A collaborative, mixed-methods evaluation of a low-cost, handheld 3D imaging system for child anthropometry

3D imaging for body measurements is regularly used for design of garments and ergonomic products. The development of low‐cost 3D scanners provided an opportunity to extend the use of 3D imaging to the health sector. We developed and tested the AutoAnthro System, the first mobile, low‐cost, full‐body, 3D imaging system designed specifically for child anthropometry. This study evaluated the efficiency, invasiveness, and user experience of the AutoAnthro System. We used a mixed‐methods, collaborative approach that included a quantitative time‐motion study and qualitative interviews of anthropometrists. For cooperative children, anthropometrists considered the use of 3D imaging an easy, “streamlined experience,” but with uncooperative children, anthropometrists reported that capturing a good quality scan was out of their control. The mean time to complete a full set of scans was 68 s (standard deviation [SD] 29), compared with 135 s (SD 22) for a set of manual measurements (stature, head circumference, and arm circumference). We observed that crying was more common during manual measurement, and anthropometrist interviews confirmed that 3D imaging was less stressful for children than manual measurement. In a previous publication, we showed the potential of 3D imaging to produce reliable and accurate measurements. In this study, we found that anthropometrists were not ready to abandon manual equipment for 3D scanners because of difficulty in measuring uncooperative children. Revising the AutoAnthro System to address anthropometrists' concerns on capturing good quality scans of uncooperative children should help to facilitate widespread use of 3D imaging for child anthropometry.

Eye-tracking en masse: Group user studies, lab infrastructure, and practices

The costs of eye-tracking technologies steadily decrease. This allows research institutions to obtain multiple eye-tracking devices. Already, several multiple eye-tracker laboratories have been established. Researchers begin to recognize the subfield of group eye-tracking. In comparison to the single-participant eye-tracking, group eye-tracking brings new tech-nical and methodological challenges. Solutions to these challenges are far from being established within the research community. In this paper, we present the Group Studies system, which manages the infrastructure of the group eye-tracking laboratory at the User Experience and Interaction Research Center (UXI) at the Slovak University of Technology in Bratislava. We discuss the functional and architectural characteristics of the system. Furthermore, we illustrate our infrastructure with one of our past studies. With this paper, we also publish the source code and the documentation of our system to be re-used.

Envisioning robotic surgery: Surgeons' needs and views on interacting with future technologies and interfaces

BACKGROUND

The development of technology in robotic surgery is typically presented from a technical perspective. This study considers the user perspective as an input to the development of technology by exploring potential solutions within and beyond the field of robotic surgery.

METHODS

Advanced technological solution concepts were selected based on a technology review and an ethnographic study. Using a future workshop method, these were rated and discussed by a group of surgeons from three perspectives: enhancing operation outcome, user experience and learning in the operating theatre.

RESULTS

Diverse technologies were considered to offer potential for supporting the surgeons' work. User experience and learning could be improved especially via solutions novel to robotic surgery. Robotic surgery technologies currently under development were mainly considered to support a good operation outcome. Suitability for practical work was elaborated upon, and related concerns were identified.

CONCLUSIONS

The results can support development of robotic surgery to enhance surgeons' work.

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews

Background

Hundreds of mental health apps are available to the general public. With increasing pressures on health care systems, they offer a potential way for people to support their mental health and well-being. However, although many are highly rated by users, few are evidence-based. Equally, our understanding of what makes apps engaging and valuable to users is limited.

Objective

The aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement.

Methods

We systematically identified apps described as being based on cognitive behavioral therapy for depression. We then conducted 2 studies. In the first, we analyzed the therapeutic functionality of apps. This corroborated existing work on apps’ fidelity to cognitive behavioral therapy theory, but we also extended prior work by examining features designed to support user engagement. Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well-being in a more general sense. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression.

Results

We identified 31 apps that purport to be based on cognitive behavioral therapy for depression. Functionality analysis (study 1) showed that they offered an eclectic mix of features, including many not based on cognitive behavioral therapy practice. Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well-being apps. The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression (study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to play an active role in supporting their mental health and well-being. Users, including health professionals, valued and used apps that incorporated both core cognitive behavioral therapy and non-cognitive behavioral therapy elements, but concerns were also expressed regarding the unsupervised use of apps. Positivity was seen as important to engagement, for example, in the context of automatic thoughts, users expressed a preference to capture not just negative but also positive ones. Privacy, security, and trust were crucial to the user experience.

Conclusions

Cognitive behavioral therapy apps for depression need to improve with respect to incorporating evidence-based cognitive behavioral therapy elements. Equally, a positive user experience is dependent on other design factors, including consideration of varying contexts of use. App designers should be able to clearly identify the therapeutic basis of their apps, but they should also draw on evidence-based strategies to support a positive and engaging user experience. The most effective apps are likely to strike a balance between evidence-based cognitive behavioral therapy strategies and evidence-based design strategies, including the possibility of eclectic therapeutic techniques.

Suitability of Inexpensive Eye-Tracking Device for User Experience Evaluations

We present the results of a study evaluating the suitability of an inexpensive eye-tracking device for the enhancement of user experience evaluations. Ensuring a comfortable user experience is an important part of the mobile application design process. Evaluation of user experience is usually done through questionnaires and interviews, but it can be improved using eye tracking sensors for user experience studies. We conducted a user experience study of DriveGreen, a mobile application devoted to ecodriving for a transition to a low-carbon society. We used an inexpensive eye-tracking device in addition to standard User Experience Questionnaire and Single Ease Question questionnaires. The results show that the inexpensive eye-tracking device data correlate with data from User Experience Questionnaire and Single Ease Question questionnaires and interviews with users. We conclude that an enhancement of user experience evaluations with inexpensive eye-tracking device is possible.

Designing for Motivation, Engagement and Wellbeing in Digital Experience

Research in psychology has shown that both motivation and wellbeing are contingent on the satisfaction of certain psychological needs. Yet, despite a long-standing pursuit in human-computer interaction (HCI) for design strategies that foster sustained engagement, behavior change and wellbeing, the basic psychological needs shown to mediate these outcomes are rarely taken into account. This is possibly due to the lack of a clear model to explain these needs in the context of HCI. Herein we introduce such a model: Motivation, Engagement and Thriving in User Experience (METUX). The model provides a framework grounded in psychological research that can allow HCI researchers and practitioners to form actionable insights with respect to how technology designs support or undermine basic psychological needs, thereby increasing motivation and engagement, and ultimately, improving user wellbeing. We propose that in order to address wellbeing, psychological needs must be considered within five different spheres of analysis including: at the point of technology adoption, during interaction with the interface, as a result of engagement with technology-specific tasks, as part of the technology-supported behavior, and as part of an individual's life overall. These five spheres of experience sit within a sixth, society, which encompasses both direct and collateral effects of technology use as well as non-user experiences. We build this model based on existing evidence for basic psychological need satisfaction, including evidence within the context of the workplace, computer games, and health. We extend and hone these ideas to provide practical advice for designers along with real world examples of how to apply the model to design practice.

Eye Tracking and Visualization: Introduction to the Special Thematic Issue of the Journal of Eye Movement Research

There is a growing interest in eye tracking technologies applied to support traditional visualization techniques like diagrams, charts, maps, or plots, either static, animated, or interactive ones. More complex data analyses are required to derive knowledge and meaning from the data. Eye tracking systems serve that purpose in combination with biological and computer vision, cognition, perception, visualization, human-computer-interaction, as well as usability and user experience research. The 10 articles collected in this thematic special issue provide interesting examples how sophisticated methods of data analysis and representation enable researchers to discover and describe fundamental spatio-temporal regularities in the data. The human visual system, supported by appropriate visualization tools, enables the human operator to solve complex tasks, like understanding and interpreting three-dimensional medical images, controlling air traffic by radar displays, supporting instrument flight tasks, or interacting with virtual realities. The development and application of new visualization techniques is of major importance for future technological progress.

Eye Tracking and Visualization: Introduction to the Special Thematic Issue of the Journal of Eye Movement Research

There is a growing interest in eye tracking technologies applied to support traditional visualization techniques like diagrams, charts, maps, or plots, either static, animated, or interactive ones. More complex data analyses are required to derive knowledge and meaning from the data. Eye tracking systems serve that purpose in combination with biological and computer vision, cognition, perception, visualization, human-computer-interaction, as well as usability and user experience research. The 10 articles collected in this thematic special issue provide interesting examples how sophisticated methods of data analysis and representation enable researchers to discover and describe fundamental spatio-temporal regularities in the data. The human visual system, supported by appropriate visualization tools, enables the human operator to solve complex tasks, like understanding and interpreting three-dimensional medical images, controlling air traffic by radar displays, supporting instrument flight tasks, or interacting with virtual realities. The development and application of new visualization techniques is of major importance for future technological progress.

Functionality of a novel follitropin alfa pen injector: results from human factor interactions by patients and nurses

OBJECTIVE

The main objective of this user experience testing study was to evaluate the impact of human factors on the use of a disposable pen containing follitropin alfa by patients and nurses with special focus on the convenience, safety and ease of use, in different types of stimulation protocols.

METHODS

Infertile women trying to conceive, and specialist nurses were recruited across 6 European countries. In total 18 patients and 19 nurses took part in the testing, which included both nurse-patient pairings and in-depth interviews. A standardized list of expected and pre-defined critical steps according to the Instructions for Use (IFU), was used to assess the correct handling of the pen.

RESULTS

During the user experience testing, no critical errors, related to the use of the pen, which could affect the success of the injection process were identified. In general, both nurses and patients found the pen very easy to learn, use and would be confident using the pen for self-injection. Nurses also found the pen very easy to train the patients.

CONCLUSIONS

The study provides valuable information on the pen from both patient and nurse perspectives in different simulated scenarios reflecting standard practice.

The Potential and Challenges of Digital Well-Being Interventions: Positive Technology Research and Design in Light of the Bitter-Sweet Ambivalence of Change

Along with the dissemination of technical assistance in nearly every part of life, there has been growing interest in the potential of technology to support well-being and human flourishing. "Positive technology" thereby takes the responsible role of a "digital coach," supporting people in achieving personal goals and behavior change. The design of such technology requires knowledge of different disciplines such as psychology, design and human-computer interaction. However, possible synergies are not yet used to full effect, and it needs common frameworks to support a more deliberate design of the "therapeutic interaction" mediated through technology. For positive technology design, positive psychology, and resource oriented approaches appear as particularly promising starting point. Besides a general fit of the basic theoretical conceptions of human change, many elements of established interventions could possibly be transferred to technology design. However, besides the power of focusing on the positive, another psychological aspect to consider are the bitter components inherent to change, such as the confrontation with a negative status quo, threat of self-esteem, and the effort required. The present research discusses the general potential and challenges within positive technology design from an interdisciplinary perspective with theoretical and practical contributions. Based on the bitter-sweet ambivalence of change as present in many psychological approaches of motivation and behavior change, the bitter-sweet continuum serves as a proxy for the mixed emotions and cognitions related to change. An empirical investigation of those factors among 177 users of self-improvement technologies provides initial support for the usefulness of the bitter-sweet perspective in understanding change dynamics. In a next step, the bitter-sweet concept is transformed into different design strategies to support positive change. The present article aims to deepen the discussion about the responsible role of technology as a well-being enhancement tool and to provide a fruitful frame for different disciplines involved in positive technology. Two aspects are highlighted: First, investigating well-being technology as a form of "therapeutic interaction," focusing on the need for sensible design solutions in the emerging dialogue between technology and user. Second, a stronger consideration of the bitter-sweet ambivalence of change, utilizing (positive) psychology interventions to full effect.

Data Collectors' Design Preferences for Mobile Electronic Data Capturing Forms

Data collectors collect health data using Mobile Electronic Data Collection Forms (MEDCFs) particularly in hard to reach areas. However, the usability and user acceptance of these forms by the data collectors are seldom considered, and yet these have an implication on the quality of the data collected and on the health decisions thereof. In this study we aimed at collecting the design preferences the data collectors felt would improve their data collection experience. For that purpose, a mid-fidelity prototype was used to accomplish six tasks and a semi-structured usability questionnaire was given. Forty eight data collectors from Uganda participated in the study between December 2017 and January 2018, indicating their preferences after interacting with the prototype. The results included a detailed feedback regarding the presentation of the forms content, form navigation, error handling, data input, and visualization of progress status. Involvement of users and other stakeholders in the design of MEDCFs using the User Centred Design (UCD) will presumably enhance usability of the data collection forms.

Assessing user acceptance towards automated and conventional sink use for hand decontamination using the technology acceptance model

Hand hygiene (HH) prevents harmful contaminants spreading in settings including domestic, health care and food handling. Strategies to improve HH range from behavioural techniques through to automated sinks that ensure hand surface cleaning. This study aimed to assess user experience and acceptance towards a new automated sink, compared to a normal sink. An adapted version of the technology acceptance model (TAM) assessed each mode of handwashing. A within-subjects design enabled N = 46 participants to evaluate both sinks. Perceived Ease of Use and Satisfaction of Use were significantly lower for the automated sink, compared to the conventional sink (p < 0.005). Across the remaining TAM factors, there was no significant difference. Participants suggested design features including jet strength, water temperature and device affordance may improve HH technology. We provide recommendations for future HH technology development to contribute a positive user experience, relevant to technology developers, ergonomists and those involved in HH across all sectors. Practitioner Summary: The need to facilitate timely, effective hand hygiene to prevent illness has led to a rise in automated handwashing systems across different contexts. User acceptance is a key factor in system uptake. This paper applies the technology acceptance model as a means to explore and optimise the design of such systems.

"Everything Happens in the Hallways": Exploring User Activity in the Corridors at Two Rehabilitation Units

OBJECTIVES

This research aimed to examine the role of the corridors in specialist inpatient rehabilitation units to inform future design of these spaces.

BACKGROUND

In healthcare settings, such as rehabilitation units, corridors have often been designed simply as spaces allowing movement between other locations. However, research suggests that corridors may be places where important social and care-related activities take place. How corridors are used and understood by patients and staff in inpatient rehabilitation settings is unclear, and a greater understanding of the role of corridors in these settings could help to inform more supportive design of these spaces.

METHODS

Independent observations of user activity were conducted at a major metropolitan inpatient spinal injury unit (SIU) and brain injury unit (BIU). Interviews were conducted with SIU patients ( n = 12), and focus groups were conducted with SIU staff ( n = 23), BIU patients ( n = 12), and BIU staff ( n = 10).

RESULTS

Results from the observations showed that the corridors were used frequently across the day, particularly by staff. Thematic analysis of staff and patient experiences found three key themes describing how corridors were used: (1) moving around, (2) delivery and experiences of quality care, and (3) a "spillover space."

CONCLUSIONS

Results demonstrate that corridors not only have an important role as connective spaces but are also used as flexible, multipurpose spaces for delivery of quality care and patient experiences. Future design should consider how these spaces can more deliberately support and contribute to patient and staff experiences of rehabilitation.

Patient Portal Use and Experience Among Older Adults: Systematic Review

Background

The older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults.

Objective

The aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults’ use and adoption of patient portals and ePHRs.

Methods

We searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption.

Results

We retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults’ experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips.

Conclusions

More research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process.

Adapting the buying funnel model of consumer behavior to the design of an online health research recruitment tool

Introduction

UMHealthResearch is the University of Michigan’s digital health research recruitment platform. It allows health researchers to connect efficiently with potentially eligible volunteers.

Methods

In 2013, the UMHealthResearch team strategically adapted a consumer behavior model, the buying funnel, to create the Digital Health Research Participation Funnel. The Digital Health Research Participation Funnel was then used to design a more active way for potential participants to volunteer for research studies through UMHealthResearch.

Results

In the 5 years before the redesign (2007–2012), an average of 1844 new accounts were created every year, whereas in the completed years after the redesign (2013–2016) the annual average improved to 3906, an increase of 111%.

Conclusion

Although a randomized design was not possible in this instance, these preintervention and postintervention data suggest that the focus on user experience is an effective strategy for improving web-based research recruitment platforms.

Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults

Background

Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process.

Objective

The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults.

Methods

The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken.

Results

The first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity.

Conclusions

There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization.

Semantic congruency of auditory warnings

The aim of this study was to explore operator experience and performance for semantically congruent and incongruent auditory icons and abstract alarm sounds. It was expected that performance advantages for congruent sounds would be present initially but would reduce over time for both alarm types. Twenty-four participants (12M/12F) were placed into auditory icon or abstract alarm groupings. For each group both congruent and incongruent alarms were used to represent different driving task scenarios. Once sounded, participants were required to respond to each alarm by selecting a corresponding driving scenario. User performance for all sound types improved over time, however even with experience a decrement in speed of response remained for the incongruent iconic sounds and in accuracy of performance for the abstract warning sounds when compared to the congruent auditory icons. Semantic congruency was found to be of more importance for auditory icons than for abstract sounds. Practitioner Summary: Alarms are used in many operating systems as emergency, alerting, or continuous monitoring signals for instance. This study found that the type and representativeness of an auditory warning will influence operator performance over time. Semantically congruent iconic sounds produced performance advantages over both incongruent iconic sounds and abstract warnings.

The Role of the Interplay between Stimulus Type and Timing in Explaining BCI-Illiteracy for Visual P300-Based Brain-Computer Interfaces

Visual P300-based Brain-Computer Interface (BCI) spellers enable communication or interaction with the environment by flashing elements in a matrix and exploiting consequent changes in end-user's brain activity. Despite research efforts, performance variability and BCI-illiteracy still are critical issues for real world applications. Moreover, there is a quite unaddressed kind of BCI-illiteracy, which becomes apparent when the same end-user operates BCI-spellers intended for different applications: our aim is to understand why some well performers can become BCI-illiterate depending on speller type. We manipulated stimulus type (factor STIM: either characters or icons), color (factor COLOR: white, green) and timing (factor SPEED: fast, slow). Each BCI session consisted of training (without feedback) and performance phase (with feedback), both in copy-spelling. For fast flashing spellers, we observed a performance worsening for white icon-speller. Our findings are consistent with existing results reported on end-users using identical white×fast spellers, indicating independence of worsening trend from users' group. The use of slow stimulation timing shed a new light on the perceptual and cognitive phenomena related to the use of a BCI-speller during both the training and the performance phase. We found a significant STIM main effect for the N1 component on P z and PO7 during the training phase and on PO8 during the performance phase, whereas in both phases neither the STIM×COLOR interaction nor the COLOR main effect was statistically significant. After collapsing data for factor COLOR, it emerged a statistically significant modulation of N1 amplitude depending to the phase of BCI session: N1 was more negative for icons than for characters both on P z and PO7 (training), whereas the opposite modulation was observed for PO8 (performance). Results indicate that both feedback and expertise with respect to the stimulus type can modulate the N1 component and that icons require more perceptual analysis. Therefore, fast flashing is likely to be more detrimental for end-users' performance in case of icon-spellers. In conclusion, the interplay between stimulus type and timing seems relevant for a satisfactory and efficient end-user's BCI-experience.

Effects of Using Child Personas in the Development of a Digital Peer Support Service for Childhood Cancer Survivors

BACKGROUND

Peer support services have the potential to support children who survive cancer by handling the physical, mental, and social challenges associated with survival and return to everyday life. Involving the children themselves in the design process allows for adapting services to authentic user behaviors and goals. As there are several challenges that put critical requirements on a user-centered design process, we developed a design method based on personas adapted to the particular needs of children that promotes health and handles a sensitive design context.

OBJECTIVE

The purpose of this study was to evaluate the effects of using child personas in the development of a digital peer support service for childhood cancer survivors.

METHODS

The user group's needs and behaviors were characterized based on cohort data and literature, focus group interviews with childhood cancer survivors (n=15, 8-12 years), stakeholder interviews with health care professionals and parents (n=13), user interviews, and observations. Data were interpreted and explained together with childhood cancer survivors (n=5) in three explorative design workshops and a validation workshop with children (n=7).

RESULTS

We present findings and insights on how to codesign child personas in the context of developing digital peer support services with childhood cancer survivors. The work resulted in three primary personas that model the behaviors, attitudes, and goals of three user archetypes tailored for developing health-promoting services in this particular use context. Additionally, we also report on the effects of using these personas in the design of a digital peer support service called Give Me a Break.

CONCLUSIONS

By applying our progressive steps of data collection and analysis, we arrive at authentic child-personas that were successfully used to design and develop health-promoting services for children in vulnerable life stages. The child-personas serve as effective collaboration and communication aids for both internal and external purposes.

Support System to Improve Reading Activity in Parkinson's Disease and Essential Tremor Patients

The use of information and communication technologies (ICTs) to improve the quality of life of people with chronic and degenerative diseases is a topic receiving much attention nowadays. We can observe that new technologies have driven numerous scientific projects in e-Health, encompassing Smart and Mobile Health, in order to address all the matters related to data processing and health. Our work focuses on helping to improve the quality of life of people with Parkinson’s Disease (PD) and Essential Tremor (ET) by means of a low-cost platform that enables them to read books in an easy manner. Our system is composed of two robotic arms and a graphical interface developed for Android platforms. After several tests, our proposal has achieved a 96.5% accuracy for A4 80 gr non-glossy paper. Moreover, our system has outperformed the state-of-the-art platforms considering different types of paper and inclined surfaces. The feedback from ET and PD patients was collected at “La Princesa” University Hospital in Madrid and was used to study the user experience. Several features such as ease of use, speed, correct behavior or confidence were measured via patient feedback, and a high level of satisfaction was awarded to most of them. According to the patients, our system is a promising tool for facilitating the activity of reading.

[Design of Telerehabilitation System Based on Safety and User Experience]

In the present study, we designed a telerehabilitation system based on handheld mobile application, motion sensor and bluetooth, which was used to improve motor function by intelligent supervision and guidance program. From the point of clinical application, the system design focused on ensuring the safety of training and enhancing the user experience of patients and doctors. The clinical trials showed that the system can provide rehabilitation training safely and conveniently.

Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy

PURPOSE

New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke.

METHOD

We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals.

RESULTS

The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted.

CONCLUSIONS

Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation.

Analysis of Mental Workload in Online Shopping: Are Augmented and Virtual Reality Consistent?

A market research company (Nielsen) reported that consumers in the Asia-Pacific region have become the most active group in online shopping. Focusing on augmented reality (AR), which is one of three major techniques used to change the method of shopping in the future, this study used a mixed design to discuss the influences of the method of online shopping, user gender, cognitive style, product value, and sensory channel on mental workload in virtual reality (VR) and AR situations. The results showed that males' mental workloads were significantly higher than females'. For males, high-value products' mental workload was significantly higher than that of low-value products. In the VR situation, the visual mental workload of field-independent and field-dependent consumers showed a significant difference, but the difference was reduced under audio-visual conditions. In the AR situation, the visual mental workload of field-independent and field-dependent consumers showed a significant difference, but the difference increased under audio-visual conditions. This study provided a psychological study of online shopping with AR and VR technology with applications in the future. Based on the perspective of embodied cognition, AR online shopping may be potential focus of research and market application. For the future design of online shopping platforms and the updating of user experience, this study provides a reference.

Evaluating clinicians' user experience and acceptability of LearnTB, a smartphone application for tuberculosis in India

BACKGROUND

Tuberculosis (TB) is the leading infectious killer, and India accounts for 2.8 of the 10.4 million TB cases that occur each year, making it the highest TB burden country worldwide. Poor quality of TB care is a major driver of the epidemic in India. India's large private, unregulated sector manages over 50% of the TB patients, with studies showing suboptimal diagnosis and treatment in the private sector. Better education of doctors using mobile applications (apps) is a possible solution. While India has seen an explosion of mobile phone services, and while the use of mobile health interventions has been gaining interest, little is known about mHealth around tuberculosis in India.

METHODS

Our study aimed to understand the user experience and acceptability of a smartphone application, LearnTB, amongst private sector academic clinicians in India. This study was conducted amongst 101 clinicians at Kasturba Hospital, Manipal, India. The user experience of participants (part 1) and acceptability (part 2) were evaluated with the use of two valid, English, paper-based questionnaires. The first questionnaire was based on the System Usability Scale (SUS); the second questionnaire was based on the Technology Acceptance Model (TAM). Data were collected during February and March 2017 and were analyzed using descriptive statistics, multiple linear regression as well as logistic regression analysis.

RESULTS

A response rate of 99% was achieved; 100 participants responded to the second questionnaire and 100% of the participants responded to the first questionnaire. User experience was very high [mean SUS score =94.4 (92.07-96.76)]. Perceived usefulness (PU) was significantly correlated to intention to use (IU) (r=0.707, P<0.0001), and perceived ease of use (PEU) was significantly correlated to PU (r=0.466, P<0.0001). Path analysis confirmed the direct relationship between PU and IU (0.936, P<0.0001), and the indirect relationship between PEU and IU (0.5102, P<0.0001). Logistic regression analysis helped target items strongly influencing IU, such as "The use of the LearnTB application is compatible with my work habits" [OR =3.20 (1.04-9.84), P=0.004] and "The use of the LearnTB application could promote good clinical practice" [OR =5.23 (1.35-20.29); P=0.016].

CONCLUSION

The first part of the study indicated high user experience of the LearnTB application. The TAM questionnaire (second part) explained a significant portion of the variance in clinicians' IU the LearnTB application. The PU of the application has the highest impact on the clinicians' IU the Learn TB application. This study provides a preliminary analysis of mobile health interventions for tuberculosis in India, and emphasizes the need for future research in this domain.

Talking to Toddlers: Drawing on Mothers' Perceptions of Using Wearable and Mobile Technology in the Home

BACKGROUND

Mother-child interactions often give rise to opportunities for early language learning in the context of everyday life. Persuasive technology has the potential to influence maternal language behaviours in the home and promote mothers' active engagement in the development of their children's communication skills.

AIM

This paper explored maternal perceptions regarding the use of a language tracking wearable (Language Environment Analysis; LENA) device and a parent education smartphone application in an 8-week trial with their young children.

METHODS

Mother/child dyads were enrolled in a feasibility trial designed to obtain objective auditory and linguistic data from each child's naturalistic settings (Control Condition), provide feedback to mothers about their child's home language environment (LENA Feedback Condition), and to explore effectiveness of an app designed to promote meaningful parent/child interactions during daily routines (LENA Feedback and App Condition).

RESULTS AND DISCUSSION

The majority of mothers (80%) who participated in the trial reported a preference for using the mobile app and/or LENA technology again. Maternal responses during this pilot informed the design of an ongoing, prospective language intervention study for parents and their young children with significant hearing loss.

Listening to the student voice to improve educational software

Academics often develop software for teaching and learning purposes with the best of intentions, only to be disappointed by the low acceptance rate of the software by their students once it is implemented. In this study, the focus is on software that was designed to enable veterinary students to record their clinical skills. A pilot of the software clearly showed that the program had not been received as well as had been anticipated, and therefore the researchers used a group interview and a questionnaire with closed-ended and open-ended questions to obtain the students' feedback. The open-ended questions were analysed with conceptual content analysis, and themes were identified. Students made valuable suggestions about what they regarded as important considerations when a new software program is introduced. The most important lesson learnt was that students cannot always predict their needs accurately if they are asked for input prior to the development of software. For that reason student input should be obtained on a continuous and regular basis throughout the design and development phases.

AIM - Agile Instrumented Monitoring for Improving User Experience of Participation in HealthIT Development

Participation of healthcare professionals in information technology development has emerged as an important challenge. As end-users, the professionals are willing to participate in the development activities, but their experiences on the current methods of participation remain mostly negative. There is lack of applicable methods for meeting the needs of agile development approach and scaling up to the largest implementation projects, while maintaining the interest of the professional users to participate in development activities and keeping up their ability to continue working in a productive manner. In this paper, we describe the Agile Instrumented Monitoring as a methodology, based on the methods of instrumented usability evaluation, for improving user experience in HealthIT development. The contribution of the proposed methodology is analyzed in relation to activities of whole iteration cycle and chosen usability evaluation methods, while the user experience of participation is addressed regarding healthcare professionals. Prospective weak and strong market tests for AIM are discussed in the conclusions for future work.

User Experience and Care Integration in Transitional Care for Older People From Hospital to Home: A Meta-Synthesis

This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.

Harm Reduction From Below: On Sharing and Caring in Drug Use

This article focuses on how recreational drug users in the Netherlands and in online communities navigate the risks and reduce the harms they associate with psychoactive drug use. To do so, we examined the protective practices they invent, use, and share with their immediate peers and with larger drug experimenting communities online. The labor involved in protective practices and that which ultimately informs harm reduction from below follows three interrelated trajectories: (1) the handling and sharing of drugs to facilitate hassle-free drug use, (2) creating pleasant and friendly spaces that we highlight under the practices of drug use attunements, and (3) the seeking and sharing of information in practices to spread the good high. We focus not only on users’ concerns but also on how these concerns shape their approach to drugs, what young people do to navigate uncertainties, and how they reach out to and create different sources of knowledge to minimize adversities and to improve highs. Harm reduction from below, we argue, can best be seen in the practices of sharing around drug use and in the caring for the larger community of drug-using peers.

Older Cancer Patients' User Experiences With Web-Based Health Information Tools: A Think-Aloud Study

Background

Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information.

Objective

This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools.

Methods

We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools.

Results

Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it.

Conclusions

Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients.

User Experience May be Producing Greater Heart Rate Variability than Motor Imagery Related Control Tasks during the User-System Adaptation in Brain-Computer Interfaces

Brain-computer interface (BCI) is technology that is developing fast, but it remains inaccurate, unreliable and slow due to the difficulty to obtain precise information from the brain. Consequently, the involvement of other biosignals to decode the user control tasks has risen in importance. A traditional way to operate a BCI system is via motor imagery (MI) tasks. As imaginary movements activate similar cortical structures and vegetative mechanisms as a voluntary movement does, heart rate variability (HRV) has been proposed as a parameter to improve the detection of MI related control tasks. However, HR is very susceptible to body needs and environmental demands, and as BCI systems require high levels of attention, perceptual processing and mental workload, it is important to assess the practical effectiveness of HRV. The present study aimed to determine if brain and heart electrical signals (HRV) are modulated by MI activity used to control a BCI system, or if HRV is modulated by the user perceptions and responses that result from the operation of a BCI system (i.e., user experience). For this purpose, a database of 11 participants who were exposed to eight different situations was used. The sensory-cognitive load (intake and rejection tasks) was controlled in those situations. Two electrophysiological signals were utilized: electroencephalography and electrocardiography. From those biosignals, event-related (de-)synchronization maps and event-related HR changes were respectively estimated. The maps and the HR changes were cross-correlated in order to verify if both biosignals were modulated due to MI activity. The results suggest that HR varies according to the experience undergone by the user in a BCI working environment, and not because of the MI activity used to operate the system.

Engaging technology-resistant elderly people: Empirical evidence from an ICT-enabled social environment

This paper presents a qualitative investigation on user reactions, opinions, and sentiments about a TV-based technological solution developed within the EasyReach Project of the EU Ambient Assisted Living Joint Program to promote social interaction of less educated elderly people, that is, those individuals who, because of poor scholarization, low income, and, possibly, linguistic barriers, still find it difficult to use computers in order to improve their socialization. Experimental data were collected by extensive trials involving 40 real-end users. A methodology called "scenario engagement" was applied to get participants engaged in a live demonstration with the mediation of a facilitator who assisted elderly people to interact with the system. Results point out that the system can be effectively employed to foster social interaction, particularly when it is introduced in a collective use environment (e.g., Senior Center). Although the focus of the investigation was on information and communication technology-enabled social environments, the end users themselves strongly suggested to include in future system releases extra functions considered as essential opportunities for their potential digital lives: that is, medical or health services and bridges toward public administration.

CDS, UX, and System Redesign - Promising Techniques and Tools to Bridge the Evidence Gap

Introduction:

In this special issue of eGEMs, we explore the struggles related to bringing evidence into day-to-day practice, what I define as the “evidence gap.” We are all aware of high quality evidence in the form of guidelines, randomized clinical trials for treatments and diagnostic tests, and clinical prediction rules, which are all readily available online. We also know that electronic health records (EHRs) are now ubiquitous in health care and in most practices across the country. How we marry this high quality evidence and the practice of medicine through effective decision support is a major challenge.

About the Issue:

All of the articles in this issue explore, in some fashion, CDS systems and how we can best bring providers and their work environment to the evidence. We are at the very early stages of the science of usability. Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice. While the featured examples, techniques, and tools in the special issue are a promising start to improving usability and CDS, many of the papers highlight current gaps in knowledge and a great need for generalizable approaches. The great promise is for “learning” approaches to generate new evidence and to integrate this evidence in reliable, patient-centered ways at scale using new technology. Closing the evidence gap is a real possibility, but only if the community works together to innovate and invest in research on the best ways to disseminate, communicate, and implement evidence in practice.

Usability, learnability and performance evaluation of Intelligent Research and Intervention Software: A delivery platform for eHealth interventions

Evaluation of an eHealth platform, Intelligent Research and Intervention Software was undertaken via cross-sectional survey of staff users and application performance monitoring. The platform is used to deliver psychosocial interventions across a range of clinical contexts, project scopes, and delivery modalities (e.g. hybrid telehealth, fully online self-managed, randomized control trials, and clinical service delivery). Intelligent Research and Intervention Software supports persuasive technology elements (e.g. tailoring, reminders, and personalization) as well as staff management tools. Results from the System Usability Scale involving 30 Staff and Administrative users across multiple projects were positive with overall mean score of 70 ("Acceptable"). The mean score for "Usability" sub-scale was 82 and for "Learnability" sub-scale 61. There were no significant differences in perceptions of usability across user groups or levels of experience. Application performance management analytics (e.g. Application Performance Index scores) across two test sites indicate the software platform is robust and reliable when compared to industry standards. Intelligent Research and Intervention Software is successfully operating as a flexible platform for creating, delivering, and evaluating eHealth interventions.

Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial

BACKGROUND

Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients' compliance with self-care, although the results are still contradictory.

OBJECTIVE

A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization.

METHODS

HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients' clinical status, use of health care resources, adherence, and user experience from the patients' and the health care professionals' perspective were studied.

RESULTS

Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients' clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study.

CONCLUSIONS

Home telemonitoring did not reduce the number of patients' HF-related hospital days and did not improve the patients' clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z).

Help-Seeking Experiences of Youth with Suicidal Ideations

Approximately 28 percent of Canadians begin to experience a mental health issue during their youth. In this article, we explore patients' perceptions of their mental healthcare experiences within a sample of youth who reported anxiety or depressive symptoms and past suicidal ideations. The study data is taken from in-depth interviews with 23 youth in British Columbia. Interview topics included support systems, help-seeking behavior and healthcare experiences. Our findings indicate that participant experiences were most positive when experiences were neither dismissive nor stigmatizing. Important factors for participants were respect, acknowledgement, information and choice. Our results generated the concept that treatment perceptions for youth with suicidal behaviours can be placed on a theoretical spectrum, which may be a useful tool for self reflection for those who support individuals with mental health conditions professionally or personally.

Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults

Background

Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population.

Objective

This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting.

Methods

A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit.

Results

Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants’ comments were addressed to improve the site’s senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends.

Conclusions

Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users’ experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway.

Modifying action sounds influences people's emotional responses and bodily sensations

We report an experiment designed to investigate the effect of modifying the sound of high-heeled shoes on women's self-reported valence, arousal, and dominance scores, as well as any changes to a variety of measures of bodily sensation. We also assessed whether self-evaluated personality traits and the enjoyment associated with wearing heels were correlated with these effects. Forty-eight women walked down a “virtual runway” while listening to four interaction sounds (leather- and polypropylene-soled high-heeled shoes contacting ceramic flooring or carpet). Analysis of the questionnaires that the participants completed indicated that the type of sonic interaction impacted valence, arousal, and dominance scores, as well as the evaluated bodily sensations. There were also correlations between these scores and both self-evaluated personality traits and the reported enjoyment associated with wearing high heels. These results demonstrate the effect that the sound of a woman's physical interaction with the environment can have, especially when her contact with the ground while walking makes a louder sound. More generally, these results demonstrate that the manipulation of product extrinsic sounds can modify people's evaluation of their emotional outcomes (valence, arousal, and dominance), as well as their bodily sensations.

Exploring the meaning of a new assistive technology device for older individuals

Researching the outcomes of assistive technology devices (ATDs) for older clients is important to facilitate clinical decision-making. However, to understand the outcomes associated with ATDs, one must investigate the users' experiences and acknowledge the user as an active participant in diverse social contexts.

PURPOSE

To enhance understanding of the users' perspective regarding ATDs, this study aimed to investigate the meaning of the ATD for older individuals still living in their home environment.

METHODS

To provide descriptions of ATD experiences, older individuals who received a new ATD to compensate for their challenges in moving around, assist in self-care or both were recruited for the study. Participants were interviewed twice, with a few months between interviews, about their experience in using their new ATD. The interview transcripts were analyzed in a hermeneutical-phenomenological research approach.

RESULTS

The analysis revealed three recurring themes associated with the description of ATD experiences: "enabling performance and choice", "transformation from requiring assistance to assisting others", and "preparing for the future".

CONCLUSION

The results show that ATDs are used to enhance competence, mastery, control, self-worth, hope, and preparedness. The ATD service delivery should be client-centered and the client should be acknowledged as an active participant in producing change.

Power mobility with collision avoidance for older adults: user, caregiver, and prescriber perspectives

Collision avoidance technology has the capacity to facilitate safer mobility among older power mobility users with physical, sensory, and cognitive impairments, thus enabling independence for more users. Little is known about consumers' perceptions of collision avoidance. This article draws on interviews (29 users, 5 caregivers, and 10 prescribers) to examine views on design and utilization of this technology. Data analysis identified three themes: "useful situations or contexts," "technology design issues and real-life application," and "appropriateness of collision avoidance technology for a variety of users." Findings support ongoing development of collision avoidance for older adult users. The majority of participants supported the technology and felt that it might benefit current users and users with visual impairments, but might be unsuitable for people with significant cognitive impairments. Some participants voiced concerns regarding the risk for injury with power mobility use and some identified situations where collision avoidance might be beneficial (driving backward, avoiding dynamic obstacles, negotiating outdoor barriers, and learning power mobility use). Design issues include the need for context awareness, reliability, and user interface specifications. User desire to maintain driving autonomy supports development of collaboratively controlled systems. This research lays the groundwork for future development by illustrating consumer requirements for this technology.

Mobile mental wellness training for stress management: feasibility and design implications based on a one-month field study

Background

Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens.

Objective

The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management.

Methods

Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva.

Results

Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems.

Conclusions

A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection.

A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression

BACKGROUND

Evidence suggests that Internet-delivered cognitive behavioral therapy (CBT) may be as effective as face-to-face delivery for depression, but attrition and engagement rates remain a challenge.

OBJECTIVE

This service-based study aimed to evaluate an online, therapist-supported, CBT-based program for depression. The program was specifically designed to address engagement issues, most notably by integrating online therapist support and communication within the platform.

METHODS

Participants were 80 adults who were registered university students. Participants used the modular online program over 8 weeks, supported by a therapist. Engagement information was gathered automatically by the online system, and analyzed for all participants. Severity of participants' self-reported symptoms of depression were assessed preintervention and postintervention using the Beck Depression Inventory-II (BDI-II). Postintervention measures were completed by 53 participants.

RESULTS

A high level of engagement was observed compared to a previous study within the same service, along with extensive use of a range of program features. A statistically significant (P<.001) decrease in self-reported depressive symptomatology from preintervention (mean BDI-II 25.47) to postintervention (mean BDI-II 15.53) with a large effect size (d=1.17) was also observed.

CONCLUSIONS

The results indicate the potential of unintrusive and easily provided online support to enhance engagement with online interventions. The system described in the paper also illustrates how such online support can be tightly integrated with interactive online programs by using a range of design strategies intended to improve the user experience.

Debunking health IT usability myths

Poor usability is a threat to patient safety and linked to productivity loss, workflow disruption, user frustration, sub-optimal product use and system de-installations. Although usability is receiving more attention nationally and internationally, myths about usability persist. This editorial debunks five common myths about usability (1) usability only concerns the look and feel of a product and is, therefore, only a minor concern, (2) usability is not measurable, (3) usability stifles innovation, (4) vendors are solely responsible for product usability, and (5) usability methods are not practical for use in healthcare.