TY - JOUR AU - Liu, Chang AU - Chamberlain, Samuel AU - Ioannidis, Konstantinos AU - Tiego, Jeggan AU - Grant, Jon AU - Yücel, Murat AU - Hellyer, Peter AU - Lochner, Christine AU - Hampshire, Adam AU - Albertella, Lucy PY - 2025/3/26 TI - Transdiagnostic Compulsivity Traits in Problematic Use of the Internet Among UK Residents: Cross-Sectional Network Analysis Study JO - J Med Internet Res SP - e66191 VL - 27 KW - compulsivity KW - problematic use of the internet KW - network analysis KW - perfectionism KW - reward drive KW - cognitive rigidity KW - transdiagnostic KW - PUI KW - mental health KW - intrapersonal factor KW - cognitive KW - internet use KW - network N2 - Background: The societal and public health costs of problematic use of the internet (PUI) are increasingly recognized as a concern across all age groups, presenting a growing challenge for mental health research. International scientific initiatives have emphasized the need to explore the potential roles of personality features in PUI. Compulsivity is a key personality trait associated with PUI and has been recognized by experts as a critical factor that should be prioritized in PUI research. Given that compulsivity is a multidimensional construct and PUI encompasses diverse symptoms, different underlying mechanisms are likely involved. However, the specific relationships between compulsivity dimensions and PUI symptoms remain unclear, limiting our understanding of compulsivity?s role in PUI. Objective: This study aimed to clarify the unique relationships among different dimensions of compulsivity, namely, perfectionism, reward drive, cognitive rigidity, and symptoms of PUI using a symptom-based network approach. Methods: A regularized partial-correlation network was fitted using a large-scale sample from the United Kingdom. Bridge centrality analysis was conducted to identify bridge nodes within the network. Node predictability analysis was performed to assess the self-determination and controllability of the nodes within the network. Results: The sample comprised 122,345 individuals from the United Kingdom (51.4% female, age: mean 43.7, SD 16.5, range 9-86 years). The analysis identified several strong mechanistic relationships. The strongest positive intracluster edge was between reward drive and PUI4 (financial consequences due to internet use; weight=0.11). Meanwhile, the strongest negative intracluster edge was between perfectionism and PUI4 (financial consequences due to internet use; weight=0.04). Cognitive rigidity showed strong relationships with PUI2 (internet use for distress relief; weight=0.06) and PUI3 (internet use for loneliness or boredom; weight=0.07). Notably, reward drive (bridge expected influence=0.32) and cognitive rigidity (bridge expected influence=0.16) were identified as key bridge nodes, positively associated with PUI symptoms. Meanwhile, perfectionism exhibited a negative association with PUI symptoms (bridge expected influence=?0.05). The network?s overall mean predictability was 0.37, with PUI6 (compulsion, predictability=0.55) showing the highest predictability. Conclusions: The findings reveal distinct relationships between different dimensions of compulsivity and individual PUI symptoms, supporting the importance of choosing targeted interventions based on individual symptom profiles. In addition, the identified bridge nodes, reward drive, and cognitive rigidity may represent promising targets for PUI prevention and intervention and warrant further investigation. UR - https://www.jmir.org/2025/1/e66191 UR - http://dx.doi.org/10.2196/66191 UR - http://www.ncbi.nlm.nih.gov/pubmed/40137076 ID - info:doi/10.2196/66191 ER - TY - JOUR AU - Rivas, Vincent Eric AU - Lesley, Ulf AU - Davoody, Nadia PY - 2025/3/24 TI - Health Care Professionals? Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study JO - JMIR Hum Factors SP - e60582 VL - 12 KW - eHealth KW - mobile health KW - mHealth KW - advanced home care KW - content analysis KW - nurse KW - staff-patient relationship KW - aging population KW - patient engagement KW - personalized care KW - patient experience N2 - Background: The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals? (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited. Objective: This study aims to explore HCPs? perspectives on using eHealth tools in advanced home care and these tools? impact on HCP-patient relationships. Methods: In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes. Results: The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction. Conclusions: The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting. UR - https://humanfactors.jmir.org/2025/1/e60582 UR - http://dx.doi.org/10.2196/60582 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60582 ER - TY - JOUR AU - Chang, Shao-Hsuan AU - Chen, Daishi AU - Chen, Chi-Sheng AU - Zhou, Dong AU - Yeh, Lung-Kun PY - 2025/2/5 TI - Device Failures and Adverse Events Associated With Rhinolaryngoscopes: Analysis of the Manufacturer and User Facility Device Experience (MAUDE) Database JO - JMIR Hum Factors SP - e67036 VL - 12 KW - medical device KW - device malfunction KW - rhinolaryngoscope KW - adverse event KW - MAUDE KW - Manufacturer and User Facility Device Experience N2 - Background: Rhinolaryngoscopes are one of the most widely used tools by otolaryngologists and speech-language pathologists in current clinical practice. However, there is limited data on adverse events associated with or caused by the use of rhinolaryngoscopes. Objective: In this study, we used the Manufacturer and User Facility Device Experience (MAUDE) database with the aim of providing insights that may assist otolaryngologists in better understanding the limitations of these devices and selecting appropriate procedures for their specific clinical setting. Methods: We characterized complications associated with the postmarket use of rhinolaryngoscope devices from the US Food and Drug Administration MAUDE database from 2016 through 2023. Results: A total of 2591 reports were identified, including 2534 device malfunctions, 56 injuries, and 1 death, from 2016 through 2023. The most common device problem with rhinolaryngoscopes was breakage (n=1058 reports, 40.8%), followed by fluid leaks (n=632 reports, 24.4%). The third most common problem was poor image quality (n=467 reports, 18%). Other device issues included contamination or device reprocessing problems (n=127 reports, 4.9%), material deformation or wear (n=125 reports, 4.8%), and device detachment (n=73 reports, 2.8%). Of the 63 reported adverse events, the most common patient-related adverse event was hemorrhage or bleeding, accounting for 18 reports, with the root causes including material deformation or wear, breakage, wrinkled rubber, or improper operation. Conclusions: Our study offers valuable insights for endoscopists and manufacturers to recognize potential issues and adverse events associated with the use of rhinolaryngoscopes. It emphasizes the need for improving device reliability, training, and procedural protocols to enhance patient safety during diagnostic procedures. UR - https://humanfactors.jmir.org/2025/1/e67036 UR - http://dx.doi.org/10.2196/67036 ID - info:doi/10.2196/67036 ER - TY - JOUR AU - Atchison, J. Christina AU - Gilby, Nicholas AU - Pantelidou, Galini AU - Clemens, Sam AU - Pickering, Kevin AU - Chadeau-Hyam, Marc AU - Ashby, Deborah AU - Barclay, S. Wendy AU - Cooke, S. Graham AU - Darzi, Ara AU - Riley, Steven AU - Donnelly, A. Christl AU - Ward, Helen AU - Elliott, Paul PY - 2025/1/9 TI - Strategies to Increase Response Rate and Reduce Nonresponse Bias in Population Health Research: Analysis of a Series of Randomized Controlled Experiments during a Large COVID-19 Study JO - JMIR Public Health Surveill SP - e60022 VL - 11 KW - study recruitment KW - response rate KW - population-based research KW - COVID-19 KW - SARS-CoV-2 KW - web-based questionnaires N2 - Background: High response rates are needed in population-based studies, as nonresponse reduces effective sample size and bias affects accuracy and decreases the generalizability of the study findings. Objective: We tested different strategies to improve response rate and reduce nonresponse bias in a national population?based COVID-19 surveillance program in England, United Kingdom. Methods: Over 19 rounds, a random sample of individuals aged 5 years and older from the general population in England were invited by mail to complete a web-based questionnaire and return a swab for SARS-CoV-2 testing. We carried out several nested randomized controlled experiments to measure the impact on response rates of different interventions, including (1) variations in invitation and reminder letters and SMS text messages and (2) the offer of a conditional monetary incentive to return a swab, reporting absolute changes in response and relative response rate (95% CIs). Results: Monetary incentives increased the response rate (completed swabs returned as a proportion of the number of individuals invited) across all age groups, sex at birth, and area deprivation with the biggest increase among the lowest responders, namely teenagers and young adults and those living in more deprived areas. With no monetary incentive, the response rate was 3.4% in participants aged 18?22 years, increasing to 8.1% with a £10 (US $12.5) incentive, 11.9% with £20 (US $25.0), and 18.2% with £30 (US $37.5) (relative response rate 2.4 [95% CI 2.0-2.9], 3.5 [95% CI 3.0-4.2], and 5.4 [95% CI 4.4-6.7], respectively). Nonmonetary strategies had a modest, if any, impact on response rate. The largest effect was observed for sending an additional swab reminder (SMS text message or email). For example, those receiving an additional SMS text message were more likely to return a completed swab compared to those receiving the standard email-SMS approach, 73.3% versus 70.2%: percentage difference 3.1% (95% CI 2.2%-4.0%). Conclusions: Conditional monetary incentives improved response rates to a web-based survey, which required the return of a swab test, particularly for younger age groups. Used in a selective way, incentives may be an effective strategy for improving sample response and representativeness in population-based studies. UR - https://publichealth.jmir.org/2025/1/e60022 UR - http://dx.doi.org/10.2196/60022 ID - info:doi/10.2196/60022 ER - TY - JOUR AU - Oudbier, J. Susan AU - Smets, A. Ellen M. AU - Nieuwkerk, T. Pythia AU - Neal, P. David AU - Nurmohamed, Azam S. AU - Meij, J. Hans AU - Dusseljee-Peute, W. Linda PY - 2025/1/8 TI - Patients? Experienced Usability and Satisfaction With Digital Health Solutions in a Home Setting: Instrument Validation Study JO - JMIR Med Inform SP - e63703 VL - 13 KW - digital health solutions KW - questionnaire development KW - usability instruments KW - self-management KW - home setting KW - validation KW - reliability N2 - Background: The field of digital health solutions (DHS) has grown tremendously over the past years. DHS include tools for self-management, which support individuals to take charge of their own health. The usability of DHS, as experienced by patients, is pivotal to adoption. However, well-known questionnaires that evaluate usability and satisfaction use complex terminology derived from human-computer interaction and are therefore not well suited to assess experienced usability of patients using DHS in a home setting. Objective: This study aimed to develop, validate, and assess an instrument that measures experienced usability and satisfaction of patients using DHS in a home setting. Methods: The development of the ?Experienced Usability and Satisfaction with Self-monitoring in the Home Setting? (GEMS) questionnaire followed several steps. Step I consisted of assessing the content validity, by conducting a literature review on current usability and satisfaction questionnaires, collecting statements and discussing these in an expert meeting, and translating each statement and adjusting it to the language level of the general population. This phase resulted in a draft version of the GEMS. Step II comprised assessing its face validity by pilot testing with Amsterdam University Medical Center?s patient panel. In step III, psychometric analysis was conducted and the GEMS was assessed for reliability. Results: A total of 14 items were included for psychometric analysis and resulted in 4 reliable scales: convenience of use, perceived value, efficiency of use, and satisfaction. Conclusions: Overall, the GEMS questionnaire demonstrated its reliability and validity in assessing experienced usability and satisfaction of DHS in a home setting. Further refinement of the instrument is necessary to confirm its applicability in other patient populations in order to promote the development of a steering mechanism that can be applied longitudinally throughout implementation, and can be used as a benchmarking instrument. UR - https://medinform.jmir.org/2025/1/e63703 UR - http://dx.doi.org/10.2196/63703 ID - info:doi/10.2196/63703 ER - TY - JOUR AU - Wagh, Vaidehi AU - Scott, W. Matthew AU - Kraeutner, N. Sarah PY - 2024/12/17 TI - Quantifying Similarities Between MediaPipe and a Known Standard to Address Issues in Tracking 2D Upper Limb Trajectories: Proof of Concept Study JO - JMIR Form Res SP - e56682 VL - 8 KW - markerless pose estimation KW - procrustes analysis KW - artificial intelligence KW - motion KW - movement tracking KW - touchscreen KW - markerless tracking KW - upper limb KW - motor N2 - Background: Markerless motion tracking methods have promise for use in a range of domains, including clinical settings where traditional marker-based systems for human pose estimation are not feasible. Artificial intelligence (AI)?based systems can offer a markerless, lightweight approach to motion capture. However, the accuracy of such systems, such as MediaPipe, for tracking fine upper limb movements involving the hand has not been explored. Objective: The aim of this study is to evaluate the 2D accuracy of MediaPipe against a known standard. Methods: Participants (N=10) performed a touchscreen-based shape-tracing task requiring them to trace the trajectory of a moving cursor using their index finger. Cursor trajectories created a reoccurring or random shape at 5 different speeds (500-2500 ms, in increments of 500 ms). Movement trajectories on each trial were simultaneously captured by the touchscreen and a separate video camera. Movement coordinates for each trial were extracted from the touchscreen and compared to those predicted by MediaPipe. Specifically, following resampling, normalization, and Procrustes transformations, root-mean-squared error (RMSE; primary outcome measure) was calculated between predicted coordinates and those generated by the touchscreen computer. Results: Although there was some size distortion in the frame-by-frame estimates predicted by MediaPipe, shapes were similar between the 2 methods and transformations improved the general overlap and similarity of the shapes. The resultant mean RMSE between predicted coordinates and those generated by the touchscreen was 0.28 (SD 0.06) normalized px. Equivalence testing revealed that accuracy differed between MediaPipe and the touchscreen, but that the true difference was between 0 and 0.30 normalized px (t114=?3.02; P=.002). Additional analyses revealed no differences in resultant RMSE between methods when comparing across lower frame rates (30 and 60 frames per second [FPS]), although there was greater RMSE for 120 FPS than for 60 FPS (t35.43=?2.51; P=.03). Conclusions: Overall, we quantified similarities between one AI-based approach to motion capture and a known standard for tracking fine upper limb movements, informing applications of such systems in domains such as clinical and research settings. Future work should address accuracy in 3 dimensions to further validate the use of AI-based systems, including MediaPipe, in such domains. UR - https://formative.jmir.org/2024/1/e56682 UR - http://dx.doi.org/10.2196/56682 ID - info:doi/10.2196/56682 ER - TY - JOUR AU - Mengistu, Meron AU - Tom, Kris AU - Gebremikael, Liben AU - Massaquoi, Notisha AU - Ezezika, Obidimma PY - 2024/11/29 TI - Tracking Implementation Outcomes of an Intensive Case Management Program for HIV: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e57452 VL - 13 KW - implementation science KW - intensive case management KW - ICM KW - human immunodeficiency virus KW - HIV KW - tracking KW - outcome KW - fidelity KW - reach KW - sustainability KW - implementation outcomes KW - perspective KW - perception KW - Toronto KW - Canada KW - descriptive statistics KW - evidence-based intervention KW - effectiveness KW - barriers KW - facilitators KW - adoption N2 - Background: Implementation science investigates the processes and factors that influence the successful adoption, implementation, and sustainability of interventions in many settings. Although conventional research places significant emphasis on the advancement and effectiveness of interventions, it is equally imperative to comprehend their performance in practical, real-life situations. Through outcome tracking, implementation science enables researchers to investigate complex implementation dynamics and go beyond efficacy, identifying the various aspects that contribute to the success of interventions. Objective: This study aims to evaluate the implementation outcomes of TAIBU?s intensive case management (ICM) model tailored for African, Caribbean, and Black communities living with HIV in the Greater Toronto Area. Specifically, it seeks to assess the fidelity, reach, and sustainability of the ICM program. Fidelity monitoring will ensure adherence to program protocols and consistency in service delivery, essential for achieving desired health outcomes. Reach assessment will examine the program?s capacity to reach the target population, including demographic coverage and engagement levels among African, Caribbean, and Black individuals. Sustainability assessment will explore the determinants influencing the longevity and impact of the ICM program. Methods: The study uses a mixed methods approach, where we will use probing questionnaires, interviews, and focus-group discussions to gather program performance and engagement data, in-depth insights, and perspectives from the implementation team responsible for delivering the ICM intervention. The collected fidelity and reach data through questionnaires will be analyzed using appropriate statistical techniques, such as descriptive statistics, to summarize the responses and identify patterns and trends within the data. Sustainability data collected through the interviews and focus groups will be analyzed and organized based on the Consolidated Framework for Implementation Research, which provides an organized way to identify and comprehend the determinants influencing implementation outcomes. Results: The study commenced in January 2024, and initial data collection is expected to be completed by December 2024. As of September 2024, we have enrolled 5 participants. Conclusions: This study will significantly contribute to improving the implementation of the ICM program. By conducting a study in an organizational or institutional setting, researchers can acquire valuable insights into the implementation process from those who are directly involved. The information gathered will inform strategies for improving implementation effectiveness; removing impediments; and enhancing the overall quality of the ICM program for African, Caribbean, and Black individuals living with HIV. International Registered Report Identifier (IRRID): DERR1-10.2196/57452 UR - https://www.researchprotocols.org/2024/1/e57452 UR - http://dx.doi.org/10.2196/57452 UR - http://www.ncbi.nlm.nih.gov/pubmed/39612213 ID - info:doi/10.2196/57452 ER - TY - JOUR AU - Almashmoum, Maryam AU - Cunningham, James AU - Ainsworth, John PY - 2024/11/13 TI - Evaluating Factors Affecting Knowledge Sharing Among Health Care Professionals in the Medical Imaging Departments of 2 Cancer Centers: Concurrent Mixed Methods Study JO - JMIR Hum Factors SP - e53780 VL - 11 KW - knowledge management KW - knowledge sharing KW - medical imaging departments KW - cancer centers KW - The Christie KW - Kuwait Cancer Control Center KW - concurrent mixed methods KW - factors KW - challenges KW - definition KW - mechanisms KW - practices N2 - Background: Knowledge sharing is a crucial part of any knowledge management implementation. It refers to sharing skills and experience among team members in an organization. In a health care setting, sharing knowledge, whether tacit or explicit, is important and can lead to better health care services. In medical imaging departments, knowledge sharing can be of particular importance. There are several factors that affect knowledge-sharing practices in medical imaging departments: individual, departmental, and technological. Evaluating the importance of these factors and understanding their use can help with improving knowledge-sharing practices in medical imaging departments. Objective: We aimed to assess the level of motivation, identify current knowledge-sharing tools, and evaluate factors affecting knowledge sharing in the medical imaging departments of 2 cancer centers, The Christie, United Kingdom, and the Kuwait Cancer Control Center (KCCC). Methods: A concurrent mixed methods study was conducted through nonprobability sampling techniques between February 1, 2023, and July 30, 2023. Semistructured interviews were used to validate the results of the quantitative analysis. Data were collected using an electronic questionnaire that was distributed among health care professionals in both cancer centers using Qualtrics. Semistructured interviews were conducted online using Microsoft Teams. The quantitative data were analyzed using the Qualtrics MX software to report the results for each question, whereas the qualitative data were analyzed using a thematic approach with codes classified through NVivo. Results: In total, 56 respondents from the KCCC and 29 from The Christie participated, with a 100% response rate (56/56, 100% and 29/29, 100%, respectively) based on the Qualtrics survey tool. A total of 59% (17/29) of health care professionals from The Christie shared their knowledge using emails and face-to-face communication as their main tools on a daily basis, and 57% (32/56) of health care professionals from the KCCC used face-to-face communication for knowledge sharing. The mean Likert-scale score of all the components that assessed the factors that affected knowledge-sharing behaviors fell between ?somewhat agree? and ?strongly agree? in both centers, excepting extrinsic motivation, which was rated as ?neither agree nor disagree.? This was similar to the results related to incentives. It was shown that 52% (15/29) of health care professionals at The Christie had no incentives to encourage knowledge-sharing practices. Therefore, establishing clear policies to manage incentives is important to increase knowledge-sharing practices. Conclusions: This study offered an evaluation of factors that affect knowledge sharing in 2 cancer centers. Most health care professionals were aware of the importance of knowledge-sharing practices in enhancing health care services. Several challenges were identified, such as time constraints, a lack of staff, and the language barrier, which limit knowledge-sharing practices. Therefore, establishing a clear policy for knowledge sharing is vital to practicing knowledge-sharing behaviors and facing any challenges that limit this practice. UR - https://humanfactors.jmir.org/2024/1/e53780 UR - http://dx.doi.org/10.2196/53780 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53780 ER - TY - JOUR AU - Kallio, Johanna AU - Kinnula, Atte AU - Mäkelä, Satu-Marja AU - Järvinen, Sari AU - Räsänen, Pauli AU - Hosio, Simo AU - Bordallo López, Miguel PY - 2024/10/31 TI - Lessons From 3 Longitudinal Sensor-Based Human Behavior Assessment Field Studies and an Approach to Support Stakeholder Management: Content Analysis JO - J Med Internet Res SP - e50461 VL - 26 KW - field trial KW - behavioral research KW - sensor data KW - machine learning KW - pervasive technology KW - stakeholder engagement KW - qualitative coding KW - mobile phone N2 - Background: Pervasive technologies are used to investigate various phenomena outside the laboratory setting, providing valuable insights into real-world human behavior and interaction with the environment. However, conducting longitudinal field trials in natural settings remains challenging due to factors such as low recruitment success and high dropout rates due to participation burden or data quality issues with wireless sensing in changing environments. Objective: This study gathers insights and lessons from 3 real-world longitudinal field studies assessing human behavior and derives factors that impacted their research success. We aim to categorize challenges, observe how they were managed, and offer recommendations for designing and conducting studies involving human participants and pervasive technology in natural settings. Methods: We developed a qualitative coding framework to categorize and address the unique challenges encountered in real-life studies related to influential factor identification, stakeholder management, data harvesting and management, and analysis and interpretation. We applied inductive reasoning to identify issues and related mitigation actions in 3 separate field studies carried out between 2018 and 2022. These 3 field studies relied on gathering annotated sensor data. The topics involved stress and environmental assessment in an office and a school, collecting self-reports and wrist device and environmental sensor data from 27 participants for 3.5 to 7 months; work activity recognition at a construction site, collecting observations and wearable sensor data from 15 participants for 3 months; and stress recognition in location-independent knowledge work, collecting self-reports and computer use data from 57 participants for 2 to 5 months. Our key extension for the coding framework used a stakeholder identification method to identify the type and role of the involved stakeholder groups, evaluating the nature and degree of their involvement and influence on the field trial success. Results: Our analysis identifies 17 key lessons related to planning, implementing, and managing a longitudinal, sensor-based field study on human behavior. The findings highlight the importance of recognizing different stakeholder groups, including those not directly involved but whose areas of responsibility are impacted by the study and therefore have the power to influence it. In general, customizing communication strategies to engage stakeholders on their terms and addressing their concerns and expectations is essential, while planning for dropouts, offering incentives for participants, conducting field tests to identify problems, and using tools for quality assurance are relevant for successful outcomes. Conclusions: Our findings suggest that field trial implementation should include additional effort to clarify the expectations of stakeholders and to communicate with them throughout the process. Our framework provides a structured approach that can be adopted by other researchers in the field, facilitating robust and comparable studies across different contexts. Constantly managing the possible challenges will lead to better success in longitudinal field trials and developing future technology-based solutions. UR - https://www.jmir.org/2024/1/e50461 UR - http://dx.doi.org/10.2196/50461 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50461 ER - TY - JOUR AU - Bowers, M. Jennifer AU - Huelsnitz, O. Chloe AU - Dwyer, A. Laura AU - Gibson, P. Laurel AU - Agurs-Collins, Tanya AU - Ferrer, A. Rebecca AU - Acevedo, M. Amanda PY - 2024/7/31 TI - Measuring Relationship Influences on Romantic Couples? Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors JO - JMIR Res Protoc SP - e48516 VL - 13 KW - cancer prevention KW - COVID-19 KW - risk perceptions KW - dyads KW - romantic relationships KW - cancer KW - oncology KW - survivor KW - survivors KW - dyad KW - spouse KW - spousal KW - partner KW - health behavior KW - health behaviors KW - cohabiting KW - cohabit KW - study design KW - recruit KW - recruitment KW - methodology KW - methods KW - enrol KW - enrolment KW - enroll KW - enrollment N2 - Background: Research has established the effects of romantic relationships on individuals? morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. Objective: We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners? engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. Methods: The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. Results: Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. Conclusions: We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. International Registered Report Identifier (IRRID): DERR1-10.2196/48516 UR - https://www.researchprotocols.org/2024/1/e48516 UR - http://dx.doi.org/10.2196/48516 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48516 ER - TY - JOUR AU - Bijker, Rimke AU - Merkouris, S. Stephanie AU - Dowling, A. Nicki AU - Rodda, N. Simone PY - 2024/7/25 TI - ChatGPT for Automated Qualitative Research: Content Analysis JO - J Med Internet Res SP - e59050 VL - 26 KW - ChatGPT KW - natural language processing KW - qualitative content analysis KW - Theoretical Domains Framework N2 - Background: Data analysis approaches such as qualitative content analysis are notoriously time and labor intensive because of the time to detect, assess, and code a large amount of data. Tools such as ChatGPT may have tremendous potential in automating at least some of the analysis. Objective: The aim of this study was to explore the utility of ChatGPT in conducting qualitative content analysis through the analysis of forum posts from people sharing their experiences on reducing their sugar consumption. Methods: Inductive and deductive content analysis were performed on 537 forum posts to detect mechanisms of behavior change. Thorough prompt engineering provided appropriate instructions for ChatGPT to execute data analysis tasks. Data identification involved extracting change mechanisms from a subset of forum posts. The precision of the extracted data was assessed through comparison with human coding. On the basis of the identified change mechanisms, coding schemes were developed with ChatGPT using data-driven (inductive) and theory-driven (deductive) content analysis approaches. The deductive approach was informed by the Theoretical Domains Framework using both an unconstrained coding scheme and a structured coding matrix. In total, 10 coding schemes were created from a subset of data and then applied to the full data set in 10 new conversations, resulting in 100 conversations each for inductive and unconstrained deductive analysis. A total of 10 further conversations coded the full data set into the structured coding matrix. Intercoder agreement was evaluated across and within coding schemes. ChatGPT output was also evaluated by the researchers to assess whether it reflected prompt instructions. Results: The precision of detecting change mechanisms in the data subset ranged from 66% to 88%. Overall ? scores for intercoder agreement ranged from 0.72 to 0.82 across inductive coding schemes and from 0.58 to 0.73 across unconstrained coding schemes and structured coding matrix. Coding into the best-performing coding scheme resulted in category-specific ? scores ranging from 0.67 to 0.95 for the inductive approach and from 0.13 to 0.87 for the deductive approaches. ChatGPT largely followed prompt instructions in producing a description of each coding scheme, although the wording for the inductively developed coding schemes was lengthier than specified. Conclusions: ChatGPT appears fairly reliable in assisting with qualitative analysis. ChatGPT performed better in developing an inductive coding scheme that emerged from the data than adapting an existing framework into an unconstrained coding scheme or coding directly into a structured matrix. The potential for ChatGPT to act as a second coder also appears promising, with almost perfect agreement in at least 1 coding scheme. The findings suggest that ChatGPT could prove useful as a tool to assist in each phase of qualitative content analysis, but multiple iterations are required to determine the reliability of each stage of analysis. UR - https://www.jmir.org/2024/1/e59050 UR - http://dx.doi.org/10.2196/59050 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59050 ER - TY - JOUR AU - Zondag, M. Anna G. AU - Hollestelle, J. Marieke AU - van der Graaf, Rieke AU - Nathoe, M. Hendrik AU - van Solinge, W. Wouter AU - Bots, L. Michiel AU - Vernooij, M. Robin W. AU - Haitjema, Saskia AU - PY - 2024/7/11 TI - Comparison of the Response to an Electronic Versus a Traditional Informed Consent Procedure in Terms of Clinical Patient Characteristics: Observational Study JO - J Med Internet Res SP - e54867 VL - 26 KW - informed consent KW - learning health care system KW - e-consent KW - cardiovascular risk management KW - digital health KW - research ethics N2 - Background: Electronic informed consent (eIC) is increasingly used in clinical research due to several benefits including increased enrollment and improved efficiency. Within a learning health care system, a pilot was conducted with an eIC for linking data from electronic health records with national registries, general practitioners, and other hospitals. Objective: We evaluated the eIC pilot by comparing the response to the eIC with the former traditional paper-based informed consent (IC). We assessed whether the use of eIC resulted in a different study population by comparing the clinical patient characteristics between the response categories of the eIC and former face-to-face IC procedure. Methods: All patients with increased cardiovascular risk visiting the University Medical Center Utrecht, the Netherlands, were eligible for the learning health care system. From November 2021 to August 2022, an eIC was piloted at the cardiology outpatient clinic. Prior to the pilot, a traditional face-to-face paper-based IC approach was used. Responses (ie, consent, no consent, or nonresponse) were assessed and compared between the eIC and face-to-face IC cohorts. Clinical characteristics of consenting and nonresponding patients were compared between and within the eIC and the face-to-face cohorts using multivariable regression analyses. Results: A total of 2254 patients were included in the face-to-face IC cohort and 885 patients in the eIC cohort. Full consent was more often obtained in the eIC than in the face-to-face cohort (415/885, 46.9% vs 876/2254, 38.9%, respectively). Apart from lower mean hemoglobin in the full consent group of the eIC cohort (8.5 vs 8.8; P=.0021), the characteristics of the full consenting patients did not differ between the eIC and face-to-face IC cohorts. In the eIC cohort, only age differed between the full consent and the nonresponse group (median 60 vs 56; P=.0002, respectively), whereas in the face-to-face IC cohort, the full consent group seemed healthier (ie, higher hemoglobin, lower glycated hemoglobin [HbA1c], lower C-reactive protein levels) than the nonresponse group. Conclusions: More patients provided full consent using an eIC. In addition, the study population remained broadly similar. The face-to-face IC approach seemed to result in a healthier study population (ie, full consenting patients) than the patients without IC, while in the eIC cohort, the characteristics between consent groups were comparable. Thus, an eIC may lead to a better representation of the target population, increasing the generalizability of results. UR - https://www.jmir.org/2024/1/e54867 UR - http://dx.doi.org/10.2196/54867 UR - http://www.ncbi.nlm.nih.gov/pubmed/38990640 ID - info:doi/10.2196/54867 ER - TY - JOUR AU - Squire, M. Claudia AU - Giombi, C. Kristen AU - Rupert, J. Douglas AU - Amoozegar, Jacqueline AU - Williams, Peyton PY - 2024/7/9 TI - Determining an Appropriate Sample Size for Qualitative Interviews to Achieve True and Near Code Saturation: Secondary Analysis of Data JO - J Med Internet Res SP - e52998 VL - 26 KW - saturation KW - sample size KW - web-based data collection KW - semistructured interviews KW - qualitative KW - research methods KW - research methodology KW - data collection KW - coding KW - interviews KW - interviewing KW - in-depth N2 - Background: In-depth interviews are a common method of qualitative data collection, providing rich data on individuals? perceptions and behaviors that would be challenging to collect with quantitative methods. Researchers typically need to decide on sample size a priori. Although studies have assessed when saturation has been achieved, there is no agreement on the minimum number of interviews needed to achieve saturation. To date, most research on saturation has been based on in-person data collection. During the COVID-19 pandemic, web-based data collection became increasingly common, as traditional in-person data collection was possible. Researchers continue to use web-based data collection methods post the COVID-19 emergency, making it important to assess whether findings around saturation differ for in-person versus web-based interviews. Objective: We aimed to identify the number of web-based interviews needed to achieve true code saturation or near code saturation. Methods: The analyses for this study were based on data from 5 Food and Drug Administration?funded studies conducted through web-based platforms with patients with underlying medical conditions or with health care providers who provide primary or specialty care to patients. We extracted code- and interview-specific data and examined the data summaries to determine when true saturation or near saturation was reached. Results: The sample size used in the 5 studies ranged from 30 to 70 interviews. True saturation was reached after 91% to 100% (n=30-67) of planned interviews, whereas near saturation was reached after 33% to 60% (n=15-23) of planned interviews. Studies that relied heavily on deductive coding and studies that had a more structured interview guide reached both true saturation and near saturation sooner. We also examined the types of codes applied after near saturation had been reached. In 4 of the 5 studies, most of these codes represented previously established core concepts or themes. Codes representing newly identified concepts, other or miscellaneous responses (eg, ?in general?), uncertainty or confusion (eg, ?don?t know?), or categorization for analysis (eg, correct as compared with incorrect) were less commonly applied after near saturation had been reached. Conclusions: This study provides support that near saturation may be a sufficient measure to target and that conducting additional interviews after that point may result in diminishing returns. Factors to consider in determining how many interviews to conduct include the structure and type of questions included in the interview guide, the coding structure, and the population under study. Studies with less structured interview guides, studies that rely heavily on inductive coding and analytic techniques, and studies that include populations that may be less knowledgeable about the topics discussed may require a larger sample size to reach an acceptable level of saturation. Our findings also build on previous studies looking at saturation for in-person data collection conducted at a small number of sites. UR - https://www.jmir.org/2024/1/e52998 UR - http://dx.doi.org/10.2196/52998 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980711 ID - info:doi/10.2196/52998 ER - TY - JOUR AU - Kauppinen, Kaisa AU - Keikhosrokiani, Pantea AU - Khan, Sehrish PY - 2024/5/21 TI - Human-Centered Design and Benefit Realization Management in Digital Health Care Solution Development: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e56125 VL - 13 KW - human-centered design KW - digital health care solution KW - electronic health record KW - benefit realization management KW - digital health care KW - health care software KW - digital health KW - information technology KW - IT KW - usability N2 - Background: Earlier research shows that a significant number of resources are wasted on software projects delivering less than the planned benefits. It has, however, been evidenced that adopting a human-centered design approach when designing health devices can be beneficial. This understanding from earlier research has raised our interest in investigating how human-centered design might contribute to realizing the potential benefits of health care software projects. To our current knowledge, this intersection of human-centered design and benefit realization management has not yet comprehensively and consistently been researched within the context of digital health care solutions. Therefore, there is a need for evidence synthesis using systematic reviews to address this potential research gap. Objective: The objective of this study is to examine if human-centered design helps benefit realization management processes in the development of digital health care solutions and thereby enables better benefit realization. We explore the evidence of assumed or confirmed benefits of using human-centered design in the health care domain and whether better results have been reported when the benefit realization management process is followed. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent studies (reported in English) to see if there is evidence that using human-centered design and benefit realization management has a positive effect on realizing set benefits in those projects. We will commence a systematic literature search using human-centered design, benefit realization management, and health care?related search terms within 5 repositories (ACM Digital Library, PubMed Central, Scopus, PubMed, and Web of Science). After removing duplicate results, a preliminary scan for titles and abstracts will be done by at least 2 reviewers. Any incongruities regarding whether to include articles for full-text review will be resolved by a third reviewer based on the predefined criteria. Results: Initial queries of 2086 records have been executed and papers are being prescreened for inclusion. The search was initiated in December 2023 and the results are expected in 2024. We anticipate finding evidence of the use of human-centered design in the development of digital health care solutions. However, we expect evidence of benefitting from both human-centered design and benefit realization management in this context to be scarce. Conclusions: This protocol will guide the review of existing literature on the use of human-centered design and benefit realization management when developing digital health care solutions. The review will specifically focus on finding evidence of confirmed benefits derived from the use of human-centered design and benefit realization management. There may be an opportunity to gain a broader understanding of the tools or approaches that provide evidence of increased benefit realization within the health care domain. International Registered Report Identifier (IRRID): DERR1-10.2196/56125 UR - https://www.researchprotocols.org/2024/1/e56125 UR - http://dx.doi.org/10.2196/56125 UR - http://www.ncbi.nlm.nih.gov/pubmed/38772023 ID - info:doi/10.2196/56125 ER - TY - JOUR AU - Vial, Stéphane AU - Boudhraâ, Sana AU - Dumont, Mathieu AU - Tremblay, Melanie AU - Riendeau, Sophie PY - 2023/8/22 TI - Developing A Mobile App With a Human-Centered Design Lens to Improve Access to Mental Health Care (Mentallys Project): Protocol for an Initial Co-Design Process JO - JMIR Res Protoc SP - e47220 VL - 12 KW - co-design KW - human-centered design KW - e-mental health KW - design expertise KW - user engagement KW - patient-centered design KW - imaginary prototype N2 - Background: Co-design is one of the human-centered design approaches that allows end users to significantly and positively impact the design of mental health technologies. It is a promising approach to foster user acceptance and engagement in digital mental health solutions. Surprisingly, there is a lack of understanding of what co-design is in this field. In this paper, co-design is approached as a cocreation process involving persons with a lived experience of mental health problems, health professionals, and design experts who lead and facilitate the overall creative process. Objective: This paper describes an initial co-design research protocol for the development of a mobile app that aims to improve access to mental health care. It highlights the characteristics of a co-design approach in e?mental health rooted in human-centered design and led by design experts alongside health experts. The paper focuses on the first steps (phase 1) of the co-design process of the ongoing Mentallys project. Methods: This Mentallys project will be located in Montréal (Quebec, Canada). The method approach will be based on the ?method stories,? depicting the ?making of? this project and reflecting adjustments needed to the protocol throughout the project in specific situations. Phase 1 of the process will focus on the desirability of the app. Targeted participants will include people with a lived experience of mental health problems, peer support workers and clinicians, and 3 facilitators (all design experts or researchers). Web-based sessions will be organized because of the COVID-19 pandemic, using Miro (RealtimeBoard Inc) and Zoom (Zoom Video Communications, Inc). Data collection will be based on the comments, thoughts, and new ideas of participants around the imaginary prototypes. Thematic analysis will be carried out after each session to inform a new version of the prototype. Results: We conducted 2 stages in phase 1 of the process. During stage 1, we explored ideas through group co-design workshops (divergent thinking). Six co-design workshops were held: 2 with only clinicians (n=7), 2 with peer support workers (n=5) and people with a lived experience of mental health problems (n=2), and 2 with all of them (n=14). A total of 6 facilitators participated in conducting activities in subgroups. During stage 2, ideas were refined through 10 dyad co-design sessions (convergent thinking). Stage 2 involved 3 participants (n=3) and 1 facilitator. Thematic analysis was performed after stage 1, while analytic questioning is being performed for stage 2. Both stages allowed several iterations of the prototypes. Conclusions: The design of the co-design process, the leadership of the design expertise throughout the process, and the different forms of co-design activities are key elements in this project. We highly recommend that health researchers partner with professional designers or design researchers who are familiar with co-design. International Registered Report Identifier (IRRID): DERR1-10.2196/47220 UR - https://www.researchprotocols.org/2023/1/e47220 UR - http://dx.doi.org/10.2196/47220 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606978 ID - info:doi/10.2196/47220 ER - TY - JOUR AU - Fernandes, Blossom AU - Neelakantan, Lakshmi AU - Shah, Himani AU - Sumant, Sushmita AU - Collins, Y. Pamela AU - Velloza, Jennifer AU - Bampton, Emily AU - Ranganathan, Swetha AU - Sibisi, Refiloe AU - Bashir, Toiba AU - Bowes, Joshua AU - David, Larisa Esther AU - Kaur, Harsimar AU - Malik, Umairah AU - Shannon, Issy AU - Gurumayum, Suvlaxmi AU - Burn, Anne-Marie AU - Sieberts, K. Solveig AU - AU - Fazel, Mina PY - 2023/6/19 TI - Evidencing the Impact of Web-Based Coproduction With Youth on Mental Health Research: Qualitative Findings From the MindKind Study JO - JMIR Public Health Surveill SP - e42963 VL - 9 KW - web-based youth coproduction KW - mental health KW - public involvement KW - young people KW - advisory groups N2 - Background: Public involvement in research is a growing phenomenon as well as a condition of research funding, and it is often referred to as coproduction. Coproduction involves stakeholder contributions at every stage of research, but different processes exist. However, the impact of coproduction on research is not well understood. Web-based young people?s advisory groups (YPAGs) were established as part of the MindKind study at 3 sites (India, South Africa, and the United Kingdom) to coproduce the wider research study. Each group site, led by a professional youth advisor, conducted all youth coproduction activities collaboratively with other research staff. Objective: This study aimed to evaluate the impact of youth coproduction in the MindKind study. Methods: To measure the impact of web-based youth coproduction on all stakeholders, the following methods were used: analysis of project documents, capturing the views of stakeholders using the Most Significant Change technique, and impact frameworks to assess the impact of youth coproduction on specific stakeholder outcomes. Data were analyzed in collaboration with researchers, advisors, and YPAG members to explore the impact of youth coproduction on research. Results: The impact was recorded on 5 levels. First, at the paradigmatic level, a novel method of conducting research allowed for a widely diverse group of YPAG representations, influencing study priorities, conceptualization, and design. Second, at the infrastructural level, the YPAG and youth advisors meaningfully contributed to the dissemination of materials; infrastructural constraints of undertaking coproduction were also identified. Third, at the organizational level, coproduction necessitated implementing new communication practices, such as a web-based shared platform. This meant that materials were easily accessible to the whole team and communication streams remained consistent. Fourth, at the group level, authentic relationships developed between the YPAG members, advisors, and the rest of the team, facilitated by regular web-based contact. Finally, at the individual level, participants reported enhanced insights into mental well-being and appreciation for the opportunity to engage in research. Conclusions: This study revealed several factors that shape the creation of web-based coproduction, with clear positive outcomes for advisors, YPAG members, researchers, and other project staff. However, several challenges of coproduced research were also encountered in multiple contexts and amid pressing timelines. For systematic reporting of the impact of youth coproduction, we propose that monitoring, evaluation, and learning systems be designed and implemented early. UR - https://publichealth.jmir.org/2023/1/e42963 UR - http://dx.doi.org/10.2196/42963 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335609 ID - info:doi/10.2196/42963 ER - TY - JOUR AU - Savoy, April AU - Patel, Himalaya AU - Shahid, Umber AU - Offner, D. Alexis AU - Singh, Hardeep AU - Giardina, D. Traber AU - Meyer, D. Ashley N. PY - 2022/9/22 TI - Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach JO - JMIR Hum Factors SP - e37313 VL - 9 IS - 3 KW - clinicians KW - community-based participatory research KW - web-based design KW - delivery of health care KW - health intervention KW - physicians KW - primary health care KW - videoconferencing N2 - Background: Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians? commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. Objective: The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. Methods: We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. Results: A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. Conclusions: ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions. UR - https://humanfactors.jmir.org/2022/3/e37313 UR - http://dx.doi.org/10.2196/37313 UR - http://www.ncbi.nlm.nih.gov/pubmed/36136374 ID - info:doi/10.2196/37313 ER - TY - JOUR AU - Tremblay, Melanie AU - Hamel, Christine AU - Viau-Guay, Anabelle AU - Giroux, Dominique PY - 2022/8/9 TI - User Experience of the Co-design Research Approach in eHealth: Activity Analysis With the Course-of-Action Framework JO - JMIR Hum Factors SP - e35577 VL - 9 IS - 3 KW - co-design KW - caregivers KW - activity analysis KW - course-of-action framework KW - participant experience KW - intrinsic description KW - guidelines KW - affordances N2 - Background: The cocreation of eHealth solutions with potential users, or co-design, can help make the solution more acceptable. However, the co-design research approach requires substantial investment, and projects are not always fruitful. Researchers have provided guidelines for the co-design approach, but these are either applicable only in specific situations or not supported by empirical data. Ways to optimize the experience of the co-design process from the point of view of the participants are also missing. Scientific literature in the co-design field generally provides an extrinsic description of the experience of participants in co-design projects. Objective: We addressed this issue by describing a co-design project and focusing on the participants? experiences looking at what was significant from their point of view. Methods: We used a qualitative situated cognitive anthropology approach for this study. Data were collected on a co-design research project that aimed to support the help-seeking process of caregivers of functionally dependent older adults. The methodology was based on the perspective of experience by Dewey and used the course-of-action theoretical and methodological framework. Data collection was conducted in 2 phases: observation of participants and recording of sessions and participant self-confrontation interviews using the session recordings. We interviewed 27% (20/74) of the participants. We analyzed the data through nonexclusive emerging categorization of themes using the constant comparative method. Results: In total, 5 emerging themes were identified. The perception of extrinsic constraints and the effects of the situation was central and the most important theme, affecting other themes (frustrating interactions with others, learning together, destabilization, and getting personal benefits). Co-occurrences between codes allowed for a visual and narrative understanding of what was significant for the participants during this project. The results highlighted the importance of the role of the research team in preparing and moderating the sessions. They also provided a detailed description of the interactions between participants during the sessions, which is a core aspect of the co-design approach. There were positive and negative aspects of the participants? experiences during this co-design project. Reflecting on our results, we provided potential affordances to shape the experience of participants in co-design. Conclusions: Potential users are an essential component of the co-design research approach. Researchers and designers should seek to offer these users a positive and contributory experience to encourage participation in further co-design initiatives. Future research should explore how the proposed affordances influence the success of the intervention. UR - https://humanfactors.jmir.org/2022/3/e35577 UR - http://dx.doi.org/10.2196/35577 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943783 ID - info:doi/10.2196/35577 ER - TY - JOUR AU - Martinez, J. Gonzalo AU - Grover, Ted AU - Mattingly, M. Stephen AU - Mark, Gloria AU - D?Mello, Sidney AU - Aledavood, Talayeh AU - Akbar, Fatema AU - Robles-Granda, Pablo AU - Striegel, Aaron PY - 2022/8/4 TI - Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers JO - JMIR Hum Factors SP - e33754 VL - 9 IS - 3 KW - stress measurement KW - heart rate variability KW - HRV KW - perceived stress KW - ecological momentary assessment KW - EMA KW - wearables KW - fitness tracker N2 - Background: Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors. Objective: This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings. Methods: In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours. Results: Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032). Conclusions: A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon. UR - https://humanfactors.jmir.org/2022/3/e33754 UR - http://dx.doi.org/10.2196/33754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925662 ID - info:doi/10.2196/33754 ER - TY - JOUR AU - Krause-Jüttler, Grit AU - Weitz, Jürgen AU - Bork, Ulrich PY - 2022/5/4 TI - Interdisciplinary Collaborations in Digital Health Research: Mixed Methods Case Study JO - JMIR Hum Factors SP - e36579 VL - 9 IS - 2 KW - team science KW - interdisciplinary KW - research collaboration KW - digital health KW - team processes N2 - Background: Digital innovations in medicine are disruptive technologies that can change the way diagnostic procedures and treatments are delivered. Such innovations are typically designed in teams with different disciplinary backgrounds. This paper concentrates on 2 interdisciplinary research teams with 20 members from the medicine and engineering sciences working jointly on digital health solutions. Objective: The aim of this paper was to identify factors on the individual, team, and organizational levels that influence the implementation of interdisciplinary research projects elaborating on digital applications for medicine and, based on the results, to draw conclusions for the proactive design of the interdisciplinary research process to make these projects successful. Methods: To achieve this aim, 2 interdisciplinary research teams were observed, and a small case study (response rate: 15/20, 75%) was conducted using a web-based questionnaire containing both closed and open self-report questions. The Spearman rank correlation coefficient was calculated to analyze the quantitative data. The answers to the open-ended questions were subjected to qualitative content analysis. Results: With regard to the interdisciplinary research projects investigated, the influencing factors of the three levels presented (individual, team, and organization) have proven to be relevant for interdisciplinary research cooperation. Conclusions: With regard to recommendations for the future design of interdisciplinary cooperation, management aspects are addressed, that is, the installation of a coordinator, systematic definition of goals, required resources, and necessary efforts on the part of the involved interdisciplinary research partners. As only small groups were investigated, further research in this field is necessary to derive more general recommendations for interdisciplinary research teams. Trial Registration: German Clinical Trials Register, DRKS00023909, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023909?; German Clinical Trials Register, DRKS00025077, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025077 UR - https://humanfactors.jmir.org/2022/2/e36579 UR - http://dx.doi.org/10.2196/36579 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507400 ID - info:doi/10.2196/36579 ER - TY - JOUR AU - Pit, Sabrina AU - Ramsden, Robyn AU - Tan, JH Aaron AU - Payne, Kristy AU - Barr, James AU - Eames, Benjamin AU - Edwards, Mike AU - Colbran, Richard PY - 2022/5/2 TI - Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help? JO - JMIR Hum Factors SP - e35094 VL - 9 IS - 2 KW - health KW - wellness KW - mobile apps KW - persuasive strategies KW - behavior change KW - review KW - health workforce KW - capability KW - career KW - employment KW - rural KW - workforce planning KW - mHealth KW - mobile health KW - digital health KW - health professional KW - user experience KW - health application KW - task support KW - social support KW - dialog support N2 - Background: Health professionals? perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals? perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini?s Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific?based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals? perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. UR - https://humanfactors.jmir.org/2022/2/e35094 UR - http://dx.doi.org/10.2196/35094 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499866 ID - info:doi/10.2196/35094 ER - TY - JOUR AU - Röhling, Marie Hanna AU - Althoff, Patrik AU - Arsenova, Radina AU - Drebinger, Daniel AU - Gigengack, Norman AU - Chorschew, Anna AU - Kroneberg, Daniel AU - Rönnefarth, Maria AU - Ellermeyer, Tobias AU - Rosenkranz, Cathérine Sina AU - Heesen, Christoph AU - Behnia, Behnoush AU - Hirano, Shigeki AU - Kuwabara, Satoshi AU - Paul, Friedemann AU - Brandt, Ulrich Alexander AU - Schmitz-Hübsch, Tanja PY - 2022/4/1 TI - Proposal for Post Hoc Quality Control in Instrumented Motion Analysis Using Markerless Motion Capture: Development and Usability Study JO - JMIR Hum Factors SP - e26825 VL - 9 IS - 2 KW - instrumented motion analysis KW - markerless motion capture KW - visual perceptive computing KW - quality control KW - quality reporting KW - gait analysis N2 - Background: Instrumented assessment of motor symptoms has emerged as a promising extension to the clinical assessment of several movement disorders. The use of mobile and inexpensive technologies such as some markerless motion capture technologies is especially promising for large-scale application but has not transitioned into clinical routine to date. A crucial step on this path is to implement standardized, clinically applicable tools that identify and control for quality concerns. Objective: The main goal of this study comprises the development of a systematic quality control (QC) procedure for data collected with markerless motion capture technology and its experimental implementation to identify specific quality concerns and thereby rate the usability of recordings. Methods: We developed a post hoc QC pipeline that was evaluated using a large set of short motor task recordings of healthy controls (2010 recordings from 162 subjects) and people with multiple sclerosis (2682 recordings from 187 subjects). For each of these recordings, 2 raters independently applied the pipeline. They provided overall usability decisions and identified technical and performance-related quality concerns, which yielded respective proportions of their occurrence as a main result. Results: The approach developed here has proven user-friendly and applicable on a large scale. Raters? decisions on recording usability were concordant in 71.5%-92.3% of cases, depending on the motor task. Furthermore, 39.6%-85.1% of recordings were concordantly rated as being of satisfactory quality whereas in 5.0%-26.3%, both raters agreed to discard the recording. Conclusions: We present a QC pipeline that seems feasible and useful for instant quality screening in the clinical setting. Results confirm the need of QC despite using standard test setups, testing protocols, and operator training for the employed system and by extension, for other task-based motor assessment technologies. Results of the QC process can be used to clean existing data sets, optimize quality assurance measures, as well as foster the development of automated QC approaches and therefore improve the overall reliability of kinematic data sets. UR - https://humanfactors.jmir.org/2022/2/e26825 UR - http://dx.doi.org/10.2196/26825 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363150 ID - info:doi/10.2196/26825 ER - TY - JOUR AU - Tanaka, Hiroki AU - Nakamura, Satoshi PY - 2022/3/29 TI - The Acceptability of Virtual Characters as Social Skills Trainers: Usability Study JO - JMIR Hum Factors SP - e35358 VL - 9 IS - 1 KW - social skills training KW - virtual agent design KW - virtual assistant KW - virtual trainer KW - chatbot KW - acceptability KW - realism KW - virtual agent KW - simulation KW - social skill KW - social interaction KW - design KW - training KW - crowdsourcing N2 - Background: Social skills training by human trainers is a well-established method to provide appropriate social interaction skills and strengthen social self-efficacy. In our previous work, we attempted to automate social skills training by developing a virtual agent that taught social skills through interaction. Previous research has not investigated the visual design of virtual agents for social skills training. Thus, we investigated the effect of virtual agent visual design on automated social skills training. Objective: The 3 main purposes of this research were to investigate the effect of virtual agent appearance on automated social skills training, the relationship between acceptability and other measures (eg, likeability, realism, and familiarity), and the relationship between likeability and individual user characteristics (eg, gender, age, and autistic traits). Methods: We prepared images and videos of a virtual agent, and 1218 crowdsourced workers rated the virtual agents through a questionnaire. In designing personalized virtual agents, we investigated the acceptability, likeability, and other impressions of the virtual agents and their relationship to individual characteristics. Results: We found that there were differences between the virtual agents in all measures (P<.001). A female anime-type virtual agent was rated as the most likeable. We also confirmed that participants? gender, age, and autistic traits were related to their ratings. Conclusions: We confirmed the effect of virtual agent design on automated social skills training. Our findings are important in designing the appearance of an agent for use in personalized automated social skills training. UR - https://humanfactors.jmir.org/2022/1/e35358 UR - http://dx.doi.org/10.2196/35358 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348468 ID - info:doi/10.2196/35358 ER - TY - JOUR AU - Nugent, Lisa AU - Anthony Kouyate, Robin AU - Jackson, Shawna AU - Smith, Y. Meredith PY - 2022/3/22 TI - Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework JO - JMIR Res Protoc SP - e16430 VL - 11 IS - 3 KW - human-centered design KW - patient-reported outcomes KW - rheumatoid arthritis KW - digital journal KW - patient diaries KW - data visualization KW - mobile phone N2 - Background: Involving chronically ill patients in the management of their health is widely recognized as a vital component of high-quality health care. However, to assume the role of informed participants, patients need both access to their health information and assistance in interpreting such data. Smartphone technology with SMS text messaging functionality offers a convenient and minimally demanding mechanism for providing such dual capabilities to patients. To date, a number of similar digital tools have been developed for use in various chronic and progressive disease conditions, including rheumatoid arthritis. Objective: This paper aims to describe the development of a research protocol that applies a human-centered design (HCD) approach to develop a mobile health (mHealth) intervention to support symptom management and treatment adherence for rheumatoid arthritis. Methods: To guide the development of the mHealth intervention for use within a commercial biotechnology context, we selected and applied an HCD framework consisting of three phases: understanding, ideation, and implementation. Results: Leveraging the framework, we mapped the key objectives and research questions to each phase and identified the HCD techniques and methods most suitable for addressing them. In addition, we identified the need to include a fourth phase, one that referred to postimplementation assessment, which would enable evaluation of patient engagement and intervention impact on symptom self-management. Conclusions: This paper presents a research protocol that applied an HCD framework to guide the development of an mHealth intervention within a commercial biotechnology context. This type of guidance is salient because commercial entities are becoming one of the leading producers of this type of intervention. However, the methodologies used and challenges faced from a research and development perspective are not well-represented in the published research literature to date. Our application of the HCD framework yielded important findings. Each phase of the HCD framework provided important guidance for increasing the likelihood that the final product would be understandable, acceptable, feasible, and engaging to use. Consistent with other researchers in the field of mHealth interventions, we identified the need to add a fourth phase to the HCD framework, one that focused on a postimplementation assessment to guide further improvements to support adoption in real-world settings. International Registered Report Identifier (IRRID): RR1-10.2196/16430 UR - https://www.researchprotocols.org/2022/3/e16430 UR - http://dx.doi.org/10.2196/16430 UR - http://www.ncbi.nlm.nih.gov/pubmed/35315784 ID - info:doi/10.2196/16430 ER - TY - JOUR AU - ten Klooster, Iris AU - Wentzel, Jobke AU - Sieverink, Floor AU - Linssen, Gerard AU - Wesselink, Robin AU - van Gemert-Pijnen, Lisette PY - 2022/3/15 TI - Personas for Better Targeted eHealth Technologies: User-Centered Design Approach JO - JMIR Hum Factors SP - e24172 VL - 9 IS - 1 KW - personas KW - clustering KW - heart failure KW - eHealth KW - user-centered design N2 - Background: The full potential of eHealth technologies to support self-management and disease management for patients with chronic diseases is not being reached. A possible explanation for these lacking results is that during the development process, insufficient attention is paid to the needs, wishes, and context of the prospective end users. To overcome such issues, the user-centered design practice of creating personas is widely accepted to ensure the fit between a technology and the target group or end users throughout all phases of development. Objective: In this study, we integrate several approaches to persona development into the Persona Approach Twente to attain a more holistic and structured approach that aligns with the iterative process of eHealth development. Methods: In 3 steps, a secondary analysis was carried out on different parts of the data set using the Partitioning Around Medoids clustering method. First, we used health-related electronic patient record data only. Second, we added person-related data that were gathered through interviews and questionnaires. Third, we added log data. Results: In the first step, 2 clusters were found, with average silhouette widths of 0.12 and 0.27. In the second step, again 2 clusters were found, with average silhouette widths of 0.08 and 0.12. In the third step, 3 clusters were identified, with average silhouette widths of 0.09, 0.12, and 0.04. Conclusions: The Persona Approach Twente is applicable for mixed types of data and allows alignment of this user-centered design method to the iterative approach of eHealth development. A variety of characteristics can be used that stretches beyond (standardized) medical and demographic measurements. Challenges lie in data quality and fitness for (quantitative) clustering. UR - https://humanfactors.jmir.org/2022/1/e24172 UR - http://dx.doi.org/10.2196/24172 UR - http://www.ncbi.nlm.nih.gov/pubmed/35289759 ID - info:doi/10.2196/24172 ER - TY - JOUR AU - Tahri Sqalli, Mohammed AU - Al-Thani, Dena AU - Elshazly, B. Mohamed AU - Al-Hijji, Mohammed AU - Alahmadi, Alaa AU - Sqalli Houssaini, Yahya PY - 2022/2/9 TI - Understanding Cardiology Practitioners? Interpretations of Electrocardiograms: An Eye-Tracking Study JO - JMIR Hum Factors SP - e34058 VL - 9 IS - 1 KW - eye tracking KW - electrocardiogram KW - ECG interpretation KW - cardiology practitioners KW - human-computer interaction KW - cardiology KW - ECG N2 - Background: Visual expertise refers to advanced visual skills demonstrated when performing domain-specific visual tasks. Prior research has emphasized the fact that medical experts rely on such perceptual pattern-recognition skills when interpreting medical images, particularly in the field of electrocardiogram (ECG) interpretation. Analyzing and modeling cardiology practitioners? visual behavior across different levels of expertise in the health care sector is crucial. Namely, understanding such acquirable visual skills may help train less experienced clinicians to interpret ECGs accurately. Objective: This study aims to quantify and analyze through the use of eye-tracking technology differences in the visual behavior and methodological practices for different expertise levels of cardiology practitioners such as medical students, cardiology nurses, technicians, fellows, and consultants when interpreting several types of ECGs. Methods: A total of 63 participants with different levels of clinical expertise took part in an eye-tracking study that consisted of interpreting 10 ECGs with different cardiac abnormalities. A counterbalanced within-subjects design was used with one independent variable consisting of the expertise level of the cardiology practitioners and two dependent variables of eye-tracking metrics (fixations count and fixation revisitations). The eye movements data revealed by specific visual behaviors were analyzed according to the accuracy of interpretation and the frequency with which interpreters visited different parts/leads on a standard 12-lead ECG. In addition, the median and SD in the IQR for the fixations count and the mean and SD for the ECG lead revisitations were calculated. Results: Accuracy of interpretation ranged between 98% among consultants, 87% among fellows, 70% among technicians, 63% among nurses, and finally 52% among medical students. The results of the eye fixations count, and eye fixation revisitations indicate that the less experienced cardiology practitioners need to interpret several ECG leads more carefully before making any decision. However, more experienced cardiology practitioners rely on their skills to recognize the visual signal patterns of different cardiac abnormalities, providing an accurate ECG interpretation. Conclusions: The results show that visual expertise for ECG interpretation is linked to the practitioner?s role within the health care system and the number of years of practical experience interpreting ECGs. Cardiology practitioners focus on different ECG leads and different waveform abnormalities according to their role in the health care sector and their expertise levels. UR - https://humanfactors.jmir.org/2022/1/e34058 UR - http://dx.doi.org/10.2196/34058 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138258 ID - info:doi/10.2196/34058 ER - TY - JOUR AU - Oberschmidt, Kira AU - Grünloh, Christiane AU - Nijboer, Femke AU - van Velsen, Lex PY - 2022/1/28 TI - Best Practices and Lessons Learned for Action Research in eHealth Design and Implementation: Literature Review JO - J Med Internet Res SP - e31795 VL - 24 IS - 1 KW - action research KW - eHealth KW - best practices KW - lessons learned N2 - Background: Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development. Objective: This literature review aims to provide more knowledge on the best practices and lessons learned from eHealth AR studies. Additionally, an overview of the context in which AR eHealth studies take place is given. Methods: A semisystematic review of 44 papers reporting on 40 different AR projects was conducted to identify the best practices and lessons learned in the research studies while accounting for the particular contextual setting and used AR approach. Results: Recommendations include paying attention to the training of stakeholders? academic skills, as well as the various roles and tasks of action researchers. The studies also highlight the need for constant reflection and accessible dissemination suiting the target group. Conclusions: This literature review identified room for improvements regarding communicating and specifying the particular AR definition and applied approach. UR - https://www.jmir.org/2022/1/e31795 UR - http://dx.doi.org/10.2196/31795 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089158 ID - info:doi/10.2196/31795 ER - TY - JOUR AU - Kip, Hanneke AU - Keizer, Julia AU - da Silva, C. Marcia AU - Beerlage-de Jong, Nienke AU - Köhle, Nadine AU - Kelders, M. Saskia PY - 2022/1/27 TI - Methods for Human-Centered eHealth Development: Narrative Scoping Review JO - J Med Internet Res SP - e31858 VL - 24 IS - 1 KW - eHealth KW - community-based participatory research KW - human-centered design KW - CeHRes Roadmap KW - internet-based intervention KW - technological innovations N2 - Background: Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective: The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods: We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results: In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions: This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process. UR - https://www.jmir.org/2022/1/e31858 UR - http://dx.doi.org/10.2196/31858 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084359 ID - info:doi/10.2196/31858 ER - TY - JOUR AU - Ogundaini, Oluwamayowa AU - de la Harpe, Retha PY - 2022/1/4 TI - The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach JO - JMIR Form Res SP - e23236 VL - 6 IS - 1 KW - agency KW - health care professionals KW - technology performativity KW - sub-Saharan Africa KW - service design KW - work activities KW - mobile phone N2 - Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants? data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. UR - https://formative.jmir.org/2022/1/e23236 UR - http://dx.doi.org/10.2196/23236 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982713 ID - info:doi/10.2196/23236 ER - TY - JOUR AU - Alwasel, Athary AU - Stergioulas, Lampros AU - Fakhimi, Masoud AU - Garn, Wolfgang PY - 2021/12/8 TI - Assessing Patient Engagement in Health Care: Proposal for a Modeling and Simulation Framework for Behavioral Analysis JO - JMIR Res Protoc SP - e30092 VL - 10 IS - 12 KW - modeling and simulation KW - behavioral analysis KW - patient engagement KW - behavioral factors, health care KW - human factors KW - outcomes KW - patient health KW - health policy KW - chronic diseases KW - behavioral model N2 - International Registered Report Identifier (IRRID): PRR1-10.2196/30092 UR - https://www.researchprotocols.org/2021/12/e30092 UR - http://dx.doi.org/10.2196/30092 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889774 ID - info:doi/10.2196/30092 ER - TY - JOUR AU - Hill, R. Jordan AU - Brown, C. Janetta AU - Campbell, L. Noll AU - Holden, J. Richard PY - 2021/11/2 TI - Usability-In-Place?Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review JO - JMIR Form Res SP - e26181 VL - 5 IS - 11 KW - mobile usability testing KW - usability inspection KW - methods KW - aging KW - literature synthesis KW - usability study KW - mobile usability KW - elderly KW - older adults KW - remote usability KW - mobility restriction N2 - Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature?a lack of remote usability testing methods, tools, and strategies for older adults, despite this population?s increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals. UR - https://formative.jmir.org/2021/11/e26181 UR - http://dx.doi.org/10.2196/26181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726604 ID - info:doi/10.2196/26181 ER - TY - JOUR AU - Szinay, Dorothy AU - Cameron, Rory AU - Naughton, Felix AU - Whitty, A. Jennifer AU - Brown, Jamie AU - Jones, Andy PY - 2021/10/11 TI - Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design JO - J Med Internet Res SP - e32365 VL - 23 IS - 10 KW - discrete choice experiment KW - stated preference methods KW - mHealth KW - digital health KW - quantitative methodology KW - uptake KW - engagement KW - methodology KW - preference KW - Bayesian KW - design KW - tutorial KW - qualitative KW - user preference UR - https://www.jmir.org/2021/10/e32365 UR - http://dx.doi.org/10.2196/32365 UR - http://www.ncbi.nlm.nih.gov/pubmed/34633290 ID - info:doi/10.2196/32365 ER - TY - JOUR AU - Helou, Samar AU - Abou-Khalil, Victoria AU - Iacobucci, Riccardo AU - El Helou, Elie AU - Kiyono, Ken PY - 2021/5/10 TI - Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation JO - J Med Internet Res SP - e25218 VL - 23 IS - 5 KW - computational ethnography KW - patient-physician communication KW - doctor-patient-computer interaction KW - electronic medical records KW - pose estimation KW - gaze KW - voice activity KW - dialogue KW - clinic layout N2 - Background: The study of doctor-patient-computer interactions is a key research area for examining doctor-patient relationships; however, studying these interactions is costly and obtrusive as researchers usually set up complex mechanisms or intrude on consultations to collect, then manually analyze the data. Objective: We aimed to facilitate human-computer and human-human interaction research in clinics by providing a computational ethnography tool: an unobtrusive automatic classifier of screen gaze and dialogue combinations in doctor-patient-computer interactions. Methods: The classifier?s input is video taken by doctors using their computers' internal camera and microphone. By estimating the key points of the doctor's face and the presence of voice activity, we estimate the type of interaction that is taking place. The classification output of each video segment is 1 of 4 interaction classes: (1) screen gaze and dialogue, wherein the doctor is gazing at the computer screen while conversing with the patient; (2) dialogue, wherein the doctor is gazing away from the computer screen while conversing with the patient; (3) screen gaze, wherein the doctor is gazing at the computer screen without conversing with the patient; and (4) other, wherein no screen gaze or dialogue are detected. We evaluated the classifier using 30 minutes of video provided by 5 doctors simulating consultations in their clinics both in semi- and fully inclusive layouts. Results: The classifier achieved an overall accuracy of 0.83, a performance similar to that of a human coder. Similar to the human coder, the classifier was more accurate in fully inclusive layouts than in semi-inclusive layouts. Conclusions: The proposed classifier can be used by researchers, care providers, designers, medical educators, and others who are interested in exploring and answering questions related to screen gaze and dialogue in doctor-patient-computer interactions. UR - https://www.jmir.org/2021/5/e25218 UR - http://dx.doi.org/10.2196/25218 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970117 ID - info:doi/10.2196/25218 ER - TY - JOUR AU - Silva, G. Anabela AU - Caravau, Hilma AU - Martins, Ana AU - Almeida, Pisco Ana Margarida AU - Silva, Telmo AU - Ribeiro, Óscar AU - Santinha, Gonçalo AU - Rocha, P. Nelson PY - 2021/1/13 TI - Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults JO - JMIR Hum Factors SP - e22774 VL - 8 IS - 1 KW - mobile phone KW - user-centered design KW - aged KW - review KW - telemedicine N2 - Background: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. Objective: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. Methods: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. Results: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. Conclusions: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations. UR - http://humanfactors.jmir.org/2021/1/e22774/ UR - http://dx.doi.org/10.2196/22774 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439128 ID - info:doi/10.2196/22774 ER - TY - JOUR AU - Ta, Vivian AU - Griffith, Caroline AU - Boatfield, Carolynn AU - Wang, Xinyu AU - Civitello, Maria AU - Bader, Haley AU - DeCero, Esther AU - Loggarakis, Alexia PY - 2020/3/6 TI - User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis JO - J Med Internet Res SP - e16235 VL - 22 IS - 3 KW - artificial intelligence KW - social support KW - artificial agents KW - chatbots KW - interpersonal relations N2 - Background: Previous research suggests that artificial agents may be a promising source of social support for humans. However, the bulk of this research has been conducted in the context of social support interventions that specifically address stressful situations or health improvements. Little research has examined social support received from artificial agents in everyday contexts. Objective: Considering that social support manifests in not only crises but also everyday situations and that everyday social support forms the basis of support received during more stressful events, we aimed to investigate the types of everyday social support that can be received from artificial agents. Methods: In Study 1, we examined publicly available user reviews (N=1854) of Replika, a popular companion chatbot. In Study 2, a sample (n=66) of Replika users provided detailed open-ended responses regarding their experiences of using Replika. We conducted thematic analysis on both datasets to gain insight into the kind of everyday social support that users receive through interactions with Replika. Results: Replika provides some level of companionship that can help curtail loneliness, provide a ?safe space? in which users can discuss any topic without the fear of judgment or retaliation, increase positive affect through uplifting and nurturing messages, and provide helpful information/advice when normal sources of informational support are not available. Conclusions: Artificial agents may be a promising source of everyday social support, particularly companionship, emotional, informational, and appraisal support, but not as tangible support. Future studies are needed to determine who might benefit from these types of everyday social support the most and why. These results could potentially be used to help address global health issues or other crises early on in everyday situations before they potentially manifest into larger issues. UR - http://www.jmir.org/2020/2/e16235/ UR - http://dx.doi.org/10.2196/16235 UR - http://www.ncbi.nlm.nih.gov/pubmed/32141837 ID - info:doi/10.2196/16235 ER - TY - JOUR AU - Prior, Sarah AU - Miller, Andrea AU - Campbell, Steven AU - Linegar, Karen AU - Peterson, Gregory PY - 2020/2/7 TI - The Challenges of Including Patients With Aphasia in Qualitative Research for Health Service Redesign: Qualitative Interview Study JO - J Participat Med SP - e12336 VL - 12 IS - 1 KW - stroke KW - communication KW - research KW - qualitative KW - aphasia KW - participatory research N2 - Background: Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is a frequent complication of stroke and is a major disability for patients and their families. The provision of services for stroke patients differs across health care providers and regions, and strategies directed at improving these services have benefited from the involvement of patients. However, patients with aphasia are often excluded from these co-design activities due to a diminished capacity to communicate verbally and a lack of health researcher experience in working with patients with aphasia. Objective: The primary aim of this paper is to identify approaches appropriate for working with patients with aphasia in an interview situation and, more generally, determine the importance of including people with aphasia in health service improvement research. The secondary aim is to describe the experiences of researchers involved in interviewing patients with aphasia. Methods: A total of 5 poststroke patients with aphasia participated in face-to-face interviews in their homes to gain insight into their in-hospital experience following their stroke. Interviews were audio-recorded, and thematic analysis was performed. The experiences of the researchers interviewing these patients were informally recorded postinterview, and themes were derived from these reflections. Results: The interview technique utilized in this study was unsuitable to gain rich, qualitative data from patients with aphasia. The experience of researchers performing these interviews suggests that preparation, emotion, and understanding were three of the main factors influencing their ability to gather useful experiential information from patients with aphasia. Patients with aphasia are valuable contributors to qualitative health services research, and researchers need to be flexible and adaptable in their methods of engagement. Conclusions: Including patients with aphasia in health service redesign research requires the use of nontraditional interview techniques. Researchers intending to engage patients with aphasia must devise appropriate strategies and methods to maximize the contributions and valuable communications of these participants. UR - https://jopm.jmir.org/2020/1/e12336 UR - http://dx.doi.org/10.2196/12336 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/12336 ER - TY - JOUR AU - ten Klooster, Iris AU - Noordzij, Leendert Matthijs AU - Kelders, Marion Saskia PY - 2020/1/21 TI - Exploring How Professionals Within Agile Health Care Informatics Perceive Visualizations of Log File Analyses: Observational Study Followed by a Focus Group Interview JO - JMIR Hum Factors SP - e14424 VL - 7 IS - 1 KW - log file analyses KW - user-centered design KW - agile KW - Markov Chains KW - health care systems N2 - Background: An increasing number of software companies work according to the agile software development method, which is difficult to integrate with user-centered design (UCD) practices. Log file analysis may provide opportunities for integrating UCD practices in the agile process. However, research within health care information technology mostly has a theoretical approach and is often focused on the researcher?s interpretation of log file analyses. Objective: We aimed to propose a systematic approach to log file analysis in this study and present this to developers to explore how they react and interpret this approach in the context of a real-world health care information system, in an attempt to answer the following question: How may log file analyses contribute to increasing the match between the health care system and its users, within the agile development method, according to agile team members? Methods: This study comprised 2 phases to answer the research question. In the first phase, log files were collected from a health care information system and subsequently analyzed (summarizing sequential patterns, heat mapping, and clustering). In the second phase, the results of these analyses are presented to agile professionals during a focus group interview. The interpretations of the agile professionals are analyzed by open axial coding. Results: Log file data of 17,924 user sessions and, in total, 176,678 activities were collected. We found that the Patient Timeline is mainly visited, with 23,707 (23,707/176,678; 13.42%) visits in total. The main unique user session occurred in 5.99% (1074/17,924) of all user sessions, and this comprised Insert Measurement Values for Patient and Patient Timeline, followed by the page Patient Settings and, finally, Patient Treatment Plan. In the heat map, we found that users often navigated to the pages Insert Measurement Values and Load Messages Collaborate. Finally, in the cluster analysis, we found 5 clusters, namely, the Information-seeking cluster, the Collaborative cluster, the Mixed cluster, the Administrative cluster, and the Patient-oriented cluster. We found that the interpretations of these results by agile professionals are related to stating hypotheses (n=34), comparing paths (n=31), benchmarking (n=22), and prioritizing (n=17). Conclusions: We found that analyzing log files provides agile professionals valuable insights into users? behavior. Therefore, we argue that log file analyses should be used within agile development to inform professionals about users? behavior. In this way, further UCD research can be informed by these results, making the methods less labor intensive. Moreover, we argue that these translations to an approach for further UCD research will be carried out by UCD specialists, as they are able to infer which goals the user had when going through these paths when looking at the log data. UR - https://humanfactors.jmir.org/2020/1/e14424 UR - http://dx.doi.org/10.2196/14424 UR - http://www.ncbi.nlm.nih.gov/pubmed/31961325 ID - info:doi/10.2196/14424 ER - TY - JOUR AU - Silva, G. Anabela AU - Simões, Patrícia AU - Santos, Rita AU - Queirós, Alexandra AU - Rocha, P. Nelson AU - Rodrigues, Mário PY - 2019/11/15 TI - A Scale to Assess the Methodological Quality of Studies Assessing Usability of Electronic Health Products and Services: Delphi Study Followed by Validity and Reliability Testing JO - J Med Internet Res SP - e14829 VL - 21 IS - 11 KW - quality of health care KW - eHealth KW - mHealth KW - efficiency N2 - Background: The usability of electronic health (eHealth) and mobile health apps is of paramount importance as it impacts the quality of care. Methodological quality assessment is a common practice in the field of health for different designs and types of studies. However, we were unable to find a scale to assess the methodological quality of studies on the usability of eHealth products or services. Objective: This study aimed to develop a scale to assess the methodological quality of studies assessing usability of mobile apps and to perform a preliminary analysis of of the scale?s feasibility, reliability, and construct validity on studies assessing usability of mobile apps, measuring aspects of physical activity. Methods: A 3-round Delphi panel was used to generate a pool of items considered important when assessing the quality of studies on the usability of mobile apps. These items were used to write the scale and the guide to assist its use. The scale was then used to assess the quality of studies on usability of mobile apps for physical activity, and it assessed in terms of feasibility, interrater reliability, and construct validity. Results: A total of 25 experts participated in the Delphi panel, and a 15-item scale was developed. This scale was shown to be feasible (time of application mean 13.10 [SD 2.59] min), reliable (intraclass correlation coefficient=0.81; 95% CI 0.55-0.93), and able to discriminate between low- and high-quality studies (high quality: mean 9.22 [SD 0.36]; low quality: mean 6.86 [SD 0.80]; P=.01). Conclusions: The scale that was developed can be used both to assess the methodological quality of usability studies and to inform its planning. UR - http://www.jmir.org/2019/11/e14829/ UR - http://dx.doi.org/10.2196/14829 UR - http://www.ncbi.nlm.nih.gov/pubmed/31730036 ID - info:doi/10.2196/14829 ER - TY - JOUR AU - Alwashmi, F. Meshari AU - Hawboldt, John AU - Davis, Erin AU - Fetters, D. Michael PY - 2019/04/26 TI - The Iterative Convergent Design for Mobile Health Usability Testing: Mixed Methods Approach JO - JMIR Mhealth Uhealth SP - e11656 VL - 7 IS - 4 KW - mHealth KW - mixed methods KW - usability KW - eHealth KW - methods UR - http://mhealth.jmir.org/2019/4/e11656/ UR - http://dx.doi.org/10.2196/11656 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025951 ID - info:doi/10.2196/11656 ER - TY - JOUR AU - Mann, M. Devin AU - Chokshi, Kuppin Sara AU - Kushniruk, Andre PY - 2018/11/28 TI - Bridging the Gap Between Academic Research and Pragmatic Needs in Usability: A Hybrid Approach to Usability Evaluation of Health Care Information Systems JO - JMIR Hum Factors SP - e10721 VL - 5 IS - 4 KW - software design KW - user-computer interface KW - medical informatics N2 - Background: Technology is increasingly embedded into the full spectrum of health care. This movement has benefited from the application of software development practices such as usability testing and agile development processes. These practices are frequently applied in both commercial or operational and academic settings. However, the relative importance placed on rapid iteration, validity, reproducibility, generalizability, and efficiency differs between the 2 settings and the needs and objectives of academic versus pragmatic usability evaluations. Objective: This paper explores how usability evaluation typically varies on key dimensions in pragmatic versus academic settings that impact the rapidity, validity, and reproducibility of findings and proposes a hybrid approach aimed at satisfying both pragmatic and academic objectives. Methods: We outline the characteristics of pragmatic versus academically oriented usability testing in health care, describe the tensions and gaps resulting from differing contexts and goals, and present a model of this hybrid process along with 2 case studies of digital development projects in which we demonstrate this integrated approach to usability evaluation. Results: The case studies presented illustrate design choices characteristic of our hybrid approach to usability evaluation. Conclusions: Designed to leverage the strengths of both pragmatically and academically focused usability studies, a hybrid approach allows new development projects to efficiently iterate and optimize from usability data as well as preserves the ability of these projects to produce deeper insights via thorough qualitative analysis to inform further tool development and usability research by way of academically focused dissemination. UR - http://humanfactors.jmir.org/2018/4/e10721/ UR - http://dx.doi.org/10.2196/10721 UR - http://www.ncbi.nlm.nih.gov/pubmed/30487119 ID - info:doi/10.2196/10721 ER - TY - JOUR AU - van Velsen, Lex AU - Evers, Mirka AU - Bara, Cristian-Dan AU - Op den Akker, Harm AU - Boerema, Simone AU - Hermens, Hermie PY - 2018/06/15 TI - Understanding the Acceptance of an eHealth Technology in the Early Stages of Development: An End-User Walkthrough Approach and Two Case Studies JO - JMIR Formativ Res SP - e10474 VL - 2 IS - 1 KW - eHealth KW - acceptance KW - design KW - walkthrough KW - agile design N2 - Background: Studies that focus on the acceptance of an electronic health (eHealth) technology generally make use of surveys. However, results of such studies hold little value for a redesign, as they focus only on quantifying end-user appreciation of general factors (eg, perceived usefulness). Objective: We present a method for understanding end-user acceptance of an eHealth technology, early in the development process: The eHealth End-User Walkthrough. Methods: During a walkthrough, a participant is guided by using the technology via a scenario, a persona, and a low-fidelity protoype. A participant is questioned about factors that may affect acceptance during and after the demonstration. We show the value of the method via two case studies. Results: During the case studies, participants commented on whether they intend to use a technology and why they would (not) use its main features. They also provided redesign advice or input for additional functions. Finally, the sessions provide guidance for the generation of business models and implementation plans. Conclusions: The eHealth End-User Walkthrough can aid design teams in understanding the acceptance of their eHealth application in a very early stage of the design process. Consequently, it can prevent a mismatch between technology and end-users? needs, wishes and context. UR - http://formative.jmir.org/2018/1/e10474/ UR - http://dx.doi.org/10.2196/10474 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684434 ID - info:doi/10.2196/10474 ER - TY - JOUR AU - Mohamad Marzuki, Fadhil Muhamad AU - Yaacob, Azwany Nor AU - Yaacob, Majdi Najib PY - 2018/05/14 TI - Translation, Cross-Cultural Adaptation, and Validation of the Malay Version of the System Usability Scale Questionnaire for the Assessment of Mobile Apps JO - JMIR Hum Factors SP - e10308 VL - 5 IS - 2 KW - usability KW - System Usability Scale KW - Malay KW - questionnaire translation KW - questionnaire validation KW - mobile app N2 - Background: A mobile app is a programmed system designed to be used by a target user on a mobile device. The usability of such a system refers not only to the extent to which product can be used to achieve the task that it was designed for, but also its effectiveness and efficiency, as well as user satisfaction. The System Usability Scale is one of the most commonly used questionnaires used to assess the usability of a system. The original 10-item version of System Usability Scale was developed in English and thus needs to be adapted into local languages to assess the usability of a mobile apps developed in other languages. Objective: The aim of this study is to translate and validate (with cross-cultural adaptation) the English System Usability Scale questionnaire into Malay, the main language spoken in Malaysia. The development of a translated version will allow the usability of mobile apps to be assessed in Malay. Methods: Forward and backward translation of the questionnaire was conducted by groups of Malay native speakers who spoke English as their second language. The final version was obtained after reconciliation and cross-cultural adaptation. The content of the Malay System Usability Scale questionnaire for mobile apps was validated by 10 experts in mobile app development. The efficacy of the questionnaire was further probed by testing the face validity on 10 mobile phone users, followed by reliability testing involving 54 mobile phone users. Results: The content validity index was determined to be 0.91, indicating good relevancy of the 10 items used to assess the usability of a mobile app. Calculation of the face validity index resulted in a value of 0.94, therefore indicating that the questionnaire was easily understood by the users. Reliability testing showed a Cronbach alpha value of .85 (95% CI 0.79-0.91) indicating that the translated System Usability Scale questionnaire is a reliable tool for the assessment of usability of a mobile app. Conclusions: The Malay System Usability Scale questionnaire is a valid and reliable tool to assess the usability of mobile app in Malaysia. UR - http://humanfactors.jmir.org/2018/2/e10308/ UR - http://dx.doi.org/10.2196/10308 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759955 ID - info:doi/10.2196/10308 ER - TY - JOUR AU - Daneshvar, Hadi AU - Anderson, Stuart AU - Williams, Robin AU - Mozaffar, Hajar PY - 2018/02/12 TI - How Can Social Media Lead to Co-Production (Co-Delivery) of New Services for the Elderly Population? A Qualitative Study JO - JMIR Hum Factors SP - e5 VL - 5 IS - 1 KW - social media KW - eHealth KW - mHealth KW - social networking KW - Web 2.0 KW - health informatics N2 - Background: The future of health care services in the European Union faces the triple challenges of aging, fiscal restriction, and inclusion. Co-production offers ways to manage informal care resources to help them cater for the growing needs of elderly people. Social media (SM) is seen as a critical enabler for co-production. Objective: The objective of this study was to investigate how SM?private Facebook groups, forums, Twitter, and blogging?acts as an enabler of co-production in health and care by facilitating its four underlying principles: equality, diversity, accessibility, and reciprocity. Methods: We used normalization process theory as our theoretical framework to design this study. We conducted a qualitative study and collected data through 20 semistructured interviews and observation of the activities of 10 online groups and individuals. We then used thematic analysis and drew on principles of co-production (equality, diversity, accessibility, and reciprocity) as a deductive coding framework to analyze our findings. Results: Our findings point to distinct patterns of feature use by different people involved in care of elderly people. This diversity makes possible the principles of co-production by offering equality among users, enabling diversity of use, making experiences accessible, and encouraging reciprocity in the sharing of knowledge and mutual support. We also identified that explication of common resources may lead to new forms of competition and conflicts. These conflicts require better management to enhance the coordination of the common pool of resources. Conclusions: SM uses afford new forms of organizing and collective engagement between patients, carers, and professionals, which leads to change in health and care communication and coordination. UR - http://humanfactors.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/humanfactors.7856 UR - http://www.ncbi.nlm.nih.gov/pubmed/29434014 ID - info:doi/10.2196/humanfactors.7856 ER - TY - JOUR AU - Wärnestål, Pontus AU - Svedberg, Petra AU - Lindberg, Susanne AU - Nygren, M. Jens PY - 2017/05/18 TI - Effects of Using Child Personas in the Development of a Digital Peer Support Service for Childhood Cancer Survivors JO - J Med Internet Res SP - e161 VL - 19 IS - 5 KW - peer KW - childhood KW - cancer KW - survivor KW - participation KW - user experience KW - service design N2 - Background: Peer support services have the potential to support children who survive cancer by handling the physical, mental, and social challenges associated with survival and return to everyday life. Involving the children themselves in the design process allows for adapting services to authentic user behaviors and goals. As there are several challenges that put critical requirements on a user-centered design process, we developed a design method based on personas adapted to the particular needs of children that promotes health and handles a sensitive design context. Objective: The purpose of this study was to evaluate the effects of using child personas in the development of a digital peer support service for childhood cancer survivors. Methods: The user group?s needs and behaviors were characterized based on cohort data and literature, focus group interviews with childhood cancer survivors (n=15, 8-12 years), stakeholder interviews with health care professionals and parents (n=13), user interviews, and observations. Data were interpreted and explained together with childhood cancer survivors (n=5) in three explorative design workshops and a validation workshop with children (n=7). Results: We present findings and insights on how to codesign child personas in the context of developing digital peer support services with childhood cancer survivors. The work resulted in three primary personas that model the behaviors, attitudes, and goals of three user archetypes tailored for developing health-promoting services in this particular use context. Additionally, we also report on the effects of using these personas in the design of a digital peer support service called Give Me a Break. Conclusions: By applying our progressive steps of data collection and analysis, we arrive at authentic child-personas that were successfully used to design and develop health-promoting services for children in vulnerable life stages. The child-personas serve as effective collaboration and communication aids for both internal and external purposes. UR - http://www.jmir.org/2017/5/e161/ UR - http://dx.doi.org/10.2196/jmir.7175 UR - http://www.ncbi.nlm.nih.gov/pubmed/28526663 ID - info:doi/10.2196/jmir.7175 ER - TY - JOUR AU - Harte, Richard AU - Glynn, Liam AU - Rodríguez-Molinero, Alejandro AU - Baker, MA Paul AU - Scharf, Thomas AU - Quinlan, R. Leo AU - ÓLaighin, Gearóid PY - 2017/03/16 TI - A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase Methodology JO - JMIR Hum Factors SP - e8 VL - 4 IS - 1 KW - human-centered design KW - user-centered design KW - usability testing KW - user interface design KW - connected health KW - human factors KW - mHealth N2 - Background: Design processes such as human-centered design, which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of human-centered design can often present a challenge when design teams are faced with the necessary, rapid, product development life cycles associated with the competitive connected health industry. Objective: We wanted to derive a structured methodology that followed the principles of human-centered design that would allow designers and developers to ensure that the needs of the user are taken into account throughout the design process, while maintaining a rapid pace of development. In this paper, we present the methodology and its rationale before outlining how it was applied to assess and enhance the usability, human factors, and user experience of a connected health system known as the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system, a system designed to continuously assess fall risk by measuring gait and balance parameters associated with fall risk. Methods: We derived a three-phase methodology. In Phase 1 we emphasized the construction of a use case document. This document can be used to detail the context of use of the system by utilizing storyboarding, paper prototypes, and mock-ups in conjunction with user interviews to gather insightful user feedback on different proposed concepts. In Phase 2 we emphasized the use of expert usability inspections such as heuristic evaluations and cognitive walkthroughs with small multidisciplinary groups to review the prototypes born out of the Phase 1 feedback. Finally, in Phase 3 we emphasized classical user testing with target end users, using various metrics to measure the user experience and improve the final prototypes. Results: We report a successful implementation of the methodology for the design and development of a system for detecting and predicting falls in older adults. We describe in detail what testing and evaluation activities we carried out to effectively test the system and overcome usability and human factors problems. Conclusions: We feel this methodology can be applied to a wide variety of connected health devices and systems. We consider this a methodology that can be scaled to different-sized projects accordingly. UR - http://humanfactors.jmir.org/2017/1/e8/ UR - http://dx.doi.org/10.2196/humanfactors.5443 UR - http://www.ncbi.nlm.nih.gov/pubmed/28302594 ID - info:doi/10.2196/humanfactors.5443 ER - TY - JOUR AU - Orlowski, Kate Simone AU - Lawn, Sharon AU - Venning, Anthony AU - Winsall, Megan AU - Jones, M. Gabrielle AU - Wyld, Kaisha AU - Damarell, A. Raechel AU - Antezana, Gaston AU - Schrader, Geoffrey AU - Smith, David AU - Collin, Philippa AU - Bidargaddi, Niranjan PY - 2015/07/09 TI - Participatory Research as One Piece of the Puzzle: A Systematic Review of Consumer Involvement in Design of Technology-Based Youth Mental Health and Well-Being Interventions JO - JMIR Human Factors SP - e12 VL - 2 IS - 2 KW - mental health KW - young people KW - technology KW - intervention KW - participatory KW - design N2 - Background: Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. Objective: To investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. Methods: Fifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. Results: A total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation. Conclusions: Consumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear. UR - http://humanfactors.jmir.org/2015/2/e12/ UR - http://dx.doi.org/10.2196/humanfactors.4361 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025279 ID - info:doi/10.2196/humanfactors.4361 ER - TY - JOUR AU - Kortum, Philip AU - Peres, Camille S. PY - 2015/06/05 TI - Evaluation of Home Health Care Devices: Remote Usability Assessment JO - JMIR Human Factors SP - e10 VL - 2 IS - 1 KW - health care evaluation mechanisms KW - human-computer interaction design and evaluation methods KW - patient satisfaction KW - usability testing N2 - 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. UR - http://humanfactors.jmir.org/2015/1/e10/ UR - http://dx.doi.org/10.2196/humanfactors.4570 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025664 ID - info:doi/10.2196/humanfactors.4570 ER - TY - JOUR AU - Arden-Close, Julia Emily AU - Smith, Emily AU - Bradbury, Katherine AU - Morrison, Leanne AU - Dennison, Laura AU - Michaelides, Danius AU - Yardley, Lucy PY - 2015/05/19 TI - A Visualization Tool to Analyse Usage of Web-Based Interventions: The Example of Positive Online Weight Reduction (POWeR) JO - JMIR Human Factors SP - e8 VL - 2 IS - 1 KW - data visualisations KW - usage KW - Web-based interventions N2 - Background: Attrition is a significant problem in Web-based interventions. Consequently, this research aims to identify the relation between Web usage and benefit from such interventions. A visualization tool has been developed that enables researchers to more easily examine large datasets on intervention usage that can be difficult to make sense of using traditional descriptive or statistical techniques alone. Objective: This paper demonstrates how the visualization tool was used to explore patterns in participants? use of a Web-based weight management intervention, termed "positive online weight reduction (POWeR)." We also demonstrate how the visualization tool can be used to perform subsequent statistical analyses of the association between usage patterns, participant characteristics, and intervention outcome. Methods: The visualization tool was used to analyze data from 132 participants who had accessed at least one session of the POWeR intervention. Results: There was a drop in usage of optional sessions after participants had accessed the initial, core POWeR sessions, but many users nevertheless continued to complete goal and weight reviews. The POWeR tools relating to the food diary and steps diary were reused most often. Differences in participant characteristics and usage of other intervention components were identified between participants who did and did not choose to access optional POWeR sessions (in addition to the initial core sessions) or reuse the food and steps diaries. Reuse of the steps diary and the getting support tools was associated with greater weight loss. Conclusions: The visualization tool provided a quick and efficient method for exploring patterns of Web usage, which enabled further analyses of whether different usage patterns were associated with participant characteristics or differences in intervention outcome. Further usage of visualization techniques is recommended to (1) make sense of large datasets more quickly and efficiently; (2) determine the likely active ingredients in Web-based interventions, and thereby enhance the benefit they may provide; and (3) guide in designing (or redesigning) of future interventions to promote greater use and engagement by enabling users to easily access valued intervention content/tools. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 31685626; http://www.isrctn.com/ISRCTN31685626 (Archived by WebCite at http://www.webcitation.org/6YXYIw9vc). UR - http://humanfactors.jmir.org/2015/1/e8/ UR - http://dx.doi.org/10.2196/humanfactors.4310 UR - http://www.ncbi.nlm.nih.gov/pubmed/27026372 ID - info:doi/10.2196/humanfactors.4310 ER - TY - JOUR AU - Asan, Onur AU - Yang, Yushi PY - 2015/04/14 TI - Using Eye Trackers for Usability Evaluation of Health Information Technology: A Systematic Literature Review JO - JMIR Human Factors SP - e5 VL - 2 IS - 1 KW - health information technology KW - eye-tracking technology KW - usability evaluation N2 - Background: Eye-tracking technology has been used to measure human cognitive processes and has the potential to improve the usability of health information technology (HIT). However, it is still unclear how the eye-tracking method can be integrated with other traditional usability methodologies to achieve its full potential. Objective: The objective of this study was to report on HIT evaluation studies that have used eye-tracker technology, and to envision the potential use of eye-tracking technology in future research. Methods: We used four reference databases to initially identify 5248 related papers, which resulted in only 9 articles that met our inclusion criteria. Results: Eye-tracking technology was useful in finding usability problems in many ways, but is still in its infancy for HIT usability evaluation. Limited types of HITs have been evaluated by eye trackers, and there has been a lack of evaluation research in natural settings. Conclusions: More research should be done in natural settings to discover the real contextual-based usability problems of clinical and mobile HITs using eye-tracking technology with more standardized methodologies and guidance. UR - http://humanfactors.jmir.org/2015/1/e5/ UR - http://dx.doi.org/10.2196/humanfactors.4062 UR - http://www.ncbi.nlm.nih.gov/pubmed/27026079 ID - info:doi/10.2196/humanfactors.4062 ER -