TY - JOUR AU - Decambron, Mélanie AU - Tchikladze Merand, Christine PY - 2025/4/22 TI - Telemedicine Booths for Screening Cardiovascular Risk Factors: Prospective Multicenter Study JO - JMIR Hum Factors SP - e57032 VL - 12 KW - cardiovascular disease risk factors KW - cardiovascular disease KW - CVD KW - cardiology KW - cardiac KW - cardiologists KW - health check KW - hypertension KW - HTN KW - hypertensive KW - high blood pressure KW - blood pressure KW - obesity KW - screening KW - health screening KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - COVID-19 KW - SARS-CoV-2 KW - Coronavirus KW - respiratory KW - infectious KW - pulmonary KW - pandemic N2 - Background: Cardiovascular risk factors such as hypertension often remain undetected and untreated. This was particularly problematic during the COVID-19 pandemic when there were fewer in-person medical consultations. Objective: This study aimed to determine whether health screening using a telemedicine booth would have an impact on people?s medical care during the COVID-19 pandemic. Methods: Health screening was run using a telemedicine booth (the consult station) that was placed in three different vaccination centers in northern France between July 2021 and September 2021. Participants followed a series of instructions to obtain various measures, including their blood pressure, BMI, and heart rate. If any measures were found to be outside of the normal range, participants were advised to consult a doctor. After 3 months, the participants with abnormal readings were contacted by telephone and were asked a series of standardized questions. The primary outcome was the percentage of respondents who reported that they had consulted a doctor since the health check. Results: Approximately 6000 people attended the 3 vaccination centers over the study period. Of these, around 2500 used the consult station. A total of 1333 participants (53.3%) were found to have abnormal readings, which mostly concerned their blood pressure, heart rate, or BMI. There were 638 participants who responded to the follow-up call, and 234 of these (37%) reported that they had consulted a doctor since the health check. However, 158 of the 638 respondents (24.8%) reported that they would have consulted a doctor even without the screening. Conclusions: We succeeded in screening large numbers of people for cardiovascular risk factors during the COVID-19 pandemic by using a telemedicine booth. Although relatively few follow-up call respondents reported that they went on to consult a physician, the screening would nevertheless have raised people?s awareness of their cardiovascular risk factors. UR - https://humanfactors.jmir.org/2025/1/e57032 UR - http://dx.doi.org/10.2196/57032 ID - info:doi/10.2196/57032 ER - TY - JOUR AU - Guo, Rongrong AU - Zhang, Jiwen AU - Yang, Fangyu AU - Wu, Ying PY - 2025/4/21 TI - Efficacy of an Intelligent and Integrated Older Adult Care Model on Quality of Life Among Home-Dwelling Older Adults: Randomized Controlled Trial JO - J Med Internet Res SP - e67950 VL - 27 KW - efficacy KW - home care KW - integrated care KW - intelligent KW - elderly people KW - quality of life KW - mobile phone N2 - Background: Integrated care models enhanced by the clinical decision support system offer innovative approaches to managing the growing global burden of older adult care. However, their efficacy remains uncertain. Objective: This study aimed to evaluate the efficacy of an intelligent and integrated older adult care model, termed the SMART (Sensors and scales [receptor], a Mobile phone autonomous response system [central nervous system in the spinal cord], a Remote cloud management center [central nervous system in the brain], and a Total care system [effector]) system, in improving the quality of life (QOL) for home-dwelling older adults. Methods: In this stratified randomized controlled trial, we consecutively recruited older adults aged 65 years or older from November 1, 2020, to December 31, 2020. Eligible participants were randomly allocated 1:1 to either the SMART group, receiving routine discharge instructions and personalized integrated care interventions across 11 domains (decreased or lost self-care ability, falls, delirium, dysphagia, incontinence, constipation, urinary retention, cognitive decline, depression, impaired skin integrity, and common diseases) generated by the SMART system, or the usual care group, receiving only routine discharge instructions. The intervention lasted for 3 months. The primary end point was the percent change in QOL from baseline to the 3-month follow-up, assessed using the World Health Organization Quality of Life Instrument - Older Adults Module. Secondary end points included functional status at the 3-month follow-up and percent changes in health self-management ability, social support, and confidence in avoiding falling from baseline to the 3-month follow-up. Data were analyzed following the intention-to-treat principle, using covariance or logistic regression models, as appropriate. Subgroup and sensitivity analyses were conducted to assess result consistency and robustness. Results: In total, 94 participants were recruited, with 48 assigned to the SMART group. The personalized and integrated care by the SMART system significantly improved the QOL among the older adults, with an estimated intervention difference of 11.97% (95% CI 7.2%-16.74%, P<.001), and social support and health self-management ability as well, with estimated intervention differences of 6.75% (95% CI 3.19%-10.3%, P<.001) and 4.95% (95% CI 0.11%-10%, P=.003), respectively, while insignificantly improving in the Modified Falls Efficacy Scale score. Similarly, the SMART system had a 66% reduction in instrumental activities of daily living disability (odds ratio [OR] 0.34, 95% CI 0.11-0.83, P=.02). However, the SMART system did not significantly affect activities of daily living disability or the Modified Falls Efficacy Scale score. The subgroup and sensitivity analyses confirmed the robustness of the findings. Conclusions: The personalized and integrated older adult care by the SMART system demonstrated significant efficacy in improving QOL, health self-management ability, and social support, while reducing instrumental activities of daily living disability among home-dwelling older adults. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010368; https://tinyurl.com/2zax24xr UR - https://www.jmir.org/2025/1/e67950 UR - http://dx.doi.org/10.2196/67950 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67950 ER - TY - JOUR AU - Lempe, Notger Paul AU - Guinemer, Camille AU - Fürstenau, Daniel AU - Dressler, Corinna AU - Balzer, Felix AU - Schaaf, Thorsten PY - 2025/4/14 TI - Health Care Social Robots in the Age of Generative AI: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e63017 VL - 14 KW - robotics KW - social robots KW - artificial intelligence KW - generative AI KW - human-robot interaction KW - health care sector KW - PRISMA N2 - Background: Social robots (SR), sensorimotor machines designed to interact with humans, can help to respond to the increasing demands in the health care sector. To ensure the successful use of this technology, acceptance is paramount. Generative artificial intelligence (AI) is an emerging technology with the potential to enhance the functionality of SR and promote user acceptance by further improving human-robot interaction. Objective: We present a protocol for a scoping review of the literature on the implementation of generative AI in SR in the health care sector. The aim of this scoping review is to map out the intersection of SR and generative AI in the health care sector; to explore if generative AI is applied in SR in the health care sector; to outline which models of generative AI and SR are used for these implementations; and to explore whether user acceptance is reported as an outcome following these implementations. This scoping review supports future research by providing an overview of the state of connectedness of 2 emerging technologies and by mapping out research gaps. Methods: We follow the methodological framework developed by Arksey and O'Malley and the recommendations by the Joanna Briggs Institute. Our protocol was drafted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews). We will conduct a systematic literature search of the online databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and IEEE Xplore, aiming to retrieve relevant data items via tabular data charting from references meeting specific inclusion criteria which are studies published from 2010 onwards, set in the health care sector, focusing on SR with physical bodies and implemented generative AI. There are no restrictions on study types. Results will be categorized, clustered, and summarized using tables, graphs, visual representations, and narratives. Results: After conducting a preliminary search and deduplication in the second quarter of 2024, we retrieved 3176 preliminary results. This scoping review will be supplemented with the next methodological steps, including retrieving the results in a reference management tool as well as screening titles, abstracts, and full text regarding specific inclusion criteria. The completion of these steps is scheduled for the second quarter of 2025. Limitations based on the heterogeneity of the included studies and the general breadth of a scoping review compared to a systematic review are to be expected. To reduce bias, we adopted a system of dual reviews and thorough documentation of the study selection. Conclusions: The conducted preliminary search implies that there are a sufficient number of heterogeneous references to complete this scoping review. To our knowledge, this is the first scoping review on generative AI in health care SR. International Registered Report Identifier (IRRID): PRR1-10.2196/63017 UR - https://www.researchprotocols.org/2025/1/e63017 UR - http://dx.doi.org/10.2196/63017 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63017 ER - TY - JOUR AU - Santoso, Budi Dian AU - Kristanti, Sinta Martina AU - Nurputra, Kesumapramudya Dian AU - Sutomo, Retno PY - 2025/4/10 TI - Development of a Mobile-Based Personal Health Record for Pediatric Attention-Deficit/Hyperactivity Disorder Management: Protocol for a Study Based on Action Research Design JO - JMIR Res Protoc SP - e60216 VL - 14 KW - ADHD KW - attention deficit and hyperactivity KW - mobile app KW - personal health records KW - action research KW - pediatric N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most widespread neurobehavioral problems during childhood. A child?s personal health record (PHR) plays an important role in the controlled routine monitoring of ADHD symptom improvement. Along with the advantages, the convenience offered by mobile technology, and the ubiquity of smartphones in contemporary society, there is a compelling need for PHR to be available in the form of a mobile app. Objective: This study aims to identify stakeholder needs, followed by designing, developing, testing, and evaluating a mobile-based PHR in the context of pediatric ADHD management. Methods: This study will adopt an action research design structured into 4 stages: diagnosing, planning, taking, and evaluating action. Stakeholders, including parents, pediatricians, occupational therapists, clinical psychologists, and teachers, will participate actively. In stage 1, stakeholder requirements for the mobile-based PHR will be explored through in-depth interviews, focus group discussions (FGDs), and document reviews. Thematic analysis will be used to identify key needs and challenges. In stage 2, a systematic literature review will be conducted to enhance user requirements analysis by synthesizing insights from existing mobile apps for pediatric ADHD management. A mobile-based PHR prototype will be designed and developed based on user requirements enhanced with systematic review results. In stage 3, the prototype will undergo a 6-week trial with participants to evaluate its functionality and address any identified issues. In stage 4, both quantitative and qualitative methods will be used to assess the app?s usability and quality. The System Usability Scale (SUS) and the User Version of the Mobile App Rating Scale (uMARS) will be used for quantitative evaluation, while interviews and FGDs will be conducted for qualitative evaluation. Results: This study commenced in October 2024. As of December 2024, 13 participants (n=5, 38.5%, parents; n=2, 15.4%, pediatricians; n=2, 15.4%, occupational therapists; n=2, 15.4%, clinical psychologists; and n=2, 15.4%, teachers) have been enrolled, meeting the minimum participant requirements for stage 1. Stage 1 was completed at the end of 2024, with stage 2 expected to be completed by September 2025, stage 3 by December 2025, and stage 4 by February 2026. The findings from each stage will inform iterative refinements to the mobile-based PHR. The final results, including usability and quality assessments, are anticipated for publication by the middle of 2026. Conclusions: This study protocol outlines a pivotal initiative to enhance the management of pediatric ADHD. By using an action research methodology and actively engaging stakeholders, the study aims to contribute significantly to the field. The iterative cycles of the research seek to develop a mobile-based PHR that is not only user friendly but also effective and uniquely attuned to the diverse needs of those involved in pediatric ADHD care. International Registered Report Identifier (IRRID): PRR1-10.2196/60216 UR - https://www.researchprotocols.org/2025/1/e60216 UR - http://dx.doi.org/10.2196/60216 UR - http://www.ncbi.nlm.nih.gov/pubmed/40208656 ID - info:doi/10.2196/60216 ER - TY - JOUR AU - Holmqvist, Sophia AU - Kaplan, Marina AU - Chaturvedi, Riya AU - Shou, Haochang AU - Giovannetti, Tania PY - 2025/4/8 TI - Longitudinal and Combined Smartwatch and Ecological Momentary Assessment in Racially Diverse Older Adults: Feasibility, Adherence, and Acceptability Study JO - JMIR Hum Factors SP - e69952 VL - 12 KW - cognitive impairment KW - smartwatch KW - longitudinal monitoring KW - ecological momentary assessment KW - aging N2 - Background: Due to the rising prevalence of Alzheimer disease and related dementias, easily deployable tools to quantify risk are needed. Smartphones and smartwatches enable unobtrusive and continuous monitoring, but there is limited information regarding the feasibility, adherence, and acceptability of digital data collection among racially diverse older adults. Objective: This paper examined the feasibility, adherence, and acceptability of a 4-week combined smartwatch monitoring and ecological momentary assessment (EMA) study in a racially diverse sample of older adults. Methods: A total of 44 older adults (aged ?55 y) with either mild cognitive impairment or healthy cognition completed an informed consent comprehension quiz, baseline cognitive testing, training regarding digital data collection, and questionnaires. Participants were instructed to wear a Garmin Vivosmart 4 smartwatch for 23 h/d for 4 weeks, sync 2 smartphone apps (Garmin and Labfront) daily, and complete a daily EMA survey with automated prompts for surveys and charging. Training time, smartwatch adherence (eg, wear time), daily EMA survey response rate, and performance on the consent quiz were quantified. Associations between feasibility and adherence metrics and participant factors were evaluated. Self-reported usability of the apps and smartwatch was collected at study end. Results: Consent comprehension quiz scores were high (mean 97.33%, SD 6.86% correct), and training sessions lasted on average 17.93 (SD 6.89) minutes. During the 4-week study, participants wore the smartwatch for an average of 21 h/d (SD 1.53) and showed an average response rate of 94% (SD 9.58%) to daily EMA surveys. In unadjusted bivariate analyses, age, race, and cognition were associated with feasibility and adherence measures, but only age and race remained significant in multivariate models. After accounting for all participant factors, older age was a significant predictor of longer training time, and Black race was a significant predictor of lower daily wear time. On the usability survey, all participants (45/45, 100%) indicated willingness to participate in future smartwatch studies, >80% (37/45) had a positive experience, and >90% (41/45) were satisfied with smartphone app syncing. Conclusions: Smartwatch monitoring, requiring daily wear, smartphone syncing, and daily EMA survey completion, is highly feasible in older adults because adherence to daily wear and EMA surveys was high, as was general satisfaction on usability surveys. Although older participants may require more training on smartwatch and smartphone procedures and automated prompting during the study period, longitudinal monitoring with the Garmin Vivosmart 4 smartwatch and Labfront app is acceptable and feasible for collecting nearly continuous data in Black and White older adults, including those with mild cognitive impairment and those without. UR - https://humanfactors.jmir.org/2025/1/e69952 UR - http://dx.doi.org/10.2196/69952 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69952 ER - TY - JOUR AU - Schweizer, Theresa AU - Gilgen-Ammann, Rahel PY - 2025/3/21 TI - Wrist-Worn and Arm-Worn Wearables for Monitoring Heart Rate During Sedentary and Light-to-Vigorous Physical Activities: Device Validation Study JO - JMIR Cardio SP - e67110 VL - 9 KW - validity KW - reliability KW - accuracy KW - wearable devices KW - wearing position KW - photoplethysmography KW - heart rate N2 - Background: Heart rate (HR) is a vital physiological parameter, serving as an indicator of homeostasis and a key metric for monitoring cardiovascular health and physiological responses. Wearable devices using photoplethysmography (PPG) technology provide noninvasive HR monitoring in real-life settings, but their performance may vary due to factors such as wearing position, blood flow, motion, and device updates. Therefore, ongoing validation of their accuracy and reliability across different activities is essential. Objectives: This study aimed to assess the accuracy and reliability of the HR measurement from the PPG-based Polar Verity Sense and the Polar Vantage V2 devices across a range of physical activities and intensities as well as wearing positions (ie, upper arm, forearm, and both wrists). Methods: Sixteen healthy participants were recruited to participate in this study protocol, which involved 9 activities of varying intensities, ranging from lying down to high-intensity interval training, each repeated twice. The HR measurements from the Verity Sense and Vantage V2 were compared with the criterion measure Polar H10 electrocardiogram (ECG) chest strap. The data were processed to eliminate artifacts and outliers. Accuracy and reliability were assessed using multiple statistical methods, including systematic bias (mean of differences), mean absolute error (MAE) and mean absolute percentage error (MAPE), Pearson product moment correlation coefficient (r), Lin concordance correlation coefficient (CCC), and within-subject coefficient of variation (WSCV). Results: All 16 participants (female=7; male=9; mean 27.4, SD 5.8 years) completed the study. The Verity Sense, worn on the upper arm, demonstrated excellent accuracy across most activities, with a systematic bias of ?0.05 bpm, MAE of 1.43 bpm, MAPE of 1.35%, r=1.00, and CCC=1.00. It also demonstrated high reliability across all activities with a WSCV of 2.57% and no significant differences between the 2 sessions. The wrist-worn Vantage V2 demonstrated moderate accuracy with a slight overestimation compared with the ECG and considerable variation in accuracy depending on the activity. For the nondominant wrist, it demonstrated a systematic bias of 2.56 bpm, MAE of 6.41 bpm, MAPE 6.82%, r=0.93, and CCC=0.92. Reliability varied considerably, ranging from a WSCV of 3.64% during postexercise sitting to 23.03% during lying down. Conclusions: The Verity Sense was found to be highly accurate and reliable, outperforming many other wearable HR devices and establishing itself as a strong alternative to ECG-based chest straps, especially when worn on the upper arm. The Vantage V2 was found to have moderate accuracy, with performance highly dependent on activity type and intensity. While it exhibited greater variability and limitations at lower HR, it performed better at higher intensities and outperformed several wrist-worn devices from previous research, particularly during vigorous activities. These findings highlight the importance of device selection and wearing position to ensure the highest possible accuracy in the intended context. UR - https://cardio.jmir.org/2025/1/e67110 UR - http://dx.doi.org/10.2196/67110 ID - info:doi/10.2196/67110 ER - TY - JOUR AU - Chiu, Ching-Ju AU - Hua, Lin-Chun AU - Chiang, Jung-Hsien AU - Chou, Chieh-Ying PY - 2025/3/18 TI - User-Centered Prototype Design of a Health Care Robot for Treating Type 2 Diabetes in the Community Pharmacy: Development and Usability Study JO - JMIR Hum Factors SP - e48226 VL - 12 KW - robot KW - diabetes KW - self-management KW - middle-aged adult KW - community pharmacy KW - older adult KW - prototype N2 - Background: Technology can be an effective tool for providing health services and disease self-management, especially in diabetes care. Technology tools for disease self-management include health-related applications for computers and smartphones as well as the use of robots. To provide a more effective continuity of care and to better understand and facilitate disease management in middle-aged and older adult patients with diabetes, robots can be used to improve the quality of care and supplement community health resources, such as community pharmacies. Objective: The aim of this study was to develop a health care robot prototype that can be integrated into current community pharmacies. Methods: Three user-centered approaches were used: (1) review of the literature on technology use among older adults, 2) reference to the seven key diabetes self-care behaviors by the American Association of Diabetes Educators (AADE), and (3) meeting with health care providers in the community. Field investigations and interviews were conducted at community pharmacies and diabetes health education centers to determine the appearance, interface, content, and function of the robot. Results: The results show that diabetes health care prototype robots can be established through user-centered design. The following important features were revealed: (1) perceived ease of use is considered a friendly operating interface; therefore, we used less than 3 buttons in an interface; (2) minimization of the interface between blue and yellow, which is unfriendly to older adults; (3) the health education mode was the most preferred mode with sound, image, and video presentation; (4) the most predilected functions are health education resources and health records, and that patient data can be easily collected through health education games and dialogue with robots; and (5) touching the screen is the most preferred operation mode. Conclusions: An evidence-based health care robot can be developed through user-centered design, an approach in which a model that connects medical needs to people with health conditions can be built, thereby facilitating the sustainable development of technology in the diabetes care field. UR - https://humanfactors.jmir.org/2025/1/e48226 UR - http://dx.doi.org/10.2196/48226 ID - info:doi/10.2196/48226 ER - TY - JOUR AU - Brobbin, Eileen AU - Drummond, Colin AU - Parkin, Stephen AU - Deluca, Paolo PY - 2025/3/14 TI - Use of Wearable Transdermal Alcohol Sensors for Monitoring Alcohol Consumption After Detoxification With Contingency Management: Pilot Randomized Feasibility Trial JO - JMIR Hum Factors SP - e64664 VL - 12 KW - alcohol KW - alcohol dependence KW - alcohol monitoring KW - alcohol treatment KW - contingency management KW - transdermal alcohol sensor KW - transdermal technology KW - wearable KW - wearable alcohol biosensor N2 - Background: Wearable transdermal alcohol sensor (TAS) devices generate continuous data on alcohol consumption through the indiscernible sweat vapors on the skin. This continuous alcohol monitoring capability could provide a new method for alcohol services to monitor service users at various stages of their alcohol treatment. Objective: We aimed to assess the feasibility of using a TAS as part of alcohol treatment with alcohol service users using the device with or without contingency management (CM). Methods: A feasibility study was conducted of a convenience sample of 29 current service users from 3 South London alcohol services. Participants were randomized into either a control (treatment as usual) or CM group (treatment as usual+CM). We assessed the feasibility of enrollment, participation, device tampering and return, and device wearability and the accuracy of data capture. These data were reported descriptively where appropriate, the groups were compared, and alcohol self-report data were compared to the transdermal alcohol concentration to assess accuracy. Results: A total of 34 individuals were approached, and 32 (94%) were enrolled and randomized (n=17, 53% to the control group and n=15, 47% to the CM group) over 5 months. In total, 3 participants withdrew (n=2, 67% from the control group and n=1, 33% from the CM group). There was a total of 203 meetings arranged (29 participants × 7 meetings), and 185 (91.1%) were attended. Only 1 of the 29 participants (3%) admitted to turning the TAS off to avoid monitoring. There were some issues with the TAS not functioning properly and not being able to be cleaned. Removals were recorded, but the definition of TAS removal may need to be improved for future trials. There was a high TAS return rate (28/29, 97% of the participants returned the TAS). Secondary outcomes suggest that the BACtrack Skyn remains an accurate tool to monitor alcohol consumption compared to self-report data and that it is acceptable to wearers over 2 weeks, with many participants (27/28, 96%) answering that they would wear it again and for longer but that the CM procedure could be made clearer. Conclusions: The delivery of CM via a TAS was feasible in this study, but recommendations for a future larger trial include that the study design should be changed to provide an operationalized rather than manual method of checking whether TAS data meet CM criteria. This would reduce researcher burden and researcher and participant time. Current recruitment and research meeting design seem suitable for a future larger trial. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 UR - https://humanfactors.jmir.org/2025/1/e64664 UR - http://dx.doi.org/10.2196/64664 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64664 ER - TY - JOUR AU - Isaac, Fadia AU - Klein, Britt AU - Nguyen, Huy AU - Watson, Shaun AU - Kennedy, A. Gerard PY - 2025/3/14 TI - Digital Cognitive Behavioral Therapy?Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial JO - JMIR Hum Factors SP - e65228 VL - 12 KW - insomnia KW - nightmares KW - posttraumatic stress disorder KW - PTSD KW - wildfires KW - cognitive behavioral therapy for insomnia KW - CBTi KW - exposure, relaxation, and rescripting therapy KW - ERRT KW - Sleep Best-i KW - mobile health KW - mHealth KW - digital health KW - computer KW - eHealth KW - bushfires N2 - Background: Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. Objective: This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Methods: Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ?8 on the Insomnia Severity Index, a score of ?3 on the Nightmare Disorder Index, or a score of ?31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants? ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder?7, the Patient Health Questionnaire?9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Results: Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention?s effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire?9. No changes were detected on the Generalized Anxiety Disorder?7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. Conclusions: The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054 UR - https://humanfactors.jmir.org/2025/1/e65228 UR - http://dx.doi.org/10.2196/65228 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65228 ER - TY - JOUR AU - Nonaka, Sayuri AU - Fujii, Susumu AU - Yamada, Chris Kosuke PY - 2025/3/5 TI - Purposes of Smartphone Health Care Apps and the Practicality of Their Functions in Disaster Situations: Qualitative Function Assessment Study JO - JMIR Form Res SP - e56862 VL - 9 KW - health care KW - disaster medicine KW - mobile app KW - survey KW - disaster situations KW - self-reliance KW - Japan KW - disaster response KW - mobile phone N2 - Background: Japan has experienced various natural disasters, including the Great East Japan Earthquake in 2011. It becomes crucial to focus on strengthening self-help measures through health care apps that are used in normal times to help people during disasters. However, little is known about what health care apps would be useful in times of disaster. Objective: This study aimed to investigate the prevalent functionalities and purposes of using health care apps during normalcy, explore their potential utility, and propose strategies for disaster response through their utilization. Methods: We focus on highly ranked health care apps (within the top 100 in the health care category for iPhones by Apple, Inc for a certain period) and reclassify their purpose of use, such as sleep, relaxation, and exercise, in detail. We also investigate the functions within each health care app (measurement, recording, advice, content provision, and guidance to actual services), based on which we determine their potential utilization during disasters and anticipate potential solutions to address disaster-related challenges. We also consider the ideal framework of health care apps in disaster response, exploring possibilities such as the necessity of new disaster-specific apps or the adaptation of existing health care apps for disaster scenarios. Results: Among the 70 free apps, the predominant functions included ?recording? (n=60 cases, 86%) and ?measurement? (n=47 cases, 67%), primarily encompassing the mechanical functions of wearable devices and smartphones. A similar trend was seen in the 77 paid apps, but ?content provision? (n=54 cases, 70%) was the most prevalent. Furthermore, the ?content provision? function was particularly common in the ?purposes of use? categories ?sleep? (?211=29; P<.001), ?relaxation? (?211=14.6; P<.001), and ?exercise? (?211=9.3; P=.002). This suggested the possibility of using the content provision function in existing health care apps to support mental and physical health even during a disaster. Conclusions: The widespread use of apps during normal times could minimize hesitation in adopting them during disasters. The findings emphasize the potential for augmenting disaster-specific content within existing apps rather than developing new ones. This approach aligns with the likelihood of preinstalled app use during emergencies, indicating a pragmatic strategy for enhancing disaster response content within prevalent apps. UR - https://formative.jmir.org/2025/1/e56862 UR - http://dx.doi.org/10.2196/56862 ID - info:doi/10.2196/56862 ER - TY - JOUR AU - Lai, Yi-Jen AU - Chiu, Hsiao-Yean AU - Wu, Ko-Chiu AU - Chang, Chun-Wei PY - 2025/3/4 TI - Diaphragmatic Breathing Interfaces to Promote Relaxation for Mitigating Insomnia: Pilot Study JO - JMIR Serious Games SP - e67000 VL - 13 KW - brief behavioral treatment for insomnia KW - sleep self-efficacy KW - mobile health KW - mHealth KW - breathing training cognitive load KW - attention KW - gamification KW - diaphragmatic breathing KW - insomnia KW - sleep KW - games KW - relaxation KW - breathing KW - breathing guidance KW - questionnaire KW - mental KW - cognition N2 - Background: Brief behavioral treatment for insomnia is an effective short-term therapy focusing on stimulus control and sleep restriction to enhance sleep quality. As a crucial part of this therapy, diaphragmatic breathing is often recommended when patients fail to fall asleep within 30 minutes. With the rise of health apps and gamification, these tools are increasingly seen as effective ways to boost self-efficacy and user engagement; however, traditional games tend to increase attention, which can negatively impact sleep and contradicts the aim of sleep therapy. This study thus explored the potential for gamification techniques to promote relaxation without disrupting sleep processes. Objective: The study developed 4 breathing guidance mechanisms, ranging from concrete to abstract: number countdown, zoom-in/out, up/down, and color gradients. The objective was to explore the relationship between game mechanics, cognitive load, relaxation effects, and attention as well as to understand how different designs impact users with varying levels of insomnia. Methods: The study was conducted in 2 phases. The first phase involved a questionnaire on the 4 guidance mechanisms. In the second phase, 33 participants classified by insomnia severity completed a Sleep Self-Efficacy Scale. They then engaged in 5 minutes of diaphragmatic breathing using each of the 4 interfaces. Relaxation effects were measured using heart rate variability via a smartwatch, attention and relaxation levels via an electroencephalogram device, and respiratory rate via a smartphone. Participants also completed the Game Experience Questionnaire and NASA Task Load Index, followed by user interviews. Results: The results indicated that competence, immersion, and challenge significantly influenced cognitive load. Specifically, competence and immersion reduced cognitive load, while challenge, negative affect, and positive affect were correlated with relaxation. Negative affect showed a positive correlation with the mean root mean square of successive differences, while positive affect exhibited a negative correlation with the mean root mean square of successive differences. Cognitive load was found to affect both relaxation and attention, with a negative correlation between mental demand and attention and a positive correlation between temporal demand and respiratory rate. Sleep self-efficacy was negatively correlated with temporal demand and negative affect and positively correlated with competence and immersion. Conclusions: Interfaces offering moderate variability and neither overly abstract nor too concrete guidance are preferable. The up/down interface was most effective, showing the best overall relaxation effect. Conversely, the number countdown interface was stress-inducing, while the zoom-in/out interface had a significant impact on insomnia-related issues, making them less suitable for insomnia-related breathing exercises. Participants showed considerable variability in their response to the color gradient interface. These findings underscore the importance of carefully considering game design elements in relaxation training. It is essential that breathing guidance designs account for the impact of the game experience to effectively promote relaxation in users. UR - https://games.jmir.org/2025/1/e67000 UR - http://dx.doi.org/10.2196/67000 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053714 ID - info:doi/10.2196/67000 ER - TY - JOUR AU - de Thurah, Lena AU - Kiekens, Glenn AU - Weermeijer, Jeroen AU - Uyttebroek, Lotte AU - Wampers, Martien AU - Bonnier, Rafaël AU - Myin-Germeys, Inez PY - 2025/3/3 TI - Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis JO - JMIR Hum Factors SP - e60096 VL - 12 KW - digital self-monitoring KW - technology appropriation KW - experience sampling method KW - mental health care KW - mental health KW - self-monitoring KW - digital health KW - adoption KW - implementation KW - thematic KW - usability KW - interview KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - acceptance N2 - Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants? prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients? mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians? and clients? choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. UR - https://humanfactors.jmir.org/2025/1/e60096 UR - http://dx.doi.org/10.2196/60096 ID - info:doi/10.2196/60096 ER - TY - JOUR AU - Plouvier, Pauline AU - Marcilly, Romaric AU - Robin, Geoffroy AU - Benamar, Chaymae AU - Robin, Camille AU - Simon, Virginie AU - Piau, Sophie Anne AU - Cambay, Isabelle AU - Schiro, Jessica AU - Decanter, Christine PY - 2025/2/24 TI - Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study JO - JMIR Hum Factors SP - e63570 VL - 12 KW - mobile apps KW - mHealth KW - mobile health KW - assisted reproductive technologies KW - evaluation KW - satisfaction KW - reproduction KW - fertility KW - ovarian stimulation KW - ease of use KW - usability KW - midwives KW - obstetrics KW - gynecology N2 - Background: Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR). Objective: This study aimed to evaluate the patients? and midwives? levels of satisfaction with the connected mobile app. Methods: We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users? opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives. Results: Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app?s ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors. Conclusions: The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team?s workload, the time savings provided by the app constitute a nonnegligible advantage. UR - https://humanfactors.jmir.org/2025/1/e63570 UR - http://dx.doi.org/10.2196/63570 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63570 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Peralta, Claudia AU - Peck, Matt AU - Reilly, Blaine AU - Buller, K. Mary PY - 2025/2/21 TI - Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study JO - JMIR Hum Factors SP - e67962 VL - 12 KW - technology-based bullying intervention KW - STAC-T KW - usability testing KW - middle school KW - rural N2 - Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. UR - https://humanfactors.jmir.org/2025/1/e67962 UR - http://dx.doi.org/10.2196/67962 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67962 ER - TY - JOUR AU - Beckett, Darcy AU - Curtis, Rachel AU - Szeto, Kimberley AU - Maher, Carol PY - 2025/2/13 TI - Changing User Experience of Wearable Activity Monitors Over 7 Years: Repeat Cross-Sectional Survey Study JO - J Med Internet Res SP - e56251 VL - 27 KW - cross-sectional survey KW - activity tracker KW - user experience KW - physical activity KW - sleep KW - diet KW - health behaviour KW - wearable activity trackers KW - cohort KW - Apple KW - Fitbit KW - preferences KW - reliability KW - accessibility KW - lifestyle KW - mobile phone N2 - Background: Lifestyle behaviors, including physical inactivity, sedentary behavior, poor sleep, and unhealthy diet, significantly impact global population health. Wearable activity trackers (WATs) have emerged as tools to enhance health behaviors; however, their effectiveness and continued use depend on their user experience. Objective: This study aims to explore changes in user experiences, preferences, and perceived impacts of WATs from 2016 to 2023. Methods: We conducted a cross-sectional online survey among an international cohort of adults (n=475, comprising 387 current and 88 former WAT users). Results were compared with a 2016 cross-sectional online survey (n=237, comprising 200 current and 37 former WAT users) using descriptive statistics and chi-square tests. The survey examined brand preference, feature usefulness, motivations, perceived health behavior change, social sharing behaviors, and technical issues. Results: In 2023, Apple (210/475, 44%) and Fitbit (101/475, 21%) were the most commonly used devices, compared with the 2016 survey where Fitbit (160/237, 68%) and Garmin devices (39/237, 17%) were most common. The median usage duration in 2023 was 18 months, significantly longer than the 7 months reported in 2016, with most users planning ongoing use. Users in both survey years reported greater improvements in physical activity than diet or sleep, despite lower improvement in physical activity in 2023 compared with 2016, contrasted with greater perceived improvements in diet and sleep. Social media sharing of WAT data notably rose to 73% (283/387) in 2023 from 35% (70/200) in 2016. However, reports of technical issues and discomfort increased, alongside a decrease in overall positive experiences. There was also a noticeable shift in discontinuation reasons, from having learned everything possible in 2016 to dissatisfaction in 2023. Conclusions: The study highlights significant shifts in WAT usage, including extended use and evolving preferences for brands and features. The rise in social media sharing indicates a deeper integration of WATs into everyday life. However, user feedback points to a need for enhanced design and functionality despite technological progress. These findings illustrate WAT?s potential in health promotion, emphasizing the need for user-focused design in diverse populations to fully realize their benefits in enhancing health behaviors. UR - https://www.jmir.org/2025/1/e56251 UR - http://dx.doi.org/10.2196/56251 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56251 ER - TY - JOUR AU - Lee, Sol-Hee AU - Kim, Jiae AU - Kim, Han-Joon PY - 2025/2/13 TI - Smartphone Application?Based Voice and Speech Training Program for Parkinson Disease: Feasibility and Satisfaction Study With a Preliminary Rater-Blinded Single-Arm Pretest and Posttest Design JO - J Med Internet Res SP - e63166 VL - 27 KW - Parkinson disease KW - speech therapy KW - mHealth KW - home-based training KW - self-delivered KW - digital health care KW - app KW - feasibility KW - voice therapy KW - mobile phone KW - satisfaction KW - effectiveness KW - smartphone KW - apps KW - single-arm study KW - mobility KW - mobile health KW - acoustic analysis KW - self-training N2 - Background: Up to 75% of patients with Parkinson disease (PD) experience voice and speech impairments, such as breathy phonation and low speech volume, which worsen over time and negatively impact the quality of life. However, given their increasingly limited mobility, face-to-face speech therapy is often inaccessible. Mobile health (mHealth) apps offer accessible and cost-effective alternatives; yet, their application in PD-specific, self-delivered voice therapy remains underexplored. Objective: This study aimed to evaluate the feasibility, adherence, and satisfaction of a self-delivered smartphone app for voice therapy in patients with PD, designed to minimize speech-language pathologist involvement while promoting patient independence. In addition, it seeks to assess the preliminary therapeutic effectiveness of the app in addressing voice and speech problems in this population. Methods: A single-arm, rater-blinded, and pretest and posttest study was conducted between September to November 2023. Patients with PD with voice and speech problems who have no problem with using Android (Google) smartphones were recruited. Participants downloaded the researcher-developed mHealth app on their smartphone and participated in a patient-tailored 5-week home-based speech training program. Each session included 5 stages: breathing, oral motor exercises, loudness, prosody, and functional speaking. The training program consisted of 20 sessions, with participants completing 1 session per day, 4 days per week. Each session lasted approximately 20-30 minutes. Adherence was monitored through app logs, satisfaction was assessed through a phone survey, and therapeutic effectiveness was evaluated using acoustic analysis and auditory-perceptual assessments. Results: Out of 30 patients were initially recruited, but 2 of them withdrew. Out of 25 participants completed all the training sessions while 3 dropped out. The adherence was above 90% in 20 participants (80%, 20/25), 70% to 90% in 4 (16%, 4/25), and below 70% in 4 (16%, 4/25). Satisfaction was 75% (18/24) among the 24 people who participated in the survey. Significant improvements were observed in all acoustic measures: the maximum phonation time increased from 11.15 (SD 5.38) seconds to 14.01 (SD 5.64) seconds (P=.003), and vocal intensity increased from 71.59 (SD 4.39) dB to 73.81 (SD 3.48) dB (P<.001) across both sustained phonation and reading tasks. Voice quality scores on the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale improved significantly (all components P<.001). Furthermore, 58.3% (14/24) of participants reported subjective improvements in their voice. Conclusions: This study demonstrates that home-based, self-training speech therapy delivered through a mHealth app is a feasible solution for patients with PD, suggesting that mHealth apps can serve as a convenient and effective alternative to face-to-face therapy by enhancing accessibility and empowering patients to actively manage their condition. UR - https://www.jmir.org/2025/1/e63166 UR - http://dx.doi.org/10.2196/63166 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63166 ER - TY - JOUR AU - Ogorek, Benjamin AU - Rhoads, Thomas AU - Smith, Erica PY - 2025/2/3 TI - Collecting Real-World Data via an In-Home Smart Medication Dispenser: Longitudinal Observational Study of Survey Panel Persistency, Response Rates, and Psychometric Properties JO - JMIR Hum Factors SP - e60438 VL - 12 KW - real-world data KW - real-world evidence KW - patient-reported outcomes KW - longitudinal studies KW - survey methods N2 - Background: A smart medication dispenser called ?spencer? is a novel generator of longitudinal survey data. The patients dispensing medication act as a survey panel and respond to questions about quality of life and patient-reported outcomes. Objectives: Our goal was to evaluate panel persistency, survey response rates, reliability, and validity of surveys administered via spencer to 4138 polychronic patients residing in the United States and Canada. Methods: Patients in a Canadian health care provider?s program were included if they were dispensing via spencer in the June 2021 to February 2024 time frame and consented to have their data used for research. Panel persistency was estimated via discrete survival methods for 2 years and survey response rates were computed for 1 year. Patients were grouped by mean response rates in the 12th month (<90% vs ?90%) to observe differential response rate trends. For reliability and validity, we used a spencer question about recent falls with ternary responses value-coded ?1, 0, and 1. For reliability, we computed Pearson correlation between mean scores over 2 years of survey responses, and transitions between mean score intervals of [0, 0.5), [?0.5, 0.5), and [0.5, 1]. For validity, we measured the association between the falls question and known factors influencing fall risk: age, biological sex, quality of life, physical and emotional health, and use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, using repeated-measures regression for covariates and Kendall ? for concomitant spencer questions. Results: From 4138 patients, dispenser persistency was 68.3% (95% CI 66.8%?69.8%) at 1 year and 51% (95% CI 49%?53%) at 2 years. Within the cohort observed beyond 1 year, 82.3% (1508/1832) kept surveys enabled through the 12th month with a mean response rate of 84.1% (SD 26.4%). The large SD was apparent in the subgroup analysis, where a responder versus nonresponder dichotomy was observed. For 234 patients with ?5 fall risk responses in each of the first 2 years, the Pearson correlation estimate between yearly mean scores was 0.723 (95% CI 0.630?0.798). For mean score intervals [0, 0.5), [?0.5, 0.5), and [0.5, 1], self-transitions were the most common, with 59.8% (140/234) of patients starting and staying in [0.5, 1]. Fall risk responses were not significantly associated with sex (P=.66) or age (P=.76) but significantly related to selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor usage, quality of life, depressive symptoms, physical health, disability, and trips to the emergency room (P<.001). Conclusions: A smart medication dispenser, spencer, generated years of longitudinal survey data from patients in their homes. Panel attrition was low, and patients continued to respond at high rates. A fall risk measure derived from the survey data showed evidence of reliability and validity. An alternative to web-based panels, spencer is a promising tool for generating patient real-world data. UR - https://humanfactors.jmir.org/2025/1/e60438 UR - http://dx.doi.org/10.2196/60438 ID - info:doi/10.2196/60438 ER - TY - JOUR AU - Maddison, Ralph AU - Nourse, Rebecca AU - Daryabeygikhotbehsara, Reza AU - Tegegne, Kassaw Teketo AU - Jansons, Paul AU - Rawstorn, Charles Jonathan AU - Atherton, John AU - Driscoll, Andrea AU - Oldenburg, Brian AU - Vasa, Rajesh AU - Kostakos, Vassilis AU - Dingler, Tilman AU - Abbott, Gavin AU - Scuffham, Paul AU - Manski-Nankervis, Elizabeth Jo-Anne AU - Kwasnicka, Dominika AU - Kensing, Finn AU - Islam, Shariful Sheikh Mohammed AU - Maeder, Anthony AU - Zhang, Yuxin PY - 2025/1/28 TI - Digital Home-Based Self-Monitoring System for People with Heart Failure: Protocol for Development of SmartHeart and Evaluation of Feasibility and Acceptability JO - JMIR Res Protoc SP - e62964 VL - 14 KW - smart home KW - health KW - chronic conditions KW - digital health KW - technology KW - behavior change KW - wearables KW - methodological considerations N2 - Background: Heart failure (HF) is a chronic, progressive condition where the heart cannot pump enough blood to meet the body?s needs. In addition to the daily challenges that HF poses, acute exacerbations can lead to costly hospitalizations and increased mortality. High health care costs and the burden of HF have led to the emerging application of new technologies to support people living with HF to stay well while living in the community. However, many digital solutions have not involved consumers and health care professionals in their design, leading to poor adoption. The SmartHeart project aimed to codevelop a smart health ecosystem to support the early detection of HF deterioration and encourage self-care, potentially preventing hospitalizations. Objective: This study aims to provide an overview of the SmartHeart project by describing our approach to designing the SmartHeart system, outlining its features, and describing the planned pilot study to determine the feasibility of the system. Methods: We used the Integrate, Design, Assess, and Share (IDEAS) framework to guide the development of the SmartHeart system, involving users (people with HF and their caregivers) and stakeholders (health care providers involved in the management of HF) in its design. SmartHeart is a complete remote heart health monitoring and automated feedback delivery system. It includes 2 user interfaces for patients: an Amazon Alexa conversational agent and a smartphone app. The system collects physiological, symptom, and behavioral data through wireless sensors and self-reports from users. These data are processed and analyzed to provide personalized health insights, self-care support, and alerts in case of health deterioration. The system also includes a web-based user interface for health care professionals, allowing them to access data, send messages to users, and receive notifications about potential health deterioration. A single-arm, multicenter pilot trial (N=20) is planned to determine the feasibility and acceptability of SmartHeart before evaluation through a randomized controlled trial. The primary outcome will be a description of the study's feasibility (recruitment, attrition, engagement, and changes in self-care). Results: The SmartHeart study started in January 2021 on procurement of funding. Recruitment for the pilot trial started in August 2024 and will be completed by March 2025. We have currently enrolled 12 participants. Follow-up of all participants will be completed by the end of May 2025. Conclusions: We have co-designed and developed a complete remote heart health monitoring and automated feedback delivery system for the early detection of HF deterioration and prevention of HF-related hospitalizations. The next step is a pilot study, which will provide valuable information on feasibility and preliminary effects to inform a larger evaluation trial. SmartHeart has the potential to augment existing health services and help people with HF stay well while living in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/62964 UR - https://www.researchprotocols.org/2025/1/e62964 UR - http://dx.doi.org/10.2196/62964 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62964 ER - TY - JOUR AU - Li, Ming-wei AU - Tsai, Yao-Chou AU - Yang, Shei-Dei Stephen AU - Pong, Yuan-Hung AU - Tsai, Yu-Ting AU - Tsai, Fang-Sheng Vincent PY - 2025/1/28 TI - The Evolution of Uroflowmetry and Bladder Diary and the Emerging Trend of Using Home Devices From Hospital to Home JO - Interact J Med Res SP - e66694 VL - 14 KW - lower urinary tract symptoms KW - uroflowmetry KW - bladder diary KW - home devices KW - bladder KW - noninvasive KW - evaluations KW - viewpoint KW - diagnostic KW - mobile health UR - https://www.i-jmr.org/2025/1/e66694 UR - http://dx.doi.org/10.2196/66694 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66694 ER - TY - JOUR AU - Zeiler, Michael AU - Dietzel, Nikolas AU - Haug, Fabian AU - Haug, Julian AU - Kammerer, Klaus AU - Pryss, Rüdiger AU - Heuschmann, Peter AU - Graessel, Elmar AU - Kolominsky-Rabas, L. Peter AU - Prokosch, Hans-Ulrich PY - 2025/1/22 TI - A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study JO - JMIR Hum Factors SP - e65022 VL - 12 KW - dementia KW - usability KW - development KW - digiDEM KW - cognitive impairment KW - older adults KW - aging KW - mobile health KW - mHealth KW - design KW - feedback KW - screening KW - user centred KW - cognitive disorder KW - user-centered KW - mobile app N2 - Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ?65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams? experiences. The prototype was tested in several iterations by various end users and continuously improved. The app?s usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. UR - https://humanfactors.jmir.org/2025/1/e65022 UR - http://dx.doi.org/10.2196/65022 ID - info:doi/10.2196/65022 ER - TY - JOUR AU - Salwei, Elizabeth Megan AU - Anders, Shilo AU - Reale, Carrie AU - Slagle, M. Jason AU - Ricketts, Todd AU - Weinger, B. Matthew PY - 2025/1/20 TI - Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing JO - JMIR Hum Factors SP - e65142 VL - 12 KW - usability KW - human factors KW - patient safety KW - over-the-counter hearing aids KW - direct-to-consumer hearing aids KW - medical device KW - hearing loss KW - adult KW - hearing impairment KW - hearing aid use KW - hearing care KW - formative usability test KW - safety KW - mobile phone N2 - Background: Only 15% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2?5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. UR - https://humanfactors.jmir.org/2025/1/e65142 UR - http://dx.doi.org/10.2196/65142 ID - info:doi/10.2196/65142 ER - TY - JOUR AU - Kim, Yumi AU - Rimmer, H. James AU - Lai, Byron AU - Oster, Robert AU - Cowan, Rachel AU - Young, Hui-Ju AU - Fisher, Gordon AU - Kim, Younguk AU - Giannone, John AU - Wilroy, D. Jereme PY - 2025/1/15 TI - Cardiometabolic Health Intervention Using Music and Exercise (CHIME) Delivered via Telehealth to Wheelchair Users: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e57423 VL - 14 KW - exercise KW - physical activity KW - wheelchair user KW - telehealth KW - disability N2 - Background: Wheelchair users live predominantly sedentary lifestyles and have a substantially higher risk for cardiometabolic disease and mortality compared to people without disabilities. Exercise training has been found to be effective in improving cardiometabolic health (CMH) outcomes among people without disabilities, but research on wheelchair users is limited and of poor quality. Objective: The primary aim of this study is to examine the immediate and sustained effects of a 24-week, telehealth, movement-to-music cardiovascular (M2M-C) exercise program on core indicators of CMH among adult wheelchair users compared to an active control group. The secondary aim is to explore the beneficial effects of M2M-C exercises on cardiovascular capacity, physical activity, and quality of life. Intervention components include tailored exercises and remote performance monitoring, delivered via live videoconference training by a telecoach and asynchronous videos. Methods: This study?s design is a parallel-arm randomized controlled trial enrolling 132 physically inactive adult wheelchair users with poor cardiometabolic profiles. The M2M-C intervention group involves 24 weeks of virtual live and monitored home exercise training (3×/wk, 15-40 min/session), followed by a 12-week maintenance period where participants have access to an online media library of exercise videos. The control group involves 36 weeks of self-guided exercise through access to a media library of exercise videos, including videos for range of motion, muscle strength, and balance. The primary outcomes are cardiometabolic indicators of health, and assessors are blinded. Results: Recruitment procedures started in January 2024 with the first participant enrolled on March 18, 2024. All data are anticipated to be collected by November 2027, and the main results of the trial are anticipated to be published by February 2028. Secondary analyses of data will be subsequently published. A total of 16 participants have been recruited as of paper submission. Conclusions: The knowledge obtained from this trial will provide evidence to inform exercise prescriptions aimed at improving CMH among adult wheelchair users. Trial Registration: ClinicalTrials.gov NCT05606432; https://clinicaltrials.gov/study/NCT05606432 International Registered Report Identifier (IRRID): DERR1-10.2196/57423 UR - https://www.researchprotocols.org/2025/1/e57423 UR - http://dx.doi.org/10.2196/57423 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57423 ER - TY - JOUR AU - Inagaki, Keigo AU - Tsuriya, Daisuke AU - Hashimoto, Takuya AU - Nakamura, Katsumasa PY - 2025/1/14 TI - Verification of the Reliability of an Automated Urine Test Strip Colorimetric Program Using Colorimetric Analysis: Survey Study JO - JMIR Form Res SP - e62772 VL - 9 KW - urine test strip KW - reliability KW - automatic urine analyzer KW - quasi-experimental study KW - colorimetric analysis KW - colorimetric KW - urinalysis KW - urinary KW - urine KW - evaluation KW - mobile phone N2 - Background: One method for noninvasive and simple urinary microalbumin testing is urine test strips. However, when visually assessing urine test strips, accurate assessment may be difficult due to environmental influences?such as lighting color and intensity?and the physical and psychological influences of the assessor. These complicate the formation of an objective assessment. Objectives: This study developed an ?automated urine test strip colorimetric program? (hereinafter referred to as ?this program?) to objectively assess urine test strips. Using this program may allow urine tests to be conducted at home. In this study, urine samples from hospitalized or outpatient patients were randomly obtained, and the reliability of this program was verified by comparing the agreement rate between this program and an automatic urine analyzer (US-3500 [Eiken Chemical Co, Ltd] and LABOSPECT 006 [Hitachi High-Tech Co, Ltd]). Furthermore, the sensitivity and specificity of the urine albumin test were investigated, and its applicability to screening for microalbuminuria was verified. Methods: A urine test strip was placed in a photography box with constant light intensity and color temperature conditions. The image taken with a smartphone camera on top of the photography box was judged by this program. This program used Accelerated KAZE to perform image-matching processing to reduce the effect of misalignment during photography. It also calculated and judged the item with the smallest color difference between the color chart and the urine test strip using the CIEDE2000 color difference formula. The agreement rate of the results of this program was investigated using the results of an automatic urine analyzer as the gold standard. Results: Compared with the judgments of an automatic urine analyzer, the average agreement rate for 12 items (protein, glucose, urobilinogen, bilirubin, ketone bodies, specific gravity, occult blood, pH, white blood cells, nitrite, creatinine, and albumin) was 78.6%. Furthermore, the average agreement rate of the 12 items within ą1 rank was 95.4%. The results showed a sensitivity of 100% and a specificity of 58.6% in determining albumin in urine, which is important for determining the stage of diabetic nephropathy. Finally, the area under the curve (0.907) derived from the receiver operating characteristic curve was satisfactory. Conclusions: The program developed by the authors can determine urine test strips without requiring calibration in a certain shooting environment. If this program can be used at home to perform urinary microalbumin tests, the early detection and treatment of diabetic nephropathy may prevent the condition from becoming severe. UR - https://formative.jmir.org/2025/1/e62772 UR - http://dx.doi.org/10.2196/62772 ID - info:doi/10.2196/62772 ER - TY - JOUR AU - Toben, Daan AU - de Wind, Astrid AU - van der Meij, Eva AU - Huirne, F. Judith A. AU - Anema, R. Johannes PY - 2025/1/14 TI - A Patient-Oriented Implementation Strategy for a Perioperative mHealth Intervention: Feasibility Cohort Study JO - JMIR Perioper Med SP - e58878 VL - 8 KW - perioperative care KW - recovery KW - feasibility KW - convalescence KW - patient-oriented KW - surgery KW - perioperative KW - eHealth KW - mHealth KW - tailor KW - customize KW - patient care KW - digital intervention KW - health intervention KW - patient education KW - surgical care KW - hospital care KW - digital health KW - perioperative medicine KW - elective surgery KW - technology KW - caregiver KW - mobile app KW - digital care N2 - Background: Day surgery is being increasingly implemented across Europe, driven in part by capacity problems. Patients recovering at home could benefit from tools tailored to their new care setting to effectively manage their convalescence. The mHealth application ikHerstel is one such tool, but although it administers its functions in the home, its implementation hinges on health care professionals within the hospital. Objective: We conducted a feasibility study of an additional patient-oriented implementation strategy for ikHerstel. This strategy aimed to empower patients to access and use ikHerstel independently, in contrast to implementation as usual, which hinges on the health care professional acting as gatekeeper. Our research question was ?How well are patients able to use ikHerstel independently of their health care professional?? Methods: We investigated the implementation strategy in terms of its recruitment, reach, dose delivered, dose received, and fidelity. Patients with a recent or prospective elective surgery were recruited using a wide array of materials to simulate patient-oriented dissemination of ikHerstel. Data were collected through web-based surveys. Descriptive analysis and open coding were used to analyze the data. Results: Recruitment yielded 213 registrations, with 55 patients ultimately included in the study. The sample was characterized by patients undergoing abdominal surgery, with high literacy and above average digital health literacy, and included an overrepresentation of women (48/55, 87%). The implementation strategy had a reach of 81% (63/78), with 87% (55/67) of patients creating a recovery plan. Patients were satisfied with their independent use of ikHerstel, rating it an average 7.0 (SD 1.9) of 10, and 54% (29/54) of patients explicitly reported no difficulties in using it. A major concern of the implementation strategy was conflicts in recommendations between ikHerstel and the health care professionals, as well as the resulting feelings of insecurity experienced by patients. Conclusions: In this small feasibility study, most patients were satisfied with the patient-oriented implementation strategy. However, the lack of involvement of health care professionals due to the strategy contributed to patient concerns regarding conflicting recommendations between ikHerstel and health care professionals. UR - https://periop.jmir.org/2025/1/e58878 UR - http://dx.doi.org/10.2196/58878 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58878 ER - TY - JOUR AU - Rosin, Magda AU - Ni Mhurchu, Cliona AU - Umali, Elaine AU - Mackay, Sally PY - 2025/1/13 TI - Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study JO - JMIR Form Res SP - e60447 VL - 9 KW - healthy food policy KW - policy implementation KW - nutrition KW - food environment KW - hospital KW - workplace KW - web-based tool KW - digital tool KW - database KW - user testing KW - food KW - drink KW - nutrition professionals KW - acceptability KW - usability N2 - Background: Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective: This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods: The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the ?Discover? (understanding of current gaps) and ?Define? (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the ?Develop? phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final ?Deliver? phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results: A new digital tool, Healthy Kai (Food) Checker?a searchable database of packaged food and drink products that classifies items according to the Policy?s nutritional criteria?was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions: Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool?s acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool?s utility. UR - https://formative.jmir.org/2025/1/e60447 UR - http://dx.doi.org/10.2196/60447 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60447 ER - TY - JOUR AU - Chen, Fu-Yu AU - Lin, Tzu-Yao AU - Huang, Yi-Cheng AU - Widianawati, Evina PY - 2025/1/7 TI - Effectiveness of Using a Digital Wearable Plantar Pressure Device to Detect Muscle Fatigue: Within-Subject, Repeated Measures Experimental Design JO - JMIR Hum Factors SP - e65578 VL - 12 KW - muscle fatigue KW - plantar pressure sensors KW - wearable devices KW - home-based monitoring N2 - Background: Muscle fatigue, characterized by reduced force generation during repetitive contractions, impacts older adults doing daily activities and athletes during sports activities. While various sensors detect muscle fatigue via muscle activity, biochemical markers, and kinematic parameters, a real-time wearable solution with high usability remains limited. Plantar pressure monitoring detects muscle fatigue through foot loading changes, seamlessly integrating into footwear to improve the usability and compliance for home-based monitoring. Objective: This study aimed to investigate the effects of muscle fatigue on plantar pressure measurements using a self-developed wearable plantar pressure system. Methods: Twelve healthy participants completed a 5-minute calf muscle fatigue protocol. The plantar pressures and surface electromyography (sEMG) activity of the gastrocnemius muscles were recorded before and after exercise. The plantar pressures at 6 regions and the median frequency (MDF) of sEMG were analyzed to quantify fatigue. Results: The self-developed foot pressure system showed a significant decrease in plantar pressure peak values at the heel of the left (P=.003) and right feet (P=.001) and at the lateral toe of the left (P=.001) and right feet (P=.026). A significant increase was observed at the metatarsal head of both the left foot (P=.001) and the right foot (P=.017). The MDF of sEMG signals significantly decreased in the left (P=.001) and right gastrocnemius (P<.001). Conclusions: Plantar pressure changes and sEMG signals effectively detect gastrocnemius muscle fatigue using the proposed wearable system, supporting the development of a wearable solution for detecting muscle fatigue suitable for home-use. UR - https://humanfactors.jmir.org/2025/1/e65578 UR - http://dx.doi.org/10.2196/65578 ID - info:doi/10.2196/65578 ER - TY - JOUR AU - Smiley, Aref AU - Finkelstein, Joseph PY - 2024/12/27 TI - Home Automated Telemanagement System for Individualized Exercise Programs: Design and Usability Evaluation JO - JMIR Biomed Eng SP - e65734 VL - 9 KW - telemedicine KW - home-based exercise KW - telerehabilitation KW - remote cycling KW - usability KW - physical rehabilitation KW - exercise therapy N2 - Background: Exercise is essential for physical rehabilitation, helping to improve functional performance and manage chronic conditions. Telerehabilitation offers an innovative way to deliver personalized exercise programs remotely, enhancing patient adherence and clinical outcomes. The Home Automated Telemanagement (HAT) System, integrated with the interactive bike (iBikE) system, was designed to support home-based rehabilitation by providing patients with individualized exercise programs that can be monitored remotely by a clinical rehabilitation team. Objective: This study aims to evaluate the design, usability, and efficacy of the iBikE system within the HAT platform. We assessed the system?s ability to enhance patient adherence to prescribed exercise regimens while minimizing patient and clinician burden in carrying out the rehabilitation program. Methods: We conducted a quasi-experimental study with 5 participants using a pre- and posttest design. Usability testing included 2 primary tasks that participants performed with the iBikE system. Task completion times, adherence to exercise protocols, and user satisfaction were measured. A System Usability Scale (SUS) was also used to evaluate participants? overall experience. After an initial introduction, users performed the tasks independently following a 1-week break to assess retention of the system?s operation skills and its functionality. Results: Task completion times improved substantially from the pretest to the posttest: execution time for task 1 reduced from a mean of 8.6 (SD 4.7) seconds to a mean of 1.8 (SD 0.8) seconds, and the time for task 2 decreased from a mean of 315 (SD 6.9) seconds to a mean of 303.4 (SD 1.1) seconds. Adherence to the prescribed cycling speed also improved, with deviations from the prescribed speed reduced from a mean of 6.26 (SD 1.00) rpm (revolutions per minute) to a mean of 4.02 (SD 0.82) rpm (t=3.305, n=5, P=.03). SUS scores increased from a mean of 92 (SD 8.6) to a mean of 97 (SD 3.3), indicating high user satisfaction and confidence in system usability. All participants successfully completed both tasks without any additional assistance during the posttest phase, demonstrating the system?s ease of use and effectiveness in supporting independent exercise. Conclusions: The iBikE system, integrated into the HAT platform, effectively supports home-based telerehabilitation by enabling patients to follow personalized exercise prescriptions with minimal need for further training or supervision. The significant improvements in task performance and exercise adherence suggest that the system is well-suited for use in home-based rehabilitation programs, promoting sustained patient engagement and adherence to exercise regimens. Further studies with larger sample sizes are recommended to validate these findings and explore the long-term benefits of the system in broader patient populations. UR - https://biomedeng.jmir.org/2024/1/e65734 UR - http://dx.doi.org/10.2196/65734 UR - http://www.ncbi.nlm.nih.gov/pubmed/39658220 ID - info:doi/10.2196/65734 ER - TY - JOUR AU - Versluis, Anke AU - Penfornis, M. Kristell AU - van der Burg, A. Sven AU - Scheltinga, L. Bouke AU - van Vliet, M. Milon H. AU - Albers, Nele AU - Meijer, Eline PY - 2024/12/20 TI - Targeting Key Risk Factors for Cardiovascular Disease in At-Risk Individuals: Developing a Digital, Personalized, and Real-Time Intervention to Facilitate Smoking Cessation and Physical Activity JO - JMIR Cardio SP - e47730 VL - 8 KW - smoking KW - physical activity KW - virtual coach KW - eHealth KW - development KW - collaboration KW - conversational agent KW - risk factor KW - cardiovascular disease KW - CVD KW - digital KW - smoking cessation KW - intervention UR - https://cardio.jmir.org/2024/1/e47730 UR - http://dx.doi.org/10.2196/47730 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47730 ER - TY - JOUR AU - Cochran, M. Jeffrey PY - 2024/12/20 TI - Developing a Sleep Algorithm to Support a Digital Medicine System: Noninterventional, Observational Sleep Study JO - JMIR Ment Health SP - e62959 VL - 11 KW - actigraphy KW - machine learning KW - accelerometer KW - sleep-wake cycles KW - sleep monitoring KW - sleep quality KW - sleep disorder KW - polysomnography KW - wearable sensor KW - electrocardiogram N2 - Background: Sleep-wake patterns are important behavioral biomarkers for patients with serious mental illness (SMI), providing insight into their well-being. The gold standard for monitoring sleep is polysomnography (PSG), which requires a sleep lab facility; however, advances in wearable sensor technology allow for real-world sleep-wake monitoring. Objective: The goal of this study was to develop a PSG-validated sleep algorithm using accelerometer (ACC) and electrocardiogram (ECG) data from a wearable patch to accurately quantify sleep in a real-world setting. Methods: In this noninterventional, nonsignificant-risk, abbreviated investigational device exemption, single-site study, participants wore the reusable wearable sensor version 2 (RW2) patch. The RW2 patch is part of a digital medicine system (aripiprazole with sensor) designed to provide objective records of medication ingestion for patients with schizophrenia, bipolar I disorder, and major depressive disorder. This study developed a sleep algorithm from patch data and did not contain any study-related or digitized medication. Patch-acquired ACC and ECG data were compared against PSG data to build machine learning classification models to distinguish periods of wake from sleep. The PSG data provided sleep stage classifications at 30-second intervals, which were combined into 5-minute windows and labeled as sleep or wake based on the majority of sleep stages within the window. ACC and ECG features were derived for each 5-minute window. The algorithm that most accurately predicted sleep parameters against PSG data was compared to commercially available wearable devices to further benchmark model performance. Results: Of 80 participants enrolled, 60 had at least 1 night of analyzable ACC and ECG data (25 healthy volunteers and 35 participants with diagnosed SMI). Overall, 10,574 valid 5-minute windows were identified (5854 from participants with SMI), and 84% (n=8830) were classified as greater than half sleep. Of the 3 models tested, the conditional random field algorithm provided the most robust sleep-wake classification. Performance was comparable to the middle 50% of commercial devices evaluated in a recent publication, providing a sleep detection performance of 0.93 (sensitivity) and wake detection performance of 0.60 (specificity) at a prediction probability threshold of 0.75. The conditional random field algorithm retained this performance for individual sleep parameters, including total sleep time, sleep efficiency, and wake after sleep onset (within the middle 50% to top 25% of the assessed devices). The only parameter where the model performance was lower was sleep onset latency (within the bottom 25% of all comparator devices). Conclusions: Using industry-best practices, we developed a sleep algorithm for use with the RW2 patch that can accurately detect sleep and wake windows compared to PSG-labeled sleep data. This algorithm may be used for a more complete understanding of well-being for patients with SMI in a real-world setting, without the need for PSG and a sleep lab. UR - https://mental.jmir.org/2024/1/e62959 UR - http://dx.doi.org/10.2196/62959 ID - info:doi/10.2196/62959 ER - TY - JOUR AU - Supplieth, Juliana AU - Lech, Sonia AU - O?Sullivan, Lorraine Julie AU - Spang, Robert AU - Voigt-Antons, Jan?Niklas AU - Schuster, Johanna PY - 2024/12/19 TI - Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study JO - JMIR Hum Factors SP - e59865 VL - 11 KW - dementia KW - tablet application development KW - multidisciplinary health care KW - feasibility study KW - general practitioners KW - digital health care N2 - Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 UR - https://humanfactors.jmir.org/2024/1/e59865 UR - http://dx.doi.org/10.2196/59865 ID - info:doi/10.2196/59865 ER - TY - JOUR AU - Choukou, Mohamed-Amine AU - Banihani, Jasem AU - Azizkhani, Sarah PY - 2024/12/13 TI - Exploring Older Adults? Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study JO - JMIR Form Res SP - e52834 VL - 8 KW - agetech KW - attitude KW - opinion KW - perception KW - perspective KW - home based KW - community based KW - research KW - strategic planning KW - gerontechnology KW - geriatric KW - older adults KW - aging KW - co-construction KW - workshop KW - inductive analysis KW - development KW - aging-in-place KW - independent N2 - Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. UR - https://formative.jmir.org/2024/1/e52834 UR - http://dx.doi.org/10.2196/52834 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52834 ER - TY - JOUR AU - Fobelets, Kristel AU - Mohanty, Nikita AU - Thielemans, Mara AU - Thielemans, Lieze AU - Lake-Thompson, Gillian AU - Liu, Meijing AU - Jopling, Kate AU - Yang, Kai PY - 2024/12/10 TI - User Perceptions of Wearability of Knitted Sensor Garments for Long-Term Monitoring of Breathing Health: Thematic Analysis of Focus Groups and a Questionnaire Survey JO - JMIR Biomed Eng SP - e58166 VL - 9 KW - health technology KW - wearability of knitted sensors KW - focus groups KW - asthma observation KW - medical device KW - wearable device KW - medical instrument KW - medical equipment KW - medical tool KW - sensor KW - physiological sensor KW - focus group KW - breathing KW - respiratory KW - respirology KW - lung KW - monitoring KW - monitor KW - health monitoring N2 - Background: Long-term unobtrusive monitoring of breathing patterns can potentially give a more realistic insight into the respiratory health of people with asthma or chronic obstructive pulmonary disease than brief tests performed in medical environments. However, it is uncertain whether users would be willing to wear these sensor garments long term. Objective: Our objective was to explore whether users would wear ordinary looking knitted garments with unobtrusive knitted-in breathing sensors long term to monitor their lung health and under what conditions. Methods: Multiple knitted breathing sensor garments, developed and fabricated by the research team, were presented during a demonstration. Participants were encouraged to touch and feel the garments and ask questions. This was followed by two semistructured, independently led focus groups with a total of 16 adults, of whom 4 had asthma. The focus group conversations were recorded and transcribed. Thematic analysis was carried out by three independent researchers in 3 phases consisting of familiarization with the data, independent coding, and overarching theme definition. Participants also completed a web-based questionnaire to probe opinion about wearability and functionality of the garments. Quantitative analysis of the sensors? performance was mapped to participants? garment preference to support the feasibility of the technology for long-term wear. Results: Key points extracted from the qualitative data were (1) garments are more likely to be worn if medically prescribed, (2) a cotton vest worn as underwear was preferred, and (3) a breathing crisis warning system was seen as a promising application. The qualitative analysis showed a preference for a loose-fitting garment style with short sleeves (13/16 participants), 11 out of 16 would also wear snug fitting garments and none of the participants would wear tight-fitting garments over a long period of time. In total, 10 out of 16 participants would wear the snug fitting knitted garment for the whole day and 13 out of 16 would be happy to wear it only during the night if not too hot. The sensitivity demands on the knitted wearable sensors can be aligned with most users? garment preferences (snug fit). Conclusions: There is an overall positive opinion about wearing a knitted sensor garment over a long period of time for monitoring respiratory health. The knit cannot be tight but a snugly fitted vest as underwear in a breathable material is acceptable for most participants. These requirements can be fulfilled with the proposed garments. Participants with asthma supported using it as a sensor garment connected to an asthma attack alert system. UR - https://biomedeng.jmir.org/2024/1/e58166 UR - http://dx.doi.org/10.2196/58166 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58166 ER - TY - JOUR AU - Bruni, Francesca AU - Mancuso, Valentina AU - Panigada, Jonathan AU - Stramba-Badiale, Marco AU - Cipresso, Pietro AU - Pedroli, Elisa PY - 2024/12/5 TI - Exploring How Older Adults Experience semAPP, a 360° Media?Based Tool for Memory Assessment: Qualitative Study JO - JMIR Aging SP - e56796 VL - 7 KW - assessment KW - virtual reality KW - 360-degree videos KW - user experience KW - memory KW - aging KW - psycho gerontology N2 - Background: Technology is already a part of our daily lives, and its influence is growing rapidly. This evolution has not spared the health care field. Nowadays, a crucial challenge is considering aspects such as design, development, and implementation, highlighting their functionality, ease of use, compatibility, performance, and safety when a new technological tool is developed. As noted in many works, the abandonment rate is usually higher when a user has a terrible experience with these instruments. It would be appropriate to incorporate the final users?whether they are patients, health care professionals, or both?in the stages of instrument design to understand their needs and preferences. Since most apps that fail did not include end users and health care professionals in the development phase, their involvement at all stages of app development may increase their commitment and improve integration, self-management, and health outcomes. Objective: This study aims (1) to develop semAPP (spatial and episodic memory assessment application), a 360° media?based tool, to assess memory in aging by simulating a real-life situation and (2) to test the usability of the app and the connected experience in an end-user population. Methods: A total of 34 older adults participated in the study: 16 (47%) healthy individuals and 18 (53%) patients with mild cognitive impairment. They used semAPP and completed qualitative and quantitative measures. The app includes 2 parts: object recognition and spatial memory tasks. During the first task, users have to navigate in an apartment freely and visit rooms, and then they must recognize the right map of the house. In the second task, users are immersed in a living room, and they have to encode and then recall some target objects, simulating a relocation. We deployed this app on an 11.2-inch iPad, and we tested its usability and the experience of users interacting with the app. We conducted descriptive analyses for both the entire sample and each subgroup; we also conducted parametric and correlation analyses to compare groups and to examine the relationship between task execution and the virtual experience, as well as the acceptance of technology. Results: Both groups judged the app as an easy-to-use tool, and they were willing to use it. Moreover, the results match the idea that usability might be influenced by different factors depending on instrument and personal features, such as presentation, functionality, system performance, interactive behavior, attitudes, skills, and personality. Conclusions: The findings support the possibility of using semAPP in older patients, as well as the importance of designing and evaluating new technological tools, considering not only the general population but also the specific target ones. UR - https://aging.jmir.org/2024/1/e56796 UR - http://dx.doi.org/10.2196/56796 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56796 ER - TY - JOUR AU - Dermody, Gordana AU - Wadsworth, Daniel AU - Dunham, Melissa AU - Glass, Courtney AU - Fritz, Roschelle PY - 2024/12/5 TI - Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review JO - JMIR Aging SP - e64367 VL - 7 KW - clinician KW - provider KW - health professional KW - smart home KW - remote monitoring KW - technology KW - readiness KW - adoption KW - preparedness N2 - Background: The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting. Results: Several factors affected clinicians? perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of ?invasive? technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusions: Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195989 UR - https://aging.jmir.org/2024/1/e64367 UR - http://dx.doi.org/10.2196/64367 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012852 ID - info:doi/10.2196/64367 ER - TY - JOUR AU - Naudé, Bérangčre 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 - Hackett, Katherine AU - Xu, Shiyun AU - McKniff, Moira AU - Paglia, Lido AU - Barnett, Ian AU - Giovannetti, Tania PY - 2024/11/22 TI - Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study JO - JMIR Hum Factors SP - e59974 VL - 11 KW - digital phenotyping KW - digital biomarkers KW - monitoring KW - mHealth KW - cognition KW - mobility KW - life space KW - depression KW - location data KW - Alzheimer disease KW - aging KW - mobile phone N2 - Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84%), mild cognitive impairment (n=5, 13%), and mild dementia (n=1, 3%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100%) participants completed the 4-week monitoring period without major technical adverse events, 100% (37/37) reported satisfaction with the explanation of study procedures, and 97% (36/37) reported no feelings of discomfort. Participants? scores on the comprehension of consent quiz were 97% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41% (15/37) reported battery drain. Moderate to strong correlations (r?0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults? personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. UR - https://humanfactors.jmir.org/2024/1/e59974 UR - http://dx.doi.org/10.2196/59974 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59974 ER - TY - JOUR AU - Park, Jinyoung AU - Lee, Jungeun AU - Noh, Dabok PY - 2024/11/21 TI - Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach JO - JMIR Hum Factors SP - e64681 VL - 11 KW - out-of-home youth KW - mental health intervention KW - mobile app KW - intervention mapping KW - youth KW - mental health KW - mHealth KW - mobile health KW - app KW - interview KW - need KW - focus group KW - emotion KW - emotional KW - young adult KW - independent living KW - emotional support KW - tool KW - emotion regulation KW - user KW - app usage N2 - Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app?s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app?s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app?s effectiveness in real-world settings and refine it continuously based on user input. UR - https://humanfactors.jmir.org/2024/1/e64681 UR - http://dx.doi.org/10.2196/64681 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64681 ER - TY - JOUR AU - Slade, Christopher AU - Benzo, M. Roberto AU - Washington, Peter PY - 2024/11/18 TI - Design Guidelines for Improving Mobile Sensing Data Collection: Prospective Mixed Methods Study JO - J Med Internet Res SP - e55694 VL - 26 KW - mobile health sensing KW - mHealth KW - active data collection KW - passive data collection KW - ecological momentary assessment KW - mobile data KW - mobile phone KW - machine learning KW - real-world setting KW - mixed method KW - college KW - student KW - user data KW - data consistency N2 - Background: Machine learning models often use passively recorded sensor data streams as inputs to train machine learning models that predict outcomes captured through ecological momentary assessments (EMA). Despite the growth of mobile data collection, challenges in obtaining proper authorization to send notifications, receive background events, and perform background tasks persist. Objective: We investigated challenges faced by mobile sensing apps in real-world settings in order to develop design guidelines. For active data, we compared 2 prompting strategies: setup prompting, where the app requests authorization during its initial run, and contextual prompting, where authorization is requested when an event or notification occurs. Additionally, we evaluated 2 passive data collection paradigms: collection during scheduled background tasks and persistent reminders that trigger passive data collection. We investigated the following research questions (RQs): (RQ1) how do setup prompting and contextual prompting affect scheduled notification delivery and the response rate of notification-initiated EMA? (RQ2) Which authorization paradigm, setup or contextual prompting, is more successful in leading users to grant authorization to receive background events? and (RQ3) Which polling-based method, persistent reminders or scheduled background tasks, completes more background sessions? Methods: We developed mobile sensing apps for iOS and Android devices and tested them through a 30-day user study asking college students (n=145) about their stress levels. Participants responded to a daily EMA question to test active data collection. The sensing apps collected background location events, polled for passive data with persistent reminders, and scheduled background tasks to test passive data collection. Results: For RQ1, setup and contextual prompting yielded no significant difference (ANOVA F1,144=0.0227; P=.88) in EMA compliance, with an average of 23.4 (SD 7.36) out of 30 assessments completed. However, qualitative analysis revealed that contextual prompting on iOS devices resulted in inconsistent notification deliveries. For RQ2, contextual prompting for background events was 55.5% (?21=4.4; P=.04) more effective in gaining authorization. For RQ3, users demonstrated resistance to installing the persistent reminder, but when installed, the persistent reminder performed 226.5% more background sessions than traditional background tasks. Conclusions: We developed design guidelines for improving mobile sensing on consumer mobile devices based on our qualitative and quantitative results. Our qualitative results demonstrated that contextual prompts on iOS devices resulted in inconsistent notification deliveries, unlike setup prompting on Android devices. We therefore recommend using setup prompting for EMA when possible. We found that contextual prompting is more efficient for authorizing background events. We therefore recommend using contextual prompting for passive sensing. Finally, we conclude that developing a persistent reminder and requiring participants to install it provides an additional way to poll for sensor and user data and could improve data collection to support adaptive interventions powered by machine learning. UR - https://www.jmir.org/2024/1/e55694 UR - http://dx.doi.org/10.2196/55694 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55694 ER - TY - JOUR AU - Preiser, Christine AU - Radionova, Natalia AU - Ög, Eylem AU - Koch, Roland AU - Klemmt, Malte AU - Müller, Regina AU - Ranisch, Robert AU - Joos, Stefanie AU - Rieger, A. Monika PY - 2024/11/18 TI - The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany JO - JMIR Hum Factors SP - e57360 VL - 11 KW - symptom checker app KW - qualitative interviews KW - general practice KW - perceived work-related psychosocial stress KW - job satisfaction KW - professional identity KW - medical diagnosis N2 - Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action. Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands? Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization. Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the ?unorganized stage? of patients? searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients? decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient?s next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data. Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients? anxiety, was too risk-averse, or made patients more insistent on their own opinions. UR - https://humanfactors.jmir.org/2024/1/e57360 UR - http://dx.doi.org/10.2196/57360 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57360 ER - TY - JOUR AU - Yang, Yanrong AU - Tavares, Jorge AU - Oliveira, Tiago PY - 2024/11/11 TI - A New Research Model for Artificial Intelligence?Based Well-Being Chatbot Engagement: Survey Study JO - JMIR Hum Factors SP - e59908 VL - 11 KW - artificial intelligence?based chatbot KW - AI-based chatbot KW - mental well-being KW - intention to engage KW - engagement behavior KW - theoretical models KW - mobile phone N2 - Background: Artificial intelligence (AI)?based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals? intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (?=.201; P=.002), social factors (?=.184; P=.007), and compatibility (?=.149; P=.03) were statistically significant for the intention to engage. Habit (?=.154; P=.01), trust (?=.253; P<.001), and intention to engage (?=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users? AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. UR - https://humanfactors.jmir.org/2024/1/e59908 UR - http://dx.doi.org/10.2196/59908 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59908 ER - TY - JOUR AU - Berger, Mathilde AU - Deblock-Bellamy, Anne AU - Chčze, Laurence AU - Robert, Thomas AU - Desrosiers, J. Julie AU - Christe, Guillaume AU - Bertrand, Martine Anne PY - 2024/11/7 TI - Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach JO - JMIR Hum Factors SP - e59897 VL - 11 KW - chronic low back pain KW - needs KW - self-management KW - physical activity KW - mobile health KW - mHealth KW - user-centered design N2 - Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. UR - https://humanfactors.jmir.org/2024/1/e59897 UR - http://dx.doi.org/10.2196/59897 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59897 ER - TY - JOUR AU - Gargot, Thomas AU - Vachaud, Amandine AU - Gilard, Clémence AU - Audrain, Alexia AU - Gomot, Marie AU - Guidotti, Marco AU - Briend, Frédéric AU - Malvy, Joëlle AU - Bonnet Brilhault, Frédérique PY - 2024/11/5 TI - A Compressive Armchair (OTO) to Perform Deep Pressure Therapy in Children With Autism Spectrum Disorder: User-Centered Design and Feasibility Study JO - JMIR Hum Factors SP - e55754 VL - 11 KW - deep pressure therapy KW - proprioception KW - compression KW - autism spectrum disorder N2 - Background: Deep pressure therapy (DPT) is widely used to reduce anxiety in children with autism spectrum disorder (ASD), but evidence of its efficacy is limited. Objective: This study aims to design a usable, nonstigmatizing compressive armchair that can be easily controlled, electronically, by the user. Methods: A user-centered approach was used to assess the usability of the device. Testing was carried out in a day hospital for children with ASD in France, with a convenience sample of children with severe forms of ASD and intellectual deficiency (N=39). The Witteman design guideline was used. The System Usability Scale and time of use were reported. Results: The final product is a compressive armchair designed to be user centered, with 4 different cells that can be inflated to induce tailored pressure on the body. The pressure level is recorded electronically. Usability was between good and excellent. The device was used by 39 children, once or twice weekly, over a period of 31 months. Each session lasted between 3 and 20 minutes. The armchair takes up less space than a hug machine. Performing sessions with the chair is feasible. Conclusions: First clinical impressions show a decrease in anxiety, improved emotional regulation, and improved attention. DPT is widely used in occupational therapy and frequently requested by parents, but efficacy studies are too scarce to make evidence-based recommendations for its use. The results presented here support further controlled efficacy studies of DPT in the treatment of anxiety in children with ASD. UR - https://humanfactors.jmir.org/2024/1/e55754 UR - http://dx.doi.org/10.2196/55754 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55754 ER - TY - JOUR AU - Bennett, E. Sarah AU - Johnston, H. Milly AU - Treneman-Evans, Georgia AU - Denison-Day, James AU - Duffy, Anthony AU - Brigden, Amberly AU - Kuberka, Paula AU - Christoforou, Nicholas AU - Ritterband, Lee AU - Koh, Jewel AU - Meadows, Robert AU - Alamoudi, Doaa AU - Nabney, Ian AU - Yardley, Lucy PY - 2024/10/31 TI - Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study JO - JMIR Hum Factors SP - e63341 VL - 11 KW - behavior change KW - digital intervention KW - insomnia KW - depression KW - anxiety KW - sleep KW - qualitative research KW - mobile phone N2 - Background: Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Methods: Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. Results: A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported ?prefer not to say.? Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Conclusions: Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout. UR - https://humanfactors.jmir.org/2024/1/e63341 UR - http://dx.doi.org/10.2196/63341 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63341 ER - TY - JOUR AU - Zhou, Shuo AU - Brunetta, Paul AU - Silvasstar, Joshva AU - Feldman, Greg AU - Oromi, Nicolas AU - Bull, Sheana PY - 2024/10/29 TI - Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e55239 VL - 12 KW - smoking cessation KW - tobacco KW - mobile phone app KW - mHealth KW - mobile health KW - iterative design KW - feasibility KW - acceptability KW - engagement KW - efficacy KW - mobile phone N2 - Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers? preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants? app use was tracked and analyzed. The primary outcome measures were participants? 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included ?quit plan,? ?tracking,? ?reminders and notifications,? ?MOtalks,? and ?motivational quotes.? The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. UR - https://mhealth.jmir.org/2024/1/e55239 UR - http://dx.doi.org/10.2196/55239 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55239 ER - TY - JOUR AU - Le Roux, Enora AU - Ursino, Moreno AU - Milovanovic, Ivana AU - Picq, Paul AU - Haignere, Jeremie AU - Rault, Gilles AU - Pougheon Bertrand, Dominique AU - Alberti, Corinne PY - 2024/10/28 TI - Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design JO - JMIR Form Res SP - e51753 VL - 8 KW - connected devices KW - cystic fibrosis KW - patient education KW - self-management KW - medical device KW - home monitoring KW - remote monitoring KW - statistical process control KW - connected health KW - alerts N2 - Background: Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home. Objective: This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment. Methods: A multicenter interventional pilot study including 36 patients was conducted. Statistical process control?the cumulative sum control chart (CUSUM)?was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected. Results: One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients. Conclusions: The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028 UR - https://formative.jmir.org/2024/1/e51753 UR - http://dx.doi.org/10.2196/51753 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51753 ER - TY - JOUR AU - Ozaki, Itsuko AU - Nishijima, Mariko AU - Shibata, Eiji AU - Zako, Yuri AU - Chiang, Chifa PY - 2024/10/25 TI - Factors Related to mHealth App Use Among Japanese Workers: Cross-Sectional Survey JO - JMIR Hum Factors SP - e54673 VL - 11 KW - mHealth KW - mobile health KW - mobile health apps KW - prevalence KW - health promotion KW - health management KW - Japanese worker KW - Japan KW - cross-sectional survey KW - disease management KW - app users KW - physical activity N2 - Background: Health care providers can make health guidance more effective by using mobile health technologies such as health apps. Although health care providers need to know who uses health apps, existing studies have yielded inconsistent results. Objective: The aim of the study was (1) to clarify the prevalence and patterns of health app use to improve health behaviors for preventing lifestyle-related diseases among Japanese workers and (2) to identify the associations among demographic characteristics, health behavior, and internet use and health app use by gender. Methods: Data were collected from a cross-sectional internet survey in 2023. In total, 2200 participants were included, with an even distribution of men and women in each age group aged 20 to 60 years. The participants were workers with smartphones and reported their gender, age, residence area, marital status, education, employment status, occupation, work pattern, diseases under treatment, health checkups, health guidance, health behaviors, internet use duration, and number of devices used. We asked about current and previous health app use for 1 month. A multivariate logistic regression analysis was conducted by gender. Results: Of the participants, 472 (21.5%) and 189 (8.6%) were current and previous health app users, respectively. Most current and previous health app users used features that record and track their physical activity and other health behaviors. Health app users?both men and women?were more likely to have health checkups (odds ratio [OR] 1.53, 95% CI 1.12-2.11 and OR 1.51, 95% CI 1.10-2.07, respectively), receive health guidance (OR 2.01, 95% CI 1.47-2.74 and OR 1.86, 95% CI 1.32-2.62, respectively), engage in regular physical activity (OR 2.57, 95% CI 1.91-3.47 and OR 1.94, 95% CI 1.41-2.67, respectively), use the internet for 120-179 minutes per day (OR 1.76, 95% CI 1.13-2.75 and OR 1.70, 95% CI 1.12-2.57, respectively), and were less likely to be older (50-59 years: OR 0.54, 95% CI 0.33-0.88 and OR 0.40, 95% CI 0.25-0.6, respectively, and 60-69 years: OR 0.37, 95% CI 0.22-0.62 and OR 0.47, 95% CI 0.28-0.77, respectively). According to gender, male health app users were more likely to be married (OR 1.69, 95% CI 1.23-2.33) and less likely to work in the security, agriculture, forestry, fishing, manufacturing, or transportation industries (OR 0.62, 95% CI 0.41-0.95). Female health app users were more likely to have a university education or higher (OR 1.55, 95% CI 1.061-2.26), maintain an appropriate body weight (OR 1.52, 95% CI 1.10-2.11), and use 3 or more devices (OR 2.13, 95% CI 1.41-3.23). Conclusions: Physical activity and health guidance are strong predictors of app use. Health care providers should assess the target populations? preferences for app use based on their characteristics, support their app use, and enhance the effectiveness of health guidance. UR - https://humanfactors.jmir.org/2024/1/e54673 UR - http://dx.doi.org/10.2196/54673 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54673 ER - TY - JOUR AU - Kim, Heon Jae AU - Lee, Cheol Ui AU - Jeong, Hun Byeong AU - Kang, Uk Byeong AU - Shim, Ryul Sung AU - Jeong, Gab In PY - 2024/10/24 TI - Accuracy of a Smart Diaper System for Nursing Home Residents for Automatically Detecting Voided Volume: Instrument Validation Study JO - JMIR Form Res SP - e58583 VL - 8 KW - smart diaper KW - urinary incontinence KW - medical device KW - voided volume KW - urine output KW - nursing home KW - older adults N2 - Background: Diapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. Objective: The aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. Methods: From January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user?s movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. Results: The average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P<.001). In the Bland-Altman figure, the difference in the mean between the 2 tests was evenly scattered without showing a specific pattern, indicating that the SDS and actual urine weight were very consistent. The difference between the mean of the 2 tests was ?0.045 of the standardized mean difference, and all measurements were located within the 95% CI, so this confirms that the 2 test methods are equivalent. Conclusions: Our study showed a fairly high correlation coefficient and ICC for all patient groups, which reveals that the 2 tests were very consistent and that the SDS can replace traditional diapers, even in a real clinical setting. This study shows the possibility that heath care professionals could be alerted by the SDS to the need for pad replacement due to incontinence, thus avoiding the development of dermatological complications. UR - https://formative.jmir.org/2024/1/e58583 UR - http://dx.doi.org/10.2196/58583 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58583 ER - TY - JOUR AU - Ramasawmy, Mel AU - Roland Persson, Dan AU - Sunkersing, David AU - Gill, Paramjit AU - Khunti, Kamlesh AU - Poole, Lydia AU - Hanif, Wasim AU - Blandford, Ann AU - Sajid, Madiha AU - Stevenson, Fiona AU - Khan, Nushrat AU - Banerjee, Amitava PY - 2024/10/24 TI - Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study JO - JMIR Hum Factors SP - e57338 VL - 11 KW - digital health KW - cardiometabolic disease KW - cardiology KW - cardiovascular risk KW - health inequality KW - health disparity KW - usability KW - user experience KW - think aloud KW - cultural barriers KW - digital divide KW - digital literacy N2 - Background: Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Objective: Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Methods: Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted ?think-aloud? interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Results: Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. Conclusions: DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs. UR - https://humanfactors.jmir.org/2024/1/e57338 UR - http://dx.doi.org/10.2196/57338 ID - info:doi/10.2196/57338 ER - TY - JOUR AU - Gibson, Irene AU - Neubeck, Lis AU - Corcoran, Marissa AU - Morland, Chris AU - Donovan, Steve AU - Jones, Jennifer AU - Costello, Caroline AU - Hynes, Lisa AU - Harris, Aisling AU - Harrahill, Mary AU - Lillis, Mary AU - Atrey, Alison AU - Ski, F. Chantal AU - Savickas, Vilius AU - Byrne, Molly AU - Murphy, W. Andrew AU - McEvoy, William John AU - Wood, David AU - Jennings, Catriona PY - 2024/10/23 TI - Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study JO - JMIR Hum Factors SP - e63707 VL - 11 KW - cardiovascular disease KW - secondary prevention KW - digital health KW - intervention development KW - co-design KW - usability testing KW - mobile health KW - usability KW - design KW - conline workshop KW - social support KW - behavioral change KW - self-monitoring N2 - Background: Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage. Objective: This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users? perspectives throughout. Methods: A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process. Results: Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02). Conclusions: Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users? needs and preferences, thereby potentially improving future engagement. UR - https://humanfactors.jmir.org/2024/1/e63707 UR - http://dx.doi.org/10.2196/63707 UR - http://www.ncbi.nlm.nih.gov/pubmed/39441626 ID - info:doi/10.2196/63707 ER - TY - JOUR AU - Sumner, Jennifer AU - Tan, Ying Si AU - Wang, Yuchen AU - Keck, Sze Camille Hui AU - Xin Lee, Wei Eunice AU - Chew, Hoon Emily Hwee AU - Yip, Wenjun Alexander PY - 2024/10/15 TI - Co-Designing Remote Patient Monitoring Technologies for Inpatients: Systematic Review JO - J Med Internet Res SP - e58144 VL - 26 KW - remote patient monitoring KW - technology KW - inpatient KW - care transition KW - systematic review KW - health technology KW - patient-centeredness KW - technology use KW - effectiveness KW - study design KW - assessment KW - pilot testing KW - health care KW - technologies KW - terminology KW - quality and consistency KW - telehealth KW - telemonitoring N2 - Background: The co-design of health technology enables patient-centeredness and can help reduce barriers to technology use. Objective: The study objectives were to identify what remote patient monitoring (RPM) technology has been co-designed for inpatients and how effective it is, to identify and describe the co-design approaches used to develop RPM technologies and in which contexts they emerge, and to identify and describe barriers and facilitators of the co-design process. Methods: We conducted a systematic review of co-designed RPM technologies for inpatients or for the immediate postdischarge period and assessed (1) their effectiveness in improving health outcomes, (2) the co-design approaches used, and (3) barriers and facilitators to the co-design process. Eligible records included those involving stakeholders co-designing RPM technology for use in the inpatient setting or during the immediate postdischarge period. Searches were limited to the English language within the last 10 years. We searched MEDLINE, Embase, CINAHL, PsycInfo, and Science Citation Index (Web of Science) in April 2023. We used the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and qualitative research. Findings are presented narratively. Results: We screened 3334 reports, and 17 projects met the eligibility criteria. Interventions were designed for pre- and postsurgical monitoring (n=6), intensive care monitoring (n=2), posttransplant monitoring (n=3), rehabilitation (n=4), acute inpatients (n=1), and postpartum care (n=1). No projects evaluated the efficacy of their co-designed RPM technology. Three pilot studies reported clinical outcomes; their risk of bias was low to moderate. Pilot evaluations (11/17) also focused on nonclinical outcomes such as usability, usefulness, feasibility, and satisfaction. Common co-design approaches included needs assessment or ideation (16/17), prototyping (15/17), and pilot testing (11/17). The most commonly reported challenge to the co-design process was the generalizability of findings, closely followed by time and resource constraints and participant bias. Stakeholders? perceived value was the most frequently reported enabler of co-design. Other enablers included continued stakeholder engagement and methodological factors (ie, the use of flexible mixed method approaches and prototyping). Conclusions: Co-design methods can help enhance interventions? relevance, usability, and adoption. While included studies measured usability, satisfaction, and acceptability?critical factors for successful implementation and uptake?we could not determine the clinical effectiveness of co-designed RPM technologies. A stronger commitment to clinical evaluation is needed. Studies? use of diverse co-design approaches can foster stakeholder inclusivity, but greater standardization in co-design terminology is needed to improve the quality and consistency of co-design research. UR - https://www.jmir.org/2024/1/e58144 UR - http://dx.doi.org/10.2196/58144 UR - http://www.ncbi.nlm.nih.gov/pubmed/39405106 ID - info:doi/10.2196/58144 ER - TY - JOUR AU - Polivka, Barbara AU - Krueger, Kathryn AU - Bimbi, Olivia AU - Huntington-Moskos, Luz AU - Nyenhuis, Sharmilee AU - Cramer, Emily AU - Eldeirawi, Kamal PY - 2024/10/10 TI - Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study JO - JMIR Form Res SP - e60147 VL - 8 KW - indoor air quality KW - asthma KW - real-time assessment KW - EMA KW - ecological momentary assessment KW - mobile phone KW - monitoring KW - air quality KW - real time KW - spirometry KW - acceptability KW - usability KW - residential toxins KW - volatile organic compounds KW - VOC KW - adult KW - female KW - women KW - college student N2 - Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. UR - https://formative.jmir.org/2024/1/e60147 UR - http://dx.doi.org/10.2196/60147 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60147 ER - TY - JOUR AU - Liang, Zilu AU - Melcer, Edward AU - Khotchasing, Kingkarn AU - Chen, Samantha AU - Hwang, Daeun AU - Hoang, Huyen Nhung PY - 2024/10/8 TI - The Role of Relevance in Shaping Perceptions of Sleep Hygiene Games Among University Students: Mixed Methods Study JO - JMIR Serious Games SP - e64063 VL - 12 KW - serious games KW - sleep hygiene KW - sleep technologies KW - co-design KW - relevance KW - self-determination theory KW - digital health KW - persuasive technology KW - behavior change N2 - Background: Sleep games are an emerging topic in the realm of serious health game research. However, designing features that are both enjoyable and effective at engaging users, particularly university students, to develop healthy sleep habits remains a challenge. Objective: This study aims to investigate user preferences for 3 sleep game prototypes, that is, Hero?s Sleep Journey, Sleep Tamagotchi, and Sleepland, and to explore their popularity and perceived utility in promoting sleep health. Methods: A mixed methods approach was used in this study. Quantitative and qualitative data were collected through a co-design workshop involving 47 university students. Participants were presented with storyboard cards of game features and were asked to provide an overall rating on each game, as well as ratings for individual features. They were also encouraged to provide free-form comments on the features and suggest improvements. In addition, participants were asked to express their preferences among the 3 games regarding which game they would most like to play and which one they found most useful for promoting sleep health. Results: Surprisingly, while Hero?s Sleep Journey was the most popular choice among participants, Sleep Tamagotchi was perceived as the most beneficial for improving sleep health. Relevance emerged as an overarching theme in the qualitative data analysis, with 3 interconnected dimensions: psychological relevance to users? personal lives, logical relevance to sleep health, and situational relevance to users? circumstantial context. We discussed how the 3 dimensions of relevance address the autonomy and relatedness constructs outlined in the self-determination theory and proposed 3 design recommendations. Conclusions: Our serious sleep game prototypes demonstrated the potential to engage university students to develop healthy sleep hygiene. Future sleep game designs should aim to create a sense of relevance to users? personal lives, sleep health goals, and situational contexts. Rather than a one-size-fits-all approach, it is essential to develop a wide range of game genres and features to cater to diverse users. Aligning game features with sleep health goals and educating users on the design rationale through sleep knowledge are also important aspects. Furthermore, allowing users to customize their game experience and manage technology boundaries is necessary to nurture a sense of control and autonomy in the process of forming good sleep hygiene. UR - https://games.jmir.org/2024/1/e64063 UR - http://dx.doi.org/10.2196/64063 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64063 ER - TY - JOUR AU - Josendal, Vik Anette AU - Bergmo, Strand Trine PY - 2024/10/4 TI - Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study JO - JMIR Aging SP - e57651 VL - 7 KW - home care KW - medication management KW - adherence KW - self-management KW - multidose drug dispensing KW - Norway KW - primary care KW - older adults N2 - Background: Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. Objective: The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. Methods: We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants? homes, and the interview transcripts were analyzed thematically. Results: All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. Conclusions: MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy. UR - https://aging.jmir.org/2024/1/e57651 UR - http://dx.doi.org/10.2196/57651 ID - info:doi/10.2196/57651 ER - TY - JOUR AU - Goehringer, Jessica AU - Kosmin, Abigail AU - Laible, Natalie AU - Romagnoli, Katrina PY - 2024/9/26 TI - Assessing the Utility of a Patient-Facing Diagnostic Tool Among Individuals With Hypermobile Ehlers-Danlos Syndrome: Focus Group Study JO - JMIR Form Res SP - e49720 VL - 8 KW - diagnostic tool KW - hypermobile Ehlers-Danlos syndrome KW - patient experiences KW - diagnostic odyssey KW - affinity mapping KW - mobile health app KW - mobile phone N2 - Background: Hypermobile Ehlers-Danlos syndrome (hEDS), characterized by joint hypermobility, skin laxity, and tissue fragility, is thought to be the most common inherited connective tissue disorder, with millions affected worldwide. Diagnosing this condition remains a challenge that can impact quality of life for individuals with hEDS. Many with hEDS describe extended diagnostic odysseys involving exorbitant time and monetary investment. This delay is due to the complexity of diagnosis, symptom overlap with other conditions, and limited access to providers. Many primary care providers are unfamiliar with hEDS, compounded by genetics clinics that do not accept referrals for hEDS evaluation and long waits for genetics clinics that do evaluate for hEDS, leaving patients without sufficient options. Objective: This study explored the user experience, quality, and utility of a prototype of a patient-facing diagnostic tool intended to support clinician diagnosis for individuals with symptoms of hEDS. The questions included within the prototype are aligned with the 2017 international classification of Ehlers-Danlos syndromes. This study explored how this tool may help patients communicate information about hEDS to their physicians, influencing the diagnosis of hEDS and affecting patient experience. Methods: Participants clinically diagnosed with hEDS were recruited from either a medical center or private groups on a social media platform. Interested participants provided verbal consent, completed questionnaires about their diagnosis, and were invited to join an internet-based focus group to share their thoughts and opinions on a diagnostic tool prototype. Participants were invited to complete the Mobile App Rating Scale (MARS) to evaluate their experience viewing the diagnostic tool. The MARS is a framework for evaluating mobile health apps across 4 dimensions: engagement, functionality, esthetics, and information quality. Qualitative data were analyzed using affinity mapping to organize information and inductively create themes that were categorized within the MARS framework dimensions to help identify strengths and weaknesses of the diagnostic tool prototype. Results: In total, 15 individuals participated in the internet-based focus groups; 3 (20%) completed the MARS. Through affinity diagramming, 2 main categories of responses were identified, including responses related to the user interface and responses related to the application of the tool. Each category included several themes and subthemes that mapped well to the 4 MARS dimensions. The analysis showed that the tool held value and utility among the participants diagnosed with hEDS. The shareable ending summary sheet provided by the tool stood out as a strength for facilitating communication between patient and provider during the diagnostic evaluation. Conclusions: The results provide insights on the perceived utility and value of the tool, including preferred phrasing, layout and design preferences, and tool accessibility. The participants expressed that the tool may improve the hEDS diagnostic odyssey and help educate providers about the diagnostic process. UR - https://formative.jmir.org/2024/1/e49720 UR - http://dx.doi.org/10.2196/49720 UR - http://www.ncbi.nlm.nih.gov/pubmed/39325533 ID - info:doi/10.2196/49720 ER - TY - JOUR AU - Müller, Pascal AU - Jahn, Patrick PY - 2024/9/12 TI - Cocreative Development of Robotic Interaction Systems for Health Care: Scoping Review JO - JMIR Hum Factors SP - e58046 VL - 11 KW - human-robot interaction KW - cocreation KW - robotics KW - user-centered design KW - health care N2 - Background: Robotic technologies present challenges to health care professionals and are therefore rarely used. Barriers such as lack of controllability and adaptability and complex control functions affect the human-robot relationship. In addition to educational opportunities, the possibility of individual adaptation can improve the usability and practical implementation of robotics. Previous work has focused on developments from a technology-centered perspective and has included user interests too late in the process. Objective: This study addresses the following research question: What cocreative research approaches are used in the field of nursing robotics to improve the usability, intended use, and goal-directed application of robotic developments for nurses and to support the nursing process? Methods: This scoping review provides an overview of the topic and the research activities taking place within it. Five databases and the reference lists of the identified publications were searched for studies without further restrictions. Studies were included if they developed and evaluated interaction and control platforms for robotic systems in health care in a cocreative way with end users. Results: The search resulted in 419 hits, of which 3 publications were included. All publications were feasibility or user studies that were mainly carried out in the European Union. The 3 interaction and control platforms presented were all prototypes and not commercially available. In addition to those in need of care, all studies also included family carers and health care professionals. Conclusions: Robotic interaction and control platforms in health care are rarely, if ever, developed and evaluated with feasibility or user studies that include prototypes and end users. While the involvement of end users is crucial, this review emphasizes that all stakeholders, including health care professionals, should participate in the development process to ensure a holistic understanding of application needs and a focus on user experiences and practical health care needs. It is emphasized that the active involvement of end users in the development process is critical to effectively meeting the needs of the target group. Trial Registration: Deutsches Register Klinischer Studien DRKS00034195; https://drks.de/search/de/trial/DRKS00034195 UR - https://humanfactors.jmir.org/2024/1/e58046 UR - http://dx.doi.org/10.2196/58046 ID - info:doi/10.2196/58046 ER - TY - JOUR AU - Oluokun, Oluwatosin Emmanuel AU - Adedoyin, Fatai Festus AU - Dogan, Huseyin AU - Jiang, Nan PY - 2024/9/12 TI - Co-Designing Digital Health Intervention for Monitoring Medication and Consultation Among Transgender People in Underserved Communities: Collaborative Approach JO - JMIR Hum Factors SP - e45826 VL - 11 KW - digital health KW - HIV/AIDS medication KW - data-driven health care KW - ART KW - transgender KW - LGTBQI+ KW - interactive management N2 - Background: In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. Objective: This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. Methods: A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. Results: The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. Conclusions: The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity. UR - https://humanfactors.jmir.org/2024/1/e45826 UR - http://dx.doi.org/10.2196/45826 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45826 ER - TY - JOUR AU - He, Yunfan AU - Chen, Han AU - Xiang, Peng AU - Zhao, Min AU - Li, Yingjun AU - Liu, Yongcheng AU - Wang, Tong AU - Liang, Jun AU - Lei, Jianbo PY - 2024/9/3 TI - Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process JO - J Med Internet Res SP - e60773 VL - 26 KW - hypertension management KW - mobile health KW - user satisfaction KW - evaluation indicator system KW - analytic hierarchy process N2 - Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5% (4/91) of the apps achieved a demand fulfillment rate exceeding 80% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. UR - https://www.jmir.org/2024/1/e60773 UR - http://dx.doi.org/10.2196/60773 UR - http://www.ncbi.nlm.nih.gov/pubmed/39226103 ID - info:doi/10.2196/60773 ER - TY - JOUR AU - Bendotti, Hollie AU - Lawler, Sheleigh AU - Ireland, David AU - Gartner, Coral AU - Marshall, M. Henry PY - 2024/8/19 TI - Co-Designing a Smoking Cessation Chatbot: Focus Group Study of End Users and Smoking Cessation Professionals JO - JMIR Hum Factors SP - e56505 VL - 11 KW - artificial intelligence KW - chatbot KW - smoking cessation KW - behavior change KW - smoking KW - mobile health KW - apps KW - digital interventions KW - smartphone KW - mobile phone N2 - Background: Our prototype smoking cessation chatbot, Quin, provides evidence-based, personalized support delivered via a smartphone app to help people quit smoking. We developed Quin using a multiphase program of co-design research, part of which included focus group evaluation of Quin among stakeholders prior to clinical testing. Objective: This study aimed to gather and compare feedback on the user experience of the Quin prototype from end users and smoking cessation professionals (SCPs) via a beta testing process to inform ongoing chatbot iterations and refinements. Methods: Following active and passive recruitment, we conducted web-based focus groups with SCPs and end users from Queensland, Australia. Participants tested the app for 1-2 weeks prior to focus group discussion and could also log conversation feedback within the app. Focus groups of SCPs were completed first to review the breadth and accuracy of information, and feedback was prioritized and implemented as major updates using Agile processes prior to end user focus groups. We categorized logged in-app feedback using content analysis and thematically analyzed focus group transcripts. Results: In total, 6 focus groups were completed between August 2022 and June 2023; 3 for SCPs (n=9 participants) and 3 for end users (n=7 participants). Four SCPs had previously smoked, and most end users currently smoked cigarettes (n=5), and 2 had quit smoking. The mean duration of focus groups was 58 (SD 10.9; range 46-74) minutes. We identified four major themes from focus group feedback: (1) conversation design, (2) functionality, (3) relationality and anthropomorphism, and (4) role as a smoking cessation support tool. In response to SCPs? feedback, we made two major updates to Quin between cohorts: (1) improvements to conversation flow and (2) addition of the ?Moments of Crisis? conversation tree. Participant feedback also informed 17 recommendations for future smoking cessation chatbot developments. Conclusions: Feedback from end users and SCPs highlighted the importance of chatbot functionality, as this underpinned Quin?s conversation design and relationality. The ready accessibility of accurate cessation information and impartial support that Quin provided was recognized as a key benefit for end users, the latter of which contributed to a feeling of accountability to the chatbot. Findings will inform the ongoing development of a mature prototype for clinical testing. UR - https://humanfactors.jmir.org/2024/1/e56505 UR - http://dx.doi.org/10.2196/56505 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56505 ER - TY - JOUR AU - Wolf, Anton Milan AU - Sauerwald, Leon AU - Kosmalla, Felix AU - Daiber, Florian AU - Krüger, Antonio AU - Landgraeber, Stefan PY - 2024/8/16 TI - Implementation and Evaluation of a Gait Training Assistant for the Use of Crutches: Usability Study JO - JMIR Hum Factors SP - e51898 VL - 11 KW - telerehabilitation KW - orthopedics KW - digital gait trainer KW - orthopedic KW - gait KW - movement KW - walk KW - walking KW - crutch KW - crutches KW - sensor KW - sensors KW - rehabilitation KW - usability KW - digital health KW - physiotherapy KW - physical therapy KW - telehealth KW - telemedicine KW - eHealth KW - virtual KW - locomotor KW - locomotion N2 - Background: Surgical procedures on the lower extremities often require weight-bearing on crutches as part of the rehabilitation process. Orthopedic elective procedures enable patients to learn the correct use of crutches in a controlled preoperative setting. Digital assistance systems can safely circumvent a shortage of skilled staff and any contact restrictions that may be necessary. Objective: The usability of a newly developed gait training assistant (GTA) for the use of crutches will be evaluated. An intervention group trained to use crutches by the digital trainer will be compared with a control group trained to use crutches conventionally by a physiotherapist. Methods: As part of the development and implementation of a novel GTA, 14 patients learned to walk with crutches by completing specific exercises while receiving live feedback. Their movements were detected by a depth sensor and evaluated in real time. Specific parameters (step length, synchronous movement, crutch angle, and crutch distance to the feet) were compared with a control group (n=14) trained to use crutches by physiotherapists. The intervention group was also assessed by a physiotherapist. At the end of the study, the patients completed questionnaires to evaluate the usability of the system (Brooke?s System Usability Scale score) and patient satisfaction. Results: All patients trained by the novel GTA were able to use crutches correctly. The intervention group showed significantly better values for crutch angle (mean ?6.3°, SD 3.5° vs mean ?12.4°, SD 4.5°; P<.001) and crutch position (mean 3.3, SD 5.1 cm vs mean ?8.5, SD 4.9 cm; P=.02). Both groups reported that they felt confident in the use of crutches, were able to follow the instructions, and enjoyed the training. Even though the majority (12/14, 86%) preferred physical therapy over a purely digital approach, most participants enjoyed using the system (13/14, 93%) and were interested in trying out other digital assistants (11/14, 79%). The usability of the GTA was rated above average by the majority (9/14, 64%) of the patients. Conclusions: The newly designed GTA is a safe method of teaching the use of crutches and is statistically superior to training by a physiotherapist. Even if patients prefer interaction with a physiotherapist over a purely digital approach, digital devices provide a safe and motivating opportunity to learn the essential locomotor skills for rehabilitation. UR - https://humanfactors.jmir.org/2024/1/e51898 UR - http://dx.doi.org/10.2196/51898 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51898 ER - TY - JOUR AU - Angonese, Giulia AU - Buhl, Mareike AU - Kuhlmann, Inka AU - Kollmeier, Birger AU - Hildebrandt, Andrea PY - 2024/8/12 TI - Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment JO - JMIR Hum Factors SP - e52310 VL - 11 KW - hearing loss KW - mobile health KW - mHealth KW - older adults KW - help seeking KW - mobile study KW - machine learning KW - supervised classification KW - feature importance KW - profiling KW - mobile phone N2 - Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual?s profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naďve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. UR - https://humanfactors.jmir.org/2024/1/e52310 UR - http://dx.doi.org/10.2196/52310 UR - http://www.ncbi.nlm.nih.gov/pubmed/39133539 ID - info:doi/10.2196/52310 ER - TY - JOUR AU - Gaur, Pooja AU - Temple, S. Dorota AU - Hegarty-Craver, Meghan AU - Boyce, D. Matthew AU - Holt, R. Jonathan AU - Wenger, F. Michael AU - Preble, A. Edward AU - Eckhoff, P. Randall AU - McCombs, S. Michelle AU - Davis-Wilson, C. Hope AU - Walls, J. Howard AU - Dausch, E. David PY - 2024/8/7 TI - Continuous Monitoring of Heart Rate Variability in Free-Living Conditions Using Wearable Sensors: Exploratory Observational Study JO - JMIR Form Res SP - e53977 VL - 8 KW - heart rate variability KW - physiological monitoring KW - wearable sensors KW - smartwatch KW - PPG KW - photoplethysmography KW - monitoring KW - physiological KW - heart rate KW - wearable KW - wearables KW - sensor KW - sensors KW - observation study KW - wearable devices KW - devices KW - remote monitoring KW - community KW - data platform KW - data collection KW - health risk N2 - Background: Wearable physiological monitoring devices are promising tools for remote monitoring and early detection of potential health changes of interest. The widespread adoption of such an approach across communities and over long periods of time will require an automated data platform for collecting, processing, and analyzing relevant health information. Objective: In this study, we explore prospective monitoring of individual health through an automated data collection, metrics extraction, and health anomaly analysis pipeline in free-living conditions over a continuous monitoring period of several months with a focus on viral respiratory infections, such as influenza or COVID-19. Methods: A total of 59 participants provided smartwatch data and health symptom and illness reports daily over an 8-month window. Physiological and activity data from photoplethysmography sensors, including high-resolution interbeat interval (IBI) and step counts, were uploaded directly from Garmin Fenix 6 smartwatches and processed automatically in the cloud using a stand-alone, open-source analytical engine. Health risk scores were computed based on a deviation in heart rate and heart rate variability metrics from each individual?s activity-matched baseline values, and scores exceeding a predefined threshold were checked for corresponding symptoms or illness reports. Conversely, reports of viral respiratory illnesses in health survey responses were also checked for corresponding changes in health risk scores to qualitatively assess the risk score as an indicator of acute respiratory health anomalies. Results: The median average percentage of sensor data provided per day indicating smartwatch wear compliance was 70%, and survey responses indicating health reporting compliance was 46%. A total of 29 elevated health risk scores were detected, of which 12 (41%) had concurrent survey data and indicated a health symptom or illness. A total of 21 influenza or COVID-19 illnesses were reported by study participants; 9 (43%) of these reports had concurrent smartwatch data, of which 6 (67%) had an increase in health risk score. Conclusions: We demonstrate a protocol for data collection, extraction of heart rate and heart rate variability metrics, and prospective analysis that is compatible with near real-time health assessment using wearable sensors for continuous monitoring. The modular platform for data collection and analysis allows for a choice of different wearable sensors and algorithms. Here, we demonstrate its implementation in the collection of high-fidelity IBI data from Garmin Fenix 6 smartwatches worn by individuals in free-living conditions, and the prospective, near real-time analysis of the data, culminating in the calculation of health risk scores. To our knowledge, this study demonstrates for the first time the feasibility of measuring high-resolution heart IBI and step count using smartwatches in near real time for respiratory illness detection over a long-term monitoring period in free-living conditions. UR - https://formative.jmir.org/2024/1/e53977 UR - http://dx.doi.org/10.2196/53977 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53977 ER - TY - JOUR AU - Vesinurm, Märt AU - Maunula, Anna AU - Olli, Päivi AU - Lillrank, Paul AU - Ijäs, Petra AU - Torkki, Paulus AU - Mäkitie, Laura AU - Laakso, M. Sini PY - 2024/8/7 TI - Effects of a Digital Care Pathway for Multiple Sclerosis: Observational Study JO - JMIR Hum Factors SP - e51872 VL - 11 KW - digital care pathway KW - multiple sclerosis KW - patient satisfaction KW - outcome KW - patient reported outcome measures KW - resource usage KW - telemedicine KW - digital care KW - outpatient clinic KW - quality of life KW - quality of care KW - communication KW - caregiver KW - chronic condition KW - strategy KW - long-term KW - patient engagement KW - digital health service N2 - Background: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. Objective: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction. Methods: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months. Results: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors? appointments, remote doctors? contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark. Conclusions: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups. UR - https://humanfactors.jmir.org/2024/1/e51872 UR - http://dx.doi.org/10.2196/51872 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51872 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Bayuo, Jonathan AU - Su, Jing Jing AU - Chow, Sum Karen Kit AU - Wong, Man Siu AU - Wong, Po Bonnie AU - Lee, Lam Athena Yin AU - Wong, Yuet Frances Kam PY - 2024/8/7 TI - Exploring the Experiences of Community-Dwelling Older Adults on Using Wearable Monitoring Devices With Regular Support From Community Health Workers, Nurses, and Social Workers: Qualitative Descriptive Study JO - J Med Internet Res SP - e49403 VL - 26 KW - community-dwelling older adults KW - focus group KW - wearable monitoring devices KW - mobile phone N2 - Background: The use of wearable monitoring devices (WMDs), such as smartwatches, is advancing support and care for community-dwelling older adults across the globe. Despite existing evidence of the importance of WMDs in preventing problems and promoting health, significant concerns remain about the decline in use after a period of time, which warrant an understanding of how older adults experience the devices. Objective: This study aims to explore and describe the experiences of community-dwelling older adults after receiving our interventional program, which included the use of a smartwatch with support from a community health workers, nurses, and social workers, including the challenges that they experienced while using the device, the perceived benefits, and strategies to promote their sustained use of the device. Methods: We used a qualitative descriptive approach in this study. Older adults who had taken part in an interventional study involving the use of smartwatches and who were receiving regular health and social support were invited to participate in focus group discussions at the end of the trial. Purposive sampling was used to recruit potential participants. Older adults who agreed to participate were assigned to focus groups based on their community. The focus group discussions were facilitated and moderated by 2 members of the research team. All discussions were recorded and transcribed verbatim. We used the constant comparison analytical approach to analyze the focus group data. Results: A total of 22 participants assigned to 6 focus groups participated in the study. The experiences of community-dwelling older adults emerged as (1) challenges associated with the use of WMDs, (2) the perceived benefits of using the WMDs, and (3) strategies to promote the use of WMDs. In addition, the findings also demonstrate a hierarchical pattern of health-seeking behaviors by older adults: seeking assistance first from older adult volunteers, then from social workers, and finally from nurses. Conclusions: Ongoing use of the WMDs is potentially possible, but it is important to ensure the availability of technical support, maintain active professional follow-ups by nurses and social workers, and include older adult volunteers to support other older adults in such programs. UR - https://www.jmir.org/2024/1/e49403 UR - http://dx.doi.org/10.2196/49403 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110493 ID - info:doi/10.2196/49403 ER - TY - JOUR AU - van den Beuken, F. Wisse M. AU - van Schuppen, Hans AU - Demirtas, Derya AU - van Halm, P. Vokko AU - van der Geest, Patrick AU - Loer, A. Stephan AU - Schwarte, A. Lothar AU - Schober, Patrick PY - 2024/7/25 TI - Investigating Users? Attitudes Toward Automated Smartwatch Cardiac Arrest Detection: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e57574 VL - 11 KW - out-of-hospital cardiac arrest KW - wearables KW - wearable KW - digital health KW - smartwatch KW - automated cardiac arrest detection KW - emergency medicine KW - emergency KW - cardiology KW - heart KW - cardiac KW - cross sectional KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - willingness KW - intent KW - intention N2 - Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in the developed world. Timely detection of cardiac arrest and prompt activation of emergency medical services (EMS) are essential, yet challenging. Automated cardiac arrest detection using sensor signals from smartwatches has the potential to shorten the interval between cardiac arrest and activation of EMS, thereby increasing the likelihood of survival. Objective: This cross-sectional survey study aims to investigate users? perspectives on aspects of continuous monitoring such as privacy and data protection, as well as other implications, and to collect insights into their attitudes toward the technology. Methods: We conducted a cross-sectional web-based survey in the Netherlands among 2 groups of potential users of automated cardiac arrest technology: consumers who already own a smartwatch and patients at risk of cardiac arrest. Surveys primarily consisted of closed-ended questions with some additional open-ended questions to provide supplementary insight. The quantitative data were analyzed descriptively, and a content analysis of the open-ended questions was conducted. Results: In the consumer group (n=1005), 90.2% (n=906; 95% CI 88.1%-91.9%) of participants expressed an interest in the technology, and 89% (n=1196; 95% CI 87.3%-90.7%) of the patient group (n=1344) showed interest. More than 75% (consumer group: n= 756; patient group: n=1004) of the participants in both groups indicated they were willing to use the technology. The main concerns raised by participants regarding the technology included privacy, data protection, reliability, and accessibility. Conclusions: The vast majority of potential users expressed a strong interest in and positive attitude toward automated cardiac arrest detection using smartwatch technology. However, a number of concerns were identified, which should be addressed in the development and implementation process to optimize acceptance and effectiveness of the technology. UR - https://humanfactors.jmir.org/2024/1/e57574 UR - http://dx.doi.org/10.2196/57574 ID - info:doi/10.2196/57574 ER - TY - JOUR AU - Wu, Fei Philip AU - Summers, Charlotte AU - Panesar, Arjun AU - Kaura, Amit AU - Zhang, Li PY - 2024/7/23 TI - AI Hesitancy and Acceptability?Perceptions of AI Chatbots for Chronic Health Management and Long COVID Support: Survey Study JO - JMIR Hum Factors SP - e51086 VL - 11 KW - AI hesitancy KW - chatbot KW - long COVID KW - diabetes KW - chronic disease management KW - technology acceptance KW - post?COVID-19 condition KW - artificial intelligence N2 - Background: Artificial intelligence (AI) chatbots have the potential to assist individuals with chronic health conditions by providing tailored information, monitoring symptoms, and offering mental health support. Despite their potential benefits, research on public attitudes toward health care chatbots is still limited. To effectively support individuals with long-term health conditions like long COVID (or post?COVID-19 condition), it is crucial to understand their perspectives and preferences regarding the use of AI chatbots. Objective: This study has two main objectives: (1) provide insights into AI chatbot acceptance among people with chronic health conditions, particularly adults older than 55 years and (2) explore the perceptions of using AI chatbots for health self-management and long COVID support. Methods: A web-based survey study was conducted between January and March 2023, specifically targeting individuals with diabetes and other chronic conditions. This particular population was chosen due to their potential awareness and ability to self-manage their condition. The survey aimed to capture data at multiple intervals, taking into consideration the public launch of ChatGPT, which could have potentially impacted public opinions during the project timeline. The survey received 1310 clicks and garnered 900 responses, resulting in a total of 888 usable data points. Results: Although past experience with chatbots (P<.001, 95% CI .110-.302) and online information seeking (P<.001, 95% CI .039-.084) are strong indicators of respondents? future adoption of health chatbots, they are in general skeptical or unsure about the use of AI chatbots for health care purposes. Less than one-third of the respondents (n=203, 30.1%) indicated that they were likely to use a health chatbot in the next 12 months if available. Most were uncertain about a chatbot?s capability to provide accurate medical advice. However, people seemed more receptive to using voice-based chatbots for mental well-being, health data collection, and analysis. Half of the respondents with long COVID showed interest in using emotionally intelligent chatbots. Conclusions: AI hesitancy is not uniform across all health domains and user groups. Despite persistent AI hesitancy, there are promising opportunities for chatbots to offer support for chronic conditions in areas of lifestyle enhancement and mental well-being, potentially through voice-based user interfaces. UR - https://humanfactors.jmir.org/2024/1/e51086 UR - http://dx.doi.org/10.2196/51086 ID - info:doi/10.2196/51086 ER - TY - JOUR AU - Leung, Lam Chung AU - Alacapa, Jason AU - Tasca, Gonçalves Bianca AU - Villanueva, Daniel Andre AU - Masulit, Saniata AU - Ignacio, Louie Marvin AU - Uy, Nicole Kathleen AU - Pell, Christopher AU - van Kalmthout, Kristian AU - Powers, Rachel AU - Fielding, Katherine AU - Jerene, Degu PY - 2024/7/23 TI - Digital Adherence Technologies and Differentiated Care for Tuberculosis Treatment and Their Acceptability Among Persons With Tuberculosis, Health Care Workers, and Key Informants in the Philippines: Qualitative Interview Study JO - JMIR Hum Factors SP - e54117 VL - 11 KW - tuberculosis KW - digital adherence technologies KW - implementation KW - acceptability KW - qualitative research KW - Philippines KW - digital health KW - tuberculosis treatment KW - support strategy KW - support KW - medication adherence KW - health care workers KW - interview KW - interviews KW - user KW - user privacy KW - privacy KW - digital adherence N2 - Background: Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB) treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whether DATs can enhance medication adherence among persons with TB. Objective: This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, among persons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs and preferences of end users. Methods: Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured within a modified social-ecological model. Results: A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized that users? technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT. They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerning technology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users? privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic. Conclusions: In the Philippines, persons with TB and HCWs showed a high level of acceptance and satisfaction with the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. Additional efforts are required to scale up the DAT program in the Philippines. UR - https://humanfactors.jmir.org/2024/1/e54117 UR - http://dx.doi.org/10.2196/54117 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54117 ER - TY - JOUR AU - Sezgin, Emre AU - Kocaballi, Baki A. AU - Dolce, Millie AU - Skeens, Micah AU - Militello, Lisa AU - Huang, Yungui AU - Stevens, Jack AU - Kemper, R. Alex PY - 2024/7/19 TI - Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study JO - JMIR Hum Factors SP - e57114 VL - 11 KW - social determinants of health KW - social needs KW - chatbot KW - conversational agent KW - primary care KW - digital health KW - iterative design KW - implementation KW - evaluation KW - usability KW - feasibility N2 - Background: Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. Objective: This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. Methods: This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot?s design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. Results: Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot?s capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. Conclusions: Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs. UR - https://humanfactors.jmir.org/2024/1/e57114 UR - http://dx.doi.org/10.2196/57114 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57114 ER - TY - JOUR AU - Marcuzzi, Anna AU - Klevanger, Elisabeth Nina AU - Aasdahl, Lene AU - Gismervik, Sigmund AU - Bach, Kerstin AU - Mork, Jarle Paul AU - Nordstoga, Lovise Anne PY - 2024/7/9 TI - An Artificial Intelligence?Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial JO - JMIR Hum Factors SP - e55716 VL - 11 KW - low back pain KW - neck pain KW - self-management KW - smartphone app KW - process evaluation KW - focus group KW - focus groups KW - musculoskeletal KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - usage KW - interview KW - interviews KW - qualitative KW - engagement N2 - Background: Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence?based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. Objective: This study is a process evaluation aiming to explore patients? engagement and experiences with the selfBACK app and specialist health care practitioners? views on adopting digital self-management tools in their clinical practice. Methods: App usage analytics in the first 12 weeks were used to explore patients? engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. Results: Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. Conclusions: Although the app?s uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. Trial Registration: ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043 UR - https://humanfactors.jmir.org/2024/1/e55716 UR - http://dx.doi.org/10.2196/55716 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980710 ID - info:doi/10.2196/55716 ER - TY - JOUR AU - Kunchay, Sahiti AU - Linden-Carmichael, N. Ashley AU - Abdullah, Saeed PY - 2024/6/20 TI - Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study JO - JMIR Hum Factors SP - e50795 VL - 11 KW - smartwatches KW - substance use KW - ecological momentary assessment KW - mobile health KW - mHealth KW - human-centered design KW - feasibility studies KW - mobile phone N2 - Background: Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused. Objective: This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life. Methods: This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period. Results: Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users? experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts. Conclusions: This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden. UR - https://humanfactors.jmir.org/2024/1/e50795 UR - http://dx.doi.org/10.2196/50795 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50795 ER - TY - JOUR AU - Porta, Xčnia AU - Nieto, Rubén AU - Serrat, Mayte AU - Bourdin Kreitz, Pierre PY - 2024/6/18 TI - Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study JO - JMIR Form Res SP - e55751 VL - 8 KW - fibromyalgia KW - chronic pain KW - pain management KW - information and communication technologies KW - use KW - satisfaction N2 - Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. UR - https://formative.jmir.org/2024/1/e55751 UR - http://dx.doi.org/10.2196/55751 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55751 ER - TY - JOUR AU - Collins, Luke AU - Nicholson, Niamh AU - Lidbetter, Nicky AU - Smithson, Dave AU - Baker, Paul PY - 2024/6/17 TI - Implementation of Anxiety UK?s Ask Anxia Chatbot Service: Lessons Learned JO - JMIR Hum Factors SP - e53897 VL - 11 KW - chatbots KW - anxiety disorders KW - corpus linguistics KW - conversational agents KW - web-based care UR - https://humanfactors.jmir.org/2024/1/e53897 UR - http://dx.doi.org/10.2196/53897 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885016 ID - info:doi/10.2196/53897 ER - TY - JOUR AU - Faizah, Aaya AU - Hardian, Azzahra Alifah Fatimah AU - Nandini, Devina Rania AU - Handayani, Wuri Putu AU - Harahap, Cyldea Nabila PY - 2024/6/5 TI - The Influence of Incentive-Based Mobile Fitness Apps on Users? Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study JO - JMIR Hum Factors SP - e50957 VL - 11 KW - incentive KW - fitness KW - mobile fitness apps KW - gender KW - continuance usage intention KW - Indonesia KW - mobile phone N2 - Background: A survey conducted by McKinsey & Company reported that, as of May 2022, as many as 26% of Indonesians had recently started to engage actively in physical activity, 32% undertook regular physical activity, and 9% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people?s sports activities. However, public interest in using these apps for any length of time is still relatively low. Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users? continuance usage intention. Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita. Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards. Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers. UR - https://humanfactors.jmir.org/2024/1/e50957 UR - http://dx.doi.org/10.2196/50957 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837199 ID - info:doi/10.2196/50957 ER - TY - JOUR AU - de Frel, Leonhard Daan AU - Schroijen, A. Mariëlle AU - Aardoom, J. Jiska AU - van Gils, Wesley AU - Huisman, D. Sasja AU - Janssen, R. Veronica AU - Versluis, Anke AU - Kleinsmann, S. Maaike AU - Atsma, E. Douwe AU - Pijl, Hanno PY - 2024/5/31 TI - Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study JO - JMIR Hum Factors SP - e45055 VL - 11 KW - diabetes mellitus KW - type 2 KW - telemedicine KW - self-management KW - patient education as topic KW - activation KW - glucose regulation KW - Center for eHealth and Wellbeing Research KW - CeHRes KW - type 2 diabetes KW - tele KW - patient education KW - CeHRes roadmap KW - diabetes KW - glucose KW - insulin KW - education KW - development KW - usability KW - medical KW - behavioral KW - psychological KW - digital consultation KW - feasibility KW - endocrinology KW - endocrine KW - focus group KW - dietitian KW - psychologist KW - nurse KW - lifestyle factor KW - diet KW - exercise KW - stress KW - sleep KW - cardiovascular disease KW - heath care professional KW - mobile phone N2 - Background: Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. Objective: The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. Methods: The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. Results: The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. Conclusions: After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail. UR - https://humanfactors.jmir.org/2024/1/e45055 UR - http://dx.doi.org/10.2196/45055 UR - http://www.ncbi.nlm.nih.gov/pubmed/38819880 ID - info:doi/10.2196/45055 ER - TY - JOUR AU - Ilhan, I. Elif AU - Jola, N. Lucia AU - van der Zalm, M. Marieke AU - Bernstein, Mike AU - Goussard, Pierre AU - Redfern, Andrew AU - Hesseling, C. Anneke AU - Hoddinott, Graeme AU - McCollum, D. Eric AU - King, Carina PY - 2024/5/30 TI - Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers JO - JMIR Hum Factors SP - e54983 VL - 11 KW - pediatrics KW - human-centered design KW - participatory design KW - pulse oximeter KW - South Africa KW - smartphone KW - mobile phone N2 - Background: Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective: The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods: We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results: Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions: Our end user?centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design. UR - https://humanfactors.jmir.org/2024/1/e54983 UR - http://dx.doi.org/10.2196/54983 ID - info:doi/10.2196/54983 ER - TY - JOUR AU - Murabito, M. Joanne AU - Faro, M. Jamie AU - Zhang, Yuankai AU - DeMalia, Angelo AU - Hamel, Alexander AU - Agyapong, Nakesha AU - Liu, Hongshan AU - Schramm, Eric AU - McManus, D. David AU - Borrelli, Belinda PY - 2024/5/30 TI - Smartphone App Designed to Collect Health Information in Older Adults: Usability Study JO - JMIR Hum Factors SP - e56653 VL - 11 KW - mobile application surveys KW - mixed methods KW - electronic data collection KW - mHealth KW - mobile health KW - mobile application KW - mobile applications KW - app KW - apps KW - application KW - applications KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - health information N2 - Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. UR - https://humanfactors.jmir.org/2024/1/e56653 UR - http://dx.doi.org/10.2196/56653 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815261 ID - info:doi/10.2196/56653 ER - TY - JOUR AU - Dinh, Mackenzie AU - Lin, Chieh Chun AU - Whitfield, Candace AU - Farhan, Zahera AU - Meurer, J. William AU - Bailey, Sarah AU - Skolarus, E. Lesli PY - 2024/5/28 TI - Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial JO - JMIR Form Res SP - e54010 VL - 8 KW - hypertension KW - cognition KW - mobile health KW - Bluetooth KW - remote KW - monitoring KW - monitor KW - low income KW - mHealth KW - hypertensive KW - cardiology KW - cardiovascular KW - feasibility KW - acceptability KW - satisfaction KW - RCT KW - randomized controlled trial KW - assessment KW - blood pressure KW - neurological N2 - Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease?related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health?based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message?linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 UR - https://formative.jmir.org/2024/1/e54010 UR - http://dx.doi.org/10.2196/54010 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805251 ID - info:doi/10.2196/54010 ER - TY - JOUR AU - Collins-Pisano, Caroline AU - Leggett, N. Amanda AU - Gambee, David AU - Fortuna, L. Karen PY - 2024/5/27 TI - Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study JO - JMIR Hum Factors SP - e41202 VL - 11 KW - family caregivers KW - dementia KW - peer support KW - technology KW - mobile phone N2 - Background: Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. Objective: The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. Methods: A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. Results: The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non?statistically significant improvements in burden, stress, and strain levels. Conclusions: This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms. UR - https://humanfactors.jmir.org/2024/1/e41202 UR - http://dx.doi.org/10.2196/41202 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801660 ID - info:doi/10.2196/41202 ER - TY - JOUR AU - Bridges, Bronwyn AU - Taylor, Jake AU - Weber, Thomas John PY - 2024/5/24 TI - Evaluation of the Parkinson?s Remote Interactive Monitoring System in a Clinical Setting: Usability Study JO - JMIR Hum Factors SP - e54145 VL - 11 KW - Parkinson disease KW - usability KW - remote monitoring KW - motor examination KW - movement disorders KW - thematic analysis KW - System Usability Scale KW - mobile phone N2 - Background: The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient?s symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient?s condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson?s Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely. Objective: We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting. Methods: Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society?sponsored revision of the Unified Parkinson?s Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics. Results: In total, 11 people with PD participated in the study (female individuals: n=5, 45%; male individuals: n=6, 55%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer?s notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant?s orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants? perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70. Conclusions: Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients? needs. UR - https://humanfactors.jmir.org/2024/1/e54145 UR - http://dx.doi.org/10.2196/54145 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787603 ID - info:doi/10.2196/54145 ER - TY - JOUR AU - Washington, T. Karla AU - Oliver, Parker Debra AU - Donehower, K. Allison AU - White, Patrick AU - Benson, J. Jacquelyn AU - Lyons, G. Patrick AU - Demiris, George PY - 2024/5/23 TI - Accessibility, Relevance, and Impact of a Symptom Monitoring Tool for Home Hospice Care: Theory Elaboration and Qualitative Assessment JO - JMIR Hum Factors SP - e51789 VL - 11 KW - caregivers KW - home care services KW - hospice care KW - signs and symptoms KW - technology KW - mobile phone N2 - Background: Early users found Engagement and Visualization to Improve Symptoms in Oncology Care (ENVISION), a web-based application designed to improve home management of hospice patients? symptoms and support patients? and family caregivers? well-being, to be generally useful and easy to use. However, they also raised concerns about potential challenges users with limited technological proficiency might experience. Objective: We sought to concurrently accomplish two interrelated study aims: (1) to develop a conceptual framework of digital inclusivity for health information systems and (2) to apply the framework in evaluating the digital inclusivity of the ENVISION application. Methods: We engaged ENVISION users (N=34) in a qualitative study in which data were collected via direct observation, think-aloud techniques, and responses to open-ended queries. Data were analyzed via theory elaboration and basic qualitative description. Results: Accessibility, relevance, and impact were identified as 3 essential considerations in evaluating a health system?s digital inclusivity. Study findings generally supported ENVISION?s digital inclusivity, particularly concerning its perceived relevance to the work of family caregivers and hospice clinicians and its potentially positive impact on symptom management and quality of life. Limitations to ENVISION?s digital inclusivity centered around issues of accessibility, particularly operability among individuals with limited technological knowledge and skills. Conclusions: The Accessibility, Relevance, and Impact conceptual framework of digital inclusivity for health information systems can help identify opportunities to strengthen the digital inclusivity of tools, such as ENVISION, intended for use by a broad and diverse range of users. UR - https://humanfactors.jmir.org/2024/1/e51789 UR - http://dx.doi.org/10.2196/51789 UR - http://www.ncbi.nlm.nih.gov/pubmed/38781581 ID - info:doi/10.2196/51789 ER - TY - JOUR AU - Aspelund, Anna AU - Valkonen, Paula AU - Viitanen, Johanna AU - Rauta, Virpi PY - 2024/5/14 TI - Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions JO - JMIR Hum Factors SP - e53691 VL - 11 KW - usability KW - UX KW - user experience KW - PX KW - patient experience KW - user-based evaluation KW - patients KW - eHealth KW - digital health solution KW - kidney disease KW - home dialysis N2 - Background: Chronic kidney disease affects 10% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients? quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease. Objective: Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution. Methods: We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores. Results: Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients? own health-related goals and fits with the needs of their everyday lives with the disease. Conclusions: A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions. UR - https://humanfactors.jmir.org/2024/1/e53691 UR - http://dx.doi.org/10.2196/53691 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743476 ID - info:doi/10.2196/53691 ER - TY - JOUR AU - Almasri, Abdullah AU - El-Kour, Y. Tatyana AU - Silva, Liliana AU - Abdulfattah, Yousef PY - 2024/5/10 TI - Evaluating the Energy Efficiency of Popular US Smartphone Health Care Apps: Comparative Analysis Study Toward Sustainable Health and Nutrition Apps Practices JO - JMIR Hum Factors SP - e58311 VL - 11 KW - mobile health KW - energy consumption in health care smartphone apps KW - dietary tracking apps KW - optimization and sustainability in mobile health KW - user engagement and experience KW - Android apps performance KW - digital health technologies KW - app KW - apps KW - applications KW - digital health KW - energy KW - consumption KW - sustainable KW - sustainability KW - environment KW - environmental KW - use KW - smartphone KW - smartphones KW - electricity KW - electrical KW - mobile phone N2 - Background: The emergence of smartphones has sparked a transformation across multiple fields, with health care being one of the most notable due to the advent of mobile health (mHealth) apps. As mHealth apps have gained popularity, there is a need to understand their energy consumption patterns as an integral part of the evolving landscape of health care technologies. Objective: This study aims to identify the key contributors to elevated energy consumption in mHealth apps and suggest methods for their optimization, addressing a significant void in our comprehension of the energy dynamics at play within mHealth apps. Methods: Through quantitative comparative analysis of 10 prominent mHealth apps available on Android platforms within the United States, this study examined factors contributing to high energy consumption. The analysis included descriptive statistics, comparative analysis using ANOVA, and regression analysis to examine how certain factors impact energy use and consumption. Results: Observed energy use variances in mHealth apps stemmed from user interactions, features, and underlying technology. Descriptive analysis revealed variability in app energy consumption (150-310 milliwatt-hours), highlighting the influence of user interaction and app complexity. ANOVA verified these findings, indicating the critical role of engagement and functionality. Regression modeling (energy consumption = ?? + ?? × notification frequency + ?? × GPS use + ?? × app complexity + ?), with statistically significant P values (notification frequency with a P value of .01, GPS use with a P value of .05, and app complexity with a P value of .03), further quantified these bases? effects on energy use. Conclusions: The observed differences in the energy consumption of dietary apps reaffirm the need for a multidisciplinary approach to bring together app developers, end users, and health care experts to foster improved energy conservation practice while achieving a balance between sustainable practice and user experience. More research is needed to better understand how to scale-up consumer engagement to achieve sustainable development goal 12 on responsible consumption and production. UR - https://humanfactors.jmir.org/2024/1/e58311 UR - http://dx.doi.org/10.2196/58311 UR - http://www.ncbi.nlm.nih.gov/pubmed/38729624 ID - info:doi/10.2196/58311 ER - TY - JOUR AU - Schnoor, Kyma AU - Talboom-Kamp, A. Esther P. W. AU - Hajti?, Muamer AU - Chavannes, H. Niels AU - Versluis, Anke PY - 2024/5/10 TI - Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users JO - JMIR Hum Factors SP - e45115 VL - 11 KW - eHealth KW - usability KW - self-management KW - diagnostic test service KW - diagnostic KW - testing KW - test service KW - perspective KW - focus group KW - user need KW - user testing KW - implementation KW - qualitative KW - test result KW - laboratory test KW - laboratory result N2 - Background: Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals? willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. Objective: This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. Methods: A qualitative method was used from a potential user?s perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. Results: In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users? health and to maintain their health. Conclusions: According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online. UR - https://humanfactors.jmir.org/2024/1/e45115 UR - http://dx.doi.org/10.2196/45115 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728071 ID - info:doi/10.2196/45115 ER - TY - JOUR AU - Wei, Lai AU - Wang, Jia Stephen PY - 2024/5/6 TI - Motion Tracking of Daily Living and Physical Activities in Health Care: Systematic Review From Designers? Perspective JO - JMIR Mhealth Uhealth SP - e46282 VL - 12 KW - motion tracking KW - daily living KW - physical activity KW - health care application KW - design KW - public health KW - systematic review KW - mobile phone N2 - Background: Motion tracking technologies serve as crucial links between physical activities and health care insights, facilitating data acquisition essential for analyzing and intervening in physical activity. Yet, systematic methodologies for evaluating motion tracking data, especially concerning user activity recognition in health care applications, remain underreported. Objective: This study aims to systematically review motion tracking in daily living and physical activities, emphasizing the critical interaction among devices, users, and environments from a design perspective, and to analyze the process involved in health care application research. It intends to delineate the design and application intricacies in health care contexts, focusing on enhancing motion tracking data?s accuracy and applicability for health monitoring and intervention strategies. Methods: Using a systematic review, this research scrutinized motion tracking data and their application in health care and wellness, examining studies from Scopus, Web of Science, EBSCO, and PubMed databases. The review used actor network theory and data-enabled design to understand the complex interplay between humans, devices, and environments within these applications. Results: Out of 1501 initially identified studies, 54 (3.66%) were included for in-depth analysis. These articles predominantly used accelerometer and gyroscope sensors (n=43, 80%) to monitor and analyze motion, demonstrating a strong preference for these technologies in capturing both dynamic and static activities. While incorporating portable devices (n=11, 20%) and multisensor configurations (n=16, 30%), the application of sensors across the body (n=15, 28%) and within physical spaces (n=17, 31%) highlights the diverse applications of motion tracking technologies in health care research. This diversity reflects the application?s alignment with activity types ranging from daily movements to specialized scenarios. The results also reveal a diverse participant pool, including the general public, athletes, and specialized groups, with a focus on healthy individuals (n=31, 57%) and athletes (n=14, 26%). Despite this extensive application range, the focus primarily on laboratory-based studies (n=39, 72%) aimed at professional uses, such as precise activity identification and joint functionality assessment, emphasizes a significant challenge in translating findings from controlled environments to the dynamic conditions of everyday physical activities. Conclusions: This study?s comprehensive investigation of motion tracking technology in health care research reveals a significant gap between the methods used for data collection and their practical application in real-world scenarios. It proposes an innovative approach that includes designers in the research process, emphasizing the importance of incorporating data-enabled design framework. This ensures that motion data collection is aligned with the dynamic and varied nature of daily living and physical activities. Such integration is crucial for developing health applications that are accessible, intuitive, and tailored to meet diverse user needs. By leveraging a multidisciplinary approach that combines design, engineering, and health sciences, the research opens new pathways for enhancing the usability and effectiveness of health technologies. UR - https://mhealth.jmir.org/2024/1/e46282 UR - http://dx.doi.org/10.2196/46282 UR - http://www.ncbi.nlm.nih.gov/pubmed/38709547 ID - info:doi/10.2196/46282 ER - TY - JOUR AU - Fink, Franziska AU - Kalter, Ivonne AU - Steindorff, Jenny-Victoria AU - Helmbold, Konrad Hans AU - Paulicke, Denny AU - Jahn, Patrick PY - 2024/4/30 TI - Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach JO - JMIR Hum Factors SP - e51587 VL - 11 KW - human-drone interaction KW - medical supplies KW - participative research KW - user-centered design KW - technology acceptance N2 - Background: The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones. Objective: This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones). Methods: A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations. Results: The study found a positive correlation between the usability of a pharmacy drone app and participants? willingness to use it (r=0.833). Participants? perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=?0.542; System Usability Scale and r=?0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration. Conclusions: With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable. UR - https://humanfactors.jmir.org/2024/1/e51587 UR - http://dx.doi.org/10.2196/51587 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687589 ID - info:doi/10.2196/51587 ER - TY - JOUR AU - Thunström, Osmanovic Almira AU - Carlsen, Krage Hanne AU - Ali, Lilas AU - Larson, Tomas AU - Hellström, Andreas AU - Steingrimsson, Steinn PY - 2024/4/29 TI - Usability Comparison Among Healthy Participants of an Anthropomorphic Digital Human and a Text-Based Chatbot as a Responder to Questions on Mental Health: Randomized Controlled Trial JO - JMIR Hum Factors SP - e54581 VL - 11 KW - chatbot KW - chatbots KW - chat-bot KW - chat-bots KW - text-only chatbot, voice-only chatbot KW - mental health KW - mental illness KW - mental disease KW - mental diseases KW - mental illnesses KW - mental health service KW - mental health services KW - interface KW - system usability KW - usability KW - digital health KW - machine learning KW - ML KW - artificial intelligence KW - AI KW - algorithm KW - algorithms KW - NLP KW - natural language processing N2 - Background: The use of chatbots in mental health support has increased exponentially in recent years, with studies showing that they may be effective in treating mental health problems. More recently, the use of visual avatars called digital humans has been introduced. Digital humans have the capability to use facial expressions as another dimension in human-computer interactions. It is important to study the difference in emotional response and usability preferences between text-based chatbots and digital humans for interacting with mental health services. Objective: This study aims to explore to what extent a digital human interface and a text-only chatbot interface differed in usability when tested by healthy participants, using BETSY (Behavior, Emotion, Therapy System, and You) which uses 2 distinct interfaces: a digital human with anthropomorphic features and a text-only user interface. We also set out to explore how chatbot-generated conversations on mental health (specific to each interface) affected self-reported feelings and biometrics. Methods: We explored to what extent a digital human with anthropomorphic features differed from a traditional text-only chatbot regarding perception of usability through the System Usability Scale, emotional reactions through electroencephalography, and feelings of closeness. Healthy participants (n=45) were randomized to 2 groups that used a digital human with anthropomorphic features (n=25) or a text-only chatbot with no such features (n=20). The groups were compared by linear regression analysis and t tests. Results: No differences were observed between the text-only and digital human groups regarding demographic features. The mean System Usability Scale score was 75.34 (SD 10.01; range 57-90) for the text-only chatbot versus 64.80 (SD 14.14; range 40-90) for the digital human interface. Both groups scored their respective chatbot interfaces as average or above average in usability. Women were more likely to report feeling annoyed by BETSY. Conclusions: The text-only chatbot was perceived as significantly more user-friendly than the digital human, although there were no significant differences in electroencephalography measurements. Male participants exhibited lower levels of annoyance with both interfaces, contrary to previously reported findings. UR - https://humanfactors.jmir.org/2024/1/e54581 UR - http://dx.doi.org/10.2196/54581 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683664 ID - info:doi/10.2196/54581 ER - TY - JOUR AU - Lee, J. Edmund W. AU - Tan, W. Warrick AU - Pham, Phat Ben Tan AU - Kawaja, Ariffin AU - Theng, Yin-Leng PY - 2024/4/24 TI - Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study JO - JMIR Serious Games SP - e47600 VL - 12 KW - wearables KW - exergames KW - older adults KW - active aging KW - rehabilitation KW - stroke N2 - Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults? views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. UR - https://games.jmir.org/2024/1/e47600 UR - http://dx.doi.org/10.2196/47600 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656778 ID - info:doi/10.2196/47600 ER - TY - JOUR AU - Tokunaga, Seiki AU - Sekiguchi, Takuya AU - Watanabe Miura, Kumi AU - Sugimoto, Hikaru AU - S Abe, Masato AU - Tamura, Kazuhiro AU - Kishimoto, Taishiro AU - Kudo, Takashi AU - Otake-Matsuura, Mihoko PY - 2024/4/22 TI - Home-Based Cognitive Intervention for Healthy Older Adults Through Asking Robots Questions: Randomized Controlled Trial JO - JMIR Aging SP - e47229 VL - 7 KW - cognitive intervention KW - home-based experiment KW - robots KW - older adults KW - technology adoption KW - digital health N2 - Background: Asking questions is common in conversations, and while asking questions, we need to listen carefully to what others say and consider the perspective our questions adopt. However, difficulties persist in verifying the effect of asking questions on older adults? cognitive function due to the lack of a standardized system for conducting experiments at participants? homes. Objective: This study examined the intervention effect of cognitive training moderated by robots on healthy older adults. A focus on the feasibility of the intervention at participants? homes was also maintained. Feasibility was evaluated by considering both the dropout rate during the intervention and the number of questions posed to each participant during the experiment. Methods: We conducted a randomized controlled trial with 81 adults older than 65 years. Participants were recruited through postal invitations and then randomized into 2 groups. The intervention group (n=40) received sessions where participants listened to photo-integrated stories and posed questions to the robots. The control group (n=41) received sessions where participants listened to photo-integrated stories and only thanked the robots for confirming participation. The participants participated in 12 dialogue sessions for 2-3 weeks. Scores of global cognitive functioning tests, recall tests, and verbal fluency tasks measured before and after the intervention were compared between the 2 groups. Results: There was no significant intervention effect on the Telephone Interview for Cognitive Status-Japanese scores, recall tests, and verbal fluency tasks. Additionally, our study successfully concluded with no participant dropouts at follow-up, confirming the feasibility of our approach. Conclusions: There was no statistically significant evidence indicating intervention benefits for cognitive functioning. Although the feasibility of home-based interventions was demonstrated, we identified areas for improvement in the future, such as setting up more efficient session themes. Further research is required to identify the effectiveness of an improved cognitive intervention involving the act of asking questions. Trial Registration: University Hospital Medical Information Network Center UMIN000039489; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045027 UR - https://aging.jmir.org/2024/1/e47229 UR - http://dx.doi.org/10.2196/47229 ID - info:doi/10.2196/47229 ER - TY - JOUR AU - Raes, Sarah AU - Prezzi, Andrea AU - Willems, Rik AU - Heidbuchel, Hein AU - Annemans, Lieven PY - 2024/4/19 TI - Investigating the Cost-Effectiveness of Telemonitoring Patients With Cardiac Implantable Electronic Devices: Systematic Review JO - J Med Internet Res SP - e47616 VL - 26 KW - systematic review KW - cost-effectiveness KW - telemonitoring KW - cardiac device KW - implantable cardioverter-defibrillator KW - ICD KW - pacemaker KW - monitoring KW - patient management KW - effectiveness KW - cost KW - quality of life KW - cardiac implantable electronic device KW - cardiac N2 - Background: Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment. Objective: This systematic review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives. Methods: A systematic review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist. Results: Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20%) calculated the incremental cost-effectiveness ratio, 1 (7%) the cost-utility ratio, and 11 (73%) the health and cost impact of telemonitoring. In total, 73% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US $912 per patient per year. Scheduled in-office visits included up to 61% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52%) reported improved quality of life, with statistically significance in only 1 (13%) study (P=.03). Conclusions: From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers? income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective. Trial Registration: PROSPERO CRD42022322334; https://tinyurl.com/puunapdr UR - https://www.jmir.org/2024/1/e47616 UR - http://dx.doi.org/10.2196/47616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640471 ID - info:doi/10.2196/47616 ER - TY - JOUR AU - Bérubé, Caterina AU - Maritsch, Martin AU - Lehmann, Franziska Vera AU - Kraus, Mathias AU - Feuerriegel, Stefan AU - Züger, Thomas AU - Wortmann, Felix AU - Stettler, Christoph AU - Fleisch, Elgar AU - Kocaballi, Baki A. AU - Kowatsch, Tobias PY - 2024/4/18 TI - Multimodal In-Vehicle Hypoglycemia Warning for Drivers With Type 1 Diabetes: Design and Evaluation in Simulated and Real-World Driving JO - JMIR Hum Factors SP - e46967 VL - 11 KW - digital health KW - voice assistant KW - ambient lighting KW - in-vehicle technology KW - health state KW - diabetes KW - hypoglycemia KW - warning KW - emotional reaction KW - technology acceptance KW - mobile phone KW - implementation N2 - Background: Hypoglycemia threatens cognitive function and driving safety. Previous research investigated in-vehicle voice assistants as hypoglycemia warnings. However, they could startle drivers. To address this, we combine voice warnings with ambient LEDs. Objective: The study assesses the effect of in-vehicle multimodal warning on emotional reaction and technology acceptance among drivers with type 1 diabetes. Methods: Two studies were conducted, one in simulated driving and the other in real-world driving. A quasi-experimental design included 2 independent variables (blood glucose phase and warning modality) and 1 main dependent variable (emotional reaction). Blood glucose was manipulated via intravenous catheters, and warning modality was manipulated by combining a tablet voice warning app and LEDs. Emotional reaction was measured physiologically via skin conductance response and subjectively with the Affective Slider and tested with a mixed-effect linear model. Secondary outcomes included self-reported technology acceptance. Participants were recruited from Bern University Hospital, Switzerland. Results: The simulated and real-world driving studies involved 9 and 10 participants with type 1 diabetes, respectively. Both studies showed significant results in self-reported emotional reactions (P<.001). In simulated driving, neither warning modality nor blood glucose phase significantly affected self-reported arousal, but in real-world driving, both did (F2,68=4.3; P<.05 and F2,76=4.1; P=.03). Warning modality affected self-reported valence in simulated driving (F2,68=3.9; P<.05), while blood glucose phase affected it in real-world driving (F2,76=9.3; P<.001). Skin conductance response did not yield significant results neither in the simulated driving study (modality: F2,68=2.46; P=.09, blood glucose phase: F2,68=0.3; P=.74), nor in the real-world driving study (modality: F2,76=0.8; P=.47, blood glucose phase: F2,76=0.7; P=.5). In both simulated and real-world driving studies, the voice+LED warning modality was the most effective (simulated: mean 3.38, SD 1.06 and real-world: mean 3.5, SD 0.71) and urgent (simulated: mean 3.12, SD 0.64 and real-world: mean 3.6, SD 0.52). Annoyance varied across settings. The standard warning modality was the least effective (simulated: mean 2.25, SD 1.16 and real-world: mean 3.3, SD 1.06) and urgent (simulated: mean 1.88, SD 1.55 and real-world: mean 2.6, SD 1.26) and the most annoying (simulated: mean 2.25, SD 1.16 and real-world: mean 1.7, SD 0.95). In terms of preference, the voice warning modality outperformed the standard warning modality. In simulated driving, the voice+LED warning modality (mean rank 1.5, SD rank 0.82) was preferred over the voice (mean rank 2.2, SD rank 0.6) and standard (mean rank 2.4, SD rank 0.81) warning modalities, while in real-world driving, the voice+LED and voice warning modalities were equally preferred (mean rank 1.8, SD rank 0.79) to the standard warning modality (mean rank 2.4, SD rank 0.84). Conclusions: Despite the mixed results, this paper highlights the potential of implementing voice assistant?based health warnings in cars and advocates for multimodal alerts to enhance hypoglycemia management while driving. Trial Registration: ClinicalTrials.gov NCT05183191; https://classic.clinicaltrials.gov/ct2/show/NCT05183191, ClinicalTrials.gov NCT05308095; https://classic.clinicaltrials.gov/ct2/show/NCT05308095 UR - https://humanfactors.jmir.org/2024/1/e46967 UR - http://dx.doi.org/10.2196/46967 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635313 ID - info:doi/10.2196/46967 ER - TY - JOUR AU - McCallum, Claire AU - Campbell, Miglena AU - Vines, John AU - Rapley, Tim AU - Ellis, Jason AU - Deary, Vincent AU - Hackett, Katie PY - 2024/4/17 TI - A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops JO - JMIR Hum Factors SP - e54172 VL - 11 KW - self-management KW - mobile health KW - mHealth KW - eHealth KW - Sjögren's syndrome KW - patient participation KW - patient involvement KW - fatigue KW - chronic disease KW - focus groups KW - complex intervention development KW - mobile phone N2 - Background: Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. Objective: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. Methods: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. Results: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. Conclusions: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users? limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities. UR - https://humanfactors.jmir.org/2024/1/e54172 UR - http://dx.doi.org/10.2196/54172 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630530 ID - info:doi/10.2196/54172 ER - TY - JOUR AU - Sobrinho, Silva Andressa Crystine da AU - Gomes, Oliveira Grace Angelica de AU - Bueno Júnior, Roberto Carlos PY - 2024/4/15 TI - Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach JO - JMIR Form Res SP - e54214 VL - 8 KW - information and communications technologies KW - ICTs KW - health care KW - digital inclusion KW - focus groups KW - health promotion KW - user KW - usability KW - health literacy KW - digital competencies KW - digital skills KW - mobile phone N2 - Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirăo Pręto, Săo Paulo, Brazil, and involved 20 older adults of both genders who were aged ?60 years and enrolled in the Physical Education Program for the Elderly at the University of Săo Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. UR - https://formative.jmir.org/2024/1/e54214 UR - http://dx.doi.org/10.2196/54214 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619865 ID - info:doi/10.2196/54214 ER - TY - JOUR AU - von Kalckreuth, Niklas AU - Feufel, A. Markus PY - 2024/4/10 TI - Influence of Disease-Related Stigma on Patients? Decisions to Upload Medical Reports to the German Electronic Health Record: Randomized Controlled Trial JO - JMIR Hum Factors SP - e52625 VL - 11 KW - electronic health record KW - EHR KW - technology acceptance KW - upload behavior KW - health-related stigma KW - intention to use KW - intention-behavior gap KW - medical reports KW - stigma KW - Germany KW - patient decision KW - digital transformation KW - implementation KW - risk KW - decision KW - risk perception KW - social stigma KW - safety N2 - Background: The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German health care system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, 3 out of 4 Germans stated that they intend to use the EHR, whereas other studies show that the intention to use a technology is not a reliable and sufficient predictor of actual use. Objective: Controlling for patients? intention to use the EHR, we investigated whether disease-specific risk perceptions related to the time course of the disease and disease-related stigma explain the additional variance in patients? decisions to upload medical reports to the EHR. Methods: In an online user study, 241 German participants were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and disease time course (acute vs chronic) and to decide whether to upload it to the EHR. Results: Disease-related stigma (odds ratio 0.154, P<.001) offset the generally positive relationship between intention to use and the upload decision (odds ratio 2.628, P<.001), whereas the disease time course showed no effect. Conclusions: Even if patients generally intend to use the EHR, risk perceptions such as those related to diseases associated with social stigma may deter people from uploading related medical reports to the EHR. To ensure the reliable use of this key technology in a digitalized health care system, transparent and easy-to-comprehend information about the safety standards of the EHR are warranted across the board, even for populations that are generally in favor of using the EHR. UR - https://humanfactors.jmir.org/2024/1/e52625 UR - http://dx.doi.org/10.2196/52625 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598271 ID - info:doi/10.2196/52625 ER - TY - JOUR AU - Chabrak, Sonia AU - Haggui, Abdeddayem AU - Allouche, Emna AU - Ouali, Sana AU - Ben Halima, Afef AU - Kacem, Slim AU - Krichen, Salma AU - Marrakchi, Sonia AU - Fehri, Wafa AU - Mourali, Sami Mohamed AU - Jabbari, Zeineb AU - Ben Halima, Manel AU - Neffati, Elyes AU - Heraiech, Aymen  AU - Slim, Mehdi AU - Kachboura, Salem AU - Gamra, Habib AU - Hassine, Majed AU - Kraiem, Sondes AU - Kammoun, Sofien AU - Bezdah, Leila AU - Jridi, Gouider AU - Bouraoui, Hatem AU - Kammoun, Samir AU - Hammami, Rania AU - Chettaoui, Rafik AU - Ben Ameur, Youssef AU - Azaiez, Fares AU - Tlili, Rami AU - Battikh, Kais AU - Ben Slima, Hedi AU - Chrigui, Rim AU - Fazaa, Samia AU - Sanaa, Islem AU - Ellouz, Yassine AU - Mosrati, Mohamed AU - Milouchi, Sami AU - Jarmouni, Soumaya AU - Ayadi, Wacef AU - Akrout, Malek AU - Razgallah, Rabie AU - Neffati, Wissal AU - Drissa, Meriem AU - Charfeddine, Selma AU - Abdessalem, Salem AU - Abid, Leila AU - Zakhama, Lilia PY - 2024/4/8 TI - National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study JO - JMIR Res Protoc SP - e47525 VL - 13 KW - Tunisia KW - study KW - pacemaker KW - implantable cardioverter defibrillator KW - cardiac resynchronization therapy KW - design KW - complication N2 - Background: In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. Objective: The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. Methods: The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). Results: The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. Conclusions: This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial Registration: ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID): RR1-10.2196/47525 UR - https://www.researchprotocols.org/2024/1/e47525 UR - http://dx.doi.org/10.2196/47525 UR - http://www.ncbi.nlm.nih.gov/pubmed/38588529 ID - info:doi/10.2196/47525 ER - TY - JOUR AU - Medina-García, Rodrigo AU - López-Rodríguez, A. Juan AU - Lozano-Hernández, María Cristina AU - Ruiz Bejerano, Verónica AU - Criscio, Paride AU - Del Cura-González, Isabel AU - PY - 2024/4/5 TI - A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study JO - JMIR Hum Factors SP - e46811 VL - 11 KW - user-centered design KW - multimorbidity KW - comorbid KW - self-care KW - medical informatics KW - primary health care KW - chronic disease KW - chronic condition KW - chronic illness KW - primary care KW - usability KW - telemedicne KW - telehealth KW - information and communication technologies KW - ICT KW - digital health KW - eHealth KW - human-computer interaction N2 - Background: Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between a patient and technology, known as usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure their relevant role in promoting self-care. Objective: The aim of this study was to analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. Methods: A descriptive observational cross-sectional usability study was performed framed in the clinical trial in the primary care health centers of Madrid Health Service of the TeNDER (Affective Based Integrated Care for Better Quality of Life) project. The TeNDER technological tool integrates sensors for monitoring physical and sleep activity along with a mobile app for consulting the data collected and working with self-management tools. This project included patients over 60 years of age who had one or more chronic diseases, at least one of which was mild-moderate cognitive impairment, Parkinson disease, or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate in the usability study. The usability variables investigated were effectiveness, which was determined by the degree of completion and the total number of errors per task; efficiency, evaluated as the average time to perform each task; and satisfaction, quantified by the System Usability Scale. Five tasks were evaluated based on real case scenarios. Usability variables were analyzed according to the sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for task completion. Results: The median age of the 38 participants was 75 (IQR 72.0-79.0) years. There was a slight majority of women (20/38, 52.6%) and the participants had a median of 8 (IQR 7.0-11.0) chronic diseases. Thirty patients completed the usability study, with a usability effectiveness result of 89.3% (134/150 tasks completed). Among the 30 patients, 66.7% (n=20) completed all tasks and 56.7% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level emerged as a facilitating factor for independent task completion (odds ratio 1.79, 95% CI 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction score was 55 (IQR 45.0-62.5) out of 100. Conclusions: Although usability effectiveness was high, the poor efficiency and usability satisfaction scores suggest that there are other factors that may interfere with the results. Multimorbidity was not confirmed to be a key factor affecting the usability of the technological tool. Trial Registration: Clinicaltrials.gov NCT05681065; https://clinicaltrials.gov/study/NCT05681065 UR - https://humanfactors.jmir.org/2024/1/e46811 UR - http://dx.doi.org/10.2196/46811 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578675 ID - info:doi/10.2196/46811 ER - TY - JOUR AU - van den Berg, N. Liselot AU - Hallensleben, Cynthia AU - Vlug, AE Lisa AU - Chavannes, H. Niels AU - Versluis, Anke PY - 2024/4/4 TI - The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study JO - JMIR Hum Factors SP - e54386 VL - 11 KW - asthma KW - short-acting beta2-agonist KW - SABA overuse KW - app KW - eHealth KW - feasibility KW - usability KW - mobile phone N2 - Background: Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication?specifically, short-acting beta2-agonist (SABA) overuse?is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. Objective: This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. Methods: A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. Results: The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; ?=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. Conclusions: The initial findings regarding the app?s feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices. UR - https://humanfactors.jmir.org/2024/1/e54386 UR - http://dx.doi.org/10.2196/54386 UR - http://www.ncbi.nlm.nih.gov/pubmed/38574348 ID - info:doi/10.2196/54386 ER - TY - JOUR AU - Adler, F. Rachel AU - Baez, Kevin AU - Morales, Paulina AU - Sotelo, Jocelyn AU - Victorson, David AU - Magasi, Susan PY - 2024/4/2 TI - Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing JO - JMIR Hum Factors SP - e51522 VL - 11 KW - mobile health KW - mHealth KW - apps KW - usability KW - cancer survivors KW - accessibility KW - disabilities KW - cancer KW - oncology KW - heuristics KW - empowerment KW - advocacy KW - mindfulness KW - problem-solving N2 - Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen?s 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app?s design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. UR - https://humanfactors.jmir.org/2024/1/e51522 UR - http://dx.doi.org/10.2196/51522 UR - http://www.ncbi.nlm.nih.gov/pubmed/38564261 ID - info:doi/10.2196/51522 ER - TY - JOUR AU - Kargarandehkordi, Ali AU - Slade, Christopher AU - Washington, Peter PY - 2024/3/25 TI - Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study JO - JMIR Res Protoc SP - e55615 VL - 13 KW - stress KW - hypertension KW - precision health KW - personalized artificial intelligence KW - wearables KW - ecological momentary assessments KW - passive sensing KW - mobile phone N2 - Background: Referred to as the ?silent killer,? elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective: The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods: The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results: Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app?s messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions: Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project?s clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/55615 UR - https://www.researchprotocols.org/2024/1/e55615 UR - http://dx.doi.org/10.2196/55615 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526539 ID - info:doi/10.2196/55615 ER - TY - JOUR AU - Chien, Shih-Ying AU - Wong, May-Kuen Alice AU - Tseng, Winston AU - Hu, Han-Chung AU - Cho, Hsiu-Ying PY - 2024/3/7 TI - Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study JO - JMIR Hum Factors SP - e51150 VL - 11 KW - chronic lung diseases KW - home-based pulmonary rehabilitation KW - telehealth KW - remote health care N2 - Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. UR - https://humanfactors.jmir.org/2024/1/e51150 UR - http://dx.doi.org/10.2196/51150 UR - http://www.ncbi.nlm.nih.gov/pubmed/38452366 ID - info:doi/10.2196/51150 ER - TY - JOUR AU - Anders, Carolin AU - Moorthy, Preetha AU - Svensson, Laura AU - Müller, Julia AU - Heinze, Oliver AU - Knaup, Petra AU - Wallwiener, Markus AU - Deutsch, M. Thomas AU - Le, Thao-Vy AU - Weinert, Lina PY - 2024/3/5 TI - Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking JO - JMIR Hum Factors SP - e50926 VL - 11 KW - mobile health KW - mHealth KW - usability KW - breast cancer KW - eye tracking KW - user interface KW - mixed methods KW - mobile phone N2 - Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app?s content regularly, and self-administration. In contrast to the app?s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients? feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. UR - https://humanfactors.jmir.org/2024/1/e50926 UR - http://dx.doi.org/10.2196/50926 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441959 ID - info:doi/10.2196/50926 ER - TY - JOUR AU - McElwain, L. Nancy AU - Fisher, C. Meghan AU - Nebeker, Camille AU - Bodway, M. Jordan AU - Islam, Bashima AU - Hasegawa-Johnson, Mark PY - 2024/2/8 TI - Evaluating Users? Experiences of a Child Multimodal Wearable Device: Mixed Methods Approach JO - JMIR Hum Factors SP - e49316 VL - 11 KW - wearable devices KW - multimodal sensing KW - user experience KW - usability KW - privacy KW - children KW - mobile phone N2 - Background: Wearable devices permit the continuous, unobtrusive collection of data from children in their natural environments and can transform our understanding of child development. Although the use of wearable devices has begun to emerge in research involving children, few studies have considered families? experiences and perspectives of participating in research of this kind. Objective: Through a mixed methods approach, we assessed parents? and children?s experiences of using a new wearable device in the home environment. The wearable device was designed specifically for use with infants and young children, and it integrates audio, electrocardiogram, and motion sensors. Methods: In study 1, semistructured phone interviews were conducted with 42 parents of children aged 1 month to 9.5 years who completed 2 day-long recordings using the device, which the children wore on a specially designed shirt. In study 2, a total of 110 parents of children aged 2 months to 5.5 years responded to a questionnaire assessing their experience of completing 3 day-long device recordings in the home. Guided by the Digital Health Checklist, we assessed parental responses from both studies in relation to the following three key domains: (1) access and usability, (2) privacy, and (3) risks and benefits. Results: In study 1, most parents viewed the device as easy to use and safe and remote visits as convenient. Parents? views on privacy related to the audio recordings were more varied. The use of machine learning algorithms (vs human annotators) in the analysis of the audio data, the ability to stop recordings at any time, and the view that the recordings reflected ordinary family life were some reasons cited by parents who expressed minimal, if any, privacy concerns. Varied risks and benefits were also reported, including perceived child comfort or discomfort, the need to adjust routines to accommodate the study, the understanding gained from the study procedures, and the parent?s and child?s enjoyment of study participation. In study 2, parents? ratings on 5 close-ended items yielded a similar pattern of findings. Compared with a ?neutral? rating, parents were significantly more likely to agree that (1) device instructions were helpful and clear (t109=?45.98; P<.001), (2) they felt comfortable putting the device on their child (t109=?22.22; P<.001), and (3) they felt their child was safe while wearing the device (t109=?34.48; P<.001). They were also less likely to worry about the audio recordings gathered by the device (t108=6.14; P<.001), whereas parents? rating of the burden of the study procedures did not differ significantly from a ?neutral? rating (t109=?0.16; P=.87). Conclusions: On the basis of parents? feedback, several concrete changes can be implemented to improve this new wearable platform and, ultimately, parents? and children?s experiences of using child wearable devices in the home setting. UR - https://humanfactors.jmir.org/2024/1/e49316 UR - http://dx.doi.org/10.2196/49316 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329785 ID - info:doi/10.2196/49316 ER - TY - JOUR AU - Fiorini, Laura AU - D'Onofrio, Grazia AU - Sorrentino, Alessandra AU - Cornacchia Loizzo, Gabriella Federica AU - Russo, Sergio AU - Ciccone, Filomena AU - Giuliani, Francesco AU - Sancarlo, Daniele AU - Cavallo, Filippo PY - 2024/1/26 TI - The Role of Coherent Robot Behavior and Embodiment in Emotion Perception and Recognition During Human-Robot Interaction: Experimental Study JO - JMIR Hum Factors SP - e45494 VL - 11 KW - social robot KW - emotion recognition KW - human emotion perception KW - human-robot interaction KW - robot cospeech gestures evaluation N2 - Background: Social robots are becoming increasingly important as companions in our daily lives. Consequently, humans expect to interact with them using the same mental models applied to human-human interactions, including the use of cospeech gestures. Research efforts have been devoted to understanding users? needs and developing robot?s behavioral models that can perceive the user state and properly plan a reaction. Despite the efforts made, some challenges regarding the effect of robot embodiment and behavior in the perception of emotions remain open. Objective: The aim of this study is dual. First, it aims to assess the role of the robot?s cospeech gestures and embodiment in the user?s perceived emotions in terms of valence (stimulus pleasantness), arousal (intensity of evoked emotion), and dominance (degree of control exerted by the stimulus). Second, it aims to evaluate the robot?s accuracy in identifying positive, negative, and neutral emotions displayed by interacting humans using 3 supervised machine learning algorithms: support vector machine, random forest, and K-nearest neighbor. Methods: Pepper robot was used to elicit the 3 emotions in humans using a set of 60 images retrieved from a standardized database. In particular, 2 experimental conditions for emotion elicitation were performed with Pepper robot: with a static behavior or with a robot that expresses coherent (COH) cospeech behavior. Furthermore, to evaluate the role of the robot embodiment, the third elicitation was performed by asking the participant to interact with a PC, where a graphical interface showed the same images. Each participant was requested to undergo only 1 of the 3 experimental conditions. Results: A total of 60 participants were recruited for this study, 20 for each experimental condition for a total of 3600 interactions. The results showed significant differences (P<.05) in valence, arousal, and dominance when stimulated with the Pepper robot behaving COH with respect to the PC condition, thus underlying the importance of the robot?s nonverbal communication and embodiment. A higher valence score was obtained for the elicitation of the robot (COH and robot with static behavior) with respect to the PC. For emotion recognition, the K-nearest neighbor classifiers achieved the best accuracy results. In particular, the COH modality achieved the highest level of accuracy (0.97) when compared with the static behavior and PC elicitations (0.88 and 0.94, respectively). Conclusions: The results suggest that the use of multimodal communication channels, such as cospeech and visual channels, as in the COH modality, may improve the recognition accuracy of the user?s emotional state and can reinforce the perceived emotion. Future studies should investigate the effect of age, culture, and cognitive profile on the emotion perception and recognition going beyond the limitation of this work. UR - https://humanfactors.jmir.org/2024/1/e45494 UR - http://dx.doi.org/10.2196/45494 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277201 ID - info:doi/10.2196/45494 ER - TY - JOUR AU - Schnoor, Kyma AU - Versluis, Anke AU - Chavannes, H. Niels AU - Talboom-Kamp, A. Esther P. W. PY - 2024/1/22 TI - Digital Triage Tools for Sexually Transmitted Infection Testing Compared With General Practitioners? Advice: Vignette-Based Qualitative Study With Interviews Among General Practitioners JO - JMIR Hum Factors SP - e49221 VL - 11 KW - eHealth KW - digital triage tool KW - sexually transmitted infection KW - STI KW - human immunodeficiency virus KW - general practitioners KW - GPs decision-making KW - digital health KW - diagnostic KW - sexually transmitted disease KW - STD KW - sexually transmitted KW - sexual transmission KW - triage KW - artificial intelligence KW - HIV KW - diagnostics KW - diagnosis KW - vignette KW - vignettes KW - interview KW - interviews KW - best practice KW - best practices KW - thematic analysis KW - referral KW - medical advice N2 - Background: Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs? decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs? decision-making process. Objective: The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs? daily medical practice. The second objective was to learn which factors influence GPs? decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs? decision-making process. Methods: A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants. Results: In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients? risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants? decision-making process were the patient?s anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool. Conclusions: The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs? decision-making process was influenced by patients? anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely. UR - https://humanfactors.jmir.org/2024/1/e49221 UR - http://dx.doi.org/10.2196/49221 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252474 ID - info:doi/10.2196/49221 ER - TY - JOUR AU - Block, J. Valerie AU - Koshal, Kanishka AU - Wijangco, Jaeleene AU - Miller, Nicolette AU - Sara, Narender AU - Henderson, Kyra AU - Reihm, Jennifer AU - Gopal, Arpita AU - Mohan, D. Sonam AU - Gelfand, M. Jeffrey AU - Guo, Chu-Yueh AU - Oommen, Lauren AU - Nylander, Alyssa AU - Rowson, A. James AU - Brown, Ethan AU - Sanders, Stephen AU - Rankin, Katherine AU - Lyles, R. Courtney AU - Sim, Ida AU - Bove, Riley PY - 2024/1/11 TI - A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack JO - JMIR Hum Factors SP - e49331 VL - 11 KW - digital health KW - mobile tools KW - falls KW - prevention KW - behavioral medicine KW - implementation science KW - closed-loop monitoring KW - multiple sclerosis KW - mobile phone N2 - Background: Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient?s specific context. Objective: This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. Methods: Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users? needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. Results: A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility?with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient?s community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). Conclusions: To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record?embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences. UR - https://humanfactors.jmir.org/2024/1/e49331 UR - http://dx.doi.org/10.2196/49331 UR - http://www.ncbi.nlm.nih.gov/pubmed/38206662 ID - info:doi/10.2196/49331 ER - TY - JOUR AU - Bérubé, Caterina AU - Lehmann, Franziska Vera AU - Maritsch, Martin AU - Kraus, Mathias AU - Feuerriegel, Stefan AU - Wortmann, Felix AU - Züger, Thomas AU - Stettler, Christoph AU - Fleisch, Elgar AU - Kocaballi, Baki A. AU - Kowatsch, Tobias PY - 2024/1/9 TI - Effectiveness and User Perception of an In-Vehicle Voice Warning for Hypoglycemia: Development and Feasibility Trial JO - JMIR Hum Factors SP - e42823 VL - 11 KW - hypoglycemia KW - type-1 diabetes mellitus KW - in-vehicle voice assistant KW - voice interface KW - voice warning KW - digital health intervention KW - mobile phone N2 - Background: Hypoglycemia is a frequent and acute complication in type 1 diabetes mellitus (T1DM) and is associated with a higher risk of car mishaps. Currently, hypoglycemia can be detected and signaled through flash glucose monitoring or continuous glucose monitoring devices, which require manual and visual interaction, thereby removing the focus of attention from the driving task. Hypoglycemia causes a decrease in attention, thereby challenging the safety of using such devices behind the wheel. Here, we present an investigation of a hands-free technology?a voice warning that can potentially be delivered via an in-vehicle voice assistant. Objective: This study aims to investigate the feasibility of an in-vehicle voice warning for hypoglycemia, evaluating both its effectiveness and user perception. Methods: We designed a voice warning and evaluated it in 3 studies. In all studies, participants received a voice warning while driving. Study 0 (n=10) assessed the feasibility of using a voice warning with healthy participants driving in a simulator. Study 1 (n=18) assessed the voice warning in participants with T1DM. Study 2 (n=20) assessed the voice warning in participants with T1DM undergoing hypoglycemia while driving in a real car. We measured participants? self-reported perception of the voice warning (with a user experience scale in study 0 and with acceptance, alliance, and trust scales in studies 1 and 2) and compliance behavior (whether they stopped the car and reaction time). In addition, we assessed technology affinity and collected the participants? verbal feedback. Results: Technology affinity was similar across studies and approximately 70% of the maximal value. Perception measure of the voice warning was approximately 62% to 78% in the simulated driving and 34% to 56% in real-world driving. Perception correlated with technology affinity on specific constructs (eg, Affinity for Technology Interaction score and intention to use, optimism and performance expectancy, behavioral intention, Session Alliance Inventory score, innovativeness and hedonic motivation, and negative correlations between discomfort and behavioral intention and discomfort and competence trust; all P<.05). Compliance was 100% in all studies, whereas reaction time was higher in study 1 (mean 23, SD 5.2 seconds) than in study 0 (mean 12.6, SD 5.7 seconds) and study 2 (mean 14.6, SD 4.3 seconds). Finally, verbal feedback showed that the participants preferred the voice warning to be less verbose and interactive. Conclusions: This is the first study to investigate the feasibility of an in-vehicle voice warning for hypoglycemia. Drivers find such an implementation useful and effective in a simulated environment, but improvements are needed in the real-world driving context. This study is a kickoff for the use of in-vehicle voice assistants for digital health interventions. UR - https://humanfactors.jmir.org/2024/1/e42823 UR - http://dx.doi.org/10.2196/42823 UR - http://www.ncbi.nlm.nih.gov/pubmed/38194257 ID - info:doi/10.2196/42823 ER - TY - JOUR AU - Young, Karen AU - Xiong, Ting AU - Lee, Rachel AU - Banerjee, Tina Ananya AU - Leslie, Myles AU - Ko, Yu Wellam AU - Pham, Quynh PY - 2024/1/1 TI - User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study JO - JMIR Hum Factors SP - e49353 VL - 11 KW - digital health KW - virtual care KW - digital therapeutics KW - prostate cancer KW - cancer survivorship KW - user-centred design KW - usability KW - supportive care KW - cultural adaptation KW - Chinese Canadians N2 - Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants? desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. UR - https://humanfactors.jmir.org/2024/1/e49353 UR - http://dx.doi.org/10.2196/49353 UR - http://www.ncbi.nlm.nih.gov/pubmed/38163295 ID - info:doi/10.2196/49353 ER - TY - JOUR AU - Shao, Huige AU - Liu, Chaoyuan AU - Tang, Li AU - Wang, Bian AU - Xie, Hebin AU - Zhang, Yiyu PY - 2023/12/28 TI - Factors Influencing the Behavioral Intentions and Use Behaviors of Telemedicine in Patients With Diabetes: Web-Based Survey Study JO - JMIR Hum Factors SP - e46624 VL - 10 KW - diabetes mellitus KW - telemedicine KW - survey KW - China KW - behavioral intention KW - acceptance KW - technology KW - technology use KW - diabetic KW - outpatient KW - eHealth KW - remote care KW - older adult patients KW - low income KW - diabetes KW - type 1 KW - type 2 N2 - Background: Telemedicine has great potential for diabetes management. The COVID-19 pandemic has boosted the development of telemedicine. However, the factors influencing the behavioral intentions to use and use behaviors of telemedicine in patients with diabetes in China are not clear. Objective: We aimed to understand the determinants of behavioral intention to use telemedicine based on an extended Unified Theory of Acceptance and Use of Technology model and to identify demographic factors associated with telemedicine use in patients with diabetes in China. Methods: Patients with diabetes who are aged ?18 years were surveyed from February 1 to February 7, 2023. We distributed the survey link in 3 WeChat groups including a total of 988 patients with diabetes from the outpatient department or patients discharged from Changsha Central Hospital. Structural equation modeling was used to understand the determinants of behavioral intention. A multivariate logistic regression analysis was used to identify the demographic factors associated with telemedicine use. Results: In total, 514 questionnaires were collected. Of the respondents, 186 (36.2%) were diagnosed with COVID-19. The measurement model showed acceptable reliability, convergent validity, discriminant validity, and data fit indices. The model explained 63.8% of the variance in behavioral intention. Social influence, performance expectancy, and facilitating conditions positively influenced behavioral intention (?=.463, P<.001; ?=.153, P=.02; and ?=.257, P=.004, respectively). Perceived susceptibility, perceived severity, and effort expectancy had no significant impact on behavioral intention (all P>.05). The overall use of telemedicine was 20.6% (104/514). After adjusting for the behavioral intention score, the multivariate regression analysis showed that age, education, and family income were associated with telemedicine use. Telemedicine use was higher in the 40 to 59 years and 18 to 39 years age groups than in the ?60 years age group (odds ratio [OR] 4.35, 95% CI 1.84-10.29, P=.001; OR 9.20, 95% CI 3.40-24.88, P<.001, respectively). Telemedicine use was higher in the senior high school and the university and more groups than in junior high school education and less group (OR 2.45, 95% CI 1.05-5.73, P=.04; OR 2.63, 95% CI 1.11-6.23, P=.03, respectively). Patients with a higher family income used telemedicine more often than the patients who had an annual family income ?Ľ10,000 (CNY Ľ1=US $0.1398; Ľ10,000-Ľ50,000 group: OR 3.90, 95% CI 1.21-12.51, P=.02; Ľ50,000-Ľ100,000 group: OR 3.91, 95% CI 1.19-12.79, P=.02; >Ľ100,000 group: OR 4.63, 95% CI 1.41-15.27, P=.01). Conclusions: Social influence, performance expectancy, and facilitating conditions positively affected the behavioral intention of patients with diabetes to use telemedicine. Young patients, highly educated patients, and patients with high family income use telemedicine more often. Promoting behavioral intention and paying special attention to the needs of older adult patients, patients with low income, and patients with low levels of education are needed to encourage telemedicine use. UR - https://humanfactors.jmir.org/2023/1/e46624 UR - http://dx.doi.org/10.2196/46624 UR - http://www.ncbi.nlm.nih.gov/pubmed/38153781 ID - info:doi/10.2196/46624 ER - TY - JOUR AU - Alder, Gemma AU - Taylor, Denise AU - Rashid, Usman AU - Olsen, Sharon AU - Brooks, Thonia AU - Terry, Gareth AU - Niazi, Khan Imran AU - Signal, Nada PY - 2023/12/11 TI - A Brain Computer Interface Neuromodulatory Device for Stroke Rehabilitation: Iterative User-Centered Design Approach JO - JMIR Rehabil Assist Technol SP - e49702 VL - 10 KW - user-centered design KW - stroke KW - rehabilitation technology KW - wearable technology KW - brain computer interface KW - BCI KW - mobile app KW - think-aloud KW - near live KW - semistructured interviews N2 - Background: Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite growing evidence of their efficacy, there is a lack of uptake and sustained use in stroke rehabilitation and a call for user-centered design approaches during technology design and development. This study focuses on a novel rehabilitation technology called exciteBCI, a complex neuromodulatory wearable technology in the prototype stage that augments locomotor rehabilitation for people with stroke. The exciteBCI consists of a brain computer interface, a muscle electrical stimulator, and a mobile app. Objective: This study presents the evaluation phase of an iterative user-centered design approach supported by a qualitative descriptive methodology that sought to (1) explore users? perspectives and experiences of exciteBCI and how well it fits with rehabilitation, and (2) facilitate modifications to exciteBCI design features. Methods: The iterative usability evaluation of exciteBCI was conducted in 2 phases. Phase 1 consisted of 3 sprint cycles consisting of single usability sessions with people with stroke (n=4) and physiotherapists (n=4). During their interactions with exciteBCI, participants used a ?think-aloud? approach, followed by a semistructured interview. At the end of each sprint cycle, device requirements were gathered and the device was modified in preparation for the next cycle. Phase 2 focused on a ?near-live? approach in which 2 people with stroke and 1 physiotherapist participated in a 3-week program of rehabilitation augmented by exciteBCI (n=3). Participants completed a semistructured interview at the end of the program. Data were analyzed from both phases using conventional content analysis. Results: Overall, participants perceived and experienced exciteBCI positively, while providing guidance for iterative changes. Five interrelated themes were identified from the data: (1) ?This is rehab? illustrated that participants viewed exciteBCI as having a good fit with rehabilitation practice; (2) ?Getting the most out of rehab? highlighted that exciteBCI was perceived as a means to enhance rehabilitation through increased engagement and challenge; (3) ?It is a tool not a therapist,? revealed views that the technology could either enhance or disrupt the therapeutic relationship; and (4) ?Weighing up the benefits versus the burden? and (5) ?Don?t make me look different? emphasized important design considerations related to device set-up, use, and social acceptability. Conclusions: This study offers several important findings that can inform the design and implementation of rehabilitation technologies. These include (1) the design of rehabilitation technology should support the therapeutic relationship between the patient and therapist, (2) social acceptability is a design priority in rehabilitation technology but its importance varies depending on the use context, and (3) there is value in using design research methods that support understanding usability in the context of sustained use. UR - https://rehab.jmir.org/2023/1/e49702 UR - http://dx.doi.org/10.2196/49702 UR - http://www.ncbi.nlm.nih.gov/pubmed/38079202 ID - info:doi/10.2196/49702 ER - TY - JOUR AU - Hsu, Che-Wei AU - Stahl, Daniel AU - Mouchlianitis, Elias AU - Peters, Emmanuelle AU - Vamvakas, George AU - Keppens, Jeroen AU - Watson, Miles AU - Schmidt, Nora AU - Jacobsen, Pamela AU - McGuire, Philip AU - Shergill, Sukhi AU - Kabir, Thomas AU - Hirani, Tia AU - Yang, Ziyang AU - Yiend, Jenny PY - 2023/12/8 TI - User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia JO - JMIR Hum Factors SP - e45453 VL - 10 KW - cognitive bias modification KW - paranoia KW - content specificity KW - mental health KW - mobile app KW - mhealth KW - digital therapeutic KW - user-centered development KW - user KW - user-friendly app KW - paranoid KW - persecution KW - persecution complex KW - delusions KW - obsession KW - megalomania KW - monomania KW - psychosis KW - psychotic N2 - Background: Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP (?Successful Treatment of Paranoia?). Objective: This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype. Methods: We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts. Results: All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ?1; control items: ?1, readability: ?3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users? ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful. Conclusions: Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users. UR - https://humanfactors.jmir.org/2023/1/e45453 UR - http://dx.doi.org/10.2196/45453 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064256 ID - info:doi/10.2196/45453 ER - TY - JOUR AU - Seinsche, Julia AU - de Bruin, D. Eling AU - Saibene, Enrico AU - Rizzo, Francesco AU - Carpinella, Ilaria AU - Ferrarin, Maurizio AU - Moza, Sotiria AU - Ritter, Tanja AU - Giannouli, Eleftheria PY - 2023/12/7 TI - A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study JO - JMIR Hum Factors SP - e48845 VL - 10 KW - older adults KW - motor-cognitive intervention KW - exergame KW - telerehabilitation KW - information and communications technologies KW - user-centered design KW - usability KW - technology acceptance N2 - Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). Objective: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. Methods: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants? perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire?3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. Results: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system?s usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ?=0.35, P=.02 to ?=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ?=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ?=?0.35; P=.02) and the UTAUT total score (?=?0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. Conclusions: The study?s findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system?s feasibility and effectiveness. UR - https://humanfactors.jmir.org/2023/1/e48845 UR - http://dx.doi.org/10.2196/48845 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060283 ID - info:doi/10.2196/48845 ER - TY - JOUR AU - Seinsche, Julia AU - de Bruin, D. Eling AU - Saibene, Enrico AU - Rizzo, Francesco AU - Carpinella, Ilaria AU - Ferrarin, Maurizio AU - Ifanger, Sarina AU - Moza, Sotiria AU - Giannouli, Eleftheria PY - 2023/11/9 TI - Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e49377 VL - 12 KW - telerehabilitation KW - home-based KW - eHealth KW - exergaming KW - older adults KW - motor-cognitive training KW - feasibility KW - pragmatic trial N2 - Background: Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management. Objective: The aim of this study is to test the feasibility and effectiveness of this novel training system. Methods: A total of 180 older adults from Switzerland, Italy, and Cyprus aged ?60 years with a prescription for rehabilitation are randomly allocated to an intervention group or a control group. Both groups continue with their usual care, whereas participants in the intervention group additionally perform a 2-week supervised exergame training program at rehabilitation centers, followed by a 10-week home training program under remote supervision. The assessment system is used to indicate the start level of each participant, and, in both intervention periods, standardized progression rules are applied. The measures of feasibility include adherence, attrition, exergame enjoyment, willingness to perform such a training program, and the number and types of help requests. Effectiveness is assessed in terms of cognitive and physical functioning, balance confidence, and quality of life. Results: Data collection started in February 2023 and is ongoing. Final measurements are expected to be performed in January 2024. Conclusions: Owing to the user-centered design approach, the Cocare system is expected to be user-friendly and offers several novel features to cover the whole continuum of care. This pragmatic trial will provide valuable information regarding final necessary adaptations and subsequent implementation efforts. Trial Registration: ClinicalTrials.gov NCT05751551; https://www.clinicaltrials.gov/study/NCT05751551 International Registered Report Identifier (IRRID): DERR1-10.2196/49377 UR - https://www.researchprotocols.org/2023/1/e49377 UR - http://dx.doi.org/10.2196/49377 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943591 ID - info:doi/10.2196/49377 ER - TY - JOUR AU - Nowell, B. William AU - Curtis, R. Jeffrey AU - Zhao, Hong AU - Xie, Fenglong AU - Stradford, Laura AU - Curtis, David AU - Gavigan, Kelly AU - Boles, Jessica AU - Clinton, Cassie AU - Lipkovich, Ilya AU - Venkatachalam, Shilpa AU - Calvin, Amy AU - Hayes, S. Virginia PY - 2023/11/7 TI - Participant Engagement and Adherence to Providing Smartwatch and Patient-Reported Outcome Data: Digital Tracking of Rheumatoid Arthritis Longitudinally (DIGITAL) Real-World Study JO - JMIR Hum Factors SP - e44034 VL - 10 KW - real-world evidence KW - real-world data KW - patients KW - rheumatoid arthritis KW - patient-reported outcomes KW - patient-generated health data KW - mobile technology KW - wearable digital technology KW - mobile phone N2 - Background: Digital health studies using electronic patient-reported outcomes (ePROs) and wearables bring new challenges, including the need for participants to consistently provide trial data. Objective: This study aims to characterize the engagement, protocol adherence, and data completeness among participants with rheumatoid arthritis enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study. Methods: Participants were invited to participate in this app-based study, which included a 14-day run-in and an 84-day main study. In the run-in period, data were collected via the ArthritisPower mobile app to increase app familiarity and identify the individuals who were motivated to participate. Successful completers of the run-in period were mailed a wearable smartwatch, and automated and manual prompts were sent to participants, reminding them to complete app input or regularly wear and synchronize devices, respectively, during the main study. Study coordinators monitored participant data and contacted participants via email, SMS text messaging, and phone to resolve adherence issues per a priori rules, in which consecutive spans of missing data triggered participant contact. Adherence to data collection during the main study period was defined as providing requested data for >70% of 84 days (daily ePRO, ?80% daily smartwatch data) or at least 9 of 12 weeks (weekly ePRO). Results: Of the 470 participants expressing initial interest, 278 (59.1%) completed the run-in period and qualified for the main study. Over the 12-week main study period, 87.4% (243/278) of participants met the definition of adherence to protocol-specified data collection for weekly ePRO, and 57.2% (159/278) did so for daily ePRO. For smartwatch data, 81.7% (227/278) of the participants adhered to the protocol-specified data collection. In total, 52.9% (147/278) of the participants met composite adherence. Conclusions: Compared with other digital health rheumatoid arthritis studies, a short run-in period appears useful for identifying participants likely to engage in a study that collects data via a mobile app and wearables and gives participants time to acclimate to study requirements. Automated or manual prompts (ie, ?It?s time to sync your smartwatch?) may be necessary to optimize adherence. Adherence varies by data collection type (eg, ePRO vs smartwatch data). International Registered Report Identifier (IRRID): RR2-10.2196/14665 UR - https://humanfactors.jmir.org/2023/1/e44034 UR - http://dx.doi.org/10.2196/44034 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934559 ID - info:doi/10.2196/44034 ER - TY - JOUR AU - de Ruiter, Hans-Peter AU - Clisbee, David AU - Houston, Rebecca AU - Skärsäter, Ingela PY - 2023/11/3 TI - The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study JO - JMIR Hum Factors SP - e47586 VL - 10 KW - home care KW - caregivers KW - ethical implications KW - communication technology KW - surveillance technology KW - public health nursing practices KW - digital vulnerability KW - care of the elderly N2 - Background: Embedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. Objective: The aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. Methods: A questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. Results: This study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. Conclusions: Beyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers. UR - https://humanfactors.jmir.org/2023/1/e47586 UR - http://dx.doi.org/10.2196/47586 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921843 ID - info:doi/10.2196/47586 ER - TY - JOUR AU - Yamada, Kazunosuke AU - Enokida, Yasuaki AU - Kato, Ryuji AU - Imaizumi, Jun AU - Takada, Takahiro AU - Ojima, Hitoshi PY - 2023/11/1 TI - The Feasibility and Reliability of Upper Arm?Worn Apple Watch Heart Rate Monitoring for Surgeons During Surgery: Observational Study JO - JMIR Hum Factors SP - e50891 VL - 10 KW - Apple Watch KW - heart rate KW - surgery KW - robot N2 - Background: Health care professionals, particularly those in surgical settings, face high stress levels, impacting their well-being. Traditional monitoring methods, like using Holter electrocardiogram monitors, are impractical in the operating room, limiting the assessment of physicians? health. Wrist-worn heart rate monitors, like the Apple Watch, offer promise but are restricted in surgeries due to sterility issues. Objective: This study aims to assess the feasibility and accuracy of using an upper arm?worn Apple Watch for heart rate monitoring during robotic-assisted surgeries, comparing its performance with that of a wrist-worn device to establish a reliable alternative monitoring site. Methods: This study used 2 identical Apple Watch Series 8 devices to monitor the heart rate of surgeons during robotic-assisted surgery. Heart rate data were collected from the wrist-worn and the upper arm?worn devices. Statistical analyses included calculating the mean difference and SD of difference between the 2 devices, constructing Bland-Altman plots, assessing accuracy based on mean absolute error and mean absolute percentage error, and calculating the intraclass correlation coefficient. Results: The mean absolute errors for the whole group and for participants A, B, C, and D were 3.63, 3.58, 2.70, 3.93, and 4.28, respectively, and the mean absolute percentage errors were 3.58%, 3.34%, 2.42%, 4.58%, and 4.00%, respectively. Bland-Altman plots and scatter plots showed no systematic error when comparing the heart rate measurements obtained from the upper arm?worn and the wrist-worn Apple Watches. The intraclass correlation coefficients for participants A, B, C, and D were 0.559, 0.651, 0.508, and 0.563, respectively, with a significance level of P<.001, indicating moderate reliability. Conclusions: The findings of this study suggest that the upper arm is a viable alternative site for monitoring heart rate during surgery using an Apple Watch. The agreement and reliability between the measurements obtained from the upper arm?worn and the wrist-worn devices were good, with no systematic error and a high level of accuracy. These findings have important implications for improving data collection and management of the physical and mental demands of operating room staff during surgery, where wearing a watch on the wrist may not be feasible. UR - https://humanfactors.jmir.org/2023/1/e50891 UR - http://dx.doi.org/10.2196/50891 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910162 ID - info:doi/10.2196/50891 ER - TY - JOUR AU - Underly, Robert AU - Dull, M. Gary AU - Nudi, Evan AU - Pionk, Timothy AU - Prevette, Kristen AU - Smith, Jeffrey PY - 2023/10/30 TI - Using a Novel Connected Device for the Collection of Puffing Topography Data for the Vuse Solo Electronic Nicotine Delivery System in a Real-World Setting: Prospective Ambulatory Clinical Study JO - JMIR Form Res SP - e49876 VL - 7 KW - topography KW - electronic cigarette KW - e-cigarette KW - electronic nicotine delivery system KW - ENDS KW - ambulatory puffing KW - use behavior KW - sessions KW - mobile phone N2 - Background: Over the last decade, the use of electronic nicotine delivery systems (ENDSs) has risen, whereas studies that describe how consumers use these products have been limited. Most studies related to ENDS use have involved study designs focused on use in a central location environment or attempted to measure use outcomes through subjective self-reported end points. The development of accurate and reliable tools to collect data in a naturalistic real-world environment is necessary to capture the complexities of ENDS use. Using connected devices in a real-world setting provides a convenient and objective approach to collecting behavioral outcomes with ENDS. Objective: The Product Use and Behavior instrument was developed and used to capture the use of the Vuse Solo ENDS in an ambulatory setting to best replicate real-world use behavior. This study aims to determine overall mean values for topography outcomes while also providing a definition for an ENDS use session. Methods: A prospective ambulatory clinical study was performed with the Product Use and Behavior instrument. Participants (n=75) were aged between 21 and 60 years, considered in good health, and were required to be established regular users of ENDSs. To better understand use behavior within the population, the sample was sorted into percentiles with bins based on daily puff counts. To frame these data in the relevant context, they were binned into low-, moderate-, and high-use categories (10th to 40th, 40th to 70th, and 70th to 100th percentiles, respectively), with the low-use group representing the nonintense category, the high-use group representing the intense category, and the moderate-use group being reflective of the average consumer. Results: Participants with higher daily use took substantially more puffs per use session (6.71 vs 4.40) and puffed more frequently (interpuff interval: 32.78 s vs 61.66 s) than participants in the low-use group. Puff duration remained consistent across the low-, moderate?, and high-use groups (2.10 s, 2.18 s, and 2.19 s, respectively). The moderate-use group had significantly shorter session lengths (P<.001) than the high- and low-use groups, which did not differ significantly from each other (P=.16). Conclusions: Using connected devices allows for a convenient and robust approach to the collection of behavioral outcomes related to product use in an ambulatory setting. By using the variables captured with these tools, it becomes possible to move away from predefined periods of use to better understand topography outcomes and define use sessions. The data presented here offer a possible method to define these sessions. These data also begin to frame international standards used for the analytical assessments of ENDSs in the correct context and begin to shed light on the differences between standardized testing regimens and actual use behavior. Trial Registration: Clinicaltrials.gov NCT04226404; https://clinicaltrials.gov/study/NCT04226404 UR - https://formative.jmir.org/2023/1/e49876 UR - http://dx.doi.org/10.2196/49876 UR - http://www.ncbi.nlm.nih.gov/pubmed/37902830 ID - info:doi/10.2196/49876 ER - TY - JOUR AU - Rego, Chryselle AU - Montague, Enid PY - 2023/10/5 TI - The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design JO - JMIR Hum Factors SP - e49675 VL - 10 KW - physician-patient interaction KW - cognitive load KW - visual feedback KW - haptic feedback KW - postsession feedback N2 - Background: The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors? ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors? ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes. Objective: Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants. Methods: This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques. Results: Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual?s cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of ?3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of ?2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score. Conclusions: Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted. UR - https://humanfactors.jmir.org/2023/1/e49675 UR - http://dx.doi.org/10.2196/49675 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796596 ID - info:doi/10.2196/49675 ER - TY - JOUR AU - Gomez-Hernandez, Miguel AU - Ferre, Xavier AU - Moral, Cristian AU - Villalba-Mora, Elena PY - 2023/9/21 TI - Design Guidelines of Mobile Apps for Older Adults: Systematic Review and Thematic Analysis JO - JMIR Mhealth Uhealth SP - e43186 VL - 11 KW - tablet KW - smartphone KW - older user KW - design recommendations KW - usability testing KW - user experience design KW - UX design KW - design KW - mobile app KW - tool KW - quality of life KW - software KW - training KW - visual design KW - older adults KW - mobile phone N2 - Background: Mobile apps are fundamental tools in today?s society for practical and social endeavors. However, these technologies are often not usable for older users. Given the increased use of mobile apps by this group of users and the impact that certain services may have on their quality of life, such as mobile health, personal finance, or online administrative procedures, a clear set of guidelines for mobile app designers is needed. Existing recommendations for older adults focus on investigations with certain groups of older adults or have not been extracted from experimental results. Objective: In this research work, we systematically reviewed the scientific literature that provided recommendations for the design of mobile apps based on usability testing with older adults and organized such recommendations into a meaningful set of design guidelines. Methods: We conducted a systematic literature review of journal and conference articles from 2010 to 2021. We included articles that carried out usability tests with populations aged >60 years and presented transferable guidelines on mobile software design, resulting in a final set of 40 articles. We then carried out a thematic analysis with 3 rounds of analysis to provide meaning to an otherwise diverse set of recommendations. At this stage, we discarded recommendations that were made by just 1 article, were based on a specific mobile app and were therefore nontransferrable, were based on other authors? literature (as opposed to recommendations based on the results of usability tests), or were not sufficiently argued. With the remaining recommendations, we identified commonalities, wrote a faithful statement for each guideline, used a common language for the entire set, and organized the guidelines into categories, thereby giving shape to an otherwise diverse set of recommendations. Results: Among the 27 resulting guidelines, the rules Simplify and Increase the size and distance between interactive controls were transversal and of the greatest significance. The rest of the guidelines were divided into 5 categories (Help & Training, Navigation, Visual Design, Cognitive Load, and Interaction) and consequent subcategories in Visual Design (Layout, Icons, and Appearance) and Interaction (Input and Output). The recommendations were structured, explained in detail, and illustrated with applied examples extracted from the selected studies, where appropriate. We discussed the design implications of applying these guidelines, contextualized with relevant studies. We also discussed the limitations of the approach followed, stressing the need for further experimentation to gain a better understanding of how older adults use mobile apps and how to better design such apps with these users in mind. Conclusions: The compiled guidelines support the design of mobile apps that cater to the needs of older adults because they are based on the results of actual usability tests with users aged >60 years. UR - https://mhealth.jmir.org/2023/1/e43186 UR - http://dx.doi.org/10.2196/43186 UR - http://www.ncbi.nlm.nih.gov/pubmed/37733401 ID - info:doi/10.2196/43186 ER - TY - JOUR AU - Kumbara, B. Abhimanyu AU - Iyer, K. Anand AU - Green, R. Courtney AU - Jepson, H. Lauren AU - Leone, Keri AU - Layne, E. Jennifer AU - Shomali, Mansur PY - 2023/9/11 TI - Impact of a Combined Continuous Glucose Monitoring?Digital Health Solution on Glucose Metrics and Self-Management Behavior for Adults With Type 2 Diabetes: Real-World, Observational Study JO - JMIR Diabetes SP - e47638 VL - 8 KW - type 2 diabetes KW - digital health KW - continuous glucose monitoring KW - artificial intelligence KW - glycemic outcomes KW - engagement KW - digital health intervention KW - mHealth KW - diabetes management N2 - Background: The BlueStar (Welldoc) digital health solution for people with diabetes incorporates data from multiple devices and generates coaching messages using artificial intelligence. The BlueStar app syncs glucose data from the G6 (Dexcom) real-time continuous glucose monitoring (RT-CGM) system, which provides a glucose measurement every 5 minutes. Objective: The objective of this real-world study of people with type 2 diabetes (T2D) using the digital health solution and RT-CGM was to evaluate change in glycemic control and engagement with the program over 3 months. Methods: Participants were current or former enrollees in an employer-sponsored health plan, were aged 18 years or older, had a T2D diagnosis, and were not using prandial insulin. Outcomes included CGM-based glycemic metrics and engagement with the BlueStar app, including logging medications taken, exercise, food details, blood pressure, weight, and hours of sleep. Results: Participants in the program that met our analysis criteria (n=52) were aged a mean of 53 (SD 9) years; 37% (19/52) were female and approximately 50% (25/52) were taking diabetes medications. The RT-CGM system was worn 90% (SD 8%) of the time over 3 months. Among individuals with suboptimal glycemic control at baseline, defined as mean glucose >180 mg/dL, clinically meaningful improvements in glycemic control were observed, including reductions in a glucose management indicator (?0.8 percentage points), time above range 181-250 mg/dL (?4.4 percentage points) and time above range >250 mg/dL (?14 percentage points; all P<.05). Time in range 70-180 mg/dL also increased by 15 percentage points (P=.016) in this population, which corresponds to an increase of approximately 3.5 hours per day in the target range. Over the 3-month study, 29% (15/52) of participants completed at least one engagement activity per week. Medication logging was completed most often by participants (23/52, 44%) at a rate of 12.1 (SD 0.8) events/week, and this was closely followed by exercise and food logging. Conclusions: The combination of an artificial intelligence?powered digital health solution and RT-CGM helped people with T2D improve their glycemic outcomes and diabetes self-management behaviors. UR - https://diabetes.jmir.org/2023/1/e47638 UR - http://dx.doi.org/10.2196/47638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590491 ID - info:doi/10.2196/47638 ER - TY - JOUR AU - Nakikj, Drashko AU - Kreda, David AU - Gehlenborg, Nils PY - 2023/8/21 TI - Alerts and Collections for Automating Patients? Sensemaking and Organizing of Their Electronic Health Record Data for Reflection, Planning, and Clinical Visits: Qualitative Research-Through-Design Study JO - JMIR Hum Factors SP - e41552 VL - 10 KW - patients KW - electronic health records KW - sensemaking KW - pattern detection KW - data organization KW - alerts KW - reports KW - collections N2 - Background: Electronic health record (EHR) data from multiple providers often exhibit important but convoluted and complex patterns that patients find hard and time-consuming to identify and interpret. However, existing patient-facing applications lack the capability to incorporate automatic pattern detection robustly and toward supporting making sense of the patient?s EHR data. In addition, there is no means to organize EHR data in an efficient way that suits the patient?s needs and makes them more actionable in real-life settings. These shortcomings often result in a skewed and incomplete picture of the patient?s health status, which may lead to suboptimal decision-making and actions that put the patient at risk. Objective: Our main goal was to investigate patients? attitudes, needs, and use scenarios with respect to automatic support for surfacing important patterns in their EHR data and providing means for organizing them that best suit patients? needs. Methods: We conducted an inquisitive research-through-design study with 14 participants. Presented in the context of a cutting-edge application with strong emphasis on independent EHR data sensemaking, called Discovery, we used high-level mock-ups for the new features that were supposed to support automatic identification of important data patterns and offer recommendations?Alerts?and means for organizing the medical records based on patients? needs, much like photos in albums?Collections. The combined audio recording transcripts and in-study notes were analyzed using the reflexive thematic analysis approach. Results: The Alerts and Collections can be used for raising awareness, reflection, planning, and especially evidence-based patient-provider communication. Moreover, patients desired carefully designed automatic pattern detection with safe and actionable recommendations, which produced a well-tailored and scoped landscape of alerts for both potential threats and positive progress. Furthermore, patients wanted to contribute their own data (eg, progress notes) and log feelings, daily observations, and measurements to enrich the meaning and enable easier sensemaking of the alerts and collections. On the basis of the findings, we renamed Alerts to Reports for a more neutral tone and offered design implications for contextualizing the reports more deeply for increased actionability; automatically generating the collections for more expedited and exhaustive organization of the EHR data; enabling patient-generated data input in various formats to support coarser organization, richer pattern detection, and learning from experience; and using the reports and collections for efficient, reliable, and common-ground patient-provider communication. Conclusions: Patients need to have a flexible and rich way to organize and annotate their EHR data; be introduced to insights from these data?both positive and negative; and share these artifacts with their physicians in clinical visits or via messaging for establishing shared mental models for clear goals, agreed-upon priorities, and feasible actions. UR - https://humanfactors.jmir.org/2023/1/e41552 UR - http://dx.doi.org/10.2196/41552 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603400 ID - info:doi/10.2196/41552 ER - TY - JOUR AU - von Kalckreuth, Niklas AU - Feufel, A. Markus PY - 2023/8/16 TI - Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany JO - JMIR Hum Factors SP - e45503 VL - 10 KW - mHealth KW - mobile health KW - confidential KW - privacy calculus KW - privacy KW - intention to use KW - adoption KW - data autonomy KW - social norms KW - trust in the provider KW - trust KW - privacy concern KW - benefit KW - attitude to privacy KW - survey KW - intention N2 - Background: With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances. Objective: This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies. Methods: A survey study was conducted to empirically validate our model, using a case vignette as cover story. Data were collected from 250 German participants and analyzed using a covariance-based structural equation model. Results: The model explains R2=79.3% of the variance in intention to use. The 3 main factors (social norms, attitude to privacy, and perceived control over personal data) influenced the intention to use mHealth apps, albeit partially indirectly. The intention to use mHealth apps is driven by the perceived benefits of the technology, trust in the provider, and social norms. Privacy concerns have no bearing on the intention to use. The attitude to privacy has a large inhibiting effect on perceived benefits, as well as on trust in the provider. Perceived control over personal data clearly dispels privacy concerns and supports the relationship of trust between the user and the provider. Conclusions: Based on the privacy calculus, our domain-specific model explains the intention to use mHealth apps better than previous, more general models. The findings allow health care providers to improve their products and to increase usage by targeting specific user groups. UR - https://humanfactors.jmir.org/2023/1/e45503 UR - http://dx.doi.org/10.2196/45503 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585259 ID - info:doi/10.2196/45503 ER - TY - JOUR AU - Hermsen, Sander AU - Verbiest, Vera AU - Buijs, Marije AU - Wentink, Eva PY - 2023/8/11 TI - Perceived Use Cases, Barriers, and Requirements for a Smart Health-Tracking Toilet Seat: Qualitative Focus Group Study JO - JMIR Hum Factors SP - e44850 VL - 10 KW - digital health KW - internet of things KW - human factors KW - health tracking KW - device KW - automated KW - biomarker KW - personal health KW - personal hygiene KW - hygiene KW - data KW - privacy KW - innovation KW - mobile phone N2 - Background: Smart bathroom technology offers unrivaled opportunities for the automated measurement of a range of biomarkers and other data. Unfortunately, efforts in this area are mostly driven by a technology push rather than market pull approach, which decreases the chances of successful adoption. As yet, little is known about the use cases, barriers, and desires that potential users of smart bathrooms perceive. Objective: This study aimed to investigate how participants from the general population experience using a smart sensor-equipped toilet seat installed in their home. The study contributes to answering the following questions: What use cases do citizens see for this innovation? and What are the limitations and barriers to its everyday use that they see, including concerns regarding privacy, the lack of fit with everyday practices, and unmet expectations for user experience? Methods: Overall, 31 participants from 30 households participated in a study consisting of 3 (partially overlapping) stages: sensitizing, in which participants filled out questionnaires to trigger their thoughts about smart bathroom use and personal health; provotyping, in which participants received a gentle provocation in the form of a smart toilet seat, which they used for 2 weeks; and discussion, in which participants took part in a web-based focus group session to discuss their experiences. Results: Participants mostly found the everyday use of the toilet, including installation and dismantling when necessary, to be relatively easy and free of complications. Where complications occurred, participants mentioned issues related to the design of the prototype, technology, or mismatches with normal practices in using toilets and hygiene. A broad range of use cases were mentioned, ranging from signaling potentially detrimental health conditions or exacerbations of existing conditions to documenting physical data to measuring biomarkers to inform a diagnosis and behavioral change. Participants differed greatly in whether they let others use, or even know about, the seat. Ownership and control over their own data were essential for most participants. Conclusions: This study showed that participants felt that a smart toilet seat could be acceptable and effective, as long as it fits everyday practices concerning toilet use and hygiene. The range of potential uses for a smart toilet seat is broad, as long as privacy and control over disclosure and data are warranted. UR - https://humanfactors.jmir.org/2023/1/e44850 UR - http://dx.doi.org/10.2196/44850 UR - http://www.ncbi.nlm.nih.gov/pubmed/37566450 ID - info:doi/10.2196/44850 ER - TY - JOUR AU - Viduani, Anna AU - Cosenza, Victor AU - Fisher, L. Helen AU - Buchweitz, Claudia AU - Piccin, Jader AU - Pereira, Rivka AU - Kohrt, A. Brandon AU - Mondelli, Valeria AU - van Heerden, Alastair AU - Araújo, Matsumura Ricardo AU - Kieling, Christian PY - 2023/8/7 TI - Assessing Mood With the Identifying Depression Early in Adolescence Chatbot (IDEABot): Development and Implementation Study JO - JMIR Hum Factors SP - e44388 VL - 10 KW - depression KW - adolescent KW - ambulatory assessment KW - chatbot KW - smartphone KW - digital mental health KW - mobile phone N2 - Background: Mental health status assessment is mostly limited to clinical or research settings, but recent technological advances provide new opportunities for measurement using more ecological approaches. Leveraging apps already in use by individuals on their smartphones, such as chatbots, could be a useful approach to capture subjective reports of mood in the moment. Objective: This study aimed to describe the development and implementation of the Identifying Depression Early in Adolescence Chatbot (IDEABot), a WhatsApp-based tool designed for collecting intensive longitudinal data on adolescents? mood. Methods: The IDEABot was developed to collect data from Brazilian adolescents via WhatsApp as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study. It supports the administration and collection of self-reported structured items or questionnaires and audio responses. The development explored WhatsApp?s default features, such as emojis and recorded audio messages, and focused on scripting relevant and acceptable conversations. The IDEABot supports 5 types of interactions: textual and audio questions, administration of a version of the Short Mood and Feelings Questionnaire, unprompted interactions, and a snooze function. Six adolescents (n=4, 67% male participants and n=2, 33% female participants) aged 16 to 18 years tested the initial version of the IDEABot and were engaged to codevelop the final version of the app. The IDEABot was subsequently used for data collection in the second- and third-year follow-ups of the IDEA-RiSCo study. Results: The adolescents assessed the initial version of the IDEABot as enjoyable and made suggestions for improvements that were subsequently implemented. The IDEABot?s final version follows a structured script with the choice of answer based on exact text matches throughout 15 days. The implementation of the IDEABot in 2 waves of the IDEA-RiSCo sample (140 and 132 eligible adolescents in the second- and third-year follow-ups, respectively) evidenced adequate engagement indicators, with good acceptance for using the tool (113/140, 80.7% and 122/132, 92.4% for second- and third-year follow-up use, respectively), low attrition (only 1/113, 0.9% and 1/122, 0.8%, respectively, failed to engage in the protocol after initial interaction), and high compliance in terms of the proportion of responses in relation to the total number of elicited prompts (12.8, SD 3.5; 91% out of 14 possible interactions and 10.57, SD 3.4; 76% out of 14 possible interactions, respectively). Conclusions: The IDEABot is a frugal app that leverages an existing app already in daily use by our target population. It follows a simple rule-based approach that can be easily tested and implemented in diverse settings and possibly diminishes the burden of intensive data collection for participants by repurposing WhatsApp. In this context, the IDEABot appears as an acceptable and potentially scalable tool for gathering momentary information that can enhance our understanding of mood fluctuations and development. UR - https://humanfactors.jmir.org/2023/1/e44388 UR - http://dx.doi.org/10.2196/44388 UR - http://www.ncbi.nlm.nih.gov/pubmed/37548996 ID - info:doi/10.2196/44388 ER - TY - JOUR AU - Tobis, Slawomir AU - Piasek-Skupna, Joanna AU - Neumann-Podczaska, Agnieszka AU - Suwalska, Aleksandra AU - Wieczorowska-Tobis, Katarzyna PY - 2023/8/4 TI - The Effects of Stakeholder Perceptions on the Use of Humanoid Robots in Care for Older Adults: Postinteraction Cross-Sectional Study JO - J Med Internet Res SP - e46617 VL - 25 KW - older adult KW - care robot KW - stakeholder KW - perception KW - needs and requirements KW - user need KW - patient need KW - elder KW - gerontology KW - geriatric KW - caregiver KW - attitude KW - opinion KW - home care KW - caregiving KW - robot N2 - Background: Efficient use of humanoid social robots in the care for older adults requires precise knowledge of expectations in this area. There is little research in this field that includes the interaction of stakeholders with the robot. Even fewer studies have compared the perceptions of older people (as care recipients) and professional caregivers (representing those taking care of older adults in teams with robots). Objective: The aim of this study was to analyze whether specific aspects of the perceptions about humanoid robots influence attitudes after interacting with the robot and to compare the opinions of different stakeholders (older people and their professional caregivers) on this topic. We analyzed the potential impact of the differences in perception of the robot between stakeholder groups with respect to how the robot should be designed and tailored to fit the specific needs of future users. We also attempted to define areas where targeted educational activities could bring the attitudes of the two groups of stakeholders closer to each other. Methods: The studied group was a conveniently available sample of individuals who took part in the presentation of and interaction with a humanoid social robot. Among them, there were 48 community-dwelling older adults (aged ?60 years), who were participants of day care units (which may signal the presence of self-care needs), and 53 professional caregivers. The participants were asked to express their views after an interaction with a humanoid social robot (TIAGo) using the Users? Needs, Requirements and Abilities Questionnaire (UNRAQ) and the Godspeed Questionnaire Series (GQS). Results: Compared to the caregivers, older adults not only assessed the robot more positively with respect to its roles as a companion and assistant (P=.009 and P=.003, respectively) but also had higher scores on their need to increase their knowledge about the robot (P=.049). Regarding the robot?s functions, the greatest differences between groups were observed for the social aspects on the UNRAQ, including decreasing the sense of loneliness (P=.003) and accompanying the user in everyday activities (P=.005). As for the GQS, the mean scores of the Animacy, Likeability, and Perceived Intelligence scales were significantly higher for older participants than for caregivers (P=.04, P<.001, and P<.001, respectively). The only parameter for which the caregivers? scores were higher than those of the older adults was the Artificial-Lifelike item from the Anthropomorphism scale of the GQS (P=.03). Conclusions: The acceptance of the social functions of a humanoid robot is related to its perception in all analyzed aspects, whereas the expected usefulness of a care robot is not linked to aspects of anthropomorphism. Successful implementation of robots in the care for older people thus depends on considering not only the fears, needs, and requirements of various stakeholders but also on the perceptions of the robot. Given the differences between the stakeholders, targeted and properly structured educational and training activities for caregivers and prospective users may enable a seamless integration of robotic technologies in care provision. UR - https://www.jmir.org/2023/1/e46617 UR - http://dx.doi.org/10.2196/46617 UR - http://www.ncbi.nlm.nih.gov/pubmed/37540548 ID - info:doi/10.2196/46617 ER - TY - JOUR AU - Kowahl, Nathan AU - Shin, Sooyoon AU - Barman, Poulami AU - Rainaldi, Erin AU - Popham, Sara AU - Kapur, Ritu PY - 2023/8/3 TI - Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study JO - JMIR Hum Factors SP - e48270 VL - 10 KW - digital measurements KW - wearable technology KW - mobility measurements KW - walking patterns KW - wearable KW - wearables KW - sensor KW - sensors KW - mobility KW - measurement KW - measurements KW - walk KW - walking KW - gait KW - step KW - wrist-worn KW - reliability KW - accuracy N2 - Background: Mobility is a meaningful aspect of an individual?s health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. Objective: Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. Methods: We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. Results: In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device?based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. Conclusions: We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions. UR - https://humanfactors.jmir.org/2023/1/e48270 UR - http://dx.doi.org/10.2196/48270 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535417 ID - info:doi/10.2196/48270 ER - TY - JOUR AU - Lawrence, Katharine AU - Singh, Nina AU - Jonassen, Zoe AU - Groom, L. Lisa AU - Alfaro Arias, Veronica AU - Mandal, Soumik AU - Schoenthaler, Antoinette AU - Mann, Devin AU - Nov, Oded AU - Dove, Graham PY - 2023/7/27 TI - Operational Implementation of Remote Patient Monitoring Within a Large Ambulatory Health System: Multimethod Qualitative Case Study JO - JMIR Hum Factors SP - e45166 VL - 10 KW - digital health KW - remote patient monitoring KW - RPM KW - human-centered design KW - human-computer interaction KW - implementation science N2 - Background: Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians? diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking. Objective: In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of ?early adopter? clinicians and patients. Methods: Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery. Results: We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. Conclusions: This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care. UR - https://humanfactors.jmir.org/2023/1/e45166 UR - http://dx.doi.org/10.2196/45166 UR - http://www.ncbi.nlm.nih.gov/pubmed/37498668 ID - info:doi/10.2196/45166 ER - TY - JOUR AU - Poblete, Yareli Jacqueline AU - Vawter, Lauren Natalie AU - Lewis, Virginia Sydney AU - Felisme, Marc Earl AU - Mohn, Adriana Paloma AU - Shea, Jennifer AU - Northrup, William Adam AU - Liu, Jie AU - Al-Rousan, Tala AU - Godino, Gideon Job PY - 2023/7/24 TI - Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study JO - JMIR Hum Factors SP - e46313 VL - 10 KW - hypertension KW - blood pressure KW - digital health KW - health education KW - self-measured blood pressure monitoring KW - remote patient monitoring N2 - Background: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. Objective: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device?s cost (16 days of measurements in any 30-day period). Methods: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (?16 days in any rolling 30-day window) and a lenient definition (?1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. Results: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Conclusions: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated. UR - https://humanfactors.jmir.org/2023/1/e46313 UR - http://dx.doi.org/10.2196/46313 UR - http://www.ncbi.nlm.nih.gov/pubmed/37486745 ID - info:doi/10.2196/46313 ER - TY - JOUR AU - Idrisov, Bulat AU - Hallgren, A. Kevin AU - Michaels, Alyssa AU - Soth, Sean AU - Darnton, James AU - Grekin, Paul AU - Woolworth, Steve AU - Saxon, J. Andrew AU - Tsui, I. Judith PY - 2023/7/13 TI - Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study JO - JMIR Hum Factors SP - e42654 VL - 10 KW - addiction KW - direct observed therapy KW - health app KW - methadone KW - mHealth KW - mobile app KW - mobile health KW - opioid KW - smartphone app KW - substance use KW - usability KW - user engagement KW - user testing KW - workload N2 - Background: Methadone, a cornerstone of opioid use disorder treatments for many decades, is an essential tool for combatting the opioid epidemic. However, requirements for observing methadone dosing in person through direct observed therapy (DOT) impose significant barriers for many patients. Digital technology can facilitate remote DOT, which could reduce barriers to methadone treatment. Currently, there are limited data on the usability of such technology among patients and counselors in methadone treatment settings. Objective: The primary objective of this study was to assess the workload, usability, and engagement of a video-based DOT mobile app for patients with opioid use disorder receiving methadone treatment. The secondary objective was to assess the workload, usability, and engagement of the provider-facing app portal used by counselors. Methods: Patients (n=12) and counselors (n=3) who previously tried video DOT for methadone through a smartphone app in an opioid treatment program participated in usability testing sessions. Participants completed essential tasks for video DOT, then provided ratings of workload (NASA Task Load Index), usability (modified System Usability Scale), and engagement (modified Engagement Scale) with the core features of the video DOT program Results: Patients and counselors reported low mental, physical, and temporal demands, successful performance, low effort, and low frustration associated with activities. Patients reported high usability (mean 85, SD 9.5) and engagement (mean 3.8, SD 1.1); counselors reported moderate usability (mean 43.3, SD 17.7) and engagement (mean 2.81, SD 0.63). Conclusions: A mobile health app that facilitates video-based DOT for methadone required a low workload for patients and counselors and was highly usable for patients in an opioid treatment program; however, there are opportunities to improve usability and engagement for the counselor-facing portal. UR - https://humanfactors.jmir.org/2023/1/e42654 UR - http://dx.doi.org/10.2196/42654 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440298 ID - info:doi/10.2196/42654 ER - TY - JOUR AU - Biehl, T. Jacob AU - Patel, Ravi AU - Lee, J. Adam PY - 2023/7/4 TI - Toward the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Survey and Interviews With Patients and Providers JO - JMIR Hum Factors SP - e40173 VL - 10 KW - sensing KW - medication adherence KW - active intervention KW - self-management KW - patient care KW - medication KW - qualitative study KW - successful intervention KW - patient support N2 - Background: Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have a broad impact. Nonadhering patients develop worsened medical conditions and increased comorbidity of disease or die. Objective: Clinical studies have shown that the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. However, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of our study was to better understand this design tension. Methods: A series of 3 qualitative studies was conducted: a web-based survey of 200 Americans that investigated existing adherence strategies and behaviors and perception of how hypothetical in-home tracking technologies would assist adherence; in-person semistructured interviews with 20 medication takers from Pittsburgh, PA, that investigated personal adherence behaviors, which included demonstration of medication locations and routines as well as an assessment of hypothetical technologies; and semistructured interviews with 6 pharmacists and 3 family physicians to gain a provider perspective on patient adherence strategies, which included feedback on hypothetical technologies in the context of their patient populations. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with the results informing the subsequent studies. Results: Synthesized, the studies identified key medication adherence behaviors amenable to technological interventions, distilled important home-sensing literacy considerations, and detailed critical privacy considerations. Specifically, 4 key insights were obtained: medication routines are heavily influenced and adapted by and through the physical location and placement of medications relative to activities of daily living, routines are chosen to be inconspicuous to maintain privacy, the value of provider-involved routines is motivated by a desire to build trust in shared decision-making, and the introduction of new technologies can create further burden on patients and providers. Conclusions: There is considerable potential to improve individual medication adherence by creating behavior-focused interventions that leverage emerging artificial intelligence (AI), machine learning (ML), and in-home Internet of Things (IoT) sensing technologies. However, success will be dependent on the technology?s ability to learn effectively and accurately from individual behaviors, needs, and routines and tailor interventions accordingly. Patient routines and attitudes toward adherence will likely affect the use of proactive (eg, AI-assistant routine modification) versus reactive (eg, notification of associated behaviors with missed dosages) intervention strategies. Successful technological interventions must support the detection and tracking of patient routines that can adjust to variations in patient location, schedule, independence, and habituation. UR - https://humanfactors.jmir.org/2023/1/e40173 UR - http://dx.doi.org/10.2196/40173 UR - http://www.ncbi.nlm.nih.gov/pubmed/37402141 ID - info:doi/10.2196/40173 ER - TY - JOUR AU - Fischer, Aurelie AU - Aguayo, A. Gloria AU - Oustric, Pauline AU - Morin, Laurent AU - Larche, Jerome AU - Benoy, Charles AU - Fagherazzi, Guy PY - 2023/6/19 TI - Co-Design of a Voice-Based Digital Health Solution to Monitor Persisting Symptoms Related to COVID-19 (UpcomingVoice Study): Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e46103 VL - 12 KW - COVID-19 KW - long COVID symptoms KW - vocal biomarkers KW - digital health KW - co-design KW - mixed methods KW - mobile phone N2 - Background: Between 10% and 20% of people with a COVID-19 infection will develop the so-called long COVID syndrome, which is characterized by fluctuating symptoms. Long COVID has a high impact on the quality of life of affected people, who often feel abandoned by the health care system and are demanding new tools to help them manage their symptoms. New digital monitoring solutions could allow them to visualize the evolution of their symptoms and could be tools to communicate with health care professionals (HCPs). The use of voice and vocal biomarkers could facilitate the accurate and objective monitoring of persisting and fluctuating symptoms. However, to assess the needs and ensure acceptance of this innovative approach by its potential users?people with persisting COVID-19?related symptoms, with or without a long COVID diagnosis, and HCPs involved in long COVID care?it is crucial to include them in the entire development process. Objective: In the UpcomingVoice study, we aimed to define the most relevant aspects of daily life that people with long COVID would like to be improved, assess how the use of voice and vocal biomarkers could be a potential solution to help them, and determine the general specifications and specific items of a digital health solution to monitor long COVID symptoms using vocal biomarkers with its end users. Methods: UpcomingVoice is a cross-sectional mixed methods study and consists of a quantitative web-based survey followed by a qualitative phase based on semistructured individual interviews and focus groups. People with long COVID and HCPs in charge of patients with long COVID will be invited to participate in this fully web-based study. The quantitative data collected from the survey will be analyzed using descriptive statistics. Qualitative data from the individual interviews and the focus groups will be transcribed and analyzed using a thematic analysis approach. Results: The study was approved by the National Research Ethics Committee of Luxembourg (number 202208/04) in August 2022 and started in October 2022 with the launch of the web-based survey. Data collection will be completed in September 2023, and the results will be published in 2024. Conclusions: This mixed methods study will identify the needs of people affected by long COVID in their daily lives and describe the main symptoms or problems that would need to be monitored and improved. We will determine how using voice and vocal biomarkers could meet these needs and codevelop a tailored voice-based digital health solution with its future end users. This project will contribute to improving the quality of life and care of people with long COVID. The potential transferability to other diseases will be explored, which will contribute to the deployment of vocal biomarkers in general. Trial Registration: ClinicalTrials.gov NCT05546918; https://clinicaltrials.gov/ct2/show/NCT05546918 International Registered Report Identifier (IRRID): DERR1-10.2196/46103 UR - https://www.researchprotocols.org/2023/1/e46103 UR - http://dx.doi.org/10.2196/46103 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335611 ID - info:doi/10.2196/46103 ER - TY - JOUR AU - Morse, Brad AU - Soares, Andrey AU - Kwan, M. Bethany AU - Allen, Marvyn AU - Lee, S. Rita AU - Desanto, Kristen AU - Holliman, Dorsey Brooke AU - Ytell, Kate AU - Schilling, M. Lisa PY - 2023/6/15 TI - A Transgender Health Information Resource: Participatory Design Study JO - JMIR Hum Factors SP - e42382 VL - 10 KW - lesbian, gay, bisexual, transgender, and queer KW - LGBTQ KW - transgender KW - mobile app KW - health information KW - participatory design KW - agile development KW - mobile phone N2 - Background: Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. Objective: We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. Methods: We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users? needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app?s objective and subjective quality. Results: A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features?the ability to filter to narrow TGHIR resources?was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. Conclusions: Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners. UR - https://humanfactors.jmir.org/2023/1/e42382 UR - http://dx.doi.org/10.2196/42382 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318836 ID - info:doi/10.2196/42382 ER - TY - JOUR AU - Hanson, Petra AU - Summers, Charlotte AU - Panesar, Arjun AU - Liarakos, Leonidas Alexandros AU - Oduro-Donkor, Dominic AU - Whyte Oshodi, Danniella AU - Hailston, Luke AU - Randeva, Harpal AU - Menon, Vinod AU - de la Fosse, Michaela AU - Kaura, Amit AU - Shuttlewood, Emma AU - Loveder, Mark AU - Poole, Donna AU - Barber, M. Thomas PY - 2023/5/31 TI - Implementation of a Digital Health Tool for Patients Awaiting Input From a Specialist Weight Management Team: Observational Study JO - JMIR Hum Factors SP - e41256 VL - 10 KW - weight management KW - precision health KW - digital health, hospital KW - secondary care KW - tier 3 weight management KW - National Health Service KW - weight KW - obese KW - obesity KW - focus group KW - perspective KW - opinion KW - attitude KW - behavior change KW - mHealth KW - mobile health KW - health app N2 - Background: Digital tools are increasingly used on a population level as a weight loss strategy for people living with overweight and obesity. Evidence supports the feasibility of digital tools for the management of obesity in a community setting, but there is only emerging evidence for the feasibility of such tools in specialist weight management services. No study has assessed the uptake of digital tools among patients awaiting their first appointment with a specialist weight management service. Objective: The objective of this study was to understand interest, acceptance, and engagement with a digital behavioral change platform to support specialist weight management. Methods: This was an observational study registered as a service innovation. All patients on the waiting list for a first appointment in the tier 3 weight management service at University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust were eligible to access the NHS-approved digital tool. Data on interest and engagement with the digital tool were collected. Routine clinical data were used to describe patient demographics. Focus groups were held to explore patients? views on the use of digital tools as part of a specialist weight management service. Results: A total of 199 patients on the waiting list were informed about the available digital tool. Just over a half (n=102, 51.3%) of patients were interested in using the app, with over one-third (n=68, 34%) of all patients engaging with the app. Overall, a third of patients on the waiting list (n=63, 32%) did not respond to the invite and 34 (17%) of patients expressed no interest in the app. Emotional eating and higher BMI was associated with interest in the Gro Health app. Male gender was associated with reduced engagement with the app. There were no differences in interest in the Gro Health app according to age, ethnicity, metabolic measures of glycemia, and lipid profile. Conclusions: It is feasible to offer digital tools such as Gro Health to patients awaiting their first appointment with specialist weight management services. Future research should explore barriers and facilitators of engagement with digital tools. Additionally, there is a need to further evaluate the effectiveness of such tools in specialist weight management services. UR - https://humanfactors.jmir.org/2023/1/e41256 UR - http://dx.doi.org/10.2196/41256 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256653 ID - info:doi/10.2196/41256 ER - TY - JOUR AU - Campbell, I. Jeffrey AU - Aturinda, Isaac AU - Mwesigwa, Evans AU - Habinka, Annabella AU - Kanyesigye, Michael AU - Holden, J. Richard AU - Siedner, J. Mark AU - Kraemer, D. John PY - 2023/5/5 TI - Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study JO - JMIR Hum Factors SP - e42952 VL - 10 KW - mobile health KW - mHealth KW - HIV KW - intention KW - SMS KW - cellular phone KW - cell phone KW - Africa KW - reminder KW - alert KW - notification KW - prompt N2 - Background: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message?based mobile health (mHealth) technology. Numerous SMS text message?based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. Objective: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message?based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. Methods: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message?based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. Results: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. Conclusions: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. UR - https://humanfactors.jmir.org/2023/1/e42952 UR - http://dx.doi.org/10.2196/42952 UR - http://www.ncbi.nlm.nih.gov/pubmed/37145834 ID - info:doi/10.2196/42952 ER - TY - JOUR AU - Odhiambo, Odero Chrisogonas AU - Ablonczy, Lukacs AU - Wright, J. Pamela AU - Corbett, F. Cynthia AU - Reichardt, Sydney AU - Valafar, Homayoun PY - 2023/5/4 TI - Detecting Medication-Taking Gestures Using Machine Learning and Accelerometer Data Collected via Smartwatch Technology: Instrument Validation Study JO - JMIR Hum Factors SP - e42714 VL - 10 KW - machine learning KW - neural networks KW - automated pattern recognition KW - medication adherence KW - ecological momentary assessment KW - digital signal processing KW - digital biomarkers N2 - Background: Medication adherence is a global public health challenge, as only approximately 50% of people adhere to their medication regimens. Medication reminders have shown promising results in terms of promoting medication adherence. However, practical mechanisms to determine whether a medication has been taken or not, once people are reminded, remain elusive. Emerging smartwatch technology may more objectively, unobtrusively, and automatically detect medication taking than currently available methods. Objective: This study aimed to examine the feasibility of detecting natural medication-taking gestures using smartwatches. Methods: A convenience sample (N=28) was recruited using the snowball sampling method. During data collection, each participant recorded at least 5 protocol-guided (scripted) medication-taking events and at least 10 natural instances of medication-taking events per day for 5 days. Using a smartwatch, the accelerometer data were recorded for each session at a sampling rate of 25 Hz. The raw recordings were scrutinized by a team member to validate the accuracy of the self-reports. The validated data were used to train an artificial neural network (ANN) to detect a medication-taking event. The training and testing data included previously recorded accelerometer data from smoking, eating, and jogging activities in addition to the medication-taking data recorded in this study. The accuracy of the model to identify medication taking was evaluated by comparing the ANN?s output with the actual output. Results: Most (n=20, 71%) of the 28 study participants were college students and aged 20 to 56 years. Most individuals were Asian (n=12, 43%) or White (n=12, 43%), single (n=24, 86%), and right-hand dominant (n=23, 82%). In total, 2800 medication-taking gestures (n=1400, 50% natural plus n=1400, 50% scripted gestures) were used to train the network. During the testing session, 560 natural medication-taking events that were not previously presented to the ANN were used to assess the network. The accuracy, precision, and recall were calculated to confirm the performance of the network. The trained ANN exhibited an average true-positive and true-negative performance of 96.5% and 94.5%, respectively. The network exhibited <5% error in the incorrect classification of medication-taking gestures. Conclusions: Smartwatch technology may provide an accurate, nonintrusive means of monitoring complex human behaviors such as natural medication-taking gestures. Future research is warranted to evaluate the efficacy of using modern sensing devices and machine learning algorithms to monitor medication-taking behavior and improve medication adherence. UR - https://humanfactors.jmir.org/2023/1/e42714 UR - http://dx.doi.org/10.2196/42714 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140971 ID - info:doi/10.2196/42714 ER - TY - JOUR AU - Sippel, Jeffrey AU - Podhajsky, Tim AU - Lin, Chen-Tan PY - 2023/4/5 TI - Patient Satisfaction With Speech Recognition in the Exam Room: Exploratory Survey JO - JMIR Hum Factors SP - e42739 VL - 10 KW - speech recognition KW - exam room KW - primary care KW - general practitioner KW - satisfaction KW - survey KW - perception KW - opinion KW - speech KW - voice KW - eHealth KW - digital health KW - health technology KW - communication technology N2 - Background: Medical speech recognition technology uses a microphone and computer software to transcribe the spoken word into text and is not typically used in outpatient clinical exam rooms. Patient perceptions regarding speech recognition in the exam room (SRIER) are therefore unknown. Objective: This study aims to characterize patient perceptions of SRIER by administering a survey to consecutive patients scheduled for acute, chronic, and wellness care in three outpatient clinic sites. Methods: We used a microphone and medical speech recognition software to complete the ?assessment and plan? portion of the after-visit summary in the patient?s presence, immediately printed the after-visit summary, and then administered a 4-question exploratory survey to 65 consecutive patients in internal medicine and pulmonary medicine clinics at an academic medical center and a community family practice clinic in 2021 to characterize patient perceptions of SRIER. All questions were completed by all participants. Results: When compared to patients? recollection of usual care (visits with no microphone and an after-visit summary without an ?assessment and plan?), 86% (n=56) of respondents agreed or strongly agreed that their provider addressed their concerns better, and 73% (n=48) agreed or strongly agreed that they understood their provider?s advice better. A total of 99% (n=64) of respondents agreed or strongly agreed that a printed after-visit summary including the ?assessment and plan? was helpful. By comparing the ?agree? and ?strongly agree? responses to the neutral responses, we found that patients felt that clinicians using SRIER addressed their concerns better (P<.001), they understood their clinician?s advice better (P<.001), and receiving a paper summary was helpful (P<.001). Patients were likely to recommend a provider using a microphone based on the Net Promoter Score of 58. Conclusions: This survey suggests patients have a very positive perception of speech recognition use in the exam room. UR - https://humanfactors.jmir.org/2023/1/e42739 UR - http://dx.doi.org/10.2196/42739 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018039 ID - info:doi/10.2196/42739 ER - TY - JOUR AU - Chagas, Azevedo Bruno AU - Pagano, Silvina Adriana AU - Prates, Oliveira Raquel AU - Praes, Cordeiro Elisa AU - Ferreguetti, Kícila AU - Vaz, Helena AU - Reis, Nogueira Zilma Silveira AU - Ribeiro, Bonisson Leonardo AU - Ribeiro, Pinho Antonio Luiz AU - Pedroso, Marques Thais AU - Beleigoli, Alline AU - Oliveira, Alves Clara Rodrigues AU - Marcolino, Soriano Milena PY - 2023/4/3 TI - Evaluating User Experience With a Chatbot Designed as a Public Health Response to the COVID-19 Pandemic in Brazil: Mixed Methods Study JO - JMIR Hum Factors SP - e43135 VL - 10 KW - user experience KW - chatbots KW - telehealth KW - COVID-19 KW - human-computer interaction KW - HCI KW - empirical studies in human-computer interaction KW - empirical studies in HCI KW - health care information systems N2 - Background: The potential of chatbots for screening and monitoring COVID-19 was envisioned since the outbreak of the disease. Chatbots can help disseminate up-to-date and trustworthy information, promote healthy social behavior, and support the provision of health care services safely and at scale. In this scenario and in view of its far-reaching postpandemic impact, it is important to evaluate user experience with this kind of application. Objective: We aimed to evaluate the quality of user experience with a COVID-19 chatbot designed by a large telehealth service in Brazil, focusing on the usability of real users and the exploration of strengths and shortcomings of the chatbot, as revealed in reports by participants in simulated scenarios. Methods: We examined a chatbot developed by a multidisciplinary team and used it as a component within the workflow of a local public health care service. The chatbot had 2 core functionalities: assisting web-based screening of COVID-19 symptom severity and providing evidence-based information to the population. From October 2020 to January 2021, we conducted a mixed methods approach and performed a 2-fold evaluation of user experience with our chatbot by following 2 methods: a posttask usability Likert-scale survey presented to all users after concluding their interaction with the bot and an interview with volunteer participants who engaged in a simulated interaction with the bot guided by the interviewer. Results: Usability assessment with 63 users revealed very good scores for chatbot usefulness (4.57), likelihood of being recommended (4.48), ease of use (4.44), and user satisfaction (4.38). Interviews with 15 volunteers provided insights into the strengths and shortcomings of our bot. Comments on the positive aspects and problems reported by users were analyzed in terms of recurrent themes. We identified 6 positive aspects and 15 issues organized in 2 categories: usability of the chatbot and health support offered by it, the former referring to usability of the chatbot and how users can interact with it and the latter referring to the chatbot?s goal in supporting people during the pandemic through the screening process and education to users through informative content. We found 6 themes accounting for what people liked most about our chatbot and why they found it useful?3 themes pertaining to the usability domain and 3 themes regarding health support. Our findings also identified 15 types of problems producing a negative impact on users?10 of them related to the usability of the chatbot and 5 related to the health support it provides. Conclusions: Our results indicate that users had an overall positive experience with the chatbot and found the health support relevant. Nonetheless, qualitative evaluation of the chatbot indicated challenges and directions to be pursued in improving not only our COVID-19 chatbot but also health chatbots in general. UR - https://humanfactors.jmir.org/2023/1/e43135 UR - http://dx.doi.org/10.2196/43135 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634267 ID - info:doi/10.2196/43135 ER - TY - JOUR AU - Phang, Sheng Ye AU - Heaukulani, Creighton AU - Martanto, Wijaya AU - Morris, Robert AU - Tong, Mian Mian AU - Ho, Roger PY - 2023/3/29 TI - Perceptions of a Digital Mental Health Platform Among Participants With Depressive Disorder, Anxiety Disorder, and Other Clinically Diagnosed Mental Disorders in Singapore: Usability and Acceptability Study JO - JMIR Hum Factors SP - e42167 VL - 10 KW - mHealth KW - mobile health KW - CBT KW - cognitive behavioral therapy KW - cognitive behavioural therapy KW - iCBT KW - internet-based cognitive behavioral therapy KW - usability KW - Post-Study System Usability Questionnaire KW - PSSUQ KW - acceptability KW - mental health KW - Singapore KW - depression disorder KW - anxiety disorder KW - mental illness KW - anxiety KW - depression KW - depressive N2 - Background: The website mindline.sg is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, mindline.sg may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders. Objective: This study aims to determine the perceived usability, acceptability, and usefulness of mindline.sg among individuals with diagnosed mental disorders in a clinical setting. Methods: A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist?s office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of mindline.sg. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of mindline.sg. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users? responses on acceptability and perceived usefulness of mindline.sg. For this study, P<.05 is considered significant. Results: We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (?=.49; P=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (?=.18; P=.03). The platform mindline.sg is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of mindline.sg. Conclusions: Our results show that mindline.sg is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of mindline.sg as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies. UR - https://humanfactors.jmir.org/2023/1/e42167 UR - http://dx.doi.org/10.2196/42167 UR - http://www.ncbi.nlm.nih.gov/pubmed/36989020 ID - info:doi/10.2196/42167 ER - TY - JOUR AU - Lentferink, Aniek AU - Oldenhuis, Hilbrand AU - Velthuijsen, Hugo AU - van Gemert-Pijnen, Lisette PY - 2023/3/10 TI - How Reflective Automated e-Coaching Can Help Employees Improve Their Capacity for Resilience: Mixed Methods Study JO - JMIR Hum Factors SP - e34331 VL - 10 KW - self-reflection KW - stress management KW - resilience KW - eHealth KW - self-tracking KW - e-Coaching KW - mobile phone N2 - Background: An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. Objective: In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees? self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process. Methods: Of the 28 participants, 14 (50%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed. Results: Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events. Conclusions: Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach. UR - https://humanfactors.jmir.org/2023/1/e34331 UR - http://dx.doi.org/10.2196/34331 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897635 ID - info:doi/10.2196/34331 ER - TY - JOUR AU - Arigo, Danielle AU - Gray, C. Robert AU - Dallal, H. Diane AU - Villareale, Jennifer AU - Zhu, Jichen PY - 2023/2/27 TI - Selection of and Response to Physical Activity?Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies JO - JMIR Hum Factors SP - e41239 VL - 10 KW - social comparison KW - physical activity KW - motivation KW - web platform KW - selection KW - exercise KW - fitness KW - mobile phone N2 - Background: Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood. Objective: We used an iterative approach to better understand users? selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets. Methods: Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior). Results: Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants? interactions with the platform (ie, the type of target selected, the time spent viewing the selected target?s profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target?s profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior. Conclusions: Capturing physical activity?based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity?based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity. UR - https://humanfactors.jmir.org/2023/1/e41239 UR - http://dx.doi.org/10.2196/41239 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848204 ID - info:doi/10.2196/41239 ER - TY - JOUR AU - Dowd, Robert AU - Jepson, H. Lauren AU - Green, R. Courtney AU - Norman, J. Gregory AU - Thomas, Roy AU - Leone, Keri PY - 2023/1/18 TI - Glycemic Outcomes and Feature Set Engagement Among Real-Time Continuous Glucose Monitoring Users With Type 1 or Non?Insulin-Treated Type 2 Diabetes: Retrospective Analysis of Real-World Data JO - JMIR Diabetes SP - e43991 VL - 8 KW - type 1 diabetes KW - T1D KW - type 2 diabetes KW - T2D KW - time in range KW - engagement KW - continuous glucose monitoring KW - continuous glucose monitor KW - CGM KW - diabetes management KW - hyperglycemia KW - health data N2 - Background: The benefits of real-time continuous glucose monitoring (RT-CGM) are well established for patients with type 1 diabetes (T1D) and patients with insulin-treated type 2 diabetes (T2D). However, the usage and effectiveness of RT-CGM in the context of non?insulin-treated T2D has not been well studied. Objective: We aimed to assess glycemic metrics and rates of RT-CGM feature utilization in users with T1D and non?insulin-treated T2D. Methods: We retrospectively analyzed data from 33,685 US-based users of an RT-CGM system (Dexcom G6; Dexcom, Inc) who self-identified as having either T1D (n=26,706) or T2D and not using insulin (n=6979). Data included glucose concentrations, alarm settings, feature usage, and event logs. Results: The T1D cohort had lower proportions of glucose values in the 70 mg/dl to 180 mg/dl range than the T2D cohort (52.1% vs 70.8%, respectively), with more values indicating hypoglycemia or hyperglycemia and higher glycemic variability. Discretionary alarms were enabled by a large majority in both cohorts. The data sharing feature was used by 38.7% (10,327/26,706) of those with T1D and 10.4% (727/6979) of those with T2D, and the mean number of followers was higher in the T1D cohort. Large proportions of patients with T1D or T2D enabled and customized their glucose alerts. Retrospective analysis features were used by the majority in both cohorts (T1D: 15,783/26,706, 59.1%; T2D: 3751/6979, 53.8%). Conclusions: Similar to patients with T1D, patients with non?insulin-treated T2D used RT-CGM system features, suggesting beneficial, routine engagement with data by patients and others involved in their care. Motivated patients with diabetes could benefit from RT-CGM coverage. UR - https://diabetes.jmir.org/2023/1/e43991 UR - http://dx.doi.org/10.2196/43991 UR - http://www.ncbi.nlm.nih.gov/pubmed/36602920 ID - info:doi/10.2196/43991 ER - TY - JOUR AU - Psavko, Simon AU - Katz, Noam AU - Mirchi, Tina AU - Green, R. Courtney PY - 2022/12/15 TI - Usability and Teachability of Continuous Glucose Monitoring Devices in Older Adults and Diabetes Educators: Task Analysis and Ease-of-Use Survey JO - JMIR Hum Factors SP - e42057 VL - 9 IS - 4 KW - medical devices KW - wearable devices KW - older adults KW - task analysis KW - usability testing KW - continuous glucose monitoring KW - glucose monitoring KW - glucose levels KW - diabetes KW - usability N2 - Background: Continuous glucose monitoring (CGM) devices continuously sense and relay glucose concentration data from the interstitial fluid to a mobile phone or receiver. Older adults benefit from this continuous monitoring of glucose levels. Proper deployment of the sensing wire is facilitated by a specialized applicator. Objective: Our aim was to assess a new seventh-generation (G7) CGM device (Dexcom, Inc) for use by adults 65 years of age or older and certified diabetes care and education specialists (CDCESs). Ease of use related to intradermal insertion and mobile app setup will be assessed and compared to the fifth- and sixth-generation systems. Methods: Formal task analysis was conducted to enumerate the number and complexity of tasks associated with CGM deployment. We recruited 10 older adults with no prior CGM experience and 10 CDCESs to assess ease of use through hands-on insertion and initiation of a G7 system followed by a survey and, for older adults, a system usability scale survey. Results: About half as many tasks are needed to deploy G7 compared to G6. Older adults and CDCESs reported overall high usability of the G7 CGM device. CDCESs noted G7?s easier setup compared to previous generations. The system usability scale score for the CGM system was 92.8, which reflects excellent usability. Conclusions: For CDCESs and for older adults using the G7 CGM system, cognitive burden is relatively low and reduced compared to previous CGM systems. Easing of this burden and simplification of the glucose monitoring aspect of proper diabetes management will likely contribute to improved outcomes in this population. UR - https://humanfactors.jmir.org/2022/4/e42057 UR - http://dx.doi.org/10.2196/42057 UR - http://www.ncbi.nlm.nih.gov/pubmed/36347498 ID - info:doi/10.2196/42057 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 - Shah, Payal AU - Raymond, K. Jennifer AU - Espinoza, Juan PY - 2022/11/30 TI - Modified e-Delphi Process for the Selection of Patient-Reported Outcome Measures for Children and Families With Type 1 Diabetes Using Continuous Glucose Monitors: Delphi Study JO - JMIR Diabetes SP - e38660 VL - 7 IS - 4 KW - type 1 diabetes KW - diabetes KW - diabetic KW - juvenile KW - pediatrics KW - paediatrics KW - child KW - youth KW - continuous glucose monitor KW - glucose KW - monitoring KW - patient reported KW - outcome measure KW - PROM KW - Delphi KW - disease management KW - self-management KW - measurement KW - instrument N2 - Background: Type 1 diabetes (T1D) management is complex and associated with significant psychosocial burden. Continuous glucose monitors (CGM) can improve disease management and outcomes and introduce new or exacerbate existing psychosocial concerns. Patient-reported outcome measures (PROMs) can be used to capture this information, but there is no consensus on which PROMs should be used in pediatric CGM research. Objective: Here we describe the process to (1) identify PROMs that could be used to assess the impact of CGMs on pediatric patients with T1D, (2) implement a modified electronic Delphi (e-Delphi) methodology to arrive at an expert consensus on which PROMs are most suitable for clinical and research applications, and (3) establish a periodicity table for the administration of PROMs over time in a real-world evidence study. Methods: To identify appropriate PROMs for pediatric patients and families with T1D and CGMs, we conducted an asynchronous, e-Delphi process with a multidisciplinary group of experts from around the country. We identified candidate instruments through a literature review. The 3-round e-Delphi process was conducted via a study website, email, and web-based forms. Participants provided opinions on the usefulness of instruments, age validation, feasibility, time, and frequency of administration. Results: In total, 16 experts participated in the e-Delphi process; 4 of whom consistently participated in all 3 rounds. We identified 62 candidate instruments, which were narrowed down to 12 final PROMs across 5 domains: diabetes distress and burden (n=4), autonomy (n=2), quality of life (n=1), psychosocial (n=3), and technology acceptance (n=2). A quarterly administration schedule was developed to reduce burden on participants. Conclusions: PROMs can provide critical insights into the psychosocial well-being of patients. The specific measures identified in the paper are particularly well suited for pediatric patients with T1D using CGMs. Clinical implementation could help health care providers, patients, and families to engage in more comprehensive disease management. UR - https://diabetes.jmir.org/2022/4/e38660 UR - http://dx.doi.org/10.2196/38660 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265838 ID - info:doi/10.2196/38660 ER - TY - JOUR AU - Polhemus, Ashley AU - Simblett, Sara AU - Dawe-Lane, Erin AU - Gilpin, Gina AU - Elliott, Benjamin AU - Jilka, Sagar AU - Novak, Jan AU - Nica, Ileana Raluca AU - Temesi, Gergely AU - Wykes, Til PY - 2022/11/23 TI - Health Tracking via Mobile Apps for Depression Self-management: Qualitative Content Analysis of User Reviews JO - JMIR Hum Factors SP - e40133 VL - 9 IS - 4 KW - depression KW - mental health KW - health tracking KW - self-management KW - data visualization KW - mobile phone N2 - Background: Tracking and visualizing health data using mobile apps can be an effective self-management strategy for mental health conditions. However, little evidence is available to guide the design of mental health?tracking mechanisms. Objective: The aim of this study was to analyze the content of user reviews of depression self-management apps to guide the design of data tracking and visualization mechanisms for future apps. Methods: We systematically reviewed depression self-management apps on Google Play and iOS App stores. English-language reviews of eligible apps published between January 1, 2018, and December 31, 2021, were extracted from the app stores. Reviews that referenced health tracking and data visualization were included in sentiment and qualitative framework analyses. Results: The search identified 130 unique apps, 26 (20%) of which were eligible for inclusion. We included 783 reviews in the framework analysis, revealing 3 themes. Impact of app-based mental health tracking described how apps increased reviewers? self-awareness and ultimately enabled condition self-management. The theme designing impactful mental health?tracking apps described reviewers? feedback and requests for app features during data reporting, review, and visualization. It also described the desire for customization and contexts that moderated reviewer preference. Finally, implementing impactful mental health?tracking apps described considerations for integrating apps into a larger health ecosystem, as well as the influence of paywalls and technical issues on mental health tracking. Conclusions: App-based mental health tracking supports depression self-management when features align with users? individual needs and goals. Heterogeneous needs and preferences raise the need for flexibility in app design, posing challenges for app developers. Further research should prioritize the features based on their importance and impact on users. UR - https://humanfactors.jmir.org/2022/4/e40133 UR - http://dx.doi.org/10.2196/40133 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416875 ID - info:doi/10.2196/40133 ER - TY - JOUR AU - Henriksen, Berg Hege AU - Knudsen, Dines Markus AU - Carlsen, Hauger Monica AU - Hjartĺker, Anette AU - Blomhoff, Rune PY - 2022/11/8 TI - A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing JO - JMIR Form Res SP - e35933 VL - 6 IS - 11 KW - digital assessment tool KW - assessment tool KW - food frequency questionnaire KW - food KW - diet KW - nutrition KW - questionnaire KW - focus group KW - interview KW - usability KW - physical activity KW - lifestyle factor KW - dietary intake KW - digital health KW - chronic disease KW - chronic condition KW - health promotion KW - cancer KW - survivor KW - thematic analysis KW - research tool KW - measurement tool N2 - Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. UR - https://formative.jmir.org/2022/11/e35933 UR - http://dx.doi.org/10.2196/35933 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346647 ID - info:doi/10.2196/35933 ER - TY - JOUR AU - Timmers, Thomas AU - van der Weegen, Walter AU - Janssen, Loes AU - Kremer, Jan AU - Kool, Bertijn Rudolf PY - 2022/11/3 TI - Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics JO - JMIR Form Res SP - e39637 VL - 6 IS - 11 KW - eHealth KW - qualitative research KW - qualitative KW - focus group KW - knee KW - surgery KW - feedback KW - user need KW - patient need KW - user centered KW - content codevelopment KW - patient involvement KW - co-design KW - participatory KW - app design KW - mobile health KW - mHealth KW - health app KW - orthopedic KW - mobile phone N2 - Background: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients? priorities. Objective: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app?s content. Conclusions: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app?s content from the patient?s perspective. Given the growing emphasis on patients? self-management, it is crucial that the information they receive is not only relevant from a health care provider?s perspective but also aligns with what really matters to patients. Trial Registration: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295 UR - https://formative.jmir.org/2022/11/e39637 UR - http://dx.doi.org/10.2196/39637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36326799 ID - info:doi/10.2196/39637 ER - TY - JOUR AU - Kytö, Mikko AU - Koivusalo, Saila AU - Ruonala, Antti AU - Strömberg, Lisbeth AU - Tuomonen, Heli AU - Heinonen, Seppo AU - Jacucci, Giulio PY - 2022/10/12 TI - Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features JO - JMIR Hum Factors SP - e36987 VL - 9 IS - 4 KW - gestational diabetes KW - mobile app KW - features KW - behavior change KW - digital health KW - eHealth KW - telehealth KW - self-tracking KW - self-management KW - personalized health care N2 - Background: Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother?s and the offspring?s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective: The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods: We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results: We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions: The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration: ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652 UR - https://humanfactors.jmir.org/2022/4/e36987 UR - http://dx.doi.org/10.2196/36987 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222806 ID - info:doi/10.2196/36987 ER - TY - JOUR AU - Ta-Johnson, P. Vivian AU - Boatfield, Carolynn AU - Wang, Xinyu AU - DeCero, Esther AU - Krupica, C. Isabel AU - Rasof, D. Sophie AU - Motzer, Amelie AU - Pedryc, M. Wiktoria PY - 2022/10/3 TI - Assessing the Topics and Motivating Factors Behind Human-Social Chatbot Interactions: Thematic Analysis of User Experiences JO - JMIR Hum Factors SP - e38876 VL - 9 IS - 4 KW - social chatbots KW - Replika KW - emotional chatbots KW - artificial intelligence KW - thematic analysis KW - human-chatbot interactions KW - chatbot KW - usability KW - interaction KW - human factors KW - motivation KW - topics KW - AI KW - perception KW - usage N2 - Background: Although social chatbot usage is expected to increase as language models and artificial intelligence improve, very little is known about the dynamics of human-social chatbot interactions. Specifically, there is a paucity of research examining why human-social chatbot interactions are initiated and the topics that are discussed. Objective: We sought to identify the motivating factors behind initiating contact with Replika, a popular social chatbot, and the topics discussed in these interactions. Methods: A sample of Replika users completed a survey that included open-ended questions pertaining to the reasons why they initiated contact with Replika and the topics they typically discuss. Thematic analyses were then used to extract themes and subthemes regarding the motivational factors behind Replika use and the types of discussions that take place in conversations with Replika. Results: Users initiated contact with Replika out of interest, in search of social support, and to cope with mental and physical health conditions. Users engaged in a wide variety of discussion topics with their Replika, including intellectual topics, life and work, recreation, mental health, connection, Replika, current events, and other people. Conclusions: Given the wide range of motivational factors and discussion topics that were reported, our results imply that multifaceted support can be provided by a single social chatbot. While previous research already established that social chatbots can effectively help address mental and physical health issues, these capabilities have been dispersed across several different social chatbots instead of deriving from a single one. Our results also highlight a motivating factor of human-social chatbot usage that has received less attention than other motivating factors: interest. Users most frequently reported using Replika out of interest and sought to explore its capabilities and learn more about artificial intelligence. Thus, while developers and researchers study human-social chatbot interactions with the efficacy of the social chatbot and its targeted user base in mind, it is equally important to consider how its usage can shape public perceptions and support for social chatbots and artificial agents in general. UR - https://humanfactors.jmir.org/2022/4/e38876 UR - http://dx.doi.org/10.2196/38876 UR - http://www.ncbi.nlm.nih.gov/pubmed/36190745 ID - info:doi/10.2196/38876 ER - TY - JOUR AU - Frechette, Mikaela AU - Fanning, Jason AU - Hsieh, Katherine AU - Rice, Laura AU - Sosnoff, Jacob PY - 2022/9/16 TI - The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study JO - JMIR Form Res SP - e32453 VL - 6 IS - 9 KW - usability testing KW - mobile health KW - wheeled device user KW - fall risk KW - telehealth KW - mHealth KW - mobile device KW - smartphone KW - health applications KW - older adults KW - elderly population KW - device usability N2 - Background: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app?s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk. UR - https://formative.jmir.org/2022/9/e32453 UR - http://dx.doi.org/10.2196/32453 UR - http://www.ncbi.nlm.nih.gov/pubmed/36112405 ID - info:doi/10.2196/32453 ER - TY - JOUR AU - Arensman, Remco AU - Kloek, Corelien AU - Pisters, Martijn AU - Koppenaal, Tjarco AU - Ostelo, Raymond AU - Veenhof, Cindy PY - 2022/9/13 TI - Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study JO - JMIR Hum Factors SP - e35316 VL - 9 IS - 3 KW - patient perspectives KW - mobile health KW - mHealth KW - home-based exercise KW - adherence KW - low back pain KW - physical therapy N2 - Background: Home-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice. Objective: The aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist. Methods: Using an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients? perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the ?Framework Method? to assist with interpretation of the data. Results: Data analysis revealed 11 categories distributed among the 3 themes ?acceptability,? ?satisfaction,? and ?performance.? Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users? perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed. Conclusions: Patients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment. UR - https://humanfactors.jmir.org/2022/3/e35316 UR - http://dx.doi.org/10.2196/35316 UR - http://www.ncbi.nlm.nih.gov/pubmed/36098993 ID - info:doi/10.2196/35316 ER - TY - JOUR AU - Tremblay, Melanie AU - Hamel, Christine AU - Viau-Guay, Anabelle AU - Giroux, Dominique PY - 2022/8/9 TI - User Experience of the Co-design Research Approach in eHealth: Activity Analysis With the Course-of-Action Framework JO - JMIR Hum Factors SP - e35577 VL - 9 IS - 3 KW - co-design KW - caregivers KW - activity analysis KW - course-of-action framework KW - participant experience KW - intrinsic description KW - guidelines KW - affordances N2 - Background: The cocreation of eHealth solutions with potential users, or co-design, can help make the solution more acceptable. However, the co-design research approach requires substantial investment, and projects are not always fruitful. Researchers have provided guidelines for the co-design approach, but these are either applicable only in specific situations or not supported by empirical data. Ways to optimize the experience of the co-design process from the point of view of the participants are also missing. Scientific literature in the co-design field generally provides an extrinsic description of the experience of participants in co-design projects. Objective: We addressed this issue by describing a co-design project and focusing on the participants? experiences looking at what was significant from their point of view. Methods: We used a qualitative situated cognitive anthropology approach for this study. Data were collected on a co-design research project that aimed to support the help-seeking process of caregivers of functionally dependent older adults. The methodology was based on the perspective of experience by Dewey and used the course-of-action theoretical and methodological framework. Data collection was conducted in 2 phases: observation of participants and recording of sessions and participant self-confrontation interviews using the session recordings. We interviewed 27% (20/74) of the participants. We analyzed the data through nonexclusive emerging categorization of themes using the constant comparative method. Results: In total, 5 emerging themes were identified. The perception of extrinsic constraints and the effects of the situation was central and the most important theme, affecting other themes (frustrating interactions with others, learning together, destabilization, and getting personal benefits). Co-occurrences between codes allowed for a visual and narrative understanding of what was significant for the participants during this project. The results highlighted the importance of the role of the research team in preparing and moderating the sessions. They also provided a detailed description of the interactions between participants during the sessions, which is a core aspect of the co-design approach. There were positive and negative aspects of the participants? experiences during this co-design project. Reflecting on our results, we provided potential affordances to shape the experience of participants in co-design. Conclusions: Potential users are an essential component of the co-design research approach. Researchers and designers should seek to offer these users a positive and contributory experience to encourage participation in further co-design initiatives. Future research should explore how the proposed affordances influence the success of the intervention. UR - https://humanfactors.jmir.org/2022/3/e35577 UR - http://dx.doi.org/10.2196/35577 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943783 ID - info:doi/10.2196/35577 ER - TY - JOUR AU - Martinez, J. Gonzalo AU - Grover, Ted AU - Mattingly, M. Stephen AU - Mark, Gloria AU - D?Mello, Sidney AU - Aledavood, Talayeh AU - Akbar, Fatema AU - Robles-Granda, Pablo AU - Striegel, Aaron PY - 2022/8/4 TI - Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers JO - JMIR Hum Factors SP - e33754 VL - 9 IS - 3 KW - stress measurement KW - heart rate variability KW - HRV KW - perceived stress KW - ecological momentary assessment KW - EMA KW - wearables KW - fitness tracker N2 - Background: Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors. Objective: This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings. Methods: In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours. Results: Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032). Conclusions: A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon. UR - https://humanfactors.jmir.org/2022/3/e33754 UR - http://dx.doi.org/10.2196/33754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925662 ID - info:doi/10.2196/33754 ER - TY - JOUR AU - Nyenhuis, Sharmilee AU - Cramer, Emily AU - Grande, Matthew AU - Huntington-Moskos, Luz AU - Krueger, Kathryn AU - Bimbi, Olivia AU - Polivka, Barbara AU - Eldeirawi, Kamal PY - 2022/8/2 TI - Utilizing Real-time Technology to Assess the Impact of Home Environmental Exposures on Asthma Symptoms: Protocol for an Observational Pilot Study JO - JMIR Res Protoc SP - e39887 VL - 11 IS - 8 KW - asthma KW - home environment KW - ecologic momentary assessment KW - air quality KW - spirometry N2 - Background: It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM2.5) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms. Objective: The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM2.5), and lung function in terms of forced expiratory volume in 1 second (FEV1%); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control. Methods: We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM2.5, and FEV1%, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility. Results: This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023. Conclusions: Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines. Trial Registration: ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076 International Registered Report Identifier (IRRID): DERR1-10.2196/39887 UR - https://www.researchprotocols.org/2022/8/e39887 UR - http://dx.doi.org/10.2196/39887 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916686 ID - info:doi/10.2196/39887 ER - TY - JOUR AU - Hu, Xiaolei AU - Jonzén, Karolina AU - Lindahl, A. Olof AU - Karlsson, Marcus AU - Norström, Fredrik AU - Lundström, Erik AU - Sunnerhagen, Stibrant Katharina PY - 2022/7/29 TI - Digital Graphic Follow-up Tool (Rehabkompassen) for Identifying Rehabilitation Needs Among People After Stroke: Randomized Clinical Feasibility Study JO - JMIR Hum Factors SP - e38704 VL - 9 IS - 3 KW - stroke KW - rehabilitation KW - needs assessment KW - outcome assessment KW - structured follow-up: follow-up KW - digital tool KW - digital health KW - eHealth KW - feasibility KW - randomized controlled trial KW - RCT KW - adherence KW - acceptability KW - clinical setting KW - Rankin scale KW - outpatient N2 - Background: Stroke is a leading cause of disability among adults, with heavy social and economic burden worldwide. A cost-effective solution is urgently needed to facilitate the identification of individual rehabilitation needs and thereby provide tailored rehabilitations to reduce disability among people who have had a stroke. A novel digital graphic follow-up tool Rehabkompassen has recently been developed to facilitate capturing the multidimensional rehabilitation needs of people who have had a stroke. Objective: The aim of this study was to evaluate the feasibility and acceptability of conducting a definitive trial to evaluate Rehabkompassen as a digital follow-up tool among people who have had a stroke in outpatient clinical settings. Methods: This pilot study of Rehabkompassen was a parallel, open-label, 2-arm prospective, proof-of-concept randomized controlled trial (RCT) with an allocation ratio of 1:1 in a single outpatient clinic. Patients who have had a stroke within the 3 previous months, aged ?18 years, and living in the community were included. The trial compared usual outpatient visits with Rehabkompassen (intervention group) and without Rehabkompassen (control group) at the 3-month follow-up as well as usual outpatient visit with Rehabkompassen at the 12-month follow-up. Information on the recruitment rate, delivery, and uptake of Rehabkompassen; assessment and outcome measures completion rates; the frequency of withdrawals; the loss of follow-up; and satisfaction scores were obtained. The key outcomes were evaluated in both groups. Results: In total, 28 patients (14 control, 14 Rehabkompassen) participated in this study, with 100 patients screened. The overall recruitment rate was 28% (28/100). Retention in the trial was 86% (24/28) at the 12-month follow-up. All participants used the tool as planned during their follow-ups, which provided a 100% (24/24) task completion rate of using Rehabkompassen and suggested excellent feasibility. Both patient- and physician-participants reported satisfaction with the instrument (19/24, 79% and 2/2, 100%, respectively). In all, 2 (N=2, 100%) physicians and 18 (N=24, 75%) patients were willing to use the tool in the future. Furthermore, modified Rankin Scale as the primary outcome and various stroke impacts as secondary outcomes were both successfully collected and compared in this study. Conclusions: This study demonstrated the high feasibility and adherence of the study protocol as well as the high acceptability of Rehabkompassen among patients who have had a stroke and physicians in an outpatient setting in comparison to the predefined criterion. The information collected in this feasibility study combined with the amendments of the study protocol may improve the future definitive RCT. The results of this trial support the feasibility and acceptability of conducting a large definitive RCT. Trial Registration: ClinicalTrials.gov NCT04915027; https://clinicaltrials.gov/ct2/show/NCT04915027 UR - https://humanfactors.jmir.org/2022/3/e38704 UR - http://dx.doi.org/10.2196/38704 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904867 ID - info:doi/10.2196/38704 ER - TY - JOUR AU - Berridge, Clara AU - Turner, R. Natalie AU - Liu, Liu AU - Karras, W. Sierramatice AU - Chen, Amy AU - Fredriksen-Goldsen, Karen AU - Demiris, George PY - 2022/7/27 TI - Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool JO - JMIR Aging SP - e39335 VL - 5 IS - 3 KW - Alzheimer disease KW - advance care planning KW - dyadic intervention KW - technology KW - remote monitoring KW - artificial intelligence KW - older adult KW - seniors KW - human-computer interaction KW - aging KW - elderly population KW - digital tool KW - educational tool KW - dementia care KW - ethics KW - informed consent N2 - Background: Monitoring technologies are used to collect a range of information, such as one?s location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult?s dignity and wishes. Objective: We designed, developed, and piloted a communication and education tool in the form of a web application called Let?s Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention?s motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. Methods: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants? experiences and recommendations to improve the intervention. Results: The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. UR - https://aging.jmir.org/2022/3/e39335 UR - http://dx.doi.org/10.2196/39335 UR - http://www.ncbi.nlm.nih.gov/pubmed/35896014 ID - info:doi/10.2196/39335 ER - TY - JOUR AU - Wood, D. Michael AU - Correa, Kim AU - Ding, Peijia AU - Sreepada, Rama AU - Loftsgard, C. Kent AU - Jordan, Isabel AU - West, C. Nicholas AU - Whyte, D. Simon AU - Portales-Casamar, Elodie AU - Görges, Matthias PY - 2022/7/15 TI - Identification of Requirements for a Postoperative Pediatric Pain Risk Communication Tool: Focus Group Study With Clinicians and Family Members JO - JMIR Pediatr Parent SP - e37353 VL - 5 IS - 3 KW - eHealth KW - risk communication KW - risk KW - decision aid KW - pain KW - individualized risk KW - surgery KW - anesthesia KW - anesthetic KW - anesthesiology KW - focus group KW - requirement definition KW - prototyping KW - prototype KW - pediatrics KW - pediatric KW - child KW - postoperative KW - prediction KW - digital health KW - development KW - user feedback KW - patient feedback KW - user-centered design N2 - Background: Pediatric surgery is associated with a risk of postoperative pain that can impact the family?s quality of life. Although some risk factors for postoperative pain are known, these are often not consistently communicated to families. In addition, although tools for risk communication exist in other domains, none are tailored to pediatric surgery. Objective: As part of a larger project to develop pain risk prediction tools, we aimed to design an easy-to-use tool to effectively communicate a child?s risk of postoperative pain to both clinicians and family members. Methods: With research ethics board approval, we conducted virtual focus groups (~1 hour each) comprising clinicians and family members (people with lived surgical experience and parents of children who had recently undergone surgery/medical procedures) at a tertiary pediatric hospital to understand and evaluate potential design approaches and strategies for effectively communicating and visualizing postoperative pain risk. Data were analyzed thematically to generate design requirements and to inform iterative prototype development. Results: In total, 19 participants (clinicians: n=10, 53%; family members: n=9, 47%) attended 6 focus group sessions. Participants indicated that risk was typically communicated verbally by clinicians to patients and their families, with severity indicated using a descriptive or a numerical representation or both, which would only occasionally be contextualized. Participants indicated that risk communication tools were seldom used but that families would benefit from risk information, time to reflect on the information, and follow-up with questions. In addition, 9 key design requirements and feature considerations for effective risk communication were identified: (1) present risk information clearly and with contextualization, (2) quantify the risk and contextualize it, (3) include checklists for preoperative family preparation, (4) provide risk information digitally to facilitate recall and sharing, (5) query the family?s understanding to ensure comprehension of risk, (6) present the risk score using multimodal formats, (7) use color coding that is nonthreatening and avoids limitations with color blindness, (8) present the most significant factors contributing to the risk prediction, and (9) provide risk mitigation strategies to potentially decrease the patient?s level of risk. Conclusions: Key design requirements for a pediatric postoperative pain risk visualization tool were established and guided the development of an initial prototype. Implementing a risk communication tool into clinical practice has the potential to bridge existing gaps in the accessibility, utilization, and comprehension of personalized risk information between health care professionals and family members. Future iterative codesign and clinical evaluation of this risk communication tool are needed to confirm its utility in practice. UR - https://pediatrics.jmir.org/2022/3/e37353 UR - http://dx.doi.org/10.2196/37353 UR - http://www.ncbi.nlm.nih.gov/pubmed/35838823 ID - info:doi/10.2196/37353 ER - TY - JOUR AU - Gustafson Sr, David AU - Horst, Julie AU - Boss, Deanne AU - Fleddermann, Kathryn AU - Jacobson, Nora AU - Roosa, Mathew AU - Ross, Charles J. AU - Gicquelais, Rachel AU - Vjorn, Olivia AU - Siegler, Tracy AU - Molfenter, Todd PY - 2022/7/14 TI - Implementation of Smartphone Systems to Improve Quality of Life for People With Substance Use Disorder: Interim Report on a Randomized Controlled Trial JO - JMIR Hum Factors SP - e35125 VL - 9 IS - 3 KW - mobile technology KW - coaching KW - substance use disorder (SUD) treatment KW - technology implementation model KW - NIATx N2 - Background: Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively. Objective: This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change. Methods: A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation. Results: This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects. Conclusions: At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts. Trial Registration: ClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184 UR - https://humanfactors.jmir.org/2022/3/e35125 UR - http://dx.doi.org/10.2196/35125 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834315 ID - info:doi/10.2196/35125 ER - TY - JOUR AU - Hardy, Amy AU - Ward, Thomas AU - Emsley, Richard AU - Greenwood, Kathryn AU - Freeman, Daniel AU - Fowler, David AU - Kuipers, Elizabeth AU - Bebbington, Paul AU - Garety, Philippa PY - 2022/7/1 TI - Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis JO - JMIR Hum Factors SP - e29725 VL - 9 IS - 3 KW - paranoia KW - psychosis KW - digital health KW - apps KW - human-centered design KW - user experience KW - adherence KW - engagement KW - therapy N2 - Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the ?digital divide.? Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the ?digital divide.? SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the ?digital divide? and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the ?digital divide.? Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the ?digital divide? on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 UR - https://humanfactors.jmir.org/2022/3/e29725 UR - http://dx.doi.org/10.2196/29725 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776506 ID - info:doi/10.2196/29725 ER - TY - JOUR AU - Engelen, Marscha AU - van Gaal, Betsie AU - Vermeulen, Hester AU - Zuidema, Rixt AU - Bredie, Sebastian AU - van Dulmen, Sandra PY - 2022/7/1 TI - The Influencing Contexts and Potential Mechanisms Behind the Use of Web-Based Self-management Support Interventions: Realistic Evaluation JO - JMIR Hum Factors SP - e34925 VL - 9 IS - 3 KW - self-management KW - telemedicine KW - chronic disease KW - cardiovascular diseases KW - rheumatoid arthritis KW - patient dropouts KW - realistic evaluation KW - program use N2 - Background: Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low. Objective: This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not. Methods: A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study. Results: This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). Patients with CVD with higher self-management and quality of life scores were less likely to use the program, whereas patients with RA with higher self-management and quality of life scores were more likely to use the program. Interviews with 10 nonusers, 10 low users, and 18 high users were analyzed to provide insight into the relationship between mechanisms and outcome. Program use was encouraged by an easy-to-use, clear, and transparent design and by recommendations from professionals and email reminders. A total of 5 BCTs were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior, delayed feedback, providing information on peer behavior, and modeling. Conclusions: This realistic evaluation showed that certain patient, disease, and program characteristics (age, education, diagnosis, program design, type of reminder, and BCTs) are associated with the use of web-based self-management support programs. These results represent the first step in improving the tailoring of web-based self-management support programs. Future research on the interaction between patient and program characteristics should be conducted to improve the tailoring of participants to program components. UR - https://humanfactors.jmir.org/2022/3/e34925 UR - http://dx.doi.org/10.2196/34925 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776437 ID - info:doi/10.2196/34925 ER - TY - JOUR AU - Zolnoori, Maryam AU - Vergez, Sasha AU - Kostic, Zoran AU - Jonnalagadda, Reddy Siddhartha AU - V McDonald, Margaret AU - Bowles, H. Kathryn K. AU - Topaz, Maxim PY - 2022/5/11 TI - Audio Recording Patient-Nurse Verbal Communications in Home Health Care Settings: Pilot Feasibility and Usability Study JO - JMIR Hum Factors SP - e35325 VL - 9 IS - 2 KW - patients KW - HHC KW - communications KW - nurse KW - audio recording KW - device N2 - Background: Patients? spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients? spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting. Objective: This study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows. Methods: This study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices?Saramonic Blink500, Sony ICD-TX6, and Black Vox 365?were further evaluated in a clinical setting (patients? homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews. Results: Saramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65% and 26%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management. Conclusions: This study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation. UR - https://humanfactors.jmir.org/2022/2/e35325 UR - http://dx.doi.org/10.2196/35325 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544296 ID - info:doi/10.2196/35325 ER - TY - JOUR AU - Buss, Helen Vera AU - Varnfield, Marlien AU - Harris, Mark AU - Barr, Margo PY - 2022/5/10 TI - A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study JO - JMIR Hum Factors SP - e35065 VL - 9 IS - 2 KW - mobile health KW - behavior change intervention KW - primary prevention KW - health promotion KW - cardiovascular disease KW - diabetes mellitus, type 2 KW - mobile phone N2 - Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ?45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants? feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. UR - https://humanfactors.jmir.org/2022/2/e35065 UR - http://dx.doi.org/10.2196/35065 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536603 ID - info:doi/10.2196/35065 ER - TY - JOUR AU - Kopka, Marvin AU - Schmieding, L. Malte AU - Rieger, Tobias AU - Roesler, Eileen AU - Balzer, Felix AU - Feufel, A. Markus PY - 2022/5/3 TI - Determinants of Laypersons? Trust in Medical Decision Aids: Randomized Controlled Trial JO - JMIR Hum Factors SP - e35219 VL - 9 IS - 2 KW - symptom checkers KW - disposition advice KW - anthropomorphism KW - artificial intelligence KW - urgency assessment KW - patient-centered care KW - human-computer interaction KW - consumer health KW - information technology KW - IT KW - mobile phone N2 - Background: Symptom checker apps are patient-facing decision support systems aimed at providing advice to laypersons on whether, where, and how to seek health care (disposition advice). Such advice can improve laypersons? self-assessment and ultimately improve medical outcomes. Past research has mainly focused on the accuracy of symptom checker apps? suggestions. To support decision-making, such apps need to provide not only accurate but also trustworthy advice. To date, only few studies have addressed the question of the extent to which laypersons trust symptom checker app advice or the factors that moderate their trust. Studies on general decision support systems have shown that framing automated systems (anthropomorphic or emphasizing expertise), for example, by using icons symbolizing artificial intelligence (AI), affects users? trust. Objective: This study aims to identify the factors influencing laypersons? trust in the advice provided by symptom checker apps. Primarily, we investigated whether designs using anthropomorphic framing or framing the app as an AI increases users? trust compared with no such framing. Methods: Through a web-based survey, we recruited 494 US residents with no professional medical training. The participants had to first appraise the urgency of a fictitious patient description (case vignette). Subsequently, a decision aid (mock symptom checker app) provided disposition advice contradicting the participants? appraisal, and they had to subsequently reappraise the vignette. Participants were randomized into 3 groups: 2 experimental groups using visual framing (anthropomorphic, 160/494, 32.4%, vs AI, 161/494, 32.6%) and a neutral group without such framing (173/494, 35%). Results: Most participants (384/494, 77.7%) followed the decision aid?s advice, regardless of its urgency level. Neither anthropomorphic framing (odds ratio 1.120, 95% CI 0.664-1.897) nor framing as AI (odds ratio 0.942, 95% CI 0.565-1.570) increased behavioral or subjective trust (P=.99) compared with the no-frame condition. Even participants who were extremely certain in their own decisions (ie, 100% certain) commonly changed it in favor of the symptom checker?s advice (19/34, 56%). Propensity to trust and eHealth literacy were associated with increased subjective trust in the symptom checker (propensity to trust b=0.25; eHealth literacy b=0.2), whereas sociodemographic variables showed no such link with either subjective or behavioral trust. Conclusions: Contrary to our expectation, neither the anthropomorphic framing nor the emphasis on AI increased trust in symptom checker advice compared with that of a neutral control condition. However, independent of the interface, most participants trusted the mock app?s advice, even when they were very certain of their own assessment. Thus, the question arises as to whether laypersons use such symptom checkers as substitutes rather than as aids in their own decision-making. With trust in symptom checkers already high at baseline, the benefit of symptom checkers depends on interface designs that enable users to adequately calibrate their trust levels during usage. Trial Registration: Deutsches Register Klinischer Studien DRKS00028561; https://tinyurl.com/rv4utcfb (retrospectively registered). UR - https://humanfactors.jmir.org/2022/2/e35219 UR - http://dx.doi.org/10.2196/35219 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503248 ID - info:doi/10.2196/35219 ER - TY - JOUR AU - Gooch, Daniel AU - Mehta, Vikram AU - Stuart, Avelie AU - Katz, Dmitri AU - Bennasar, Mohamed AU - Levine, Mark AU - Bandara, Arosha AU - Nuseibeh, Bashar AU - Bennaceur, Amel AU - Price, Blaine PY - 2022/4/27 TI - Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study JO - JMIR Hum Factors SP - e34606 VL - 9 IS - 2 KW - older adults KW - health KW - emotion KW - affect KW - well-being KW - tangible interaction KW - TUI N2 - Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. UR - https://humanfactors.jmir.org/2022/2/e34606 UR - http://dx.doi.org/10.2196/34606 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475781 ID - info:doi/10.2196/34606 ER - TY - JOUR AU - Kavanagh, E. Meaghan AU - Chiavaroli, Laura AU - Glenn, J. Andrea AU - Heijmans, Genevieve AU - Grant, M. Shannan AU - Chow, Chi-Ming AU - Josse, G. Robert AU - Malik, S. Vasanti AU - Watson, William AU - Lofters, Aisha AU - Holmes, Candice AU - Rackal, Julia AU - Srichaikul, Kristie AU - Sherifali, Diana AU - Snelgrove-Clarke, Erna AU - Udell, A. Jacob AU - Juni, Peter AU - Booth, L. Gillian AU - Farkouh, E. Michael AU - Leiter, A. Lawrence AU - Kendall, C. Cyril W. AU - Jenkins, A. David J. AU - Sievenpiper, L. John PY - 2022/4/21 TI - A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study JO - JMIR Hum Factors SP - e34704 VL - 9 IS - 2 KW - portfolio diet KW - dietary portfolio KW - nutrition therapy KW - dietary application KW - eHealth KW - usability testing KW - quality improvement KW - mobile phone N2 - Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective: The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users? perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users? perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users? needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool. UR - https://humanfactors.jmir.org/2022/2/e34704 UR - http://dx.doi.org/10.2196/34704 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451981 ID - info:doi/10.2196/34704 ER - TY - JOUR AU - Malik, Tanya AU - Ambrose, Jacques Adrian AU - Sinha, Chaitali PY - 2022/4/12 TI - Evaluating User Feedback for an Artificial Intelligence?Enabled, Cognitive Behavioral Therapy?Based Mental Health App (Wysa): Qualitative Thematic Analysis JO - JMIR Hum Factors SP - e35668 VL - 9 IS - 2 KW - digital mental health KW - artificial intelligence KW - user reviews KW - cognitive behavioral therapy KW - CBT N2 - Background: Digital mental health apps are rapidly becoming a common source of accessible support across the world, but their effectiveness is often influenced by limited helpfulness and engagement. Objective: This study?s primary objective was to analyze feedback content to understand users? experiences with engaging with a digital mental health app. As a secondary objective, an exploratory analysis captured the types of mental health app users. Methods: This study utilized a user-led approach to understanding factors for engagement and helpfulness in digital mental health by analyzing feedback (n=7929) reported on Google Play Store about Wysa, a mental health app (1-year period). The analysis of keywords in the user feedback categorized and evaluated the reported user experience into the core domains of acceptability, usability, usefulness, and integration. The study also captured key deficits and strengths of the app and explored salient characteristics of the types of users who benefit from accessible digital mental health support. Results: The analysis of user feedback found the app to be overwhelmingly positively reviewed (6700/7929, 84.50% 5-star rating). The themes of engaging exercises, interactive interface, and artificial intelligence (AI) conversational ability indicated the acceptability of the app, while the nonjudgmentality and ease of conversation highlighted its usability. The app?s usefulness was portrayed by themes such as improvement in mental health, convenient access, and cognitive restructuring exercises. Themes of privacy and confidentiality underscored users? preference for the integrated aspects of the app. Further analysis revealed 4 predominant types of individuals who shared app feedback on the store. Conclusions: Users reported therapeutic elements of a comfortable, safe, and supportive environment through using the digital mental health app. Digital mental health apps may expand mental health access to those unable to access traditional forms of mental health support and treatments. UR - https://humanfactors.jmir.org/2022/2/e35668 UR - http://dx.doi.org/10.2196/35668 UR - http://www.ncbi.nlm.nih.gov/pubmed/35249886 ID - info:doi/10.2196/35668 ER - TY - JOUR AU - Menon, Rijuta AU - Meyer, Julien AU - Nippak, Pria AU - Begum, Housne PY - 2022/4/1 TI - Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use JO - JMIR Hum Factors SP - e33493 VL - 9 IS - 2 KW - mobile health KW - alcohol use disorder KW - disease management KW - mobile apps KW - Unified Theory of Acceptance and Use of Technology N2 - Background: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA. UR - https://humanfactors.jmir.org/2022/2/e33493 UR - http://dx.doi.org/10.2196/33493 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363145 ID - info:doi/10.2196/33493 ER - TY - JOUR AU - Tanaka, Hiroki AU - Nakamura, Satoshi PY - 2022/3/29 TI - The Acceptability of Virtual Characters as Social Skills Trainers: Usability Study JO - JMIR Hum Factors SP - e35358 VL - 9 IS - 1 KW - social skills training KW - virtual agent design KW - virtual assistant KW - virtual trainer KW - chatbot KW - acceptability KW - realism KW - virtual agent KW - simulation KW - social skill KW - social interaction KW - design KW - training KW - crowdsourcing N2 - Background: Social skills training by human trainers is a well-established method to provide appropriate social interaction skills and strengthen social self-efficacy. In our previous work, we attempted to automate social skills training by developing a virtual agent that taught social skills through interaction. Previous research has not investigated the visual design of virtual agents for social skills training. Thus, we investigated the effect of virtual agent visual design on automated social skills training. Objective: The 3 main purposes of this research were to investigate the effect of virtual agent appearance on automated social skills training, the relationship between acceptability and other measures (eg, likeability, realism, and familiarity), and the relationship between likeability and individual user characteristics (eg, gender, age, and autistic traits). Methods: We prepared images and videos of a virtual agent, and 1218 crowdsourced workers rated the virtual agents through a questionnaire. In designing personalized virtual agents, we investigated the acceptability, likeability, and other impressions of the virtual agents and their relationship to individual characteristics. Results: We found that there were differences between the virtual agents in all measures (P<.001). A female anime-type virtual agent was rated as the most likeable. We also confirmed that participants? gender, age, and autistic traits were related to their ratings. Conclusions: We confirmed the effect of virtual agent design on automated social skills training. Our findings are important in designing the appearance of an agent for use in personalized automated social skills training. UR - https://humanfactors.jmir.org/2022/1/e35358 UR - http://dx.doi.org/10.2196/35358 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348468 ID - info:doi/10.2196/35358 ER - TY - JOUR AU - Chen, Jinying AU - Wijesundara, G. Jessica AU - Enyim, E. Gabrielle AU - Lombardini, M. Lisa AU - Gerber, S. Ben AU - Houston, K. Thomas AU - Sadasivam, S. Rajani PY - 2022/3/7 TI - Understanding Patients? Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study JO - JMIR Hum Factors SP - e34452 VL - 9 IS - 1 KW - coronary KW - monitor KW - elder KW - health app KW - symptom KW - eHealth KW - mobile health KW - intention KW - barrier KW - facilitator N2 - Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients? intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as ?If this app were available to me, I would use it.? Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1%), 45 (45%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90% (90/100) White, 39% (39/100) women, and 88% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65%) agreed or strongly agreed that they would use the app, among which 53 (82%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75% among those aged 65-74 years and dropped to 44% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. UR - https://humanfactors.jmir.org/2022/1/e34452 UR - http://dx.doi.org/10.2196/34452 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254269 ID - info:doi/10.2196/34452 ER - TY - JOUR AU - Scholten, Jan Henk AU - Shih, Chia-Ding AU - Ma, Ran AU - Malhotra, Kara AU - Reyzelman, M. Alexander PY - 2022/3/1 TI - Utilization of a Smart Sock for the Remote Monitoring of Patients With Peripheral Neuropathy: Cross-sectional Study of a Real-world Registry JO - JMIR Form Res SP - e32934 VL - 6 IS - 3 KW - diabetes KW - diabetic foot ulcer KW - temperature monitoring KW - digital health KW - wearable KW - neuropathy KW - remote patient monitoring KW - ulcer KW - foot KW - temperature KW - monitoring KW - medical device KW - utilization KW - risk KW - complication KW - registry N2 - Background: Remote patient monitoring (RPM) devices are increasingly being used in caring for patients to reduce risks of complications. Temperature monitoring specifically has been shown in previous studies to provide a useful signal of inflammation that may help prevent foot ulcers. Objective: In this cross-sectional study, we evaluated utilization data for patients who were prescribed smart socks as remote temperature monitoring devices. Methods: This study evaluated data from a patient registry from January to July 2021. The utilization data, which were collected starting from the first full month since patients were prescribed the smart socks, were evaluated along with retention over time, the average time that the socks were worn, and the number of days that the socks were worn per month and per week. Results: A total of 160 patients wore the smart sock RPM device for 22 to 25 days per month on average. The retention rate was 91.9% (147/160) at the end of the 7-month period; a total of 13 patients were lost to follow-up during this period. The average number of days that the socks were worn per week was 5.8. The percentage of patients with a utilization rate of >15 days ranged from 79.7% (106/133) to 91.9% (125/136) each month. Conclusions: This study shows a high level of utilization for a smart sock RPM device and a high compliance rate. A future prospective study on the clinical outcomes after the use of the smart socks may further solidify the idea of conducting temperature monitoring for foot ulcer prevention. UR - https://formative.jmir.org/2022/3/e32934 UR - http://dx.doi.org/10.2196/32934 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230248 ID - info:doi/10.2196/32934 ER - TY - JOUR AU - Kohlbrenner, Dario AU - Clarenbach, F. Christian AU - Ivankay, Adam AU - Zimmerli, Lukas AU - Gross, S. Christoph AU - Kuhn, Manuel AU - Brunschwiler, Thomas PY - 2022/2/16 TI - Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk JO - JMIR Hum Factors SP - e31448 VL - 9 IS - 1 KW - home monitoring KW - digital health KW - respiratory disease KW - usability KW - feasibility KW - adherence KW - disease management KW - chronic disease KW - patient monitoring N2 - Background: Research integrating multisensory home-monitoring in respiratory disease is scarce. Therefore, we created a novel multisensory home-monitoring device tailored for long-term respiratory disease management (named the CAir-Desk). We hypothesize that recent technological accomplishments can be integrated into a multisensory participant-driven platform. We also believe that this platform could improve chronic disease management and be accessible to large groups at an acceptable cost. Objective: This study aimed to report on user adherence and acceptance as well as system functionality of the CAir-Desk in a sample of participants with stable chronic obstructive pulmonary disease (COPD) or asthma. Methods: We conducted an observational usability study. Participants took part in 4 weeks of home-monitoring with the CAir-Desk. The CAir-Desk recorded data from all participants on symptom burden, physical activity, spirometry, and environmental air quality; data on sputum production, and nocturnal cough were only recorded for participants who experienced symptoms. After the study period, participants reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. We used descriptive statistics and visualizations to display results. Results: Ten participants, 5 with COPD and 5 with asthma took part in this study. They completed symptom burden questionnaires on a median of 96% (25th percentile 14%, 75th percentile 96%), spirometry recordings on 55% (20%, 94%), wrist-worn physical activity recordings on 100% (97%, 100%), arm-worn physical activity recordings on 45% (13%, 63%), nocturnal cough recordings on 34% (9%, 54%), sputum recordings on 5% (3%, 12%), and environmental air quality recordings on 100% (99%, 100%) of the study days. The participants indicated that the measurements consumed a median of 13 (10, 15) min daily, and that they preferred the wrist-worn physical activity monitor to the arm-worn physical activity monitor. Conclusions: The CAir-Desk showed favorable technical performance and was well-accepted by our sample of participants with stable COPD and asthma. The obtained insights were used in a redesign of the CAir-Desk, which is currently applied in a randomized controlled trial including an interventional program. UR - https://humanfactors.jmir.org/2022/1/e31448 UR - http://dx.doi.org/10.2196/31448 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171107 ID - info:doi/10.2196/31448 ER - TY - JOUR AU - Cao, Rui AU - Azimi, Iman AU - Sarhaddi, Fatemeh AU - Niela-Vilen, Hannakaisa AU - Axelin, Anna AU - Liljeberg, Pasi AU - Rahmani, M. Amir PY - 2022/1/18 TI - Accuracy Assessment of Oura Ring Nocturnal Heart Rate and Heart Rate Variability in Comparison With Electrocardiography in Time and Frequency Domains: Comprehensive Analysis JO - J Med Internet Res SP - e27487 VL - 24 IS - 1 KW - electrocardiography KW - ECG KW - wearable device KW - heart rate variability KW - Oura smart ring N2 - Background: Photoplethysmography is a noninvasive and low-cost method to remotely and continuously track vital signs. The Oura Ring is a compact photoplethysmography-based smart ring, which has recently drawn attention to remote health monitoring and wellness applications. The ring is used to acquire nocturnal heart rate (HR) and HR variability (HRV) parameters ubiquitously. However, these parameters are highly susceptible to motion artifacts and environmental noise. Therefore, a validity assessment of the parameters is required in everyday settings. Objective: This study aims to evaluate the accuracy of HR and time domain and frequency domain HRV parameters collected by the Oura Ring against a medical grade chest electrocardiogram monitor. Methods: We conducted overnight home-based monitoring using an Oura Ring and a Shimmer3 electrocardiogram device. The nocturnal HR and HRV parameters of 35 healthy individuals were collected and assessed. We evaluated the parameters within 2 tests, that is, values collected from 5-minute recordings (ie, short-term HRV analysis) and the average values per night sleep. A linear regression method, the Pearson correlation coefficient, and the Bland?Altman plot were used to compare the measurements of the 2 devices. Results: Our findings showed low mean biases of the HR and HRV parameters collected by the Oura Ring in both the 5-minute and average-per-night tests. In the 5-minute test, the error variances of the parameters were different. The parameters provided by the Oura Ring dashboard (ie, HR and root mean square of successive differences [RMSSD]) showed relatively low error variance compared with the HRV parameters extracted from the normal interbeat interval signals. The Pearson correlation coefficient tests (P<.001) indicated that HR, RMSSD, average of normal heart beat intervals (AVNN), and percentage of successive normal beat-to-beat intervals that differ by more than 50 ms (pNN50) had high positive correlations with the baseline values; SD of normal beat-to-beat intervals (SDNN) and high frequency (HF) had moderate positive correlations, and low frequency (LF) and LF:HF ratio had low positive correlations. The HR, RMSSD, AVNN, and pNN50 had narrow 95% CIs; however, SDNN, LF, HF, and LF:HF ratio had relatively wider 95% CIs. In contrast, the average-per-night test showed that the HR, RMSSD, SDNN, AVNN, pNN50, LF, and HF had high positive relationships (P<.001), and the LF:HF ratio had a moderate positive relationship (P<.001). The average-per-night test also indicated considerably lower error variances than the 5-minute test for the parameters. Conclusions: The Oura Ring could accurately measure nocturnal HR and RMSSD in both the 5-minute and average-per-night tests. It provided acceptable nocturnal AVNN, pNN50, HF, and SDNN accuracy in the average-per-night test but not in the 5-minute test. In contrast, the LF and LF:HF ratio of the ring had high error rates in both tests. UR - https://www.jmir.org/2022/1/e27487 UR - http://dx.doi.org/10.2196/27487 UR - http://www.ncbi.nlm.nih.gov/pubmed/35040799 ID - info:doi/10.2196/27487 ER - TY - JOUR AU - Thirumalai, Mohanraj AU - Brown, Nashira AU - Niranjan, Soumya AU - Townsend, Sh'Nese AU - Powell, Anne Mary AU - Neal, Whitney AU - Schleicher, Erica AU - Raparla, Venkatadri AU - Oster, Robert AU - Demark-Wahnefried, Wendy AU - Pekmezi, Dori PY - 2022/1/4 TI - An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study JO - JMIR Hum Factors SP - e29494 VL - 9 IS - 1 KW - interactive voice response systems KW - usability KW - exercise KW - physical activity KW - rural health KW - telehealth N2 - Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. UR - https://humanfactors.jmir.org/2022/1/e29494 UR - http://dx.doi.org/10.2196/29494 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982714 ID - info:doi/10.2196/29494 ER - TY - JOUR AU - Wang, Y. Elizabeth AU - Breyer, N. Benjamin AU - Lee, W. Austin AU - Rios, Natalie AU - Oni-Orisan, Akinyemi AU - Steinman, A. Michael AU - Sim, Ida AU - Kenfield, A. Stacey AU - Bauer, R. Scott PY - 2021/12/24 TI - Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study JO - JMIR Hum Factors SP - e30767 VL - 8 IS - 4 KW - BPH KW - mobile health KW - mHealth KW - telehealth KW - telemedicine N2 - Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients? individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians? visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. UR - https://humanfactors.jmir.org/2021/4/e30767 UR - http://dx.doi.org/10.2196/30767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951599 ID - info:doi/10.2196/30767 ER - TY - JOUR AU - Majid, Shazmin AU - Reeves, Stuart AU - Figueredo, Grazziela AU - Brown, Susan AU - Lang, Alexandra AU - Moore, Matthew AU - Morriss, Richard PY - 2021/12/20 TI - The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review JO - JMIR Ment Health SP - e27991 VL - 8 IS - 12 KW - user-centered design KW - participatory design KW - human-computer interaction KW - patient and public involvement KW - self-monitoring technology KW - bipolar disorder KW - mobile phone N2 - Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9%) self-monitoring app was classified as having low user involvement, 4 (36%) self-monitoring apps were classified as having medium user involvement, and 2 (18%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care?based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. UR - https://mental.jmir.org/2021/12/e27991 UR - http://dx.doi.org/10.2196/27991 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931992 ID - info:doi/10.2196/27991 ER - TY - JOUR AU - van Wier, F. Marieke AU - Urry, Emily AU - Lissenberg-Witte, I. Birgit AU - Kramer, E. Sophia PY - 2021/12/20 TI - A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study JO - J Med Internet Res SP - e27599 VL - 23 IS - 12 KW - hearing impairment KW - social media use KW - app use KW - benefits from social media KW - eHealth KW - mobile phone N2 - Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. UR - https://www.jmir.org/2021/12/e27599 UR - http://dx.doi.org/10.2196/27599 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932013 ID - info:doi/10.2196/27599 ER - TY - JOUR AU - Markossian, W. Talar AU - Boyda, Jason AU - Taylor, Jennifer AU - Etingen, Bella AU - Modave, François AU - Price, Ron AU - Kramer, J. Holly PY - 2021/12/15 TI - A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study JO - JMIR Hum Factors SP - e29197 VL - 8 IS - 4 KW - chronic kidney disease KW - mobile app KW - self-management KW - mHealth KW - mobile apps KW - digital health KW - kidney disease KW - smartphone N2 - Background: Chronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD. Objective: The objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD. Methods: Our stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data. Results: Patients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms. Conclusions: Patients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence. UR - https://humanfactors.jmir.org/2021/4/e29197 UR - http://dx.doi.org/10.2196/29197 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914614 ID - info:doi/10.2196/29197 ER - TY - JOUR AU - Göttgens, Irene AU - Oertelt-Prigione, Sabine PY - 2021/12/6 TI - The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices JO - JMIR Mhealth Uhealth SP - e28102 VL - 9 IS - 12 KW - human-centered design KW - design thinking KW - user-centered design KW - design-based research KW - methodology KW - review KW - mobile phone N2 - Background: Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations. Objective: This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research. Methods: A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users. Results: This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user?s needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners. Conclusions: We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups. UR - https://mhealth.jmir.org/2021/12/e28102 UR - http://dx.doi.org/10.2196/28102 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874893 ID - info:doi/10.2196/28102 ER - TY - JOUR AU - Li, Chong AU - Song, Xinyu AU - Chen, Shugeng AU - Wang, Chuankai AU - He, Jieying AU - Zhang, Yongli AU - Xu, Shuo AU - Yan, Zhijie AU - Jia, Jie AU - Shull, Peter PY - 2021/11/23 TI - Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System on Patients with Stroke: Randomized Controlled Trial JO - JMIR Serious Games SP - e30184 VL - 9 IS - 4 KW - stroke KW - augmented reality KW - serious game KW - upper limb motor function KW - cognitive function KW - home-based rehabilitation N2 - Background: A serious game?based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training. Objective: This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient?s acceptance of the proposed system. Methods: A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients? adoption of the system in the experimental group after the final intervention. Results: All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group?s FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation. Conclusions: The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz UR - https://games.jmir.org/2021/4/e30184 UR - http://dx.doi.org/10.2196/30184 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817390 ID - info:doi/10.2196/30184 ER - TY - JOUR AU - Oladele, David AU - Iwelunmor, Juliet AU - Gbajabiamila, Titilola AU - Obiezu-Umeh, Chisom AU - Okwuzu, Ogoamaka Jane AU - Nwaozuru, Ucheoma AU - Musa, Zaidat Adesola AU - Idigbe, Ifeoma AU - Tahlil, Kadija AU - Tang, Weiming AU - Conserve, F. Donaldson AU - Rosenberg, E. Nora AU - David, N. Agatha AU - Tucker, Joseph AU - Ezechi, Oliver PY - 2021/11/17 TI - The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences JO - JMIR Form Res SP - e25824 VL - 5 IS - 11 KW - HIV self-testing KW - adolescents KW - young people KW - photo verification KW - mobile app KW - Nigeria N2 - Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results: A total of 19 users?12 women and 7 men?with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app?s low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app?s self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user?s privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app?s linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people. UR - https://formative.jmir.org/2021/11/e25824 UR - http://dx.doi.org/10.2196/25824 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787579 ID - info:doi/10.2196/25824 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 - Baumgartner, L. Susan AU - Buffkin Jr, Eric D. AU - Rukavina, Elise AU - Jones, Jason AU - Weiler, Elizabeth AU - Carnes, C. Tony PY - 2021/11/8 TI - A Novel Digital Pill System for Medication Adherence Measurement and Reporting: Usability Validation Study JO - JMIR Hum Factors SP - e30786 VL - 8 IS - 4 KW - digital pills KW - digital medication KW - ingestible event marker KW - ingestible sensor KW - human factors KW - usability KW - validation study KW - medication adherence KW - medication nonadherence KW - remote patient monitoring KW - mobile phone N2 - Background: Medication nonadherence is a costly problem that is common in clinical use and clinical trials alike, with significant adverse consequences. Digital pill systems have proved to be effective and safe solutions to the challenges of nonadherence, with documented success in improving adherence and health outcomes. Objective: The aim of this human factors validation study is to evaluate a novel digital pill system, the ID-Cap System from etectRx, for usability among patient users in a simulated real-world use environment. Methods: A total of 17 patients with diverse backgrounds who regularly take oral prescription medications were recruited. After training and a period of training decay, the participants were asked to complete 12 patient-use scenarios during which errors or difficulties were logged. The participants were also interviewed about their experiences with the ID-Cap System. Results: The participants ranged in age from 27 to 74 years (mean 51 years, SD 13.8 years), and they were heterogeneous in other demographic factors as well, such as education level, handedness, and sex. In this human factors validation study, the patient users completed 97.5% (196/201) of the total use scenarios successfully; 75.1% (151/201) were completed without any failures or errors. The participants found the ID-Cap System easy to use, and they were able to accurately and proficiently record ingestion events using the device. Conclusions: The participants demonstrated the ability to safely and effectively use the ID-Cap System for its intended use. The ID-Cap System has great potential as a useful tool for encouraging medication adherence and can be easily implemented by patient users. UR - https://humanfactors.jmir.org/2021/4/e30786 UR - http://dx.doi.org/10.2196/30786 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747709 ID - info:doi/10.2196/30786 ER - TY - JOUR AU - Luo, Yan AU - Dozier, Krystal AU - Ikenberg, Carin PY - 2021/10/26 TI - Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis JO - J Med Internet Res SP - e27966 VL - 23 IS - 10 KW - electronic personal health records KW - human-technology interaction factors KW - clinical notes KW - smartphone app KW - ease of understanding N2 - Background: An electronic personal health record (ePHR), also known as a personal health record (PHR), has been broadly defined as an electronic application through which individuals can access, manage, and share their health information in a secure and confidential environment. Although ePHRs can benefit individuals as well as caregivers and health care providers, the use of ePHRs among individuals continues to remain low. Objective: The current study aims to examine the relationship between human-technology interaction factors and ePHR use among adults and then to compare the different effects of human-technology interaction factors on ePHR use between younger adults (18-54 years old) and older adults (55 years of age and over). Methods: We analyzed data from the Health Information National Trends Survey (HINTS 5 cycle 3) collected from US adults aged 18 years old and over in 2019. Descriptive analysis was conducted for all variables and each item of ePHR use. Bivariate tests (Pearson correlation coefficient for categorical variable and F test for continuous variables) were conducted over 2 age groups. Finally, after adjustments were made for sociodemographics and health care resources, a weighted multiple linear regression was conducted to examine the relationship between human-technology interaction factors and ePHR use. Results: The final sample size of 1363 (average age 51.19) was divided into 2 age groups: 18 to 54 years old and 55 years old and older. The average level of ePHR use was low (mean 2.76, range 0-8). There was no significant difference in average ePHR use between the 2 age groups. Including clinical notes was positively related to ePHR use in both groups: 18 to 54 years old (?=.28, P=.005), 55 years old and older (?=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults (?=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults (?=.13; P=.003). Conclusions: This study found that including clinical notes was positively related to ePHR use in both age groups, which suggested that including clinical notes as a part of ePHRs might improve the effective use of ePHRs among patients. Moreover, accessing ePHRs using a smartphone app was associated with higher ePHR use among younger adults while ease of understanding health information in ePHRs was linked to higher ePHR use among older adults. The design of ePHRs should provide the option of being accessible through mobile devices to promote greater ePHR use among young people. For older adults, providers could add additional notes to explain the health information recorded in the ePHRs. UR - https://www.jmir.org/2021/10/e27966 UR - http://dx.doi.org/10.2196/27966 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698646 ID - info:doi/10.2196/27966 ER - TY - JOUR AU - Oppelaar, C. Martinus AU - van den Wijngaart, S. Lara AU - Merkus, M. Peter J. F. AU - Croonen, A. Ellen AU - Hugen, C. Cindy A. AU - Brouwer, L. Marianne AU - Boehmer, M. Annemie L. AU - Roukema, Jolt PY - 2021/10/20 TI - It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study JO - J Med Internet Res SP - e29218 VL - 23 IS - 10 KW - eHealth KW - asthma KW - pediatrics KW - telemonitoring KW - lung function tests KW - lung function KW - spirometry KW - home monitoring KW - mHealth KW - app KW - smartphone KW - asthma control KW - child KW - outpatients KW - remote consultations KW - quality improvement KW - patient care management KW - telemetry KW - application KW - FEV1 KW - pulmonary care N2 - Background: The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective: The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods: This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results: A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97% (38/39) at the start and 87% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions: Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own. UR - https://www.jmir.org/2021/10/e29218 UR - http://dx.doi.org/10.2196/29218 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668868 ID - info:doi/10.2196/29218 ER - TY - JOUR AU - Suffoletto, Brian AU - Goldstein, Tina AU - Gotkiewicz, Dawn AU - Gotkiewicz, Emily AU - George, Brandie AU - Brent, David PY - 2021/10/14 TI - Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e32271 VL - 5 IS - 10 KW - college KW - mental health KW - self-management KW - digital intervention KW - mHealth N2 - Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 UR - https://formative.jmir.org/2021/10/e32271 UR - http://dx.doi.org/10.2196/32271 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647893 ID - info:doi/10.2196/32271 ER - TY - JOUR AU - Egan, J. Kieren AU - Hodgson, William AU - Dunlop, D. Mark AU - Imperatore, Gennaro AU - Kirk, Alison AU - Maguire, Roma PY - 2021/10/1 TI - A Novel Mobile App (?CareFit?) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study JO - JMIR Form Res SP - e27358 VL - 5 IS - 10 KW - physical activity KW - Android KW - COVID-19 KW - intervention KW - co-design KW - exercise KW - app KW - development KW - support KW - caregiver N2 - Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, ?CareFit,? by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. UR - https://formative.jmir.org/2021/10/e27358 UR - http://dx.doi.org/10.2196/27358 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406969 ID - info:doi/10.2196/27358 ER - TY - JOUR AU - Shikako, Keiko AU - Mogo, I. Ebele R. AU - Grand-Maison, Valerie AU - Simpson, Robert AU - Pritchard-Wiart, Lesley AU - Majnemer, Annette AU - PY - 2021/9/16 TI - Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study JO - JMIR Form Res SP - e23877 VL - 5 IS - 9 KW - implementation research KW - mobile health KW - children with disabilities KW - physical activity promotion KW - digital health KW - inclusive leisure participation KW - mobile phone N2 - Background: The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors. Objective: In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities. Methods: We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework. Results: We developed a product that responds to users? identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users? active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population. Conclusions: Interactions between users and the app can sustain user engagement and behavior change. We will improve the app?s next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups. UR - https://formative.jmir.org/2021/9/e23877 UR - http://dx.doi.org/10.2196/23877 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528886 ID - info:doi/10.2196/23877 ER - TY - JOUR AU - Dharanikota, Spurthy AU - LeRouge, M. Cynthia AU - Lyon, Victoria AU - Durneva, Polina AU - Thompson, Matthew PY - 2021/9/14 TI - Identifying Enablers of Participant Engagement in Clinical Trials of Consumer Health Technologies: Qualitative Study of Influenza Home Testing JO - J Med Internet Res SP - e26869 VL - 23 IS - 9 KW - consumer health care technologies KW - CHTs KW - smartphone-supported home tests KW - Smart-HT KW - premarket clinical trials KW - trial engagement KW - at-home diagnostic testing KW - mobile phone N2 - Background: A rise in the recent trend of self-managing health using consumer health technologies highlights the importance of efficient and successful consumer health technology trials. Trials are particularly essential to support large-scale implementations of consumer health technologies, such as smartphone-supported home tests. However, trials are generally fraught with challenges, such as inadequate enrollment, lack of fidelity to interventions, and high dropout rates. Understanding the reasons underlying individuals? participation in trials can inform the design and execution of future trials of smartphone-supported home tests. Objective: This study aims to identify the enablers of potential participants? trial engagement for clinical trials of smartphone-supported home tests. We use influenza home testing as our instantiation of a consumer health technology subject to trial to investigate the dispositional and situational enablers that influenced trial engagement. Methods: We conducted semistructured interviews with 31 trial participants using purposive sampling to facilitate demographic diversity. The interviews included a discussion of participants? personal characteristics and external factors that enabled their trial engagement with a smartphone-supported home test for influenza. We performed both deductive and inductive thematic analyses to analyze the interview transcripts and identify enabler themes. Results: Our thematic analyses revealed a structure of dispositional and situational enablers that enhanced trial engagement. Situationally, clinical affiliation, personal advice, promotional recruitment strategies, financial incentives, and insurance status influenced trial engagement. In addition, digital health literacy, motivation to advance medical research, personal innovativeness, altruism, curiosity, positive attitude, and potential to minimize doctors? visits were identified as the dispositional enablers for trial engagement in our study. Conclusions: We organized the identified themes for dispositional and situational enablers of trial engagement with a smartphone-supported home test into a research framework that can guide future research as well as the trial design and execution of smartphone-supported home tests. We suggest several trial design and engagement strategies to enhance the financial and scientific viability of these trials that pave the way for advancements in patient care. Furthermore, our study also offers practical strategies to trial organizers to enhance participants? enrollment and engagement in clinical trials of these home tests. UR - https://www.jmir.org/2021/9/e26869 UR - http://dx.doi.org/10.2196/26869 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519664 ID - info:doi/10.2196/26869 ER - TY - JOUR AU - Greshake Tzovaras, Bastian AU - Senabre Hidalgo, Enric AU - Alexiou, Karolina AU - Baldy, Lukaz AU - Morane, Basile AU - Bussod, Ilona AU - Fribourg, Melvin AU - Wac, Katarzyna AU - Wolf, Gary AU - Ball, Mad PY - 2021/9/10 TI - Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study JO - J Med Internet Res SP - e28116 VL - 23 IS - 9 KW - symptom tracking KW - COVID-19 KW - wearable devices KW - self-tracking KW - citizen science KW - netnographic analysis KW - cocreation N2 - Background: Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices. Objective: This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data. Methods: We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion. Results: The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa. Conclusions: As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates. UR - https://www.jmir.org/2021/9/e28116 UR - http://dx.doi.org/10.2196/28116 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505836 ID - info:doi/10.2196/28116 ER - TY - JOUR AU - Elnaggar, Abdelaziz AU - von Oppenfeld, Julia AU - Whooley, A. Mary AU - Merek, Stephanie AU - Park, G. Linda PY - 2021/9/2 TI - Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study JO - JMIR Hum Factors SP - e25356 VL - 8 IS - 3 KW - physical activity KW - cardiac rehabilitation KW - digital health KW - mobile app KW - wearable device, mHealth KW - mobile phone N2 - Background: Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. Objective: This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. Methods: We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. Results: Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. Conclusions: By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults. UR - https://humanfactors.jmir.org/2021/3/e25356 UR - http://dx.doi.org/10.2196/25356 UR - http://www.ncbi.nlm.nih.gov/pubmed/34473064 ID - info:doi/10.2196/25356 ER - TY - JOUR AU - Ledermann, Katharina AU - Abou Khaled, Omar AU - Caon, Maurizio AU - Berger, Thomas AU - Chabwine, N. Joelle AU - Wicht, Joachim AU - Martin-Soelch, Chantal PY - 2021/8/26 TI - An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study JO - JMIR Res Protoc SP - e26930 VL - 10 IS - 8 KW - chronic pain KW - older adults KW - mHealth KW - online intervention KW - self-management N2 - Background: Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population. Objective: To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults. Methods: The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app. Results: Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022. Conclusions: Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/26930 UR - https://www.researchprotocols.org/2021/8/e26930 UR - http://dx.doi.org/10.2196/26930 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435969 ID - info:doi/10.2196/26930 ER - TY - JOUR AU - Siedlikowski, Maia AU - Curiale, Lianna AU - Rauch, Frank AU - Tsimicalis, Argerie PY - 2021/8/10 TI - Experiences of Children With Osteogenesis Imperfecta in the Co-design of the Interactive Assessment and Communication Tool Sisom OI: Secondary Analysis of Qualitative Design Sessions JO - JMIR Pediatr Parent SP - e22784 VL - 4 IS - 3 KW - child health KW - symptom assessment KW - communication KW - mobile applications KW - software N2 - Background: Children with osteogenesis imperfecta (OI) experience a diversity of symptoms that expose them to difficult physical, mental, and social challenges. Sisom (DHealth) is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic conditions express their symptoms. Recently, the co-design of the Sisom OI paper prototype was launched by seeking the perspectives of end users, including children with OI and their clinicians. Objective: The aim of this study is to describe the experiences that children with OI were prompted to share with researchers during the co-design of the Sisom OI paper prototype. Methods: A secondary analysis of qualitative data was conducted at a university-affiliated, pediatric, orthopedic hospital. The data sources consisted of interview transcripts, drawings, field notes, and observations derived from interviewing 12 children with OI who participated in the co-design of the Sisom OI paper prototype. The themes and subthemes identified from the data sources were generated using qualitative description. Results: Three themes were identified. The first, Relating to Others, described the balance between feeling different versus feeling similar to other children. The subthemes were Common OI Experience, Feeling Different, and Feeling Just Like Others. The second, Relating to Their Condition, described children?s positive and negative interactions with their own condition and health care. The subthemes were Understanding Their Condition, Special Relationship with the Hospital, and Difficult Treatments and Procedures. The third, Reflecting on Capabilities, described children?s recognition of their strengths and limitations. The subthemes were Perceiving Limitations, Overcoming Isolation, and Celebrating Strengths. Conclusions: This co-design process provided children with OI the space to not only contribute to the development of the end product but also eloquently describe their experiences. These findings, based on the descriptions given by the children themselves, offer us a unique understanding of what it means to grow up with OI. UR - https://pediatrics.jmir.org/2021/3/e22784 UR - http://dx.doi.org/10.2196/22784 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383677 ID - info:doi/10.2196/22784 ER - TY - JOUR AU - Rogers, C. Courtney AU - Moutinho Jr, J. Thomas AU - Liu, Xiaoyue AU - Valdez, S. Rupa PY - 2021/8/10 TI - Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work JO - JMIR Hum Factors SP - e27452 VL - 8 IS - 3 KW - Crohn disease KW - inflammatory bowel diseases KW - chronic disease KW - self-management KW - consumer health information technology KW - qualitative research KW - user-centered design KW - patient work KW - context KW - articulation work KW - diet KW - nutrition N2 - Background: Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. Objective: The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. Methods: We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. Results: Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. Conclusions: This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time. UR - https://humanfactors.jmir.org/2021/3/e27452 UR - http://dx.doi.org/10.2196/27452 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383664 ID - info:doi/10.2196/27452 ER - TY - JOUR AU - Ingvaldsen, Hegna Sigrid AU - Tronvik, Erling AU - Brenner, Eiliv AU - Winnberg, Ingunn AU - Olsen, Alexander AU - Gravdahl, Bruvik Gřril AU - Stubberud, Anker PY - 2021/7/28 TI - A Biofeedback App for Migraine: Development and Usability Study JO - JMIR Form Res SP - e23229 VL - 5 IS - 7 KW - mHealth KW - headache KW - wearables KW - smartphone N2 - Background: Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient. Objective: The objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine. Methods: In a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively. Results: A total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes. Conclusions: The app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps. UR - https://formative.jmir.org/2021/7/e23229 UR - http://dx.doi.org/10.2196/23229 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319243 ID - info:doi/10.2196/23229 ER - TY - JOUR AU - Duffy, Anthony AU - Christie, Greg AU - Moreno, Sylvain PY - 2021/7/26 TI - Examining Challenges to the Incorporation of End Users in the Design of Digital Health Interventions: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e28083 VL - 10 IS - 7 KW - digital health KW - end user(s) KW - user experience KW - UX KW - health behavior KW - intervention KW - co-design KW - mobile health KW - mHealth N2 - Background: The process of designing a digital health intervention (DHI)?also referred to as mobile health or eHealth?spans needs assessments, technical functionality and feasibility, user satisfaction, effectiveness, impact, and value. These interventions are causing a rapid evolution in the landscape of health care. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI design is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries, both of which approach, understand, and involve end users differently in the framing of a DHI. Objective: The objective of this systematic review is to assess the challenges to incorporating end users in the design stage of digital health interventions, to identify key pain points, and to identify limitations and gaps for areas of future investigation. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist will be used to structure this protocol. A systematic search of the PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Scopus, and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal. Results: As of February 2021, we have completed a preliminary literature search examining challenges to the incorporation of end users in the design stage of DHIs. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by December 2021. Conclusions: This systematic review aims to provide an effective summary of key pain points toward incorporating end users in DHIs. Results from this review will provide an evidence base for a better approach to end user involvement in the interest of improving efficacy and uptake of DHIs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238164 International Registered Report Identifier (IRRID): PRR1-10.2196/28083 UR - https://www.researchprotocols.org/2021/7/e28083 UR - http://dx.doi.org/10.2196/28083 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309578 ID - info:doi/10.2196/28083 ER - TY - JOUR AU - Song, Ting AU - Yu, Ping AU - Bliokas, Vida AU - Probst, Yasmine AU - Peoples, E. Gregory AU - Qian, Siyu AU - Houston, Lauren AU - Perez, Pascal AU - Amirghasemi, Mehrdad AU - Cui, Tingru AU - Hitige, Rathnayaka Nadeesha Pathiraja AU - Smith, Anne Natalie PY - 2021/7/20 TI - A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case JO - JMIR Mhealth Uhealth SP - e20650 VL - 9 IS - 7 KW - mHealth KW - smartphone KW - mobile apps KW - chronic disease KW - surgery KW - obesity KW - theory KW - community-based participatory research KW - mobile phone N2 - Background: Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. Objective: This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. Methods: We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. Results: In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient?s risk level, as informed by the person?s response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. Conclusions: This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions. UR - https://mhealth.jmir.org/2021/7/e20650 UR - http://dx.doi.org/10.2196/20650 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283030 ID - info:doi/10.2196/20650 ER - TY - JOUR AU - Mulgund, Pavankumar AU - Sharman, Raj AU - Rifkin, Daniel AU - Marrazzo, Sam PY - 2021/7/19 TI - Design, Development, and Evaluation of a Telemedicine Platform for Patients With Sleep Apnea (Ognomy): Design Science Research Approach JO - JMIR Form Res SP - e26059 VL - 5 IS - 7 KW - design science research KW - telemedicine platform KW - sleep apnea care KW - mHealth KW - telemedicine KW - sleep apnea KW - mobile health KW - web application KW - mobile phone N2 - Background: With an aging population and the escalating cost of care, telemedicine has become a societal imperative. Telemedicine alternatives are especially relevant to patients seeking care for sleep apnea, with its prevalence approaching one billion cases worldwide. Increasing awareness has led to a surge in demand for sleep apnea care; however, there is a shortage of the resources and expertise necessary to cater to the rising demand. Objective: The aim of this study is to design, develop, and evaluate a telemedicine platform, called Ognomy, for the consultation, diagnosis, and treatment of patients with sleep apnea. Methods: Using the design science research methodology, we developed a telemedicine platform for patients with sleep apnea. To explore the problem, in the analysis phase, we conducted two brainstorming workshops and structured interviews with 6 subject matter experts to gather requirements. Following that, we conducted three design and architectural review sessions to define and evaluate the system architecture. Subsequently, we conducted 14 formative usability assessments to improve the user interface of the system. In addition, 3 trained test engineers performed end-to-end system testing to comprehensively evaluate the platform. Results: Patient registration and data collection, physician appointments, video consultation, and patient progress tracking have emerged as critical functional requirements. A telemedicine platform comprising four artifacts?a mobile app for patients, a web app for providers, a dashboard for reporting, and an artificial intelligence?based chatbot for customer onboarding and support?was developed to meet these requirements. Design reviews emphasized the need for a highly cohesive but loosely coupled interaction among the platform?s components, which was achieved through a layered modular architecture using third-party application programming interfaces. In contrast, critical findings from formative usability assessments focused on the need for a more straightforward onboarding process for patients, better status indicators during patient registration, and reorganization of the appointment calendar. Feedback from the design reviews and usability assessments was translated into technical improvements and design enhancements that were implemented in subsequent iterations. Conclusions: Sleep apnea is an underdiagnosed and undertreated condition. However, with increasing awareness, the demand for quality sleep apnea care is likely to surge, and creative alternatives are needed. The results of this study demonstrate the successful application of a framework using a design science research paradigm to design, develop, and evaluate a telemedicine platform for patients with sleep apnea and their providers. UR - https://formative.jmir.org/2021/7/e26059 UR - http://dx.doi.org/10.2196/26059 UR - http://www.ncbi.nlm.nih.gov/pubmed/34279237 ID - info:doi/10.2196/26059 ER - TY - JOUR AU - Karakoyun, Toeresin AU - Podhaisky, Hans-Peter AU - Frenz, Ann-Kathrin AU - Schuhmann-Giampieri, Gabriele AU - Ushikusa, Thais AU - Schröder, Daniel AU - Zvolanek, Michal AU - Lopes Da Silva Filho, Agnaldo PY - 2021/7/13 TI - Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study JO - JMIR Med Inform SP - e24633 VL - 9 IS - 7 KW - medical device KW - levonorgestrel-releasing intrauterine system KW - mobile medical app KW - mobile phone N2 - Background: Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective: Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone?based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods: The MyIUS app is classified as a medical device and uses an artificial intelligence?based bleeding pattern prediction algorithm to estimate a woman?s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results: The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions: By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting. UR - https://medinform.jmir.org/2021/7/e24633 UR - http://dx.doi.org/10.2196/24633 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255688 ID - info:doi/10.2196/24633 ER - TY - JOUR AU - Scheibe, Madlen AU - Lang, Caroline AU - Druschke, Diana AU - Arnold, Katrin AU - Luntz, Edwin AU - Schmitt, Jochen AU - Holthoff-Detto, Vjera PY - 2021/7/12 TI - Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study JO - JMIR Hum Factors SP - e27156 VL - 8 IS - 3 KW - telemedicine KW - aged KW - multimorbidity KW - dementia KW - patient acceptance of health care KW - health care quality, access, and evaluation KW - qualitative research N2 - Background: The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. Objective: We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? Methods: We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. Results: Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. Conclusions: The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps. UR - https://humanfactors.jmir.org/2021/3/e27156 UR - http://dx.doi.org/10.2196/27156 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255664 ID - info:doi/10.2196/27156 ER - TY - JOUR AU - Habukawa, Chizu AU - Ohgami, Naoto AU - Arai, Takahiko AU - Makata, Haruyuki AU - Tomikawa, Morimitsu AU - Fujino, Tokihiko AU - Manabe, Tetsuharu AU - Ogihara, Yoshihito AU - Ohtani, Kiyotaka AU - Shirao, Kenichiro AU - Sugai, Kazuko AU - Asai, Kei AU - Sato, Tetsuya AU - Murakami, Katsumi PY - 2021/6/17 TI - Wheeze Recognition Algorithm for Remote Medical Care Device in Children: Validation Study JO - JMIR Pediatr Parent SP - e28865 VL - 4 IS - 2 KW - asthma KW - children KW - infant KW - wheezing KW - wheeze recognition algorithm KW - pediatrics KW - remote KW - medical devices KW - validation KW - home management KW - algorithm KW - detection KW - chronic illness N2 - Background: Since 2020, peoples? lifestyles have been largely changed due to the COVID-19 pandemic worldwide. In the medical field, although many patients prefer remote medical care, this prevents the physician from examining the patient directly; thus, it is important for patients to accurately convey their condition to the physician. Accordingly, remote medical care should be implemented and adaptable home medical devices are required. However, only a few highly accurate home medical devices are available for automatic wheeze detection as an exacerbation sign. Objective: We developed a new handy home medical device with an automatic wheeze recognition algorithm, which is available for clinical use in noisy environments such as a pediatric consultation room or at home. Moreover, the examination time is only 30 seconds, since young children cannot endure a long examination time without crying or moving. The aim of this study was to validate the developed automatic wheeze recognition algorithm as a clinical medical device in children at different institutions. Methods: A total of 374 children aged 4-107 months in pediatric consultation rooms of 10 institutions were enrolled in this study. All participants aged ?6 years were diagnosed with bronchial asthma and patients ?5 years had reported at least three episodes of wheezes. Wheezes were detected by auscultation with a stethoscope and recorded for 30 seconds using the wheeze recognition algorithm device (HWZ-1000T) developed based on wheeze characteristics following the Computerized Respiratory Sound Analysis guideline, where the dominant frequency and duration of a wheeze were >100 Hz and >100 ms, respectively. Files containing recorded lung sounds were assessed by each specialist physician and divided into two groups: 177 designated as ?wheeze? files and 197 as ?no-wheeze? files. Wheeze recognitions were compared between specialist physicians who recorded lung sounds and those recorded using the wheeze recognition algorithm. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for all recorded sound files, and evaluated the influence of age and sex on the wheeze detection sensitivity. Results: Detection of wheezes was not influenced by age and sex. In all files, wheezes were differentiated from noise using the wheeze recognition algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value of the wheeze recognition algorithm were 96.6%, 98.5%, 98.3%, and 97.0%, respectively. Wheezes were automatically detected, and heartbeat sounds, voices, and crying were automatically identified as no-wheeze sounds by the wheeze recognition algorithm. Conclusions: The wheeze recognition algorithm was verified to identify wheezing with high accuracy; therefore, it might be useful in the practical implementation of asthma management at home. Only a few home medical devices are available for automatic wheeze detection. The wheeze recognition algorithm was verified to identify wheezing with high accuracy and will be useful for wheezing management at home and in remote medical care. UR - https://pediatrics.jmir.org/2021/2/e28865 UR - http://dx.doi.org/10.2196/28865 UR - http://www.ncbi.nlm.nih.gov/pubmed/33875413 ID - info:doi/10.2196/28865 ER - TY - JOUR AU - Trettin, Bettina AU - Danbjřrg, Boe Dorthe AU - Andersen, Flemming AU - Feldman, Steven AU - Agerskov, Hanne PY - 2021/5/10 TI - Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study JO - JMIR Dermatol SP - e26673 VL - 4 IS - 1 KW - mHealth KW - psoriasis KW - biologics KW - participatory design KW - teledermatology KW - mobile phone N2 - Background: In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients? needs. Objective: This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design. Methods: Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps?plan, act, observe, and reflect?in the methodology of participatory design. Results: Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app. Conclusions: Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions. UR - https://derma.jmir.org/2021/1/e26673 UR - http://dx.doi.org/10.2196/26673 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632817 ID - info:doi/10.2196/26673 ER - TY - JOUR AU - McCall, C. Hugh AU - Hadjistavropoulos, D. Heather AU - Sundström, Francis Christopher Richard PY - 2021/4/29 TI - Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression JO - J Med Internet Res SP - e26939 VL - 23 IS - 4 KW - ICBT KW - internet KW - depression KW - anxiety KW - persuasive design KW - eHealth N2 - Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17). Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT. UR - https://www.jmir.org/2021/4/e26939 UR - http://dx.doi.org/10.2196/26939 UR - http://www.ncbi.nlm.nih.gov/pubmed/33913811 ID - info:doi/10.2196/26939 ER - TY - JOUR AU - Rafiei, Ramin AU - Williams, Chelsea AU - Jiang, Jeannette AU - Aungst, Dy Timothy AU - Durrer, Matthias AU - Tran, Dao AU - Howald, Ralph PY - 2021/3/18 TI - Digital Health Integration Assessment and Maturity of the United States Biopharmaceutical Industry: Forces Driving the Next Generation of Connected Autoinjectable Devices JO - JMIR Mhealth Uhealth SP - e25406 VL - 9 IS - 3 KW - digital health KW - artificial intelligence KW - drug delivery KW - biopharma KW - autoinjector KW - injectable devices KW - disease management KW - autoimmune KW - oncology KW - rare diseases UR - https://mhealth.jmir.org/2021/3/e25406 UR - http://dx.doi.org/10.2196/25406 UR - http://www.ncbi.nlm.nih.gov/pubmed/33621188 ID - info:doi/10.2196/25406 ER - TY - JOUR AU - Mariamo, Audrey AU - Temcheff, Elizabeth Caroline AU - Léger, Pierre-Majorique AU - Senecal, Sylvain AU - Lau, Alexandra Marianne PY - 2021/3/18 TI - Emotional Reactions and Likelihood of Response to Questions Designed for a Mental Health Chatbot Among Adolescents: Experimental Study JO - JMIR Hum Factors SP - e24343 VL - 8 IS - 1 KW - chatbots KW - conversational agents KW - mental health KW - well-being KW - adolescents KW - user experience KW - user preferences N2 - Background: Psychological distress increases across adolescence and has been associated with several important health outcomes with consequences that can extend into adulthood. One type of technological innovation that may serve as a unique intervention for youth experiencing psychological distress is the conversational agent, otherwise known as a chatbot. Further research is needed on the factors that may make mental health chatbots destined for adolescents more appealing and increase the likelihood that adolescents will use them. Objective: The aim of this study was to assess adolescents? emotional reactions and likelihood of responding to questions that could be posed by a mental health chatbot. Understanding adolescent preferences and factors that could increase adolescents? likelihood of responding to chatbot questions could assist in future mental health chatbot design destined for youth. Methods: We recruited 19 adolescents aged 14 to 17 years to participate in a study with a 2×2×3 within-subjects factorial design. Each participant was sequentially presented with 96 chatbot questions for a duration of 8 seconds per question. Following each presentation, participants were asked to indicate how likely they were to respond to the question, as well as their perceived affective reaction to the question. Demographic data were collected, and an informal debriefing was conducted with each participant. Results: Participants were an average of 15.3 years old (SD 1.00) and mostly female (11/19, 58%). Logistic regressions showed that the presence of GIFs predicted perceived emotional valence (?=?.40, P<.001), such that questions without GIFs were associated with a negative perceived emotional valence. Question type predicted emotional valence, such that yes/no questions (?=?.23, P=.03) and open-ended questions (?=?.26, P=.01) were associated with a negative perceived emotional valence compared to multiple response choice questions. Question type also predicted the likelihood of response, such that yes/no questions were associated with a lower likelihood of response compared to multiple response choice questions (?=?.24, P=.03) and a higher likelihood of response compared to open-ended questions (?=.54, P<.001). Conclusions: The findings of this study add to the rapidly growing field of teen-computer interaction and contribute to our understanding of adolescent user experience in their interactions with a mental health chatbot. The insights gained from this study may be of assistance to developers and designers of mental health chatbots. UR - https://humanfactors.jmir.org/2021/1/e24343 UR - http://dx.doi.org/10.2196/24343 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734089 ID - info:doi/10.2196/24343 ER - TY - JOUR AU - Chaniaud, Noémie AU - Megalakaki, Olga AU - Capo, Sophie AU - Loup-Escande, Emilie PY - 2021/3/17 TI - Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study JO - JMIR Hum Factors SP - e24846 VL - 8 IS - 1 KW - user characteristics KW - health literacy KW - home medical devices KW - usability study KW - remote health KW - home health N2 - Background: The Smart Angel home medical device allows ambulatory surgery patients to monitor their own health by taking their blood pressure and oxygen levels and answering a health questionnaire from home. Currently, this device is a prototype in the design phase, and no usability evaluation has been performed. This preventive device must be usable by patients with different profiles; however, it is important to select patients carefully to ensure their safety when using the device. As such, it would be interesting to know how to select or exclude patients. However, the links between user characteristics and the usability of this home medical device remain unclear. Objective: This study aims to better understand the links between certain characteristics of potential patients (ie, age, education, technophilia, and health literacy) and the usability (ie, effectiveness, efficiency, and satisfaction) of Smart Angel, as defined by the ISO 9241-11. Methods: We conducted an experimental study involving 36 participants investigating the effects of 4 patient characteristics (ie, age, education, technophilia, and health literacy) on usability, measured in terms of effectiveness, efficiency, and satisfaction. A mixed methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). First, to help participants project themselves into the real use of the Smart Angel device, they watched a scenario in a video. Second, the participants completed a set of questionnaires to show the extent of their health literacy level (Newest Vital Sign [NVS] and the Health Literacy Survey [HLS]) and then operated Smart Angel devices. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (System Usability Scale [SUS]). The qualitative observational data were coded using inductive analysis by 2 independent researchers specialized in cognitive psychology and cognitive ergonomics. Results: The results show a moderate and positive correlation between age and effectiveness (r=0.359; P=.03) and efficiency (r=0.357; P=.03). There is strong correlation between health literacy scored by the NVS and effectiveness (r=0.417; P=.01), efficiency (r=-0.38; P=.02), and satisfaction (r=0.45; P=.006). However, there is a weak correlation between technophilia and usability and no relationship between education level and usability. Conclusions: Our results show that literacy level and age are 2 important factors to consider when selecting future users of the Smart Angel device to ensure patient safety. This study also serves as an example promoting mixed methodologies in assessments of medical device usability that cannot be performed under real-world conditions. UR - https://humanfactors.jmir.org/2021/1/e24846 UR - http://dx.doi.org/10.2196/24846 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729161 ID - info:doi/10.2196/24846 ER - TY - JOUR AU - Kowatsch, Tobias AU - Lohse, Kim-Morgaine AU - Erb, Valérie AU - Schittenhelm, Leo AU - Galliker, Helen AU - Lehner, Rea AU - Huang, M. Elaine PY - 2021/2/22 TI - Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: Four Design and Evaluation Studies JO - J Med Internet Res SP - e23612 VL - 23 IS - 2 KW - ubiquitous coaching KW - augmented reality KW - health care KW - treatment adherence KW - design science research KW - physiotherapy KW - chronic back pain KW - pain KW - chronic pain KW - exercise KW - adherence KW - treatment KW - conversational agent KW - smartphone KW - mobile phone N2 - Background: Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. Objective: To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. Methods: We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients? perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. Results: Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality?based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. Conclusions: The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders. UR - https://www.jmir.org/2021/2/e23612 UR - http://dx.doi.org/10.2196/23612 UR - http://www.ncbi.nlm.nih.gov/pubmed/33461957 ID - info:doi/10.2196/23612 ER - TY - JOUR AU - Carlin, Thomas AU - Vuillerme, Nicolas PY - 2021/1/13 TI - Step and Distance Measurement From a Low-Cost Consumer-Based Hip and Wrist Activity Monitor: Protocol for a Validity and Reliability Assessment JO - JMIR Res Protoc SP - e21262 VL - 10 IS - 1 KW - activity monitor KW - pedometer KW - measurement KW - validity KW - reliability KW - walking KW - step count KW - distance N2 - Background: Self-tracking via wearable and mobile technologies is becoming an essential part of personal health management. At this point, however, little information is available to substantiate the validity and reliability of low-cost consumer-based hip and wrist activity monitors, with regard more specifically to the measurements of step counts and distance traveled while walking. Objective: The aim of our study is to assess the validity and reliability of step and distance measurement from a low-cost consumer-based hip and wrist activity monitor specific in various walking conditions that are commonly encountered in daily life. Specifically, this study is designed to evaluate whether and to what extent validity and reliability could depend on the sensor placement on the human body and the walking task being performed. Methods: Thirty healthy participants will be instructed to wear four PBN 2433 (Nakosite) activity monitors simultaneously, with one placed on each hip and each wrist. Participants will attend two experimental sessions separated by 1 week. During each experimental session, two separate studies will be performed. In study 1, participants will be instructed to complete a 2-minute walk test along a 30-meter indoor corridor under 3 walking speeds: very slow, slow, and usual speed. In study 2, participants will be required to complete the following 3 conditions performed at usual walking speed: walking on flat ground, upstairs, and downstairs. Activity monitor measured step count and distance values will be computed along with the actual step count (determined from video recordings) and distance (measured using a measuring tape) to determine validity and reliability for each activity monitor placement and each walking condition. Results: Participant recruitment and data collection began in January 2020. As of June 2020, we enrolled 8 participants. Dissemination of study results in peer-reviewed journals is expected in spring 2021. Conclusions: To the best of our knowledge, this is the first study that examines the validity and reliability of step and distance measurement during walking using the PBN 2433 (Nakosite) activity monitor. Results of this study will provide beneficial information on the effects of activity monitor placement, walking speed, and walking tasks on the validity and reliability of step and distance measurement. We believe such information is of utmost importance to general consumers, clinicians, and researchers. International Registered Report Identifier (IRRID): DERR1-10.2196/21262 UR - http://www.researchprotocols.org/2021/1/e21262/ UR - http://dx.doi.org/10.2196/21262 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439138 ID - info:doi/10.2196/21262 ER - TY - JOUR AU - Hawley-Hague, Helen AU - Tacconi, Carlo AU - Mellone, Sabato AU - Martinez, Ellen AU - Chiari, Lorenzo AU - Helbostad, Jorunn AU - Todd, Chris PY - 2021/1/12 TI - One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study JO - JMIR Rehabil Assist Technol SP - e19690 VL - 8 IS - 1 KW - aged KW - postural balance KW - telerehabilitation KW - patient compliance KW - accidental falls KW - mobile phone N2 - Background: Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective: This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods: There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results: In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions: Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability. UR - http://rehab.jmir.org/2021/1/e19690/ UR - http://dx.doi.org/10.2196/19690 UR - http://www.ncbi.nlm.nih.gov/pubmed/33433398 ID - info:doi/10.2196/19690 ER - TY - JOUR AU - Vinci, Christine AU - Brandon, O. Karen AU - Kleinjan, Marloes AU - Hernandez, M. Laura AU - Sawyer, E. Leslie AU - Haneke, Jody AU - Sutton, K. Steven AU - Brandon, H. Thomas PY - 2020/12/31 TI - Augmented Reality for Smoking Cessation: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e21643 VL - 8 IS - 12 KW - augmented reality KW - smoking cessation KW - cue exposure therapy KW - cue reactivity KW - behavior change KW - smoking KW - smartphone app KW - mobile phone N2 - Background: The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations. Objective: The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app. Methods: In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images. Results: Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=?2.14, P=.03; d=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all P>.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). Conclusions: All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed. UR - http://mhealth.jmir.org/2020/12/e21643/ UR - http://dx.doi.org/10.2196/21643 UR - http://www.ncbi.nlm.nih.gov/pubmed/33382377 ID - info:doi/10.2196/21643 ER - TY - JOUR AU - Khowaja, Kamran AU - Al-Thani, Dena PY - 2020/10/28 TI - New Checklist for the Heuristic Evaluation of mHealth Apps (HE4EH): Development and Usability Study JO - JMIR Mhealth Uhealth SP - e20353 VL - 8 IS - 10 KW - mHealth KW - eHealth KW - heuristic evaluation KW - expert evaluation KW - self-monitoring KW - behavior change KW - design guidelines KW - framework N2 - Background: Diabetes is one of the leading causes of death in developing countries. Existing mobile health (mHealth) app design guidelines lack a description of the support of continuous self-monitoring of health status, behavior change to improve and adopt a healthy lifestyle, and communication with health educators and health care professionals in case of any need. Objective: This paper presents the development of a specialized set of heuristics called heuristic evaluation for mHealth apps (HE4EH) as an all-in-one tool and its applicability by performing a heuristic evaluation of an mHealth app. Methods: An extensive review of heuristics and checklists was used to develop the HE4EH. The HE4EH was evaluated by domain experts for heuristics, checklist items, severity ratings, and overall satisfaction. The OneTouch app, which helps individuals with diabetes manage their blood glucose levels, was evaluated using HE4EH to identify usability problems that need to be fixed in the app. Results: The expert evaluation of HE4EH revealed that the heuristics were important, relevant, and clear. The checklist items across the heuristics were clear, relevant, and acceptably grouped. In terms of evaluating the OneTouch app using the HE4EH, the most frequently violated heuristics included Content, Visibility, Match, and Self-monitoring. Most of the usability problems found were minor. The system usability scale score indicated that the OneTouch app is marginally acceptable. Conclusions: This heuristic evaluation using the OneTouch app shows that the HE4EH can play a vital role for designers, researchers, and practitioners to use HE4EH heuristics and checklist items as a tool to design a new or evaluate and improve an existing mHealth app. UR - http://mhealth.jmir.org/2020/10/e20353/ UR - http://dx.doi.org/10.2196/20353 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112252 ID - info:doi/10.2196/20353 ER - TY - JOUR AU - Chaniaud, Noémie AU - Métayer, Natacha AU - Megalakaki, Olga AU - Loup-Escande, Emilie PY - 2020/9/21 TI - Effect of Prior Health Knowledge on the Usability of Two Home Medical Devices: Usability Study JO - JMIR Mhealth Uhealth SP - e17983 VL - 8 IS - 9 KW - usability KW - prior health knowledge KW - mHealth KW - home medical devices KW - blood pressure monitor KW - pulse oximeter N2 - Background: Studies on the usability of health care devices are becoming more common, although usability standards are not necessarily specified and followed. Yet, there is little knowledge about the impact of the context of use on the usability outcome. It is specified in the usability standard (ISO 9241-11, 2018) of a device that it may be affected by its context of use and especially by the characteristics of its users. Among these, prior health knowledge (ie, knowledge about human body functioning) is crucial. However, no study has shown that prior health knowledge influences the usability of medical devices.  Objective: Our study aimed to fill this gap by analyzing the relationship between the usability of two home medical devices (soon to be used in the context of ambulatory surgery) and prior health knowledge through an experimental approach. Methods: For assessing the usability of two home medical devices (blood pressure monitor and pulse oximeter), user tests were conducted among 149 students. A mixed-methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). Participants completed a questionnaire to show the extent of their previous health knowledge and then operated both devices randomly. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (system usability scale [SUS]). The qualitative observational data were coded using inductive analysis by two independent researchers specialized in cognitive psychology and cognitive ergonomics. Correlational analyses and clusters were performed to test how usability relates to sociodemographic characteristics and prior health knowledge. Results: The results indicated a lack of usability for both devices. Regarding the blood pressure monitor (137 participants), users made approximately 0.77 errors (SD 1.49), and the mean SUS score was 72.4 (SD 21.07), which is considered ?satisfactory.? The pulse oximeter (147 participants) appeared easier to use, but participants made more errors (mean 0.99, SD 0.92), and the mean SUS score was 71.52 (SD 17.29), which is considered ?satisfactory.? The results showed a low negative and significant correlation only between the effectiveness of the two devices and previous knowledge (blood pressure monitor: r=?0.191, P=.03; pulse oximeter: r=?0.263, P=.001). More subtly, we experimentally identified the existence of a threshold level (?˛2,146=10.9, P=.004) for health knowledge to correctly use the pulse oximeter, but this was missing for the blood pressure monitor. Conclusions: This study has the following two contributions: (1) a theoretical interest highlighting the importance of user characteristics including prior health knowledge on usability outcomes and (2) an applied interest to provide recommendations to designers and medical staff. UR - http://mhealth.jmir.org/2020/9/e17983/ UR - http://dx.doi.org/10.2196/17983 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955454 ID - info:doi/10.2196/17983 ER - TY - JOUR AU - Perlmutter, Alexander AU - Benchoufi, Mehdi AU - Ravaud, Philippe AU - Tran, Viet-Thi PY - 2020/9/11 TI - Identification of Patient Perceptions That Can Affect the Uptake of Interventions Using Biometric Monitoring Devices: Systematic Review of Randomized Controlled Trials JO - J Med Internet Res SP - e18986 VL - 22 IS - 9 KW - systematic review KW - patient perceptions KW - biometric monitoring device KW - randomized controlled trials KW - accelerometer KW - pedometer KW - ecological momentary assessment KW - electrochemical biosensor KW - adoption KW - uptake KW - real-world N2 - Background: Biometric monitoring devices (BMDs) are wearable or environmental trackers and devices with embedded sensors thatcan remotely collect high-frequency objective data on patients? physiological, biological, behavioral, and environmentalcontexts (for example, fitness trackers with accelerometer). The real-world effectiveness of interventions using biometric monitoring devices depends on patients? perceptions of these interventions. Objective: We aimed to systematically review whether and how recent randomized controlled trials (RCTs) evaluating interventions using BMDs assessed patients? perceptions toward the intervention. Methods: We systematically searched PubMed (MEDLINE) from January 1, 2017, to December 31, 2018, for RCTs evaluating interventions using BMDs. Two independent investigators extracted the following information: (1) whether the RCT collected information on patient perceptions toward the intervention using BMDs and (2) if so, what precisely was collected, based on items from questionnaires used and/or themes and subthemes identified from qualitative assessments. The two investigators then synthesized their findings in a schema of patient perceptions of interventions using BMDs. Results: A total of 58 RCTs including 10,071 participants were included in the review (the median number of randomized participants was 60, IQR 37-133). BMDs used in interventions were accelerometers/pedometers (n=35, 60%), electrochemical biosensors (eg, continuous glucose monitoring; n=18, 31%), or ecological momentary assessment devices (eg, carbon monoxide monitors for smoking cessation; n=5, 9%). Overall, 26 (45%) trials collected information on patient perceptions toward the intervention using BMDs and allowed the identification of 76 unique aspects of patient perceptions that could affect the uptake of these interventions (eg, relevance of the information provided, alarm burden, privacy and data handling, impact on health outcomes, independence, interference with daily life). Patient perceptions were unevenly collected in trials. For example, only 5% (n=3) of trials assessed how patients felt about privacy and data handling aspects of the intervention using BMDs. Conclusions: Our review showed that less than half of RCTs evaluating interventions using BMDs assessed patients? perceptions toward interventions using BMDs. Trials that did assess perceptions often only assessed a fraction of them. This limits the extrapolation of the results of these RCTs to the real world. We thus provide a comprehensive schema of aspects of patient perceptions that may affect the uptake of interventions using BMDs and which should be considered in future trials. Trial Registration: PROSPERO CRD42018115522; https://tinyurl.com/y5h8fjgx UR - http://www.jmir.org/2020/9/e18986/ UR - http://dx.doi.org/10.2196/18986 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915153 ID - info:doi/10.2196/18986 ER - TY - JOUR AU - ter Stal, Silke AU - Broekhuis, Marijke AU - van Velsen, Lex AU - Hermens, Hermie AU - Tabak, Monique PY - 2020/9/4 TI - Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study JO - JMIR Hum Factors SP - e19987 VL - 7 IS - 3 KW - embodied conversational agent KW - appearance design KW - health status assessment KW - older adults KW - eHealth N2 - Background: Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. Objective: This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users? likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. Methods: The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent?s advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. Results: A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. Conclusions: Agent age and gender little influence users? impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps. UR - https://humanfactors.jmir.org/2020/3/e19987 UR - http://dx.doi.org/10.2196/19987 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886068 ID - info:doi/10.2196/19987 ER - TY - JOUR AU - Kim, Ben AU - McKay, M. Sandra AU - Lee, Joon PY - 2020/9/3 TI - Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study JO - J Med Internet Res SP - e19732 VL - 22 IS - 9 KW - frailty KW - mobile health KW - wearables KW - physical activity KW - home care KW - prediction KW - predictive modeling, older adults KW - activities of daily living, sleep N2 - Background: Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0% to 59.1%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. Objective: The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. Methods: From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. Results: A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). Conclusions: We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services. UR - https://www.jmir.org/2020/9/e19732 UR - http://dx.doi.org/10.2196/19732 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880582 ID - info:doi/10.2196/19732 ER - TY - JOUR AU - King, D'Arcy AU - Khan, Sundas AU - Polo, Jennifer AU - Solomon, Jeffrey AU - Pekmezaris, Renee AU - Hajizadeh, Negin PY - 2020/8/4 TI - Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study JO - JMIR Rehabil Assist Technol SP - e16004 VL - 7 IS - 2 KW - chronic obstructive pulmonary disease KW - usability testing KW - telehealth KW - telerehabilitation KW - vulnerable populations N2 - Background: Telehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices. Objective: The objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study. Methods: Usability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions. Results: During usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements. Conclusions: Usability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions. UR - http://rehab.jmir.org/2020/2/e16004/ UR - http://dx.doi.org/10.2196/16004 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749229 ID - info:doi/10.2196/16004 ER - TY - JOUR AU - Mena, J. Luis AU - Félix, G. Vanessa AU - Ostos, Rodolfo AU - González, J. Armando AU - Martínez-Peláez, Rafael AU - Melgarejo, D. Jesus AU - Maestre, E. Gladys PY - 2020/7/20 TI - Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e18012 VL - 8 IS - 7 KW - mHealth KW - photoplethysmography KW - blood pressure monitoring KW - hypertension N2 - Background: Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective: This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations. UR - https://mhealth.jmir.org/2020/7/e18012 UR - http://dx.doi.org/10.2196/18012 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459642 ID - info:doi/10.2196/18012 ER - TY - JOUR AU - Wegner, Stephan AU - Lohmeyer, Quentin AU - Wahlen, Dimitri AU - Neumann, Sandra AU - Groebli, Jean-Claude AU - Meboldt, Mirko PY - 2020/6/3 TI - Value of Eye-Tracking Data for Classification of Information Processing?Intensive Handling Tasks: Quasi-Experimental Study on Cognition and User Interface Design JO - JMIR Hum Factors SP - e15581 VL - 7 IS - 2 KW - human factors engineering KW - mobile eye tracking KW - benchmarking KW - home care KW - usability KW - self-management KW - quantitative research KW - quantitative evaluation N2 - Background: In order to give a wide range of people the opportunity to ensure and support home care, one approach is to develop medical devices that are as user-friendly as possible. This allows nonexperts to use medical devices that were originally too complicated to use. For a user-centric development of such medical devices, it is essential to understand which user interface design best supports patients, caregivers, and health care professionals. Objective: Using the benefits of mobile eye tracking, this work aims to gain a deeper understanding of the challenges of user cognition. As a consequence, its goal is to identify the obstacles to the usability of the features of two different designs of a single medical device user interface. The medical device is a patient assistance device for home use in peritoneal dialysis therapy. Methods: A total of 16 participants, with a subset of seniors (8/16, mean age 73.7 years) and young adults (8/16, mean age 25.0 years), were recruited and participated in this study. The handling cycle consisted of seven main tasks. Data analysis started with the analysis of task effectiveness for searching for error-related tasks. Subsequently, the in-depth gaze data analysis focused on these identified critical tasks. In order to understand the challenges of user cognition in critical tasks, gaze data were analyzed with respect to individual user interface features of the medical device system. Therefore, it focused on the two dimensions of dwell time and fixation duration of the gaze. Results: In total, 97% of the handling steps for design 1 and 96% for design 2 were performed correctly, with the main challenges being task 1 insert, task 2 connect, and task 6 disconnect for both designs. In order to understand the two analyzed dimensions of the physiological measurements simultaneously, the authors propose a new graphical representation. It distinguishes four different patterns to compare the eye movements associated with the two designs. The patterns identified for the critical tasks are consistent with the results of the task performance. Conclusions: This study showed that mobile eye tracking provides insights into information processing in intensive handling tasks related to individual user interface features. The evaluation of each feature of the user interface promises an optimal design by combining the best found features. In this way, manufacturers are able to develop products that can be used by untrained people without prior knowledge. This would allow home care to be provided not only by highly qualified nurses and caregivers, but also by patients themselves, partners, children, or neighbors. UR - http://humanfactors.jmir.org/2020/2/e15581/ UR - http://dx.doi.org/10.2196/15581 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490840 ID - info:doi/10.2196/15581 ER - TY - JOUR AU - Zhong, Runting AU - Rau, Patrick Pei-Luen PY - 2020/5/26 TI - A Mobile Phone?Based Gait Assessment App for the Elderly: Development and Evaluation JO - JMIR Mhealth Uhealth SP - e14453 VL - 8 IS - 5 KW - aged KW - gait KW - mHealth KW - telemedicine KW - falls prevention N2 - Background: Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. Objective: This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. Methods: The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. Results: Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. Conclusions: This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone?based gait assessment app. The feedback of the participants would help to design more elderly-friendly products. UR - https://mhealth.jmir.org/2020/5/e14453 UR - http://dx.doi.org/10.2196/14453 UR - http://www.ncbi.nlm.nih.gov/pubmed/32473005 ID - info:doi/10.2196/14453 ER - TY - JOUR AU - Davies, Alan AU - Mueller, Julia AU - Hennings, Jean AU - Caress, Ann-Louise AU - Jay, Caroline PY - 2020/5/15 TI - Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype JO - JMIR Hum Factors SP - e16289 VL - 7 IS - 2 KW - chronic obstructive pulmonary disease KW - app design KW - mHealth KW - ecological momentary assessment KW - mobile phone N2 - Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps. Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD. Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data. Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001). Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods. UR - http://humanfactors.jmir.org/2020/2/e16289/ UR - http://dx.doi.org/10.2196/16289 UR - http://www.ncbi.nlm.nih.gov/pubmed/32410730 ID - info:doi/10.2196/16289 ER - TY - JOUR AU - Stevens, Timothy AU - McGinnis, S. Ryan AU - Hewgill, Blake AU - Choquette, H. Rebecca AU - Tourville, W. Timothy AU - Harvey, Jean AU - Lachapelle, Richard AU - Beynnon, D. Bruce AU - Toth, J. Michael AU - Skalka, Christian PY - 2020/5/11 TI - A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile?Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation JO - JMIR Hum Factors SP - e16605 VL - 7 IS - 2 KW - device use tracking KW - internet of things KW - neuromuscular electrical stimulation KW - exercise KW - smart devices KW - mHealth KW - rehabilitation KW - mobile health KW - digital health N2 - Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System?based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software?tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. UR - http://humanfactors.jmir.org/2020/2/e16605/ UR - http://dx.doi.org/10.2196/16605 UR - http://www.ncbi.nlm.nih.gov/pubmed/32384052 ID - info:doi/10.2196/16605 ER - TY - JOUR AU - Yaacob, Azwany Nor AU - Mohamad Marzuki, Fadhil Muhamad AU - Yaacob, Majdi Najib AU - Ahmad, Bariyah Shahrul AU - Abu Hassan, Radzi Muhammad PY - 2020/2/25 TI - Effectiveness of the ColorApp Mobile App for Health Education and Promotion for Colorectal Cancer: Quasi-Experimental Study JO - JMIR Hum Factors SP - e15487 VL - 7 IS - 1 KW - colorectal cancer KW - mobile app KW - effectiveness KW - knowledge KW - attitude N2 - Background: Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods: A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results: There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F1,95=0.36, P=.55). Conclusions: The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer. UR - https://humanfactors.jmir.org/2020/1/e15487 UR - http://dx.doi.org/10.2196/15487 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130119 ID - info:doi/10.2196/15487 ER - TY - JOUR AU - Purkayastha, Saptarshi AU - Addepally, Abhishek Siva AU - Bucher, Sherri PY - 2020/2/3 TI - Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial JO - JMIR Hum Factors SP - e14146 VL - 7 IS - 1 KW - cognitive behavioral therapy KW - mHealth KW - mental health KW - heuristics KW - usability N2 - Background: Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression. Objective: Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM. Methods: We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies. Results: The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users. Conclusions: As among the first studies to directly compare the usability of a mobile app?based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app. UR - http://humanfactors.jmir.org/2020/1/e14146/ UR - http://dx.doi.org/10.2196/14146 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012043 ID - info:doi/10.2196/14146 ER - TY - JOUR AU - Safi, Sabur AU - Danzer, Gerhard AU - Schmailzl, JG Kurt PY - 2019/11/29 TI - Empirical Research on Acceptance of Digital Technologies in Medicine Among Patients and Healthy Users: Questionnaire Study JO - JMIR Hum Factors SP - e13472 VL - 6 IS - 4 KW - innovative health care applications KW - e-Health KW - Technology Acceptance Model KW - health care innovation KW - electronic medical records KW - ePatient Survey KW - sex differences KW - medical technology N2 - Background: In recent years, interest in digital technologies such as electronic health, mobile health, telemedicine, big data, and health apps has been increasing in the health care sector. Acceptance and sustainability of these technologies play a considerable role for innovative health care apps. Objective: This study aimed to identify the spread of and experience with new digital technologies in the medical sector in Germany. Methods: We analyzed the acceptance of new health care technologies by applying the Technology Acceptance Model to data obtained in the German ePatient Survey 2018. This survey used standardized questionnaires to gain insight into the prevalence, impact, and development of digital health applications in a study sample of 9621 patients with acute and chronic conditions and healthy users. We extracted sociodemographic data and details on the different health app types used in Germany and conducted an evaluation based on the Technology Acceptance Model. Results: The average age of the respondents was 59.7 years, with a standard deviation of 16 years. Digital health care apps were generally accepted, but differences were observed among age groups and genders of the respondents. Men were more likely to accept digital technologies, while women preferred coaching and consultation apps. Analysis of the user typology revealed that most users were patients (n=4041, 42%), followed by patients with acute conditions (n=3175, 33%), and healthy users (n=2405, 25%). The majority (n=6542, 68%) discovered coaching or medication apps themselves on the internet, while more than half of the users faced initial difficulties operating such apps. The time of use of the same app or program ranged from a few days (n=1607, 37%) and several months (n=1694, 39%) to ?1 year (n=1042, 24%). Most respondents (n=6927, 72%) stated that they would like to receive customized health care apps from their physician. Conclusions: The acceptance of digital technologies in the German health care sector varies depending on age and gender. The broad acceptance of medical digital apps could potentially improve individualized health care solutions and warrants governance. UR - http://humanfactors.jmir.org/2019/4/e13472/ UR - http://dx.doi.org/10.2196/13472 UR - http://www.ncbi.nlm.nih.gov/pubmed/31782741 ID - info:doi/10.2196/13472 ER - TY - JOUR AU - Wang, Guangyu AU - Zhou, Silu AU - Rezaei, Shahbaz AU - Liu, Xin AU - Huang, Anpeng PY - 2019/10/30 TI - An Ambulatory Blood Pressure Monitor Mobile Health System for Early Warning for Stroke Risk: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e14926 VL - 7 IS - 10 KW - ambulatory blood pressure monitor KW - mHealth KW - stroke-risk early warning KW - abnormal blood pressure data analyzing KW - longitudinal observational study N2 - Background: Stroke, as a leading cause of death around the globe, has become a heavy burden on our society. Studies show that stroke can be predicted and prevented if a person?s blood pressure (BP) status is appropriately monitored via an ambulatory blood pressure monitor (ABPM) system. However, currently there exists no efficient and user-friendly ABPM system to provide early warning for stroke risk in real-time. Moreover, most existing ABPM devices measure BP during the deflation of the cuff, which fails to reflect blood pressure accurately. Objective: In this study, we sought to develop a new ABPM mobile health (mHealth) system that was capable of monitoring blood pressure during inflation and could detect early stroke-risk signals in real-time. Methods: We designed an ABPM mHealth system that is based on mobile network infrastructure and mobile apps. The proposed system contains two major parts: a new ABPM device in which an inflation-type BP measurement algorithm is embedded, and an abnormal blood pressure data analysis algorithm for stroke-risk prediction services at our health data service center. For evaluation, the ABPM device was first tested using simulated signals and compared with the gold standard of a mercury sphygmomanometer. Then, the performance of our proposed mHealth system was evaluated in an observational study. Results: The results are presented in two main parts: the device test and the longitudinal observational studies of the presented system. The average measurement error of the new ABPM device with the inflation-type algorithm was less than 0.55 mmHg compared to a reference device using simulated signals. Moreover, the results of correlation coefficients and agreement analyses show that there is a strong linear correlation between our device and the standard mercury sphygmomanometer. In the case of the system observational study, we collected a data set with 88 features, including real-time data, user information, and user records. Our abnormal blood pressure data analysis algorithm achieved the best performance, with an area under the curve of 0.904 for the low risk level, 0.756 for the caution risk level, and 0.912 for the high-risk level. Our system enables a patient to be aware of their risk in real-time, which improves medication adherence with risk self-management. Conclusions: To our knowledge, this device is the first ABPM device that measures blood pressure during the inflation process and has obtained a government medical license. Device tests and longitudinal observational studies were conducted in Peking University hospitals, and they showed the device?s high accuracy for BP measurements, its efficiency in detecting early signs of stroke, and its efficiency at providing an early warning for stroke risk. UR - http://mhealth.jmir.org/2019/10/e14926/ UR - http://dx.doi.org/10.2196/14926 UR - http://www.ncbi.nlm.nih.gov/pubmed/31670694 ID - info:doi/10.2196/14926 ER - TY - JOUR AU - Radomski, D. Ashley AU - Wozney, Lori AU - McGrath, Patrick AU - Huguet, Anna AU - Hartling, Lisa AU - Dyson, P. Michele AU - Bennett, J. Kathryn AU - Newton, S. Amanda PY - 2019/10/23 TI - Potential Reduction of Symptoms With the Use of Persuasive Systems Design Features in Internet-Based Cognitive Behavioral Therapy Programs for Children and Adolescents With Anxiety: A Realist Synthesis JO - JMIR Ment Health SP - e13807 VL - 6 IS - 10 KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - persuasive communication KW - anxiety KW - children KW - adolescents KW - review KW - treatment effectiveness KW - clinical effectiveness KW - treatment efficacy KW - clinical N2 - Background: Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy?therapeutic content, technological features, and interactions between the user and program?intended to reduce users? anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. Objective: The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. Methods: A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our prespecified inclusion criteria were appraised for relevance and methodological rigor. Data extraction was guided by the persuasive systems design (PSD) model. The model describes 28 technological design features, organized into 4 categories that help users meet their health goals: primary task support, dialogue support, system credibility support, and social support. We generated initial hypotheses for how PSD (mechanisms) and program delivery (context of use) features were linked to symptom changes (outcomes) across iCBT programs using realist and meta-ethnographic techniques. These hypothesized context-mechanism-outcome configurations were refined during analysis using evidence from the literature to improve their explanatory value. Results: A total of 63 documents detailing 15 iCBT programs were included. A total of six iCBT programs were rated high for relevance, and most studies were of moderate-to-high methodological rigor. A total of 11 context-mechanism-outcome configurations (final hypotheses) were generated. Configurations primarily comprised PSD features from the primary task and dialogue support categories. Several key PSD features (eg, self-monitoring, simulation, social role, similarity, social learning, and rehearsal) were consistently reported in programs shown to reduce anxiety; many features were employed simultaneously, suggesting synergy when grouped. We also hypothesized the function of PSD features in generating iCBT impacts. Adjunct support was identified as an important aspect of context that may have complemented certain PSD features in reducing users? anxiety. Conclusions: This synthesis generated context-mechanism-outcome configurations (hypotheses) about the potential function, combination, and impact of iCBT program components thought to support desired program effects. We suggest that, when delivered with adjunct support, PSD features may contribute to reduced anxiety for child and adolescent users. Formal testing of the 11 configurations is required to confirm their impact on anxiety-based outcomes. From this we encourage a systematic and deliberate approach to iCBT design and evaluation to increase the pool of evidence-based interventions available to prevent and treat children and adolescents with anxiety. UR - https://mental.jmir.org/2019/10/e13807 UR - http://dx.doi.org/10.2196/13807 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647474 ID - info:doi/10.2196/13807 ER - TY - JOUR AU - Woods, Leanna AU - Duff, Jed AU - Roehrer, Erin AU - Walker, Kim AU - Cummings, Elizabeth PY - 2019/9/23 TI - Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart JO - JMIR Nursing SP - e14633 VL - 2 IS - 1 KW - heart failure KW - mobile health (mHealth) KW - mobile apps KW - self-management KW - mobile phone KW - patient involvement N2 - Background: Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management. Objective: The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart. Methods: Seven patients, four family caregivers, and seven multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor. Results: The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member?s contact details, schedule medical appointments, and store documents. The My Plan section contains nine important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development. Conclusions: We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use. UR - https://nursing.jmir.org/2019/1/e14633 UR - http://dx.doi.org/10.2196/14633 UR - http://www.ncbi.nlm.nih.gov/pubmed/34345774 ID - info:doi/10.2196/14633 ER - TY - JOUR AU - Klein, Pauline AU - Lawn, Sharon AU - Tsourtos, George AU - van Agteren, Joep PY - 2019/09/03 TI - Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study JO - JMIR Hum Factors SP - e14023 VL - 6 IS - 3 KW - mental health KW - mHealth KW - tobacco KW - smoking cessation KW - public health KW - technology N2 - Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants? smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants? responses to the second interview. Stage 2 interviews explored participants? perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users? psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations. UR - https://humanfactors.jmir.org/2019/3/e14023 UR - http://dx.doi.org/10.2196/14023 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482850 ID - info:doi/10.2196/14023 ER - TY - JOUR AU - Dunsmuir, Dustin AU - Wu, Helen AU - Sun, Terri AU - West, C. Nicholas AU - Lauder, R. Gillian AU - Görges, Matthias AU - Ansermino, Mark J. PY - 2019/07/04 TI - A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility JO - JMIR Perioper Med SP - e12305 VL - 2 IS - 2 KW - pain management KW - pain, postoperative period KW - outpatients KW - mobile apps KW - child KW - parents N2 - Background: Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child?s pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting. Objective: The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents? satisfaction. Methods: Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child?s pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user?s adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app?s ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round. Results: Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30% (interquartile range [IQR] 22%-33%) of alerts within 1 hour in round 1, and subsequently to median 60% (IQR 44%-64%) in round 2 and median 64% (IQR 56%-72%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts. Conclusions: It is feasible for parents or guardians to use Panda at home to manage their child?s medication schedule and track their pain. Simple modifications to the app?s alert sounds and user interface improved response times. UR - https://periop.jmir.org/2019/2/e12305/ UR - http://dx.doi.org/10.2196/12305 UR - http://www.ncbi.nlm.nih.gov/pubmed/33393928 ID - info:doi/10.2196/12305 ER - TY - JOUR AU - Grady, Mike AU - Venugopal, Usha AU - Robert, Katia AU - Hurrell, Graham AU - Schnell, Oliver PY - 2019/07/03 TI - Health Care Professionals? Clinical Perspectives and Acceptance of a Blood Glucose Meter and Mobile App Featuring a Dynamic Color Range Indicator and Blood Sugar Mentor: Online Evaluation in Seven Countries JO - JMIR Hum Factors SP - e13847 VL - 6 IS - 3 KW - ColorSure Dynamic Range Indicator KW - Blood Sugar Mentor KW - mobile app KW - blood glucose meter KW - self-monitoring of blood glucose KW - health care professionals N2 - Background: Despite many new therapies and technologies becoming available in the last decade, people with diabetes continue to struggle to achieve good glycemic control. Innovative and affordable solutions are needed to support health care professionals (HCPs) to improve patient outcomes. Objective: To gather current self-management perceptions of HCPs in seven countries and investigate HCP satisfaction with a new glucose meter and mobile app featuring a dynamic color range indicator and a blood sugar mentor. Methods: A total of 355 HCPs, including 142 endocrinologists (40.0%), 108 primary care physicians (30.4%), and 105 diabetes nurses (29.6%), were recruited from the United Kingdom (n=50), France (n=50), Germany (n=50), India (n=54), Algeria (50), Canada (n=51), and the United States (n=50). HCPs experienced the OneTouch Verio Reflect glucose meter and the OneTouch Reveal mobile app online from their own office computers using interactive demonstrations via webpages and multiple animations. After providing demographic and clinical practice insights, HCPs responded to statements about the utility of the system. Results: Concerning current practice, 83.1% (295/355) of HCPs agreed that poor numeracy or health literacy was a barrier for their patients. A total of 85.9% (305/355) and 92.1% (327/355) of HCPs responded that type 2 diabetes (T2D) and type 1 diabetes (T1D) patients were aware of what represented a low, in-range, or high blood glucose result. Only 62.0% (220/355) felt current glucose meters made it easy for patients to understand if results were in range. A total of 50.1% (178/355) and 78.0% (277/355) of HCPs were confident that T1D and T2D patients took action for low or high results. A total of 87.0% (309/355) agreed that the ColorSure Dynamic Range Indicator could help them teach patients how to interpret results and 88.7% (315/355) agreed it made them more aware of hyper- and hypoglycemic results so they could take action. A total of 83.7% (297/355) of HCPs agreed that the Blood Sugar Mentor feature gave personalized guidance, insight, and encouragement so patients could take action. A total of 82.8% (294/355) of HCPs also agreed that the Blood Sugar Mentor provided real-time guidance to reinforce the goals HCPs had set so patients could take steps to manage their diabetes between office visits. After experiencing the full system, 85.9% (305/355) of HCPs agreed it was beneficial for patients with lower numeracy or health literacy; 96.1% (341/355) agreed that it helped patients understand when results were low, in range, or high; and 91.0% (323/355) agreed that the way it displayed diabetes information would make patients more inclined to act upon results. A total of 89.0% (316/355) of HCPs agreed that it would be helpful for agreeing upon appropriate in-range goals for their patients for their next clinic visit. Conclusions: This multi-country online study provides evidence that HCPs were highly satisfied with the OneTouch Verio Reflect meter and the OneTouch Reveal mobile app. Each of these use color-coded information and the Blood Sugar Mentor feature to assist patients with interpreting, analyzing, and acting upon their blood glucose results, which is particularly beneficial to keep patients on track between scheduled office visits. UR - https://humanfactors.jmir.org/2019/3/e13847/ UR - http://dx.doi.org/10.2196/13847 UR - http://www.ncbi.nlm.nih.gov/pubmed/31271146 ID - info:doi/10.2196/13847 ER - TY - JOUR AU - Jalil, Sakib AU - Myers, Trina AU - Atkinson, Ian AU - Soden, Muriel PY - 2019/06/06 TI - Complementing a Clinical Trial With Human-Computer Interaction: Patients? User Experience With Telehealth JO - JMIR Hum Factors SP - e9481 VL - 6 IS - 2 KW - clinical user-experience evaluation KW - telehealth KW - type 2 diabetes KW - user experience KW - human-computer interaction KW - patient-centered KW - patient-technology interaction KW - eHealth N2 - Background: The use of telehealth to monitor patients from home is on the rise. Telehealth technology is evaluated in a clinical trial with measures of health outcomes and cost-effectiveness. However, what happens between a technology and the patients is not investigated during a clinical trial?the telehealth technology remains as a ?black box.? Meanwhile, three decades of research in the discipline of human-computer interaction (HCI) presents design, implementation, and evaluation of technologies with a primary emphasis on users. HCI research has exposed the importance of user experience (UX) as an essential part of technology development and evaluation. Objective: This research investigates the UX of patients with type 2 diabetes mellitus (T2D) with a telehealth in-home monitoring device to manage T2D from home. We investigate how the UX during a clinical trial can be researched and what a clinical trial can learn from HCI research. Methods: We adopted an ethnographic philosophy and conducted a contextual inquiry due to time limitations followed by semistructured interviews of 9 T2D patients. We defined the method as Clinical User-experience Evaluation (CUE). The patients were enrolled in a telehealth clinical trial of T2D; however, this research was an independent study conducted by information technologists and health researchers for a user-centered evaluation of telehealth. Results: Key analytical findings were that patients valued the benefits of in-home monitoring, but the current device did not possess all functionalities that patients wanted. The results include patients? experiences and emotions while using the device, patients? perceived benefits of the device, and how patients domesticated the device. Further analysis showed the influence of the device on patients? awareness, family involvement, and design implications for telehealth for T2D. Conclusions: HCI could complement telehealth clinical trials and uncover knowledge about T2D patients? UX and future design implications. Through HCI we can look into the ?black box? phenomenon of clinical trials and create patient-centered telehealth solutions. UR - http://humanfactors.jmir.org/2019/2/e9481/ UR - http://dx.doi.org/10.2196/humanfactors.9481 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172958 ID - info:doi/10.2196/humanfactors.9481 ER - TY - JOUR AU - Quinn, C. Charlene AU - Staub, Sheila AU - Barr, Erik AU - Gruber-Baldini, Ann PY - 2019/05/23 TI - Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study JO - JMIR Aging SP - e12276 VL - 2 IS - 1 KW - older adult KW - caregiver KW - mobile health KW - patient engagement N2 - Background: Evaluation of digital health applications to support older adults? independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers. Objective: The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ?65 years. The app was designed to improve engagement of the patient-informal caregiver team. Methods: This observational usability study was conducted in participants? homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ?65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS). Results: The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1). Conclusions: Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping. UR - http://aging.jmir.org/2019/1/e12276/ UR - http://dx.doi.org/10.2196/12276 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518271 ID - info:doi/10.2196/12276 ER - TY - JOUR AU - Rodriguez, Sarah AU - Hwang, Kevin AU - Wang, Jing PY - 2019/05/23 TI - Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers JO - JMIR Form Res SP - e10388 VL - 3 IS - 2 KW - patient-generated health data KW - connected health KW - remote monitoring KW - electronic health record KW - hypertension KW - patient reported outcome KW - self-measured blood pressure KW - self-monitoring of blood pressure N2 - Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider?s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. UR - http://formative.jmir.org/2019/2/e10388/ UR - http://dx.doi.org/10.2196/10388 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124468 ID - info:doi/10.2196/10388 ER - TY - JOUR AU - Zhang, Lingling AU - Babu, V. Sabarish AU - Jindal, Meenu AU - Williams, E. Joel AU - Gimbel, W. Ronald PY - 2019/05/23 TI - A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study JO - JMIR Res Protoc SP - e13502 VL - 8 IS - 5 KW - heart failure KW - mobile health KW - self-management KW - patient engagement KW - virtual human N2 - Background: Heart failure (HF) causes significant economic and humanistic burden for patients and their families, especially those with a low income, partly due to high hospital readmission rates. Optimal self-care is considered an important nonpharmacological aspect of HF management that can improve health outcomes. Emerging evidence suggests that self-management assisted by smartphone apps may reduce rehospitalization rates and improve the quality of life of patients. We developed a virtual human?assisted, patient-centered mobile health app (iHeartU) for patients with HF to enhance their engagement in self-management and improve their communication with health care providers and family caregivers. iHeartU may help patients with HF in self-management to reduce the technical knowledge and usability barrier while maintaining a low cost and natural, effective social interaction with the user. Objective: With a standardized systematic usability assessment, this study had two objectives: (1) to determine the obstacles to effective and efficient use of iHeartU in patients with HF and (2) to evaluate of HF patients? adoption, satisfaction, and engagement with regard to the of iHeartU app. Methods: The basic methodology to develop iHeartU systems consists of a user-centric design, development, and mixed methods formative evaluation. The iterative design and evaluation are based on the guidelines of the American College of Cardiology Foundation and American Heart Association for the management of heart failure and the validated ?Information, Motivation, and Behavioral skills? behavior change model. Our hypothesis is that this method of a user-centric design will generate a more usable, useful, and easy-to-use mobile health system for patients, caregivers, and practitioners. Results: The prototype of iHeartU has been developed. It is currently undergoing usability testing. As of September 2018, the first round of usability testing data have been collected. The final data collection and analysis are expected to be completed by the end of 2019. Conclusions: The main contribution of this project is the development of a patient-centered self-management system, which may support HF patients? self-care at home and aid in the communication between patients and their health care providers in a more effective and efficient way. Widely available mobile phones serve as care coordination and ?no-cost? continuum of care. For low-income patients with HF, a mobile self-management tool will expand their accessibility to care and reduce the cost incurred due to emergency visits or readmissions. The user-centered design will improve the level of engagement of patients and ultimately lead to better health outcomes. Developing and testing a novel mobile system for patients with HF that incorporates chronic disease management is critical for advancing research and clinical practice of care for them. This research fills in the gap in user-centric design and lays the groundwork for a large-scale population study in the next phase. International Registered Report Identifier (IRRID): DERR1-10.2196/13502 UR - http://www.researchprotocols.org/2019/5/e13502/ UR - http://dx.doi.org/10.2196/13502 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124472 ID - info:doi/10.2196/13502 ER - TY - JOUR AU - Choe, Kyoung Eun AU - Duarte, E. Marisa AU - Suh, Hyewon AU - Pratt, Wanda AU - Kientz, A. Julie PY - 2019/05/17 TI - Communicating Bad News: Insights for the Design of Consumer Health Technologies JO - JMIR Hum Factors SP - e8885 VL - 6 IS - 2 KW - mobile health KW - eHealth KW - mHealth KW - patient-centered care KW - health communication KW - empathy N2 - Background: As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient?s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective: The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods: On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients? family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results: We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians? specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients? visit, anticipating patients? feelings, building a partnership of trust with patients, acknowledging patients? physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients? level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions: The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients? individual preferences, supporting interfaces for sharing patients? context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next. UR - http://humanfactors.jmir.org/2019/2/e8885/ UR - http://dx.doi.org/10.2196/humanfactors.8885 UR - http://www.ncbi.nlm.nih.gov/pubmed/31102374 ID - info:doi/10.2196/humanfactors.8885 ER - TY - JOUR AU - Shah, M. Lochan AU - Yang, E. William AU - Demo, C. Ryan AU - Lee, A. Matthias AU - Weng, Daniel AU - Shan, Rongzi AU - Wongvibulsin, Shannon AU - Spaulding, M. Erin AU - Marvel, A. Francoise AU - Martin, S. Seth PY - 2019/05/15 TI - Technical Guidance for Clinicians Interested in Partnering With Engineers in Mobile Health Development and Evaluation JO - JMIR Mhealth Uhealth SP - e14124 VL - 7 IS - 5 KW - mHealth KW - cardiology KW - myocardial infarction KW - personalized medicine UR - http://mhealth.jmir.org/2019/5/e14124/ UR - http://dx.doi.org/10.2196/14124 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094337 ID - info:doi/10.2196/14124 ER - TY - JOUR AU - Crowell, R. Charles AU - Deska, C. Jason AU - Villano, Michael AU - Zenk, Julaine AU - Roddy Jr, T. John PY - 2019/05/10 TI - Anthropomorphism of Robots: Study of Appearance and Agency JO - JMIR Hum Factors SP - e12629 VL - 6 IS - 2 KW - psychology, social KW - social perception KW - theory of mind KW - cognitive science KW - perception KW - cognition KW - robotics KW - telerobotics KW - human factors engineering N2 - Background: As the prevalence of robots increases each year, understanding how we anthropomorphize and interact with them is extremely important. The three-factor theory of anthropomorphism, called the Sociality, Effectance, Elicited agent Knowledge model, guided this study. As anthropomorphism involves a person making attributions of human likeness toward a nonhuman object, this model implies that anthropomorphism can be influenced either by factors related to the person or the object. Objective: The aim of this study was to explore factors influencing the anthropomorphism of robots, specifically the robot?s appearance (humanoid vs nonhumanoid) and agency (autonomous vs nonautonomous). We expected a humanoid robot would be anthropomorphized to a greater extent than one that was nonhumanoid. In addition, we expected that inducing an agency belief to the effect that a robot was making its own decisions would increase anthropomorphism compared with a nonagency belief that the robot was being remotely controlled by a human. We also sought to identify any role gender might play in anthropomorphizing the robot. Methods: Participants (N=99) were primed for agency or nonagency belief conditions and then saw a brief video depicting either a humanoid or nonhumanoid robot interacting with a confederate. After viewing the video, they completed 4 measures: perception to humanoid robots scale (PERNOD), the Epley anthropomorphic adjectives measure, the Fussel anthropomorphic adjective checklist, and the Anthropomorphic Tendencies Scale (ATS). Results: Findings with the PERNOD scale indicated subjects did perceive the 2 robots differently, F6,86=6.59, P<.001, which means the appearance manipulation was effective. Results with the Epley adjectives indicated that participants were more willing to attribute humanlike behavioral traits to the nonhumanoid rather than the humanoid robot, F1,91=5.76, P=.02. The Fussel adjective checklist results showed that subjects were more willing to attribute humanlike social qualities to the remote controlled than the autonomous robot, F1,91=5.30, P=.02. Finally, the ATS revealed the only gender effects in this study, with females reporting more endorsement of anthropomorphism for pets (P=.02) and less for showing negative emotions toward anthropomorphized objects (P<.001) if they had witnessed the humanoid rather than the nonhumanoid robot. Conclusions: Contrary to our expectations, participants were less willing to make humanlike attributions toward a robot when its morphology was more humanlike and were more willing to make those attributions when they were told that the robot was being remotely controlled by a person rather than acting on its own. In retrospect, these outcomes may have occurred because the humanoid robot used here had a smaller overall stature than the nonhumanoid robot, perhaps making it seem more toylike and because subjects made attributions toward the person behind the remote-controlled robot rather than toward the robot itself. UR - http://humanfactors.jmir.org/2019/2/e12629/ UR - http://dx.doi.org/10.2196/12629 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094323 ID - info:doi/10.2196/12629 ER - TY - JOUR AU - Pfisterer, J. Kaylen AU - Boger, Jennifer AU - Wong, Alexander PY - 2019/05/09 TI - Prototyping the Automated Food Imaging and Nutrient Intake Tracking System: Modified Participatory Iterative Design Sprint JO - JMIR Hum Factors SP - e13017 VL - 6 IS - 2 KW - participatory iterative design KW - usability assessment KW - perceived workload KW - feasibility assessment KW - application-driven research KW - systematic prototyping KW - nutritional support KW - long-term care N2 - Background: A total of 45% of older adults living in long-term care (LTC) have some form of malnutrition. Several methods of tracking food and fluid intake exist, but they are limited in terms of their accuracy and ease of application. An easy-to-use, objective, accurate, and comprehensive food intake system designed with LTC in mind may provide additional insights regarding nutritional support systems and nutritional interventions. Objective: The aim of this study was to conduct a multistage participatory iterative design sprint of a Goldilocks quality horizontal prototype for the Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) system. Specific design objectives included the following: (1) identify practice-relevant problems and solutions through user-centered participatory design, (2) mitigate feasibility-related barriers to uptake, and (3) employ user-centered technology development. Methods: A 6-stage iterative participatory design sprint was developed and executed. A total of 38 participants and advisors representing 15 distinct roles (eg, personal support worker, nurse, and dietitian) were engaged in the design sprint. Subjective workload (Raw Task Load Index), subjective usability scales, and a modified Ravden checklist were used to assess project advisors? perceptions of the AFINI-T system prototype compared with the current method of food and fluid intake charting. Results: The top priorities for this system were identified as the following: ease of use, high accuracy, system reliability, ease of maintenance, and requirement of integrating with the current PointClickCare system. Data from project advisors informed design decisions leading to a Goldilocks quality horizontal prototype of the AFINI-T system. Compared with the current food and fluid intake charting system, AFINI-T was perceived to have the following: less time demands (t10.8=4.89; P<.001), less effort (t13.5=5.55; P<.001), and less frustration (t13.0=3.80; P=.002). Usability ratings of the AFINI-T prototype were high, with a subjective usability score mean of 89.2 and the highest ratings on a modified Ravden usability checklist of ?very satisfactory? for 7 out of 8 sections. Conclusions: The AFINI-T concept system appears to have good practice relevance as a tool for an intelligent food and fluid intake tracking system in LTC. The AFINI-T concept system may provide improvement over the current system, and advisors are keen to try the AFINI-T system. This research gives tangible examples of how the sprint method can be adapted and applied to the development of novel needs-based application-driven technology. UR - http://humanfactors.jmir.org/2019/2/e13017/ UR - http://dx.doi.org/10.2196/13017 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094336 ID - info:doi/10.2196/13017 ER - TY - JOUR AU - Griffin, Lauren AU - Lee, Donghee AU - Jaisle, Alyssa AU - Carek, Peter AU - George, Thomas AU - Laber, Eric AU - Lok, Benjamin AU - Modave, François AU - Paskett, Electra AU - Krieger, Janice PY - 2019/05/08 TI - Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach JO - JMIR Hum Factors SP - e12700 VL - 6 IS - 2 KW - communication KW - cell phone KW - mobile phone KW - culturally appropriate technology KW - interdisciplinary research KW - colon cancer KW - cancer screening N2 - Background: Patients are increasingly using mobile health (mHealth) apps to monitor their health and educate themselves about medical issues. Despite the increasing popularity of such apps, poor design and usability often lead to suboptimal continued use of these apps and subsequently to poor adherence to the behavior changes at which they are aimed. One solution to these design problems is for app developers to use user-centered design (UCD) principles to consider the context and needs of users during the development process. Objective: This study aimed to present a case study on the design and development process for an mHealth app that uses virtual human technology (VHT) to encourage colorectal cancer (CRC) screening among patients aged 50 years and above. Methods: We have first provided an overview of the project and discussed its utilization of VHT. We have then reviewed UCD principles and how they can be incorporated into the development of health apps. We have described how we used UCD processes during the app?s development. We have then discussed the unique roles played by communication researchers, computer scientists, clinicians, and community participants in creating an mHealth app that is credible, usable, effective, and accessible to its target audience. Results: The principles of UCD were woven throughout the project development, with researchers collecting feedback from patients and providers at all stages and using that feedback to improve the credibility, usability, effectiveness, and accessibility of the mHealth app. The app was designed in an iterative process, which encouraged feedback and improvement of the app and allowed teams from different fields to revisit topics and troubleshoot problems. Conclusions: Implementing a UCD process contributed to the development of an app, which not only reflected cross-disciplinary expertise but also the needs, wants, and concerns of patients. UR - http://humanfactors.jmir.org/2019/2/e12700/ UR - http://dx.doi.org/10.2196/12700 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066688 ID - info:doi/10.2196/12700 ER - TY - JOUR AU - Jeffs, Lianne AU - Jamieson, Trevor AU - Saragosa, Marianne AU - Mukerji, Geetha AU - Jain, K. Arsh AU - Man, Rachel AU - Desveaux, Laura AU - Shaw, James AU - Agarwal, Payal AU - Hensel, M. Jennifer AU - Maione, Maria AU - Onabajo, Nike AU - Nguyen, Megan AU - Bhatia, R. PY - 2019/04/16 TI - Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study JO - JMIR Hum Factors SP - e9720 VL - 6 IS - 2 KW - virtual care solutions KW - peritoneal dialysis KW - qualitative research KW - patient-centric care KW - chronic kidney disease N2 - Background: Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. Objective: In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients? outcomes and experiences. Methods: This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders?6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers?participated in this study. Results: The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. Conclusions: Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home. UR - https://humanfactors.jmir.org/2019/2/e9720/ UR - http://dx.doi.org/10.2196/humanfactors.9720 UR - http://www.ncbi.nlm.nih.gov/pubmed/30990460 ID - info:doi/10.2196/humanfactors.9720 ER - TY - JOUR AU - Kakarmath, S. Sujay AU - de Redon, Emily AU - Centi, Jayne Amanda AU - Palacholla, Ramya AU - Kvedar, Joseph AU - Jethwani, Kamal AU - Agboola, Stephen PY - 2018/12/21 TI - Assessing the Usability of an Automated Continuous Temperature Monitoring Device (iThermonitor) in Pediatric Patients: Non-Randomized Pilot Study JO - JMIR Pediatr Parent SP - e10804 VL - 1 IS - 2 KW - connected health KW - continuous monitoring KW - mobile phone KW - pediatric KW - temperature N2 - Background: Fever is an important vital sign and often the first one to be assessed in a sick child. In acutely ill children, caregivers are expected to monitor a child?s body temperature at home after an initial medical consult. Fever literacy of many caregivers is known to be poor, leading to fever phobia. In children with a serious illness, the responsibility of periodically monitoring temperature can add substantially to the already stressful experience of caring for a sick child. Objective: The objective of this pilot study was to assess the feasibility of using the iThermonitor, an automated temperature measurement device, for continuous temperature monitoring in postoperative and postchemotherapy pediatric patients. Methods: We recruited 25 patient-caregiver dyads from the Pediatric Surgery Department at the Massachusetts General Hospital (MGH) and the Pediatric Cancer Centers at the MGH and the Dana Farber Cancer Institute. Enrolled dyads were asked to use the iThermonitor device for continuous temperature monitoring over a 2-week period. Surveys were administered to caregivers at enrollment and at study closeout. Caregivers were also asked to complete a daily event-monitoring log. The Generalized Anxiety Disorder-7 item questionnaire was also used to assess caregiver anxiety at enrollment and closeout. Results: Overall, 19 participant dyads completed the study. All 19 caregivers reported to have viewed temperature data on the study-provided iPad tablet at least once per day, and more than a third caregivers did so six or more times per day. Of all participants, 74% (14/19) reported experiencing an out-of-range temperature alert at least once during the study. Majority of caregivers reported that it was easy to learn how to use the device and that they felt confident about monitoring their child?s temperature with it. Only 21% (4/9) of caregivers reported concurrently using a device other than the iThermonitor to monitor their child?s temperature during the study. Continuous temperature monitoring was not associated with an increase in caregiver anxiety. Conclusions: The study results reveal that the iThermonitor is a highly feasible and easy-to-use device for continuous temperature monitoring in pediatric oncology and surgery patients. Trial Registration: ClinicalTrials.gov NCT02410252; https://clinicaltrials.gov/ct2/show/NCT02410252 (Archived by WebCite at http://www.webcitation.org/73LnO7hel) UR - http://pediatrics.jmir.org/2018/2/e10804/ UR - http://dx.doi.org/10.2196/10804 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518304 ID - info:doi/10.2196/10804 ER - TY - JOUR AU - Shtrichman, Ronit AU - Conrad, Stefan AU - Schimo, Kai AU - Shachar, Ran AU - Machluf, Ehud AU - Mindal, Enrique AU - Epstein, Howard AU - Epstein, Shirli AU - Paz, Alan PY - 2018/11/26 TI - Use of a Digital Medication Management System for Effective Assessment and Enhancement of Patient Adherence to Therapy (ReX): Feasibility Study JO - JMIR Hum Factors SP - e10128 VL - 5 IS - 4 KW - medication adherence KW - medication nonadherence KW - personalized medicine KW - therapy management N2 - Background: Medication nonadherence is a major problem in health care, imposing poor clinical outcomes and a heavy financial burden on all stakeholders. Current methods of medication adherence assessment are severely limited: they are applied only periodically, do not relate to actual pill intake, and suffer from patient bias due to errors, misunderstanding, or intentional nonadherence. ReX is an innovative medication management system designed to address poor patient adherence and enhance patient engagement with their therapy. ReX controls and tracks pills from the point of packaging right through to the patient?s mouth. ReX generates robust, real-time adherence data. The system enables patients to report outcomes, complete surveys, and receive messages and instructions. ReX includes a reusable drug dispensing unit, disposable cassette containing pills, and a cloud-based data portal. Objective: We aimed to evaluate ReX feasibility by human factor studies including evaluation of ReX safety; ReX acceptance and usability; and ReX efficacy of providing pills according to a preprogrammed dose regimen, managing reminders and adherence data, and enhancing the adherence rate compared with the standard of care. Methods: The ReX system was evaluated in 2 human factor, nonclinical feasibility studies. Human subjects used ReX for the administration of pill-shaped Tic Tac sweets. The initial study evaluated ReX use and pill intake administration; second was a self-controlled, 4-day home-use study. All subjects took pills at home, according to a preprogrammed dose regimen, for 4 days each via the device (ReX test) or from standard packaging (control test). The adherence rate (percent of pills taken) was measured by the study subject?s report, remaining pills count, and ReX records (in the ReX test). ReX safety and usability were evaluated by a questionnaire filled out by the subject. Results: The initial feasibility study evaluated usability and acceptance of the ReX novel approach to pill dispensing. All subjects successfully managed 2 pill intakes. The ReX device was rated as easy to use by 81% (48/59) of subjects. The 4-day home-use study evaluated the safety, efficacy, and usability of the ReX system. No adverse event occurred; no pill overdose or pill malformation was reported. The overall adherence rate in the ReX test was 97.6% compared with 76.3% in the control test (P<.001). Real-time, personalized reminders provided in the event of a delay in pill intake contributed to 18.0% of doses taken during the ReX test. The ReX system was found easy to use by 87% (35/40) of subjects; 90% (36/40) felt comfortable using it for their medication. Conclusions: ReX?s novel ?tracking to the mouth? technology was found usable and accepted by subjects. The assessment of adherence rates was reliable; adherence of subjects to the dose regimen was significantly enhanced when using ReX compared with the standard of care. UR - http://humanfactors.jmir.org/2018/4/e10128/ UR - http://dx.doi.org/10.2196/10128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30478020 ID - info:doi/10.2196/10128 ER - TY - JOUR AU - Asfaw, Ayele Alemseged AU - Yan, H. Connie AU - Sweiss, Karen AU - Wirth, Scott AU - Ramirez, H. Victor AU - Patel, R. Pritesh AU - Sharp, K. Lisa PY - 2018/11/12 TI - Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study JO - JMIR Cancer SP - e12 VL - 4 IS - 2 KW - antineoplastic therapy KW - challenges KW - race/ethnicity KW - medication adherence KW - multiple myeloma N2 - Background: Many recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested. Objective: This study aimed to explore patients? (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs. Methods: An in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology?Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance. Results: A total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80% (16/20) were African American. In addition, 18 (90%, 18/20) owned a smartphone and 85% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60% (12/20) of the patients expressed interest in trying a bottle in the future. Conclusions: Results identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned. UR - http://cancer.jmir.org/2018/2/e12/ UR - http://dx.doi.org/10.2196/cancer.9918 UR - http://www.ncbi.nlm.nih.gov/pubmed/30425032 ID - info:doi/10.2196/cancer.9918 ER - TY - JOUR AU - Scherer, M. Aaron AU - Witteman, O. Holly AU - Solomon, Jacob AU - Exe, L. Nicole AU - Fagerlin, Angela AU - Zikmund-Fisher, J. Brian PY - 2018/10/19 TI - Improving the Understanding of Test Results by Substituting (Not Adding) Goal Ranges: Web-Based Between-Subjects Experiment JO - J Med Internet Res SP - e11027 VL - 20 IS - 10 KW - decision making, education of patients, electronic health record, computer graphics, clinical laboratory information systems N2 - Background: Most displays of laboratory test results include a standard reference range. For some patients (eg, those with chronic conditions), however, getting a result within the standard range may be unachievable, inappropriate, or even harmful. Objective: The objective of our study was to test the impact of including clinically appropriate goal ranges outside the standard range in the visual displays of laboratory test results. Methods: Participants (N=6776) from a demographically diverse Web-based panel viewed hypothetical glycated hemoglobin (HbA1c) test results (HbA1c either 6.2% or 8.2%) as part of a type 2 diabetes management scenario. Test result visual displays included either a standard range (4.5%-5.7%) only, a goal range (6.5%-7.5%) added to the standard range, or the goal range only. The results were displayed in 1 of the following 3 display formats: (1) a table; (2) a simple, two-colored number line (simple line); or (3) a number line with diagnostic categories indicated via colored blocks (block line). Primary outcome measures were comprehension of and negative reactions to test results. Results: While goal range information did not influence the understanding of HbA1c=8.2% results, the goal range only display produced higher levels of comprehension and decreased negative reactions to HbA1c=6.2% test results compared with the no goal range and goal range added conditions. Goal range information was less helpful in the block line condition versus the other formats. Conclusions: Replacing the standard range with a clinically appropriate goal range could help patients better understand how their test results relate to their personal targets. UR - http://www.jmir.org/2018/10/e11027/ UR - http://dx.doi.org/10.2196/11027 UR - http://www.ncbi.nlm.nih.gov/pubmed/30341053 ID - info:doi/10.2196/11027 ER - TY - JOUR AU - Martinez, William AU - Threatt, L. Anthony AU - Rosenbloom, Trent S. AU - Wallston, A. Kenneth AU - Hickson, B. Gerald AU - Elasy, A. Tom PY - 2018/9/24 TI - A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing JO - JMIR Hum Factors SP - e26 VL - 5 IS - 3 KW - diabetes mellitus, type 2 KW - patient portals KW - qualitative research KW - consumer health informatics N2 - Background: Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use. Objective: The aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record. Methods: We applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met). Results: The sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants? mean age was 63 years (range 45-78 years), 57% (8/14) were female, and 50% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients? diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5). Conclusions: Our results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use. UR - http://humanfactors.jmir.org/2018/3/e26/ UR - http://dx.doi.org/10.2196/humanfactors.9569 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249579 ID - info:doi/10.2196/humanfactors.9569 ER - TY - JOUR AU - Steijlen, SM Annemarijn AU - Jansen, MB Kaspar AU - Albayrak, Armagan AU - Verschure, O. Derk AU - Van Wijk, F. Diederik PY - 2018/07/30 TI - A Novel 12-Lead Electrocardiographic System for Home Use: Development and Usability Testing JO - JMIR Mhealth Uhealth SP - e10126 VL - 6 IS - 7 KW - 12-lead ECG system KW - electrocardiography KW - home use KW - handheld KW - user-centered design N2 - Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Early diagnosis is of pivotal importance for patients with cardiac arrhythmias and ischemia to minimize the consequences like strokes and myocardial infarctions. The chance of capturing signals of arrhythmias or ischemia is substantially high when a 12-lead electrocardiogram (ECG) can be recorded at the moment when a patient experiences the symptoms. However, until now, available diagnostic systems (Holter monitors and other wearable ECG sensors) have not enabled patients to record a reliable 12-lead ECG at home. Objective: The objective of this project was to develop a user-friendly system that enables persons with cardiac complaints to record a reliable 12-lead ECG at home to improve the diagnostic process and, consequently, reduce the time between the onset of symptoms and adequate treatment. Methods: Using an iterative design approach, ECGraph was developed. The system consists of an ECG measurement system and a mobile app, which were developed with the help of several concept tests. To evaluate the design, a prototype of the final design was built and a final technical performance test and usability test were executed. Results: The ECG measurement system consists of a belt and 4 limb straps. Ten wet Ag/AgCl electrodes are placed in the belt to optimize skin-electrode contact. The product is controlled via an app on the mobile phone of the user. Once a person experiences symptoms, he or she can put on the belt and record ECGs within a few minutes. Short instructions, supported by visualizations, offer guidance during use. ECGs are sent wirelessly to the caregiver, and the designated expert can quickly interpret the results. Usability tests with the final prototype (n=6) showed that the participants were able to put on the product within 8 minutes during first-time use. However, we expect that the placement of the product can be executed faster when the user becomes more familiar with the product. Areas of improvement focus mainly on confidence during product use. In the technical performance test, a 12-lead ECG was made and reproduced 6 times. Conclusions: We developed a new 12-lead ECG system for home use. The product is expected to be more user-friendly than current hospital ECG systems and is designed to record more reliable data than current ECG systems for home use, which makes it suitable for expert interpretation. The system has great potential to be incorporated into an outpatient practice, so that arrhythmias and ischemia can be diagnosed and treated as early as possible. UR - http://mhealth.jmir.org/2018/7/e10126/ UR - http://dx.doi.org/10.2196/10126 UR - http://www.ncbi.nlm.nih.gov/pubmed/30061094 ID - info:doi/10.2196/10126 ER - TY - JOUR AU - Giordanengo, Alain AU - Řzturk, Pinar AU - Hansen, Helen Anne AU - Ĺrsand, Eirik AU - Grřttland, Astrid AU - Hartvigsen, Gunnar PY - 2018/07/11 TI - Design and Development of a Context-Aware Knowledge-Based Module for Identifying Relevant Information and Information Gaps in Patients With Type 1 Diabetes Self-Collected Health Data JO - JMIR Diabetes SP - e10431 VL - 3 IS - 3 KW - context aware KW - knowledge-based system KW - diabetes KW - self-collected health data KW - information gaps N2 - Background: Patients with diabetes use an increasing number of self-management tools in their daily life. However, health institutions rarely use the data generated by these services mainly due to (1) the lack of data reliability, and (2) medical workers spending too much time extracting relevant information from the vast amount of data produced. This work is part of the FullFlow project, which focuses on self-collected health data sharing directly between patients? tools and EHRs. Objective: The main objective is to design and implement a prototype for extracting relevant information and documenting information gaps from self-collected health data by patients with type 1 diabetes using a context-aware approach. The module should permit (1) clinicians to assess the reliability of the data and to identify issues to discuss with their patients, and (2) patients to understand the implication their lifestyle has on their disease. Methods: The identification of context and the design of the system relied on (1) 2 workshops in which the main author participated, 1 patient with type 1 diabetes, and 1 clinician, and (2) a co-design session involving 5 patients with type 1 diabetes and 4 clinicians including 2 endocrinologists and 2 diabetes nurses. The software implementation followed a hybrid agile and waterfall approach. The testing relied on load, and black and white box methods. Results: We created a context-aware knowledge-based module able to (1) detect potential errors, and information gaps from the self-collected health data, (2) pinpoint relevant data and potential causes of noticeable medical events, and (3) recommend actions to follow to improve the reliability of the data issues and medical issues to be discussed with clinicians. The module uses a reasoning engine following a hypothesize-and-test strategy built on a knowledge base and using contextual information. The knowledge base contains hypotheses, rules, and plans we defined with the input of medical experts. We identified a large set of contextual information: emotional state (eg, preferences, mood) of patients and medical workers, their relationship, their metadata (eg, age, medical specialty), the time and location of usage of the system, patient-collected data (eg, blood glucose, basal-bolus insulin), patients? goals and medical standards (eg, insulin sensitivity factor, in range values). Demonstrating the usage of the system revealed that (1) participants perceived the system as useful and relevant for consultation, and (2) the system uses less than 30 milliseconds to treat new cases. Conclusions: Using a knowledge-based system to identify anomalies concerning the reliability of patients? self-collected health data to provide information on potential information gaps and to propose relevant medical subjects to discuss or actions to follow could ease the introduction of self-collected health data into consultation. Combining this reasoning engine and the system of the FullFlow project could improve the diagnostic process in health care. UR - http://diabetes.jmir.org/2018/3/e10431/ UR - http://dx.doi.org/10.2196/10431 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291097 ID - info:doi/10.2196/10431 ER - TY - JOUR AU - Pulantara, Wayan I. AU - Parmanto, Bambang AU - Germain, Anne PY - 2018/05/17 TI - Development of a Just-in-Time Adaptive mHealth Intervention for Insomnia: Usability Study JO - JMIR Hum Factors SP - e21 VL - 5 IS - 2 KW - Just-in-Time Adaptive Intervention KW - JITAI KW - mobile health KW - mHealth KW - sleep KW - insomnia KW - usability KW - smartphone KW - iREST N2 - Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this ?Just in Time Adaptive Intervention? for insomnia?an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools?can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a Just in Time Adaptive Intervention application platform called iREST (?interactive Resilience Enhancing Sleep Tactics?) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the Iterative and Incremental Development software development model. Requirement analysis was based on the case study?s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the Just in Time Adaptive Intervention architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of Just in Time Adaptive Intervention. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean 12.23, SD 8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as ?highly usable?, achieving a mean System Usability Score score of 85.74 (SD 12.37), which translates to an adjective rating of ?Excellent?. The participants also gave high scores on ?ease of use and learnability? with an average score of 4.33 (SD 0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of Just in Time Adaptive Intervention in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based Just in Time Adaptive Intervention is not only feasible, but also works effectively. UR - http://humanfactors.jmir.org/2018/2/e21/ UR - http://dx.doi.org/10.2196/humanfactors.8905 UR - http://www.ncbi.nlm.nih.gov/pubmed/29773529 ID - info:doi/10.2196/humanfactors.8905 ER - TY - JOUR AU - Harte, Richard AU - Hall, Tony AU - Glynn, Liam AU - Rodríguez-Molinero, Alejandro AU - Scharf, Thomas AU - Quinlan, R. Leo AU - ÓLaighin, Gearóid PY - 2018/04/26 TI - Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study JO - JMIR Hum Factors SP - e18 VL - 5 IS - 2 KW - smartphone KW - aged KW - elderly KW - wearable electronic devices KW - telemedicine KW - user-computer interface KW - education KW - user centered-design KW - usability KW - connected health KW - human factors KW - falls detection N2 - Background: Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one?s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status. Objective: The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology. Methods: All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks. Results: The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system. Conclusions: Supplementary basic smartphone training may be critical in trials where a smartphone app?based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system. UR - http://humanfactors.jmir.org/2018/2/e18/ UR - http://dx.doi.org/10.2196/humanfactors.7718 UR - http://www.ncbi.nlm.nih.gov/pubmed/29699969 ID - info:doi/10.2196/humanfactors.7718 ER - TY - JOUR AU - Zikmund-Fisher, J. Brian AU - Scherer, M. Aaron AU - Witteman, O. Holly AU - Solomon, B. Jacob AU - Exe, L. Nicole AU - Fagerlin, Angela PY - 2018/03/26 TI - Effect of Harm Anchors in Visual Displays of Test Results on Patient Perceptions of Urgency About Near-Normal Values: Experimental Study JO - J Med Internet Res SP - e98 VL - 20 IS - 3 KW - decision making KW - education of patients KW - electronic health record KW - computer graphics KW - clinical laboratory information systems N2 - Background: Patient-facing displays of laboratory test results typically provide patients with one reference point (the ?standard range?). Objective: To test the effect of including an additional harm anchor reference point in visual displays of laboratory test results, which indicates how far outside of the standard range values would need to be in order to suggest substantial patient risk. Methods: Using a demographically diverse, online sample, we compared the reactions of 1618 adults in the United States who viewed visual line displays that included both standard range and harm anchor reference points (?Many doctors are not concerned until here?) to displays that included either (1) only a standard range, (2) standard range plus evaluative categories (eg, ?borderline high?), or (3) a color gradient showing degree of deviation from the standard range. Results: Providing the harm anchor reference point significantly reduced perceived urgency of close-to-normal alanine aminotransferase and creatinine results (P values <.001) but not generally for platelet count results. Notably, display type did not significantly alter perceptions of more extreme results in potentially harmful ranges. Harm anchors also substantially reduced the number of participants who wanted to contact their doctor urgently or go to the hospital about these test results. Conclusions: Presenting patients with evaluative cues regarding when test results become clinically concerning can reduce the perceived urgency of out-of-range results that do not require immediate clinical action. UR - http://www.jmir.org/2018/3/e98/ UR - http://dx.doi.org/10.2196/jmir.8889 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581088 ID - info:doi/10.2196/jmir.8889 ER - TY - JOUR AU - Subotic-Kerry, Mirjana AU - King, Catherine AU - O'Moore, Kathleen AU - Achilles, Melinda AU - O'Dea, Bridianne PY - 2018/03/23 TI - General Practitioners? Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery JO - JMIR Hum Factors SP - e12 VL - 5 IS - 1 KW - anxiety KW - depression KW - adolescent KW - general practitioners KW - internet N2 - Background: Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs? views need to be measured. Objective: This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. Methods: GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. Results: A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. Conclusions: GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured. UR - http://humanfactors.jmir.org/2018/1/e12/ UR - http://dx.doi.org/10.2196/humanfactors.8913 UR - http://www.ncbi.nlm.nih.gov/pubmed/29572203 ID - info:doi/10.2196/humanfactors.8913 ER - TY - JOUR AU - Hohenstein, C. Jess AU - Baumer, PS Eric AU - Reynolds, Lindsay AU - Murnane, L. Elizabeth AU - O'Dell, Dakota AU - Lee, Seoho AU - Guha, Shion AU - Qi, Yu AU - Rieger, Erin AU - Gay, Geri PY - 2018/02/28 TI - Supporting Accurate Interpretation of Self-Administered Medical Test Results for Mobile Health: Assessment of Design, Demographics, and Health Condition JO - JMIR Hum Factors SP - e9 VL - 5 IS - 1 KW - mobile health KW - health informatics KW - patient-generated health data KW - user-computer interface KW - decision making KW - patient-centered care N2 - Background: Technological advances in personal informatics allow people to track their own health in a variety of ways, representing a dramatic change in individuals? control of their own wellness. However, research regarding patient interpretation of traditional medical tests highlights the risks in making complex medical data available to a general audience. Objective: This study aimed to explore how people interpret medical test results, examined in the context of a mobile blood testing system developed to enable self-care and health management. Methods: In a preliminary investigation and main study, we presented 27 and 303 adults, respectively, with hypothetical results from several blood tests via one of the several mobile interface designs: a number representing the raw measurement of the tested biomarker, natural language text indicating whether the biomarker?s level was low or high, or a one-dimensional chart illustrating this level along a low-healthy axis. We measured respondents? correctness in evaluating these results and their confidence in their interpretations. Participants also told us about any follow-up actions they would take based on the result and how they envisioned, generally, using our proposed personal health system. Results: We find that a majority of participants (242/328, 73.8%) were accurate in their interpretations of their diagnostic results. However, 135 of 328 participants (41.1%) expressed uncertainty and confusion about their ability to correctly interpret these results. We also find that demographics and interface design can impact interpretation accuracy, including false confidence, which we define as a respondent having above average confidence despite interpreting a result inaccurately. Specifically, participants who saw a natural language design were the least likely (421.47 times, P=.02) to exhibit false confidence, and women who saw a graph design were less likely (8.67 times, P=.04) to have false confidence. On the other hand, false confidence was more likely among participants who self-identified as Asian (25.30 times, P=.02), white (13.99 times, P=.01), and Hispanic (6.19 times, P=.04). Finally, with the natural language design, participants who were more educated were, for each one-unit increase in education level, more likely (3.06 times, P=.02) to have false confidence. Conclusions: Our findings illustrate both promises and challenges of interpreting medical data outside of a clinical setting and suggest instances where personal informatics may be inappropriate. In surfacing these tensions, we outline concrete interface design strategies that are more sensitive to users? capabilities and conditions. UR - http://humanfactors.jmir.org/2018/1/e9/ UR - http://dx.doi.org/10.2196/humanfactors.8620 UR - http://www.ncbi.nlm.nih.gov/pubmed/29490894 ID - info:doi/10.2196/humanfactors.8620 ER - TY - JOUR AU - Schmocker, S. Kaspar AU - Zwahlen, S. Fabian AU - Denecke, Kerstin PY - 2018/02/26 TI - Mobile App for Simplifying Life With Diabetes: Technical Description and Usability Study of GlucoMan JO - JMIR Diabetes SP - e6 VL - 3 IS - 1 KW - diabetes management KW - patient empowerment KW - mobile health KW - self-care KW - chronic disease management KW - diabetes mellitus KW - mobile apps N2 - Background: Patients with diabetes can be affected by several comorbidities that require immediate action when occurring as they may otherwise cause fatal or consequential damage. For this reason, patients must closely monitor their metabolism and inject insulin when necessary. The documentation of glucose values and other relevant measurements is often still on paper in a diabetes diary. Objective: The goal of this work is to develop and implement a novel mobile health system for the secure collection of relevant data referring to a person?s metabolis and to digitize the diabetes diary to enable continuous monitoring for both patients and treating physicians. One specific subgoal is to enable data transmission of health parameters to secure data storage. Methods: The process of implementing the system consists of (1) requirements analysis with patients and physicians to identify patient needs and specify relevant functionalities, (2) design and development of the app and the data transmission, and (3) usability study. Results: We developed and implemented the mobile app GlucoMan to support data collection pertaining to a person?s metabolism. An automated transfer of measured values from a glucometer was implemented. Medication and nutrition data could be entered using product barcodes. Relevant background knowledge such as information on carbohydrates was collected from existing databases. The recorded data was transmitted using international interoperability standards to the MIDATA.coop storage platform. The usability study revealed some design issues that needs to be solved, but in principle, the study results show that the app is easy to use and provides useful features. Conclusions: Data collection on a patient?s metabolism can be supported with a multifunctional app such as GlucoMan. Besides monitoring, continuous data can be documented and made available to the treating physician. GlucoMan allows patients to monitor disease-relevant parameters and decide who accesses their health data. In this way, patients are empowered not only to manage diabetes but also manage their health data. UR - http://diabetes.jmir.org/2018/1/e6/ UR - http://dx.doi.org/10.2196/diabetes.8160 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291070 ID - info:doi/10.2196/diabetes.8160 ER - TY - JOUR AU - Grady, Mike AU - Katz, Barry Laurence AU - Anderson, Pamela AU - Levy, Leonard Brian PY - 2018/01/09 TI - Health Care Professionals? Clinical Perspectives on Glycemic Control and Satisfaction With a New Blood Glucose Meter With a Color Range Indicator: Online Evaluation in India, Russia, China, and the United States JO - JMIR Diabetes SP - e1 VL - 3 IS - 1 KW - color range indicator KW - blood glucose meter KW - self-monitoring of blood glucose KW - health care professionals N2 - Background: We previously demonstrated in patients with diabetes that displaying blood glucose results in association with color improved their ability to interpret glucose results. Objective: The objective of this study was to investigate the perceptions of health care professionals (HCPs) in specific countries about the value of color on a new glucose meter and to determine if HCP perspectives among countries differ on the value of this approach in clinical practice. Methods: A total of 180 HCPs, including 105 endocrinologists, 34 primary care physicians, 25 diabetes educators, and 16 pharmacists, were recruited from India (n=50), Russia (n=50), China (n=50), and the United States (n=30). These HCPs experienced the OneTouch Select Plus Simple glucose meter online from their own office computer using interactive demonstrations (webpages, meter simulator, and video clips). After providing demographic and current clinical practice insights, HCPs responded to questions about the utility of the color-enhanced glucose meter. Results: Mean age and years in their current professional role for the 180 HCPs was 41.3 (SD 8.1) and 13.3 (SD 6.8) years for endocrinologists, 41.3 (SD 8.3) and 14.1 (SD 6.8) years for primary care physicians, 37.5 (SD 8.7) and 12.7 (SD 6.8) years for diabetes educators, and 35.9 (SD 5.3) and 9.5 (SD 5.2) years for pharmacists. In all, 88% (44/50) of Russian and 83% (25/30) of American HCPs said their patients find it easy to recognize low, in-range, or high blood glucose results compared to 56% (28/50) of HCPs in China and 42% (21/50) in India. Regardless of country, HCPs had less confidence that their patients act on blood glucose results with 52% (26/50) in Russia, 63% (19/30) in the United States, 60% (30/50) in China, and 40% (20/50) in India responding positively. During the interactive online meter experience, HCPs from all countries responded positively to questions about a meter with color features. After reflecting on the value of this meter, most HCPs strongly agreed or agreed their patients would be more inclined to act on results using a meter with color features (Russia: 92%, 46/50; United States: 70%, 21/30; China: 98%, 49/50; India: 94%, 47/50). They also said that color was particularly useful for patients with lower numeracy or education who may struggle with interpreting results (Russia: 98%, 49/50; United States: 77%, 23/30; China: 100%, 50/50; India: 82%, 41/50). Conclusions: This multicountry online study provides evidence that HCPs had high overall satisfaction with the OneTouch Select Plus glucose meter, which uses color-coded information to assist patients with interpreting blood glucose results. This may be especially helpful in patient populations with low numeracy or literacy and limited access to health care and direct interaction with HCPs. UR - http://diabetes.jmir.org/2018/1/e1/ UR - http://dx.doi.org/10.2196/diabetes.9143 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291071 ID - info:doi/10.2196/diabetes.9143 ER - TY - JOUR AU - Puri, Arjun AU - Kim, Ben AU - Nguyen, Olivier AU - Stolee, Paul AU - Tung, James AU - Lee, Joon PY - 2017/11/15 TI - User Acceptance of Wrist-Worn Activity Trackers Among Community-Dwelling Older Adults: Mixed Method Study JO - JMIR Mhealth Uhealth SP - e173 VL - 5 IS - 11 KW - health KW - mHealth KW - fitness trackers KW - older adults N2 - Background: Wearable activity trackers are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer-grade wearable activity trackers are increasingly ubiquitous in the market, but the attitudes toward, as well as acceptance and voluntary use of, these trackers in older population are poorly understood. Objective: The aim of this study was to assess acceptance and usage of wearable activity trackers in Canadian community-dwelling older adults, using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. A total of 20 older adults aged 55 years and older were recruited from Southwestern Ontario. Participants used 2 different wearable activity trackers (Xiaomi Mi Band and Microsoft Band) separately for each segment in the crossover design study for 21 days (ie, 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing 2 different devices. Semistructured interviews were conducted with 4 participants, and a content analysis was performed. Results: Participants ranged in age from 55 years to 84 years (mean age: 64 years). The Mi Band gained higher levels of acceptance (16/20, 80%) compared with the Microsoft Band (10/20, 50%). The equipment characteristics dimension scored significantly higher for the Mi Band (P<.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (P<.05). Multivariate logistic regression with 3 covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of the following main themes: (1) smartphones as facilitators of wearable activity trackers; (2) privacy is less of a concern for wearable activity trackers, (3) value proposition: self-awareness and motivation; (4) subjective norm, social support, and sense of independence; and (5) equipment characteristics matter: display, battery, comfort, and aesthetics. Conclusions: Older adults were mostly accepting of wearable activity trackers, and they had a clear understanding of its value for their lives. Wearable activity trackers were uniquely considered more personal than other types of technologies, thereby the equipment characteristics including comfort, aesthetics, and price had a significant impact on the acceptance. Results indicated that privacy was less of concern for older adults, but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of wearable activity trackers among older adults. UR - http://mhealth.jmir.org/2017/11/e173/ UR - http://dx.doi.org/10.2196/mhealth.8211 UR - http://www.ncbi.nlm.nih.gov/pubmed/29141837 ID - info:doi/10.2196/mhealth.8211 ER - TY - JOUR AU - Liu, Na AU - Kim, Jinman AU - Jung, Younhyun AU - Arisy, Adani AU - Nicdao, Ann Mary AU - Mikaheal, Mary AU - Baldacchino, Tanya AU - Khadra, Mohamed AU - Sud, Kamal PY - 2017/08/29 TI - Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design JO - JMIR Hum Factors SP - e21 VL - 4 IS - 3 KW - remote-monitoring KW - home hemodialysis KW - co-presence enhancement KW - design N2 - Background: Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the ?presence? of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. Objective: This study presents an HHD system design for hemodialysis patients with features to enhance patient?s perceived ?copresence? with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. Methods: A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Results: Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with ?Very Happy? as the emotional status, 2167 entries with a ?Happy? status, 56 entries with a ?Neutral? status, 18 entries with an ?Unhappy? status, and 24 entries with a ?Very unhappy? status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients? change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients? feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients? status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses. Conclusions: The copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems. UR - http://humanfactors.jmir.org/2017/3/e21/ UR - http://dx.doi.org/10.2196/humanfactors.7078 UR - http://www.ncbi.nlm.nih.gov/pubmed/28851680 ID - info:doi/10.2196/humanfactors.7078 ER - TY - JOUR AU - Gibbons, C. Michael AU - Lowry, Z. Svetlana AU - Patterson, S. Emily PY - 2014/12/18 TI - Applying Human Factors Principles to Mitigate Usability Issues Related to Embedded Assumptions in Health Information Technology Design JO - JMIR Human Factors SP - e3 VL - 1 IS - 1 KW - cultural ergonomics KW - culturally informed design KW - EHR KW - health care disparities KW - health information technology KW - human factors KW - patient portal KW - patient safety KW - usability KW - workflow N2 - Background: There is growing recognition that design flaws in health information technology (HIT) lead to increased cognitive work, impact workflows, and produce other undesirable user experiences that contribute to usability issues and, in some cases, patient harm. These usability issues may in turn contribute to HIT utilization disparities and patient safety concerns, particularly among ?non-typical? HIT users and their health care providers. Health care disparities are associated with poor health outcomes, premature death, and increased health care costs. HIT has the potential to reduce these disparate outcomes. In the computer science field, it has long been recognized that embedded cultural assumptions can reduce the usability, usefulness, and safety of HIT systems for populations whose characteristics differ from ?stereotypical? users. Among these non-typical users, inappropriate embedded design assumptions may contribute to health care disparities. It is unclear how to address potentially inappropriate embedded HIT design assumptions once detected. Objective: The objective of this paper is to explain HIT universal design principles derived from the human factors engineering literature that can help to overcome potential usability and/or patient safety issues that are associated with unrecognized, embedded assumptions about cultural groups when designing HIT systems. Methods: Existing best practices, guidance, and standards in software usability and accessibility were subjected to a 5-step expert review process to identify and summarize those best practices, guidance, and standards that could help identify and/or address embedded design assumptions in HIT that could negatively impact patient safety, particularly for non-majority HIT user populations. An iterative consensus-based process was then used to derive evidence-based design principles from the data to address potentially inappropriate embedded cultural assumptions. Results: Design principles that may help identify and address embedded HIT design assumptions are available in the existing literature. Conclusions: Evidence-based HIT design principles derived from existing human factors and informatics literature can help HIT developers identify and address embedded cultural assumptions that may underlie HIT-associated usability and patient safety concerns as well as health care disparities. UR - http://humanfactors.jmir.org/2014/1/e3/ UR - http://dx.doi.org/10.2196/humanfactors.3524 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025349 ID - info:doi/10.2196/humanfactors.3524 ER -