Using Human-Centred Design to Codesign Patient Engagement Tools With a Patient Advisory Council: Successes and Challenges

BACKGROUND

Co-build is one of the four pillars of the Patient Engagement Framework from the Canadian Institutes of Health Research Strategy for Patient Oriented Research. Collaborating with Patient Research Partners (PRPs) using co-build approaches can enhance the applicability of healthcare tools produced. Human Centred Design (HCD), a problem-solving methodology focused on creating functional solutions for users, offers a promising approach to co-building patient engagement tools.

OBJECTIVE

To describe the process of using a HCD approach to co-build patient engagement tools with PRPs and to identify successes and challenges encountered.

METHODS

A HCD working group was formed from a Patient Advisory Council (PAC) that supports a research program to optimize laboratory test ordering in hospitalized patients. The HCD working group included nine PRPs, two patient engagement team members, and a HCD specialist. The working group employed the Double Diamond 4D design methodology: Discover, Define, Design, and Deliver, along with patient engagement principles of mutual respect, inclusiveness, support, and co-build. At the conclusion of the HCD process, we conducted a semi-structured debrief session to obtain perspectives on challenges and successes from all working group members. These were then summarized and collated iteratively with feedback from the group members.

RESULTS

The working group met 31 times in 12 months and co-developed three patient engagement tools (an infographic, a video, and a website) to educate and engage hospitalized patients about the bloodwork process. HCD working group members valued the diverse and inclusive environment within the group, the available enrichment opportunities in HCD and qualitative research, and presence of patient engagement team members. Challenges noted included delays in timelines due to difficulties with consensus-building and redundancy in discussion topics.

CONCLUSION

HCD approaches can be effectively combined with the principles of patient engagement to facilitate co-building with PRPs in healthcare. Future research is required to further the evidence for these strategies and their application in co-building processes, including use of clear project mapping and timelines and transparent consensus-building approaches.

PATIENT OR PUBLIC CONTRIBUTION

A PAC that consisted of nine PRPs guided this study. PRPs collaborated throughout the study. The current six PRPs were involved in the decision to write and are co-authors on this manuscript. PAC members had participated equally in the conduct of a prior qualitative study to understand patient needs about bloodwork processes in hospitals. With the guidance of a HCD specialist, PRPs contributed to decisions on content, wording, and imagery for the tools. The PAC members are currently collaborating on a study to implement these tools in hospitals and to evaluate the utility from a patient perspective.

The Influence of Patient-Provider Communication on Self-Management Among Patients With Chronic Illness: A Systematic Mixed Studies Review

AIM

To explore the influence of patient-provider communication on patient self-management of chronic illness.

DESIGN

Systematic Mixed Studies Review.

DATA SOURCES

CINAHL, Google Scholar, EMBASE and PubMed were searched until March 2024.

METHODS

Employed a result-based convergent design and the Mixed Method Appraisal Tool to evaluate studies. Narrative analysis, quantitative studies and thematic analysis for qualitative studies and overall results.

RESULTS

Thirteen articles published between 2003 and 2023 were included. Chronic illnesses studied: diabetes, heart failure, hypertension, chronic obstructive pulmonary disease and asthma. Data synthesis yielded the overarching theme: adaptive interpersonal communication. An approach that adapts communication content to each patient's unique needs, employs verbal and nonverbal communication, builds a connection and establishes patient rapport.

CONCLUSION

Available evidence suggests that patient-provider communication influences chronic illness self-management. A provider's ability to adjust and tailor their communication style is an important factor in helping patients to achieve optimal self-management. Future research should explore this phenomenon in other common chronic illnesses not included in this review. Additionally, research on the patient's role in this process could help improve patient-provider communication.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Findings from this review have significant implications for shared and participatory decision making, where patients and providers collaborate to develop plans of care for patients to achieve optimal self-management. Additionally, this review can contribute to the development of educational content and communication strategies for nurses and all healthcare professionals caring for patients with chronic illnesses.

IMPACT

This is the first mixed studies systematic review to describe the influence patient-provider communication on patient self-management of chronic illness. These findings consolidate existing evidence, providing a pathway for practical application to clinical practice and the potential to significantly impact the delivery of patient-centred care and healthcare quality.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Pathways of how health literacy and social support are associated with health outcomes in 17 European countries: Results of mediation analyses

OBJECTIVES

To estimate and compare (1) how social support (SS) acts as a mediator for the association between health literacy (HL) and health outcomes, and (2) how HL acts as a mediator for the association between SS and health outcomes.

STUDY DESIGN

Mediation analyses.

METHODS

Data from the Health Literacy Survey 2019 (HLS19) were analyzed including 42,445 participants in 17 European countries. Four mediation models were tested with two health outcomes: self-reported health (SRH) and health-related limitations (Global Activity Limitations Indicator, GALI). In two models, SS was the mediator between HL and SRH and in the other two models HL was the mediator between SS and GALI.

RESULTS

SS is a significant mediator of the association between HL and SRH in all countries and between HL and GALI in eight countries. Up to 25-30 % of the total effect was mediated by SS. In addition, HL is a significant mediator of the association between SS and SRH in 15 countries and between SS and GALI in eight countries. With regard to SRH, SS may be regarded as the more relevant mediator between HL and SRH; whereas for GALI, HL can be considered the mediating factor between SS and GALI, as the proportions mediated were higher in the respective models in most countries.

CONCLUSIONS

Both HL and SS may serve as significant mediators in the models of both health measures, but to different extents. Planning interventions to mutually improve SS and HL may help communities improve health.

Evaluating Perceptions of the CANreduce 2.0 eHealth Intervention for Cannabis Use: Focus Group Study

BACKGROUND

Cannabis is the most widely used illicit drug, and admissions for cannabis use disorders (CUDs) are increasing globally, posing a significant public health challenge. Despite its negative consequences, a substantial proportion of individuals with problematic use do not seek treatment. In recent years, digital health interventions (DHIs) have emerged as accessible and cost-effective solutions, empowering users to manage their health care. CANreduce is one such eHealth intervention that has demonstrated effectiveness in reducing cannabis use (CU); however, its suboptimal adherence rates underscore the need for strategies to enhance user engagement and motivation.

OBJECTIVE

This study aims to improve the effectiveness, adherence, and user experience of the Spanish version of CANreduce 2.0 by employing focus groups (FGs) within a user-centered design approach that actively involves both users and professionals.

METHODS

Separate FGs were conducted for users and professionals, involving a total of 10 participants. Users were recruited from individuals registered on the CANreduce 2.0 platform and active cannabis users, while professionals comprised addiction specialists familiar with the platform. Each session was held remotely and moderated by 2 interviewers following a semistructured script. Qualitative analysis of the transcripts was performed using MAXQDA software and content analysis methodology to identify key themes related to the acceptability, usability, and utility of CANreduce 2.0.

RESULTS

The qualitative analysis identified 3 main themes, encompassing 15 subcodes. Within the "motivation and awareness" theme, both users (n=6, mean age 31.8 years, SD 4.1 years) and professionals (n=4, mean age 37.25 years, SD 1.71 years) frequently discussed the importance of "motivation" and "problem awareness" as crucial for the success of CANreduce 2.0. In the "guidance and use" theme, the subcode "complement to face-to-face therapy" was the most emphasized. Professionals supported CANreduce 2.0 as a valuable adjunct to in-person therapy, serving as both an educational and monitoring tool, with no objections raised by either group. Lastly, within the "content and design" theme, "information," "small achievements," and "personalized content" emerged as key areas for improvement, highlighting the need to enhance motivation and adherence through gamification and tailored content.

CONCLUSIONS

Personalization, robust motivational strategies, and an engaging, interactive design are essential for the success of DHIs, particularly in addiction treatment. Collaboration among technology developers, health care professionals, and users should be central to the development process, fostering the cocreation of practical and effective solutions that are responsive to the needs of those seeking treatment. This approach ensures that DHIs are not only functional but also widely accepted and impactful. Insights from this study will inform the ongoing refinement of CANreduce 2.0, enhancing its relevance and effectiveness in addressing CU.

Improving lung cancer decision-making using a conversation tool (iDECIDE): a stepped wedge pragmatic clinical trial

Lung cancer is a leading cause of cancer-related mortality. However, few treatment decision-making resources exist. In this study, we evaluate a low literacy lung cancer treatment conversation tool to enhance shared decision-making (SDM). The Improving Decision-Making Encounters in Lung Cancer (iDECIDE) pragmatic, stepped-wedge cluster randomized trial evaluates the effectiveness of a conversation tool for patients with lung cancer. Our primary outcome is SDM, a multifaceted outcome consisting of decisional conflict (DCS), decision self-efficacy (DSES), satisfaction with communication (COMRADE), and assessment of lung cancer knowledge. SDM is assessed 2 weeks, 3 months, and 6 months after patients' treatment decision-making encounter. Each measure within the primary outcome will be assessed separately. We began recruiting patients in 2022 from four health care centers and will conduct outcome assessments at four timepoints over 6 months. We aim to recruit 230 patients by 2025. We seek to address the gaps in NSCLC decision-making support using an innovative trial design to determine whether our conversation tool improves SDM and other patient-centered outcomes.Clinical Trial Registration: NCT05407168 (clinicaltrials.gov).

Examining Challenges to Co-Design Digital Health Interventions With End Users: Systematic Review

BACKGROUND

Digital health interventions (DHIs) are changing the dynamic of health care by providing personalized, private, and instantaneous solutions to end users. However, the explosion of digital health has been fraught with challenges. The approach to co-design with end users varies across a diverse domain of stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital stakeholders (ie, user experience and retention) and health stakeholders (ie, safety and efficacy). Several methodologies and frameworks are being implemented to address this challenge to varying degrees of success.

OBJECTIVE

We aimed to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken to identify the key problem areas at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users.

METHODS

We conducted a systematic search of key databases for co-design studies involving end users in DHIs. Searches were divided into 3 relevant streams: health behavior, user experience, and digital methodologies and frameworks. The eligibility criteria were guided by the PerSPEcTiF framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In line with this framework, studies were included in this review that (1) address research on DHIs; (2) focus on interaction and co-design with end users; (3) explain results such that uptake, effectiveness, satisfaction, and health outcomes are discernible, positively or negatively; and (4) describe actionable procedures for better DHI design. The search was conducted in a diverse group of 6 bibliographical databases from January 2015 to May 2024: PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Institute of Electrical and Electronics Engineers Xplore, and Scopus. From the 13,961 studies initially screened for titles and abstracts, 489 (3.6%) were eligible for a full-text screening, of which 171 (1.2%) studies matched the inclusion criteria and were included in a qualitative synthesis.

RESULTS

Of the 171 studies analyzed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies. These studies identified several core themes when co-designing with end users: advancements, which included participatory co-design; challenges, which included participatory co-design, environment and context, testing, and cost and scale; and gaps, which included a pragmatic hybridized framework and industry implementability.

CONCLUSIONS

This research supports a pragmatic shift toward using mixed methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of digital health co-designers with the pragmatism of Agile design methodology and the rigor of health care metrics.

TRIAL REGISTRATION

PROSPERO CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238164.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/28083.

Employment Trajectories of Recently Certified Peer Support Specialists: A Longitudinal Qualitative Analysis

BACKGROUND

Recent work has highlighted the challenges and benefits that certified peer specialists (CPSs) experience in the workforce. While their work can lead to personal fulfillment and financial independence for CPSs, and improved mental health and substance use recovery outcomes for their clients, little is known about CPS employment trajectories or the circumstances that impact their early-career workforce involvement over time.

METHODS

This study used within- and across-case analyses of longitudinal data from qualitative interviews with 13 CPS that participated in a multistate, 3 year observational prospective cohort study of CPS graduates to explore employment changes and circumstances that led to these transitions. Qualitative results were organized according to whether cases were "employed as a CPS at follow-up" (N = 5) or "not employed as CPS at follow-up" (N = 8).

RESULTS

Participants "employed as a CPS" at follow-up held various positions following certification, and they shared a sense of optimism about their future work. At the second interview, most remained in the same positions they held at baseline and described personal fulfillment and a supportive work environment as reasons for remaining. Participants who were "not employed as a CPS" at follow-up were also not employed as a CPS at their baseline interview but aspired to pursue future CPS work. At their second interview, many remained unemployed due to poor health and disability, or described past traumatic experiences, stress, and burnout related to being a CPS as reasons for leaving the CPS work force. All participants were challenged to find work as a CPS at various moments in their trajectories.

CONCLUSION

Results indicate that securing employment as a CPS was challenging for participants. Findings are discussed with implications for supporting CPS job seeking, well-being, and workforce retention.

Development of an Online Scenario-Based Tool to Enable Research Participation and Public Engagement in Cystic Fibrosis Newborn Screening: Mixed Methods Study

BACKGROUND

Newborn screening aims to identify babies affected by rare but serious genetic conditions. As technology advances, there is the potential to expand the newborn screening program following evaluation of the likely benefits and drawbacks. To inform these decisions, it is important to consider the family experience of screening and the views of the public. Engaging in public dialogue can be difficult. The conditions, screening processes, and associated moral and ethical considerations are complex.

OBJECTIVE

This study aims to develop a stand-alone online resource to enable a range of stakeholders to understand whether and how next-generation sequencing should be incorporated into the CF screening algorithm.

METHODS

Around 4 development workshops with policymakers, parents, and other stakeholders informed the design of an interactive activity, including the structure, content, and questions posed. Stakeholders were recruited to take part in the development workshops via purposeful and snowball sampling methods to achieve a diversity of views across roles and organizations, with email invitations sent to representative individuals with lived, clinical, and academic experience related to CF and screening. Ten stakeholders informed the development process including those with lived experience of CF (2/10, 20%), clinicians (2/10, 20%), and representatives from relevant government, charity, and research organizations (6/10, 60%). Vignettes constructed using interview data and translated into scripts were recorded to provide short films to represent and provoke consideration of families' experiences. Participants were recruited (n=6, adults older than 18 years) to test the resulting resource. Study advertisements were circulated via physical posters and digital newsletters to recruit participants who self-identified as having a reading difficulty or having English as a second language.

RESULTS

An open access online resource, "Cystic Fibrosis Newborn Screening: You Decide," was developed and usability and acceptability tested to provide the "user" (eg, a parent, the general public, or a health care professional) with an interactive scenario-based presentation of the potential outcomes of extended genetic testing, allowing them to visualize the impact on families. This included a learning workbook that explains key concepts and processes. The resulting tool facilitates public engagement with and understanding of complex genetic and screening concepts.

CONCLUSIONS

Online resources such as the one developed during this work have the potential to help people form considered views and facilitate access to the perspectives of parents and the wider public on genetic testing. These may be otherwise difficult to obtain but are of importance to health care professionals and policymakers.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06299566; https://clinicaltrials.gov/study/NCT06299566.

Initial psychotropic prescriptions and symptom associations in first-visit patients with major depressive disorder: A single-center cross-sectional study

AIM

There are limited reports regarding psychotropic prescriptions in first-visit patients with major depressive disorder (MDD). The objective of this study is to clarify the prescription patterns of psychotropics and their association with symptoms among first-visit patients with MDD in Japan.

METHODS

In this cross-sectional analysis, we examined 376 first-visit patients diagnosed with MDD. Depressive symptoms were evaluated using the Quick Inventory of Depressive Symptomatology Japanese version (QIDS-J). To assess personality traits, we administered the Japanese version of the Ten Item Personality Inventory (TIPI-J), and psychotic symptoms were evaluated using the PRIME Screen-Revised (PS-J).

RESULTS

Among the first-visit patients with MDD, 31.4% (118/376) were prescribed antidepressants, and 18.1% (68/376) received benzodiazepines. Overall, 40.2% (151/376) of the patients were prescribed at least one psychotropic medication. In a multivariate logistic regression model using the forced entry method, missing data on educational attainment and the view of myself domain of the QIDS-J were negatively associated, while the concentration/decision-making domain of the QIDS-J was positively associated with antidepressant prescription.

CONCLUSION

More than half of the first-visit patients did not receive any psychotropic medication. Psychiatrists appear to consider specific symptoms and personality traits when deciding whether to prescribe medications, which may also be influenced by patient preferences. Further studies, including longitudinal analyses, are needed to explore these associations in more detail.

Allies not enemies-creating a more empathetic and uplifting patient experience through technology and art

OBJECTIVE

To understand whether art and technology (mainly conversational agents) may help oncology patients to experience a more humanized journey.

METHODS

This narrative review encompasses a comprehensive examination of the existing literature in this field by a multicenter, multidisciplinary, and multiprofessional team aiming to analyze the current developments and potential future directions of using art and technology for patient engagement.

RESULTS

We identified three major themes of patient engagement with art and three major themes of patient engagement with technologies. Two real-case scenarios are reported from our experience to practically envision how findings from the literature can be implemented in different contexts.

CONCLUSION

Art therapy and technologies can be ancillary supports for healthcare professionals but are not substitutive of their expertise and responsibilities. Such tools may help to convey a more empathetic and uplifting patient journey if properly integrated within clinical practice, whereby the humanistic touch of medicine remains pivotal.

Implementing Oncologic Nursing Care Plans in Electronic Health Records With Two Taxonomies: A Pilot Study

BACKGROUND

Nursing care plans document the nursing process, displaying actions, and illustrating expected outcomes. Their integration into electronic health records (EHRs) is critical for accurate documentation, enhanced by standardized nursing terminologies that promote communication, critical reasoning, and patient safety through consistent language for information.

OBJECTIVE

This study aimed to identify appropriate standardized nursing terminology tailored to the context of a Northern Italian Cancer Center and research facility for developing nursing care plans and starting their integration into institutional EHRs.

METHODS

Participatory action research was conducted to select proper terminology respecting the oncological setting, develop nursing care plans, and start their implementation in EHRs. The nursing team of a pilot ward collaborated closely with the researchers as coresearchers. Care plan samples were presented using the North American Nursing Diagnosis Association-International Nursing Intervention Classification, Nursing Outcomes Classification, and International Classification for Nursing Practice (ICNP) in the test section of the EHRs to gather nurses' preferences. Quantitative data collection, focus groups, and survey analyses were conducted.

RESULTS

Nurses chose the ICNP for its flexibility but sought better methods to define patient severity in assessments and outcomes. They suggested incorporating the Common Terminology Criteria for Adverse Events to enable context-sensitive care plans.

CONCLUSIONS

End-user involvement is essential for developing EHRs, enhancing system usability, and reducing implementation resistance. Including nurses in management decisions empowers them, and improves care quality.

Quality of Life, Anxiety and Depression after Acute Type B Aortic Dissection

BACKGROUND

Type B aortic dissection (TBAD) is an acute cardiovascular emergency but also a condition warranting life-long surveillance. The long-term consequences on physical and mental well-being are largely unknown. The primary aim was to analyze self-reported Health-Related Quality of Life (HRQoL) and symptoms of anxiety and depression in patients with chronic TBAD. The secondary aim was to describe changes in physical and sexual activity following TBAD.

METHODS

This is a population-based cross-sectional survey study. All patients hospitalised with acute TBAD in Stockholm County 2017-2021, and alive on March 31, 2023, were invited to answer questionnaires on HRQoL (EQ-5D-5L, EQ VAS), anxiety (HADS-A), depression (HADS-D), physical activity (SED-GIH) and sexual activity (men: IIEF-5, women: FSFI-6).

RESULTS

Out of 88 invited TBAD patients, 49 (56%) participated. Median age was 72 years (IQR 62-81) and 41% were women. The median time from the acute event to the questionnaire response was 42 months (IQR 27-60). The mean EQ VAS score was 62. The largest negative impacts on the participants health status were seen in the "pain/discomfort" (66% of participants), "anxiety/depression" (53%) and "Mobility" (45%) domains. Based on the HADS questionnaire, 20% had a score indicating symptoms of depression, whereas 14% had a score indicating symptoms of anxiety. Overall, 69% reported a change in physical activity and 42% reported a change in sexual activity.

CONCLUSIONS

TBAD patients reported substantially reduced mental and physical well-being several years after the acute event. This new and important finding should be considered by health-care providers and in future follow-up protocols.

Development and Implementation of MyPainHub, a Web-Based Resource for People With Musculoskeletal Conditions and Their Health Care Professionals: Mixed Methods Study

BACKGROUND

Musculoskeletal conditions, including low back pain (LBP), neck pain, and knee osteoarthritis, are the greatest contributors to years lived with disability worldwide. Resources aiming to aid both patients and health care professionals (HCPs) exist but are poorly implemented and adopted.

OBJECTIVE

We aimed to develop and implement MyPainHub, an evidence-based web-based resource designed to provide comprehensive, credible and accessible information for people with, and HCPs who manage, common musculoskeletal conditions.

METHODS

This mixed methods study adhered to the New South Wales Translational Research Framework and was evaluated against the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Consultation with key stakeholders (patients, HCPs, researchers, industry, consumer groups, and website developers) informed content, design, features, and functionality. Development then aimed to meet the identified need for a "one-stop shop"-a central location for information about common musculoskeletal conditions tailored to a person's condition and risk of poor outcomes. MyPainHub was then developed through an iterative process and implementation strategies were tailored to different health care settings. Quantitative and qualitative evaluation occurred with patients and HCPs.

RESULTS

In total, 127 stakeholders participated in the development phase; initial consultation with them led to embedding 2 validated screening tools (the Short Form Örebro Musculoskeletal Pain Screening Questionnaire and the Keele STarT MSK tool) in MyPainHub to guide information tailoring for patients based on risk of poor outcomes. Development occurred in parallel and feedback from stakeholders informed design and content including structure, functionality, and phrasing and images to use to emphasize key points. Consultation resulted in information for patients being categorized using key guideline-based messages (general information, your pathway, exercise, and imaging) while information for clinicians was categorized into assessment, management, and prognosis. Implementation occurred in different health care settings with the most effective strategies being interactive education via webinars and workshops. The evaluation phase involved web-based questionnaires (patients: n=44; HCPs: n=29) and focus groups (patients: n=6; HCPs: n=6). Patients and HCPs found MyPainHub user-friendly, acceptable, credible, and potentially able to support self-management. Patient participants identified areas for improvement such as including more specific information on preventative measures and pain relief options. Despite positive feedback, only 35% (10/29) of HCPs used MyPainHub with their patients. HCP participants identified challenges including insufficient training and lack of familiarity with using web-based resources in existing clinical workflows. Following implementation, the information contained on MyPainHub changed knowledge and practice for some patients and HCPs.

CONCLUSIONS

Following extensive and iterative stakeholder engagement, MyPainHub was developed as an evidence-based web-based resource and perceived by patients and HCPs as user-friendly, credible, and acceptable. Active implementation strategies are required for adoption and implementation and greater training focusing on strategies to implement MyPainHub into clinical practice may be necessary.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619000871145; https://tinyurl.com/438kkyt3.

Patient partner engagement in the publication process: challenges and possible solutions

Patient engagement in research is gaining traction as an international standard, and often requirement, of many health research funding agencies. Drivers of this increase include patient interest, increased attention to and recognition of the value of patients' voices in research, and more patients leading or partnering in the conduct research. Patient engagement includes collaborating and providing insights into research question and study design, and may extend to the publication process. When patients contribute to publications, they can bring unique perspectives that may enhance the impact, reach, and utility of the research in real-world contexts. Currently, there is limited systematic guidance to support patient partners as they navigate this complex publication process. As a result, it can be difficult for patient partners to understand when and how they should be included as authors, how to collaborate in the writing process, and how to complete mandatory tasks during the submission process. In this paper, we review barriers and facilitators within existing publication practices and offer recommendations to ensure that the scientific publication process is more transparent and accessible for patient partners.

Digital Transformation in Patient Organizations: Interview and Focus Group Study

BACKGROUND

Patient organizations (POs) are an integral part of the health care landscape, serving as advocates and support systems for patients and their families. As the digitalization of health care accelerates, POs are challenged to adapt their diverse roles to digital formats. However, the extent and form of POs' digital adaptation and the challenges POs encounter in their digital transformation remain unexplored.

OBJECTIVE

This study aims to investigate the digital transformation processes within POs. We examined the types of digital activities and processes implemented, people involved in respective tasks, challenges encountered, and attitudes toward the digitalization of POs.

METHODS

The study was carried out by the multicenter interdisciplinary research network Pandora. We adopted a qualitative exploratory approach by conducting 37 semistructured interviews and 2 focus groups with representatives and members of POs in Germany. Results were obtained using a deductive-inductive approach based on a qualitative content analysis. Methods and results were reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist.

RESULTS

POs primarily apply basic digital tools to engage in communication, health education, and information dissemination. Some also develop specific mobile apps and collect health data through patient registries. Volunteers cover a considerable part of the workload. Sometimes, POs collaborate with external partners, such as health professionals or other nonprofit organizations. Furthermore, many (13/46, 28%) interviewees referred to the importance of involving members in digitalization efforts to better meet their needs. However, they described the actual practices used to involve members in, for example, developing digital services as limited, passive, or implicit. When evaluating digital transformation processes, representatives and members of POs expressed generally positive attitudes and acknowledged their potential to improve the accessibility of support services, management efficiency, and outreach. Still, resource constraints; the complexity of digital initiatives; and accessibility issues for certain demographic groups, especially older persons, were frequently mentioned as challenges. Several (15/46, 33%) interviewees highlighted POs' increasing responsibility to support their members' digital competencies and digital health literacy.

CONCLUSIONS

POs are actively involved in the digital transformation of health services. To navigate challenges and further shape and sustain digital activities and processes, POs may benefit from governance frameworks, that is, a clear plan outlining with whom, how, and with what objectives digital projects are being realized. Support from public, scientific, and policy institutions to enhance the process through training, mentorship, and fostering collaborative networks seems warranted.

ChatGPT 35 Better Improves Comprehensibility of English, Than Spanish, Generated Responses to Osteosarcoma Questions

BACKGROUND

Despite adequate discussion and counseling in the office, inadequate health literacy or language barriers may make it difficult to follow instructions from a physician and access necessary resources. This may negatively impact survival outcomes. Most healthcare materials are written at a 10th grade level, while many patients read at an 8th grade level. Hispanic Americans comprise about 25% of the US patient population, while only 6% of physicians identify as bilingual.

QUESTIONS/PURPOSE

(1) Does ChatGPT 3.5 provide appropriate responses to frequently asked patient questions that are sufficient for clinical practice and accurate in English and Spanish? (2) What is the comprehensibility of the responses provided by ChatGPT 3.5 and are these modifiable?

METHODS

Twenty frequently asked osteosarcoma patient questions, evaluated by two fellowship-trained musculoskeletal oncologists were input into ChatGPT 3.5. Responses were evaluated by two independent reviewers to assess appropriateness for clinical practice, and accuracy. Responses were graded using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level test (FKGL). The responses were then input into ChatGPT 3.5 for a second time with the following command "Make text easier to understand". The same method was done in Spanish.

RESULTS

All responses generated were appropriate for a patient-facing informational platform. There was no difference in the Flesch Reading Ease Score between English and Spanish responses before the modification (p = 0.307) and with the Flesch-Kincaid grade level (p = 0.294). After modification, there was a statistically significant difference in comprehensibility between English and Spanish responses (p = 0.003 and p = 0.011).

CONCLUSION

In both English and Spanish, none of the ChatGPT generated responses were found to be factually inaccurate. ChatGPT was able to modify responses upon follow-up with a simplified command. However, it was shown to be better at improving English responses than equivalent Spanish responses.

The correlation between social support, coping style, advance care planning readiness, and quality of life in patients with amyotrophic lateral sclerosis: a cross-sectional study

OBJECTIVE

The primary goal for clinical healthcare professionals is to enhance the quality of life (QOL) of patients with amyotrophic lateral sclerosis (ALS). This study aimed to explore the correlation between social support, coping style, advance care planning (ACP) readiness, and QOL in patients with ALS. We also sought to analyze the mediating effect of coping style and ACP readiness between social support and QOL, and to provide insights for developing targeted interventions to improve patients' QOL.

METHODS

A cross-sectional design was used, with participants recruited through convenience sampling in Tianjin, China. Statistical analysis included the t-test, analysis of variance, correlation analysis, and mediating effect analysis.

RESULTS

The study included 215 participants. The QOL of patients with ALS was at a medium level, with significant correlations between social support, coping style, ACP readiness, and QOL (all p < 0.01). The direct effect of social support on QOL was 0.403 (p = 0.018), accounting for 41.85% of the total effect. The total indirect effect of social support on QOL through coping style and ACP readiness was 0.560 (p < 0.001), accounting for 58.15% of the total effect. The chain mediating effect involving facing, avoiding, and ACP readiness accounted for 16.72%.

CONCLUSION

Social support directly influenced QOL and had an indirect impact through coping style and ACP readiness. Healthcare professionals can improve the QOL of patients with ALS by enhancing social support, disease-coping ability, and ACP readiness in clinical practice.

'Wisdom Is Knowledge Plus Experience': Qualitative Study of Lived Experience and Researcher Perspectives on Suicide Research Co-Production

The need for involvement of people with lived experience of suicide in the conduct of suicide research and intervention has been recognised in research and policy. However, there is limited understanding and guidance on how to support their genuine and safe engagement in suicide research. This qualitative study considered the perspectives of 19 people with lived experience of suicide, and 17 researchers engaged in suicide-related research to explore their needs, expectations and experience of co-produced suicide-related research. Data was collected between October and December 2020 via semi-structured interviews. Thematic analysis resulted in five themes: (1) towards co-production, (2) power imbalances, (3) heterogeneity of lived experience, (4) enhancing safety and (5) value of co-production. Participants considered lived experience involvement at all stages of research to improve research impact and outcomes. However, persisting power imbalances were experienced by participants and participatory approaches did not always align with existing research systems and organisational structures. Complexities identified by participants related to accommodating different skills, experiences and social identities of those with a lived experience perspective and balancing safeguarding principles with strength-based approaches that may capitalise on participants' existing strengths. Delphi guidelines developed from an associated consensus study on active involvement of people with lived experience of suicide in suicide research address some of the concerns mentioned by study participants and form a useful resource to guide future research endeavours.

Counseling in a different language: An analysis of experiences and resources in multilingual genetic counseling

This study set out to investigate the experiences of bilingual/multilingual genetic counselors in the United States and Canada who have counseled in a non-English language and characterize their training experiences to identify potential areas for improvement. A total of 32 bilingual and/or multilingual genetic counselors completed online surveys. Approximately 83% of participants typically counsel patients in languages for which they believe their proficiency is at least good without the participation of an interpreter. Challenges to providing language-concordant care include insufficient patient-facing translation tools/resources, with roughly half reporting they have created their own resources out of necessity. For training programs, there was a strong desire for more supervision in bilingual/multilingual genetic counseling students' non-English language during training to help foster genetics-related language skills development.

The implementation of design methodologies for supporting shared decision making in healthcare services: A systematic review

OBJECTIVES

This systematic review examines how design methodologies support Shared Decision Making (SDM), identifies the most suitable for future use, explores types of methodologies used, challenges faced, and the impact on patients, clinicians, and care pathways.

METHODS

Studies were searched on Medline, Web of Science, Scopus and grey literature (Google Scholar, CORDIS) up to July 2024, following PRISMA guidelines.

RESULTS

were analysed to identify patient involvement, design strategies, SDM solutions, and their impact on care paths, professionals, and patients.

RESULTS

Out of 2499 studies and 39 grey literature projects identified, 22 studies (reported in 35 publications) were selected, primarily from the USA and Europe (2015 onward). User-Centered Design predominated, involving health professionals more than patients. IPDAS standards were common. Evaluations showed improved patient experience and SDM role, with a potential increase in healthcare professionals' workload.

CONCLUSION

Although design methodologies are used in SDM implementation, improvement is needed. Service Design can enhance implementation by analysing the entire SDM process, while co-creative approaches develop patient-focused solutions that integrate smoothly into health professionals' workflows.

PRACTICAL IMPLICATIONS

Introducing SDM in healthcare is complex, but design methodologies can help by analysing stakeholder needs, providing a broader care path view, and facilitating SDM implementation.

The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment

BACKGROUND

Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability.

OBJECTIVE

Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs.

METHODS

Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles.

RESULTS

Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information.

CONCLUSIONS

Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners.

Peripheral Electrical Stimulation on Motor Function and Activities of Daily Living After Stroke: A Systematic Review and Network Meta-analysis

OBJECTIVE

To compare the effects of different peripheral electrical stimulation protocols and current frequencies for poststroke motor function and activities of daily living.

DATA SOURCES

Seven databases (PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-Fang Database, and Chinese Biomedical Database) were searched from inception to August 2024.

STUDY SELECTION

Two reviewers independently performed the literature selection. The included studies were randomized controlled trials providing peripheral electrical stimulation for patients with stroke.

DATA EXTRACTION

Two reviewers independently extracted data following a predeveloped Excel data collection sheet, including trial characteristics, intervention and comparator details, and outcome data. The risk of bias was evaluated by RoB2 tool, and the PRISMA guidelines were followed for reporting.

DATA SYNTHESIS

A total of 106 trials with 7513 participants were included. Meta-analysis showed that neuromuscular electrical stimulation (NMES) could be the optimal electrical stimulation protocol for improving the Fugl-Meyer Assessment score (standardized mean difference=1.67; 95% confidence interval [1.14-2.21]) and the modified Barthel Index score (standardized mean difference=1.73; 95% confidence interval [1.10-2.37]). The results showed that different frequencies of electrical stimulation ranked the top 5 in descending order for improving: (1) the Fugl-Meyer Assessment scores as follows: 20-30 Hz_NMES (surface under the cumulative ranking curve [SUCRA]=87.5%)>100 Hz_NMES (SUCRA=75.4%)>100 Hz_functional electrical stimulation (SUCRA=70.9%)>20/35 Hz_transcutaneous electrical acupoint stimulation (SUCRA=69.8%)>1-4 Hz_electrical acupuncture (SUCRA=69.6%) and (2) the modified Barthel Index scores as follows: 100 Hz_transcutaneous electrical nerve stimulation (SUCRA=77.3%)>5/15 Hz_NMES (SUCRA=68.3%)>100 Hz_transcutaneous electrical acupoint stimulation (SUCRA=65.6%)>35-50 Hz_functional electrical stimulation (SUCRA=64.8%)>1-4 Hz_electrical acupuncture (SUCRA=60.0%).

CONCLUSIONS

Adding electrical stimulation based on routine rehabilitation training can improve the motor dysfunction and activities of daily living of patients with stroke. Specifically, NMES with 20-30 Hz improves motor function best, whereas 100 Hz_transcutaneous electrical nerve stimulation improves activities of daily living best.

The use of coaching in stroke rehabilitation: a scoping review

PURPOSE

Stroke results in long-term impacts on a person's life requiring ongoing management after formal rehabilitation ends. Coaching can support people to build competencies and skills for managing health-related challenges and has the potential to support stroke survivors to continue achieving goals on their own following rehabilitation. This review sought to describe the research on coaching interventions for adults living with stroke.

MATERIALS AND METHODS

A scoping review to explore how coaching is defined and used in stroke rehabilitation intervention research. PubMed, CINAHL, Medline, and PsycINFO databases were searched using terms to represent coaching, rehabilitation practitioners, and stroke, the results were extracted into COVIDENCE. Data were described and synthesized to identify similarities and differences among coaching interventions.

RESULTS

Twenty-eight articles describing 15 interventions were included and categorized based on their focus as Health Coaching, Coaching for Exercise and Physical Activity, Coaching for Engagement in Activity or Participation, and Transition Coaching. Common elements of coaching interventions were goal setting, problem solving and education with emotional support being infrequent. Notably, coaching definitions and techniques were frequently not described.

CONCLUSIONS

Coaching in stroke rehabilitation is diverse but has common foci and elements. More research using clear descriptions of coaching is required.

Wearable Smartphone-Based Multisensory Feedback System for Torso Posture Correction: Iterative Design and Within-Subjects Study

BACKGROUND

The prevalence of stroke is high in both males and females, and it rises with age. Stroke often leads to sensor and motor issues, such as hemiparesis affecting one side of the body. Poststroke patients require torso stabilization exercises, but maintaining proper posture can be challenging due to their condition.

OBJECTIVE

Our goal was to develop the Postural SmartVest, an affordable wearable technology that leverages a smartphone's built-in accelerometer to monitor sagittal and frontal plane changes while providing visual, tactile, and auditory feedback to guide patients in achieving their best-at-the-time posture during rehabilitation.

METHODS

To design the Postural SmartVest, we conducted brainstorming sessions, therapist interviews, gathered requirements, and developed the first prototype. We used this initial prototype in a feasibility study with individuals without hemiparesis (n=40, average age 28.4). They used the prototype during 1-hour seated sessions. Their feedback led to a second prototype, which we used in a pilot study with a poststroke patient. After adjustments and a kinematic assessment using the Vicon Gait Plug-in system, the third version became the Postural SmartVest. We assessed the Postural SmartVest in a within-subject experiment with poststroke patients (n=40, average age 57.1) and therapists (n=20, average age 31.3) during rehabilitation sessions. Participants engaged in daily activities, including walking and upper limb exercises, without and with app feedback.

RESULTS

The Postural SmartVest comprises a modified off-the-shelf athletic lightweight compression tank top with a transparent pocket designed to hold a smartphone running a customizable Android app securely. This app continuously monitors sagittal and frontal plane changes using the built-in accelerometer sensor, providing multisensory feedback through audio, vibration, and color changes. Patients reported high ratings for weight, comfort, dimensions, effectiveness, ease of use, stability, durability, and ease of adjustment. Therapists noted a positive impact on rehabilitation sessions and expressed their willingness to recommend it. A 2-tailed t-test showed a significant difference (P<.001) between the number of the best-at-the-time posture positions patients could maintain in 2 stages, without feedback (mean 13.1, SD 7.12) and with feedback (mean 4.2, SD 3.97), demonstrating the effectiveness of the solution in improving posture awareness.

CONCLUSIONS

The Postural SmartVest aids therapists during poststroke rehabilitation sessions and assists patients in improving their posture during these sessions.

Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study

BACKGROUND

Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process.

OBJECTIVE

The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention.

METHODS

The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops.

RESULTS

Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed.

CONCLUSIONS

The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention.

Participant Contributions to Person-Generated Health Data Research Using Mobile Devices: Scoping Review

BACKGROUND

Mobile devices offer an emerging opportunity for research participants to contribute person-generated health data (PGHD). There is little guidance, however, on how to best report findings from studies leveraging those data. Thus, there is a need to characterize current reporting practices so as to better understand the potential implications for producing reproducible results.

OBJECTIVE

The primary objective of this scoping review was to characterize publications' reporting practices for research that collects PGHD using mobile devices.

METHODS

We comprehensively searched PubMed and screened the results. Qualifying publications were classified according to 6 dimensions-1 covering key bibliographic details (for all articles) and 5 covering reporting criteria considered necessary for reproducible and responsible research (ie, "participant," "data," "device," "study," and "ethics," for original research). For each of the 5 reporting dimensions, we also assessed reporting completeness.

RESULTS

Out of 3602 publications screened, 100 were included in this review. We observed a rapid increase in all publications from 2016 to 2021, with the largest contribution from US authors, with 1 exception, review articles. Few original research publications used crowdsourcing platforms (7%, 3/45). Among the original research publications that reported device ownership, most (75%, 21/28) reported using participant-owned devices for data collection (ie, a Bring-Your-Own-Device [BYOD] strategy). A significant deficiency in reporting completeness was observed for the "data" and "ethics" dimensions (5 reporting factors were missing in over half of the research publications). Reporting completeness for data ownership and participants' access to data after contribution worsened over time.

CONCLUSIONS

Our work depicts the reporting practices in publications about research involving PGHD from mobile devices. We found that very few papers reported crowdsourcing platforms for data collection. BYOD strategies are increasingly popular; this creates an opportunity for improved mechanisms to transfer data from device owners to researchers on crowdsourcing platforms. Given substantial reporting deficiencies, we recommend reaching a consensus on best practices for research collecting PGHD from mobile devices. Drawing from the 5 reporting dimensions in this scoping review, we share our recommendations and justifications for 9 items. These items require improved reporting to enhance data representativeness and quality and empower participants.

Digital Age Transformation in Patient-Physician Communication: 25-Year Narrative Review (1999-2023)

BACKGROUND

The evolution of patient-physician communication has changed since the emergence of the World Wide Web. Health information technology (health IT) has become an influential tool, providing patients with access to a breadth of health information electronically. While such information has greatly facilitated communication between patients and physicians, it has also led to information overload and the potential for spreading misinformation. This could potentially result in suboptimal health care outcomes for patients. In the digital age, effectively integrating health IT with patient empowerment, strong patient-physician relationships, and shared decision-making could be increasingly important for health communication and reduce these risks.

OBJECTIVE

This review aims to identify key factors in health communication and demonstrate how essential elements in the communication model, such as health IT, patient empowerment, and shared decision-making, can be utilized to optimize patient-physician communication and, ultimately, improve patient outcomes in the digital age.

METHODS

Databases including PubMed, Web of Science, Scopus, PsycINFO, and IEEE Xplore were searched using keywords related to patient empowerment, health IT, shared decision-making, patient-physician relationship, and health communication for studies published between 1999 and 2023. The data were constrained by a modified query using a multidatabase search strategy. The screening process was supported by the web-based software tool Rayyan. The review methodology involved carefully designed steps to provide a comprehensive summary of existing research. Topic modeling, trend analysis, and synthesis were applied to analyze and evaluate topics, trends, and gaps in health communication.

RESULTS

From a total of 389 selected studies, topic modeling analysis identified 3 primary topics: (1) Patient-Physician Relationship and Shared Decision-Making, (2) Patient Empowerment and Education Strategies, and (3) Health Care Systems and Health IT Implementations. Trend analysis further indicated their frequency and prominence in health communication from 1999 to 2023. Detailed examinations were conducted using secondary terms, including trust, health IT, patient-physician relationship, and patient empowerment, derived from the main topics. These terms clarified the collective impact on improving health communication dynamics. The synthesis of the role of health IT in health communication models underscores its critical role in shaping patient-centered health care frameworks.

CONCLUSIONS

This review highlights the significant contributions of key topics that should be thoroughly investigated and integrated into health communication models in the digital age. While health IT plays an essential role in promoting shared decision-making and patient empowerment, challenges such as usability, privacy concerns, and digital literacy remain significant barriers. Future research should prioritize evaluating these key themes and addressing the challenges associated with health IT in health communication models. Additionally, exploring how emerging technologies, such as artificial intelligence, can support these goals may provide valuable insights for enhancing health communication.

The Paradigm Shift From Patient to Health Consumer: 20 Years of Value Assessment in Health

Health care is undergoing a "revolution," where patients are becoming consumers and armed with apps, consumer review scores, and, in some countries, high out-of-pocket costs. Although economic analyses and health technology assessment (HTA) have come a long way in their evaluation of the clinical, economic, ethical, legal, and societal perspectives that may be impacted by new technologies and procedures, these approaches do not reflect underlying patient preferences that may be important in the assessment of "value" in the current value-based health care transition. The major challenges that come with the transformation to a value-based health care system lead to questions such as "How are economic analyses, often the basis for policy and reimbursement decisions, going to switch from a societal to an individual perspective?" and "How do we then assess (economic) value, considering individual preference heterogeneity, as well as varying heuristics and decision rules?" These challenges, related to including the individual perspective in cost-effectiveness analysis (CEA), have been widely debated. Cost-effectiveness measures treatments in terms of costs and quality-adjusted life-years (QALYs), where QALYs assume that a health state that is more desirable is more valuable, and therefore, value is equated with preference or desirability. QALYs have long been criticized for empirical and conceptual shortcomings. However, policy makers in many countries have used QALY measures to make health coverage decisions, although now, patients, and patient advocates, are questioning the valuation methodologies. This has led to the development of new approaches to valuing health, which are already starting to be used in the United States. This paper reviews 20-25 years of value assessment approaches in health and concludes with challenges and opportunities for value assessment methods in health in the years to come.

Multicomponent telerehabilitation program for veterans with multimorbidity: A randomized controlled feasibility study

BACKGROUND

Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.

OBJECTIVE

To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.

DESIGN

Randomized controlled cross-over feasibility study.

SETTING

Telehealth from Veterans Affairs Medical Center to participants' homes.

PARTICIPANTS

Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.

INTERVENTION

The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.

MAIN OUTCOME MEASURES

The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.

RESULTS

Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks.

CONCLUSIONS

The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.

Advancing cancer care through digital access in the USA: a state-of-the-art review of patient portals in oncology

Patient portal use among patients with cancer has increased significantly in recent years. This state-of-the-art review seeks to address and analyse literature involving patient portal use by patients with cancer and their care partners. In this review, we queried articles from PubMed published between January 2018 and April 2024 that describe recent trends and the current presence of portals in cancer care for patients, proxy users and/or care partners. We searched for articles addressing three overarching themes: (1) trends and disparities in portal adoption and use among patients with cancer, (2) use of specific portal components and functions in cancer care and (3) associations between portal use and cancer-related outcomes. Our search identified 278 unique studies, of which 82 were relevant empiric studies that met inclusion criteria and were included in this review. These papers aligned with 12 subthemes, including disparities in patient portal access, growing use of telemedicine via patient portal and patient access to immediately available to electronic health information. Our findings indicate that patient portals play an increasingly important role in helping patients manage their cancer care, despite few disparities that contribute to inequitable use. However, despite consistent growth in use over recent years, there are many areas for improvement in how portals support patients with cancer and a demand for functionality to continually evolve with patient needs.

The role of an inpatient aphasia-friendly choir for people with post-stroke communication impairment from the perspective of the multidisciplinary team: An exploratory study

BACKGROUND

There is a growing body of evidence showing the value of community singing-based rehabilitation on psychosocial well-being and communication for people with post-stroke communication impairment (PSCI). However, there has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the perspective of the stroke multidisciplinary team (MDT).

AIMS

To explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir, at a stroke rehabilitation centre in South Wales, UK, may play in the rehabilitation of people with PSCI.

METHODS & PROCEDURES

Eight participants were recruited from the stroke rehabilitation centre's MDT. Semi-structured interviews were conducted and the verbatim transcripts were analysed using thematic analysis according to Braun and Clark's work of 2006.

OUTCOMES & RESULTS

Four main themes were identified: (1) breaking down social isolation barriers; (2) patient voice and patient choice; (3) collective well-being and engagement; and (4) the therapeutic benefits across the MDT. The experiences and perceptions overlap, highlighting the wide-reaching therapeutic benefits of singing collaboratively.

CONCLUSIONS & IMPLICATIONS

This research enables us to discover more about how the inpatient aphasia-friendly choir may enhance an individual's well-being, communication and confidence, and their overall rehabilitation from the MDT's perspective. By increasing our understanding of which aspects of the aphasia-friendly choir are most valued, future choir sessions can be better tailored to patients' needs. Additionally, the findings presented here could be taken forward and included in future speech and language therapy interventions, leading to increased patient ownership, not only of the choir but also of their other therapy goals.

WHAT THIS PAPER ADDS

What is already known on this subject Previous research suggests positive implications for therapeutic collaborative singing on psychosocial well-being and communication for people with PSCI. There has been little consideration of the potential value an inpatient aphasia-friendly choir may have through the lens of the stroke MDT. The aim of this research was to explore the experiences and views of the MDT on the role an established inpatient aphasia-friendly choir may play in the rehabilitation of people with PSCI. What this paper adds to the existing knowledge This research highlights the benefits of an inpatient aphasia-friendly choir for an individual's well-being, communication and confidence. An increased understanding enables future choir sessions to be better tailored to patients' needs. What are the potential or actual clinical implications of this work? Participating in the choir was felt to offer an increased opportunity for functional therapy goals in an inpatient setting. The MDT frequently discussed the choir's ability to 'normalise' therapeutic approaches for the patients. A greater understanding of the choir participants empowers therapists to personalise therapy plans further, facilitating effectiveness, efficiency and holistic practice.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

14. Children and Adolescents: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Medical researchers' perception of sharing of metadata from case report forms

Introduction

Publishing medical metadata stored in case report forms (CRFs) is a prerequisite for the development of a learning health system (LHS) by fostering reuse of metadata and standardization in health research. The aim of our study was to investigate medical researchers' (MRs) willingness to share CRFs, to identify reasons for and against CRF sharing, and to determine if and under which conditions MRs might consider sharing CRF metadata via a public registry.

Methods

We examined CRF data sharing commitments for 1842 interventional trials registered on the German Clinical Trials Registry (DRKS) from January 1, 2020, to December 31, 2021. We invited 1360 individuals registered as contacts on DRKS to participate in a web-based survey between May 10, 2022, and June 30, 2022.

Results

Only 0.3% (5/1842) of data sharing commitments in DRKS included a plan to share blank CRFs. Survey results showed high support for CRF sharing. More than 70% of respondents (223/301) were willing to share their CRFs, and 83.7% (252/301) were interested in CRF reuse. The most frequently reported reason for CRF sharing was improvement of comparability and interpretability of patient data (244/301; 81.0%). The most frequently reported reason against CRF sharing was missing approval by the sponsor (160/301; 53.2%). Researchers conducting commercial trials were significantly less likely to share CRFs than those conducting noncommercial trials (63.3% vs. 76.2%, OR 0.54, 95% CI 0.32-0.92) and they were less likely to reuse CRFs (78.5% vs. 84.6%, OR 0.66, 95% CI 0.35-1.24). The most frequently mentioned prerequisite for publication of CRFs in a public registry was its trustworthiness (244/301, 81.1%).

Conclusion

Data sharing commitments in DRKS revealed a low awareness of CRF sharing. Survey results showed generally strong support for CRF sharing, including the willingness to publish CRFs in a public registry, although legal and practical barriers were identified.

A Practical Guide to Participatory Design Sessions for the Development of Information Visualizations: Tutorial

Unlabelled

Participatory design is an increasingly common informatics method to engage intended audiences in the development of health-related resources. Participatory design is particularly helpful for developing information visualizations that aim to improve health outcomes by means of improved comprehension, communication or engagement, and subsequent behavior changes. Existing literature on participatory design lacks the practical details that influence the success of the method and does not address emergent issues, such as strategies to enhance internet-based data collection. In this tutorial, our objective is to provide practical guidance on how to prepare for, conduct, and analyze participatory design sessions for information visualization. The primary audience for this tutorial is research teams, but this guide is relevant for organizations and other health professionals looking to design visualizations for their patient populations, as they can use this guide as a procedural manual. This start-to-finish guide provides information on how to prepare for design sessions by setting objectives and applying theoretical foundations, planning design sessions to match project goals, conducting design sessions in different formats with varying populations, and carrying out effective analysis. We also address how the methods in this guide can be implemented in the context of resource constraints. This tutorial contains a glossary of relevant terms, pros and cons of variations in the type of design session, an informed consent template, a preparation checklist, a sample design session guide and selection of useful design session prompts, and examples of how surveys can supplement the design process.

The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy

BACKGROUND

Chronic diseases are a global health challenge, and therefore, more attention should be paid to improving self-efficacy in people with chronic diseases. This study examined the relationship between family health and self-efficacy, and explored the mediating role of perceived social support and the moderating role of health literacy. The aim is to enhance the self-efficacy of chronic patients by improving family health, social support, and health literacy, thereby improving their physical and mental state.

METHODS

A cross-sectional study based on psychological and behavioural factors was conducted, namely, the 2022 China Residents Survey, which included 5150 Chinese patients with chronic diseases. The General Self-Efficacy Scale-Short Form was used to assess self-efficacy, the Health Literacy Questionnaire-short form was used to assess health literacy, the Perceived Social Support Scale-Short Form was used to evaluate perceived social support, and the Chinese version of the Family Health Scale-Short Form was used to assess family health status.

RESULTS

Family health of patients with chronic diseases had a significant positive effect on self-efficacy. Perceived social support was identified as a partial mediator between family health and self-efficacy, accounting for 59.39% of the total effect. Health literacy moderated the impact of family health on perceived social support and self-efficacy.

CONCLUSIONS

Chronic diseases have become a global health challenge, and more attention should be paid to improving the self-efficacy of the chronically ill population. Our results not only facilitate the understanding of the relationship mechanisms between family health and self-efficacy in chronic patients but can also serve as a guide for healthcare workers and policymakers who wish to provide better care for patients.

Electronic Communication Between Children's Caregivers and Health Care Teams: Scoping Review on Parental Caregiver's Perceptions and Experience

Background

Asynchronous communication via electronic modes (e-communication), including patient portals, secure messaging services, SMS text messaging, and email, is increasingly used to supplement synchronous face-to-face medical visits; however, little is known about its quality in pediatric settings.

Objective

This review aimed to summarize contemporary literature on pediatric caregivers' experiences with and perspectives of e-communication with their child's health care team to identify how e-communication has been optimized to improve patient care.

Methods

A scoping review following the Arksey and O'Malley methodological framework searched PubMed, CINAHL, Embase, and Web of Science using terms such as "Electronic Health Records" and "Communication" from 2013 to 2023 that discussed caregiver experiences and perspectives of e-communication with their child's health care provider. Studies were excluded if they were abstracts, non-English papers, nonscientific papers, systematic reviews, or quality improvement initiatives, or pertained to synchronous telemedicine. We conducted a two-step screening process by scanning the title and abstract and reviewing the full text by two independent screeners to confirm eligibility. From an initial 903 articles identified via the database search, 23 articles fulfilled all the inclusion criteria and are included in this review.

Results

Of the 23 articles meeting the inclusion criteria, 11 used quantitative methods, 7 used qualitative methods, and 5 used mixed methods. The caregiver sample sizes ranged from 51 to 3339 in the quantitative studies and 8 to 36 in the qualitative and mixed methods studies. A majority (n=17) used the patient portal that was self-categorized by the study. Secure messaging through a portal or other mobile health app was used in 26% (n=6) of the studies, while nonsecure messaging outside of the portal was used 17% (n=4) of the time and email was used 33.3% (n=8) of the time. In 19 of the studies, parents reported positive experiences with and a desire for e-communication methods.

Conclusions

The literature overwhelmingly supported caregiver satisfaction with and desire for e-communication in health care, but no literature intentionally studied how to improve the quality of e-communication, which is a critical gap to address.

Supporting Patients' Use of Digital Services in Primary Health Care in England: Synthesis of Evidence From a Mixed Methods Study of "Digital Facilitation"

Background

General medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined "digital facilitation" as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services.

Objective

We report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study's objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions.

Methods

Our study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package's results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders.

Results

Triangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them.

Conclusions

Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions.

Iterative Development of an Interactive Website to Support Shared Decision-Making in Metastatic Breast Cancer

Recent treatment advances have resulted in significantly increased survival times following metastatic breast cancer (MBC) diagnosis. Novel treatment approaches-and their related side effects-have changed the landscape of MBC treatment decision-making. We developed a prototype of an online educational tool to prepare patients with MBC for shared decision-making with their oncologists. We describe the five phases of tool development: (1) in-depth, semi-structured qualitative interviews and (2) feedback on storyboards of initial content with patients with MBC and oncology providers. This was followed by three phases of iterative feedback with patients in which they responded to (3) initial, non-navigable website content and (4) a beta version of the full website. In the final phase (5), patients newly diagnosed with MBC (N = 6) used the website prototype for 1 week and completed surveys assessing acceptability, feasibility, treatment knowledge, preparation for decision-making, and self-efficacy for decision-making. Participants in Phase 1 characterized a cyclical process of MBC treatment decision-making and identified key information needs. Website content and structure was iteratively developed in Phases 2-4. Most participants in Phase 5 (n = 4) accessed the website 2-5 times. All participants who accessed the website at least once (n = 5) felt they learned new information from the website prototype and would recommend it to others newly-diagnosed with MBC. After using the website prototype, participants reported high preparation and self-efficacy for decision-making. This multiphase, iterative process resulted in a prototype intervention designed to support decision-making for MBC patients.

The impact of family systems and social networks on substance use initiation and recovery among women with substance use disorders

OBJECTIVE

While social networks influence individuals with substance use disorders (SUDs), the mechanisms for such influence are under-explored among women who use drugs. This study triangulates the perspectives of criminal justice professionals, SUD treatment professionals, and women with past and current experiences with substance use to explore these dynamics.

METHOD

We conducted semistructured interviews (N = 42) in 2022 with women with current or past opioid use disorder (n = 20), SUD treatment professionals (n = 12), and criminal justice professionals (n = 10) who work with women with opioid use disorder. Interviews centered around participants' backgrounds, perceived barriers and facilitators to medications for opioid use disorder (MOUD) treatment, and gender-specific issues in MOUD treatment. All interviews were audio-recorded, transcribed, and deidentified. We used a four-step qualitative data analysis process to code transcripts.

RESULTS

Across these participants' accounts, we identified mechanisms by which women's social networks influenced their opioid use trajectories: intergenerational substance use, family support and strain, intimate partner influence, and peer support and pressure. Overall, the emergent themes in the present study reflect the embedded nature of support within social systems. Women who had access to and engaged with various forms of social support tended to be those who use/used MOUD and self-identified as in recovery.

CONCLUSIONS

Combining MOUD treatment with psychosocial interventions allows women to heal from trauma, learn effective coping skills, and receive valuable resources to support recovery. Interventions focusing on family resilience and peer recovery support can disrupt the cycle of addiction and promote MOUD treatment success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patient-centered care measures through the eyes of South African Radiographers and patients: A survey approach

BACKGROUND

Worldwide there has been a shift in the ideology within healthcare systems that focuses on 'people' rather than the 'patients'. A patient should not only be perceived by their condition but rather viewed holistically as a person. Within a South African (SA) context, the constitution has been amended to state that all South African citizens have the right to healthcare that is caring, free from harm, and effective. Hence, it can be rationalized that patient-centered care (PCC) is a necessary and vital approach in South African healthcare as well. A study conducted by Hyde and Hardy in the United Kingdom (UK) explored measures of PCC from radiography patients, radiographers, radiography managers, radiography educators, and radiography students' perspectives. This study was duplicated to define informed measures of PCC from a South African perspective. Therefore, this study aimed to gain perspectives on PCC measures in diagnostic radiography within a sample of the South African community. This paper focuses on the perspectives of the clinical radiographer and patient respondents.

METHOD

This study was conducted using a quantitative approach with the use of an online survey. The Qualtrics software was utilized to design the survey. The survey consisted of three PCC themes; use of technology, comfort and emotional support, and control over the environment. Recruitment of the subgroups was via advertisement in social media, email networks, and word of mouth.

RESULTS

There were 28 radiographer responses and 14 patient responses. The data were analyzed using SPSS software version 28. Patient care while explaining the use of technology in radiography, received positive responses from both respondent groups. Patient care measures that explored comfort and emotional support received varied responses from patients and radiographers. Important PCC concepts, such as asking the patient about their care needs and health problems, were lacking. Patients indicated that radiographers do not include their family members in the discussion of the care needs even though family involvement is a PCC element.

CONCLUSION

The perceptions of PCC measures differed between the two groups which indicated that there are still some gaps in clinical practice. Patient involvement in their care and individualized care should be prioritized. There is a need for family involvement during radiography procedures to be better highlighted within clinical practice. It is also recommended that more importance be placed on PCC during undergraduate training. While service delivery is important, radiographers must not disregard their PCC responsibilities towards the patient.

Through Their Eyes: Using Photovoice to Capture the Capacity-Building Journey of Long Covid Patient Experts

BACKGROUND

Long Covid, characterised by persistent symptoms following the coronavirus disease 2019 (COVID-19) infection, significantly impacts the quality of life. Engaging patients in research and care through participatory methods can enhance a shared understanding of illness and improve the relevance of research.

OBJECTIVE

We define Patient Experts (PEs) as persons (including patients, caregivers and providers) who have completed a series of training sessions on team building, research methods and communication at the Patient Engagement Studio, University of South Carolina (PES USC). This study explores the use of photovoice to document the experiences and capacity-building journey of Long Covid PEs within PES USC.

METHODS

The study employed photovoice within the COVID-19-Focused Virtual Patient Engagement Studio (CoVIP Studio). PEs submitted photographs and narratives at two distinct time points. Among the 18 PEs who participated in the project, 47 photos were collected during the training, and 31 were collected at the project's conclusion. Thematic analysis was conducted to capture changes in patient perspectives and engagement.

RESULTS

Initial themes identified were "Hope through Community," "Collaborative Education and Research" and "Strength and Endurance." By the project's end, themes had evolved to "Working as a Team to Share and Acquire Knowledge," "Enhanced Confidence in the Future of Care" and "Perseverance and Progress." These findings highlight the transformative impact of patient engagement and the utility of photovoice in documenting longitudinal shifts in patient perspectives.

CONCLUSION

Photovoice effectively engaged Long Covid patients and captured their evolving roles and perceptions as PEs. The study underscores the value of patient-led participatory methods in enhancing the relevance and applicability of clinical research, advocating for their broader adoption to improve patient-centred care and research outcomes.

PATIENT OR PUBLIC CONTRIBUTION

A CoVIP Studio stakeholder advisory board (CoVIP SAB) guided the co-development and implementation of this project. The CoVIP SAB comprised nine members with complementary skills and expertise, including three patients, three clinicians who provide care to patients with COVID-19 and three researchers with expertise in patient-centred research, COVID-19 and/or patient engagement and collaborate with patients as co-investigators. The board contributed to project design and implementation, refining photovoice prompts and shaping dissemination strategies. In addition, one PE who actively participated in all phases of the project contributed to the writing of this paper and is a coauthor. All project activities involved patients and/or caregivers with lived experience of Long Covid.

Early-stage implementation of peer-led interventions for emergency department patients with substance use disorder: Findings from a formative qualitative evaluation

INTRODUCTION

Emergency department (ED)-based peer recovery coach (PRC) programs can improve access to substance use disorder treatment (SUD) for ED patients. As literature on early stages of PRC implementation is limited, we conducted a qualitative assessment of ED PRC program implementation from several US-based PRC programs focusing on barriers and facilitators for implementation and providing recommendations based on the findings.

METHODS

We collected qualitative data from 39 key informants (peer recovery coaches, PRC program managers, ED physicians and staff, representatives of community-based organizations) via 6 focus groups and 21 interviews in February-December 2023. We transcribed audio-recordings and analyzed data using codebook thematic analysis.

RESULTS

We identified the following major themes related to specific barriers and recommendations to address them. To facilitate timely linkage to PRCs, programs would regularly inform ED staff about the program and its linkage procedures, establish trust between PRC and ED staff, streamline the linkage procedures, and choose an "opt-out" linkage approach. To address barriers related to external referrals, programs use "warm handoff" and "warm line" strategies, maintain and update a comprehensive catalog of resources, and familiarize peer coaches with local service providers. Telehealth services implementation requires addressing logistical barriers, ensuring patients' privacy, and training peer coaches on building trust and rapport online. Peer coaches' wellness and quality of services can be improved by limiting PRC's workload, prioritizing quality over quantity, facilitating self-, peer- and professional care to mitigate stress and burnout; and, importantly, by providing supportive supervision and training to peer coaches and advocating for PRC team as an equal partner in the ED settings. To facilitate PRC program adoption and sustainment program managers engage local communities and program champions, seek diverse sources of funding, and advocate for structural changes to accommodate recruitment and retention of peer recovery coaches.

CONCLUSIONS

We compiled a wealth of best practices used by PRC programs to address numerous implementation barriers and challenges. These recommendations are intended for PRC program planners, managers and champions, hospital leadership, and state and local public health agencies leading SUD epidemic response.

Unlocking success: community engagement for enhanced HIV care outcomes

BACKGROUND

Though social determinants are the primary drivers of health, few studies of people living with HIV focus on non-clinical correlates of insecure and/or fragmented connections with the care system. Our team uses linked clinical and multisector non-clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of individuals living with HIV and other invested community members to guide and inform this research. Our objective is to generate consultant-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same.

METHODS

Our research team partnered with the Indiana Clinical and Translational Sciences Institute's Research Jam to develop and implement a human-centered design research plan to engage individuals with experience relevant to our research. We recruited a panel of consultants composed of people living with HIV and/or clinicians and individuals from agencies that provide medical and non-medical services to people living with HIV in Marion County, Indiana. To date, we have used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our future engagement and research activities.

RESULTS

Since the inception of the project, 48 consultants have joined the panel. Thirty-five continue to be actively engaged and have participated in one or more of the six sessions conducted to date. Consultants have helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference.

CONCLUSIONS

We utilize community engagement to expand the scope of our research and find that the process provides value to both consultants and the research team. Human-centered design enhances this partnership by keeping it person-centered, developing empathy and trust between consultants and researchers, increasing consultant retention, and empowering consultants to collaborate meaningfully with the research team. The use of these methods is essential to conduct relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community consultants.

Exploring Patient, Proxy, and Clinician Perspectives on the Value and Impact of an Inpatient Portal: A Reflexive Thematic Analysis

BACKGROUND

Research exploring perspectives on inpatient portals reports that patients desire the information affordances of inpatient portals, and clinicians recognize their value for improving patient experience but also express caution regarding sharing aspects of the medical record. This study contributed to the existing literature on inpatient portals by considering the psychosocial dimension of clinician resistance to information sharing with inpatients and the power dynamic associated with clinician-patient information asymmetry. Along with the information affordances commonly discussed in this area, this study explored perspectives on the novel option to audio record consultations via an inpatient portal.

OBJECTIVE

This study aims to understand patient, proxy, and clinician perspectives on the value and impact of an inpatient portal within the Australian context. It explores clinician resistance and receptivity to sharing aspects of the medical record with patients and the power dynamic that characterizes the relationship between clinician and patient. It considers how an inpatient portal might assist in the transformation of this relationship such that this relationship could be characterized by greater information symmetry.

METHODS

Interviews were conducted with patients (n=20), proxies (n=4), and clinicians (n=21) recruited from 3 areas within the Royal Melbourne Hospital, where the portal would later be implemented. A largely inductive reflexive thematic analysis was conducted.

RESULTS

Patient and proxy participants reported that they wanted to understand what is happening in their care for peace of mind and that an inpatient portal could support this understanding. Clinician participants reflected on how they might transform their information-sharing practice to provide greater transparency in their relationship with patients. Participants considered the types of information that could be shared and how this information could be shared via an inpatient portal. Four key themes were generated: (1) affording the patient and proxy awareness, control, and reassurance through sharing accessible and meaningful information; (2) protecting the clinician and safeguarding quality health care in information sharing; (3) flexibly deploying the functions depending upon clinician, patient, proxy, and context; and (4) moving toward person-centered care: empowerment and equity via an inpatient portal.

CONCLUSIONS

An inpatient portal provides an opportunity to reconceptualize the medical record and how this information might be shared with patients while they are admitted to the hospital, such that they have more understanding as to what is happening in their care, which ultimately supports their well-being. The transition to a more transparent information-sharing culture in the Australian hospital context will take time. An inpatient portal is a critical step in facilitating this transition and creating more informational symmetry in the clinician-patient relationship.

Rationale and study protocol of a regional health panel in Saxony, Germany (GEPASA)

BACKGROUND

The citizens' perspectives on health care are central to the assessment of the health care situation and to regional development. In Germany, however, strategic goals for health care delivery are planned based on population statistics and partly on regional morbidity. Saxony is a German federal state with high average age and low density of physicians which makes the population perspective on quality of health care especially intersting. No existing panel surveys cover issues related to the perceived quality of health care delivery on a regional level in Germany.

AIM

We aim to conduct a longitudinal panel study of the perceived health status and perceived quality of health care of the Saxon citizens as a basis for the systematic derivation of health care goals/measures and target group-specific, regionally suitable prevention measures.

METHODS

With an anticipated 15% response rate, 15,000 potential participants have to be contacted to achieve a calculated sample size of about 2,250 participants. The questionnaire will be circulated every other year with the option for adaptations depending on insights of each panel wave. The study protocol was approved by the local ethics committee of the Technische Universität Dresden, Germany (ethical approval code BO-EK-320072022) and has been registered at the German Clinical Trials Register as the German WHO primary registry (study registration number DRKS00031229).

DISCUSSION AND OUTLOOK

The results are intended to identify gaps in health care and to develop patient-centered health care goals for the region together with stakeholders in Saxon health care planning. At the same time, longitudinal data allow mapping of perceived health status and perceived health care trends.

A New Research Model for Artificial Intelligence-Based Well-Being Chatbot Engagement: Survey Study

BACKGROUND

Artificial intelligence (AI)-based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being.

OBJECTIVE

This study aimed to identify the factors that impact individuals' intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness.

METHODS

We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach.

RESULTS

The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior.

CONCLUSIONS

The new extended model provides a theoretical basis for studying users' AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users.

Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach

BACKGROUND

Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development.

OBJECTIVE

This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs.

METHODS

A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3).

RESULTS

A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations.

CONCLUSIONS

This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP.

Development of Self-Management Skills in 14- to 16-Year-Old Adolescents with Chronic Health Conditions: A Qualitative Study

BACKGROUND

The American Academy of Pediatrics recommends that adolescents with chronic health conditions begin to assume responsibility for their own care by age 14. The goal of this qualitative one-time interview study is to learn how 14- to 16-year-old adolescents with chronic health conditions begin to develop self-management skills and the role that caregivers play in the learning process.

METHODS

Twenty adolescents ages 14-16 with chronic renal (n = 5), gastrointestinal (n = 5), hematologic (n = 5), or rheumatologic (n = 5) diseases, and 20 caregivers (dyads), completed individual semi-structured interviews discussing the adolescents' current degree of self-management. Six coders analyzed transcripts using thematic framework analysis.

RESULTS

Three primary themes emerged: continuum, motivations, and tools. Both adolescents and caregivers described progress along a self-management continuum with varying levels of responsibility for the adolescents, ranging from passive to responsible. Caregivers' behaviors similarly varied from directive management to supported self-management. Motivations for self-management skills were described in relation to one's health, self, and others. Families utilized a variety of tools to facilitate movement toward supported self-management with the adolescent.

CONCLUSIONS

The development of adolescent self-management of their chronic condition is a complex, shifting continuum between caregiver and adolescent. This continuum may be impacted by adolescent motivation and tools/problem solving available to the family. Pediatric healthcare providers can support self-management by assessing and attending to each patient's motivations; building a road map individualized to each patient's skills; and offering time in outpatient clinic to practice self-management strategies.