Modeling Task Scheduling in Complex Healthcare Environments: Identifying Relevant Factors

Multiple task coordination involves scheduling tasks, completing tasks, and integrating tasks into a workflow. Task scheduling can influence outcomes of safety, satisfaction, and efficiency when completing tasks. This is especially important in complex life-critical environments such as healthcare, which incurs many situations where there are multiple tasks and limited resources for addressing all tasks. One approach for understanding tasks coordination is the Strategic Task Overload Management (STOM) model, which is a model for task scheduling behavior. In this theoretical paper, we discuss how this model can be extended to a complex healthcare environment. There are additional considerations (e.g., time) which must be considered when applying this model to healthcare. Ultimately, understanding how emergency physicians make multiple task scheduling decisions will advance theories and models, such as STOM, which can then in turn be implemented to improve scheduling behaviors in complex healthcare environments.

Medication Management Apps: Usable by Older Adults?

For older adults, managing medications can be a burden and could lead to medication non-adherence. To decrease risks associated with medication non-adherence, healthcare providers may recommend medication reminder apps as an assistive tool. However, these apps are often not designed with consideration of older adults' needs, capabilities, and limitations. To identify whether available apps are suitable for older adults, we conducted an in-depth cognitive walkthrough and a heuristic evaluation of the most commonly downloaded medication reminder app. Findings revealed three main issues: 1) difficulty in navigation, 2) poor visibility, and 3) a lack of transparency. We also selected the top five downloaded medication reminder apps and categorized user reviews to assess app functionality and usability problems. The results of our analysis provide guidance for app design for older adult users to provide effective tools for managing medications and supporting patient/user health.

Understanding the Medication Adherence Strategies of Older Adults with Hypertension

Many older adults are living with at least one chronic disease and must adhere to prescribed medication to mitigate and control its impact. Hypertension is one chronic disease that affects a significant portion of the world’s population, especially older adults, and is responsible for a high number of annual deaths. It is asymptomatic, meaning that there are no perceptible symptoms and, as such, older adults may struggle with adhering to their prescribed antihypertensive medications. How one internalizes the disease may influence the degree of success in managing the condition. The current study analyzed archival data from a multifaceted prospective memory intervention for older adults with hypertension who were nonadherent to their medication. We coded their responses to self-management interview questions to identify the common themes regarding the knowledge and sense of control the older adults held relevant to managing their illness. Participants’ responses revealed how they internalized hypertension and their medication, as well as the strategies and goals they reportedly used to manage the illness. The association strategy was found to be the most commonly used within participants’ routines. In addition, many participants expressed a general lack of knowledge about the disease or their medication, and their goals regarding hypertension management were general and inexplicit (e.g., “to reduce their blood pressure). This information informs the design of more effective and longer-lasting interventions geared toward significantly improving the medication adherence of older adults diagnosed with hypertension.

Diagnosis, narrative identity, and asymptomatic disease

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve 'mismatches' between one's beliefs about one's health status on the one hand, and bodily sensations or past experience on the other. Patients' attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety.

Understanding Older Adult's Perceptions of Factors that Support Trust in Human and Robot Care Providers

As the population of older adults increase so will the need for care providers, both human and robot. Trust is a key aspect to establish and maintain a successful older adult-care provider relationship. However, due to trust volatility it is essential to understand it within specific contexts. This proposed mixed methods study will explore what dimensions of trust emerge as important within the human-human and human-robot dyads in older adults and care providers. First, this study will help identify key qualities that support trust in a care provider relationship. By understanding what older adults perceive as needing to trust humans and robots for various care tasks, we can begin to provide recommendations based on user expectations for design to support trust.

Understanding the Potential of PARO for Healthy Older Adults

As the population ages, there is an increasing need for socio-emotional support for older adults. A potential way to meet this need is through interacting with pet-type robots such as the seal robot, PARO. There was a need to extend research on PARO's potential benefits beyond cognitively impaired and dependently living older adults. Because independently living, cognitively intact older adults may also have socio-emotional needs, the primary goal of this study was to investigate their attitudes, emotions, and engagement with PARO to identify its potential applicability to this demographic. Thirty older adults participated in an interaction period with PARO, and their attitudes and emotions toward PARO were assessed before and after using a multi-method approach. Video of the interaction was coded to determine the types and frequency of engagements participants initiated with PARO. Overall, there were no pre-post interaction differences on these measures. However, semi-structured interviews suggested that these older adults had positive attitudes towards PARO's attributes, thought it would be easy to use, and perceived potential uses for both themselves and others. Participants varied in their frequency of engagement with PARO. A novel finding is that this active engagement frequency uniquely predicted post-interaction period positive affect. This study advances understanding of healthy older adults' attitudes, emotions, and engagement with PARO and of possible ways in which PARO could provide social and emotional support to healthy older adults. The results are informative for future research and design of pet-type robots.

Older Users' Acceptance of an Assistive Robot: Attitudinal Changes Following Brief Exposure

INTRODUCTION

Many older adults wish to age-in-place. Robot assistance at home may be beneficial for older adults who are experiencing limitations in performing home activities. In this study we investigate older Americans' robot acceptance before and after exposure to a domestic mobile manipulator, with an emphasis on understanding trialability (i.e., "trying out" a robot for a short time period) and result demonstrability (i.e., observing the results of the robot's functionality).

METHOD

Older adult participants observed a mobile manipulator robot autonomously demonstrating three tasks: delivering medication, learning to turn off a light switch, and organizing home objects. We administered pre and post exposure questionnaires about participants' opinions and attitudes toward the robot, as well as a semi-structured interview about each demonstration.

RESULTS

We found that demonstration of a mobile manipulator assistive robot did, in fact, influence older adults' acceptance. There was a significant increase, pre vs. post, in positive perceptions of robot usefulness and ease of use for 8 of the 12 Robot Opinions Questionnaire items. Furthermore, in the Assistance Preference Checklist, eighteen tasks significantly differed between pre and post exposure, with older adults showing a greater openness to robot assistance after exposure to the robot.

CONCLUSION

Thus, demonstration of robot capability positively affected older adults' preferences for robot assistance for tasks in the home. Interview data suggest that the robot's capability and reliability influenced older adults' first impressions of the robot.

Envisioning the Future for Older Adults: Autonomy, Health, Well-being, and Social Connectedness with Technology Support

Envisioning the future of older adults of 2050 is a challenging task given the heterogeneity of the older adult population. We consider primarily the domains of home, health, and social participation for individuals over age 65 and the potential role of information, communication, and robotic technology for enhanced independence, maintenance of autonomy, and enriched quality of life. We develop several scenarios to illustrate the diversity of circumstances, health, and living situations for older adults in the future. We discuss possible negative outcomes resulting from the proliferation of technology, including increased social isolation and a widening digital divide. However, we focus primarily on envisioning desired situations wherein older adults have autonomy and independence; are easily able to manage their health and wellness needs; have rich and rewarding opportunities for social connectedness, personal growth, continued life purpose, and overall high quality of life. To attain this future, we must be acting now: designing the technology with involvement by today's older adults who represent the needs and capabilities of tomorrow's older adults; developing the necessary infrastructure to support widespread availability and deployment of these technologies; and supporting the integration of technology into people's lives at younger ages with adaptive functionality to support changing needs and preferences.

Acceptance of televideo technology by adults aging with a mobility impairment for health and wellness interventions

Televideo technology (e.g., Skype) has potential to support adults as they age by facilitating their interactions with people remotely; this potential may be even greater for adults aging with pre-existing mobility impairments, who face challenges interacting with others in person due to lack of transportation or accessibility. Our research employed questionnaire and interview methodologies to investigate this understudied population about their attitudes toward televideo technology for supporting social engagement, healthcare provider access, and physical activity. Participants were 14 adults aging with self-reported mobility impairments (50–70 years of age). Overall, participants were open to accepting televideo technology for social engagement, healthcare provider access, and physical activity. Participants perceived these technologies to be useful and perceived additional benefits, including the feeling of “being there” by enabling the viewing of facial expressions and the environment of the other person. Concerns included perceptions that televideo technologies lack security and privacy. Participants also expressed concerns that these technologies are difficult to use and are difficult to learn to use. The findings have implications for education, training, and deployment of televideo technology for home-based interventions for adults aging with pre-existing mobility impairments.

Older Adults' Acceptance of Activity Trackers

OBJECTIVE

To assess the usability and acceptance of activity tracking technologies by older adults.

METHOD

First in our multimethod approach, we conducted heuristic evaluations of two activity trackers that revealed potential usability barriers to acceptance. Next, questionnaires and interviews were administered to 16 older adults ( Mage = 70, SDage = 3.09, rangeage = 65-75) before and after a 28-day field study to understand facilitators and additional barriers to acceptance. These measurements were supplemented with diary and usage data and assessed whether and why users overcame usability issues.

RESULTS

The heuristic evaluation revealed usability barriers in System Status Visibility, Error Prevention, and Consistency and Standards. The field study revealed additional barriers (e.g., accuracy, format) and acceptance-facilitators (e.g., goal tracking, usefulness, encouragement).

DISCUSSION

The acceptance of wellness management technologies, such as activity trackers, may be increased by addressing acceptance-barriers during deployment (e.g., providing tutorials on features that were challenging, communicating usefulness).

Reasonableness, Credibility, and Clinical Disagreement

Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence itself, such as our beliefs about the credibility of the speaker or source of the evidence. In evaluating evidence, there is thus a need for reflective awareness about why we accept or dismiss particular claims.

Understanding older adults' perceptions of and attitudes towards exergames

Purpose

Maintaining physical activity is a key component of successful aging and has benefits for both physical and cognitive functioning in the older adult population. One promising method for engaging in physical activity is through exergames, which are video games designed to promote exercise. Exergames have the potential to be used by a wide range of people, including older adults, in a variety of settings, such as at home, in community living environments, or senior centers. However, exergames have not been designed for older adults (e.g., with respect to their attitudes, needs). Thus, older adults may not adopt these systems if they perceive them as not useful or relevant to them.

Method

Twenty older adults (aged 60-79) interacted with two exergames, and were then interviewed about their perceptions of the system's ease of use and usefulness, as well as their general attitudes towards the system.

Results

Participants identified the potential for exergames' usefulness for various goals, such as to increase their physical activity. However, they also reported negative attitudes concerning the system, including perceiving barriers to system use. Overall, participants said they would use the system in the future and recommend it to other people at their age for improving health, despite these use challenges.

Conclusion

The older adults were open to adopting exergames, which could provide opportunities to increase physical activity. Given the participants' overall positive perceptions of the usefulness of exergames, designers must address the perceived challenges of using these systems. Understanding barriers and facilitators for older adults' use of exergames can guide design, training, and adoption of these systems.

CHALLENGES OF TRAINING OLDER ADULTS IN A HOME HEALTH CARE CONTEXT

The health care domain is experiencing a shift from traditional hospital-based care to care delivered in a patient's home setting. Although home health care provides many benefits, it creates new challenges and difficulties for professional caregivers (e.g., registered nurses) who are performing complex medical tasks without the support often present in a health care environment. In addition to performing these tasks themselves, registered nurses are also responsible for training patients to perform many of these tasks, which may include using medical devices and managing complex medication regimens. The purpose of this research was to identify and systematically categorize the issues facing registered nurses (RNs) when training older adult patients. Eight RNs participated in individual structured interviews wherein they were asked to describe the difficulties and frustrations associated with training older adult patients to use medical devices and manage medication independently. The data were categorized as patient-related, RN-related, or situation-related issues. The results highlight the complexity of training device use and medication management, as well as the needs of RNs for forms of additional support in training older adult patients.

Commanding Home Robots

Developing robots that are useful to older adults is more than simply creating robots that complete household tasks. Careful consideration of the users’ capabilities, robot autonomy, and task is needed. Perceived usefulness, according to the Technology Acceptance Model (TAM), is described as a person’s perception of how well the technology’s capability matches his or her own needs. The purpose of this qualitative study was to investigate the construct of perceived usefulness within the context of robot assistance and user capability. Two user groups participated: mobile older adults (N = 12; used no ambulation aid) and older adults with mobility loss (N=12; used walker or wheelchair). Participants took part in a think aloud task. We asked participants to discuss their robot control preferences for household tasks (e.g., clean, find and fetch). Older adults with mobility loss tended to prefer to command/control the robot themselves (low robot autonomy); however, mobile older adults’ preferences were split between commanding/controlling the robot themselves (low robot autonomy) or the robot commands/controls itself (high robot autonomy). Reasons for their preferences were task specific and related to barriers/facilitators of robot acceptance, such as trust, reliability, and user need. Findings provide practical guidance to choosing robot autonomy level, broadly defined, for different groups of older adults.

"Commanding Your Robot" Older Adults' Preferences for Methods of Robot Control

Home robots have the potential to assist older adults in maintaining their independence. However, robots deployed in older adults' homes will be required to interact with untrained, novice users. The way untrained users, such as older adults, provide commands or control the robot (i.e., "method of robot control") will likely impact the ease of use and adoption of the robot. The current study explored older adults' preferences for controlling robots. Twelve independently-living older adults (ages 68-79) observed a functioning personal robot in a home setting, and were interviewed about their opinions regarding specific methods of robot control (i.e., laser pointer, physical manipulation, and devices). The older adults perceived advantages and disadvantages of these specific methods, including 'specificity in command', 'accurate robot performance', 'limitations in their own physical capability', and 'challenges in using control device.' The older adults also completed a questionnaire measuring their willingness to use 10 different types of methods of robot control. These data revealed that older adults were willing to use a variety of methods. Although older adults were limited in their spontaneous ideas about robot control (i.e., limited to voice command), once exposed to other options they were willing and open to a variety of control methods.

Macquarie Surgical Innovation Identification Tool (MSIIT): a study protocol for a usability and pilot test

INTRODUCTION

Medicine relies on innovation to continually improve. However, innovation is potentially risky, and not all innovations are successful. Therefore, it is important to identify innovations prospectively and provide support, to make innovation as safe and effective as possible. The Macquarie Surgical Innovation Identification Tool (MSIIT) is a simple checklist designed as a practical tool for hospitals to identify planned surgical innovations. This project aims to test the usability and pilot the use of the MSIIT in a surgical setting.

METHODS AND ANALYSIS

The project will run in two phases at two Australian hospitals, one public and one private. Phase I will involve interviews, focus groups and a survey of hospital administrators and surgical teams to assess the usability and system requirements for the use of the MSIIT. Current practice regarding surgical innovation within participating hospitals will be mapped, and the best implementation strategy for MSIIT completion will be established. Phase II will involve trialling the MSIIT for each surgery within the trial period by various surgical personnel. Follow-up interviews, focus groups and a survey will be conducted with trial participants to collect feedback on their experience of using the MSIIT during the trial period. Comparative data on rates of surgical innovation during the trial period will also be gathered from existing hospital systems and compared to the rates identified by the MSIIT.

ETHICS AND DISSEMINATION

Ethical approval has been obtained. The results of this study will be presented to interested health services and other stakeholders, presented at conferences and published in a peer-reviewed MEDLINE-indexed journal.

Potential Intrusiveness of Aware Home Technology: Perceptions of Older Adults

Older individuals in particular might benefit from an aware domestic environment. Yet, fear of intrusion is a potential barrier that might keep older adults from adopting smart technologies in the home. In this study, 44 participants (aged 65–75) were given a tour of the Georgia Tech Aware Home and shown five prototype smart home devices. The structured interviews after the tour yielded 2136 quotes containing the participants' opinions about living in a technology-rich home environment. A subset addressing technology intrusiveness of five devices is presented in this paper. The results show three domains of potential technology intrusion in the home as perceived by the older adults: physical obtrusiveness, invasion of privacy, and security risk. Technology intrusiveness represented 19% of the total technology judgments, but accounted for almost half of the negative judgments in general. The distribution of the participants' conditional statements (e.g., I wouldn't mind privacy intrusion if) suggested a careful weighing of potential intrusiveness against benefits such as prolonged independence for some of the devices in particular.

Comprehension of Explicit and Implicit Warning Information in Younger and Older Adults

Successful comprehension of warning text necessitates an ability to understand both explicitly stated safety information, as well as information about hazards and safe product usage that may be implied. Comprehension level for this type of text may vary across age groups as a function of normal age-related changes that may be experienced in memory and text comprehension in general. To date, there has been no comprehensive investigation of how well younger and older adults understand explicit and implicit information associated with actual product warnings. In the current study, 43 older and 42 younger adults read text from consumer product warnings and then rated the truth/falsity of statements containing information that was either explicitly stated or implied by the warnings. The results suggest both older and younger adults are able to recognize information that is explicitly associated with an actual product warning. However, they are less able to recognize information that can be inferred from warnings. These data also suggest that older adults perceive themselves to understand consumer warnings fairly well.