TY - JOUR AU - Holetzek, Tim AU - Häusler, Andreas AU - Gödde, Kathrin AU - Rapp, Michael AU - Spallek, Jacob AU - Holmberg, Christine PY - 2025/3/24 TI - The Role of the Installed Base in Information Exchange Among General Practitioners in Germany: Mixed Methods Study JO - J Med Internet Res SP - e65241 VL - 27 KW - digitalization KW - general practitioners KW - Germany KW - information and communication technologies KW - information exchange KW - primary health care KW - digital transformation KW - mixed methods study KW - digital health KW - health application KW - qualitative interview N2 - Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2%, SD 24.64), fax (n=109, 43.9%, SD 25.40), or post (n=50, 20.2%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs? communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs? practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers? perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation. UR - https://www.jmir.org/2025/1/e65241 UR - http://dx.doi.org/10.2196/65241 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65241 ER - TY - JOUR AU - Duffy, Anthony AU - Boroumandzad, Nazanin AU - Sherman, Lopez Alfredo AU - Christie, Gregory AU - Riadi, Indira AU - Moreno, Sylvain PY - 2025/3/14 TI - Examining Challenges to Co-Design Digital Health Interventions With End Users: Systematic Review JO - J Med Internet Res SP - e50178 VL - 27 KW - digital health KW - end users KW - user experience KW - health behavior KW - intervention KW - co-design KW - mobile health KW - mHealth KW - digital health citizen N2 - Background: Digital health interventions (DHIs) are changing the dynamic of health care by providing personalized, private, and instantaneous solutions to end users. However, the explosion of digital health has been fraught with challenges. The approach to co-design with end users varies across a diverse domain of stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital stakeholders (ie, user experience and retention) and health stakeholders (ie, safety and efficacy). Several methodologies and frameworks are being implemented to address this challenge to varying degrees of success. Objective: We aimed to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken to identify the key problem areas at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users. Methods: We conducted a systematic search of key databases for co-design studies involving end users in DHIs. Searches were divided into 3 relevant streams: health behavior, user experience, and digital methodologies and frameworks. The eligibility criteria were guided by the PerSPEcTiF framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In line with this framework, studies were included in this review that (1) address research on DHIs; (2) focus on interaction and co-design with end users; (3) explain results such that uptake, effectiveness, satisfaction, and health outcomes are discernible, positively or negatively; and (4) describe actionable procedures for better DHI design. The search was conducted in a diverse group of 6 bibliographical databases from January 2015 to May 2024: PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Institute of Electrical and Electronics Engineers Xplore, and Scopus. From the 13,961 studies initially screened for titles and abstracts, 489 (3.6%) were eligible for a full-text screening, of which 171 (1.2%) studies matched the inclusion criteria and were included in a qualitative synthesis. Results: Of the 171 studies analyzed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies. These studies identified several core themes when co-designing with end users: advancements, which included participatory co-design; challenges, which included participatory co-design, environment and context, testing, and cost and scale; and gaps, which included a pragmatic hybridized framework and industry implementability. Conclusions: This research supports a pragmatic shift toward using mixed methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of digital health co-designers with the pragmatism of Agile design methodology and the rigor of health care metrics. Trial Registration: PROSPERO CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238164 International Registered Report Identifier (IRRID): RR2-10.2196/28083 UR - https://www.jmir.org/2025/1/e50178 UR - http://dx.doi.org/10.2196/50178 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50178 ER - TY - JOUR AU - Hua, Zhong AU - Yuqing, Song AU - Qianwen, Liu AU - Hong, Chen PY - 2025/3/10 TI - Factors Influencing eHealth Literacy Worldwide: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e50313 VL - 27 KW - meta-analysis KW - eHealth literacy KW - eHealth KW - Technology Acceptance Model KW - Literacy and Health Conceptual Framework KW - social determinants of health KW - digital health KW - consumer N2 - Background: eHealth literacy has increasingly emerged as a critical determinant of health, highlighting the importance of identifying its influencing factors; however, these factors remain unclear. Numerous studies have explored this concept across various populations, presenting an opportunity for a systematic review and synthesis of the existing evidence to better understand eHealth literacy and its key determinants. Objective: This study aimed to provide a systematic review of factors influencing eHealth literacy and to examine their impact across different populations. Methods: We conducted a comprehensive search of papers from PubMed, CNKI, Embase, Web of Science, Cochrane Library, CINAHL, and MEDLINE databases from inception to April 11, 2023. We included all those studies that reported the eHealth literacy status measured with the eHealth Literacy Scale (eHEALS). Methodological validity was assessed with the standardized Joanna Briggs Institute (JBI) critical appraisal tool prepared for cross-sectional studies. Meta-analytic techniques were used to calculate the pooled standardized ? coefficient with 95% CIs, while heterogeneity was assessed using I2, the Q test, and ?2. Meta-regressions were used to explore the effect of potential moderators, including participants? characteristics, internet use measured by time or frequency, and country development status. Predictors of eHealth literacy were integrated according to the Literacy and Health Conceptual Framework and the Technology Acceptance Model (TAM). Results: In total, 17 studies met the inclusion criteria for the meta-analysis. Key factors influencing higher eHealth literacy were identified and classified into 3 themes: (1) actions (internet usage: ?=0.14, 95% CI 0.102-0.182, I2=80.4%), (2) determinants (age: ?=?0.042, 95% CI ?0.071 to ?0.020, I2=80.3%; ethnicity: ?=?2.613, 95% CI ?4.114 to ?1.112, I2=80.2%; income: ?=0.206, 95% CI 0.059-0.354, I2=64.6%; employment status: ?=?1.629, 95% CI ?2.323 to ?0.953, I2=99.7%; education: ?=0.154, 95% CI 0.101-0.208, I2=58.2%; perceived usefulness: ?=0.832, 95% CI 0.131-1.522, I2=68.3%; and self-efficacy: ?=0.239, 95% CI 0.129-0.349, I2=0.0%), and (3) health status factor (disease: ?=?0.177, 95% CI ?0.298 to ?0.055, I2=26.9%). Conclusions: This systematic review, guided by the Literacy and Health Conceptual Framework model, identified key factors influencing eHealth literacy across 3 dimensions: actions (internet usage), determinants (age, ethnicity, income, employment status, education, perceived usefulness, and self-efficacy), and health status (disease). These findings provide valuable guidance for designing interventions to enhance eHealth literacy. Trial Registration: PROSPERO CRD42022383384; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022383384 UR - https://www.jmir.org/2025/1/e50313 UR - http://dx.doi.org/10.2196/50313 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50313 ER - TY - JOUR AU - Li, Xuezhu AU - Huang, Lifeng AU - Zhang, Hui AU - Liang, Zhanming PY - 2025/3/5 TI - Enabling Telemedicine From the System-Level Perspective: Scoping Review JO - J Med Internet Res SP - e65932 VL - 27 KW - telemedicine KW - telehealth KW - digital health KW - success factors KW - challenges N2 - Background: Telemedicine is a strategy for providing health care services remotely that improves service accessibility. Telemedicine has attracted growing research interest in the past 10 years, including systematic reviews that synthesize evidence to share experiences and enhance knowledge. However, most of the published systematic reviews have focused on synthesizing evidence from studies on telemedicine at the organizational level. A collected understanding of factors on the system level that influence the successful implementation and adoption of telemedicine needs to be developed, especially in regional and rural areas. Objective: This scoping review aims to explore key success factors and challenges that influence the implementation and adoption of telemedicine at the system level, particularly in regional and rural areas. Methods: This scoping review was conducted in accordance with the framework by Arksey and O?Malley and reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 5 databases (CINAHL, Cochrane, Medline, Ovid, and Scopus) were searched for research articles published in English between January 2010 and 2023, using the established inclusion criteria. Results: Of the 10,691 papers identified, 89 were included in this review, including 16 (17.98%) studies conducted in regional and rural areas and 13 (14.61%) in metropolitan areas. Another 13 (14.61%) studies were conducted in both metropolitan areas and regional and rural areas. Overall, 6 categories with more than 70 key success factors, including system-level requirements (n=13, 18.40%), economic considerations and funding (n=6, 8.70%), technological requirements (n=6, 8.70%), organizational requirements (n=19, 27.54%), understanding and supporting clinicians (n=12, 17.39%), and understanding and improving patients? perceptions (n=13, 18.84%), were identified. Additionally, 5 categories containing over 50 challenges, including those related to system levels (n=11, 23.91%), technological requirements (n=6, 13.04%), organizational requirements (n=13, 28.26%), clinicians (n=10, 21.74%), and patients (n=6, 13.04%), were identified. Among the identified factors, 11 (9.57%) were specific to regional and rural areas. Conclusions: This scoping review confirms that the successful implementation of telemedicine requires collective efforts at both the system and organizational levels, including coordination and collaboration across different regions and organizations. It underscores the importance of establishing a national network that enhances public awareness of telemedicine and clarity in payment and benefit distribution models and strengthens data security protection measures. The review also highlights the necessity of addressing infrastructural deficiencies, including internet connectivity in regional and rural areas, and suggests the implementation of targeted incentives and support measures. The required collective efforts are detailed in the proposed framework that promotes popularizing telemedicine, enhancing the overall quality and efficiency of health care services, and achieving broader health equity. UR - https://www.jmir.org/2025/1/e65932 UR - http://dx.doi.org/10.2196/65932 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053725 ID - info:doi/10.2196/65932 ER - TY - JOUR AU - Lochhead, Chris AU - Fisher, B. Robert PY - 2025/2/27 TI - On the Necessity of Multidisciplinarity in the Development of at-Home Health Monitoring Platforms for Older Adults: Systematic Review JO - JMIR Hum Factors SP - e59458 VL - 12 KW - multi-disciplinarity KW - gait assessment KW - machine learning KW - at-home health monitoring KW - older adults KW - elderly KW - artificial intelligence KW - AI KW - gait KW - development KW - health monitoring KW - monitoring KW - systematic review KW - monitoring system KW - barriers KW - caregiver KW - efficiency KW - effectiveness N2 - Background: The growth of aging populations globally has increased the demand for new models of care. At-home, computerized health care monitoring is a growing paradigm, which explores the possibility of reducing workloads, lowering the demand for resource-intensive secondary care, and providing more precise and personalized care. Despite the potential societal benefit of autonomous monitoring systems when implemented properly, uptake in health care institutions is slow, and a great volume of research across disciplines encounters similar common barriers to real-world implementation. Objective: The goal of this systematic review was to construct an evaluation framework that can assess research in terms of how well it addresses already identified barriers to application and then use that framework to analyze the literature across disciplines and identify trends between multidisciplinarity and the likelihood of research being developed robustly. Methods: This paper introduces a scoring framework for evaluating how well individual pieces of research address key development considerations using 10 identified common barriers to uptake found during meta-review from different disciplines across the domain of health care monitoring. A scoping review is then conducted using this framework to identify the impact that multidisciplinarity involvement has on the effective development of new monitoring technologies. Specifically, we use this framework to measure the relationship between the use of multidisciplinarity in research and the likelihood that a piece of research will be developed in a way that gives it genuine practical application. Results: We show that viewpoints of multidisciplinarity; namely across computer science and medicine alongside public and patient involvement (PPI) have a significant positive impact in addressing commonly encountered barriers to application research and development according to the evaluation criteria. Using our evaluation metric, multidisciplinary teams score on average 54.3% compared with 35% for teams made up of medical experts and social scientists, and 2.68 for technical-based teams, encompassing computer science and engineering. Also identified is the significant effect that involving either caregivers or end users in the research in a co-design or PPI-based capacity has on the evaluation score (29.3% without any input and between 48.3% and 36.7% for end user or caregiver input respectively, on average). Conclusions: This review recommends that, to limit the volume of novel research arbitrarily re-encountering the same issues in the limitations of their work and hence improve the efficiency and effectiveness of research, multidisciplinarity should be promoted as a priority to accelerate the rate of advancement in this field and encourage the development of more technology in this domain that can be of tangible societal benefit. UR - https://humanfactors.jmir.org/2025/1/e59458 UR - http://dx.doi.org/10.2196/59458 ID - info:doi/10.2196/59458 ER - TY - JOUR AU - Soleymani, Dagmar AU - Pougheon-Bertrand, Dominique AU - Gagnayre, Rémi PY - 2025/2/7 TI - A Digital Behavior Change Intervention for Health Promotion for Adults in Midlife: Protocol for a Multidimensional Assessment Study JO - JMIR Res Protoc SP - e60559 VL - 14 KW - digital behavior change intervention KW - assessment protocol KW - middle-aged adults KW - health promotion KW - user account KW - mixed assessments KW - health information technologies N2 - Background: To support lifelong health promotion and disease prevention, Santé publique France studied the methodology for building a social marketing scheme with a digital intervention targeting middle-aged adults, specifically socioeconomically disadvantaged groups. The digital intervention aims to encourage people aged 40-55 years to look after their health in the short and medium terms by adopting small actions relating to 8 health determinants: nutrition, physical activity, smoking, alcohol, stress, cognitive health, sleep, and environmental health. In the long term, the intervention intends to prevent frailty and reduce the burden of multimorbidities in older age, particularly for lower socioeconomic groups. Objective: This study aims to measure behavior changes among registered users of the future website. The protocol assesses the impact of the website based on users? implementation of small actions relating to the 8 health determinants. Specifically, it intends to evaluate the website?s performance in terms of engaging a specific population, triggering behavior change, raising awareness about a multifactorial approach to health, and encouraging user interaction with the website?s resources. Methods: The methodology is based on clinical assessments developed alongside the website according to the functionalities offered to registered users in their personalized space. The assessment tool design draws on logic models for digital interventions, and their consistency for digital applications is verified. The target audience is clearly defined from the outset. The protocol sets out a 3-step assessment: upon registration, after 3 weeks of use, and after 10 weeks of use (end of assessment). Users are divided into 2 groups (socioeconomically disadvantaged users and others) to characterize differences and make corrections. The protocol uses a mixed assessment approach based on website traffic and user login data. Specific and identifiable behavior changes are documented by monitoring the same individuals from T0 to T2, using verbatim comments to classify them into profiles and conducting semistructured individual interviews with a sample of users. Results: The protocol creates a multidimensional assessment of digital intervention, showing that during a given timeline, interactions with users can reveal their capabilities, opportunities, and motivations to adopt healthy lifestyles. The protocol?s principles were integrated into the development of a personal account to assess users? behavior changes. Given the delayed launch of the website, no recruitment or effects analysis of the protocol took place. Conclusions: As no multidimensional assessment protocol is currently available for digital behavior change interventions, our methods reveal that the different framework stages can strengthen the effect measurement, consolidate the choice of assumptions used within the logic model and steer the digital intervention toward action while reducing the burden of information. The suitability of the assessment protocol remains to be evaluated given the delayed launch of the website. International Registered Report Identifier (IRRID): PRR1-10.2196/60559 UR - https://www.researchprotocols.org/2025/1/e60559 UR - http://dx.doi.org/10.2196/60559 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60559 ER - TY - JOUR AU - Rose, Christian AU - Shearer, Emily AU - Woller, Isabela AU - Foster, Ashley AU - Ashenburg, Nicholas AU - Kim, Ireh AU - Newberry, Jennifer PY - 2025/2/6 TI - Identifying High-Priority Ethical Challenges for Precision Emergency Medicine: Nominal Group Study JO - JMIR Form Res SP - e68371 VL - 9 KW - precision medicine KW - emergency medicine KW - ethical considerations KW - nominal group study KW - consensus framework N2 - Background: Precision medicine promises to revolutionize health care by providing the right care to the right patient at the right time. However, the emergency department?s unique mandate to treat ?anyone, anywhere, anytime? creates critical tensions with precision medicine?s requirements for comprehensive patient data and computational analysis. As emergency departments serve as health care?s safety net and provide a growing proportion of acute care in America, identifying and addressing the ethical challenges of implementing precision medicine in this setting is crucial to prevent exacerbation of existing health care disparities. The rapid advancement of precision medicine technologies makes it imperative to understand these challenges before widespread implementation in emergency care settings. Objective: This study aimed to identify high priority ethical concerns facing the implementation of precision medicine in the emergency department. Methods: We conducted a qualitative study using a modified nominal group technique (NGT) with emergency physicians who had previous knowledge of precision medicine concepts. The NGT process consisted of four phases: (1) silent generation of ideas, (2) round-robin sharing of ideas, (3) structured discussion and clarification, and (4) thematic grouping of priorities. Participants represented diverse practice settings (county hospital, community hospital, academic center, and integrated managed care consortium) and subspecialties (education, ethics, pediatrics, diversity, equity, inclusion, and informatics) across various career stages from residents to late-career physicians. Results: A total of 12 emergency physicians identified 82 initial challenges during individual ideation, which were consolidated to 48 unique challenges after removing duplicates and combining related items. The average participant contributed 6.8 (SD 2.9) challenges. These challenges were organized into a framework with 3 themes: values, privacy, and justice. The framework identified the need to address these themes across 3 time points of the precision medicine process: acquisition of data, actualization in the care setting, and the after effects of its use. This systematic organization revealed interrelated concerns spanning from data collection and bias to implementation challenges and long-term consequences for health care equity. Conclusions: Our study developed a novel framework that maps critical ethical challenges across 3 domains (values, privacy, and justice) and 3 temporal stages of precision medicine implementation. This framework identifies high-priority areas for future research and policy development, particularly around data representation, privacy protection, and equitable access. Successfully addressing these challenges is essential to realize precision medicine?s potential while preserving emergency medicine?s core mission as health care?s safety net. UR - https://formative.jmir.org/2025/1/e68371 UR - http://dx.doi.org/10.2196/68371 ID - info:doi/10.2196/68371 ER - TY - JOUR AU - Gabrielli, Silvia AU - Mayora Ibarra, Oscar AU - Forti, Stefano PY - 2025/1/16 TI - A Holistic Digital Health Framework to Support Health Prevention Strategies in the First 1000 Days JO - JMIR Pediatr Parent SP - e55235 VL - 8 KW - digital health KW - digital therapeutics KW - behavioral intervention technology KW - prevention KW - citizen science KW - first 1000 days UR - https://pediatrics.jmir.org/2025/1/e55235 UR - http://dx.doi.org/10.2196/55235 ID - info:doi/10.2196/55235 ER - TY - JOUR AU - Bienefeld, Nadine AU - Keller, Emanuela AU - Grote, Gudela PY - 2025/1/13 TI - AI Interventions to Alleviate Healthcare Shortages and Enhance Work Conditions in Critical Care: Qualitative Analysis JO - J Med Internet Res SP - e50852 VL - 27 KW - artificial intelligence KW - AI KW - work design KW - sociotechnical system KW - work KW - job KW - occupational health KW - sociotechnical KW - new work KW - future of work KW - satisfaction KW - health care professionals KW - intensive care KW - ICU KW - stress mitigation KW - worker KW - employee KW - stress KW - health care professional KW - overburdened KW - burden KW - burnout KW - autonomy KW - competence KW - flexible KW - task KW - workplace KW - hospital N2 - Background: The escalating global scarcity of skilled health care professionals is a critical concern, further exacerbated by rising stress levels and clinician burnout rates. Artificial intelligence (AI) has surfaced as a potential resource to alleviate these challenges. Nevertheless, it is not taken for granted that AI will inevitably augment human performance, as ill-designed systems may inadvertently impose new burdens on health care workers, and implementation may be challenging. An in-depth understanding of how AI can effectively enhance rather than impair work conditions is therefore needed. Objective: This research investigates the efficacy of AI in alleviating stress and enriching work conditions, using intensive care units (ICUs) as a case study. Through a sociotechnical system lens, we delineate how AI systems, tasks, and responsibilities of ICU nurses and physicians can be co-designed to foster motivating, resilient, and health-promoting work. Methods: We use the sociotechnical system framework COMPASS (Complementary Analysis of Sociotechnical Systems) to assess 5 job characteristics: autonomy, skill diversity, flexibility, problem-solving opportunities, and task variety. The qualitative analysis is underpinned by extensive workplace observation in 6 ICUs (approximately 559 nurses and physicians), structured interviews with work unit leaders (n=12), and a comparative analysis of data science experts? and clinicians? evaluation of the optimal levels of human-AI teaming. Results: The results indicate that AI holds the potential to positively impact work conditions for ICU nurses and physicians in four key areas. First, autonomy is vital for stress reduction, motivation, and performance improvement. AI systems that ensure transparency, predictability, and human control can reinforce or amplify autonomy. Second, AI can encourage skill diversity and competence development, thus empowering clinicians to broaden their skills, increase the polyvalence of tasks across professional boundaries, and improve interprofessional cooperation. However, careful consideration is required to avoid the deskilling of experienced professionals. Third, AI automation can expand flexibility by relieving clinicians from administrative duties, thereby concentrating their efforts on patient care. Remote monitoring and improved scheduling can help integrate work with other life domains. Fourth, while AI may reduce problem-solving opportunities in certain areas, it can open new pathways, particularly for nurses. Finally, task identity and variety are essential job characteristics for intrinsic motivation and worker engagement but could be compromised depending on how AI tools are designed and implemented. Conclusions: This study demonstrates AI?s capacity to mitigate stress and improve work conditions for ICU nurses and physicians, thereby contributing to resolving health care staffing shortages. AI solutions that are thoughtfully designed in line with the principles for good work design can enhance intrinsic motivation, learning, and worker well-being, thus providing strategic value for hospital management, policy makers, and health care professionals alike. UR - https://www.jmir.org/2025/1/e50852 UR - http://dx.doi.org/10.2196/50852 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50852 ER - TY - JOUR AU - Foran, M. Heather AU - Kubb, Christian AU - Mueller, Janina AU - Poff, Spencer AU - Ung, Megan AU - Li, Margaret AU - Smith, Michael Eric AU - Akinyemi, Akinniyi AU - Kambadur, Melanie AU - Waller, Franziska AU - Graf, Mario AU - Boureau, Y-Lan PY - 2024/12/6 TI - An Automated Conversational Agent Self-Help Program: Randomized Controlled Trial JO - J Med Internet Res SP - e53829 VL - 26 KW - well-being KW - chatbot KW - randomized controlled trial KW - prevention KW - flourishing N2 - Background: Health promotion and growth-based interventions can effectively improve individual well-being; however, significant gaps in access and utilization still exist. Objective: This study aims to develop and test the effectiveness and implementation of a new, widely targeted conversational agent prevention program (Zenny) designed to enhance well-being. Methods: A total of 1345 individuals in the United States were recruited online and randomly assigned to either (1) a self-help program intervention delivered via an automated conversational agent on WhatsApp or (2) an active control group that had access to evidence-based wellness resources available online. The primary outcomes were well-being (measured using the 5-item World Health Organization Well-being Scale), psychosocial flourishing (assessed with the Flourishing Scale), and positive psychological health (evaluated with the Mental Health Continuum-Short Form). Outcome measures were collected at baseline and again 1 month postassessment. All analyses were conducted using an intention-to-treat approach. Results: Both groups showed significant improvements in well-being (self-help program intervention group effect size: Cohen d=0.26, P<.001; active control group effect size: d=0.24, P<.001), psychosocial flourishing (intervention: d=0.19, P<.001; active control: d=0.18, P<.001), and positive psychological health (intervention: d=0.17, P=.001; active control: d=0.24, P<.001) at postassessment. However, there were no significant differences in effectiveness between the 2 groups (P ranged from .56 to .92). As hypothesized a priori, a greater number of days spent actively engaging with the conversational agent was associated with larger improvements in well-being at postassessment among participants in the intervention group (?=.109, P=.04). Conclusions: The findings from this study suggest that the free conversational agent wellness self-help program was as effective as evidence-based web resources. Further research should explore strategies to increase participant engagement over time, as only a portion of participants were actively involved, and higher engagement was linked to greater improvements in well-being. Long-term follow-up studies are also necessary to assess whether these effects remain stable over time. Trial Registration: ClinicalTrials.gov NCT06208566; https://clinicaltrials.gov/ct2/show/NCT06208566; OSF Registries osf.io/ahe2r; https://doi.org/10.17605/osf.io/ahe2r UR - https://www.jmir.org/2024/1/e53829 UR - http://dx.doi.org/10.2196/53829 UR - http://www.ncbi.nlm.nih.gov/pubmed/39641985 ID - info:doi/10.2196/53829 ER - TY - JOUR AU - Sussex, Jon AU - Atherton, Helen AU - Abel, Gary AU - Clark, Christopher AU - Cockcroft, Emma AU - Leach, Brandi AU - Marriott, Christine AU - Newbould, Jennifer AU - Pitchforth, Emma AU - Winder, Rachel AU - Campbell, John PY - 2024/12/4 TI - Supporting Patients? Use of Digital Services in Primary Health Care in England: Synthesis of Evidence From a Mixed Methods Study of ?Digital Facilitation? JO - JMIR Hum Factors SP - e52516 VL - 11 KW - web-based health services KW - primary care KW - digital facilitation KW - evidence synthesis KW - medical practitioners KW - digital services KW - digital intervention KW - mixed methods study KW - scoping review KW - ethnography N2 - Background: General medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined ?digital facilitation? as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services. Objective: We report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study?s objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions. Methods: Our study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package?s results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders. Results: Triangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them. Conclusions: Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions. UR - https://humanfactors.jmir.org/2024/1/e52516 UR - http://dx.doi.org/10.2196/52516 ID - info:doi/10.2196/52516 ER - TY - JOUR AU - Naudé, Bérangère AU - Rigaud, Anne-Sophie AU - Pino, Maribel PY - 2024/12/2 TI - Investigating the Acceptability of an Interactive Television Intervention Promoting Social Links Among Older Adults Living at Home and in Care Institutions: Qualitative Interview and Questionnaire Study JO - JMIR Hum Factors SP - e58051 VL - 11 KW - interactive television KW - iTV KW - acceptance KW - older adults KW - nursing home KW - residential facility KW - technology acceptance model KW - TAM KW - mobile phone N2 - Background: When older adults (OAs) can no longer live independently at home, they have the option to choose from various types of geriatric care institutions, such as residential facilities or nursing homes. For several years now, thanks to the development of interactive television (iTV), social link functions have been accessible directly on televisions, tools that are already integrated into residents? rooms. The acceptance of technologies specifically targeting older users, as well as iTV, has been widely documented in the literature, incorporating factors from the innovation resistance model. Objective: This research aims to enrich the acceptance of existing models of innovation by OAs living in different settings. Methods: User tests were carried out to evaluate OAs? experiences with iTV and identify the factors involved in its acceptance. A total of 32 OAs living at home, in nursing homes, or in residential facilities in France were interviewed between November 2022 and June 2023. iTV acceptance was examined using an interview grid based on the technology acceptance model and included the following factors: intention to use, perceived usefulness, perceived ease of use, user resistance, anxiety, facilitating conditions, and user characteristics. Results: The deductive qualitative analysis based on the technology acceptance model helped to identify 33 concepts. Conclusions: This study has contributed to the literature on the acceptance of iTV by OAs living at home and in geriatric institutions, particularly by enriching existing models and proposing new avenues for reflection. UR - https://humanfactors.jmir.org/2024/1/e58051 UR - http://dx.doi.org/10.2196/58051 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58051 ER - TY - JOUR AU - Härkönen, Henna AU - Myllykangas, Kirsi AU - Kärppä, Mikko AU - Rasmus, Maaria Kirsi AU - Gomes, Francis Julius AU - Immonen, Milla AU - Hyvämäki, Piia AU - Jansson, Miia PY - 2024/12/2 TI - Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study JO - J Med Internet Res SP - e52715 VL - 26 KW - cerebrovascular disease KW - stroke KW - digitalization KW - interventions KW - health care professional KW - client KW - patient KW - mHealth KW - mobile health KW - application KW - digital health KW - smartphones KW - health system KW - qualitative KW - descriptive study KW - brain KW - blood vessel disease KW - cerebrovascular disorder KW - Finland KW - interviews KW - efficiency KW - information KW - quality KW - accountability KW - neurology KW - neuroscience KW - brain injury KW - mobile phone N2 - Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. Objective: This study aims to identify opportunities for DHIs from clients? and health care professionals? perspectives to address health system challenges and improve CVD care. Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care. UR - https://www.jmir.org/2024/1/e52715 UR - http://dx.doi.org/10.2196/52715 UR - http://www.ncbi.nlm.nih.gov/pubmed/39622027 ID - info:doi/10.2196/52715 ER - TY - JOUR AU - Bermejo-Martínez, Gemma AU - Julián, Antonio José AU - Villanueva-Blasco, José Víctor AU - Aibar, Alberto AU - Corral-Abós, Ana AU - Abarca-Sos, Alberto AU - Generelo, Eduardo AU - Mur, Melania AU - Bueno, Manuel AU - Ferrer, Elisa AU - Artero, Isabel AU - García-González, Luis AU - Murillo-Pardo, Berta AU - Ferriz, Roberto AU - Menal-Puey, Susana AU - Marques-Lopes, Iva AU - Fajó-Pascual, Marta AU - Ibor-Bernalte, Eduardo AU - Zaragoza Casterad, Javier PY - 2024/11/20 TI - Development of a Web Platform to Facilitate the Implementation and Evaluation of Health Promoting Schools: Protocol for a Double Diamond Design Approach JO - JMIR Res Protoc SP - e52110 VL - 13 KW - web platform KW - health promoting schools KW - co-design process KW - Double Diamond Design Model KW - implementation processes. N2 - Background: Health Promoting Schools (HPS) have emerged as a powerful framework to promote healthy behaviors in many countries. However, HPS still present several challenges, highlighting the excessive workload involved in the accreditation, design, implementation, and evaluation processes. In this sense, a resource to facilitate the implementation processes may have a positive impact on the support of HPS. Objective: The aim of this study was to describe the co-design processes undertaken and resulting learnings to develop the Red Escuelas Promotoras de Salud (network of health promoting schools; REDEPS)-Gestion platform to facilitate the accreditation, design, implementation procedures, and evaluation processes of the Aragon's Health-Promoting School Network. Methods: The Double Diamond Design Approach was used to co-design this web-platform. The different stakeholders that participated in this co-design, progressed through a 4-stage reflective phase, to discover, define, develop, and deliver the REDEPS-Gestion platform. Results: Participants agreed that the functions of the REDEPS-Gestion platform should permit the management of both the educational centers and the administration such as accreditation processes, definition and review intervention projects, and preparation and review of the different progress reports to evaluate the HPS. Despite co-design being a well-established approach to creative practice, especially within the public sector, some challenges emerged during the co-design process, such as engaging and facilitating stakeholders? participation or the complexity of combining the interests of all stakeholders. This approach allowed us to identify the main barriers for future users and implement platform improvements. Conclusions: We hope that the REDEPS-Gestion platform will therefore be able to contribute to facilitating the implementation of HPS. The Double Diamond Design Approach used to co-design this web platform was an efficient and feasible methodological design approach. The REDEPS-Gestion platform will facilitate HPS implementation in Aragon as well as all the processes involving HPS. Future work will determine its effectiveness in improving HPS implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/52110 UR - https://www.researchprotocols.org/2024/1/e52110 UR - http://dx.doi.org/10.2196/52110 UR - http://www.ncbi.nlm.nih.gov/pubmed/39566054 ID - info:doi/10.2196/52110 ER - TY - JOUR AU - Belaid, Loubna AU - Sarmiento, Ivan AU - Dion, Anna AU - Rojas Cardenas, Andrés AU - Cockcroft, Anne AU - Andersson, Neil PY - 2024/11/18 TI - Factors Influencing Domestic Human Trafficking in Africa: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e56392 VL - 13 KW - domestic human trafficking KW - Africa KW - scoping review protocol KW - protocol KW - human trafficking KW - trafficking KW - modern slavery KW - human rights violation KW - discourse analysis KW - exploitation KW - fuzzy cognitive map N2 - Background: Human trafficking is a human rights violation in every region of the world. The African continent is not spared. Every year, millions of people experience significant health and social consequences. International organizations and governments combating human trafficking are hindered by a lack of knowledge about what factors influence domestic (within-country) human trafficking. Objective: This study aims to conduct a scoping review to collate and synthesize literature on factors influencing domestic trafficking in Africa. Methods: We will follow Arksey and O?Malley?s framework to answer the question about reported influences on domestic human trafficking and their relative weight. The search strategy will explore PubMed, CINAHL, Web of Science, and Scopus. A total of 2 independent researchers will select quantitative, qualitative, or mixed methods studies that examine relationships influencing domestic human trafficking. We will document our results by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We will extract a list of all reported relationships between identified factors influencing domestic human trafficking in each study. Based on a discourse analysis approach, we will weigh the strengths of the relationships based on how frequently they are reported across the included studies. We will summarize the findings as fuzzy cognitive maps depicting the relationships reported in the literature. The maps represent the influences between concepts (nodes) linked by arrows (edges) going from each cause to its outcomes. These maps are helpful visual summaries of the factors associated with domestic human trafficking, allowing a comparison with maps to be created by stakeholder groups. Results: This project received financial support in March 2023. We expect to start the project in March 2024. We recruited 2 research staff members to conduct the scoping review and expect to publish the results in March 2025. Conclusions: The review will provide a comprehensive understanding of factors influencing domestic human trafficking in Africa. The overlap of human trafficking with other forms of exploitation, the limited literature on domestic human trafficking, and the likely diversity of factors are challenges for the review. We propose strategies to address these challenges. International Registered Report Identifier (IRRID): PRR1-10.2196/56392 UR - https://www.researchprotocols.org/2024/1/e56392 UR - http://dx.doi.org/10.2196/56392 UR - http://www.ncbi.nlm.nih.gov/pubmed/39556420 ID - info:doi/10.2196/56392 ER - TY - JOUR AU - Bogale, Binyam AU - Vesinurm, Märt AU - Lillrank, Paul AU - Celius, Gulowsen Elisabeth AU - Halvorsrud, Ragnhild PY - 2024/11/15 TI - Visual Modeling Languages in Patient Pathways: Scoping Review JO - Interact J Med Res SP - e55865 VL - 13 KW - patient pathways KW - visual modeling languages KW - business process model and notation KW - BPMN KW - unified modeling language KW - UML KW - domain-specific modeling languages KW - scoping review N2 - Background: Patient pathways (PPs) are presented as a panacea solution to enhance health system functions. It is a complex concept that needs to be described and communicated well. Modeling plays a crucial role in promoting communication, fostering a shared understanding, and streamlining processes. Only a few existing systematic reviews have focused on modeling methods and standardized modeling languages. There remains a gap in consolidated knowledge regarding the use of diverse visual modeling languages. Objective: This scoping review aimed to compile visual modeling languages used to represent PPs, including the justifications and the context in which a modeling language was adopted, adapted, combined, or developed. Methods: After initial experimentation with the keywords used to describe the concepts of PPs and visual modeling languages, we developed a search strategy that was further refined and customized to the major databases identified as topically relevant. In addition, we consulted gray literature and conducted hand searches of the referenced articles. Two reviewers independently screened the articles in 2 stages using preset inclusion criteria, and a third reviewer voted on the discordance. Data charting was done using an iteratively developed form in the Covidence software. Descriptive and thematic summaries were presented following rounds of discussion to produce the final report. Results: Of 1838 articles retrieved after deduplication, 22 satisfied our inclusion criteria. Clinical pathway is the most used phrase to represent the PP concept, and most papers discussed the concept without providing their operational definition. We categorized the visual modeling languages into five categories: (1) general purpose?modeling language (GPML) adopted without major extension or modification, (2) GPML used with formal extension recommendations, (3) combination of 2 or more modeling languages, (4) a developed domain-specific modeling language (DSML), and (5) ontological modeling languages. The justifications for adopting, adapting, combining, and developing visual modeling languages varied accordingly and ranged from versatility, expressiveness, tool support, and extensibility of a language to domain needs, integration, and simplification. Conclusions: Various visual modeling languages were used in PP modeling, each with varying levels of abstraction and granularity. The categorization we made could aid in a better understanding of the complex combination of PP and modeling languages. Standardized GPMLs were used with or without any modifications. The rationale to propose any modification to GPMLs evolved as more evidence was presented following requirement analyses to support domain constructs. DSMLs are infrequently used due to their resource-intensive development, often initiated at a project level. The justifications provided and the context where DSMLs were created are paramount. Future studies should assess the merits and demerits of using a visual modeling language to facilitate PP communications among stakeholders and use evaluation frameworks to identify, modify, or develop them, depending on the scope and goal of the modeling need. UR - https://www.i-jmr.org/2024/1/e55865 UR - http://dx.doi.org/10.2196/55865 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55865 ER - TY - JOUR AU - de Vette, Frederiek AU - Ruiz-Rodriguez, Aurora AU - Tabak, Monique AU - Oude Nijeweme-d'Hollosy, Wendy AU - Hermens, Hermie AU - Vollenbroek-Hutten, Miriam PY - 2024/11/8 TI - Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process JO - JMIR Form Res SP - e13723 VL - 8 KW - game based KW - gamification KW - game KW - eHealth KW - telemedicine KW - development KW - design KW - engagement KW - game preferences KW - older adults KW - self-management KW - prototyping KW - evaluations KW - creative N2 - Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform?s training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game ?Stranded!? The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. UR - https://formative.jmir.org/2024/1/e13723 UR - http://dx.doi.org/10.2196/13723 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/13723 ER - TY - JOUR AU - Mozafari, Sogol AU - Yang, Alan AU - Talaei-Khoei, Jason PY - 2024/10/10 TI - Health Locus of Control and Medical Behavioral Interventions: Systematic Review and Recommendations JO - Interact J Med Res SP - e52287 VL - 13 KW - medical behavioral interventions KW - health locus of control KW - internal control KW - external control KW - patient behavior KW - synthesis KW - review methods KW - literature review KW - narrative review KW - behavior change N2 - Background: Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual?s likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions. Objective: This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC. Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared. Results: Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed. Conclusions: We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts. UR - https://www.i-jmr.org/2024/1/e52287 UR - http://dx.doi.org/10.2196/52287 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52287 ER - TY - JOUR AU - Iqbal, Meesha AU - Cazaban, Ganduglia Cecilia AU - Morgan, Robert AU - Bauer, Cici AU - Siddiqi, Sameen PY - 2024/9/18 TI - Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study JO - JMIR Res Protoc SP - e59836 VL - 13 KW - health system KW - healthcare system KW - health care KW - responsiveness KW - Pakistan KW - Low-and middle-income countries N2 - Background: Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. Objective: We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. Methods: The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ? will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an ?observation checklist? of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. Results: The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. Conclusions: This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. International Registered Report Identifier (IRRID): DERR1-10.2196/59836 UR - https://www.researchprotocols.org/2024/1/e59836 UR - http://dx.doi.org/10.2196/59836 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59836 ER - TY - JOUR AU - Mess, Veronica Elisabeth AU - Kramer, Frank AU - Krumme, Julia AU - Kanelakis, Nico AU - Teynor, Alexandra PY - 2024/9/13 TI - Use of Creative Frameworks in Health Care to Solve Data and Information Problems: Scoping Review JO - JMIR Hum Factors SP - e55182 VL - 11 KW - creative frameworks KW - data and information problems KW - data collection KW - data processing KW - data provision KW - health care KW - information visualization KW - interdisciplinary teams KW - user-centered design KW - user-centered data design KW - user-centric development N2 - Background: Digitization is vital for data management, especially in health care. However, problems still hinder health care stakeholders in their daily work while collecting, processing, and providing health data or information. Data are missing, incorrect, cannot be collected, or information is inadequately presented. These problems can be seen as data or information problems. A proven way to elicit requirements for (software) systems is by using creative frameworks (eg, user-centered design, design thinking, lean UX [user experience], or service design) or creative methods (eg, mind mapping, storyboarding, 6 thinking hats, or interaction room). However, to what extent they are used to solve data or information-related problems in health care is unclear. Objective: The primary objective of this scoping review is to investigate the use of creative frameworks in addressing data and information problems in health care. Methods: Following JBI guidelines and the PRISMA-ScR framework, this paper analyzes selected papers, answering whether creative frameworks addressed health care data or information problems. Focusing on data problems (elicitation or collection, processing) and information problems (provision or visualization), the review examined German and English papers published between 2018 and 2022 using keywords related to ?data,? ?design,? and ?user-centered.? The database SCOPUS was used. Results: Of the 898 query results, only 23 papers described a data or information problem and a creative method to solve it. These were included in the follow-up analysis and divided into different problem categories: data collection (n=7), data processing (n=1), information visualization (n=11), and mixed problems meaning data and information problem present (n=4). The analysis showed that most identified problems fall into the information visualization category. This could indicate that creative frameworks are particularly suitable for solving information or visualization problems and less for other, more abstract areas such as data problems. The results also showed that most researchers applied a creative framework after they knew what specific (data or information) problem they had (n=21). Only a minority chose a creative framework to identify a problem and realize it was a data or information problem (n=2). In response to these findings, the paper discusses the need for a new approach that addresses health care data and information challenges by promoting collaboration, iterative feedback, and user-centered development. Conclusions: Although the potential of creative frameworks is undisputed, applying these in solving data and information problems is a minority. To harness this potential, a suitable method needs to be developed to support health care system stakeholders. This method could be the User-Centered Data Approach. UR - https://humanfactors.jmir.org/2024/1/e55182 UR - http://dx.doi.org/10.2196/55182 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55182 ER - TY - JOUR AU - Lyles, Courtney AU - Berrean, Beth AU - Buenaventura, Ana AU - Milter, Svetlana AU - Hernandez, Daniel Dayana AU - Sarkar, Urmimala AU - Gutierrez, Christian AU - Palmer, Nynikka AU - Brown III, William PY - 2024/8/16 TI - Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study JO - JMIR Hum Factors SP - e53939 VL - 11 KW - mHealth KW - mobile health KW - eHealth KW - electronic health KW - application KW - digital health KW - digital ecosystem KW - informatics KW - community-based KW - community KW - co-design KW - human-centered design KW - community health KW - population health KW - technology KW - innovation KW - operations KW - social needs KW - health resources KW - qualitative analysis N2 - Background: Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective: We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods: Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results: Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled ?Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN),? was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions: Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs? needs, especially given the resources, training, and customization needed in these settings. UR - https://humanfactors.jmir.org/2024/1/e53939 UR - http://dx.doi.org/10.2196/53939 ID - info:doi/10.2196/53939 ER - TY - JOUR AU - Lukkien, M. Dirk R. AU - Ipakchian Askari, Sima AU - Stolwijk, E. Nathalie AU - Hofstede, M. Bob AU - Nap, Herman Henk AU - Boon, C. Wouter P. AU - Peine, Alexander AU - Moors, M. Ellen H. AU - Minkman, N. Mirella M. PY - 2024/7/31 TI - Making Co-Design More Responsible: Case Study on the Development of an AI-Based Decision Support System in Dementia Care JO - JMIR Hum Factors SP - e55961 VL - 11 KW - responsible innovation KW - co-design KW - ethics KW - decision support systems KW - gerontechnology KW - dementia KW - long-term care N2 - Background: Emerging technologies such as artificial intelligence (AI) require an early-stage assessment of potential societal and ethical implications to increase their acceptability, desirability, and sustainability. This paper explores and compares 2 of these assessment approaches: the responsible innovation (RI) framework originating from technology studies and the co-design approach originating from design studies. While the RI framework has been introduced to guide early-stage technology assessment through anticipation, inclusion, reflexivity, and responsiveness, co-design is a commonly accepted approach in the development of technologies to support the care for older adults with frailty. However, there is limited understanding about how co-design contributes to the anticipation of implications. Objective: This paper empirically explores how the co-design process of an AI-based decision support system (DSS) for dementia caregivers is complemented by explicit anticipation of implications. Methods: This case study investigated an international collaborative project that focused on the co-design, development, testing, and commercialization of a DSS that is intended to provide actionable information to formal caregivers of people with dementia. In parallel to the co-design process, an RI exploration took place, which involved examining project members? viewpoints on both positive and negative implications of using the DSS, along with strategies to address these implications. Results from the co-design process and RI exploration were analyzed and compared. In addition, retrospective interviews were held with project members to reflect on the co-design process and RI exploration. Results: Our results indicate that, when involved in exploring requirements for the DSS, co-design participants naturally raised various implications and conditions for responsible design and deployment: protecting privacy, preventing cognitive overload, providing transparency, empowering caregivers to be in control, safeguarding accuracy, and training users. However, when comparing the co-design results with insights from the RI exploration, we found limitations to the co-design results, for instance, regarding the specification, interrelatedness, and context dependency of implications and strategies to address implications. Conclusions: This case study shows that a co-design process that focuses on opportunities for innovation rather than balancing attention for both positive and negative implications may result in knowledge gaps related to social and ethical implications and how they can be addressed. In the pursuit of responsible outcomes, co-design facilitators could broaden their scope and reconsider the specific implementation of the process-oriented RI principles of anticipation and inclusion. UR - https://humanfactors.jmir.org/2024/1/e55961 UR - http://dx.doi.org/10.2196/55961 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55961 ER - TY - JOUR AU - Butler-Henderson, Kerryn AU - Gray, Kathleen AU - Arabi, Salma PY - 2024/7/25 TI - Roles and Responsibilities of the Global Specialist Digital Health Workforce: Analysis of Global Census Data JO - JMIR Med Educ SP - e54137 VL - 10 KW - workforce KW - functions KW - digital health KW - census KW - census data KW - workforce survey KW - survey KW - support KW - development KW - use KW - management KW - health data KW - health information KW - health knowledge KW - health technology KW - Australia KW - New Zealand KW - online content KW - digital data N2 - Background: The Global Specialist Digital Health Workforce Census is the largest workforce survey of the specialist roles that support the development, use, management, and governance of health data, health information, health knowledge, and health technology. Objective: This paper aims to present an analysis of the roles and functions reported by respondents in the 2023 census. Methods: The 2023 census was deployed using Qualtrics and was open from July 1 to August 13, 2023. A broad definition was provided to guide respondents about who is in the specialist digital health workforce. Anyone who self-identifies as being part of this workforce could undertake the survey. The data was analyzed using descriptive statistical analysis and thematic analysis of the functions respondents reported in their roles. Results: A total of 1103 respondents completed the census, with data reported about their demographic information and their roles. The majority of respondents lived in Australia (n=870, 78.9%) or New Zealand (n=130, 11.8%), with most (n=620, 56.3%) aged 35?54 years and identifying as female (n=720, 65.3%). The top four occupational specialties were health informatics (n=179, 20.2%), health information management (n=175, 19.8%), health information technology (n=128, 14.4%), and health librarianship (n=104, 11.7%). Nearly all (n=797, 90%) participants identified as a manager or professional. Less than half (430/1019, 42.2%) had a formal qualification in a specialist digital health area, and only one-quarter (244/938, 26%) held a credential in a digital health area. While two-thirds (502/763, 65.7%) reported undertaking professional development in the last year, most were self-directed activities, such as seeking information or consuming online content. Work undertaken by specialist digital health workers could be classified as either leadership, functional, occupational, or technological. Conclusions: Future specialist digital health workforce capability frameworks should include the aspects of leadership, function, occupation, and technology. This largely unqualified workforce is undertaking little formal professional development to upskill them to continue to support the safe delivery and management of health and care through the use of digital data and technology. UR - https://mededu.jmir.org/2024/1/e54137 UR - http://dx.doi.org/10.2196/54137 ID - info:doi/10.2196/54137 ER - TY - JOUR AU - Bolinger, Elaina AU - Tyl, Benoit PY - 2024/6/17 TI - Key Considerations for Designing Clinical Studies to Evaluate Digital Health Solutions JO - J Med Internet Res SP - e54518 VL - 26 KW - evidence generation KW - clinical robustness KW - clinical trials KW - digital health KW - solutions KW - digital health solutions KW - DHS KW - health care system KW - patients KW - patient KW - individuals KW - individual KW - healthcare system KW - control arm adaptations KW - randomization methods KW - real-world data KW - platform research UR - https://www.jmir.org/2024/1/e54518 UR - http://dx.doi.org/10.2196/54518 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885020 ID - info:doi/10.2196/54518 ER - TY - JOUR AU - Pienkowska, Anita AU - Ravaut, Mathieu AU - Mammadova, Maleyka AU - Ang, Chin-Siang AU - Wang, Hanyu AU - Ong, Chwen Qi AU - Bojic, Iva AU - Qin, Mengqi Vicky AU - Sumsuzzman, Md Dewan AU - Ajuebor, Onyema AU - Boniol, Mathieu AU - Bustamante, Paola Juana AU - Campbell, James AU - Cometto, Giorgio AU - Fitzpatrick, Siobhan AU - Kane, Catherine AU - Joty, Shafiq AU - Car, Josip PY - 2024/6/13 TI - Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis JO - JMIR Form Res SP - e53574 VL - 8 KW - World Health Organization KW - WHO KW - public surveillance KW - natural language processing KW - NLP KW - artificial intelligence KW - AI KW - COVID-19 KW - SARS-COV-2 KW - COVID-19 pandemic KW - human-generated analysis KW - decision-making KW - strategic policy KW - health workforce KW - news article KW - media content analysis KW - news coverage KW - health care worker KW - mental health KW - death risk KW - intervention KW - efficiency KW - public health KW - surveillance KW - innovation KW - innovative method N2 - Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19?related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic?s onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence?assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. UR - https://formative.jmir.org/2024/1/e53574 UR - http://dx.doi.org/10.2196/53574 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869940 ID - info:doi/10.2196/53574 ER - TY - JOUR AU - Salvi, Amey AU - Gillenwater, A. Logan AU - Cockrum, P. Brandon AU - Wiehe, E. Sarah AU - Christian, Kaitlyn AU - Cayton, John AU - Bailey, Timothy AU - Schwartz, Katherine AU - Dir, L. Allyson AU - Ray, Bradley AU - Aalsma, C. Matthew AU - Reda, Khairi PY - 2024/6/11 TI - Development of a Real-Time Dashboard for Overdose Touchpoints: User-Centered Design Approach JO - JMIR Hum Factors SP - e57239 VL - 11 KW - overdose prevention KW - dashboards KW - fatality review KW - data integration KW - visualizations KW - visualization KW - dashboard KW - fatality KW - death KW - overdose KW - overdoses KW - overdosing KW - prevention KW - develop KW - development KW - design KW - interview KW - interviews KW - focus group KW - focus groups KW - touchpoints KW - touchpoint KW - substance abuse KW - drug abuse N2 - Background: Overdose Fatality Review (OFR) is an important public health tool for shaping overdose prevention strategies in communities. However, OFR teams review only a few cases at a time, which typically represent a small fraction of the total fatalities in their jurisdiction. Such limited review could result in a partial understanding of local overdose patterns, leading to policy recommendations that do not fully address the broader community needs. Objective: This study explored the potential to enhance conventional OFRs with a data dashboard, incorporating visualizations of touchpoints?events that precede overdoses?to highlight prevention opportunities. Methods: We conducted 2 focus groups and a survey of OFR experts to characterize their information needs and design a real-time dashboard that tracks and measures decedents? past interactions with services in Indiana. Experts (N=27) were engaged, yielding insights on essential data features to incorporate and providing feedback to guide the development of visualizations. Results: The findings highlighted the importance of showing decedents? interactions with health services (emergency medical services) and the justice system (incarcerations). Emphasis was also placed on maintaining decedent anonymity, particularly in small communities, and the need for training OFR members in data interpretation. The developed dashboard summarizes key touchpoint metrics, including prevalence, interaction frequency, and time intervals between touchpoints and overdoses, with data viewable at the county and state levels. In an initial evaluation, the dashboard was well received for its comprehensive data coverage and its potential for enhancing OFR recommendations and case selection. Conclusions: The Indiana touchpoints dashboard is the first to display real-time visualizations that link administrative and overdose mortality data across the state. This resource equips local health officials and OFRs with timely, quantitative, and spatiotemporal insights into overdose risk factors in their communities, facilitating data-driven interventions and policy changes. However, fully integrating the dashboard into OFR practices will likely require training teams in data interpretation and decision-making. UR - https://humanfactors.jmir.org/2024/1/e57239 UR - http://dx.doi.org/10.2196/57239 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861717 ID - info:doi/10.2196/57239 ER - TY - JOUR AU - Weirauch, Vera AU - Soehnchen, Clarissa AU - Burmann, Anja AU - Meister, Sven PY - 2024/5/31 TI - Methods, Indicators, and End-User Involvement in the Evaluation of Digital Health Interventions for the Public: Scoping Review JO - J Med Internet Res SP - e55714 VL - 26 KW - digital health KW - digital health intervention KW - public end user KW - evaluation methods KW - evaluation criteria KW - end-user involvement KW - scoping review N2 - Background: Digital health interventions (DHIs) have the potential to enable public end users, such as citizens and patients, to manage and improve their health. Although the number of available DHIs is increasing, examples of successfully established DHIs in public health systems are limited. To counteract the nonuse of DHIs, they should be comprehensively evaluated while integrating end users. Unfortunately, there is a wide variability and heterogeneity according to the approaches of evaluation, which creates a methodological challenge. Objective: This scoping review aims to provide an overview of the current established processes for evaluating DHIs, including methods, indicators, and end-user involvement. The review is not limited to a specific medical field or type of DHI but offers a holistic overview. Methods: This scoping review was conducted following the JBI methodology for scoping reviews based on the framework by Arksey & O?Malley and complies with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Three scientific databases (PubMed, Scopus, and Science Direct) were searched in April 2023. English and German studies between 2008 and 2023 were considered when evaluating DHIs that explicitly address public end users. The process of study selection was carried out by several researchers to avoid reviewer bias. Results: The search strategy identified 9618 publications, of which 160 were included. Among these included articles, 200 evaluations were derived and analyzed. The results showed that there is neither a consensus on the methods to evaluate DHIs nor a commonly agreed definition or usage of the evaluated indicators, which results in a broad variety of evaluation practices. This aligns with observations of the existing literature. It was found that there is a lack of references to existing frameworks for the evaluation of DHIs. The majority of the included studies referred to user-centered approaches and involved end users in the evaluation process. As assistance for people developing and evaluating DHIs and as a basis for thinking about appropriate ways to evaluate DHIs, a results matrix was created where the findings were combined per DHI cluster. Additionally, general recommendations for the evaluators of DHIs were formulated. Conclusions: The findings of this scoping review offer a holistic overview of the variety and heterogeneity according to the approaches of evaluation of DHIs for public end users. Evaluators of these DHIs should be encouraged to reference established frameworks or measurements for justification. This would ease the transferability of the results among similar evaluation studies within the digital health sector, thereby enhancing the coherence and comparability of research in this area. UR - https://www.jmir.org/2024/1/e55714 UR - http://dx.doi.org/10.2196/55714 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819891 ID - info:doi/10.2196/55714 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 - Ray, Jessica AU - Finn, Benjamin Emily AU - Tyrrell, Hollyce AU - Aloe, F. Carlin AU - Perrin, M. Eliana AU - Wood, T. Charles AU - Miner, S. Dean AU - Grout, Randall AU - Michel, J. Jeremy AU - Damschroder, J. Laura AU - Sharifi, Mona PY - 2024/5/21 TI - User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies JO - J Med Internet Res SP - e51952 VL - 26 KW - user-centered design KW - implementation science KW - clinical decision support KW - human factors KW - implementation KW - decision support KW - develop KW - development KW - framework KW - frameworks KW - design KW - user-centered KW - digital health KW - health technology KW - health technologies KW - need KW - needs KW - tailor KW - tailoring KW - guidance KW - guideline KW - guidelines KW - pediatric KW - pediatrics KW - child KW - children KW - obese KW - obesity KW - weight KW - overweight KW - primary care N2 - Background: Electronic health record?based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. Trial Registration: ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011 UR - https://www.jmir.org/2024/1/e51952 UR - http://dx.doi.org/10.2196/51952 UR - http://www.ncbi.nlm.nih.gov/pubmed/38771622 ID - info:doi/10.2196/51952 ER - TY - JOUR AU - Tilahun, Naniye Kefyalew AU - Adem, Bashir Jibril AU - Atinafu, Temesgen Wabi AU - Walle, Damtew Agmasie AU - Mengestie, Demeke Nebyu AU - Birhanu, Yeneneh Abraham PY - 2024/5/10 TI - Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study JO - Online J Public Health Inform SP - e51601 VL - 16 KW - mobile-based partograph KW - mHealth KW - mobile health KW - cross-sectional KW - questionnaire KW - questionnaires KW - survey KW - surveys KW - modified TAM KW - technology acceptance model KW - intention to use KW - obstetric health care providers KW - Ethiopia KW - intent KW - intention KW - TAM KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - partograph KW - digital health KW - health technology KW - birth KW - women's health KW - obstetrics KW - obstetric KW - obstetric health care KW - labor monitoring N2 - Background: A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. Objective: The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. Methods: We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. Results: About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (?=.184; P=.02) and attitude (?=.521; P=.002). Perceived ease of use had a positive influence on attitude (?=.382; P=.003), perceived usefulness (?=.503; P=.002), and intention to use (?=.369; P=.001). Job relevance had a positive influence on perceived usefulness (?=.408; P=.001) and intention to use (?=.185; P=.008). Attitude positively influenced intention to use (?=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (?=.020; P=.61) and intention to use (?=?.066; P=.07). Conclusions: Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use. UR - https://ojphi.jmir.org/2024/1/e51601 UR - http://dx.doi.org/10.2196/51601 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728079 ID - info:doi/10.2196/51601 ER - TY - JOUR AU - Doan, Xengie AU - Rossi, Arianna AU - Botes, Marietjie AU - Selzer, Annika PY - 2024/4/30 TI - Comparing Attitudes Toward Different Consent Mediums: Semistructured Qualitative Study JO - JMIR Hum Factors SP - e53113 VL - 11 KW - consent KW - transparency KW - data governance KW - visualization KW - health data sharing N2 - Background: As consent for data sharing evolves with the digital age, plain-text consent is not the only format in which information can be presented. However, designing a good consent form is highly challenging. The addition of graphics, video, and other mediums to use can vary widely in effectiveness; and improper use can be detrimental to users. Objective: This study aims to explore the expectations and experiences of adults toward consent given in infographic, video, text, newsletter, and comic forms in a health data sharing scenario to better understand the appropriateness of different mediums and identify elements of each medium that most affect engagement with the content. Methods: We designed mock consent forms in infographic, video, text, newsletter, and comic versions. Semistructured interviews were conducted with adults who were interviewed about their expectations for consent and were then shown each consent medium and asked about engaging elements across mediums, preferences for consent mediums, and the value of document quality criteria. We transcribed and qualitatively co-coded to identify themes and perform analyses. Results: We interviewed 24 users and identified different thematic archetypes based on participant goals, such as the Trust Seeker, who considered their own understanding and trust in organizations when making decisions. The infographic was ranked first for enhancing understanding, prioritizing information, and maintaining the proper audience fit for serious consent in health data sharing scenarios. In addition, specific elements such as structure, step-by-step organization, and readability were preferred engaging elements. Conclusions: We identified archetypes to better understand user needs and elements that can be targeted to enhance user engagement with consent forms; this can help inform the design of more effective consent in the future. Overall, preferences for mediums are highly contextual, and more research should be done. UR - https://humanfactors.jmir.org/2024/1/e53113 UR - http://dx.doi.org/10.2196/53113 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687983 ID - info:doi/10.2196/53113 ER - TY - JOUR AU - Loriot, Amélie AU - Larceneux, Fabrice AU - Guillard, Valérie AU - Bertocchio, Jean-Philippe PY - 2024/4/26 TI - Patients? Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study JO - J Med Internet Res SP - e45702 VL - 26 KW - telehealth KW - teleconsultation KW - social representations KW - perceived proximity KW - semiotic square N2 - Background: In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions. Objective: We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients. Methods: This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology. Results: We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 ?paths? through which adherence to telehealth may improve. Conclusions: Our semiotic square illustrating patients? adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools. UR - https://www.jmir.org/2024/1/e45702 UR - http://dx.doi.org/10.2196/45702 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669676 ID - info:doi/10.2196/45702 ER - TY - JOUR AU - Hellstrand Tang, Ulla AU - Smith, Frida AU - Karilampi, Leyla Ulla AU - Gremyr, Andreas PY - 2024/4/26 TI - Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool JO - JMIR Hum Factors SP - e50889 VL - 11 KW - digital KW - bottom-up innovation KW - complexity KW - eHealth KW - health care KW - nonadoption, abandonment, scale-up, spread, and sustainability complexity assessment tool KW - NASSS-CAT KW - mobile phone N2 - Background: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. Objective: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. Methods: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. Results: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization?s readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization?s system and its setting. Conclusions: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations. UR - https://humanfactors.jmir.org/2024/1/e50889 UR - http://dx.doi.org/10.2196/50889 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669076 ID - info:doi/10.2196/50889 ER - TY - JOUR AU - Elkefi, Safa AU - Asan, Onur PY - 2024/4/24 TI - Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients JO - JMIR Hum Factors SP - e53053 VL - 11 KW - cancer KW - communication KW - trust KW - satisfaction KW - technology KW - workload KW - work system factors N2 - Background: Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. Objective: This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. Methods: This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. Results: We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). Conclusions: Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients? experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience. UR - https://humanfactors.jmir.org/2024/1/e53053 UR - http://dx.doi.org/10.2196/53053 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656776 ID - info:doi/10.2196/53053 ER - TY - JOUR AU - Tate, D. Allan AU - Fertig, R. Angela AU - de Brito, N. Junia AU - Ellis, M. Émilie AU - Carr, Patrick Christopher AU - Trofholz, Amanda AU - Berge, M. Jerica PY - 2024/4/24 TI - Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment JO - JMIR Form Res SP - e49512 VL - 8 KW - adherence KW - burden KW - data quality KW - ecological momentary assessment KW - mental health KW - mHealth KW - mobile health KW - participant adherence KW - public health KW - stress KW - study design KW - survey burden KW - survey N2 - Background: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. Objective: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. Methods: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question ?Overall, how difficult was it for you to fill out the surveys today?? on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. Results: The burden was low at 1.2 (SD 1.14) indicating ?a little? burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English?speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (?=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. Conclusions: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives. UR - https://formative.jmir.org/2024/1/e49512 UR - http://dx.doi.org/10.2196/49512 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656787 ID - info:doi/10.2196/49512 ER - TY - JOUR AU - Aggarwal, Monica AU - Hutchison, G. Brian AU - Kokorelias, M. Kristina AU - Ramsden, R. Vivian AU - Ivers, M. Noah AU - Pinto, Andrew AU - Uphsur, G. Ross E. AU - Wong, T. Sabrina AU - Pimlott, Nick AU - Slade, Steve PY - 2024/4/23 TI - The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review JO - JMIR Res Protoc SP - e55860 VL - 13 KW - research impact KW - primary health care KW - measurement KW - definition KW - concept KW - development KW - implementation KW - health policy KW - policy KW - health service KW - rapid review KW - review KW - research KW - policies KW - societal KW - productivity KW - literature database N2 - Background: The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. Objective: The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. Methods: The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. Results: The results of this study are expected at the end of 2024. Conclusions: The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. International Registered Report Identifier (IRRID): PRR1-10.2196/55860 UR - https://www.researchprotocols.org/2024/1/e55860 UR - http://dx.doi.org/10.2196/55860 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652900 ID - info:doi/10.2196/55860 ER - TY - JOUR AU - Hailemariam, Tesfahun AU - Atnafu, Asmamaw AU - Gezie, Lemma AU - Kaasbøll, Jens AU - Klein, Jorn AU - Tilahun, Binyam PY - 2024/3/4 TI - Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model JO - JMIR Hum Factors SP - e47081 VL - 11 KW - data capturing KW - data use KW - eCHIS KW - electronic community health information system KW - health extension worker KW - HEW KW - intention to use KW - service provision KW - Unified Theory of Acceptance and Use of Technology 2 KW - UTAUT2 model N2 - Background: IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. Objective: This study aimed to assess HEWs? intentions to use the eCHIS for health data management and service provision. Methods: A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs? intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. Results: A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (?=0.256; P=.007), self-expectancy (?=0.096; P=.04), social influence (?=0.203; P=.02), and hedonic motivation (?=0.217; P=.03) were significantly associated with HEWs? intention to use the eCHIS. Conclusions: HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management. UR - https://humanfactors.jmir.org/2024/1/e47081 UR - http://dx.doi.org/10.2196/47081 UR - http://www.ncbi.nlm.nih.gov/pubmed/38437008 ID - info:doi/10.2196/47081 ER - TY - JOUR AU - Le Roy, Barbara AU - Martin-Krumm, Charles AU - Poupon, Charlotte AU - Richieri, Raphaëlle AU - Malbos, Eric AU - Barthélémy, Fanny AU - Guedj, Eric AU - Trousselard, Marion PY - 2024/1/22 TI - Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population JO - JMIR Form Res SP - e45637 VL - 8 KW - countermeasures KW - mental health KW - physical activity KW - virtual reality KW - user experience N2 - Background: Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system). Objective: This study aims to investigate the impact of physical exercise in a VR environment. Methods: A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence). Results: First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality?stimulation=1.90; hedonic quality?identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04). Conclusions: These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine. UR - https://formative.jmir.org/2024/1/e45637 UR - http://dx.doi.org/10.2196/45637 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252484 ID - info:doi/10.2196/45637 ER - TY - JOUR AU - Tang, Chia-Chun AU - Chen, Hsi AU - Tsai, Shao-Yu AU - Wu, Wei-Wen PY - 2023/12/19 TI - Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model JO - JMIR Hum Factors SP - e49687 VL - 10 KW - infectious disease KW - protective behavior KW - COVID KW - health belief model KW - causal comparative KW - causal KW - protective KW - prevention KW - opinion KW - opinions KW - attitude KW - attitudes KW - COVID-19 KW - pandemic KW - infection control KW - public safety KW - public health KW - survey KW - surveys N2 - Background: While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors. Objective: This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic. Methods: This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals? protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants? various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used. Results: A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants? sex, residency, perceived barriers, self-efficacy, and cues of action. Conclusions: This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement. UR - https://humanfactors.jmir.org/2023/1/e49687 UR - http://dx.doi.org/10.2196/49687 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49687 ER - TY - JOUR AU - López Seguí, Francesc AU - Cos Codina, Joan AU - Ricou Ríos, Laura AU - Martínez Segura, Isabel María AU - Miró Mezquita, Laura AU - Escrich Navarro, Raquel AU - Davins Riu, Meritxell AU - Estrada Cuxart, Oriol AU - Anashkin Kachalin, German AU - Moreno-Martínez, Daniel PY - 2023/10/6 TI - Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study JO - JMIR Hum Factors SP - e47390 VL - 10 KW - change management KW - normalization process theory KW - NPT KW - 3D printing KW - readiness for change KW - Normalization Measure Development questionnaire KW - NoMAD KW - implementation KW - tertiary hospital KW - barrier KW - readiness KW - printing KW - survey KW - development KW - questionnaire KW - support KW - communicate KW - assessment KW - users KW - transformation N2 - Background: The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. Objective: This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. Methods: We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. Results: In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. Conclusions: The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation. UR - https://humanfactors.jmir.org/2023/1/e47390 UR - http://dx.doi.org/10.2196/47390 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801353 ID - info:doi/10.2196/47390 ER - TY - JOUR AU - Xiao, Jin AU - Kopycka-Kedzierawski, Dorota AU - Ragusa, Patricia AU - Mendez Chagoya, Alberto Luis AU - Funkhouser, Kimberly AU - Lischka, Tamara AU - Wu, Tong Tong AU - Fiscella, Kevin AU - Kar, Saswati Kumari AU - Al Jallad, Nisreen AU - Rashwan, Noha AU - Ren, Johana AU - Meyerowitz, Cyril AU - PY - 2023/8/18 TI - Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study JO - JMIR Hum Factors SP - e45418 VL - 10 KW - teledentistry KW - mDentistry KW - oral diseases KW - virtual visit KW - intraoral camera KW - COVID-19 KW - pandemic response KW - mobile phone N2 - Background: Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP). Objective: This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic. Methods: This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model. Results: A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos. Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients? conditions. Conclusions: The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health?promoting behaviors. UR - https://humanfactors.jmir.org/2023/1/e45418 UR - http://dx.doi.org/10.2196/45418 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594795 ID - info:doi/10.2196/45418 ER - TY - JOUR AU - van Kessel, Robin AU - Roman-Urrestarazu, Andres AU - Anderson, Michael AU - Kyriopoulos, Ilias AU - Field, Samantha AU - Monti, Giovanni AU - Reed, D. Shelby AU - Pavlova, Milena AU - Wharton, George AU - Mossialos, Elias PY - 2023/7/25 TI - Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review JO - J Med Internet Res SP - e48000 VL - 25 KW - digital health KW - uptake KW - implementation KW - adoption KW - framework KW - digital therapeutics KW - scoping review KW - thematic analysis KW - digital medicine KW - policy N2 - Background: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. Objective: In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. Methods: A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. Results: We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. Conclusions: The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system?s readiness for digital therapeutics. UR - https://www.jmir.org/2023/1/e48000 UR - http://dx.doi.org/10.2196/48000 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490322 ID - info:doi/10.2196/48000 ER - TY - JOUR AU - Johansen, Kristoffer Simon AU - Kanstrup, Marie Anne AU - Haseli, Kian AU - Stenmo, Hildebrandt Visti AU - Thomsen, Laust Janus AU - Rathleff, Skovdal Michael PY - 2023/4/28 TI - Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study JO - JMIR Hum Factors SP - e44462 VL - 10 KW - mobile health KW - mHealth KW - design KW - patient physician relationship KW - collaborative care KW - shared decision-making KW - adolescents KW - parents KW - knee pain KW - patellofemoral pain KW - Osgood Schlatter KW - musculoskeletal KW - general practice KW - primary care KW - mobile phone N2 - Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents? self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents? knee pain in a general practice setting. Objective: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents? everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. Methods: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. Results: Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants? roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. Conclusions: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. UR - https://humanfactors.jmir.org/2023/1/e44462 UR - http://dx.doi.org/10.2196/44462 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115609 ID - info:doi/10.2196/44462 ER - TY - JOUR AU - Jacob, Christine AU - Lindeque, Johan AU - Klein, Alexander AU - Ivory, Chris AU - Heuss, Sabina AU - Peter, K. Marc PY - 2023/3/23 TI - Assessing the Quality and Impact of eHealth Tools: Systematic Literature Review and Narrative Synthesis JO - JMIR Hum Factors SP - e45143 VL - 10 KW - eHealth KW - mobile health KW - mHealth KW - digital health KW - technology assessment KW - technology adoption KW - technology implementation N2 - Background: Technological advancements have opened the path for many technology providers to easily develop and introduce eHealth tools to the public. The use of these tools is increasingly recognized as a critical quality driver in health care; however, choosing a quality tool from the myriad of tools available for a specific health need does not come without challenges. Objective: This review aimed to systematically investigate the literature to understand the different approaches and criteria used to assess the quality and impact of eHealth tools by considering sociotechnical factors (from technical, social, and organizational perspectives). Methods: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the PubMed, Cochrane, Web of Science, Scopus, and ProQuest databases for studies published between January 2012 and January 2022 in English, which yielded 675 results, of which 40 (5.9%) studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with a thematic analysis and narrative synthesis of emergent themes. Results: Similar measures from the different papers, frameworks, and initiatives were aggregated into 36 unique criteria grouped into 13 clusters. Using the sociotechnical approach, we classified the relevant criteria into technical, social, and organizational assessment criteria. Technical assessment criteria were grouped into 5 clusters: technical aspects, functionality, content, data management, and design. Social assessment criteria were grouped into 4 clusters: human centricity, health outcomes, visible popularity metrics, and social aspects. Organizational assessment criteria were grouped into 4 clusters: sustainability and scalability, health care organization, health care context, and developer. Conclusions: This review builds on the growing body of research that investigates the criteria used to assess the quality and impact of eHealth tools and highlights the complexity and challenges facing these initiatives. It demonstrates that there is no single framework that is used uniformly to assess the quality and impact of eHealth tools. It also highlights the need for a more comprehensive approach that balances the social, organizational, and technical assessment criteria in a way that reflects the complexity and interdependence of the health care ecosystem and is aligned with the factors affecting users? adoption to ensure uptake and adherence in the long term. UR - https://humanfactors.jmir.org/2023/1/e45143 UR - http://dx.doi.org/10.2196/45143 UR - http://www.ncbi.nlm.nih.gov/pubmed/36843321 ID - info:doi/10.2196/45143 ER - TY - JOUR AU - Fossouo Tagne, Joel AU - Yakob, Amin Reginald AU - Mcdonald, Rachael AU - Wickramasinghe, Nilmini PY - 2023/2/24 TI - Linking Activity Theory Within User-Centered Design: Novel Framework to Inform Design and Evaluation of Adverse Drug Reaction Reporting Systems in Pharmacy JO - JMIR Hum Factors SP - e43529 VL - 10 KW - pharmacovigilance KW - adverse drug reaction KW - pharmacist KW - user-centered design KW - activity theory N2 - Background: Adverse drug reactions (ADRs) may cause serious injuries including death. Timely reporting of ADRs may play a significant role in patient safety; however, underreporting exists. Enhancing the electronic communication of ADR information to regulators and between health care providers has the potential to reduce recurrent ADRs and improve patient safety. Objective: The main objectives were to explore the low rate of ADR reporting by community pharmacists (CPs) in Australia, evaluate the usability of an existing reporting system, and how this knowledge may influence the design of subsequent electronic ADR reporting systems. Methods: The study was carried out in 2 stages. Stage 1 involved qualitative semistructured interviews to identify CPs? perceived barriers and facilitators to ADR reporting. Data were analyzed by thematic analysis, and identified themes were subsequently aligned to the task-technology fit (TTF) framework. The second stage involved a usability evaluation of a commercial web-based ADR reporting system. A structured interview protocol that combined virtual observation, think-aloud moderating techniques, retrospective questioning of the overall user experience, and a System Usability Scale (SUS). The field notes from the interviews were subjected to thematic analysis. Results: In total, 12 CPs were interviewed in stage 1, and 7 CPs participated in stage 2. The interview findings show that CPs are willing to report ADRs but face barriers from environmental, organizational, and IT infrastructures. Increasing ADR awareness, improving workplace practices, and implementing user-focused electronic reporting systems were seen as facilitators of ADR reporting. User testing of an existing system resulted in above average usability (SUS 68.57); however, functional and user interpretation issues were identified. Design elements such as a drop-down menu, free-text entry, checkbox, and prefilled data fields were perceived to be extremely useful for navigating the system and facilitating ADR reporting. Conclusions: Existing reporting systems are not suited to report ADRs, or adapted to workflow, and are rarely used by CPs. Our study uncovered important contextual information for the design of future ADR reporting interventions. Based on our study, a multifaceted, theory-guided, user-centered, and best practice approach to design, implementation, and evaluation may be critical for the successful adoption of ADR reporting electronic interventions and patient safety. Future studies are needed to evaluate the effectiveness of theory-driven frameworks used in the design and implementation of ADR reporting systems. UR - https://humanfactors.jmir.org/2023/1/e43529 UR - http://dx.doi.org/10.2196/43529 UR - http://www.ncbi.nlm.nih.gov/pubmed/36826985 ID - info:doi/10.2196/43529 ER - TY - JOUR AU - Nes, Gonçalves Andréa Aparecida AU - Zlamal, Jaroslav AU - Linnerud, Wang Silje Christin AU - Steindal, A. Simen AU - Solberg, Trygg Marianne PY - 2023/2/3 TI - A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype JO - JMIR Hum Factors SP - e44101 VL - 10 KW - clinical practice KW - guidance application model KW - nursing students KW - constructive alignment KW - metacognition KW - technological tool KW - nursing KW - nursing profession KW - application KW - mobile health, eHealth KW - educator KW - communication N2 - Background: The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students? clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice. Objective: We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice. Methods: This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing. Results: This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application?s name and logo, technical architecture, guidance and assessment module, and security and privacy. Conclusions: This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies. UR - https://humanfactors.jmir.org/2023/1/e44101 UR - http://dx.doi.org/10.2196/44101 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735289 ID - info:doi/10.2196/44101 ER - TY - JOUR AU - Thérouanne, Pierre AU - Hayotte, Meggy AU - Halgand, Florent AU - d'Arripe-Longueville, Fabienne PY - 2023/1/23 TI - The Acceptability of Technology-Based Physical Activity Interventions in Postbariatric Surgery Women: Insights From Qualitative Analysis Using the Unified Theory of Acceptance and Use of Technology 2 Model JO - JMIR Hum Factors SP - e42178 VL - 10 KW - acceptability KW - health technology KW - physical activity KW - obesity KW - UTAUT2 N2 - Background: Bariatric surgery offers an opportunity for physical activity (PA) promotion due to patients? increased ability to engage in PA. Technology-based PA interventions are promising tools for promoting PA to support patients in this key period. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model is a recognized theoretical model for examining technology acceptability. Although a previous study reported that 92% of women with obesity have high acceptability of at least one technology-based PA intervention, little is known about the factors that lead to different levels of acceptability between technologies and therefore the reasons for choosing a preferred intervention. Objective: The purpose of this study was to (1) characterize the acceptability of 3 technology-based PA interventions (ie, telehealth, active video game, mobile app) in the context of bariatric surgery, and (2) explore patients? preference motives. This study, using a qualitative design, examined the suitability of the UTAUT2 model in this specific context. Methods: Participants (n=26) read written French descriptions of the technology-based PA interventions with illustrations and chose their preferred intervention. Semidirective interviews were conducted to explore the reasons for their choice of the preferred intervention, notably using the UTAUT2 framework. Data were analyzed based on inductive and deductive approaches. Results: All participants who preferred a technology-based PA intervention (ie, active video game, n=10; mobile app, n=10; telehealth, n=6) expressed a behavioral intention to use it. In addition, some of them expressed a high behavioral intention to use another technology (ie, active video game, n=4; mobile app, n=1; telehealth, n=7). All the constructs of the UTAUT2 emerged during the qualitative interviews and were specified through subcategories. Additional constructs also emerged, especially other motivational factors. Conclusions: This study showed that, in the context of technology-based PA interventions for postbariatric patients, the UTAUT2 is suitable, although additional motivational factors (which were not considered by the UTAUT2 model) should be considered. UR - https://humanfactors.jmir.org/2023/1/e42178 UR - http://dx.doi.org/10.2196/42178 UR - http://www.ncbi.nlm.nih.gov/pubmed/36689255 ID - info:doi/10.2196/42178 ER - TY - JOUR AU - Shan, Yi AU - Ji, Meng AU - Xie, Wenxiu AU - Lam, Kam-Yiu AU - Chow, Chi-Yin PY - 2022/12/2 TI - Public Trust in Artificial Intelligence Applications in Mental Health Care: Topic Modeling Analysis JO - JMIR Hum Factors SP - e38799 VL - 9 IS - 4 KW - public trust KW - public opinion KW - AI application KW - artificial intelligence KW - mental health care KW - topic modeling KW - topic KW - theme KW - term KW - visualization KW - user feedback KW - user review KW - Google Play KW - health app: mHealth KW - mobile health KW - digital health KW - eHealth KW - mental health KW - mental illness KW - mental disorder N2 - Background: Mental disorders (MDs) impose heavy burdens on health care (HC) systems and affect a growing number of people worldwide. The use of mobile health (mHealth) apps empowered by artificial intelligence (AI) is increasingly being resorted to as a possible solution. Objective: This study adopted a topic modeling (TM) approach to investigate the public trust in AI apps in mental health care (MHC) by identifying the dominant topics and themes in user reviews of the 8 most relevant mental health (MH) apps with the largest numbers of reviewers. Methods: We searched Google Play for the top MH apps with the largest numbers of reviewers, from which we selected the most relevant apps. Subsequently, we extracted data from user reviews posted from January 1, 2020, to April 2, 2022. After cleaning the extracted data using the Python text processing tool spaCy, we ascertained the optimal number of topics, drawing on the coherence scores and used latent Dirichlet allocation (LDA) TM to generate the most salient topics and related terms. We then classified the ascertained topics into different theme categories by plotting them onto a 2D plane via multidimensional scaling using the pyLDAvis visualization tool. Finally, we analyzed these topics and themes qualitatively to better understand the status of public trust in AI apps in MHC. Results: From the top 20 MH apps with the largest numbers of reviewers retrieved, we chose the 8 (40%) most relevant apps: (1) Wysa: Anxiety Therapy Chatbot; (2) Youper Therapy; (3) MindDoc: Your Companion; (4) TalkLife for Anxiety, Depression & Stress; (5) 7 Cups: Online Therapy for Mental Health & Anxiety; (6) BetterHelp-Therapy; (7) Sanvello; and (8) InnerHour. These apps provided 14.2% (n=559), 11.0% (n=431), 13.7% (n=538), 8.8% (n=356), 14.1% (n=554), 11.9% (n=468), 9.2% (n=362), and 16.9% (n=663) of the collected 3931 reviews, respectively. The 4 dominant topics were topic 4 (cheering people up; n=1069, 27%), topic 3 (calming people down; n=1029, 26%), topic 2 (helping figure out the inner world; n=963, 25%), and topic 1 (being an alternative or complement to a therapist; n=870, 22%). Based on topic coherence and intertopic distance, topics 3 and 4 were combined into theme 3 (dispelling negative emotions), while topics 2 and 1 remained 2 separate themes: theme 2 (helping figure out the inner world) and theme 1 (being an alternative or complement to a therapist), respectively. These themes and topics, though involving some dissenting voices, reflected an overall high status of trust in AI apps. Conclusions: This is the first study to investigate the public trust in AI apps in MHC from the perspective of user reviews using the TM technique. The automatic text analysis and complementary manual interpretation of the collected data allowed us to discover the dominant topics hidden in a data set and categorize these topics into different themes to reveal an overall high degree of public trust. The dissenting voices from users, though only a few, can serve as indicators for health providers and app developers to jointly improve these apps, which will ultimately facilitate the treatment of prevalent MDs and alleviate the overburdened HC systems worldwide. UR - https://humanfactors.jmir.org/2022/4/e38799 UR - http://dx.doi.org/10.2196/38799 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459412 ID - info:doi/10.2196/38799 ER - TY - JOUR AU - Tennant, Ryan AU - Tetui, Moses AU - Grindrod, Kelly AU - Burns, M. Catherine PY - 2022/11/10 TI - Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study JO - JMIR Hum Factors SP - e39670 VL - 9 IS - 4 KW - cognitive work analysis KW - contextual design KW - COVID-19 KW - decision making KW - health care system KW - pandemic KW - vaccination clinics KW - workplace stress N2 - Background: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. Objective: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. Methods: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. Results: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. Conclusions: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making. UR - https://humanfactors.jmir.org/2022/4/e39670 UR - http://dx.doi.org/10.2196/39670 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219839 ID - info:doi/10.2196/39670 ER - TY - JOUR AU - Nunes, Nuno AU - Adamo, Greta AU - Ribeiro, Miguel AU - R Gouveia, Bruna AU - Rubio Gouveia, Elvio AU - Teixeira, Pedro AU - Nisi, Valentina PY - 2022/9/14 TI - Modeling Adoption, Security, and Privacy of COVID-19 Apps: Findings and Recommendations From an Empirical Study Using the Unified Theory of Acceptance and Use of Technology JO - JMIR Hum Factors SP - e35434 VL - 9 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - UTAUT KW - empirical study KW - structural equation modeling KW - confirmatory factor analysis KW - security KW - privacy KW - global health KW - technology solution KW - research model KW - technology acceptance KW - digital health KW - mobile health N2 - Background: The global health crisis caused by COVID-19 has drastically changed human society in a relatively short time. However, this crisis has offered insights into the different roles that such a worldwide virus plays in the lives of people and how those have been affected, as well as eventually proposing new solutions. From the beginning of the pandemic, technology solutions have featured prominently in virus control and in the frame of reference for international travel, especially contact tracing and passenger locator applications. Objective: The objective of this paper is to study specific areas of technology acceptance and adoption following a unified theory of acceptance and use of technology (UTAUT) research model. Methods: We presented a research model based on UTAUT constructs to study the determinants for adoption of COVID-19?related apps using a questionnaire. We tested the model via confirmatory factor analysis (CFA) and structural equation modeling (SEM) using travelers? data from an insular tourist region. Results: Our model explained 90.3% of the intention to use (N=9555) and showed an increased understanding of the vital role of safety, security, privacy, and trust in the usage intention of safety apps. Results also showed how the impact of COVID-19 is not a strong predictor of adoption, while age, education level, and social capital are essential moderators of behavioral intention. Conclusions: In terms of scientific impact, the results described here provide important insights and contributions not only for researchers but also for policy and decision makers by explaining the reasons behind the adoption and usage of apps designed for COVID-19. UR - https://humanfactors.jmir.org/2022/3/e35434 UR - http://dx.doi.org/10.2196/35434 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862671 ID - info:doi/10.2196/35434 ER - TY - JOUR AU - Shuldiner, Jennifer AU - Srinivasan, Diya AU - Hall, N. Justin AU - May, R. Carl AU - Desveaux, Laura PY - 2022/9/12 TI - Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory JO - JMIR Hum Factors SP - e39430 VL - 9 IS - 3 KW - virtual care KW - emergency department KW - Normalization Process Theory N2 - Background: COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care?s potential role remains unclear in the urgent care setting. In December 2020, the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health Sciences Centre by connecting patients to emergency physicians through an online portal. Objective: This study aims to understand whether and how ED physicians were able to integrate a virtual ED alongside in-person operations. Methods: We conducted semistructured interviews with ED physicians guided by the Normalization Process Theory (NPT). The NPT provides a framework to understand how individuals and teams navigate the process of embedding new models of care as part of normal practice. All physicians who had worked within the virtual ED model were invited to participate. Data were analyzed using a combination of inductive and deductive techniques informed by the NPT. Results: A total of 14 physicians were interviewed. Participant experiences were categorized into 1 of 2 groups: 1 group moved to normalize the virtual ED in practice, while the other described barriers to routine adoption. These groups differed in their perception of the patient benefits as well as the perceived role in the virtual ED. The group that normalized the virtual ED model saw value for patients (coherence) and was motivated by patient satisfaction witnessed (reflexive monitoring) at the end of the virtual appointment. By contrast, the other group did not find virtual ED work reflective of the perceived role of urgent care (cognitive participation) and felt their skills as ED physicians were underutilized. The limited ability to examine patients and a sense that patient issues were not fully resolved at the end of the virtual appointment caused frustration among the second group. Conclusions: As further digital integration within the health care system occurs, it will be essential to support the evolution of staff skill sets to ensure physicians are satisfied with the care they are providing to their patients, while also ensuring the technology and process are efficient. UR - https://humanfactors.jmir.org/2022/3/e39430 UR - http://dx.doi.org/10.2196/39430 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094801 ID - info:doi/10.2196/39430 ER - TY - JOUR AU - Duffy, Anthony AU - Christie, J. Gregory AU - Moreno, Sylvain PY - 2022/9/9 TI - The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review JO - JMIR Hum Factors SP - e35693 VL - 9 IS - 3 KW - digital health KW - end users KW - user experience KW - health behavior KW - intervention KW - co-design KW - mobile health KW - mobile phone N2 - Background: Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective: In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods: A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as ?digital health design,? ?mHealth design,? ?e-Health design,? ?agile health,? and ?agile healthcare.? The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results: A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions: Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos. UR - https://humanfactors.jmir.org/2022/3/e35693 UR - http://dx.doi.org/10.2196/35693 UR - http://www.ncbi.nlm.nih.gov/pubmed/36083628 ID - info:doi/10.2196/35693 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 - Ye, Jiancheng AU - Woods, Donna AU - Bannon, Jennifer AU - Bilaver, Lucy AU - Kricke, Gayle AU - McHugh, Megan AU - Kho, Abel AU - Walunas, Theresa PY - 2022/6/24 TI - Identifying Contextual Factors and Strategies for Practice Facilitation in Primary Care Quality Improvement Using an Informatics-Driven Model: Framework Development and Mixed Methods Case Study JO - JMIR Hum Factors SP - e32174 VL - 9 IS - 2 KW - quality improvement KW - practice facilitation KW - primary care KW - mixed-methods KW - practice facilitator KW - informatics KW - electronic health record KW - implementation science KW - implementation KW - challenge KW - strategy KW - framework KW - perspective N2 - Background: The past decade has seen increasing opportunities and efforts to integrate quality improvement into health care. Practice facilitation is a proven strategy to support redesign and improvement in primary care practices that focuses on building organizational capacity for continuous improvement. Practice leadership, staff, and practice facilitators all play important roles in supporting quality improvement in primary care. However, little is known about their perspectives on the context, enablers, barriers, and strategies that impact quality improvement initiatives. Objective: This study aimed to develop a framework to enable assessment of contextual factors, challenges, and strategies that impact practice facilitation, clinical measure performance, and the implementation of quality improvement interventions. We also illustrated the application of the framework using a real-world case study. Methods: We developed the TITO (task, individual, technology, and organization) framework by conducting participatory stakeholder workshops and incorporating their perspectives to identify enablers and barriers to quality improvement and practice facilitation. We conducted a case study using a mixed methods approach to demonstrate the use of the framework and describe practice facilitation and factors that impact quality improvement in a primary care practice that participated in the Healthy Hearts in the Heartland study. Results: The proposed framework was used to organize and analyze different stakeholders? perspectives and key factors based on framework domains. The case study showed that practice leaders, staff, and practice facilitators all influenced the success of the quality improvement program. However, these participants faced different challenges and used different strategies. The framework showed that barriers stemmed from patients? social determinants of health, a lack of staff and time, and unsystematic facilitation resources, while enablers included practice culture, staff buy-in, implementation of effective practice facilitation strategies, practice capacity for change, and shared complementary resources from similar, ongoing programs. Conclusions: Our framework provided a useful and generalizable structure to guide and support assessment of future practice facilitation projects, quality improvement initiatives, and health care intervention implementation studies. The practice leader, staff, and practice facilitator all saw value in the quality improvement program and practice facilitation. Practice facilitators are key liaisons to help the quality improvement program; they help all stakeholders work toward a shared target and leverage tailored strategies. Taking advantage of resources from competing, yet complementary, programs as additional support may accelerate the effective achievement of quality improvement goals. Practice facilitation?supported quality improvement programs may be opportunities to assist primary care practices in achieving improved quality of care through focused and targeted efforts. The case study demonstrated how our framework can support a better understanding of contextual factors for practice facilitation, which could enable well-prepared and more successful quality improvement programs for primary care practices. Combining implementation science and informatics thinking, our TITO framework may facilitate interdisciplinary research in both fields. UR - https://humanfactors.jmir.org/2022/2/e32174 UR - http://dx.doi.org/10.2196/32174 UR - http://www.ncbi.nlm.nih.gov/pubmed/35749211 ID - info:doi/10.2196/32174 ER - TY - JOUR AU - Sousa, Sonia AU - Kalju, Tiina PY - 2022/6/13 TI - Modeling Trust in COVID-19 Contact-Tracing Apps Using the Human-Computer Trust Scale: Online Survey Study JO - JMIR Hum Factors SP - e33951 VL - 9 IS - 2 KW - human-computer interaction KW - COVID-19 KW - human factors KW - trustworthy AI KW - contact-tracing KW - app KW - safety KW - trust KW - artificial intelligence KW - Estonia KW - case study KW - monitoring KW - surveillance KW - perspective KW - awareness KW - design KW - covid KW - mobile app KW - mHealth KW - mobile health N2 - Background: The COVID-19 pandemic has caused changes in technology use worldwide, both socially and economically. This pandemic crisis has brought additional measures such as contact-tracing apps (CTAs) to help fight against spread of the virus. Unfortunately, the low adoption rate of these apps affected their success. There could be many reasons for the low adoption, including concerns of security and privacy, along with reported issues of trust in CTAs. Some concerns are related with how CTAs could be used as surveillance tools or their potential threats to privacy as they involve health data. For example, in Estonia, the CTA named HOIA had approximately 250,000 downloads in the middle of January 2021. However, in 2021, only 4.7% of the population used HOIA as a COVID-19 CTA. The reasons for the low adoption include lack of competency, and privacy and security concerns. This lower adoption and the lack of trustworthiness persist despite efforts of the European Union in building ethics and trustworthy artificial intelligence (AI)-based apps. Objective: The aim of this study was to understand how to measure trust in health technologies. Specifically, we assessed the usefulness of the Human-Computer Trust Scale (HCTS) to measure Estonians? trust in the HOIA app and the causes for this lack of trust. Methods: The main research question was: Can the HCTS be used to assess citizens? perception of trust in health technologies? We established four hypotheses that were tested with a survey. We used a convenience sample for data collection, including sharing the questionnaire on social network sites and using the snowball method to reach all potential HOIA users in the Estonian population. Results: Among the 78 respondents, 61 had downloaded the HOIA app with data on usage patterns. However, 20 of those who downloaded the app admitted that it was never opened despite most claiming to regularly use mobile apps. The main reasons included not understanding how it works, and privacy and security concerns. Significant correlations were found between participants? trust in CTAs in general and their perceived trust in the HOIA app regarding three attributes: competency (P<.001), risk perception (P<.001), and reciprocity (P=.01). Conclusions: This study shows that trust in the HOIA app among Estonian residents did affect their predisposition to use the app. Participants did not generally believe that HOIA could help to control the spread of the virus. The result of this work is limited to HOIA and health apps that use similar contact-tracing methods. However, the findings can contribute to gaining a broader understanding and awareness of the need for designing trustworthy technologies. Moreover, this work can help to provide design recommendations that ensure trustworthiness in CTAs, and the ability of AI to use highly sensitive data and serve society. UR - https://humanfactors.jmir.org/2022/2/e33951 UR - http://dx.doi.org/10.2196/33951 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699973 ID - info:doi/10.2196/33951 ER - TY - JOUR AU - Yeng, Kandabongee Prosper AU - Fauzi, Ali Muhammad AU - Sun, Luyi AU - Yang, Bian PY - 2022/5/25 TI - Assessing the Legal Aspects of Information Security Requirements for Health Care in 3 Countries: Scoping Review and Framework Development JO - JMIR Hum Factors SP - e30050 VL - 9 IS - 2 KW - legal requirement KW - information security KW - healthcare KW - security practice N2 - Background: The loss of human lives from cyberattacks in health care is no longer a probabilistic quantification but a reality that has begun. In addition, the threat scope is also expanding to involve a threat of national security, among others, resulting in surging data breaches within the health care sector. For that matter, there have been provisions of various legislation, regulations, and information security governance tools such as policies, standards, and directives toward enhancing health care information security?conscious care behavior among users. Meanwhile, in a research scenario, there are no comprehensive required security practices to serve as a yardstick in assessing security practices in health care. Moreover, an analysis of the holistic view of the requirements that need more concentration of management, end users, or both has not been comprehensively developed. Thus, there is a possibility that security practice research will leave out vital requirements. Objective: The objective of this study was to systematically identify, assess, and analyze the state-of-the-art information security requirements in health care. These requirements can be used to develop a framework to serve as a yardstick for measuring the future real security practices of health care staff. Methods: A scoping review was, as a result, adopted to identify, assess, and analyze the information security requirement sources within health care in Norway, Indonesia, and Ghana. Results: Of 188 security and privacy requirement sources that were initially identified, 130 (69.1%) were fully read by the authors. Subsequently, of these 188 requirement documents, 82 (43.6%) fully met the inclusion criteria and were accessed and analyzed. In total, 253 security and privacy requirements were identified in this work. The findings were then used to develop a framework to serve as a benchmark for modeling and analyzing health care security practices. Conclusions: On the basis of these findings, a framework for modeling, analyzing, and developing effective security countermeasures, including incentivization measures, was developed. Following this framework, research results of health care security practices would be more reliable and effective than relying on incomprehensive security requirements. UR - https://humanfactors.jmir.org/2022/2/e30050 UR - http://dx.doi.org/10.2196/30050 UR - http://www.ncbi.nlm.nih.gov/pubmed/35612891 ID - info:doi/10.2196/30050 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 - Schretzlmaier, Patrik AU - Hecker, Achim AU - Ammenwerth, Elske PY - 2022/3/9 TI - Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study JO - JMIR Hum Factors SP - e34918 VL - 9 IS - 1 KW - mHealth KW - mobile health KW - mobile apps KW - diabetes mellitus KW - technology acceptance KW - UTAUT2 KW - mobile phone N2 - Background: In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective: This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods: In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results: This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions: This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context. UR - https://humanfactors.jmir.org/2022/1/e34918 UR - http://dx.doi.org/10.2196/34918 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262493 ID - info:doi/10.2196/34918 ER - TY - JOUR AU - Terlouw, Gijs AU - Kuipers, Derek AU - Veldmeijer, Lars AU - van 't Veer, Job AU - Prins, Jelle AU - Pierie, Jean-Pierre PY - 2022/2/3 TI - Boundary Objects as Dialogical Learning Accelerators for Social Change in Design for Health: Systematic Review JO - JMIR Hum Factors SP - e31167 VL - 9 IS - 1 KW - boundary objects KW - health KW - innovation KW - design KW - systematic review N2 - Background: Boundary objects can add value for innovative design and implementation research in health care through their organizational focus and the dynamic structure between ill-structured and tailored use. However, when innovation is approached as a boundary object, more attention will need to be paid to the preimplementation phase. Research and design thinking pay attention to the preimplementation stage but do not have a social or organizational focus per se. The integration of boundary objects in design methodologies can provide a more social and organizational focus in innovative design projects by mapping out the mechanisms that occur at boundaries during design. Four dialogical learning mechanisms that can be triggered at boundaries have been described in the literature: identification, coordination, reflection, and transformation. These mechanisms seem suitable for integration in innovative design research on health. Objective: Focusing on innovation in health, this study aims to find out whether the different learning mechanisms can be linked to studies on health innovation that mention boundary objects as a concept and assess whether the related mechanisms provide insight into the stage of the design and implementation or change process. Methods: The following 6 databases were searched for relevant abstracts: PubMed, Scopus, Education Resources Information Center, PsycINFO, Information Science and Technology Abstracts, and Embase. These databases cover a wide range of published studies in the field of health. Results: Our initial search yielded 3102 records; after removing the duplicates, 2186 (70.47%) records were screened on the title and abstract, and 25 (0.81%) papers were included; of the 13 papers where we identified 1 mechanism, 5 (38%) described an innovation or innovative project, and of the 12 papers where we identified more mechanisms, 9 (75%) described the development or implementation of an innovation. The reflective mechanism was not identified solely but was present in papers describing a more successful development or implementation project of innovation. In these papers, the predetermined goals were achieved, and the process of integration was relatively smoother. Conclusions: The concept of boundary objects has found its way into health care. Although the idea of a boundary object was introduced to describe how specific artifacts can fulfill a bridging function between different sociocultural sites and thus have a social focus, the focus in the included papers was often on the boundary object itself rather than the social effect. The reflection and transformation mechanisms were underrepresented in the included studies but based on the findings in this review, pursuing to trigger the reflective mechanism in design, development, and implementation projects can lead to a more fluid and smooth integration of innovation into practice. UR - https://humanfactors.jmir.org/2022/1/e31167 UR - http://dx.doi.org/10.2196/31167 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113023 ID - info:doi/10.2196/31167 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 - Mariakakis, Alex AU - Karkar, Ravi AU - Patel, N. Shwetak AU - Kientz, A. Julie AU - Fogarty, James AU - Munson, A. Sean PY - 2022/1/3 TI - Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology JO - JMIR Hum Factors SP - e30474 VL - 9 IS - 1 KW - mobile health KW - survey instrument KW - health screening KW - health belief model KW - path analysis KW - user design KW - health technology KW - health intervention technology KW - digital health KW - mobile phone N2 - Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people?s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. UR - https://humanfactors.jmir.org/2022/1/e30474 UR - http://dx.doi.org/10.2196/30474 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982038 ID - info:doi/10.2196/30474 ER - TY - JOUR AU - Ahadzadeh, Sadat Ashraf AU - Wu, Ling Shin AU - Ong, Sim Fon AU - Deng, Ruolan PY - 2021/12/29 TI - The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study JO - J Med Internet Res SP - e28086 VL - 23 IS - 12 KW - mobile health KW - mHealth KW - internal health locus of control KW - performance expectancy KW - effort expectancy KW - social influence KW - mediation N2 - Background: Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual?s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective: The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods: A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results: The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (?=?0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (?=0.104, P<.001), effort expectancy (?=0.056, P=.02), and social influence (?=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions: This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption. UR - https://www.jmir.org/2021/12/e28086 UR - http://dx.doi.org/10.2196/28086 UR - http://www.ncbi.nlm.nih.gov/pubmed/34964718 ID - info:doi/10.2196/28086 ER - TY - JOUR AU - Shorey, Shefaly AU - Tan, Chye Thiam AU - AU - Mathews, Jancy AU - Yu, Yan Chun AU - Lim, Hoon Siew AU - Shi, Luming AU - Ng, Debby Esperanza AU - Chan, Huak Yiong AU - Law, Evelyn AU - Chee, Cornelia AU - Chong, Seng Yap PY - 2021/12/24 TI - Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study JO - J Med Internet Res SP - e27033 VL - 23 IS - 12 KW - depression KW - development KW - education KW - parent KW - perinatal KW - support KW - telehealth KW - mobile phone N2 - Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child?s development. Given the rise in technology and parents? preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles?the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. UR - https://www.jmir.org/2021/12/e27033 UR - http://dx.doi.org/10.2196/27033 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260376 ID - info:doi/10.2196/27033 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 - Marques, M. Marta AU - Matos, Marcela AU - Mattila, Elina AU - Encantado, Jorge AU - Duarte, Cristiana AU - Teixeira, J. Pedro AU - Stubbs, James R. AU - Sniehotta, F. Falko AU - Ermes, Miikka AU - Harjumaa, Marja AU - Leppänen, Juha AU - Välkkynen, Pasi AU - Silva, N. Marlene AU - Ferreira, Cláudia AU - Carvalho, Sérgio AU - Palmeira, Lara AU - Horgan, Graham AU - Heitmann, Lilienthal Berit AU - Evans, H. Elizabeth AU - Palmeira, L. António PY - 2021/12/3 TI - A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study JO - J Med Internet Res SP - e25305 VL - 23 IS - 12 KW - mHealth KW - behavior change techniques KW - weight management KW - motivation KW - self-regulation KW - emotion regulation KW - self-monitoring KW - user testing KW - logic models N2 - Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union?s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ?5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. UR - https://www.jmir.org/2021/12/e25305 UR - http://dx.doi.org/10.2196/25305 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870602 ID - info:doi/10.2196/25305 ER - TY - JOUR AU - Pan, Jing AU - Dong, Hua AU - Bryan-Kinns, Nick PY - 2021/11/19 TI - Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation JO - JMIR Aging SP - e30420 VL - 4 IS - 4 KW - older adults KW - mHealth KW - initial adoption KW - technology acceptance KW - design KW - mobile phone N2 - Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults? perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults? perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults? perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults? adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. UR - https://aging.jmir.org/2021/4/e30420 UR - http://dx.doi.org/10.2196/30420 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807836 ID - info:doi/10.2196/30420 ER - TY - JOUR AU - Noorbergen, J. Tyler AU - Adam, P. Marc T. AU - Teubner, Timm AU - Collins, E. Clare PY - 2021/11/10 TI - Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development JO - JMIR Mhealth Uhealth SP - e27896 VL - 9 IS - 11 KW - co-design KW - mHealth KW - guidelines KW - qualitative study KW - mobile phone N2 - Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research. UR - https://mhealth.jmir.org/2021/11/e27896 UR - http://dx.doi.org/10.2196/27896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757323 ID - info:doi/10.2196/27896 ER - TY - JOUR AU - Tremblay, Melanie AU - Latulippe, Karine AU - Guay, Manon AU - Provencher, Véronique AU - Giguère, Anick AU - Poulin, Valérie AU - Dubé, Véronique AU - Giroux, Dominique PY - 2021/8/18 TI - Usability of a Co-designed eHealth Prototype for Caregivers: Combination Study of Three Frameworks JO - JMIR Hum Factors SP - e26532 VL - 8 IS - 3 KW - usability evaluation KW - co-design KW - research methods KW - caregivers KW - service providers KW - product objectives N2 - Background: Co-design (or the participation of users) has shown great potential in the eHealth domain, demonstrating positive results. Nevertheless, the co-design approach cannot guarantee the usability of the system designed, and usability assessment is a complex analysis to perform, as evaluation criteria will differ depending on the usability framework (or set of criteria) used. ISO (International Organization for Standardization) on usability (ISO 9241-210), Nielsen heuristic, and Garrett element of user experience inform different yet complementary aspects of usability. Objective: This study aims to assess the usability and user experience of a co-design prototype by combining 3 complementary frameworks. Methods: To help caregivers provide care for functionally impaired older people, an eHealth tool was co-designed with caregivers, health and social service professionals, and community workers assisting caregivers. The prototype was a website that aims to support the help-seeking process for caregivers (finding resources) and allow service providers to advertise their services (offering resources). We chose an exploratory study method to assess usability in terms of each objective. The first step was to assess users? first impressions of the website. The second was a task scenario with a think-aloud protocol. The final step was a semistructured interview. All steps were performed individually (with a moderator) in a single session. The data were analyzed using 3 frameworks. Results: A total of 10 participants were recruited, 5 for each objective of the website. We were able to identify several usability problems, most of which were located in the information design and interface design dimensions (Garrett framework). Problems in both dimensions were mainly coded as effectiveness and efficiency (ISO framework) and error prevention and match between the systemand the real world (Nielsen heuristic). Conclusions: Our study provided a novel contribution about usability analysis by combining the 3 different models to classify the problems found. This combination provided a holistic understanding of the usability improvements needed. It can also be used to analyze other eHealth products. International Registered Report Identifier (IRRID): RR2-10.2196/11634 UR - https://humanfactors.jmir.org/2021/3/e26532 UR - http://dx.doi.org/10.2196/26532 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406123 ID - info:doi/10.2196/26532 ER - TY - JOUR AU - Mano, Rita PY - 2021/4/22 TI - Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis JO - JMIR Hum Factors SP - e21251 VL - 8 IS - 2 KW - mobile health apps KW - health empowerment KW - health management behaviors KW - costs-benefits KW - mobile phone N2 - Background: Rising criticism about the risks associated with the use of mobile health apps necessitates a critical perspective to assess the use of these apps. A cost-benefit approach involving several moderating factors can be used to detect technology effects and individual-level push and pull factors related to health attitudes, lifestyle, and health management behaviors. Objective: We introduce a cost-benefit perspective to examine how health attitudes related to mobile health apps and health situational factors (health crises, health changes, and hospitalization) affect the likelihood of adopting lifestyle and health management behaviors among app users. Methods: The analysis is based on individuals? reported use of mobile health apps. The sample included 1495 US adults aged over 18 years who were contacted by landline or cellphone. A total of 50.96% (762/1495) of the participants were women. A set of logistic regression models was used to predict lifestyle and health management behaviors among users considering variations in the extent of use, health attitudes, health situation, and socioeconomic characteristics. Results: The findings indicate that the proposed models were reasonably adequate. In all, 88.76% (1327/1495) of the cases were correctly classified regarding lifestyle behaviors, but only 71.97% (1076/1495) of the cases were correctly classified regarding health management behaviors. Although a large percentage of individuals changed their attitudes following the use of mobile health apps, only a small proportion adopted health management behaviors. The use of mobile health apps affected up to 67.95% (1016/1495) of the users for consultation and 71.97% (1076/1495) of the users for decision making. The model was effective for 88.76% (1327/1495) of the cases regarding lifestyle behaviors but only 71.97% (1076/1495) regarding health management behaviors. The moderating effect of regular use of mobile health apps significantly affects lifestyle (Wald=61.795; B=2.099; P<.005) but not health management behaviors (Wald=12.532; B=0.513; P=.01). These results collectively indicate that the use of mobile health apps for health management is partially effective. Conclusions: The use of mobile health apps is a main route to instigate the process of health empowerment and shape health attitudes. However, an accurate assessment of the effectiveness of mobile health apps necessitates distinguishing between lifestyle and health management behaviors and adopting a cost-benefit approach because individuals facing health concerns, such as a chronic disease, health emergency, health crisis, or health change, consider their affordances and situational effects. These moderators generate a push and pull framework in the decision-making process that balances the costs and benefits of use. UR - https://humanfactors.jmir.org/2021/2/e21251 UR - http://dx.doi.org/10.2196/21251 UR - http://www.ncbi.nlm.nih.gov/pubmed/33885372 ID - info:doi/10.2196/21251 ER - TY - JOUR AU - Baumgartner, Andrew AU - Kunkes, Taylor AU - Clark, M. Collin AU - Brady, A. Laura AU - Monte, V. Scott AU - Singh, Ranjit AU - Wahler Jr, G. Robert AU - Chen, Winnie Huei-Yen PY - 2020/8/13 TI - Opportunities and Recommendations for Improving Medication Safety: Understanding the Medication Management System in Primary Care Through an Abstraction Hierarchy JO - JMIR Hum Factors SP - e18103 VL - 7 IS - 3 KW - patient safety KW - polypharmacy KW - potentially inappropriate medications KW - primary care N2 - Background: Despite making great strides in improving the treatment of diseases, the minimization of unintended harm by medication therapy continues to be a major hurdle facing the health care system. Medication error and prescription of potentially inappropriate medications (PIMs) represent a prevalent source of harm to patients and are associated with increased rates of adverse events, hospitalizations, and increased health care costs. Attempts to improve medication management systems in primary care have had mixed results. Implementation of new interventions is difficult because of complex contextual factors within the health care system. Abstraction hierarchy (AH), the first step in cognitive work analysis (CWA), is used by human factors practitioners to describe complex sociotechnical systems. Although initially intended for the nuclear power domain and interface design, AH has been used successfully to aid the redesign of numerous health care systems such as the design of decision support tools, mobile patient monitoring apps, and a telephone triage system. Objective: This paper aims to refine our understanding of the primary care office in relation to a patient?s medication through the development of an AH. Emphasis was placed on the elements related to medication safety to provide guidance for the design of a safer medication management system in primary care. Methods: The AH development was guided by the methodology used by seminal CWA literature. It was initially developed by 2 authors and later fine-tuned by an expert panel of clinicians, social scientists, and a human factors engineer. It was subsequently refined until an agreement was reached. A means-ends analysis was performed and described for the nodes of interest. The model represents the primary care office space through functional purposes, values and priorities, function-related purposes, object-related processes, and physical objects. Results: This model depicts the medication management system at various levels of abstraction. The resulting components must be balanced and coordinated to provide medical treatment with limited health care resources. Understanding the physical and informational constraints on activities that occur in a primary care office depicted in the AH defines areas in which medication safety can be improved. Conclusions: Numerous means-ends relationships were identified and analyzed. These can be further evaluated depending on the specific needs of the user. Recommendations for optimizing a medication management system in a primary care facility were made. Individual practices can use AH for clinical redesign to improve prescribing and deprescribing practices. UR - http://humanfactors.jmir.org/2020/3/e18103/ UR - http://dx.doi.org/10.2196/18103 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788157 ID - info:doi/10.2196/18103 ER - TY - JOUR AU - Greenhalgh, Trisha AU - Wherton, Joseph AU - Shaw, Sara AU - Papoutsi, Chrysanthi AU - Vijayaraghavan, Shanti AU - Stones, Rob PY - 2019/12/19 TI - Infrastructure Revisited: An Ethnographic Case Study of how Health Information Infrastructure Shapes and Constrains Technological Innovation JO - J Med Internet Res SP - e16093 VL - 21 IS - 12 KW - information infrastructure KW - structuration theory KW - video consultations KW - neo-institutional theory KW - organizational ethnography KW - hidden work KW - actor-network theory N2 - Background: Star defined infrastructure as something other things ?run on?; it consists mainly of ?boring things.? Building on her classic 1999 paper, and acknowledging contemporary developments in technologies, services, and systems, we developed a new theorization of health information infrastructure with five defining characteristics: (1) a material scaffolding, backgrounded when working and foregrounded upon breakdown; (2) embedded, relational, and emergent; (3) collectively learned, known, and practiced (through technologically-supported cooperative work and organizational routines); (4) patchworked (incrementally built and fixed) and path-dependent (influenced by technical and socio-cultural legacies); and (5) institutionally supported and sustained (eg, embodying standards negotiated and overseen by regulatory and professional bodies). Objective: Our theoretical objective was, in a health care context, to explore what information infrastructure is and how it shapes, supports, and constrains technological innovation. Our empirical objective was to examine the challenges of implementing and scaling up video consultation services. Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to ?boring things?: the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate incrementally, taking account of technological and socio-cultural legacies; (5) consider standards but also where these standards come from and what priorities and interests they represent; and (6) seek to create leeway for these standards to be adapted to different local conditions. UR - http://www.jmir.org/2019/12/e16093/ UR - http://dx.doi.org/10.2196/16093 UR - http://www.ncbi.nlm.nih.gov/pubmed/31855184 ID - info:doi/10.2196/16093 ER - TY - JOUR AU - Grace-Farfaglia, Patricia PY - 2019/07/19 TI - Social Cognitive Theories and Electronic Health Design: Scoping Review JO - JMIR Hum Factors SP - e11544 VL - 6 IS - 3 KW - social theory KW - design KW - health promotion KW - behavioral economics KW - social support KW - social media KW - serious games N2 - Background: There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective: This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods: The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results: Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions: This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution. UR - https://humanfactors.jmir.org/2019/3/e11544/ UR - http://dx.doi.org/10.2196/11544 UR - http://www.ncbi.nlm.nih.gov/pubmed/31325290 ID - info:doi/10.2196/11544 ER - TY - JOUR AU - Ohligs, Marian AU - Pereira, Carina AU - Voigt, Verena AU - Koeny, Marcus AU - Janß, Armin AU - Rossaint, Rolf AU - Czaplik, Michael PY - 2019/05/01 TI - Evaluation of an Anesthesia Dashboard Functional Model Based on a Manufacturer-Independent Communication Standard: Comparative Feasibility Study JO - JMIR Hum Factors SP - e12553 VL - 6 IS - 2 KW - operating room KW - anesthesia KW - interconnection KW - networking KW - human-computer interaction KW - process optimization KW - intelligent alarms KW - decision-support systems KW - 11073 SDC KW - service-oriented device connectivity N2 - Background: Current anesthesia workspaces consist of several technical devices, such as patient monitors, anesthesia machines, among others. Commonly, they are produced by different manufacturers; thus, they differ in terms of their modus operandi, user interface, and representation of alarms. Merging the information from these devices using a single joint protocol and displaying it in a single graphical user interface could lead to a general improvement in perioperative management. For this purpose, the recently approved and published Institute of Electrical and Electronics Engineers 11073 service-oriented device connectivity standard was implemented. Objective: This paper aims to develop and then evaluate an anesthesia workstation (ANWS) functional model in terms of usability, fulfillment of clinical requirements, and expected improvements in patient safety. Methods: To compare the self-developed ANWS with the conventional system, a pilot observational study was conducted at the University Hospital Aachen, Germany. A total of 5 anesthesiologists were asked to perform different tasks using the ANWS and then the conventional setup. For evaluation purposes, response times were measured and an interaction-centered usability test with an eye-tracking system was carried out. Finally, the subjects were asked to fill in a questionnaire in order to measure user satisfaction. Results: Response times were significantly higher when using the ANWS, but decreased considerably after one repetition. Furthermore, usability was rated as excellent (?95) according to the System Usability Scale score, and the majority of clinical requirements were met. Conclusions: In general, the results were highly encouraging, considering that the ANWS was only a functional model, as well as the lack of training of the participants. However, further studies are necessary to improve the universal user interface and the interplay of the various networked devices. UR - http://humanfactors.jmir.org/2019/2/e12553/ UR - http://dx.doi.org/10.2196/12553 UR - http://www.ncbi.nlm.nih.gov/pubmed/31042150 ID - info:doi/10.2196/12553 ER - TY - JOUR AU - Zibrowski, Elaine AU - Shepherd, Lisa AU - Booth, Richard AU - Sedig, Kamran AU - Gibson, Candace PY - 2019/02/06 TI - A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting JO - JMIR Hum Factors SP - e11714 VL - 6 IS - 1 KW - Lean health care KW - emergency medicine KW - privacy and confidentiality KW - work intensification KW - qualitative research N2 - Background: Many emergency departments (EDs) have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients? vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients? informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so. Objective: This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care. Methods: From July to December 2017, semistructured interviews were iteratively conducted with health care professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1000 beds, and approximately 128,000 patients visit its 2 EDs annually. In response to poor wait times, in 2013, the hospital?s 2 EDs underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency. Results: Overall, 15 nurses and 5 physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. Although, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members, and visitors. In an attempt to work around limitations they encountered and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better protected individuals? informational and physical privacy. Conclusions: To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better affording privacy and confidentiality for patient encounters. These searches likely increased clinical time and added to these patients? length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean?s principle of value-added activities. Future exploration of the perspectives of patients, family members, and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted. UR - http://humanfactors.jmir.org/2019/1/e11714/ UR - http://dx.doi.org/10.2196/11714 UR - http://www.ncbi.nlm.nih.gov/pubmed/30724743 ID - info:doi/10.2196/11714 ER - TY - JOUR AU - Chokshi, Kuppin Sara AU - Mann, M. Devin PY - 2018/12/19 TI - Innovating From Within: A Process Model for User-Centered Digital Development in Academic Medical Centers JO - JMIR Hum Factors SP - e11048 VL - 5 IS - 4 KW - academic medical centers KW - digital health KW - heath information technology KW - innovation KW - process model KW - user-centered design N2 - Background: Design thinking and human-centered design approaches have become increasingly common in health care literature, particularly in relation to health information technology (HIT), as a pathway toward the development of usable, diffusible tools and processes. There is a need in academic medical centers tasked with digital innovation for a comprehensive process model to guide development that incorporates current industry trends, including design thinking and lean and agile approaches to digital development. Objective: This study aims to describe the foundations and phases of our model for user-centered HIT development. Methods: Based on our experience, we established an integrated approach and rigorous process for HIT development that leverages design thinking and lean and agile strategies in a pragmatic way while preserving methodological integrity in support of academic research goals. Results: A four-phased pragmatic process model was developed for user-centered digital development in HIT. Conclusions: The model for user-centered HIT development that we developed is the culmination of diverse innovation projects and represents a multiphased, high-fidelity process for making more creative, flexible, efficient, and effective tools. This model is a critical step in building a rigorous approach to HIT design that incorporates a multidisciplinary, pragmatic perspective combined with academic research practices and state-of-the-art approaches to digital product development to meet the unique needs of health care. UR - http://humanfactors.jmir.org/2018/4/e11048/ UR - http://dx.doi.org/10.2196/11048 UR - http://www.ncbi.nlm.nih.gov/pubmed/30567688 ID - info:doi/10.2196/11048 ER - TY - JOUR AU - Zibrowski, Elaine AU - Shepherd, Lisa AU - Sedig, Kamran AU - Booth, Richard AU - Gibson, Candace PY - 2018/12/13 TI - Easier and Faster Is Not Always Better: Grounded Theory of the Impact of Large-Scale System Transformation on the Clinical Work of Emergency Medicine Nurses and Physicians JO - JMIR Hum Factors SP - e11013 VL - 5 IS - 4 KW - health care KW - emergency medicine KW - grounded theory KW - workflow KW - hospital N2 - Background: The effectiveness of Lean Thinking as a quality improvement method for health care has been contested due, in part, to our limited contextual understanding of how it affects the working conditions and clinical workflow of nurses and physicians. Although there are some initial indications, arising from prevalence surveys and interviews, that Lean may intensify work performed within medical environments, the evidence base still requires detailed descriptions of the changes that were actually introduced to individuals? clinical workflow and how these changes impacted health care professionals. Objective: The aim of this study was to explore ways in which a Lean intervention may impact the clinical work of emergency medicine nurses and physicians. Methods: We used a realist grounded theory approach to explore the clinical work of nurses and physicians practicing in 2 emergency medicine departments from a single teaching hospital in Canada. The hospital has 1000 beds with 128,000 emergency department (ED) visits annually. In 2013, both sites began a large-scale, Lean-driven system transformation of their practice environments. In-person interviews were iteratively conducted with health care professionals from July to December 2017. Information from transcripts was coded into categories and compared with existing codes. With repeated review of transcripts and evolving coding, we organized categories into themes. Data collection continued to theoretical sufficiency. Results: A total of 15 emergency medicine nurses and 5 physicians were interviewed. Of these, 18 individuals had practiced for at least 10 years. Our grounded theory involved 3 themes: (1) organization of our clinical work, (2) pushed pace in the front cell, and (3) the toll this all takes on us. Although the intervention was supposed to make the EDs work easier, faster, and better, the participants in our study indicated that the changes made had the opposite impact. Nurses and physicians described ways in which the reconfigured EDs disrupted their established practice routines and resulted in the intensification of their work. Participants also identified indications of deskilling of nurses? work and how the new push-forward model of patient care had detrimental impacts on their physical, cognitive, and emotional well-being. Conclusions: To our knowledge, this is the first study to describe the impact of Lean health care on the working conditions and actual work of emergency medicine nurses and physicians. We theorize that rather than support health care professionals in their management of the complexities that characterize emergency medicine, the physical and process-based changes introduced by the Lean intervention acted to further complicate their working environment. We have illuminated some unintended consequences associated with accelerating patient flow on the clinical workflow and perceived well-being of health care professionals. We identify some areas for reconsideration by the departments and put forward ideas for future research. UR - http://humanfactors.jmir.org/2018/4/e11013/ UR - http://dx.doi.org/10.2196/11013 UR - http://www.ncbi.nlm.nih.gov/pubmed/30545817 ID - info:doi/10.2196/11013 ER - TY - JOUR AU - Sahin, T. Ned AU - Keshav, U. Neha AU - Salisbury, P. Joseph AU - Vahabzadeh, Arshya PY - 2018/01/04 TI - Second Version of Google Glass as a Wearable Socio-Affective Aid: Positive School Desirability, High Usability, and Theoretical Framework in a Sample of Children with Autism JO - JMIR Hum Factors SP - e1 VL - 5 IS - 1 KW - autism KW - technology KW - digital health KW - augmented reality KW - virtual reality KW - smartglasses KW - usability KW - schools KW - education KW - classroom KW - IDEA KW - IEP KW - special education N2 - Background: Computerized smartglasses are being developed as an assistive technology for daily activities in children and adults with autism spectrum disorder (ASD). While smartglasses may be able to help with educational and behavioral needs, their usability and acceptability in children with ASD is largely unknown. There have been reports of negative social perceptions surrounding smartglasses use in mainstream populations, a concern given that assistive technologies may already carry their own stigma. Children with ASD may also have a range of additional behavioral, developmental, and social challenges when asked to use this emerging technology in school and home settings. Objective: The usability and acceptability of Glass Enterprise Edition (Glass), the successor to Google Glass smartglasses, were explored in children with ASD and their caregivers. Methods: Eight children with ASD and their caregivers were recruited to attend a demonstration session with Glass smartglasses the week they were publicly released. The children had a wide range of ability, including limited speech to speaking, and represented a full range of school ages (6 to 17 years). Children and caregivers were interviewed about their experience of using the smartglasses and whether they would use them at school and home. Results: All 8 children succeeded in using Glass and did not feel stressed (8/8, 100%) or experience any overwhelming sensory or emotional issues during the session (8/8, 100%). All 8 children (8/8, 100%) endorsed that they would be willing to wear and use the device in both home and school settings. Caregivers felt the experience was fun for the children (8/8, 100%), and most caregivers felt the experience was better than they had expected (6/8, 75%). Conclusions: A wide age and ability range of children with ASD used Glass immediately after it was released and found it to be usable and acceptable. Despite concerns about potential stigma or social acceptability, all of the children were prepared to use the technology in both home and school settings. Encouragingly, most caregivers noted a very positive response. There were no behavioral, developmental, or social- or stigma-related concerns during or after the session. Smartglasses may be a useful future technology for children with ASD and are readily accepted for use by children with ASD and their caregivers. UR - http://humanfactors.jmir.org/2018/1/e1/ UR - http://dx.doi.org/10.2196/humanfactors.8785 UR - http://www.ncbi.nlm.nih.gov/pubmed/29301738 ID - info:doi/10.2196/humanfactors.8785 ER - TY - JOUR AU - Tao, Donghua AU - LeRouge, Cynthia AU - Smith, Jody K. AU - De Leo, Gianluca PY - 2017/10/06 TI - Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults JO - JMIR Hum Factors SP - e25 VL - 4 IS - 4 KW - consumer health information KW - World Wide Web KW - Internet KW - information services KW - quality control KW - young adults KW - evaluation studies as topic KW - medical informatics N2 - Background: Today?s health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care?related purposes. Objective: To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults? use of health websites for health care?related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults? use of health websites for health care?related purposes. Methods: The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants? means of assessing information quality on health websites. Results: Five dimensions of information quality for health websites were identified: Completeness of information, Understandability of information, Relevance of information, Depth of information, and Accuracy of information. Completeness of information and Understandability of information were rated as the two most important quality dimensions by the study participants. Results indicated that these five information quality dimensions for health websites were supported by the following main driver themes: Content, Design, Links, Consumer resources, Search functionality, Supporting references, User focus, Content FAQ, Open access, Policy statements, and Site performance. Conclusions: This study contributes to the literature by developing a health website information quality conceptual framework with quality dimensions and associated drivers specified for a young educated adult population. The detailed quality drivers supporting the corresponding quality dimensions provide a rich picture of young educated adults? perceptions on health website information quality. This framework can be used to guide the development of health websites, as well as the foundation for a means to evaluate health information from existing health websites with young educated adults as the target audience. UR - http://humanfactors.jmir.org/2017/4/e25/ UR - http://dx.doi.org/10.2196/humanfactors.6455 UR - http://www.ncbi.nlm.nih.gov/pubmed/28986336 ID - info:doi/10.2196/humanfactors.6455 ER - TY - JOUR AU - St-Maurice, D. Justin AU - Burns, M. Catherine PY - 2017/07/28 TI - Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs JO - JMIR Hum Factors SP - e16 VL - 4 IS - 3 KW - clinical decision-making KW - health services research KW - qualitative research KW - primary health care KW - medical records systems, computerized N2 - Background: Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. Objective: An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. Methods: The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Results: Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient?s domain and enable the exploration of the shared decision-making (SDM) paradigm. Conclusion: Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a controller and could be useful for mobile app development. UR - http://humanfactors.jmir.org/2017/3/e16/ UR - http://dx.doi.org/10.2196/humanfactors.6857 UR - http://www.ncbi.nlm.nih.gov/pubmed/28754650 ID - info:doi/10.2196/humanfactors.6857 ER - TY - JOUR AU - Witteman, O. Holly AU - Presseau, Justin AU - Nicholas Angl, Emily AU - Jokhio, Iffat AU - Schwalm, JD AU - Grimshaw, M. Jeremy AU - Bosiak, Beth AU - Natarajan, K. Madhu AU - Ivers, M. Noah PY - 2017/03/01 TI - Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome JO - JMIR Hum Factors SP - e6 VL - 4 IS - 1 KW - user-centered design KW - codesign KW - medication adherence KW - health behavior KW - health education KW - myocardial infarction KW - secondary prevention KW - stents N2 - Background: Taking all recommended secondary prevention cardiac medications and fully participating in a formal cardiac rehabilitation program significantly reduces mortality and morbidity in the year following a heart attack. However, many people who have had a heart attack stop taking some or all of their recommended medications prematurely and many do not complete a formal cardiac rehabilitation program. Objective: The objective of our study was to develop a user-centered, theory-based, scalable intervention of printed educational materials to encourage and support people who have had a heart attack to use recommended secondary prevention cardiac treatments. Methods: Prior to the design process, we conducted theory-based interviews and surveys with patients who had had a heart attack to identify key determinants of secondary prevention behaviors. Our interdisciplinary research team then partnered with a patient advisor and design firm to undertake an iterative, theory-informed, user-centered design process to operationalize techniques to address these determinants. User-centered design requires considering users? needs, goals, strengths, limitations, context, and intuitive processes; designing prototypes adapted to users accordingly; observing how potential users respond to the prototype; and using those data to refine the design. To accomplish these tasks, we conducted user research to develop personas (archetypes of potential users), developed a preliminary prototype using behavior change theory to map behavior change techniques to identified determinants of medication adherence, and conducted 2 design cycles, testing materials via think-aloud and semistructured interviews with a total of 11 users (10 patients who had experienced a heart attack and 1 caregiver). We recruited participants at a single cardiac clinic using purposive sampling informed by our personas. We recorded sessions with users and extracted key themes from transcripts. We held interdisciplinary team discussions to interpret findings in the context of relevant theory-based evidence and iteratively adapted the intervention accordingly. Results: Through our iterative development and testing, we identified 3 key tensions: (1) evidence from theory-based studies versus users? feelings, (2) informative versus persuasive communication, and (3) logistical constraints for the intervention versus users? desires or preferences. We addressed these by (1) identifying root causes for users? feelings and addressing those to better incorporate theory- and evidence-based features, (2) accepting that our intervention was ethically justified in being persuasive, and (3) making changes to the intervention where possible, such as attempting to match imagery in the materials to patients? self-images. Conclusions: Theory-informed interventions must be operationalized in ways that fit with user needs. Tensions between users? desires or preferences and health care system goals and constraints must be identified and addressed to the greatest extent possible. A cluster randomized controlled trial of the final intervention is currently underway. UR - http://humanfactors.jmir.org/2017/1/e6/ UR - http://dx.doi.org/10.2196/humanfactors.6502 UR - http://www.ncbi.nlm.nih.gov/pubmed/28249831 ID - info:doi/10.2196/humanfactors.6502 ER - TY - JOUR AU - Sage, Adam AU - Roberts, Courtney AU - Geryk, Lorie AU - Sleath, Betsy AU - Tate, Deborah AU - Carpenter, Delesha PY - 2017/02/01 TI - A Self-Regulation Theory?Based Asthma Management Mobile App for Adolescents: A Usability Assessment JO - JMIR Hum Factors SP - e5 VL - 4 IS - 1 KW - mHealth KW - asthma KW - mobile KW - usability N2 - Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of a high-fidelity wireframe for an asthma self-management app intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18 years) with persistent asthma who owned a smartphone (N=8). Adolescents were asked to evaluate a PDF app wireframe consisting of 76 screen shots displaying app features, including log in and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: (1) usability, (2) behavioral intentions to use, (3) confusing aspects, and (4) suggestions for improvement. Results: The app wireframe was generally well received, and several suggestions for improvement were recorded. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the wireframe useful for managing their asthma. Conclusions: Early stage usability tests guided by government usability guidelines (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes. UR - http://humanfactors.jmir.org/2017/1/e5/ UR - http://dx.doi.org/10.2196/humanfactors.7133 UR - http://www.ncbi.nlm.nih.gov/pubmed/28148471 ID - info:doi/10.2196/humanfactors.7133 ER - TY - JOUR AU - Nelson, A. Lyndsay AU - Mayberry, S. Lindsay AU - Wallston, Kenneth AU - Kripalani, Sunil AU - Bergner, M. Erin AU - Osborn, Y. Chandra PY - 2016/09/08 TI - Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes JO - JMIR Hum Factors SP - e23 VL - 3 IS - 2 KW - mobile health KW - patient adherence KW - type 2 diabetes mellitus KW - text messaging KW - health status disparities N2 - Background: Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of adults with T2DM, but few have been tested with disadvantaged populations. Objective: To develop Rapid Education/Encouragement And Communications for Health (REACH), a tailored, text messaging intervention to support the self-care adherence of disadvantaged patients with T2DM, based on the Information-Motivation-Behavioral skills model. We then tested REACH?s usability to make improvements before evaluating its effects. Methods: We developed REACH?s content and functionality using an empirical and theory-based approach, findings from a previously pilot-tested intervention, and the expertise of our interdisciplinary research team. We recruited 36 adults with T2DM from Federally Qualified Health Centers to participate in 1 of 3 rounds of usability testing. For 2 weeks, participants received daily text messages assessing and promoting self-care, including tailored messages addressing users? unique barriers to adherence, and weekly text messages with adherence feedback. We analyzed quantitative and qualitative user feedback and system-collected data to improve REACH. Results: Participants were, on average, 52.4 (SD 9.5) years old, 56% (20/36) female, 63% (22/35) were a racial or ethnic minority, and 67% (22/33) had an income less than US $35,000. About half were taking insulin, and average hemoglobin A1c level was 8.2% (SD 2.2%). We identified issues (eg, user concerns with message phrasing, technical restrictions with responding to assessment messages) and made improvements between testing rounds. Overall, participants favorably rated the ease of understanding (mean 9.6, SD 0.7) and helpfulness (mean 9.3, SD 1.4) of self-care promoting text messages on a scale of 1-10, responded to 96% of assessment text messages, and rated the helpfulness of feedback text messages 8.5 (SD 2.7) on a scale of 1-10. User feedback led to refining our study enrollment process so that users understood the flexibility in message timing and that computers, not people, send the messages. Furthermore, research assistants? feedback on the enrollment process helped improve participants? engagement with study procedures. Conclusions: Testing technology-delivered interventions with disadvantaged adults revealed preferences and concerns unique to this population. Through iterative testing and multiple data sources, we identified and responded to users? intervention preferences, technical issues, and shortcomings in our research procedures. UR - http://humanfactors.jmir.org/2016/2/e23/ UR - http://dx.doi.org/10.2196/humanfactors.6029 UR - http://www.ncbi.nlm.nih.gov/pubmed/27609738 ID - info:doi/10.2196/humanfactors.6029 ER - TY - JOUR AU - Percival, Jennifer AU - McGregor, Carolyn PY - 2016/07/28 TI - An Evaluation of Understandability of Patient Journey Models in Mental Health JO - JMIR Hum Factors SP - e20 VL - 3 IS - 2 KW - patient-journey modeling KW - process modeling KW - technology integration KW - health information technology N2 - Background: There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives: This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method: Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results: The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions: The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot case study to a more diversified group of clinicians and health care support workers. UR - http://humanfactors.jmir.org/2016/2/e20/ UR - http://dx.doi.org/10.2196/humanfactors.5640 UR - http://www.ncbi.nlm.nih.gov/pubmed/27471006 ID - info:doi/10.2196/humanfactors.5640 ER - TY - JOUR AU - Gustafson Jr, H. David AU - Maus, Adam AU - Judkins, Julianne AU - Dinauer, Susan AU - Isham, Andrew AU - Johnson, Roberta AU - Landucci, Gina AU - Atwood, K. Amy PY - 2016/01/14 TI - Using the NIATx Model to Implement User-Centered Design of Technology for Older Adults JO - JMIR Human Factors SP - e2 VL - 3 IS - 1 KW - eHealth KW - user-centered design KW - technology KW - aging in place KW - independent living KW - consumer participation KW - accessibility UR - http://humanfactors.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.4853 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025985 ID - info:doi/10.2196/humanfactors.4853 ER - TY - JOUR AU - Kayser, Lars AU - Kushniruk, Andre AU - Osborne, H. Richard AU - Norgaard, Ole AU - Turner, Paul PY - 2015/05/20 TI - Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs JO - JMIR Human Factors SP - e9 VL - 2 IS - 1 KW - eHealth literacy KW - requirements KW - user involvement N2 - Background: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. Objective: The objective of this paper is to propose how users? needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. Methods: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users? competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. Results: The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users? needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Conclusions: Developing effective eHealth products requires complete understanding of the end-users? needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users? needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems. UR - http://humanfactors.jmir.org/2015/1/e9/ UR - http://dx.doi.org/10.2196/humanfactors.3696 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025228 ID - info:doi/10.2196/humanfactors.3696 ER -