted of part 1, elements of asthma self-management (25 items), and part 2, design of an interactive narrative and a serious game (13 items); 38 experts were involved in Delphi round 2. In total, 24 statements in part 1 and 13 items in part 2 had item-CVI values >0.80. The average CVI was 0.9, which was considered acceptable. Four narrative plots and five game sessions were developed during the second phase. Challenges with the scenario, scoring, and feedback on asthma difficulties were designed to promote a growth mindset for learners. Conclusions: We developed a culture-specific, computer-based asthma program containing an interactive narrative and a serious game to deliver asthma self-management and promote a growth mindset among Indonesian children. %M 34515641 %R 10.2196/28796 %U https://www.jmir.org/2021/9/e28796 %U https://doi.org/10.2196/28796 %U http://www.ncbi.nlm.nih.gov/pubmed/34515641 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e28381 %T Robotic Pharmacy Implementation and Outcomes in Saudi Arabia: A 21-Month Usability Study %A Momattin,Hisham %A Arafa,Shokry %A Momattin,Shahad %A Rahal,Rayan %A Waterson,James %+ Mouwasat Medical Services, Mouwasat Hospital, 16 D Street, Dammam, 32263, Saudi Arabia, 966 9200 04477, Hisham.Momattin@mouwasat.com %K patient satisfaction %K automation %K integration %K medication error %K outpatient %K medication management %K usability %K medication dispensing %K robotics %K pharmacy %K medication records %K error %K record %K implementation %K outcome %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: We describe the introduction, use, and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was specifically undertaken to increase throughput, reduce medication dispensing error rates, improve patient satisfaction, and free up pharmacists’ time to allow for increased face-to-face consultations with patients. Objective: We forecasted growth of our outpatient service at 25% per annum over 5- and 10-year horizons and set out to prepare our outpatient pharmacy service to meet this demand. Initial project goals were set as a 50% reduction in the average patient wait time, a 15% increase in patient satisfaction regarding pharmacy wait time and pharmacy services, a 25% increase in pharmacist productivity, and zero dispensing errors. This was expected to be achieved within 10 months of go-live. Realignment of pharmacist activity toward counseling and medication review with patients was a secondary goal, along with the rapid development of a reputation in the served community for patient-centered care. Methods: Preimplementation data for patient wait time for dispensing of prescribed medications as a specific measure of patient satisfaction was gathered as part of wider ongoing data collection in this field. Pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1000 prescriptions were also aggregated. All preimplementation data was gathered over an 11-month period. Results: From go-live, data were gathered on the above metrics in 1-month increments. At the 10-month point, there had been a 53% reduction in the average wait time, a 20% increase in patient satisfaction regarding pharmacy wait time, with a 22% increase in overall patient satisfaction regarding pharmacy services, and a 33% increase in pharmacist productivity. A zero dispensing error rate was reported. Conclusions: The robotic pharmacy solution studied was highly effective, but a robust upstream supply chain is vital to ensure stock levels, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility’s software systems for appointments, medication records, and prescription generation in order to garner its full benefits. Overall patient satisfaction with pharmacy services is strongly influenced by wait time and follow-up studies are required to identify how to use this positive effect and make optimal use of freed-up pharmacist time. The extra time spent by pharmacists with patients and the opportunity for complete overview of the patient’s medication history, which full integration provides, may allow us to address challenging issues such as medication nonadherence. Reduced wait times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing patients to have increased contact time with pharmacists. %M 34304149 %R 10.2196/28381 %U https://humanfactors.jmir.org/2021/3/e28381 %U https://doi.org/10.2196/28381 %U http://www.ncbi.nlm.nih.gov/pubmed/34304149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28163 %T Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study %A MacPherson,Megan %A Cranston,Kaela %A Johnston,Cara %A Locke,Sean %A Jung,Mary E %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9670, mary.jung@ubc.ca %K text messaging %K prediabetic state %K telemedicine %K telecommunications %K exercise %K diet %K preventive medicine %K mHealth %K intervention development %K behavior change %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective: This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods: A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results: 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions: This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users. %M 34448713 %R 10.2196/28163 %U https://formative.jmir.org/2021/8/e28163 %U https://doi.org/10.2196/28163 %U http://www.ncbi.nlm.nih.gov/pubmed/34448713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24393 %T Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study %A McCall,Terika %A Ali,Muhammad Osama %A Yu,Fei %A Fontelo,Paul %A Khairat,Saif %+ Center for Medical Informatics, Yale School of Medicine, 300 George Street, Suite 501, New Haven, CT, 06511, United States, 1 203 737 5379, terika.mccall@yale.edu %K African Americans %K women %K mental health %K anxiety %K depression %K telemedicine %K mHealth %K mobile applications %K digital health %K user-centered design %K mobile phone %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants’ visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants’ acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. %M 34133313 %R 10.2196/24393 %U https://formative.jmir.org/2021/8/e24393 %U https://doi.org/10.2196/24393 %U http://www.ncbi.nlm.nih.gov/pubmed/34133313 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e24927 %T User Evaluation of the Swedish Patient Accessible Electronic Health Record: System Usability Scale %A Hägglund,Maria %A Scandurra,Isabella %+ Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, 1 tr, Uppsala, 752 37, Sweden, 46 0729999381, maria.hagglund@kbh.uu.se %K usability %K system usability scale %K evaluation %K patient accessible electronic health records %K open notes %K patient portals %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Transparency is increasingly called for in health care, especially, when it comes to patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient accessible electronic health record (PAEHR), accessible online via the national patient portal. User characteristics and perceived benefits of using a PAEHR influence behavioral intention for use and adoption, but poor usability that increases the effort expectancy can have a negative impact. It is, therefore, of interest to explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective: The aim of this study was to explore how the users of the Swedish PAEHR experience the usability of the system and to identify differences in these experiences based on the level of transparency of the region. Methods: A survey study was conducted to elicit opinions and experiences of patients using Journalen. The data were collected from June to October 2016. The questionnaire included questions regarding the usability of the system from the System Usability Scale (SUS). The SUS analysis was the focus of this paper. Analysis was performed on different levels: nationally looking at the whole data set and breaking it down by focusing on 2 different regions to explore differences in experienced usability based on the level of transparency. Results: During the survey period, 423,141 users logged into Journalen, of which 2587 unique users completed the survey (response rate 0.61%). The total mean score for all respondents to the SUS items was 79.81 (SD 14.25), which corresponds to a system with good usability. To further explore whether the level of transparency in a region would affect the user’s experience of the usability of the system, we analyzed the 2 regions with the most respondents: Region Uppsala (the first to launch, with a high level of transparency), and Region Skåne (an early implementer, with a low level of transparency at the time of the survey). Of the participants who responded to at least 1 SUS statement, 520 stated that they had received care in Region Skåne, whereas 331 participants had received care in Region Uppsala. Uppsala’s mean SUS score was 80.71 (SD 13.41), compared with Skåne’s mean of 79.37 (SD 13.78). Conclusions: The Swedish national PAEHR Journalen has a reasonably good usability (mean SUS score 79.81, SD 14.25); however, further research into more specific usability areas are needed to ensure usefulness and ease of use in the future. A somewhat higher SUS score for the region with high transparency compared with the region with low transparency could indicate a relationship between the perceived usability of a PAEHR and the level of transparency offered, but further research on the relationship between transparency and usability is required. %M 34313596 %R 10.2196/24927 %U https://humanfactors.jmir.org/2021/3/e24927 %U https://doi.org/10.2196/24927 %U http://www.ncbi.nlm.nih.gov/pubmed/34313596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22510 %T Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App %A Resnick,Daniel %A Schapira,Marilyn M %A Smith,Jazmine M %A Bautista,Allison %A Xu,Chang %A Jones,Liz %A Aysola,Jaya %+ Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1229 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9475, jaysola@upenn.edu %K mHealth %K cancer prevention %K goal setting %K social networks %K health disparities %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app’s acceptability by qualitatively analyzing open-ended responses regarding participants’ overall experience with the app. We assessed participants’ engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76% (31/41) were women. App use data were captured from all participants, and 83% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app’s ease of use and health behavior–promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal–setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. %M 34259162 %R 10.2196/22510 %U https://formative.jmir.org/2021/7/e22510 %U https://doi.org/10.2196/22510 %U http://www.ncbi.nlm.nih.gov/pubmed/34259162 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e23174 %T Descriptive Review of Online Information Resources for People With Stroke: Protocol for a Scoping Review %A Inglis-Jassiem,Gakeemah %A Grimmer,Karen %A Conradie,Thandi %A Louw,Quinette %+ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg, Cape Town, 8000, South Africa, 27 0219389667, gakeemah@sun.ac.za %K stroke %K online resources %K content %K readability %K design %D 2021 %7 13.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with stroke and their caregivers experience numerous information needs; internet-based resources may offer cost-effective ways to improve access to information about this condition and its management, including the availability of resources and support. The quality of online health information is, therefore, an important consideration for both developers and consumers of these online resources. Objective: This study aims to map and evaluate the content, readability, understandability, design, and quality characteristics of freely available online information resources (ie, websites) that empower people with stroke and their caregivers with information and self-help strategies poststroke. Methods: This descriptive review will follow the five systematic and rigorous methodological steps that are recommended for scoping reviews, which include the following: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarizing, and reporting the results. Data will then be synthesized and analyzed thematically. Results: As of February 2021, the scoping review is in the data extraction stage. Data will be synthesized, and the first results are expected to be submitted for publication in an open-access peer-reviewed journal in August 2021. In addition, we will develop an accessible summary of the results for stakeholder meetings. Ethical approval is not required for this review, as it will only include publicly available information. Conclusions: This study is novel and will evaluate the typology, content, and design-related criteria, including accessibility, aesthetics, navigability, interactivity, privacy, and data protection, of online information resources for stroke. The review will be limited to online resources published in English. International Registered Report Identifier (IRRID): DERR1-10.2196/23174 %M 34255721 %R 10.2196/23174 %U https://www.researchprotocols.org/2021/7/e23174 %U https://doi.org/10.2196/23174 %U http://www.ncbi.nlm.nih.gov/pubmed/34255721 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e18130 %T MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study %A Ding,Eric Y %A Erskine,Nathaniel %A Stut,Wim %A McManus,David D %A Peterson,Amy %A Wang,Ziyue %A Escobar Valle,Jorge %A Albuquerque,Daniella %A Alonso,Alvaro %A Botkin,Naomi F %A Pack,Quinn R %A McManus,David D %+ Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 5088561984, eric.ding@umassmed.edu %K cardiac rehabilitation %K telerehabilitation %K health watch %K mHealth %K exercise %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch–informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch–based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. %M 34255660 %R 10.2196/18130 %U https://humanfactors.jmir.org/2021/3/e18130 %U https://doi.org/10.2196/18130 %U http://www.ncbi.nlm.nih.gov/pubmed/34255660 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e26012 %T Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study %A Willis,Matthew %A Brand Hein,Leah %A Hu,Zhaoxian %A Saran,Rajiv %A Argentina,Marissa %A Bragg-Gresham,Jennifer %A Krein,Sarah L %A Gillespie,Brenda %A Zheng,Kai %A Veinot,Tiffany C %+ School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI, 48109, United States, 1 7347632285, mandwill@umich.edu %K user interaction %K dialysis %K usability %K informatics intervention %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)—low blood pressure during hemodialysis—is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based interventions hold promise as a platform for patient activation. However, little is known about the usability challenges that patients undergoing hemodialysis may face when using tablet-based informatics interventions, especially while dialyzing. Objective: This study aims to test the usability of a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing–based mentoring from patient peers via videoconferencing. Methods: We conducted a cross-sectional, mixed methods usability evaluation of the tablet-based intervention by using think-aloud methods, field notes, and structured observations. These qualitative data were evaluated by trained researchers using a structured data collection instrument to capture objective observational data. We calculated descriptive statistics for the quantitative data and conducted inductive content analysis using the qualitative data. Results: Findings from 14 patients cluster around general constraints such as the use of one arm, dexterity issues, impaired vision, and lack of experience with touch screen devices. Our task-by-task usability results showed that specific sections with the greatest difficulty for users were logging into the intervention (difficulty score: 2.08), interacting with the quizzes (difficulty score: 1.92), goal setting (difficulty score: 2.28), and entering and exiting videoconference rooms (difficulty score: 2.07) that are used to engage with peers during motivational interviewing sessions. Conclusions: In this paper, we present implications for designing informatics interventions for patients on dialysis and detail resulting changes to be implemented in the next version of this intervention. We frame these implications first through the context of the role the patients’ physical body plays when interacting with the intervention and then through the digital considerations for software and interface interaction. %M 34121664 %R 10.2196/26012 %U https://humanfactors.jmir.org/2021/2/e26012 %U https://doi.org/10.2196/26012 %U http://www.ncbi.nlm.nih.gov/pubmed/34121664 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e22915 %T A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study %A McMaughan,Darcy Jones %A Lin,Sherry %A Ozmetin,Jennifer %A Beverly,Judith Gayle %A Brog,Joshua %A Naiser,Emily %+ Oklahoma State University, 423 Willard, Stillwater, OK, United States, 1 979 204 3983, darcy.mcmaughan@okstate.edu %K youth with special health care needs %K health care transitions %K eHealth %K usability %K concurrent think aloud method %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92% (1065/1300) with a cutoff score of 73.33% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76%) and navigation (ease of use: 114/150, 76%; hyperlinks: 163/200, 81.5%; structure: 159/200, 79.5%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. %M 34032579 %R 10.2196/22915 %U https://formative.jmir.org/2021/5/e22915 %U https://doi.org/10.2196/22915 %U http://www.ncbi.nlm.nih.gov/pubmed/34032579 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e19564 %T Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study %A Palotai,Miklos %A Wallack,Max %A Kujbus,Gergo %A Dalnoki,Adam %A Guttmann,Charles %+ Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA, 02215, United States, 1 617 278 0613, palotai@bwh.harvard.edu %K multiple sclerosis %K fatigue %K depression %K mobile application %K mobile phone %K real-time assessment %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88%) used the app, of which 51 (91%) completed all one-time questionnaires and 47 (84%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. %M 33861208 %R 10.2196/19564 %U https://mhealth.jmir.org/2021/4/e19564 %U https://doi.org/10.2196/19564 %U http://www.ncbi.nlm.nih.gov/pubmed/33861208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25657 %T Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation %A Tremoulet,Patrice D %A Shah,Priyanka D %A Acosta,Alisha A %A Grant,Christian W %A Kurtz,Jon T %A Mounas,Peter %A Kirchhoff,Michael %A Wade,Elizabeth %+ Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall Room 115K, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53777, tremoulet@rowan.edu %K discharge summary %K usability %K electronic health record (EHR) %K care coordination %K elderly patients %K patient safety %K heuristic evaluation %K human factors %D 2021 %7 15.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. Objective: This study aimed to (1) identify the information about elderly patients’ recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)–generated discharge summaries, thereby increasing patient safety. Methods: A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. Results: The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 “helpful, but not always necessary” items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. Conclusions: Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition–related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization. %M 33856353 %R 10.2196/25657 %U https://www.jmir.org/2021/4/e25657 %U https://doi.org/10.2196/25657 %U http://www.ncbi.nlm.nih.gov/pubmed/33856353 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e19519 %T Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study %A Richardson,Julie %A Letts,Lori %A Sinclair,Susanne %A Chan,David %A Miller,Jordan %A Donnelly,Catherine %A Smith-Turchyn,Jenna %A Wojkowski,Sarah %A Gravesande,Janelle %A Loyola Sánchez,Adalberto %+ School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, IAHS Room 403, Hamilton, ON, L8S 1C7, Canada, 1 905 525 9140 ext 27811, jrichard@mcmaster.ca %K rehabilitation %K physiotherapy %K occupational therapy %K self-management %K function %K web-based application %K usability %K user-centered design %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ≥45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. %M 33734090 %R 10.2196/19519 %U https://rehab.jmir.org/2021/1/e19519 %U https://doi.org/10.2196/19519 %U http://www.ncbi.nlm.nih.gov/pubmed/33734090 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e24846 %T Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study %A Chaniaud,Noémie %A Megalakaki,Olga %A Capo,Sophie %A Loup-Escande,Emilie %+ Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations, Université de Picardie Jules Verne, Chemin du Thil, Amiens, UR UPJV 7273, France, 33 3 22 82 70 59, noemie.chaniaud@u-picardie.fr %K user characteristics %K health literacy %K home medical devices %K usability study %K remote health %K home health %D 2021 %7 17.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Smart Angel home medical device allows ambulatory surgery patients to monitor their own health by taking their blood pressure and oxygen levels and answering a health questionnaire from home. Currently, this device is a prototype in the design phase, and no usability evaluation has been performed. This preventive device must be usable by patients with different profiles; however, it is important to select patients carefully to ensure their safety when using the device. As such, it would be interesting to know how to select or exclude patients. However, the links between user characteristics and the usability of this home medical device remain unclear. Objective: This study aims to better understand the links between certain characteristics of potential patients (ie, age, education, technophilia, and health literacy) and the usability (ie, effectiveness, efficiency, and satisfaction) of Smart Angel, as defined by the ISO 9241-11. Methods: We conducted an experimental study involving 36 participants investigating the effects of 4 patient characteristics (ie, age, education, technophilia, and health literacy) on usability, measured in terms of effectiveness, efficiency, and satisfaction. A mixed methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). First, to help participants project themselves into the real use of the Smart Angel device, they watched a scenario in a video. Second, the participants completed a set of questionnaires to show the extent of their health literacy level (Newest Vital Sign [NVS] and the Health Literacy Survey [HLS]) and then operated Smart Angel devices. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (System Usability Scale [SUS]). The qualitative observational data were coded using inductive analysis by 2 independent researchers specialized in cognitive psychology and cognitive ergonomics. Results: The results show a moderate and positive correlation between age and effectiveness (r=0.359; P=.03) and efficiency (r=0.357; P=.03). There is strong correlation between health literacy scored by the NVS and effectiveness (r=0.417; P=.01), efficiency (r=-0.38; P=.02), and satisfaction (r=0.45; P=.006). However, there is a weak correlation between technophilia and usability and no relationship between education level and usability. Conclusions: Our results show that literacy level and age are 2 important factors to consider when selecting future users of the Smart Angel device to ensure patient safety. This study also serves as an example promoting mixed methodologies in assessments of medical device usability that cannot be performed under real-world conditions. %M 33729161 %R 10.2196/24846 %U https://humanfactors.jmir.org/2021/1/e24846 %U https://doi.org/10.2196/24846 %U http://www.ncbi.nlm.nih.gov/pubmed/33729161 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26702 %T Going Remote—Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study %A Hill,Jordan R %A Harrington,Addison B %A Adeoye,Philip %A Campbell,Noll L %A Holden,Richard J %+ Department of Medicine, Indiana University School of Medicine, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 7655438559, jrh6@iu.edu %K COVID-19 %K mobile usability testing %K usability inspection %K methods %K aging %K agile %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective: Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods: We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention—a medication management app—and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results: In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions: The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them. Trial Registration: ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858 %M 33606655 %R 10.2196/26702 %U https://mhealth.jmir.org/2021/3/e26702 %U https://doi.org/10.2196/26702 %U http://www.ncbi.nlm.nih.gov/pubmed/33606655 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e18164 %T A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study %A Abrantes,Diogo %A Teles,Soraia %A Tavares de Sousa,Rita %A Freitas,Alberto %A Vieira-Marques,Pedro %A Ferreira,Ana %+ Center for Health Technology and Services Research, University of Porto, Rua Dr Plácido da Costa, s/n, Porto, 4200-450, Portugal, 351 225 513 622, dmabrantes@gmail.com %K aging %K ambient assisted living %K elderly %K usability testing %K user-centered design %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Aging of the global population is slowly paving the way for new markets for care products and services. The desire of older people to maintain their independence while remaining at home is boosting the development of ambient assisted living (AAL) solutions. Lack of user awareness of AAL solutions paired with an insufficient use of user-centered and participatory design approaches in the development of these products has hindered the uptake of these solutions by end users. Objective: This study aims to describe the usability and users’ experiences within a novel platform, ActiveAdvice, aimed at offering advice and a holistic market overview of AAL products and services. Methods: Usability tests were performed on the developed platform among identified prospective end users, with 32 older adults and informal carers from 4 European countries being part of the user tests. The usability and appeal of the web interface design, information flow, and information architecture were analyzed by collecting both objective and subjective measures. These would include pretest and posttest surveys, along with a series of think-aloud tasks to be performed within the platform. Results: The outcomes suggest that the ActiveAdvice platform’s objectives and functionalities are mostly aligned with the needs and expectations of end users, who demonstrated interest in using it, stressing its purpose along with its simple and intuitive interaction. Task completion rates were high, and participants had good satisfaction rates when navigating the platform. However, the tests still advocate for an improved design at some points and better disclosure of information. Conclusions: Our findings shed light on a few peculiarities of interface design, information architecture, user needs, and preferred functionalities, which should be applied to future developments of similar platforms with related services. The AAL field could benefit from tools supporting the dissemination of available AAL solutions and how they can improve one's quality of life. These tools may benefit not only older adults but also caregivers, business owners, and governmental employees. %M 33646134 %R 10.2196/18164 %U https://aging.jmir.org/2021/1/e18164 %U https://doi.org/10.2196/18164 %U http://www.ncbi.nlm.nih.gov/pubmed/33646134 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21986 %T Usability, Perceived Usefulness, and Shared Decision-Making Features of the AFib 2gether Mobile App: Protocol for a Single-Arm Intervention Study %A Kapoor,Alok %A Andrade,Andreza %A Hayes,Anna %A Mazor,Kathleen %A Possidente,Carl %A Nolen,Kim %A Hegeman-Dingle,Rozelle %A McManus,David %+ Department of Medicine, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, United States, 1 9178564538, Alok.Kapoor@umassmemorial.org %K shared decision making %K mobile health %K stroke risk %K anticoagulation risk %K anticoagulation education %K atrial fibrillation %K anticoagulation therapy %K anticoagulation %K atrial flutter %K mobile phone %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Centers for Disease Control and Prevention has estimated that atrial fibrillation (AF) affects between 2.7 million and 6.1 million people in the United States. Those who have AF tend to have a much higher stroke risk than others. Although most individuals with AF benefit from anticoagulation (AC) therapy, a significant majority are hesitant to start it. To add, providers often struggle in helping patients negotiate the decision to start AC therapy. To assist in the communication between patients and providers regarding preferences and knowledge about AC therapy, different strategies are being used to try and solve this problem. In this research study, we will have patients and providers utilize the AFib 2gether app with hopes that it will create a platform for shared decision making regarding the prevention of stroke in patients with AF receiving AC therapy. Objective: The aim of our study is to measure several outcomes related to encounters between patients and their cardiology providers where AFib 2gether is used. These outcomes include usability and perceived usefulness of the app from the perspective of patients and providers. In addition, we will assess the extent and nature of shared decision making. Methods: Eligible patients and providers will evaluate the AFib 2gether mobile app for usability and perceived usefulness in facilitating shared decision making regarding understanding the patient’s risk of stroke and whether or not to start AC therapy. Both patients and providers will review the app and complete multiple questionnaires about the usability and perceived usefulness of the mobile app in a clinical setting. We will also audio-record a subset of encounters to assess for evidence of shared decision making. Results: Enrollment in the AFib 2gether shared decision-making study is still ongoing for both patients and providers. The first participant enrolled on November 22, 2019. Analysis and publishing of results are expected to be completed in spring 2021. Conclusions: The AFib 2gether app emerged from a desire to increase the ability of patients and providers to engage in shared decision making around understanding the risk of stroke and AC therapy. We anticipate that the AFib 2gether mobile app will facilitate patient discussion with their cardiologist and other providers. Additionally, we hope the study will help us identify barriers that providers face when placing patients on AC therapy. We aim to demonstrate the usability and perceived usefulness of the app with a future goal of testing the value of our approach in a larger sample of patients and providers at multiple medical centers across the country. Trial Registration: ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID): DERR1-10.2196/21986 %M 33625361 %R 10.2196/21986 %U https://www.researchprotocols.org/2021/2/e21986 %U https://doi.org/10.2196/21986 %U http://www.ncbi.nlm.nih.gov/pubmed/33625361 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e21545 %T Exploring the Feasibility of Relapse Prevention Strategies in Interdisciplinary Multimodal Pain Therapy Programs: Qualitative Study %A Elbers,Stefan %A Pool,Jan %A Wittink,Harriët %A Köke,Albère %A Smeets,Rob %+ Research Group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, PO Box 12011, Utrecht, Netherlands, 31 88 481 8181, stefan.elbers@hu.nl %K chronic pain %K interdisciplinary treatment %K rehabilitation %K relapse %K behavior change %K goal setting %K pain %K behavior %K feasibility %K strategy %K treatment %D 2020 %7 11.12.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although interdisciplinary multimodal pain treatment (IMPT) programs are widely regarded as treatment of choice for patients with chronic pain, there are signs that many patients are unable to maintain their treatment gains in the long term. To facilitate the maintenance of positive treatment outcomes over time, we developed two relapse prevention strategies. Objective: The main objective of this study was to explore the feasibility of these strategies within the context of IMPT programs. Methods: We performed a feasibility study using 3 workbook prototypes containing either one or both strategies. For a period of 6 months, the workbooks were made available in two IMPT facilities. Qualitative data were collected through a focus group and semistructured interviews. We performed a thematic analysis using a deductive approach with (1) applicability to the treatment program, (2) acceptability of the workbook content, and (3) form, as predefined themes. Results: The final dataset consisted of transcripts from a focus group with health care providers and 11 telephone interviews and 2 additional in-depth interviews with patients. In general, the intervention was perceived as useful, easy to use, and in line with the treatment program. The data also include suggestions to further improve the use of both strategies, including more specific implementation guidelines, revised goal-setting procedure, and development of a mobile health version. However, several factors, including a high dropout rate and small sample size, impact the external validity of our findings. Conclusions: This study should be regarded as a first step in the process of transforming the prototype workbook into an effective intervention for clinical practice. Although these initial results indicate a favorable evaluation of both behavior regulation strategies within the workbook, this study encountered multiple barriers regarding implementation and data collection that limit the generalizability of these results. Future research efforts should specifically address the fidelity of HCPs and patients and should include clear procedures regarding recruitment and use of both relapse prevention strategies during treatment. %M 33306035 %R 10.2196/21545 %U http://humanfactors.jmir.org/2020/4/e21545/ %U https://doi.org/10.2196/21545 %U http://www.ncbi.nlm.nih.gov/pubmed/33306035 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20353 %T New Checklist for the Heuristic Evaluation of mHealth Apps (HE4EH): Development and Usability Study %A Khowaja,Kamran %A Al-Thani,Dena %+ Information & Computing Technology, College of Science & Engineering, Hamad Bin Khalifa University, LAS Building, Education City, Doha, , Qatar, 974 66314481, kamran.khowaja@gmail.com %K mHealth %K eHealth %K heuristic evaluation %K expert evaluation %K self-monitoring %K behavior change %K design guidelines %K framework %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diabetes is one of the leading causes of death in developing countries. Existing mobile health (mHealth) app design guidelines lack a description of the support of continuous self-monitoring of health status, behavior change to improve and adopt a healthy lifestyle, and communication with health educators and health care professionals in case of any need. Objective: This paper presents the development of a specialized set of heuristics called heuristic evaluation for mHealth apps (HE4EH) as an all-in-one tool and its applicability by performing a heuristic evaluation of an mHealth app. Methods: An extensive review of heuristics and checklists was used to develop the HE4EH. The HE4EH was evaluated by domain experts for heuristics, checklist items, severity ratings, and overall satisfaction. The OneTouch app, which helps individuals with diabetes manage their blood glucose levels, was evaluated using HE4EH to identify usability problems that need to be fixed in the app. Results: The expert evaluation of HE4EH revealed that the heuristics were important, relevant, and clear. The checklist items across the heuristics were clear, relevant, and acceptably grouped. In terms of evaluating the OneTouch app using the HE4EH, the most frequently violated heuristics included Content, Visibility, Match, and Self-monitoring. Most of the usability problems found were minor. The system usability scale score indicated that the OneTouch app is marginally acceptable. Conclusions: This heuristic evaluation using the OneTouch app shows that the HE4EH can play a vital role for designers, researchers, and practitioners to use HE4EH heuristics and checklist items as a tool to design a new or evaluate and improve an existing mHealth app. %M 33112252 %R 10.2196/20353 %U http://mhealth.jmir.org/2020/10/e20353/ %U https://doi.org/10.2196/20353 %U http://www.ncbi.nlm.nih.gov/pubmed/33112252 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e16989 %T Mobile App for Monitoring 3-Month Postoperative Functional Outcome After Hip Fracture: Usability Study %A Geerds,Merle A J %A Nijmeijer,Wieke S %A Hegeman,J H %A Vollenbroek-Hutten,Miriam M R %+ Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, Almelo, 7609 PP, Netherlands, 31 0631345083, m.geerds@zgt.nl %K hip fracture %K remote monitoring %K elderly %K telemedicine %K orthogeriatric %K mHealth %K app %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As a result of an aging population, there has been an increasing incidence of hip fractures worldwide. In the Netherlands, in order to improve the quality of care for elderly patients with hip fractures, the multidisciplinary Centre for Geriatric Traumatology was established in 2008 at the Department of Trauma Surgery at Ziekenhuisgroep Twente hospital (located in Almelo and Hengelo in the Netherlands). Objective: Though the Dutch Hip Fracture audit is used to monitor the quality of care for patients with fractures of the hip, only 30.7% of patients complete registration in the 3-month follow-up period. Mobile apps offer an opportunity for improvement in this area. The aim of this study was to investigate the usability and acceptance of a mobile app for gathering indicators of quality of care in a 3-month follow-up period after postoperative treatment of hip fracture. Methods: From July 2017 to December 2017, patients who underwent surgical treatment for hip fracture were recruited. Patients and caregivers, who were collectively considered the participant cohort, were asked to download the app and answer a questionnaire. Participants were divided into two groups—those who downloaded the app and those who did not download the app. A telephone interview that was based upon the Unified Theory of Acceptance and Use of Technology was conducted with a subset of participants from each group (1:1 ratio). This study was designated as not being subject to the Dutch Medical Research Involving Human Subjects Act according to the appropriate medical research ethics committees. Results: Of the patients and caregivers who participated, 26.4% (29/110) downloaded the app, whereas 73.6% (81/110) did not. Telephone interviews with the subset of participants (n=24 per group) revealed that 54.0% (13/24) of the group of participants who did not download the app had forgotten the study. Among the group who downloaded the app, 95.8% (23/24) had the intention of completing the questionnaire, but only 4.2% (1/24) did so. The reasons for not completing the questionnaire included technical problems, cognitive disorders, or patient dependency on caregivers. Most participants in the group who downloaded the app self-reported a high level of expertise in using a smartphone (22/24, 91.7%), and sufficient facilitating conditions for using a smartphone were self-reported in both groups (downloaded the app: 23/24, 95.8%; did not download the app: 21/24, 87.5%), suggesting that these factors were not barriers to completion. Conclusions: Despite self-reported intention to use the app, smartphone expertise, and sufficient facilitating conditions for smartphone use, implementation of the mobile app was infeasible for daily practice. This was due to a combination of technical problems, factors related to the implementation process, and the population of interest having cognitive disorders or a dependency on caregivers for mobile technology. %M 32924949 %R 10.2196/16989 %U https://humanfactors.jmir.org/2020/3/e16989 %U https://doi.org/10.2196/16989 %U http://www.ncbi.nlm.nih.gov/pubmed/32924949 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e17203 %T An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study %A Downie,Aron Simon %A Hancock,Mark %A Abdel Shaheed,Christina %A McLachlan,Andrew J %A Kocaballi,Ahmet Baki %A Williams,Christopher M %A Michaleff,Zoe A %A Maher,Chris G %+ Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Level 10 KGV Building, Missenden Road, Camperdown, 2050, Australia, 61 2 9850 6382, aron.downie@sydney.edu.au %K low back pain %K community pharmacy %K decision support systems, clinical %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. Objective: This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. Methods: A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. Results: Pharmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. Conclusions: A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development. %M 32390593 %R 10.2196/17203 %U https://medinform.jmir.org/2020/5/e17203 %U https://doi.org/10.2196/17203 %U http://www.ncbi.nlm.nih.gov/pubmed/32390593 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e17088 %T Development and Usability Testing of a Web-Based and Therapist-Assisted Coping Skills Program for Managing Psychosocial Problems in Individuals With Hand and Upper Limb Injuries: Mixed Methods Study %A Babatunde,Folarin Omoniyi %A MacDermid,Joy %A Grewal,Ruby %A Macedo,Luciana %A Szekeres,Mike %+ School of Rehabilitation Science, Institute of Applied Health Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON, L8S 1C7, Canada, 1 9055259140 ext 22867, babatufo@mcmaster.ca %K usability testing %K upper extremities %K psychosocial %K internet %K coping skills %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. Objective: This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. Methods: The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. Results: In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. Conclusions: We describe the development and usability testing of HOCOS; a new web-based psychosocial intervention for individuals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants. %M 32374265 %R 10.2196/17088 %U http://humanfactors.jmir.org/2020/2/e17088/ %U https://doi.org/10.2196/17088 %U http://www.ncbi.nlm.nih.gov/pubmed/32374265 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e13875 %T Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive Study %A Turk,Amadea %A Fairclough,Emma %A Grason Smith,Gillian %A Lond,Benjamin %A Nanton,Veronica %A Dale,Jeremy %+ Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom, 44 02476522891, jeremy.dale@warwick.ac.uk %K caregivers %K information technology %K internet %D 2019 %7 20.8.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers’ resilience. It aims to provide personalized access to information and resources that are responsive to individuals’ caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. Objective: This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. Methods: We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Results: Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. Conclusions: The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation. %M 31518272 %R 10.2196/13875 %U https://aging.jmir.org/2019/2/e13875 %U https://doi.org/10.2196/13875 %U http://www.ncbi.nlm.nih.gov/pubmed/31518272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13621 %T Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study %A Weichelt,Bryan %A Heimonen,Tomi %A Gorucu,Serap %A Redmond,Emily %A Vechinski,Josef %A Pflughoeft,Kurt %A Bendixsen,Casper %A Salzwedel,Marsha %A Scott,Erika %A Namkoong,Kang %A Purschwitz,Mark %A Rautiainen,Risto %A Murphy,Dennis J %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 7152217276, weichelt.bryan@marshfieldresearch.org %K agriculture %K risk %K wounds and injuries %K safety %K farms %K news %K newspaper article %D 2019 %7 02.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Injury data and reports provide valuable information for both public and private organizations to guide programming, policy, and prevention, but in the increasingly complex and dangerous industry of US agriculture, the injury surveillance needed to produce this data is lacking. To address the gap, AgInjuryNews was established in 2015. The system includes fatal and nonfatal injury cases derived from publicly available reports, including occupational and nonoccupational injuries, occurring in the agricultural, forestry, and fishing (AFF) industry. Objective: The study aimed to develop a stakeholder-engaged redesign of the interactive, up-to-date, and publicly available dataset of US AFF injury and fatality reports. Methods: Instructor-led heuristic evaluations within a 15-student undergraduate course, data from 8 student participants of laboratory-based usability testing and 2016 and 2017 AgInjuryNews-registered user surveys, coupled with input from the National Steering Committee informed the development priorities for 2018. An interdisciplinary team employed an agile methodology of 2-week sprints developing in ASP.NET and Structured Query Language to deliver an intuitive frontend and a flexible, yet structured, backend, including a case report input form for capturing more than 50 data points on each injury report. Results: AgInjuryNews produced 17,714 page views from 43 countries in 2018 captured via Google Analytics, whereas 623 injury reports were coded and loaded, totaling more than 31,000 data points. Newly designed features include customizable email alerts, an interactive map, and expanded search and filter options. User groups such as the Bureau of Labor Statistics and the Agricultural Safety and Health Council of America have endorsed the system within their networks. News media have cited or referenced the system in national outlets such as the New York Times, Politico, and the Washington Post. Conclusions: The new system’s features, functions, and improved data granularity have sparked innovative lines of research and increased collaborative interest domestically and abroad. It is anticipated that this nontraditional sentinel surveillance system and its dataset will continue to serve many purposes for public and private agricultural safety and health stakeholders in the years to come.  %M 31376278 %R 10.2196/13621 %U http://formative.jmir.org/2019/3/e13621/ %U https://doi.org/10.2196/13621 %U http://www.ncbi.nlm.nih.gov/pubmed/31376278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e9232 %T A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates %A Ferrara,Giannina %A Kim,Jenna %A Lin,Shuhao %A Hua,Jenna %A Seto,Edmund %+ Department of Environmental & Occupational Health Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 357234, Seattle, WA, 98195, United States, 1 206 543 1475, eseto@uw.edu %K diet %K nutrition assessment %K behavior and behavior mechanisms %D 2019 %7 17.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied. Objective: The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding. Methods: The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference. Results: Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4% for calories, 1.0% for carbohydrates, 10.4% for protein, and −6.5% for fat. Conclusions: Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies. %M 31102369 %R 10.2196/mhealth.9232 %U http://mhealth.jmir.org/2019/5/e9232/ %U https://doi.org/10.2196/mhealth.9232 %U http://www.ncbi.nlm.nih.gov/pubmed/31102369 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e13009 %T Patients’ Experiences of Using a Consumer mHealth App for Self-Management of Heart Failure: Mixed-Methods Study %A Woods,Leanna Sarah %A Duff,Jed %A Roehrer,Erin %A Walker,Kim %A Cummings,Elizabeth %+ School of Nursing, University of Tasmania, 1 Leichhardt Street, Darlinghurst, 2010, Australia, 61 0285727930, leannaj@utas.edu.au %K heart failure %K mobile health (mHealth) %K mobile apps %K usability study %K Mobile Application Rating Scale %K patient experience %K self-management %K mobile phone %D 2019 %7 02.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To support the self-management of heart failure, a team of hospital clinicians, patients, and family caregivers have co-designed the consumer mobile health app, Care4myHeart. Objective: This research aimed to determine patient experiences of using the app to self-manage heart failure. Methods: Patients with heart failure used the app for 14 days on their own smart device in a home setting, following which a mixed-methods evaluation was performed. Eight patients were recruited, of whom six completed the Mobile Application Rating Scale and attended an interview. Results: The overall app quality score was “acceptable” with 3.53 of 5 points, with the aesthetics (3.83/5) and information (3.78/5) subscales scoring the highest. The lowest mean score was in the app-specific subscale representing the perceived impact on health behavior change (2.53/5). Frequently used features were weight and fluid restriction tracking, with graphical representation of data particularly beneficial for improved self-awareness and ongoing learning. The use of technology for self-management will fundamentally differ from current practices and require a change in daily routines. However, app use was correlated with potential utility for daily management of illness with benefits of accurate recording and review of personal health data and as a communication tool for doctors to assist with care planning, as all medical information is available in one place. Technical considerations included participants’ attitudes toward technology, functionality and data entry issues, and relatively minor suggested changes. Conclusions: The findings from this usability study suggest that a significant barrier to adoption is the lack of integration of technology into everyday life in the context of already established disease self-management routines. Future studies should explore the barriers to adoption and sustainability of consumer mobile health interventions for chronic conditions, particularly whether introducing such apps is more beneficial at the commencement of a self-management regimen. %M 31045504 %R 10.2196/13009 %U http://humanfactors.jmir.org/2019/2/e13009/ %U https://doi.org/10.2196/13009 %U http://www.ncbi.nlm.nih.gov/pubmed/31045504 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13226 %T A Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management: Results of the User-Centered Design Process %A Schild,Stefanie %A Sedlmayr,Brita %A Schumacher,Ann-Kathrin %A Sedlmayr,Martin %A Prokosch,Hans-Ulrich %A St.Pierre,Michael %A , %+ Department of Medical Informatics, Biometrics and Epidemiology, Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Wetterkreuz 13, Erlangen, 91058, Germany, 49 9131 85 26785, stefanie.schild@fau.de %K anesthesiology %K checklist %K crew resource management, healthcare %K emergency treatment %K ergonomics %K human factors %K practice guideline %K reference books, medical %K resuscitation %K user-computer interface %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stressful situations during intraoperative emergencies have negative impact on human cognitive functions. Consequently, task performance may decrease and patient safety may be compromised. Cognitive aids can counteract these effects and support anesthesiologists in their crisis management. The Professional Association of German Anesthesiologists set up a project to develop a comprehensive set of digital cognitive aids for intraoperative emergencies. A parallel development for several software platforms and stationary and mobile devices will accommodate the inhomogeneity of the information technology infrastructure within German anesthesia departments. Objective: This paper aimed to provide a detailed overview of how the task of developing a digital cognitive aid for intraoperative crisis management in anesthesia was addressed that meets user requirements and is highly user-friendly. Methods: A user-centered design (UCD) process was conducted to identify, specify, and supplement the requirements for a digital cognitive aid. The study covered 4 aspects: analysis of the context of use, specification of user requirements, development of design solutions, and evaluation of design solutions. Three prototypes were developed and evaluated by end users of the application. Following each evaluation, the new requirements were prioritized and used for redesign. For the first and third prototype, the System Usability Scale (SUS) score was determined. The second prototype was evaluated with an extensive Web-based questionnaire. The evaluation of the third prototype included a think-aloud protocol. Results: The chosen methods enabled a comprehensive collection of requirements and helped to improve the design of the application. The first prototype achieved an average SUS score of 74 (SD 12), indicating good usability. The second prototype included the following main revisions: 2-column layout, initial selection of patient type (infant, adult, or parturient), 4 offered search options, and the option to check off completed action steps. Its evaluation identified the following major revision points: add quick selection for resuscitation checklists, design the top bar and tabs slightly larger, and add more pictograms to the text. The third prototype achieved an average SUS score of 77 (SD 15). The evaluation of the think-aloud protocol revealed a good intuitiveness of the application and identified a missing home button as the main issue. Conclusions: Anesthesiology—as an acute medical field—is particularly characterized by its high demands on decision making and action in dynamic, or time-critical situations. The integration of usability aspects is essential for everyday and emergency suitability. The UCD process allowed us to develop a prototypical digital cognitive aid, exhibiting high usability and user satisfaction in the demanding environment of anesthesiological emergencies. Both aspects are essential to increase the acceptance of the application in later stages. The study approach, combining different methods for determining user requirements, may be useful for other implementation projects in a highly demanding environment. %M 31033445 %R 10.2196/13226 %U http://mhealth.jmir.org/2019/4/e13226/ %U https://doi.org/10.2196/13226 %U http://www.ncbi.nlm.nih.gov/pubmed/31033445 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 1 %P e13163 %T Therapist-Guided Tablet-Based Telerehabilitation for Patients With Aphasia: Proof-of-Concept and Usability Study %A Gerber,Stephan Moreno %A Schütz,Narayan %A Uslu,Arif Sinan %A Schmidt,Nadine %A Röthlisberger,Carina %A Wyss,Patric %A Perny,Sandra %A Wyss,Corina %A Koenig-Bruhin,Monica %A Urwyler,Prabitha %A Nyffeler,Thomas %A Marchal-Crespo,Laura %A Mosimann,Urs Peter %A Müri,René Martin %A Nef,Tobias %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland, 41 31 632 75 79, tobias.nef@artorg.unibe.ch %K aphasia %K high-intensity training %K telerehabilitation %K multiplatform system %D 2019 %7 26.04.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Aphasia is the loss or impairment of language functions and affects everyday social life. The disorder leads to the inability to understand and be understood in both written and verbal communication and affects the linguistic modalities of auditory comprehension, verbal expression, reading, and writing. Due to heterogeneity of the impairment, therapy must be adapted individually and dynamically to patient needs. An important factor for successful aphasia therapy is dose and intensity of therapy. Tablet computer–based apps are a promising treatment method that allows patients to train independently at home, is well accepted, and is known to be beneficial for patients. In addition, it has been shown to ease the burden of therapists. Objective: The aim of this project was to develop an adaptive multimodal system that enables aphasic patients to train at home using language-related tasks autonomously, allows therapists to remotely assign individualized tasks in an easy and time-efficient manner, and tracks the patient’s progress as well as creation of new individual exercises. Methods: The system consists of two main parts: (1) the patient’s interface, which allows the patient to exercise, and (2) the therapist’s interface, which allows the therapist to assign new exercises to the patient and supervise the patient’s progress. The pool of exercises is based on a hierarchical language structure. Using questionnaires, therapists and patients evaluated the system in terms of usability (ie, System Usability Scale) and motivation (ie, adapted Intrinsic Motivation Inventory). Results: A total of 11 speech and language therapists (age: mean 28, SD 7 years) and 15 patients (age: mean 53, SD 10 years) diagnosed with aphasia participated in this study. Patients rated the Bern Aphasia App in terms of usability (scale 0-100) as excellent (score >70; Z=–1.90; P=.03) and therapists rated the app as good (score >85; Z=–1.75; P=.04). Furthermore, patients enjoyed (scale 0-6) solving the exercises (score>3; mean 3.5, SD 0.40; Z=–1.66; P=.049). Conclusions: Based on the questionnaire scores, the system is well accepted and simple to use for patients and therapists. Furthermore, the new tablet computer–based app and the hierarchical language exercise structure allow patients with different types of aphasia to train with different doses and intensities independently at home. Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy. %M 31025946 %R 10.2196/13163 %U http://rehab.jmir.org/2019/1/e13163/ %U https://doi.org/10.2196/13163 %U http://www.ncbi.nlm.nih.gov/pubmed/31025946 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12103 %T Usable Mobile App for Community Education on Colorectal Cancer: Development Process and Usability Study %A Mohamad Marzuki,Muhamad Fadhil %A Yaacob,Nor Azwany %A bin Yaacob,Najib Majdi %A Abu Hassan,Muhammad Radzi %A Ahmad,Shahrul Bariyah %+ Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150, Malaysia, 60 194743054, fadhilmarzuki@gmail.com %K colorectal cancer %K mobile app %K development %K mHealth %D 2019 %7 16.04.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Participation in colorectal cancer screening is still low among Malaysians despite the increasing trend of incidence, with more than half of the new cases being detected in the advanced stages. Knowledge improvement might increase screening participation and thus improve the chances of disease detection. With the advancement of communication technology, people nowadays prefer to read from their mobile phone using a Web browser or mobile apps compared with the traditional printed material. Therefore, health education and promotion should adapt this behavior change in educating the community. Objective: This study aimed to document the process of designing and developing a mobile app for community education on colorectal cancer and assess the usability of the prototype. Methods: The nominal group technique (NGT) was used for the content development of the mobile app. NGT involving community educationists and clinicians combined with community representatives as the target users identified relevant health information and communication strategies including features for a user-friendly mobile app. The prototype was developed using framework Ionic 1, based on the Apache Cordova and Angular JS (Google). It was published in the Google Play store. In total, 50 mobile phone users aged 50 years and above and who had never been diagnosed with any type of cancer were invited to download and use the app. They were asked to assess the usability of the app using the validated Malay version of System Usability Scale Questionnaire for the Assessment of Mobile Apps questionnaire. The One-sample t test was used to assess the usability score with a cut-off value of 68 for the usable mobile app. Results: The Colorectal Cancer Awareness Application (ColorApp) was successfully developed in the local Malay language. The NGT discussion had suggested 6 main menus in the ColorApp prototype, which are Introduction, Sign and Symptoms, Risk Factors, Preventive Measures, Colorectal Cancer Screening Program, and immunochemical fecal occult blood test kit. A total of 2 additional artificial intelligence properties menus were added to allow user-ColorApp interaction: Analyze Your Status and ColorApp Calculator. The prototype has been published in the Google Play store. The mean usability score was 72 (SD 11.52), which indicates that ColorApp is a usable mobile app, and it can be used as a tool for community education on colorectal cancer. Conclusions: ColorApp mobile app can be used as a user-friendly tool for community education on colorectal cancer. %M 30990454 %R 10.2196/12103 %U http://humanfactors.jmir.org/2019/2/e12103/ %U https://doi.org/10.2196/12103 %U http://www.ncbi.nlm.nih.gov/pubmed/30990454 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12471 %T Live Usability Testing of Two Complex Clinical Decision Support Tools: Observational Study %A Richardson,Safiya %A Feldstein,David %A McGinn,Thomas %A Park,Linda S %A Khan,Sundas %A Hess,Rachel %A Smith,Paul D %A Mishuris,Rebecca Grochow %A McCullagh,Lauren %A Mann,Devin %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, NY, 11549, United States, 1 404 695 7883, srichard12@northwell.edu %K usability %K usability testing %K user experience %K clinical decision support %K health informatics %K provider adoption %K workflow %K live usability %K clinical prediction rules %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction with complex CDS in the real clinical environment. Objective: This study aimed to further understand the barriers and facilitators of meaningful CDS usage within a real clinical context. Methods: This qualitative observational study was conducted with 3 primary care providers during 6 patient care sessions. In patients with the chief complaint of sore throat, a CDS tool built with the Centor Score was used to stratify the risk of group A Streptococcus pharyngitis. In patients with a chief complaint of cough or upper respiratory tract infection, a CDS tool built with the Heckerling Rule was used to stratify the risk of pneumonia. During usability testing, all human-computer interactions, including audio and continuous screen capture, were recorded using the Camtasia software. Participants’ comments and interactions with the tool during clinical sessions and participant comments during a postsession brief interview were placed into coding categories and analyzed for generalizable themes. Results: In the 6 encounters observed, primary care providers toggled between addressing either the computer or the patient during the visit. Minimal time was spent listening to the patient without engaging the EHR. Participants mostly used the CDS tool with the patient, asking questions to populate the calculator and discussing the results of the risk assessment; they reported the ability to do this as the major benefit of the tool. All providers were interrupted during their use of the CDS tool by the need to refer to other sections of the chart. In half of the visits, patients’ clinical symptoms challenged the applicability of the tool to calculate the risk of bacterial infection. Primary care providers rarely used the incorporated incentives for CDS usage, including progress notes and patient instructions. Conclusions: Live usability testing of these CDS tools generated insights about their role in the patient-provider interaction. CDS may contribute to the interaction by being simultaneously viewed by the provider and patient. CDS can improve usability and lessen the strain it places on providers by being short, flexible, and customizable to unique provider workflow. A useful component of CDS is being as widely applicable as possible and ensuring that its functions represent the fastest way to perform a particular task. %M 30985283 %R 10.2196/12471 %U http://humanfactors.jmir.org/2019/2/e12471/ %U https://doi.org/10.2196/12471 %U http://www.ncbi.nlm.nih.gov/pubmed/30985283 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 3 %P e12378 %T Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems %A Buitenweg,David C %A Bongers,Ilja L %A van de Mheen,Dike %A van Oers,Hans AM %A van Nieuwenhuizen,Chijs %+ Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037 DB, Netherlands, 31 13 4668338, d.c.buitenweg@tilburguniversity.edu %K mobile app %K quality of life %K mental health %K homeless persons %K medical informatics %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language‐based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants’ previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. %M 30920381 %R 10.2196/12378 %U http://mental.jmir.org/2019/3/e12378/ %U https://doi.org/10.2196/12378 %U http://www.ncbi.nlm.nih.gov/pubmed/30920381 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e9958 %T User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients %A Prince,Rebecca M %A Soung Yee,Anthony %A Parente,Laura %A Enright,Katherine A %A Grunfeld,Eva %A Powis,Melanie %A Husain,Amna %A Gandhi,Sonal %A Krzyzanowska,Monika K %+ University Health Network, 610 University Ave., Toronto, ON,, Canada, 1 416 946 6542, monika.krzyzanowska@uhn.ca %K prototype %K Web-based tool %K toxicity management %K chemotherapy %K self-management %D 2019 %7 28.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population. Objective: This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities. Methods: User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users. Results: Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information. Conclusions: Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption. %M 30920373 %R 10.2196/jmir.9958 %U http://www.jmir.org/2019/3/e9958/ %U https://doi.org/10.2196/jmir.9958 %U http://www.ncbi.nlm.nih.gov/pubmed/30920373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11374 %T Pregnant Users’ Perceptions of the Birth Plan Interface in the “My Prenatal Care” App: Observational Validation Study %A Moraes Carrilho,Juliana %A Oliveira,Isaias José Ramos %A Santos,Dimitri %A Osanan,Gabriel Costa %A Cruz-Correia,Ricardo João %A Reis,Zilma Silveira Nogueira %+ Informatics Center in Health, Universidade Federal de Minas Gerais, Faculty of Medicine, Av Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30140070, Brazil, 55 31985177473, zilma.medicina@gmail.com %K birth plan %K perinatal care %K usability, mobile health %K mobile app %K pregnancy %K prenatal care %K mobile phone %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users’ positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women’s perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user’s perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users’ performance in accomplishing previously prepared tasks, we found that 10 of 11 (91%) women were capable of completing at least 6 of 8 (75%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. %M 30920372 %R 10.2196/11374 %U http://formative.jmir.org/2019/1/e11374/ %U https://doi.org/10.2196/11374 %U http://www.ncbi.nlm.nih.gov/pubmed/30920372 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e12232 %T Usability Testing of a Mobile App to Report Medication Errors Anonymously: Mixed-Methods Approach %A George,Doris %A Hassali,Mohamed Azmi %A HSS,Amar-Singh %+ Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, 11800, Malaysia, 60 052085555 ext 5293, doris.moh.gov@gmail.com %K mobile app %K usability %K medication error reporting %K anonymous %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Reporting of medication errors is one of the essential mechanisms to identify risky health care systems and practices that lead to medication errors. Unreported medication errors are a real issue; one of the identified causes is a burdensome medication error reporting system. An anonymous and user-friendly mobile app for reporting medication errors could be an alternative method of reporting medication error in busy health care settings. Objective: The objective of this paper is to report usability testing of the Medication Error Reporting App (MERA), a mobile app for reporting medication errors anonymously. Methods: Quantitative and qualitative methods were employed involving 45 different testers (pharmacists, doctors, and nurses) from a large tertiary hospital in Malaysia. Quantitative data was retrieved using task performance and rating of MERA and qualitative data were retrieved through focus group discussions. Three sessions, with 15 testers each session, were conducted from January to March 2018. Results: The majority of testers were pharmacists (23/45, 51%), female (35/45, 78%), and the mean age was 36 (SD 9) years. A total of 135 complete reports were successfully submitted by the testers (three reports per tester) and 79.2% (107/135) of the reports were correct. There was significant improvement in mean System Usability Scale scores in each session of the development process (P<.001) and mean time to report medication errors using the app was not significantly different between each session (P=.70) with an overall mean time of 6.7 (SD 2.4) minutes. Testers found the app easy to use, but doctors and nurses were unfamiliar with terms used especially medication process at which error occurred and type of error. Although, testers agreed the app can be used in the future for reporting, they were apprehensive about security, validation, and abuse of feedback featured in the app. Conclusions: MERA can be used to report medication errors easily by various health care personnel and it has the capacity to provide feedback on reporting. However, education on medication error reporting should be provided to doctors and nurses in Malaysia and the security of the app needs to be established to boost reporting by this method. %M 30578216 %R 10.2196/12232 %U http://humanfactors.jmir.org/2018/4/e12232/ %U https://doi.org/10.2196/12232 %U http://www.ncbi.nlm.nih.gov/pubmed/30578216 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10804 %T Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study %A Kakarmath,Sujay S %A de Redon,Emily %A Centi,Amanda Jayne %A Palacholla,Ramya %A Kvedar,Joseph %A Jethwani,Kamal %A Agboola,Stephen %+ Partners Connected Health, 25 New Chardon Street, 3rd Floor, Suite 300, Boston, MA, 02114, United States, 1 6177242158, acenti@partners.org %K connected health %K continuous monitoring %K mobile phone %K pediatric %K temperature %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Fever is an important vital sign and often the first one to be assessed in a sick child. In acutely ill children, caregivers are expected to monitor a child’s body temperature at home after an initial medical consult. Fever literacy of many caregivers is known to be poor, leading to fever phobia. In children with a serious illness, the responsibility of periodically monitoring temperature can add substantially to the already stressful experience of caring for a sick child. Objective: The objective of this pilot study was to assess the feasibility of using the iThermonitor, an automated temperature measurement device, for continuous temperature monitoring in postoperative and postchemotherapy pediatric patients. Methods: We recruited 25 patient-caregiver dyads from the Pediatric Surgery Department at the Massachusetts General Hospital (MGH) and the Pediatric Cancer Centers at the MGH and the Dana Farber Cancer Institute. Enrolled dyads were asked to use the iThermonitor device for continuous temperature monitoring over a 2-week period. Surveys were administered to caregivers at enrollment and at study closeout. Caregivers were also asked to complete a daily event-monitoring log. The Generalized Anxiety Disorder-7 item questionnaire was also used to assess caregiver anxiety at enrollment and closeout. Results: Overall, 19 participant dyads completed the study. All 19 caregivers reported to have viewed temperature data on the study-provided iPad tablet at least once per day, and more than a third caregivers did so six or more times per day. Of all participants, 74% (14/19) reported experiencing an out-of-range temperature alert at least once during the study. Majority of caregivers reported that it was easy to learn how to use the device and that they felt confident about monitoring their child’s temperature with it. Only 21% (4/9) of caregivers reported concurrently using a device other than the iThermonitor to monitor their child’s temperature during the study. Continuous temperature monitoring was not associated with an increase in caregiver anxiety. Conclusions: The study results reveal that the iThermonitor is a highly feasible and easy-to-use device for continuous temperature monitoring in pediatric oncology and surgery patients. Trial Registration: ClinicalTrials.gov NCT02410252; https://clinicaltrials.gov/ct2/show/NCT02410252 (Archived by WebCite at http://www.webcitation.org/73LnO7hel) %M 31518304 %R 10.2196/10804 %U http://pediatrics.jmir.org/2018/2/e10804/ %U https://doi.org/10.2196/10804 %U http://www.ncbi.nlm.nih.gov/pubmed/31518304 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10932 %T Usability Evaluation of a Mobile Phone–Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study %A Moradian,Saeed %A Krzyzanowska,Monika K %A Maguire,Roma %A Morita,Plinio P %A Kukreti,Vishal %A Avery,Jonathan %A Liu,Geoffrey %A Cafazzo,Joseph %A Howell,Doris %+ Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, , Toronto, ON,, Canada, 1 416 946 4501 ext 3419, Doris.Howell@uhn.ca %K mobile apps %K mobile health %K mobile phone %K patient-centered care %K patient remote monitoring %K self-care %K symptom management %K usability testing %K mobile phone %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system. Objective: This study aims to evaluate the usability of the ASyMS, a mobile phone–based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS. Methods: We used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence. Results: The thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80% (8/10) of participants had great motivation to use the ASyMS, 70% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation. Conclusions: The ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed. %M 30578238 %R 10.2196/10932 %U http://cancer.jmir.org/2018/2/e10932/ %U https://doi.org/10.2196/10932 %U http://www.ncbi.nlm.nih.gov/pubmed/30578238 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10073 %T Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study %A Nieroda,Marzena Ewa %A Lophatananon,Artitaya %A McMillan,Brian %A Chen,Li-Chia %A Hughes,John %A Daniels,Rona %A Clark,James %A Rogers,Simon %A Muir,Kenneth Ross %+ Division of Management Sciences and Marketing, Alliance Manchester Business School, The University of Manchester, Booth Street West, Manchester, M13 9PL, United Kingdom, 44 161 275 6739, marzena.nieroda@manchester.ac.uk %K early detection of cancer %K cancer education %K cancer symptoms %K cancer risk %K personalized risk %K website development %K REACT %D 2018 %7 04.07.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation. Objective: The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK. Methods: Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection. Results: The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk. Conclusions: This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation. %M 29973334 %R 10.2196/10073 %U http://cancer.jmir.org/2018/2/e10073/ %U https://doi.org/10.2196/10073 %U http://www.ncbi.nlm.nih.gov/pubmed/29973334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10457 %T An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing %A Srikesavan,Cynthia %A Williamson,Esther %A Cranston,Tim %A Hunter,John %A Adams,Jo %A Lamb,Sarah E %+ Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, United Kingdom, 44 01865737907, cynthia.srikesavan@ndorms.ox.ac.uk %K rheumatoid arthritis %K hand joints %K exercise training %K web-based %D 2018 %7 27.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. Objective: We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. Methods: We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. Results: A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. Conclusions: mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences. %M 29950288 %R 10.2196/10457 %U http://www.jmir.org/2018/6/e10457/ %U https://doi.org/10.2196/10457 %U http://www.ncbi.nlm.nih.gov/pubmed/29950288 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e17 %T A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design %A Zheng,Hua %A Rosal,Milagros C %A Li,Wenjun %A Borg,Amy %A Yang,Wenyun %A Ayers,David C %A Franklin,Patricia D %+ Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 (508) 856 5748, patricia.franklin@umassmed.edu %K usability evaluation %K patient decision support %K knee osteoarthritis %K total knee replacement %K outcome prediction %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants’ responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results: Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra “next page” click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions: We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients’ use. %M 29712620 %R 10.2196/humanfactors.8568 %U http://humanfactors.jmir.org/2018/2/e17/ %U https://doi.org/10.2196/humanfactors.8568 %U http://www.ncbi.nlm.nih.gov/pubmed/29712620 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e16 %T Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App %A Alnasser,Aroub %A Kyle,Janet %A Alkhalifah,Abdulrahman %A Marais,Debbi %+ Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa %K mHealth %K weight loss %K obesity %K smartphones %K mobile applications %K Saudi Arabia %K women's health %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. Objective: The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. Methods: In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. Results: The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. Conclusions: Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind. %M 29666042 %R 10.2196/humanfactors.9765 %U http://humanfactors.jmir.org/2018/2/e16/ %U https://doi.org/10.2196/humanfactors.9765 %U http://www.ncbi.nlm.nih.gov/pubmed/29666042 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e51 %T More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design %A Giunti,Guido %A Mylonopoulou,Vasiliki %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Sevilla, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %K user-computer interface %K software design %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. %M 29500159 %R 10.2196/mhealth.9437 %U http://mhealth.jmir.org/2018/3/e51/ %U https://doi.org/10.2196/mhealth.9437 %U http://www.ncbi.nlm.nih.gov/pubmed/29500159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e27 %T A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study %A Wang,Chih-Jau %A Chaovalit,Pimwadee %A Pongnumkul,Suporn %+ National Electronics and Computer Technology Center, 112 Phahonyothin Road, Khlong Nueng, Khlong Luang District, Pathum Thani, 12120, Thailand, 66 2 564 6900 ext 72293, wang.chihjau@gmail.com %K mobile health %K breast feeding %K mobile applications %K health promotion %K usability %K usefulness %D 2018 %7 26.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women. Methods: Our study was reviewed and approved by Thailand’s National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis. Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system. %M 29374000 %R 10.2196/mhealth.8337 %U http://mhealth.jmir.org/2018/1/e27/ %U https://doi.org/10.2196/mhealth.8337 %U http://www.ncbi.nlm.nih.gov/pubmed/29374000 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e1 %T Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results %A Kinner,Ellen M %A Armer,Jessica S %A McGregor,Bonnie A %A Duffecy,Jennifer %A Leighton,Susan %A Corden,Marya E %A Gauthier Mullady,Janine %A Penedo,Frank J %A Lutgendorf,Susan K %+ Department of Psychological & Brain Sciences, University of Iowa, W322 Seashore Hall, Iowa City, IA, 52242, United States, 1 319 335 2432, susan-lutgendorf@uiowa.edu %K ovarian cancer %K quality of life %K feasibility studies %K eHealth %K psychological stress %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. %M 29335233 %R 10.2196/cancer.8430 %U http://cancer.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/cancer.8430 %U http://www.ncbi.nlm.nih.gov/pubmed/29335233 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e3 %T VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study %A Beatty,Alexis L %A Magnusson,Sara L %A Fortney,John C %A Sayre,George G %A Whooley,Mary A %+ Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way, Seattle, WA,, United States, 1 206 764 2008, beattya@uw.edu %K cardiac rehabilitation %K mobile applications %K exercise therapy %K exercise %K rehabilitation research %K telemedicine %K habits %K qualitative research %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR. Objective: The aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability. Methods: We recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users. Results: We conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44% (11/25 tasks) to 78% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (“I think it’ll be good to track my exercise and to see what I’m doing”), a desire for introductory training (“Initially, training with a technical person, instead of me relying on myself”), and an expectation for sharing data with providers (“It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor”). Conclusions: With participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology. %M 29335235 %R 10.2196/humanfactors.8017 %U http://humanfactors.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/humanfactors.8017 %U http://www.ncbi.nlm.nih.gov/pubmed/29335235 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 3 %P e18 %T User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study %A Tobler-Ammann,Bernadette C %A Surer,Elif %A Knols,Ruud H %A Borghese,N Alberto %A de Bruin,Eling D %+ Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, OST U 103A, Rämistrasse 100, Zurich, 8091, Switzerland, 41 44 255 24 91, bernadette.tobler@usz.ch %K usability %K user perspective %K mixed-methods %K exergames %K visuo-spatial neglect %K stroke %D 2017 %7 25.08.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. Objective: The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. Methods: A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. Results: The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. Conclusions: Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. Trial Registration: Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ) %M 28842390 %R 10.2196/games.8013 %U http://games.jmir.org/2017/3/e18/ %U https://doi.org/10.2196/games.8013 %U http://www.ncbi.nlm.nih.gov/pubmed/28842390 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e22 %T Usability of a Culturally Informed mHealth Intervention for Symptoms of Anxiety and Depression: Feedback From Young Sexual Minority Men %A Fleming,John B %A Hill,Yvette N %A Burns,Michelle Nicole %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 503 3114, jbfleming@gmail.com %K mHealth %K eHealth %K homosexuality, male %K adolescents, male %K anxiety %K depression %D 2017 %7 25.08.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To date, we are aware of no interventions for anxiety and depression developed as mobile phone apps and tailored to young sexual minority men, a group especially at risk of anxiety and depression. We developed TODAY!, a culturally informed mobile phone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive behavioral therapy (CBT) and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (eg, tips for current distress and visualizations of mood by context). Objective: The aim of this study was to conduct usability testing to understand how young sexual minority men interact with the app, to inform later stages of intervention development. Methods: Participants (n=9) were young sexual minority men aged 18-20 years (Mean=19.00, standard deviation [SD]=0.71; 44% black, 44% white, and 11.1% Latino), who endorsed at least mild depression and anxiety symptoms. Participants were recruited via flyers, emails to college lesbian, gay, bisexual, and transgender (LGBT) organizations, Web-based advertisements, another researcher’s database of sexual minority youth interested in research participation, and word of mouth. During recorded interviews, participants were asked to think out loud while interacting with the TODAY! app on a mobile phone or with paper prototypes. Feedback identified from these recordings and from associated field notes were subjected to thematic analysis using a general inductive approach. To aid interpretation of results, methods and results are reported according to the consolidated criteria for reporting qualitative research (COREQ). Results: Thematic analysis of usability feedback revealed a theme of general positive feedback, as well as six recurring themes that informed continued development: (1) functionality (eg, highlight new material when available), (2) personalization (eg, more tailored feedback), (3) presentation (eg, keep content brief), (4) aesthetics (eg, use brighter colors), (5) LGBT or youth content (eg, add content about coming out), and (6) barriers to use (eg, perceiving psychoeducation as homework). Conclusions: Feedback from usability testing was vital to understanding what young sexual minority men desire from a mobile phone intervention for symptoms of anxiety and depression and was used to inform the ongoing development of such an intervention. %M 28842389 %R 10.2196/humanfactors.7392 %U http://humanfactors.jmir.org/2017/3/e22/ %U https://doi.org/10.2196/humanfactors.7392 %U http://www.ncbi.nlm.nih.gov/pubmed/28842389 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e158 %T Conventional Cognitive Behavioral Therapy Facilitated by an Internet-Based Support System: Feasibility Study at a Psychiatric Outpatient Clinic %A Månsson,Kristoffer NT %A Klintmalm,Hugo %A Nordqvist,Ragnar %A Andersson,Gerhard %+ Department of Psychology, Stockholm University, Frescati Hagväg 8, Stockholm, 106 91, Sweden, 46 (0)705803267, kristoffer.mansson@psychology.su.se %K cognitive behavioral therapy %K Internet-treatment %K psychiatry %K blended therapy %D 2017 %7 24.08.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive behavioral therapies have been shown to be effective for a variety of psychiatric and somatic disorders, but some obstacles can be noted in regular psychiatric care; for example, low adherence to treatment protocols may undermine effects. Treatments delivered via the Internet have shown promising results, and it is an open question if the blend of Internet-delivered and conventional face-to-face cognitive behavioral therapies may help to overcome some of the barriers of evidence-based treatments in psychiatric care. Objective: We evaluated the feasibility of an Internet-based support system at an outpatient psychiatric clinic in Sweden. For instance, the support system made it possible to send messages and share information between the therapist and the patient before and after therapy sessions at the clinic. Methods: Nine clinical psychologists participated and 33 patients were enrolled in the current study. We evaluated the usability and technology acceptance after 12 weeks of access. Moreover, clinical data on common psychiatric symptoms were assessed before and after the presentation of the support system. Results: In line with our previous study in a university setting, the Internet-based support system has the potential to be feasible also when delivered in a regular psychiatric setting. Notably, some components in the system were less frequently used. We also found that patients improved on common outcome measures for depressive and anxious symptoms (effect sizes, as determined by Cohen d, ranged from 0.20-0.69). Conclusions: This study adds to the literature suggesting that modern information technology could be aligned with conventional face-to-face services. %M 28838884 %R 10.2196/resprot.6035 %U http://www.researchprotocols.org/2017/8/e158/ %U https://doi.org/10.2196/resprot.6035 %U http://www.ncbi.nlm.nih.gov/pubmed/28838884 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e18 %T Exploring User Learnability and Learning Performance in an App for Depression: Usability Study %A Stiles-Shields,Colleen %A Montague,Enid %A Lattie,Emily G %A Schueller,Stephen M %A Kwasny,Mary J %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0414, ecsshields@uchicago.edu %K apps %K learning %K cognitive therapy %K usability testing %K depression %D 2017 %7 11.08.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health apps tend to be narrow in their functioning, with their focus mostly being on tracking, management, or psychoeducation. It is unclear what capability such apps have to facilitate a change in users, particularly in terms of learning key constructs relating to behavioral interventions. Thought Challenger (CBITs, Chicago) is a skill-building app that engages users in cognitive restructuring, a core component of cognitive therapy (CT) for depression. Objective: The purpose of this study was to evaluate the learnability and learning performance of users following initial use of Thought Challenger. Methods: Twenty adults completed in-lab usability testing of Thought Challenger, which comprised two interactions with the app. Learnability was measured via completion times, error rates, and psychologist ratings of user entries in the app; learning performance was measured via a test of CT knowledge and skills. Nonparametric tests were conducted to evaluate the difference between individuals with no or mild depression to those with moderate to severe depression, as well as differences in completion times and pre- and posttests. Results: Across the two interactions, the majority of completion times were found to be acceptable (5 min or less), with minimal errors (1.2%, 10/840) and successful completion of CT thought records. Furthermore, CT knowledge and skills significantly improved after the initial use of Thought Challenger (P=.009). Conclusions: The learning objectives for Thought Challenger during initial uses were successfully met in an evaluation with likely end users. The findings therefore suggest that apps are capable of providing users with opportunities for learning of intervention skills. %M 28801301 %R 10.2196/humanfactors.7951 %U http://humanfactors.jmir.org/2017/3/e18/ %U https://doi.org/10.2196/humanfactors.7951 %U http://www.ncbi.nlm.nih.gov/pubmed/28801301 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e19 %T Usability Assessment of the Missouri Cancer Registry’s Published Interactive Mapping Reports: Round One %A Ben Ramadan,Awatef Ahmed %A Jackson-Thompson,Jeannette %A Schmaltz,Chester Lee %+ Missouri Cancer Registry and Research Center (MCR-ARC), University of Missouri-Columbia, 401 Clark Hall, Columbia, MO, 65211, United States, 1 573 882 7775, aab365@mail.missouri.edu %K geographic information systems %K health professionals %K interactive maps %K Missouri Cancer Registry %K usability %D 2017 %7 04.08.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background:  Many users of spatial data have difficulty interpreting information in health-related spatial reports. The Missouri Cancer Registry and Research Center (MCR-ARC) has produced interactive reports for several years. These reports have never been tested for usability. Objective:  The aims of this study were to: (1) conduct a multi-approach usability testing study to understand ease of use (user friendliness) and user satisfaction; and (2) evaluate the usability of MCR-ARC’s published InstantAtlas reports. Methods:   An institutional review board (IRB) approved mixed methodology usability testing study using a convenience sample of health professionals. A recruiting email was sent to faculty in the Master of Public Health program and to faculty and staff in the Department of Health Management and Informatics at the University of Missouri-Columbia. The study included 7 participants. The test included a pretest questionnaire, a multi-task usability test, and the System Usability Scale (SUS). Also, the researchers collected participants’ comments about the tested maps immediately after every trial. Software was used to record the computer screen during the trial and the participants’ spoken comments. Several performance and usability metrics were measured to evaluate the usability of MCR-ARC’s published mapping reports. Results: Of the 10 assigned tasks, 6 reached a 100% completion success rate, and this outcome was relative to the complexity of the tasks. The simple tasks were handled more efficiently than the complicated tasks. The SUS score ranged between 20-100 points, with an average of 62.7 points and a median of 50.5 points. The tested maps’ effectiveness outcomes were better than the efficiency and satisfaction outcomes. There was a statistically significant relationship between the subjects’ performance on the study test and the users’ previous experience with geographic information system (GIS) tools (P=.03). There were no statistically significant relationships between users’ performance and satisfaction and their education level, work type, or previous experience in health care (P>.05). There were strong positive correlations between the three measured usability elements. Conclusions: The tested maps should undergo an extensive refining and updating to overcome all the discovered usability issues and meet the perspectives and needs of the tested maps’ potential users. The study results might convey the perspectives of academic health professionals toward GIS health data. We need to conduct a second-round usability study with public health practitioners and cancer professionals who use GIS tools on a routine basis. Usability testing should be conducted before and after releasing MCR-ARC’s maps in the future. %M 28778842 %R 10.2196/humanfactors.7899 %U http://humanfactors.jmir.org/2017/3/e19/ %U https://doi.org/10.2196/humanfactors.7899 %U http://www.ncbi.nlm.nih.gov/pubmed/28778842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e112 %T Systematic and Iterative Development of a Smartphone App to Promote Sun-Protection Among Holidaymakers: Design of a Prototype and Results of Usability and Acceptability Testing %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 01912088974, angela.rodrigues@newcastle.ac.uk %K sun-protection %K sunburn %K sunscreening agents %K sunbathing %K health behavior %K health promotion %K formative research %K intervention %D 2017 %7 12.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Sunburn and intermittent exposure to ultraviolet rays are risk factors for melanoma. Sunburn is a common experience during holidays, making tourism settings of particular interest for skin cancer prevention. Holidaymakers are a volatile populations found at different locations, which may make them difficult to reach. Given the widespread use of smartphones, evidence suggests that this might be a novel, convenient, scalable, and feasible way of reaching the target population. Objective: The main objective of this study was to describe and appraise the process of systematically developing a smartphone intervention (mISkin app) to promote sun-protection during holidays. Methods: The iterative development process of the mISkin app was conducted over four sequential stages: (1) identify evidence on the most effective behavior change techniques (BCTs) used (active ingredients) as well as theoretical predictors and theories, (2) evidence-based intervention design, (3) co-design with users of the mISkin app prototype, and (4) refinement of the app. Each stage provided key findings that were subsequently used to inform the design of the mISkin app. Results: The sequential approach to development integrates different strands of evidence to inform the design of an evidence-based intervention. A systematic review on previously tested interventions to promote sun-protection provided cues and constraints for the design of this intervention. The development and design of the mISkin app also incorporated other sources of information, such as other literature reviews and experts’ consultations. The developed prototype of the mISkin app was evaluated by engaging potential holidaymakers in the refinement and further development of the mISkin app through usability (ease-of-use) and acceptability testing of the intervention prototype. All 17 participants were satisfied with the mISkin prototype and expressed willingness to use it. Feedback on the app was integrated in the optimization process of the mISkin app. Conclusions: The mISkin app was designed to promote sun-protection among holidaymakers and was based on current evidence, experts’ knowledge and experience, and user involvement. Based on user feedback, the app has been refined and a fully functional version is ready for formal testing in a feasibility pilot study. %M 28606892 %R 10.2196/resprot.7172 %U http://www.researchprotocols.org/2017/6/e112/ %U https://doi.org/10.2196/resprot.7172 %U http://www.ncbi.nlm.nih.gov/pubmed/28606892 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 2 %P e13 %T A Web-Based Graphical Food Frequency Assessment System: Design, Development and Usability Metrics %A Franco,Rodrigo Zenun %A Alawadhi,Balqees %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 118 378 7668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition assessment %K FFQ %K food frequency questionnaire %K personalized nutrition %K nutrition informatics %K dietary intake %K usability %K SUS %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Food frequency questionnaires (FFQs) are well established in the nutrition field, but there remain important questions around how to develop online tools in a way that can facilitate wider uptake. Also, FFQ user acceptance and evaluation have not been investigated extensively. Objective: This paper presents a Web-based graphical food frequency assessment system that addresses challenges of reproducibility, scalability, mobile friendliness, security, and usability and also presents the utilization metrics and user feedback from a deployment study. Methods: The application design employs a single-page application Web architecture with back-end services (database, authentication, and authorization) provided by Google Firebase’s free plan. Its design and responsiveness take advantage of the Bootstrap framework. The FFQ was deployed in Kuwait as part of the EatWellQ8 study during 2016. The EatWellQ8 FFQ contains 146 food items (including drinks). Participants were recruited in Kuwait without financial incentive. Completion time was based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS higher than 70 are considered to be good. Results: A total of 235 participants created accounts in the system, and 163 completed the FFQ. Of those 163 participants, 142 reported their gender (93 female, 49 male) and 144 reported their date of birth (mean age of 35 years, range from 18-65 years). The mean completion time for all FFQs (n=163), excluding periods of interruption, was 14.2 minutes (95% CI 13.3-15.1 minutes). Female participants (n=93) completed in 14.1 minutes (95% CI 12.9-15.3 minutes) and male participants (n=49) completed in 14.3 minutes (95% CI 12.6-15.9 minutes). Participants using laptops or desktops (n=69) completed the FFQ in an average of 13.9 minutes (95% CI 12.6-15.1 minutes) and participants using smartphones or tablets (n=91) completed in an average of 14.5 minutes (95% CI 13.2-15.8 minutes). The median SUS score (n=141) was 75.0 (interquartile range [IQR] 12.5), and 84% of the participants who completed the SUS classified the system either “good” (n=50) or “excellent” (n=69). Considering only participants using smartphones or tablets (n=80), the median score was 72.5 (IQR 12.5), slightly below the SUS median for desktops and laptops (n=58), which was 75.0 (IQR 12.5). No significant differences were found between genders or age groups (below and above the median) for the SUS or completion time. Conclusions: Taking into account all the requirements, the deployment used professional cloud computing at no cost, and the resulting system had good user acceptance. The results for smartphones/tablets were comparable with desktops/laptops. This work has potential to promote wider uptake of online tools that can assess dietary intake at scale. %M 28483746 %R 10.2196/humanfactors.7287 %U http://humanfactors.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/humanfactors.7287 %U http://www.ncbi.nlm.nih.gov/pubmed/28483746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e123 %T Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards %A Lauritsen,Lise %A Andersen,Louise %A Olsson,Emilia %A Søndergaard,Stine Rauff %A Nørregaard,Lasse Benn %A Løventoft,Philip Kaare %A Svendsen,Signe Dunker %A Frøkjær,Erik %A Jensen,Hans Mørch %A Hageman,Ida %A Kessing,Lars Vedel %A Martiny,Klaus %+ Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Edel Sauntes Alle 10, Copenhagen, 2100 Ø, Denmark, 45 38647100, klaus.martiny@regionh.dk %K depressive disorder, major %K electronic monitoring %K graph drawing %K sleep %K self-assessment %K observational study %K inpatients %K patient participation %K chronotherapeutics %D 2017 %7 21.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients suffering from depression have a high risk of relapse and readmission in the weeks following discharge from inpatient wards. Electronic self-monitoring systems that offer patient-communication features are now available to offer daily support to patients, but the usability, acceptability, and adherence to these systems has only been sparsely investigated. Objective: We aim to test the usability, acceptability, adherence, and clinical outcome of a newly developed computer-based electronic self-assessment system (the Daybuilder system) in patients suffering from depression, in the period from discharge until commencing outpatient treatment in the Intensive Outpatient Unit for Affective Disorders. Methods: Patients suffering from unipolar major depression that were referred from inpatient wards to an intensive outpatient unit were included in this study before their discharge, and were followed for four weeks. User satisfaction was assessed using semiqualitative questionnaires and the System Usability Scale (SUS). Patients were interviewed at baseline and at endpoint with the Hamilton depression rating scale (HAM-D17), the Major Depression Inventory (MDI), and the 5-item World Health Organization Well-Being Index (WHO-5). In this four-week period patients used the Daybuilder system to self-monitor mood, sleep, activity, and medication adherence on a daily basis. The system displayed a graphical representation of the data that was simultaneously displayed to patients and clinicians. Patients were phoned weekly to discuss their data entries. The primary outcomes were usability, acceptability, and adherence to the system. The secondary outcomes were changes in: the electronically self-assessed mood, sleep, and activity scores; and scores from the HAM-D17, MDI, and WHO-5 scales. Results: In total, 76% of enrolled patients (34/45) completed the four-week study. Five patients were readmitted due to relapse. The 34 patients that completed the study entered data for mood on 93.8% of the days (872/930), sleep on 89.8% of the days (835/930), activity on 85.6% of the days (796/930), and medication on 88.0 % of the days (818/930). SUS scores were 86.2 (standard deviation [SD] 9.7) and 79% of the patients (27/34) found that the system lived up to their expectations. A significant improvement in depression severity was found on the HAM-D17 from 18.0 (SD 6.5) to 13.3 (SD 7.3; P<.01), on the MDI from 27.1 (SD 13.1) to 22.1 (SD 12.7; P=.006), and in quality of life on the WHO-5 from 31.3 (SD 22.9) to 43.4 (SD 22.1; P<.001) scales, but not on self-assessed mood (P=.08). Mood and sleep parameters were highly variable from day-to-day. Sleep-offset was significantly delayed from baseline, averaging 48 minutes (standard error 12 minutes; P<.001). Furthermore, when estimating delay of sleep-onset (with sleep quality included in the model) during the study period, this showed a significant negative effect on mood (P=.03) Conclusions: The Daybuilder systems performed well technically, and patients were satisfied with the system and had high adherence to self-assessments. The dropout rate and the gradual delay in sleep emphasize the need for continued clinical support for these patients, especially when considering sleep guidance. %M 28432040 %R 10.2196/jmir.6673 %U http://www.jmir.org/2017/4/e123/ %U https://doi.org/10.2196/jmir.6673 %U http://www.ncbi.nlm.nih.gov/pubmed/28432040 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e63 %T Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study %A Hayashi,Aki %A Yamaguchi,Satoko %A Waki,Kayo %A Fujiu,Katsuhito %A Hanafusa,Norio %A Nishi,Takahiro %A Tomita,Hyoe %A Kobayashi,Haruka %A Fujita,Hideo %A Kadowaki,Takashi %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo,, Japan, 81 3 3815 5411 ext 34462, kwaki-tky@umin.ac.jp %K telemedicine %K mobile phone app %K hemodialysis %K self-management %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D’s usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89% (SD 23), 95% (SD 7), and 78% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. %M 28428168 %R 10.2196/resprot.7105 %U http://www.researchprotocols.org/2017/4/e63/ %U https://doi.org/10.2196/resprot.7105 %U http://www.ncbi.nlm.nih.gov/pubmed/28428168 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e7 %T Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis %A Ferron,Joelle C %A Brunette,Mary F %A Geiger,Pamela %A Marsch,Lisa A %A Adachi-Mejia,Anna M %A Bartels,Stephen J %+ Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth Hitchcock Medical Center, 105 Pleasant Street, Hugh Gallon Office Park, Main Bldg, Concord, NH, 03301, United States, 1 603 271 5044, joelle.ferron@dartmouth.edu %K mHealth %K mobile apps %K smoking cessation %K schizophrenia %K psychotic disorders %D 2017 %7 03.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly—66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills. %M 28258047 %R 10.2196/humanfactors.5933 %U http://humanfactors.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/humanfactors.5933 %U http://www.ncbi.nlm.nih.gov/pubmed/28258047 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e7 %T SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women’s Perceptions %A Munro,Sarah %A Hui,Amber %A Salmons,Vanessa %A Solomon,Carolyn %A Gemmell,Emily %A Torabi,Nahal %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4026, patti.janssen@ubc.ca %K pregnancy %K text messaging %K prenatal education %K health behavior %D 2017 %7 07.02.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women’s preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women’s perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages “all the time” (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. %M 28174149 %R 10.2196/publichealth.6949 %U http://publichealth.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/publichealth.6949 %U http://www.ncbi.nlm.nih.gov/pubmed/28174149 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e1 %T Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App %A Pereira-Azevedo,Nuno %A Osório,Luís %A Fraga,Avelino %A Roobol,Monique J %+ Department of Urology, Erasmus University Medical Center, Room NA-1706, PO Box 2040, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA Rotterdam, Netherlands, 31 107032240, nuno@pereira-azevedo.com %K mHealth %K prostate cancer %K nomogram %D 2017 %7 06.01.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ≥7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high—92% (27.7/30), 87% (26.2/30), and 89% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app’s interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. %M 28410180 %R 10.2196/cancer.6750 %U http://cancer.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/cancer.6750 %U http://www.ncbi.nlm.nih.gov/pubmed/28410180 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e47 %T Web-Based Intervention to Reduce Substance Abuse and Depressive Symptoms in Mexico: Development and Usability Test %A Tiburcio,Marcela %A Lara,Ma Asunción %A Aguilar Abrego,Araceli %A Fernández,Morise %A Martínez Vélez,Nora %A Sánchez,Alejandro %+ Ramón de la Fuente Muñiz, National Institute of Psychiatry, Department of Social Sciences in Health, Direction of Epidemiological and Psychosocial Research, Calz Mexico-Xochimilco 101, Col San Lorenzo Huipulco, Del Tlalpan, Mexico City, 14370, Mexico, 52 5541605162, tibsam@imp.edu.mx %K substance abuse %K depressive symptoms %K Internet %K cognitive behavioral therapy %K usability %D 2016 %7 29.09.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: The development of Web-based interventions for substance abuse in Latin America is a new field of interest with great potential for expansion to other Spanish-speaking countries. Objective: This paper describes a project aimed to develop and evaluate the usability of the Web-based Help Program for Drug Abuse and Depression (Programa de Ayuda para Abuso de Drogas y Depresión, PAADD, in Spanish) and also to construct a systematic frame of reference for the development of future Web-based programs. Methods: The PAADD aims to reduce substance use and depressive symptoms with cognitive behavioral techniques translated into Web applications, aided by the participation of a counselor to provide support and guidance. This Web-based intervention includes 4 steps: (1) My Starting Point, (2) Where Do I Want to Be? (3) Strategies for Change, and (4) Maintaining Change. The development of the program was an interactive multistage process. The first stage defined the core structure and contents, which were validated in stage 2 by a group of 8 experts in addiction treatment. Programming of the applications took place in stage 3, taking into account 3 types of end users: administrators, counselors, and substance users. Stage 4 consisted of functionality testing. In stage 5, a total of 9 health professionals and 20 drug users currently in treatment voluntarily interacted with the program in a usability test, providing feedback about adjustments needed to improve users’ experience. Results: The main finding of stage 2 was the consensus of the health professionals about the cognitive behavioral strategies and techniques included in PAADD being appropriate for changing substance use behaviors. In stage 5, the health professionals found the functionalities easy to learn; their suggestions were related to the page layout, inclusion of confirmation messages at the end of activities, avoiding “read more” links, and providing feedback about every activity. On the other hand, the users said the information presented within the modules was easy to follow and suggested more dynamic features with concrete instructions and feedback. Conclusions: The resulting Web-based program may have advantages over traditional face-to-face therapies owing to its low cost, wide accessibility, anonymity, and independence of time and distance factors. The detailed description of the process of designing a Web-based program is an important contribution to others interested in this field. The potential benefits must be verified in specific studies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 25429892; http://www.controlled-trials.com/ISRCTN25429892 (Archived by WebCite at http://www.webcitation.org/6ko1Fsvym) %M 27687965 %R 10.2196/mental.6001 %U http://mental.jmir.org/2016/3/e47/ %U https://doi.org/10.2196/mental.6001 %U http://www.ncbi.nlm.nih.gov/pubmed/27687965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e208 %T Older Cancer Patients’ User Experiences With Web-Based Health Information Tools: A Think-Aloud Study %A Bolle,Sifra %A Romijn,Geke %A Smets,Ellen M A %A Loos,Eugene F %A Kunneman,Marleen %A van Weert,Julia C M %+ Amsterdam School of Communication Research/ ASCoR, Department of Communication Science, University of Amsterdam, P.O. Box 15791, Amsterdam, 1001 NG, Netherlands, 31 205254886, S.Bolle@uva.nl %K user experience %K eHealth %K usability %K think aloud %K aging %K cancer %D 2016 %7 25.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective: This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods: We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results: Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions: Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients. %M 27457709 %R 10.2196/jmir.5618 %U http://www.jmir.org/2016/7/e208/ %U https://doi.org/10.2196/jmir.5618 %U http://www.ncbi.nlm.nih.gov/pubmed/27457709 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 3 %P e21 %T Evaluation of Web-Based Consumer Medication Information: Content and Usability of 4 Australian Websites %A Raban,Magdalena Z %A Tariq,Amina %A Richardson,Lauren %A Byrne,Mary %A Robinson,Maureen %A Li,Ling %A Westbrook,Johanna I %A Baysari,Melissa T %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, 2109, Australia, 61 298502433, magda.raban@mq.edu.au %K consumer health information %K health communication %K prescription drugs %K nonprescription drugs %K drug information service %K Internet %K usability testing %D 2016 %7 21.07.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Medication is the most common intervention in health care, and written medication information can affect consumers’ medication-related behavior. Research has shown that a large proportion of Australians search for medication information on the Internet. Objective: To evaluate the medication information content, based on consumer medication information needs, and usability of 4 Australian health websites: Better Health Channel, myDr, healthdirect, and NPS MedicineWise . Methods: To assess website content, the most common consumer medication information needs were identified using (1) medication queries to the healthdirect helpline (a telephone helpline available across most of Australia) and (2) the most frequently used medications in Australia. The most frequently used medications were extracted from Australian government statistics on use of subsidized medicines in the community and the National Census of Medicines Use. Each website was assessed to determine whether it covered or partially covered information and advice about these medications. To assess website usability, 16 consumers participated in user testing wherein they were required to locate 2 pieces of medication information on each website. Brief semistructured interviews were also conducted with participants to gauge their opinions of the websites. Results: Information on prescription medication was more comprehensively covered on all websites (3 of 4 websites covered 100% of information) than nonprescription medication (websites covered 0%-67% of information). Most websites relied on consumer medicines information leaflets to convey prescription medication information to consumers. Information about prescription medication classes was less comprehensive, with no website providing all information examined about antibiotics and antidepressants. Participants (n=16) were able to locate medication information on websites in most cases (accuracy ranged from 84% to 91%). However, a number of usability issues relating to website navigation and information display were identified. For example, websites not allowing combinations of search terms to be entered in search boxes and continuous blocks of text without subheadings. Conclusions: Of the 4 Australian health information websites tested, none provided consumers with comprehensive medication information on both prescription and nonprescription medications in a user-friendly way. Using data on consumer information needs and user testing to guide medication information content and website design is a useful approach to inform consumer website development. %M 27443680 %R 10.2196/ijmr.5651 %U http://www.i-jmr.org/2016/3/e21/ %U https://doi.org/10.2196/ijmr.5651 %U http://www.ncbi.nlm.nih.gov/pubmed/27443680 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e144 %T Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers %A Hattink,Bart %A Droes,Rose-Marie %A Sikkes,Sietske %A Oostra,Ellen %A Lemstra,Afina W %+ VU University Medical Center, Department of Psychiatry, Postbus 74077, Amsterdam, 1070 BB, Netherlands, 31 207885622, b.hattink@vumc.nl %K dementia %K Alzheimer disease %K patient portal %K electronic health record %K eHealth %D 2016 %7 21.07.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Dementia is a progressive and highly disabling neurodegenerative disease that will likely become highly prevalent in the future due to the globally aging population. To improve health care efficiency and quality for dementia care, eHealth could help with, for example, an online portal, such as the Digital Alzheimer Center (DAC) of the Vrije Universiteit Medical Center Amsterdam. It provides up-to-date disease information, peer-to-peer contact, and methods for contacting the hospital and health professionals. Objective: We aimed to investigate the usability and usefulness of the DAC for patients with dementia and carers to get insight into the feasibility and value of this eHealth app in dementia care and to recommend potential improvements. Methods: A descriptive study among patients, carers, and health care professionals was performed. Mixed methods were used, consisting of observations (n=10, 4 people with dementia, 6 carers), an online survey (n=287; 88 patients, 199 carers), and semistructured interviews (n=18; 6 patients, 6 carers, 6 health care professionals). During the observations, participants performed a set of five different prescribed tasks on the portal. Speed, number of errors, and navigation were noted. The online survey aimed to assess users’ opinions on the portal’s usability and usefulness. Semistructured interviews were conducted in a subsample of patients, carers, and health care professionals to gain more in-depth information. Results: In the usability assessment, eight categories of errors were distinguished, of which three were of critical, two of medium, and three of low severity. In the survey, 45% (40/88) of the patients and 53% (105/199) of the carers indicated they used the portal. In all, 33% (12/36) of patients and 61% (62/102) of carers found it easy to learn to work with the portal. Most considered the DAC generally useful: 65% (17/26) of patients and 78% (67/86) of carers found the DAC useful, especially for understanding dementia (patients: 64%, 16/25; carers: 62%, 53/86). In the semistructured interviews, the site was generally rated positively on usability and usefulness and being well designed. People with dementia and carers indicated it helped them to understand and deal with dementia. Conclusions: To our knowledge, this is the first study investigating the usability and usefulness of an Internet portal especially designed for people with dementia and their carers. An online patient portal could be a useful means to help to support patients and carers in dealing with dementia: the majority of users positively evaluated usability and usefulness of the portal, and appreciated the information on it. However, only a minority of patients found it easy to work with the portal. Good design and frequent usability testing is essential to offer a good online portal. %M 27444209 %R 10.2196/resprot.5040 %U http://www.researchprotocols.org/2016/3/e144/ %U https://doi.org/10.2196/resprot.5040 %U http://www.ncbi.nlm.nih.gov/pubmed/27444209 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e18 %T Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records %A Press,Anne %A DeStio,Catherine %A McCullagh,Lauren %A Kapoor,Sandeep %A Morley,Jeanne %A , %A Conigliaro,Joseph %+ Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY, 11030, United States, 1 267 979 7940, anniepress@gmail.com %K clinical decision support %K adoption %K primary care %K usability %K SBIRT %D 2016 %7 08.07.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods. Objective: The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home. Methods: Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version. Results: Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient’s visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade “1” for the statement, “I would like to use this system frequently” during the first round of testing but a “5” during the second round of analysis. Conclusions: The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers’ perceptions of the SBIRT tool and their specific clinical workflow. %M 27393643 %R 10.2196/humanfactors.5820 %U http://humanfactors.jmir.org/2016/2/e18/ %U https://doi.org/10.2196/humanfactors.5820 %U http://www.ncbi.nlm.nih.gov/pubmed/27393643 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e76 %T Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer %A Arvidsson,Susann %A Gilljam,Britt-Mari %A Nygren,Jens %A Ruland,Cornelia Maria %A Nordby-Bøe,Trude %A Svedberg,Petra %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, SE-301 18, Sweden, 46 35 16 71 00, susann.arvidsson@hh.se %K cancer %K children %K communication %K mobile app %K participation %K validation %D 2016 %7 24.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. %M 27343004 %R 10.2196/mhealth.5715 %U http://mhealth.jmir.org/2016/2/e76/ %U https://doi.org/10.2196/mhealth.5715 %U http://www.ncbi.nlm.nih.gov/pubmed/27343004 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e113 %T Building a Tailored, Patient-Guided, Web-Based Self-Management Intervention ‘ReumaUitgedaagd!’ for Adults With a Rheumatic Disease: Results of a Usability Study and Design for a Randomized Control Trail %A Ammerlaan,Judy W %A Mulder,Olga K %A de Boer-Nijhof,Nienke C %A Maat,Bertha %A Kruize,Aike A %A van Laar,Jaap %A van Os-Medendorp,Harmieke %A Geenen,Rinie %+ University Medical Center Utrecht, Department Rheumatology and Clinical Immunology, PO Box 85 500, Utrecht, 3508 GA, Netherlands, 31 887558660, j.ammerlaan@umcutrecht.nl %K Web-based %K self-management %K tailored %K intervention %K pilot study %K randomized controlled trial %K personal goal %K rheumatic diseases %D 2016 %7 23.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: The chronic nature of rheumatic diseases imposes daily challenges upon those affected and causes patients to make daily decisions about the way they self-manage their illness. Although there is attention to self-management and evidence for the desirability of tailored interventions to support people with a rheumatic disease, interventions based on individual needs and preferences are scarce. Objective: To provide a systematic and comprehensive description of the theoretical considerations for building a Web-based, expert, patient-guided, and tailored intervention for adult patients with a rheumatic disease. Also, to present the results of a usability study on the feasibility of this intervention, and its study design in order to measure the effectiveness. Methods: To fit the intervention closely to the autonomy, needs, and preferences of the individual patient, a research team comprising patient representatives, health professionals, Web technicians, and communication experts was formed. The research team followed the new guidance by the Medical Research Council (MRC) for developing and evaluating complex interventions as a guide for the design of the intervention. Results: Considerations from self-determination theory and a comprehensive assessment of preferences and needs in patients with a rheumatic disease guided the development of the Web-based intervention. The usability study showed that the intervention was useful, easy to use, and accepted and appreciated by the target group of patients. The planned randomized controlled trial is designed to be conducted among 120 adults with a rheumatic disease, who are assigned to the self-management intervention or a self-help control group. Both groups will be asked to formulate personal goals they want to achieve concerning their self-management. Progress toward the personal goal is the primary outcome measure of this study. Self-reported Web-based measures will be assessed before randomization at baseline, and 3 and 6 months after randomization. Also, feasibility and adherence to the Web-based self-management intervention as process outcomes will be evaluated. Conclusion: By identifying the individual goals at the beginning of the intervention and customizing the intervention to the individual patient, we aim to improve the usefulness and effectiveness of the Web-based self-management intervention. If proven effective, ReumaUitgedaagd! Online will be implemented in the Netherlands. %M 27339472 %R 10.2196/resprot.5735 %U http://www.researchprotocols.org/2016/2/e113/ %U https://doi.org/10.2196/resprot.5735 %U http://www.ncbi.nlm.nih.gov/pubmed/27339472 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 1 %P e16 %T Effects of Information Visualization on Older Adults’ Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study %A Price,Margaux M %A Crumley-Branyon,Jessica J %A Leidheiser,William R %A Pak,Richard %+ Clemson University, Department of Psychology, 418 Brackett Hall, Clemson, SC, 29634, United States, 1 864 656 1584, richpak@clemson.edu %K Information visualization %K aging %K health-related websites %K working memory %D 2016 %7 01.06.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults’ decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. Objective: The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Methods: Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Results: Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Conclusions: Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan. %M 27251110 %R 10.2196/humanfactors.5106 %U http://humanfactors.jmir.org/2016/1/e16/ %U https://doi.org/10.2196/humanfactors.5106 %U http://www.ncbi.nlm.nih.gov/pubmed/27251110 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e44 %T Development of the Lupus Interactive Navigator as an Empowering Web-Based eHealth Tool to Facilitate Lupus Management: Users Perspectives on Usability and Acceptability %A Neville,Carolyn %A Da Costa,Deborah %A Rochon,Murray %A Peschken,Christine A %A Pineau,Christian A %A Bernatsky,Sasha %A Keeling,Stephanie %A Avina-Zubieta,Antonio %A Lye,Elizabeth %A Eng,Davy %A Fortin,Paul R %+ Centre de recherche du CHU de Québec - Université Laval, Faculté de médecine, Université Laval, 2705, boul. Laurier, Room H-1365, Quebec, QC, G1V 4G2, Canada, 1 418 654 2178, Paul.Fortin@crhudequebec.ulaval.ca %K Systemic lupus erythematosus %K web-based eHealth tool %K self-management %K empowerment %K usability %K navigation %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Systemic Lupus Erythematosus (SLE) is a serious, complex, and chronic illness. Similar to most other chronic illness states, there is great interest in helping persons with SLE engage in their disease management. Objective: The objectives of this study were to (1) develop the Lupus Interactive Navigator (LIN), a web-based self-management program for persons with SLE, and (2) test the LIN for usability and acceptability. Methods: The LIN development platform was based on the results of preliminary comprehensive needs assessments and adapted from the Oncology Interactive Navigator, a web-based tool developed for persons with cancer. Medical researchers, writers, designers, and programmers worked with clinical experts and persons with SLE to develop content for the LIN. Usability and acceptability of the LIN was tested on individuals with SLE meeting American College of Rheumatology criteria, who were recruited from five Canadian SLE clinics. Participants were provided with access to the LIN and were asked to use it over a two-week period. Following the testing period, participants were contacted for a 30-minute telephone interview to assess usability and acceptability. Results: The content for the LIN was subdivided into six primary information topics with interview videos featuring rheumatologists, allied health professionals, and persons with SLE. Usability and acceptability of the LIN was tested on 43 females with SLE. Of these, 37 (86%) completed telephone interviews. The average age was 43.6 (SD 15.9) years and disease duration averaged 14.1 (SD 10.8) years. Median time spent on LIN was 16.3 (interquartile range [IQR]:13.7, 53.5) minutes and median number of sessions was 2 (IQR: 1, 3). Overall, Likert ratings (0=strongly disagree; 7=strongly agree) of website usability and content were very high, with 75% scoring >6 out of 7 on all items. All participants agreed that LIN was easy to use, would recommend it to others with SLE, and would refer to it for future questions about SLE. Very high ratings were also given to relevancy, credibility, and usefulness of the information provided. Overall, 73% of the participants rated all topics helpful to very helpful. Participants who reported more prior knowledge about SLE rated items regarding improvement in knowledge and helpfulness relatively lower than persons with less prior knowledge. Most participants commented that the LIN would be very useful to those newly diagnosed with SLE. Minor revisions were recommended. Conclusions: This study furthers the understanding of the needs in the SLE community and delivers a unique eHealth tool to promote self-management in persons with SLE. The LIN was found to be highly acceptable in content and usability. The information provided on LIN may be most helpful for individuals with less experience with the disease, such as those newly diagnosed, indicating the need to tailor the content for persons with more SLE experience. %M 27240666 %R 10.2196/resprot.4219 %U http://www.researchprotocols.org/2016/2/e44/ %U https://doi.org/10.2196/resprot.4219 %U http://www.ncbi.nlm.nih.gov/pubmed/27240666 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 2 %P e15 %T Facilitating Secure Sharing of Personal Health Data in the Cloud %A Thilakanathan,Danan %A Calvo,Rafael A %A Chen,Shiping %A Nepal,Surya %A Glozier,Nick %+ Software Engineering Lab, School of Electrical and Information Engineering, The University of Sydney, Level 5, Bldg J03 (Electrical Engineering Building), Maze Crescent, Sydney, 2006, Australia, 61 02 9351 8171, Danan.Thilakanathan@sydney.edu.au %K self care %K telemedicine %K privacy %K computer security %K information dissemination %D 2016 %7 27.05.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective: This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods: We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results: We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions: We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. %M 27234691 %R 10.2196/medinform.4756 %U http://medinform.jmir.org/2016/2/e15/ %U https://doi.org/10.2196/medinform.4756 %U http://www.ncbi.nlm.nih.gov/pubmed/27234691 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 2 %P e14 %T An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence–Powered Medication Reconciliation Tool %A Long,Ju %A Yuan,Michael Juntao %A Poonawala,Robina %+ McCoy College of Business Administration, Department of Computer Information Systems and Quantitative Methods, Texas State University, 601 University Dr, San Marcos, TX, 78666, United States, 1 5123006829, jl38@txstate.edu %K medication reconciliation %K adverse drug event %K medication errors %K medication adherence %K patient medication knowledge %K decision making, shared %D 2016 %7 16.05.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Medication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap. Objective: The aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen. Methods: In this study, we developed iPad-based software tools, with AI decision support, to engage patients to “self-service” medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool’s user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool’s usability afterward. Results: All patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving. Conclusions: We have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians. %M 27185210 %R 10.2196/ijmr.5462 %U http://www.i-jmr.org/2016/2/e14/ %U https://doi.org/10.2196/ijmr.5462 %U http://www.ncbi.nlm.nih.gov/pubmed/27185210 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men %A LeGrand,Sara %A Muessig,Kathryn Elizabeth %A McNulty,Tobias %A Soni,Karina %A Knudtson,Kelly %A Lemann,Alex %A Nwoko,Nkechinyere %A Hightow-Weidman,Lisa B %+ Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive, Room 305, Durham, NC, 27710, United States, 1 9194380448, sara.legrand@duke.edu %K mobile applications %K video games %K serious games %K HIV %K medication adherence %K health knowledge, attitudes, practice %K youth %K men who have sex with men %D 2016 %7 13.05.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM. Objective: This study used a multiphase, iterative development process to create an ART adherence app for YMSM. Methods: The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population’s ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype. Results: The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably. Conclusions: An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM. %M 27178752 %R 10.2196/games.5687 %U http://games.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/games.5687 %U http://www.ncbi.nlm.nih.gov/pubmed/27178752 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e13 %T The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence %A Nelson,Lyndsay A %A Bethune,Magaela C %A Lagotte,Andrea E %A Osborn,Chandra Y %+ Center for Health Behavior and Health Education, Vanderbilt University Medical Center, 2525 West End Ave, Suite 370, Nashville, TN, 37203, United States, 1 615 936 8468, chandra.osborn@vanderbilt.edu %K Website %K Usability Testing %K Type 2 Diabetes Mellitus %K Medication Adherence %K Intervention %D 2016 %7 12.05.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website’s benefits can identify barriers to user engagement and maximize future use. Objective: We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial. Methods: We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants’ favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP. Results: Enrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an unspecified format). Participants also reported difficulty accessing the site and, once accessed, using all of its features. Participants recommended improving the site’s user interface to facilitate quick, efficient access to all features and content. Conclusions: Adults with T2DM rated the Diabetes MAP website favorably on surveys, but focus groups gave more in-depth feedback on the user experience (eg, difficulty accessing the site, maximizing all of the site’s features and content, and recovering from errors). Appropriate usability testing methods ensure Web-delivered interventions work as intended and any benefits are not diminished by usability challenges. %M 27174496 %R 10.2196/humanfactors.5177 %U http://humanfactors.jmir.org/2016/1/e13/ %U https://doi.org/10.2196/humanfactors.5177 %U http://www.ncbi.nlm.nih.gov/pubmed/27174496 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e14 %T The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website %A Barbara,Angela M %A Dobbins,Maureen %A Haynes,R. Brian %A Iorio,Alfonso %A Lavis,John N %A Raina,Parminder %A Levinson,Anthony J %+ Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, MDCL 3117, 1280 Main Street West, Hamilton, ON,, Canada, 1 905 525 9120 ext 26525, levinsa@mcmaster.ca %K online health information %K health informatics %K elderly %K consumer health information %K qualitative research %K usability testing %K Internet %K evidence-based medicine %K knowledge translation %K aging %K website %D 2016 %7 11.05.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Objective: Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Methods: Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. Results: A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal’s strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. Conclusions: The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites. %M 27170443 %R 10.2196/humanfactors.4800 %U http://humanfactors.jmir.org/2016/1/e14/ %U https://doi.org/10.2196/humanfactors.4800 %U http://www.ncbi.nlm.nih.gov/pubmed/27170443 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e24 %T Development of a Weight Loss Mobile App Linked With an Accelerometer for Use in the Clinic: Usability, Acceptability, and Early Testing of its Impact on the Patient-Doctor Relationship %A Choo,Seryung %A Kim,Ju Young %A Jung,Se Young %A Kim,Sarah %A Kim,Jeong Eun %A Han,Jong Soo %A Kim,Sohye %A Kim,Jeong Hyun %A Kim,Jeehye %A Kim,Yongseok %A Kim,Dongouk %A Steinhubl,Steve %+ Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic Of Korea, 82 31 787 7796, kkamduri@snubh.org %K mobile apps %K electronic health record %K weight reduction programs %K physician-patient relations %D 2016 %7 31.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Although complications of obesity are well acknowledged and managed by clinicians, management of obesity itself is often difficult, which leads to its underdiagnosis and undertreatment in hospital settings. However, tools that could improve the management of obesity, including self-monitoring, engagement with a social network, and open channels of communication between the patient and doctor, are limited in a clinic-based setting. Objective: The objective of our study was to evaluate the usability and acceptability of a newly developed mobile app linked with an accelerometer and its early effects on patient-doctor relationships. Methods: From September 2013 to February 2014, we developed a mobile app linked with an accelerometer as a supportive tool for a clinic-based weight loss program. The app used information from electronic health records and delivered tailored educational material. Personal goal setting, as well as monitoring of weight changes and physical activity combined with feedback, are key features of the app. We also incorporated an interactive message board for patients and doctors. During the period of March 2014 to May 2014, we tested our mobile app for 1 month in participants in a hospital clinic setting. We assessed the app’s usability and acceptability, as well as the patient-doctor relationship, via questionnaires and analysis of app usage data. Results: We recruited 30 individuals (18 male and 12 female) for the study. The median number of log-ins per day was 1.21, with the most frequently requested item being setting goals, followed by track physical activities and view personal health status. Scales of the depth of the patient-doctor relationship decreased from 27.6 (SD 4.8) to 25.1 (SD 4.5) by a Wilcoxon signed rank test (P=.02). Conclusions: A mobile phone app linked with an accelerometer for a clinic-based weight loss program is useful and acceptable for weight management but exhibited less favorable early effects on patient-doctor relationships. %M 27032541 %R 10.2196/mhealth.4546 %U http://mhealth.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/mhealth.4546 %U http://www.ncbi.nlm.nih.gov/pubmed/27032541 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e20 %T Design of a Tablet Computer App for Facilitation of a Molecular Blood Culture Test in Clinical Microbiology and Preliminary Usability Evaluation %A Samson,Lasse L %A Pape-Haugaard,Louise %A Meltzer,Michelle C %A Fuchs,Martin %A Schønheyder,Henrik C %A Hejlesen,Ole %+ Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 C1-223, Aalborg, 9220, Denmark, 45 99409940, lsamson@hst.aau.dk %K usability %K mobile applications %K tablet computers %K clinical simulation %K health information systems %K diagnostic test %K clinical microbiology %D 2016 %7 18.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: User mobility is an important aspect of the development of clinical information systems for health care professionals. Mobile phones and tablet computers have obtained widespread use by health care professionals, offering an opportunity for supporting the access to patient information through specialized applications (apps) while supporting the mobility of the users. The use of apps for mobile phones and tablet computers may support workflow of complex tasks, for example, molecular-based diagnostic tests in clinical microbiology. Multiplex Blood Culture Test (MuxBCT) is a molecular-based diagnostic test used for rapid identification of pathogens in positive blood cultures. To facilitate the workflow of the MuxBCT, a specialized tablet computer app was developed as an accessory to the diagnostic test. The app aims to reduce the complexity of the test by step-by-step guidance of microscopy and to assist users in reaching an exact bacterial or fungal diagnosis based on blood specimen observations and controls. Additionally, the app allows for entry of test results, and communication thereof to the laboratory information system (LIS). Objective: The objective of the study was to describe the design considerations of the MuxBCT app and the results of a preliminary usability evaluation. Methods: The MuxBCT tablet app was developed and set up for use in a clinical microbiology laboratory. A near-live simulation study was conducted in the clinical microbiology laboratory to evaluate the usability of the MuxBCT app. The study was designed to achieve a high degree of realism as participants carried out a scenario representing the context of use for the MuxBCT app. As the MuxBCT was under development, the scenario involved the use of molecular blood culture tests similar to the MuxBCT for identification of microorganisms from positive blood culture samples. The study participants were observed, and their interactions with the app were recorded. After the study, the participants were debriefed to clarify observations. Results: Four medical laboratory technicians, for example, representative of end users of the app, participated in the clinical simulation study. Using the MuxBCT app, the study participants successfully identified and reported all microorganisms from the positive blood cultures examined. Three of the four participants reported that they found the app useful, while one study participant reported that she would prefer to make notes on paper and later enter them into the LIS. Conclusions: The preliminary usability evaluation results indicate that use of the MuxBCT tablet app can facilitate the workflow of the MuxBCT diagnostic test. %M 26993432 %R 10.2196/mhealth.5041 %U http://mhealth.jmir.org/2016/1/e20/ %U https://doi.org/10.2196/mhealth.5041 %U http://www.ncbi.nlm.nih.gov/pubmed/26993432 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e10 %T Implementation of a Computerized Screening Inventory: Improved Usability Through Iterative Testing and Modification %A Boudreaux,Edwin D %A Fischer,Andrew Christopher %A Haskins,Brianna Lyn %A Saeed Zafar,Zubair %A Chen,Guanling %A Chinai,Sneha A %+ Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 334 3817, edwin.boudreaux@umassmed.edu %K behavioral medicine %K computers %K electronic health records %K public health %K screening %K telemedicine %D 2016 %7 09.03.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: The administration of health screeners in a hospital setting has traditionally required (1) clinicians to ask questions and log answers, which can be time consuming and susceptible to error, or (2) patients to complete paper-and-pencil surveys, which require third-party entry of information into the electronic health record and can be vulnerable to error and misinterpretation. A highly promising method that avoids these limitations and bypasses third-party interpretation is direct entry via a computerized inventory. Objective: To (1) computerize medical and behavioral health screening for use in general medical settings, (2) optimize patient acceptability and feasibility through iterative usability testing and modification cycles, and (3) examine how age relates to usability. Methods: A computerized version of 15 screeners, including behavioral health screeners recommended by a National Institutes of Health Office of Behavioral and Social Sciences Research collaborative workgroup, was subjected to systematic usability testing and iterative modification. Consecutive adult, English-speaking patients seeking treatment in an urban emergency department were enrolled. Acceptability was defined as (1) the percentage of eligible patients who agreed to take the assessment (initiation rate) and (2) average satisfaction with the assessment (satisfaction rate). Feasibility was defined as the percentage of the screening items completed by those who initiated the assessment (completion rate). Chi-square tests, analyses of variance, and Pearson correlations were used to detect whether improvements in initiation, satisfaction, and completion rates were seen over time and to examine the relation between age and outcomes. Results: Of 2157 eligible patients approached, 1280 agreed to complete the screening (initiation rate=59.34%). Statistically significant increases were observed over time in satisfaction (F3,1061=3.35, P=.019) and completion rates (F3,1276=25.44, P<.001). Younger age was associated with greater initiation (initiated, mean [SD], 46.6 [18.7] years; declined: 53.0 [19.5] years, t2,155=−7.6, P<.001), higher completion (r=−.20, P<.001), and stronger satisfaction (r=−.23, P<.001). Conclusions: In a rapid-paced emergency department with a heterogeneous patient population, 59.34% (1280/2157) of all eligible patients initiated the computerized screener with a completion rate reaching over 90%. Usability testing revealed several critical principles for maximizing usability of the computerized medical and behavioral health screeners used in this study. Further work is needed to identify usability issues pertaining to other screeners, racially and ethnically diverse patient groups, and different health care settings. %M 27025766 %R 10.2196/humanfactors.4896 %U http://humanfactors.jmir.org/2016/1/e10/ %U https://doi.org/10.2196/humanfactors.4896 %U http://www.ncbi.nlm.nih.gov/pubmed/27025766 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e7 %T Evaluating the Usability and Perceived Impact of an Electronic Medical Record Toolkit for Atrial Fibrillation Management in Primary Care: A Mixed-Methods Study Incorporating Human Factors Design %A Tran,Kim %A Leblanc,Kori %A Valentinis,Alissia %A Kavanagh,Doug %A Zahr,Nina %A Ivers,Noah M %+ OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada, 1 6476789375, kim.tran2@uhn.ca %K primary health care, atrial fibrillation, electronic health records, mixed-methods research, evidence-based medicine %D 2016 %7 17.02.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Atrial fibrillation (AF) is a common and preventable cause of stroke. Barriers to reducing stroke risk through appropriate prescribing have been identified at the system, provider, and patient levels. To ensure a multifaceted initiative to address these barriers is effective, it is essential to incorporate user-centered design to ensure all intervention components are optimized for users. Objective: To test the usability of an electronic medical record (EMR) toolkit for AF in primary care with the goal of further refining the intervention to meet the needs of primary care clinicians. Methods: An EMR-based toolkit for AF was created and optimized through usability testing and iterative redesign incorporating a human factors approach. A mixed-methods pilot study consisting of observations, semi-structured interviews, and surveys was conducted to examine usability and perceived impact on patient care and workflow. Results: A total of 14 clinicians (13 family physicians and 1 nurse practitioner) participated in the study. Nine iterations of the toolkit were created in response to feedback from clinicians and the research team; interface-related changes were made, additional AF-related resources were added, and functionality issues were fixed to make the toolkit more effective. After improvements were made, clinicians expressed that the toolkit improved accessibility to AF-related information and resources, served as a reminder for guideline-concordant AF management, and was easy to use. Most clinicians intended to continue using the toolkit for patient care. With respect to impact on care, clinicians believed the toolkit increased the thoroughness of their assessments for patients with AF and improved the quality of AF-related care received by their patients. Conclusions: The positive feedback surrounding the EMR toolkit for AF and its perceived impact on patient care can be attributed to the adoption of a user-centered design that merged clinically important information about AF management with user needs. This study demonstrates the utility of a human factors approach to piloting and refining an intervention prior to wide-scale implementation. %M 27026394 %R 10.2196/humanfactors.4289 %U http://humanfactors.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/humanfactors.4289 %U http://www.ncbi.nlm.nih.gov/pubmed/27026394 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e16 %T The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda %A English,Lauren Lacey %A Dunsmuir,Dustin %A Kumbakumba,Elias %A Ansermino,John Mark %A Larson,Charles P %A Lester,Richard %A Barigye,Celestine %A Ndamira,Andrew %A Kabakyenga,Jerome %A Wiens,Matthew O %+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2733 Heather Street, Vancouver, BC, , Canada, 1 604 997 7753, mowiens@outlook.com %K infectious disease %K postdischarge mortality %K mHealth %K prediction model %K risk assessment %K usability %K Africa %K resource-limited settings %D 2016 %7 15.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation. Objective: Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool. Methods: Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children’s Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient’s risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements. Results: The average time to complete the PARA app decreased by 30% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen saturation interface, but modifications following Phase 1 cut this time by half. The average time-to-completion (during Phase 2) for doctors/medical students was 3 minutes 56 seconds. All participants agreed they would use the PARA app if available at their health facility. Given a high PARA risk score, participants suggested several interventions that would be appropriate for the sociocultural context in southwestern Uganda, which involved strengthening discharge and referral procedures within the current health care system. Conclusions: Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly app, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. Doctors and medical students had shorter task completion times, though all participants reported the usefulness of this tool to improve postdischarge outcomes. %M 26879041 %R 10.2196/mhealth.5167 %U http://mhealth.jmir.org/2016/1/e16/ %U https://doi.org/10.2196/mhealth.5167 %U http://www.ncbi.nlm.nih.gov/pubmed/26879041 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e6 %T Sociotechnical Human Factors Involved in Remote Online Usability Testing of Two eHealth Interventions %A Wozney,Lori M %A Baxter,Pamela %A Fast,Hilary %A Cleghorn,Laura %A Hundert,Amos S %A Newton,Amanda S %+ Centre for Research in Family Health, IWK Health Centre, 5850—5980 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 902 470 7541, loriwozney@gmail.com %K usability inspection %K Web-conferencing %K telemedicine %K HCI design and evaluation methods %K walk-through evaluation %K real-time systems %K human centered-computing %D 2016 %7 03.02.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Research in the fields of human performance technology and human computer interaction are challenging the traditional macro focus of usability testing arguing for methods that help test moderators assess “use in context” (ie, cognitive skills, usability understood over time) and in authentic “real world” settings. Human factors in these complex test scenarios may impact on the quality of usability results being derived yet there is a lack of research detailing moderator experiences in these test environments. Most comparative research has focused on the impact of the physical environment on results, and rarely on how the sociotechnical elements of the test environment affect moderator and test user performance. Improving our understanding of moderator roles and experiences with conducting “real world” usability testing can lead to improved techniques and strategies Objective: To understand moderator experiences of using Web-conferencing software to conduct remote usability testing of 2 eHealth interventions. Methods: An exploratory case study approach was used to study 4 moderators’ experiences using Blackboard Collaborate for remote testing sessions of 2 different eHealth interventions. Data collection involved audio-recording iterative cycles of test sessions, collecting summary notes taken by moderators, and conducting 2 90-minute focus groups via teleconference. A direct content analysis with an inductive coding approach was used to explore personal accounts, assess the credibility of data interpretation, and generate consensus on the thematic structure of the results. Results: Following the convergence of data from the various sources, 3 major themes were identified: (1) moderators experienced and adapted to unpredictable changes in cognitive load during testing; (2) moderators experienced challenges in creating and sustaining social presence and untangling dialogue; and (3) moderators experienced diverse technical demands, but were able to collaboratively troubleshoot with test users. Conclusions: Results highlight important human-computer interactions and human factor qualities that impact usability testing processes. Moderators need an advanced skill and knowledge set to address the social interaction aspects of Web-based usability testing and technical aspects of conferencing software during test sessions. Findings from moderator-focused studies can inform the design of remote testing platforms and real-time usability evaluation processes that place less cognitive burden on moderators and test users. %M 27026291 %R 10.2196/humanfactors.4602 %U http://humanfactors.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/humanfactors.4602 %U http://www.ncbi.nlm.nih.gov/pubmed/27026291 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e11 %T Assessing the Usability of Web-Based Alcohol Education for Older Adults: A Feasibility Study %A Fink,Arlene %A Kwan,Lorna %A Osterweil,Dan %A Van Draanen,Jenna %A Cooke,Alexis %A Beck,John C %+ Arlene Fink Associates, 1562 Casale Road, Pacific Palisades, CA, 90272, United States, 1 3104544296, arlene.fink@gmail.com %K alcohol %K older adults %K elderly %K web-based %K education %K online alcohol education %D 2016 %7 01.02.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Older adults can experience unfavorable health effects from drinking at relatively low consumption levels because of age-related physiological changes and alcohol’s potentially adverse interactions with declining health, increased medication-use and diminishing functional status. At the same time, alcohol use in older adults may be protective against heart disease, stroke, and other disorders associated with aging. We developed “A Toast to Health in Later Life! Wise Drinking as We Age,” a web-based educational intervention to teach older adults to balance drinking risks and benefits. Objective: To examine the intervention’s feasibility in a sample of community-dwelling current drinkers ≥55 years of age and examine its effects on their quantity and frequency of alcohol use, adherence to standard drinking guidelines, and alcohol-related risks. Methods: Participants were recruited in person, by mail and by telephone between September and October 2014 from a community-based social services organization serving Los Angeles County. Once enrolled, participants were randomly assigned to the intervention or to a control group. The conceptual frameworks for the intervention were the Health Belief Model, models of adult learning, and the US Department of Health and Human Services guidelines for designing easy-to-use websites. The intervention’s content focuses on the relationship between drinking and its effects on older adults’ medical conditions, use of medications, and ability to perform daily activities. It also addresses quantity and frequency of alcohol use, drinking and driving and binge drinking. The control group did not receive any special intervention. Data on alcohol use and risks for both groups came from the online version of the Alcohol-Related Problems Survey and were collected at baseline and four weeks later. Data on usability were collected online from the intervention group immediately after it completed its review of the website. Results: The 49 intervention and 47 control participants did not differ at baseline in age, ethnicity, medication use, medical conditions, or alcohol use and both groups were mostly female, college-educated, and in good health. Of the intervention participants, 94% (46/49) had little or no difficulty using the website, with 67% (33/49) reporting that they will change the way they think about drinking because of their exposure to the education. At the 4-week follow-up, the intervention group reported drinking less (P=.02). No changes between groups were found in quantity and frequency, adherence to recommended guidelines, or risk status. Conclusions: Community-dwelling older adults are receptive to online alcohol education. To be most effective, the education should be included as a component of a larger effort consisting of screening and counseling preferably in a health care setting. %M 26832213 %R 10.2196/resprot.4545 %U http://www.researchprotocols.org/2016/1/e11/ %U https://doi.org/10.2196/resprot.4545 %U http://www.ncbi.nlm.nih.gov/pubmed/26832213 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e13 %T Natural Language Search Interfaces: Health Data Needs Single-Field Variable Search %A Jay,Caroline %A Harper,Simon %A Dunlop,Ian %A Smith,Sam %A Sufi,Shoaib %A Goble,Carole %A Buchan,Iain %+ Information Management Group, School of Computer Science, University of Manchester, Kilburn Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1612750599, simon.harper@manchester.ac.uk %K searching behavior %K search engine %K research data archives %K user-computer interface %D 2016 %7 14.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Data discovery, particularly the discovery of key variables and their inter-relationships, is key to secondary data analysis, and in-turn, the evolving field of data science. Interface designers have presumed that their users are domain experts, and so they have provided complex interfaces to support these “experts.” Such interfaces hark back to a time when searches needed to be accurate first time as there was a high computational cost associated with each search. Our work is part of a governmental research initiative between the medical and social research funding bodies to improve the use of social data in medical research. Objective: The cross-disciplinary nature of data science can make no assumptions regarding the domain expertise of a particular scientist, whose interests may intersect multiple domains. Here we consider the common requirement for scientists to seek archived data for secondary analysis. This has more in common with search needs of the “Google generation” than with their single-domain, single-tool forebears. Our study compares a Google-like interface with traditional ways of searching for noncomplex health data in a data archive. Methods: Two user interfaces are evaluated for the same set of tasks in extracting data from surveys stored in the UK Data Archive (UKDA). One interface, Web search, is “Google-like,” enabling users to browse, search for, and view metadata about study variables, whereas the other, traditional search, has standard multioption user interface. Results: Using a comprehensive set of tasks with 20 volunteers, we found that the Web search interface met data discovery needs and expectations better than the traditional search. A task × interface repeated measures analysis showed a main effect indicating that answers found through the Web search interface were more likely to be correct (F1,19=37.3, P<.001), with a main effect of task (F3,57=6.3, P<.001). Further, participants completed the task significantly faster using the Web search interface (F1,19=18.0, P<.001). There was also a main effect of task (F2,38=4.1, P=.025, Greenhouse-Geisser correction applied). Overall, participants were asked to rate learnability, ease of use, and satisfaction. Paired mean comparisons showed that the Web search interface received significantly higher ratings than the traditional search interface for learnability (P=.002, 95% CI [0.6-2.4]), ease of use (P<.001, 95% CI [1.2-3.2]), and satisfaction (P<.001, 95% CI [1.8-3.5]). The results show superior cross-domain usability of Web search, which is consistent with its general familiarity and with enabling queries to be refined as the search proceeds, which treats serendipity as part of the refinement. Conclusions: The results provide clear evidence that data science should adopt single-field natural language search interfaces for variable search supporting in particular: query reformulation; data browsing; faceted search; surrogates; relevance feedback; summarization, analytics, and visual presentation. %M 26769334 %R 10.2196/jmir.4912 %U http://www.jmir.org/2016/1/e13/ %U https://doi.org/10.2196/jmir.4912 %U http://www.ncbi.nlm.nih.gov/pubmed/26769334 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e3 %T Usability Evaluation of a Mobile Monitoring System to Assess Symptoms After a Traumatic Injury: A Mixed-Methods Study %A Price,Matthew %A Sawyer,Tyler %A Harris,Madison %A Skalka,Christian %+ Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Room 248, 2 Colchester Avenue, Burlington, VT, 05405, United States, 1 8026563801, matthew.price@uvm.edu %K mobile phone %K trauma %K posttraumatic stress disorder %K usability %D 2016 %7 11.01.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Victims of trauma are at high risk for mental health conditions such as posttraumatic stress disorder and depression. Regular assessment of mental health symptoms in the post-trauma period is necessary to identify those at greatest risk and provide treatment. The multiple demands of the acute post-trauma period present numerous barriers to such assessments. Mobile apps are a method by which to overcome these barriers in order to regularly assess symptoms, identify those at risk, and connect patients to needed services. Objective: The current study conducted a usability evaluation of a system to monitor mental health symptoms after a trauma. The system was developed to promote ease of use and facilitate quick transmission of data. Methods: A sample of 21 adults with a history of trauma completed a standardized usability test in a laboratory setting followed by a qualitative interview. Results: Usability testing indicated that the app was easy to use and that patients were able to answer several questions in less than 1 minute (mean [SD] 29.37 [7.53]; range 15-57). Qualitative analyses suggested that feedback should be included in such an app and recommendations for the type of feedback were offered. Conclusions: The results of the current study indicate that a mobile app to monitor post-trauma mental health symptoms would be well received by victims. Personalized feedback to the user was identified as critical to promote the usability of the software. %M 26753673 %R 10.2196/mental.5023 %U http://mental.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/mental.5023 %U http://www.ncbi.nlm.nih.gov/pubmed/26753673 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e7 %T A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study %A Nitsch,Martina %A Dimopoulos,Christina N %A Flaschberger,Edith %A Saffran,Kristina %A Kruger,Jenna F %A Garlock,Lindsay %A Wilfley,Denise E %A Taylor,Craig B %A Jones,Megan %+ Ferdinand Porsche Distance Learning University of Applied Sciences, Lothringerstraße 4-8, Vienna, 1040, Austria, 43 1 505 77 78 ext 152, martina.nitsch@fernfh.ac.at %K usability study %K engagement %K adherence %K dropout %K digital health intervention %K online program %K self-help %K eating disorder %K mobile application %D 2016 %7 11.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement. Objective: The aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program—a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement. Methods: We conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires. Results: Participants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users’ symptoms, the program’s features and effectiveness, trust, anonymity, and affordability were relevant to engagement. Conclusions: This study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of “real-world” adoption. %M 26753539 %R 10.2196/jmir.4972 %U http://www.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/jmir.4972 %U http://www.ncbi.nlm.nih.gov/pubmed/26753539 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e1 %T Web-Based Cognitive Behavioral Relapse Prevention Program With Tailored Feedback for People With Methamphetamine and Other Drug Use Problems: Development and Usability Study %A Takano,Ayumi %A Miyamoto,Yuki %A Kawakami,Norito %A Matsumoto,Toshihiko %+ Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, 7-3-1 Hongo,, Bunkyo-ku,, Tokyo, 113-0033, Japan, 81 3 5841 3522, ayumi-takano@umin.ac.jp %K web-based %K drug dependence %K relapse prevention %K cognitive behavioral therapy %K motivational interviewing %K self-monitoring %K Internet %D 2016 %7 06.01.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches. Objective: The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability. Methods: We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions. Results: In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants’ motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested. Conclusions: The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs. %M 26740264 %R 10.2196/mental.4875 %U http://mental.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/mental.4875 %U http://www.ncbi.nlm.nih.gov/pubmed/26740264 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e272 %T Usability and Acceptance of the Librarian Infobutton Tailoring Environment: An Open Access Online Knowledge Capture, Management, and Configuration Tool for OpenInfobutton %A Jing,Xia %A Cimino,James J %A Del Fiol,Guilherme %+ Department of Social and Public Health, Ohio University, W357, Grover Center, Athens, OH, , United States, 1 740 593 0750, jingx@ohio.edu %K clinical decision support systems/instrumentation %K evaluation studies as topic %K knowledge management tool %K The Librarian Infobutton Tailoring Environment %D 2015 %7 30.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Librarian Infobutton Tailoring Environment (LITE) is a Web-based knowledge capture, management, and configuration tool with which users can build profiles used by OpenInfobutton, an open source infobutton manager, to provide electronic health record users with context-relevant links to online knowledge resources. Objective: We conducted a multipart evaluation study to explore users’ attitudes and acceptance of LITE and to guide future development. Methods: The evaluation consisted of an initial online survey to all LITE users, followed by an observational study of a subset of users in which evaluators’ sessions were recorded while they conducted assigned tasks. The observational study was followed by administration of a modified System Usability Scale (SUS) survey. Results: Fourteen users responded to the survey and indicated good acceptance of LITE with feedback that was mostly positive. Six users participated in the observational study, demonstrating average task completion time of less than 6 minutes and an average SUS score of 72, which is considered good compared with other SUS scores. Conclusions: LITE can be used to fulfill its designated tasks quickly and successfully. Evaluators proposed suggestions for improvements in LITE functionality and user interface. %M 26621250 %R 10.2196/jmir.4281 %U http://www.jmir.org/2015/11/e272/ %U https://doi.org/10.2196/jmir.4281 %U http://www.ncbi.nlm.nih.gov/pubmed/26621250 %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 2 %N 2 %P e10 %T Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera %A Shubert,Tiffany E %A Basnett,Jeanna %A Chokshi,Anang %A Barrett,Mark %A Komatireddy,Ravi %+ Shubert Consulting, 1 Coggins Mine Ct, Chapel Hill, NC, North Carolina, United States, 1 919 360 1970, tiffany@shubertconsulting.net %K aging, fall prevention, technology, evidence-based, Kinect, falls %D 2015 %7 05.11.2015 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs. Objective: Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise. Methods: Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience. Results: A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as “at risk for falls”. Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 ± 21.2 with a range of 32.5 to 97.5. Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk. Conclusions: Results support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries. Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care. %M 28582244 %R 10.2196/rehab.4776 %U http://rehab.jmir.org/2015/2/e10/ %U https://doi.org/10.2196/rehab.4776 %U http://www.ncbi.nlm.nih.gov/pubmed/28582244 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e235 %T An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives %A Duman-Lubberding,Sanne %A van Uden-Kraan,Cornelia F %A Peek,Niels %A Cuijpers,Pim %A Leemans,C René %A Verdonck-de Leeuw,Irma M %+ Department of Otolaryngology / Head and Neck Surgery, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, Netherlands, 31 20 444 0931, s.lubberding@vumc.nl %K cancer %K tertiary prevention %K participatory design approach %K follow-up care %K supportive care %D 2015 %7 21.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective: The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods: Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results: Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but indicated that it should be incorporated in the HNC cancer care pathway to ensure all survivors would benefit. Conclusions: Health care professionals experienced several barriers in directing patients to supportive care. They were positive toward the development and implementation of an eHealth application and expected it could support survivors in obtaining supportive care tailored to their needs. The cognitive walkthroughs revealed several points for optimizing the application prototype and developing an efficient implementation strategy. Including health care professionals in an early phase of a participatory design approach is valuable in developing an eHealth application and an implementation strategy meeting stakeholders’ needs. %M 26489918 %R 10.2196/jmir.4870 %U http://www.jmir.org/2015/10/e235/ %U https://doi.org/10.2196/jmir.4870 %U http://www.ncbi.nlm.nih.gov/pubmed/26489918 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e122 %T TRAK App Suite: A Web-Based Intervention for Delivering Standard Care for the Rehabilitation of Knee Conditions %A Spasić,Irena %A Button,Kate %A Divoli,Anna %A Gupta,Satyam %A Pataky,Tamas %A Pizzocaro,Diego %A Preece,Alun %A van Deursen,Robert %A Wilson,Chris %+ School of Computer Science & Informatics, Cardiff University, Queen's Buildings, 5 The Parade, Cardiff, CF24 3AA, United Kingdom, 44 029 2087 0320, i.spasic@cs.cardiff.ac.uk %K internet %K social media %K web applications %K mobile applications %K usability testing %K knee %K rehabilitation %K exercise %K self-management %D 2015 %7 16.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Standard care for the rehabilitation of knee conditions involves exercise programs and information provision. Current methods of rehabilitation delivery struggle to keep up with large volumes of patients and the length of treatment required to maximize the recovery. Therefore, the development of novel interventions to support self-management is strongly recommended. Such interventions need to include information provision, goal setting, monitoring, feedback, and support groups, but the most effective methods of their delivery are poorly understood. The Internet provides a medium for intervention delivery with considerable potential for meeting these needs. Objective: The objective of this study was to demonstrate the feasibility of a Web-based app and to conduct a preliminary review of its practicability as part of a complex medical intervention in the rehabilitation of knee disorders. This paper describes the development, implementation, and usability of such an app. Methods: An interdisciplinary team of health care professionals and researchers, computer scientists, and app developers developed the TRAK app suite. The key functionality of the app includes information provision, a three-step exercise program based on a standard care for the rehabilitation of knee conditions, self-monitoring with visual feedback, and a virtual support group. There were two types of stakeholders (patients and physiotherapists) that were recruited for the usability study. The usability questionnaire was used to collect both qualitative and quantitative information on computer and Internet usage, task completion, and subjective user preferences. Results: A total of 16 patients and 15 physiotherapists participated in the usability study. Based on the System Usability Scale, the TRAK app has higher perceived usability than 70% of systems. Both patients and physiotherapists agreed that the given Web-based approach would facilitate communication, provide information, help recall information, improve understanding, enable exercise progression, and support self-management in general. The Web app was found to be easy to use and user satisfaction was very high. The TRAK app suite can be accessed at http://apps.facebook.com/kneetrak/. Conclusions: The usability study suggests that a Web-based intervention is feasible and acceptable in supporting self-management of knee conditions. %M 26474643 %R 10.2196/resprot.4091 %U http://www.researchprotocols.org/2015/4/e122/ %U https://doi.org/10.2196/resprot.4091 %U http://www.ncbi.nlm.nih.gov/pubmed/26474643 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e11 %T Usability and Acceptability of ASSESS MS: Assessment of Motor Dysfunction in Multiple Sclerosis Using Depth-Sensing Computer Vision %A Morrison,Cecily %A D'Souza,Marcus %A Huckvale,Kit %A Dorn,Jonas F %A Burggraaff,Jessica %A Kamm,Christian Philipp %A Steinheimer,Saskia Marie %A Kontschieder,Peter %A Criminisi,Antonio %A Uitdehaag,Bernard %A Dahlke,Frank %A Kappos,Ludwig %A Sellen,Abigail %+ Microsoft Research, Human Experience & Design, 21 Station Road, Cambridge, , United Kingdom, 44 1223 479951, cecilym@microsoft.com %K depth-sensing computer vision %K information interfaces and presentation %K Kinect %K motor skills %K multiple sclerosis %K rehabilitation %D 2015 %7 24.06.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: Sensor-based recordings of human movements are becoming increasingly important for the assessment of motor symptoms in neurological disorders beyond rehabilitative purposes. ASSESS MS is a movement recording and analysis system being developed to automate the classification of motor dysfunction in patients with multiple sclerosis (MS) using depth-sensing computer vision. It aims to provide a more consistent and finer-grained measurement of motor dysfunction than currently possible. Objective: To test the usability and acceptability of ASSESS MS with health professionals and patients with MS. Methods: A prospective, mixed-methods study was carried out at 3 centers. After a 1-hour training session, a convenience sample of 12 health professionals (6 neurologists and 6 nurses) used ASSESS MS to capture recordings of standardized movements performed by 51 volunteer patients. Metrics for effectiveness, efficiency, and acceptability were defined and used to analyze data captured by ASSESS MS, video recordings of each examination, feedback questionnaires, and follow-up interviews. Results: All health professionals were able to complete recordings using ASSESS MS, achieving high levels of standardization on 3 of 4 metrics (movement performance, lateral positioning, and clear camera view but not distance positioning). Results were unaffected by patients’ level of physical or cognitive disability. ASSESS MS was perceived as easy to use by both patients and health professionals with high scores on the Likert-scale questions and positive interview commentary. ASSESS MS was highly acceptable to patients on all dimensions considered, including attitudes to future use, interaction (with health professionals), and overall perceptions of ASSESS MS. Health professionals also accepted ASSESS MS, but with greater ambivalence arising from the need to alter patient interaction styles. There was little variation in results across participating centers, and no differences between neurologists and nurses. Conclusions: In typical clinical settings, ASSESS MS is usable and acceptable to both patients and health professionals, generating data of a quality suitable for clinical analysis. An iterative design process appears to have been successful in accounting for factors that permit ASSESS MS to be used by a range of health professionals in new settings with minimal training. The study shows the potential of shifting ubiquitous sensing technologies from research into the clinic through a design approach that gives appropriate attention to the clinic environment. %M 27025782 %R 10.2196/humanfactors.4129 %U http://humanfactors.jmir.org/2015/1/e11/ %U https://doi.org/10.2196/humanfactors.4129 %U http://www.ncbi.nlm.nih.gov/pubmed/27025782 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e10 %T Evaluation of Home Health Care Devices: Remote Usability Assessment %A Kortum,Philip %A Peres,S Camille %+ Rice University, Department of Psychology, 6100 Main Street MS25, Houston, TX, 77005, United States, 1 7133484813, pkortum@rice.edu %K health care evaluation mechanisms %K human-computer interaction design and evaluation methods %K patient satisfaction %K usability testing %D 2015 %7 05.06.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: An increasing amount of health care is now performed in a home setting, away from the hospital. While there is growing anecdotal evidence about the difficulty patients and caregivers have using increasingly complex health care devices in the home, there has been little systematic scientific study to quantify the global nature of home health care device usability in the field. Research has tended to focus on a handful of devices, making it difficult to gain a broad view of the usability of home-care devices in general. Objective: The objective of this paper is to describe a remote usability assessment method using the System Usability Scale (SUS), and to report on the usability of a broad range of health care devices using this metric. Methods: A total of 271 participants selected and rated up to 10 home health care devices of their choice using the SUS, which scores usability from 0 (unusable) to 100 (highly usable). Participants rated a total of 455 devices in their own home without an experimenter present. Results: Usability scores ranged from 98 (oxygen masks) to 59 (home hormone test kits). An analysis conducted on devices that had at least 10 ratings showed that the effect of device on SUS scores was significant (P<.001), and that the usability of these devices was on the low end when compared with other commonly used items in the home, such as microwave ovens and telephones. Conclusions: A large database of usability scores for home health care devices collected using this remote methodology would be beneficial for physicians, patients, and their caregivers. %M 27025664 %R 10.2196/humanfactors.4570 %U http://humanfactors.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/humanfactors.4570 %U http://www.ncbi.nlm.nih.gov/pubmed/27025664 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e37 %T Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage %A Lim,Joanne %A Cloete,Garth %A Dunsmuir,Dustin T %A Payne,Beth A %A Scheffer,Cornie %A von Dadelszen,Peter %A Dumont,Guy A %A Ansermino,J Mark %+ Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Clinical Support Building, 950 W. 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 2000 ext 6669, jlim2@cw.bc.ca %K pulse oximetry %K mHealth app %K predictive model %K usability analysis %K design methodology %D 2015 %7 17.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Pre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter. Objective: The aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system. Methods: Development of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town. Results: After ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7). To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec). Conclusions: By including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway. %M 25887292 %R 10.2196/mhealth.3942 %U http://mhealth.jmir.org/2015/2/e37/ %U https://doi.org/10.2196/mhealth.3942 %U http://www.ncbi.nlm.nih.gov/pubmed/25887292 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e17 %T Engaging Community Stakeholders to Evaluate the Design, Usability, and Acceptability of a Chronic Obstructive Pulmonary Disease Social Media Resource Center %A Stellefson,Michael %A Chaney,Beth %A Chaney,Don %A Paige,Samantha %A Payne-Purvis,Caroline %A Tennant,Bethany %A Walsh-Childers,Kim %A Sriram,PS %A Alber,Julia %+ Center for Digital Health and Wellness, Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, United States, 1 352 294 1805, mstellefson@ufl.edu %K COPD %K health communication %K social media %K patient education %D 2015 %7 28.01.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Patients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. Objective: The purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. Methods: A multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). Results: The majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype’s information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. Conclusions: Patient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education. %M 25630449 %R 10.2196/resprot.3959 %U http://www.researchprotocols.org/2015/1/e17/ %U https://doi.org/10.2196/resprot.3959 %U http://www.ncbi.nlm.nih.gov/pubmed/25630449 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e14 %T Development of MijnAVL, an Interactive Portal to Empower Breast and Lung Cancer Survivors: An Iterative, Multi-Stakeholder Approach %A Kuijpers,Wilma %A Groen,Wim G %A Oldenburg,Hester SA %A Wouters,Michel WJM %A Aaronson,Neil K %A van Harten,Wim H %+ The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, Amsterdam, , Netherlands, 31 205122861, w.v.harten@nki.nl %K cancer survivors %K interactive portal %K development %K usability testing %K empowerment %D 2015 %7 22.01.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: MijnAVL (MyAVL) is an interactive portal being developed to empower cancer survivors. Literature review and focus groups yielded the selection of features such as access to the electronic medical record (EMR), patient reported outcomes (PROs) and related feedback, and a physical activity support program. Objective: Our aim was to present a final design of MijnAVL based on (1) health professionals' evaluation of proposed features, (2) cancer survivors’ evaluation of a first draft, and (3) cancer survivors’ evaluation of a functional online prototype. Methods: Professionals from various disciplines gave input to the content of and procedures related to MijnAVL. Subsequently, 16 cancer survivors participated in an interview to evaluate content and graphic design of a first draft (shown with screenshots). Finally, 7 survivors participated in a usability test with a fully functional prototype. They performed predefined tasks (eg, logging in, finding a test result, completing a questionnaire) while thinking aloud. Descriptive statistics and simple content analysis were used to analyze the data of both the interviews and the usability tests. Results: Professionals supported access to the EMR (eg, histology reports, lab results, and their letters to general practitioners). They also informed the development of PROs and the physical activity support program. Based on the first draft, survivors selected the preferred graphic design, approved the features and provided suggestions for the content (eg, explanation of medical jargon, more concise texts, notification by emails). Usability tests revealed that it was relatively easy to navigate the website and use the different features. Recommendations included, among others, a frequently asked questions section and the use of hyperlinks between different parts of the website. Conclusions: The development of MijnAVL, an interactive portal to empower breast and lung cancer survivors, was performed iteratively and involved multiple groups of end-users. This approach resulted in a usable and understandable final version. Its effectiveness should be determined in further research. %M 25614924 %R 10.2196/resprot.3796 %U http://www.researchprotocols.org/2015/1/e14/ %U https://doi.org/10.2196/resprot.3796 %U http://www.ncbi.nlm.nih.gov/pubmed/25614924 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e1 %T A Mobile App for Securely Capturing and Transferring Clinical Images to the Electronic Health Record: Description and Preliminary Usability Study %A Landman,Adam %A Emani,Srinivas %A Carlile,Narath %A Rosenthal,David I %A Semakov,Simon %A Pallin,Daniel J %A Poon,Eric G %+ Brigham and Women\'s Hospital, Department of Emergency Medicine, 75 Francis Street, Boston, MA, 02115, United States, 1 617 525 8497, alandman@partners.org %K mobile phone %K photographs %K electronic health records %K telemedicine %D 2015 %7 02.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. Objective: The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences. Methods: We developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization’s enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization’s secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics. Results: Twenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch. Conclusions: CliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is now available to all clinical users in our hospital, providing a secure and efficient way to capture clinical images and to insert them into the EHR. Future clinical image apps should more closely link clinical images and clinical documentation and consider enabling secure transmission over public WiFi or cellular networks. %M 25565678 %R 10.2196/mhealth.3481 %U http://mhealth.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/mhealth.3481 %U http://www.ncbi.nlm.nih.gov/pubmed/25565678 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 1 %N 1 %P e2 %T Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults %A Hong,Yan %A Goldberg,Daniel %A Dahlke,Deborah Vollmer %A Ory,Marcia G %A Cargill,Jessica S %A Coughlin,Rachel %A Hernandez,Edgar %A Kellstedt,Debra K %A Peres,S Camille %+ School of Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX, 77843, United States, 1 9798621700, yhong@sph.tamhsc.edu %K physical activity %K mobile health, older adults %K usability testing %K user experience %D 2014 %7 13.10.2014 %9 Original Paper %J JMIR Human Factors %G English %X Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants’ comments were addressed to improve the site’s senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users’ experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway. %M 27025254 %R 10.2196/humanfactors.3787 %U http://humanfactors.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/humanfactors.3787 %U http://www.ncbi.nlm.nih.gov/pubmed/27025254 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e31 %T Study of the Usability of Spaced Retrieval Exercise Using Mobile Devices for Alzheimer’s Disease Rehabilitation %A Zmily,Ahmad %A Mowafi,Yaser %A Mashal,Ehab %+ School of Computer Engineering and Information Technology, German Jordanian University, PO Box 35247, Amman, 11180, Jordan, 962 6 429 4444, ahmad.zmily@gju.edu.jo %K Alzheimer disease %K Alzheimer disease rehabilitation %K spaced retrieval exercise %K usability study %K mobile human computer interaction %D 2014 %7 14.08.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Alzheimer's disease (AD) is an irreversible brain disease that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest daily tasks. Recent studies showed that people with AD might actually benefit from physical exercises and rehabilitation processes. Studies show that rehabilitation would also add value in making the day for an individual with AD a little less foggy, frustrating, isolated, and stressful for as long as possible. Objective: The focus of our work was to explore the use of modern mobile technology to enable people with AD to improve their abilities to perform activities of daily living, and hence to promote independence and participation in social activities. Our work also aimed at reducing the burden on caregivers by increasing the AD patients’ sense of competence and ability to handle behavior problems. Methods: We developed ADcope, an integrated app that includes several modules that targeted individuals with AD, using mobile devices. We have developed two different user interfaces: text-based and graphic-based. To evaluate the usability of the app, 10 participants with early stages of AD were asked to run the two user interfaces of the spaced retrieval memory exercise using a tablet mobile device. Results: We selected 10 participants with early stages of AD (average age: 75 years; 6/10, 60% males, 4/10, 40% females). The average elapsed time per question between the text-based task (14.04 seconds) and the graphic-based task (12.89 seconds) was significantly different (P=.047). There was also a significant difference (P<.001) between the average correct answer score between the text-based task (7.60/10) and the graphic-based task (8.30/10), and between the text-based task (31.50/100) and the graphic-based task (27.20/100; P<.001). Correlation analysis for the graphic-based task showed that the average elapsed time per question and the workload score were negatively correlated (−.93, and −.79, respectively) to the participants’ performance (P<.001 and P=.006, respectively). Conclusions: We found that people with early stages of AD used mobile devices successfully without any prior experience in using such devices. Participants’ measured workload scores were low and posttask satisfaction in fulfilling the required task was conceivable. Results indicate better performance, less workload, and better response time for the graphic-based task compared with the text-based task. %M 25124077 %R 10.2196/mhealth.3136 %U http://mhealth.jmir.org/2014/3/e31/ %U https://doi.org/10.2196/mhealth.3136 %U http://www.ncbi.nlm.nih.gov/pubmed/25124077 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e59 %T A Rehabilitation Tool Designed for Intensive Web-Based Cognitive Training: Description and Usability Study %A Cruz,Vítor Tedim %A Pais,Joana %A Bento,Virgílio %A Mateus,Cátia %A Colunas,Márcio %A Alves,Ivânia %A Coutinho,Paula %A Rocha,Nelson Pacheco %+ Neurology Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Rua Doutor Cândido de Pinho, Santa Maria da Feira, 4520-211, Portugal, 351 936 173 516, vitor.cruz@chedv.min-saude.pt %K cognitive training %K cognitive deficits %K neurorehabilitation %K Web-based applications %K eHealth systems %K usability test %D 2013 %7 13.12.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients. Objective: The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs. Methods: From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient’s home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer’s disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire. Results: A total of 48/80 patients (60%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4%) were not interested in performing the exercises at home; 19/48 patients (39%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier. Conclusions: This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs. %M 24334248 %R 10.2196/resprot.2899 %U http://www.researchprotocols.org/2013/2/e59/ %U https://doi.org/10.2196/resprot.2899 %U http://www.ncbi.nlm.nih.gov/pubmed/24334248 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e47 %T An Interactive, Bilingual Touch Screen Program to Promote Breastfeeding Among Hispanic Rural Women: Usability Study %A Joshi,Ashish %A Wilhelm,Susan %A Aguirre,Trina %A Trout,Kate %A Amadi,Chioma %+ Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, , United States, 1 402 559 2327, ashish.joshi@unmc.edu %K usability %K breastfeeding %K education %K evaluation %K computer %D 2013 %7 07.11.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior. Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful. Objective: The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings. Methods: A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed. Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS). Results: The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90%, 9/10), and 60% (6/10) had breastfed less than 6 months. There were 90% (9/10) of the study participants that had no prior history of taking prenatal classes and 80% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks. Conclusions: The study participants were able to navigate through the multimedia program with ease and obtain relevant breastfeeding related health information. The interactive, touch screen computer-based breastfeeding program had high acceptance among 10 Hispanic women living in rural settings. %M 24200498 %R 10.2196/resprot.2872 %U http://www.researchprotocols.org/2013/2/e47/ %U https://doi.org/10.2196/resprot.2872 %U http://www.ncbi.nlm.nih.gov/pubmed/24200498