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Valdez RS, Lyon SE, Corbett JP, Wellbeloved-Stone C, Hasan S, Taylor L, DeBoer MD, Cherñavvsky D, Patek SD. Macroergonomic components of the patient work system shaping dyadic care management during adolescence: a case study of type 1 diabetes. ERGONOMICS 2024:1-21. [PMID: 38712661 DOI: 10.1080/00140139.2024.2343942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
The role of the social, physical, and organisational environments in shaping how patients and their caregivers perform work remains largely unexplored in human factors/ergonomics literature. This study recruited 19 dyads consisting of a parent and their child with type 1 diabetes to be interviewed individually and analysed using a macroergonomic framework. Our findings aligned with the macroergonomic factors as presented in previous models, while highlighting the need to expand upon certain components to gain a more comprehensive representation of the patient work system as relevant to dyadic management. Examples of design efforts that should follow from these findings include expanding existing data sharing options to include information from the external environment and capitalising on the capabilities of artificial intelligence as a decision support system. Future research should focus on longitudinally assessing patient work systems throughout transition periods in addition to more explicitly exploring the roles of social network members.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, Virginia, USA
- Health Discovery & Innovations, University of Virginia, Charlottesville, Virginia, USA
| | - Sophie E Lyon
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Saadiq Hasan
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Lauren Taylor
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D DeBoer
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia, Charlottesville, Virginia, USA
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel Cherñavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Dexcom, Inc., San Diego, California, USA
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2
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Xiao Y, Fulda KG, Young RA, Hendrix ZN, Daniel KM, Chen KY, Zhou Y, Roye JL, Kosmari L, Wilson J, Espinoza AM, Sutcliffe KM, Pitts SI, Arbaje AI, Chui MA, Blair S, Sloan D, Jackson M, Gurses AP. Patient Partnership Tools to Support Medication Safety in Community-Dwelling Older Adults: Protocol for a Nonrandomized Stepped Wedge Clinical Trial. JMIR Res Protoc 2024; 13:e57878. [PMID: 38684080 PMCID: PMC11091807 DOI: 10.2196/57878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources. OBJECTIVE This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety. METHODS The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits. RESULTS The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024. CONCLUSIONS This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits. TRIAL REGISTRATION ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57878.
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Affiliation(s)
- Yan Xiao
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
- College of Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Kimberley G Fulda
- Department of Family Medicine and Osteopathic Manipulative Medicine and North Texas Primary Care Practice-Based Research Network (NorTex), University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Richard A Young
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Z Noah Hendrix
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kathryn M Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Kay Yut Chen
- College of Business, University of Texas at Arlington, Arlington, TX, United States
| | - Yuan Zhou
- College of Engineering, University of Texas at Arlington, Arlington, TX, United States
| | - Jennifer L Roye
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Ludmila Kosmari
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Joshua Wilson
- College of Liberal Arts, University of Texas at Arlington, Arlington, TX, United States
| | - Anna M Espinoza
- Department of Family Medicine and Osteopathic Manipulative Medicine and North Texas Primary Care Practice-Based Research Network (NorTex), University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Kathleen M Sutcliffe
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Samantha I Pitts
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alicia I Arbaje
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Michelle A Chui
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Somer Blair
- Office of Clinical Research, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Dawn Sloan
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Masheika Jackson
- Family Medicine Residency Program, John Peter Smith Health Network, Fort Worth, TX, United States
| | - Ayse P Gurses
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
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Liebzeit D, Geiger O, Jaboob S, Bjornson S, Strayer A, Buck H, Werner NE. Older Adults' Process of Collaborating With a Support Team During Transitions From Hospital to Home: A Grounded Theory Study. THE GERONTOLOGIST 2024; 64:gnad096. [PMID: 37436125 DOI: 10.1093/geront/gnad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how older adults engage with multiple sources of support and resources during transitions from hospital to home, a period of high vulnerability. This study aims to describe how older adults identify and collaborate with a support team, including unpaid/family caregivers, health care providers, and professional and social networks, during the transition. RESEARCH DESIGN AND METHODS This study utilized grounded theory methodology. One-on-one interviews were conducted with adults aged 60 and older following their discharge from a medical/surgical inpatient unit in a large midwestern teaching hospital. Data were analyzed using open, axial, and selective coding. RESULTS Participants (N = 25) ranged from 60 to 82 years of age, 11 were female, and all participants were White, non-Hispanic. They described a process of identifying a support team and collaborating with that team to manage at home and progress their health, mobility, and engagement. Support teams varied, but included collaborations between the older person, unpaid/family caregiver(s), and their health care providers. Their collaboration was impacted by the participant's professional and social networks. DISCUSSION AND IMPLICATIONS Older adults collaborate with multiple sources of support and this collaboration is a dynamic process that varies across phases of their transition from hospital to home. Findings reveal opportunities for assessing individual's support and social networks, in addition to health and functional status, to determine needs and leverage resources during transitions in care.
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Affiliation(s)
- Daniel Liebzeit
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Olivia Geiger
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Saida Jaboob
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | | | - Andrea Strayer
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Harleah Buck
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Nicole E Werner
- School of Public Health, Indiana University-Bloomington, Bloomington, Indiana, USA
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Buck HG, Howland C, Stawnychy MA, Aldossary H, Cortés YI, DeBerg J, Durante A, Graven LJ, Irani E, Jaboob S, Massouh A, Oberfrank NDCF, Saylor MA, Wion RK, Bidwell JT. Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review. J Cardiovasc Nurs 2024:00005082-990000000-00168. [PMID: 38306302 DOI: 10.1097/jcn.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. OBJECTIVE The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? METHODS This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. RESULTS Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. CONCLUSIONS Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.
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Mueller EL, Cochrane AR, Carroll AE. Perceptions of chemotherapy calendar creation among US pediatric oncologists. Pediatr Blood Cancer 2023; 70:e30688. [PMID: 37737717 PMCID: PMC10615882 DOI: 10.1002/pbc.30688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND An effective chemotherapy calendar system between the clinician and the patient/caregiver can improve patient-centered outcomes. There is lack of research on how chemotherapy calendars are created and what aspects are important to pediatric oncology physicians. PROCEDURE In an online survey of pediatric oncology physicians, we evaluated institutional practices, perceptions of chemotherapy calendar creation, and desires for future tools. A total of 220 survey participants provided data (10.4% participant response rate) from 123 institutions (53.5% represented institutions). RESULTS Participants indicated that 72% always or most of the time their institution provides a chemotherapy calendar, most commonly at the start of a new cycle (90%) or with a dosing change (68%). Factors such as the health literacy of the family, prior nonadherence, type of cancer, and desire of the family affected the creation decision. Advanced practice providers (45%) or nurse coordinator/navigators (43%) were most likely to create the chemotherapy calendar. No significant difference was found between the likelihood of creating a chemotherapy calendar and institutional size (p = .09) or physician years in practice (p = .26). Approximately 95% of participants indicated chemotherapy calendar creation software that improved ease and efficiency would be moderately to extremely useful. CONCLUSION Future efforts should focus on co-design of an efficient and effective chemotherapy calendar by engaging with nursing and advanced practice providers along with caregivers of children with cancer.
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Affiliation(s)
- Emily L Mueller
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202
| | - Anneli R Cochrane
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN 46202
| | - Aaron E Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, IN 46202
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Haaland I, Metta E, Moen K. The use of PrEP among men who have sex with men and transgender women as Biomedical Prevention Work: A conceptual framework. Soc Sci Med 2023; 333:116147. [PMID: 37556992 DOI: 10.1016/j.socscimed.2023.116147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/06/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
Based on ethnographic fieldwork among men who have sex with men and transgender women in Tanzania, this article explores the various types of work that may go into enrolment into PrEP programming and using pre-exposure prophylaxis (PrEP). PrEP protects against HIV acquisition and is widely touted as an essential tool in 'ending AIDS by 2030'. While taking PrEP has often been portrayed as 'just taking a pill a day' in public health campaigns, a striking observation during fieldwork was that enrolling in PrEP programming and adhering to PrEP involved a wide range of tasks. Inspired by this fieldwork experience and the literature on sociology of work, more specifically illness work and patient work, we started to think of these tasks as work. This paper identifies the range of tasks that PrEP users in Dar es Salaam had to perform as part of their enrolment and usage of PrEP. We provide a description of these tasks, organised into three categories of work that we refer to as (a) readying work, (b) user work, and (c) social navigation work that jointly make up what we propose to call biomedical prevention work. We further suggest that this analytical framework can be applicable to other biomedical prevention methods in other contexts.
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Affiliation(s)
- Inga Haaland
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Emmy Metta
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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Rogers CC, Jang SS, Tidwell W, Shaughnessy S, Milburn J, Hauck FR, Williams IC, Valdez RS. Designing mobile health to align with the social determinants of health. Front Digit Health 2023; 5:1193920. [PMID: 37274765 PMCID: PMC10232872 DOI: 10.3389/fdgth.2023.1193920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
The maternal health crisis in the United States is becoming increasingly worse, with disparities continuing to escalate among marginalized populations. mHealth can contribute to addressing the Social Determinants of Health (SDOH) that produce inequities in maternal morbidity and mortality. Reducing inequities through mHealth can be achieved by designing these technologies to align with SDOH. As mHealth developed to support maternal health has primarily supported the extension of clinical care, there is an opportunity to integrate frameworks and methods from human factors/ergonomics and public health to produce thorough comprehension of SDOH through intentional partnerships with marginalized populations. Potential for this opportunity is presented through a case study derived from a community-based participatory research process focused on transportation access to maternal health services. Through multi-faceted, interdisciplinary, and community-based approaches to designing mHealth that attends to the systemic factors that generate and escalate inequities, improvements in the maternal health crisis could be realized.
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Affiliation(s)
- Courtney C. Rogers
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
| | - Sophia S. Jang
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | | | | | - Juliane Milburn
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Fern R. Hauck
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Ishan C. Williams
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Rupa S. Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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8
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Fadare O, Witry M. "There Is Method to This Madness" A Qualitative Investigation of Home Medication Management by Older Adults. PHARMACY 2023; 11:pharmacy11020042. [PMID: 36961020 PMCID: PMC10037564 DOI: 10.3390/pharmacy11020042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES This paper explores (1) the systems and processes older adults use to manage medications at home, and (2) the well-being goals of personal interest that motivate them. METHODS Qualitative interviews were conducted in the homes of 12 older adults in a small city in the Midwest United States. Interviews were analyzed using inductive template analysis. RESULTS The average age of older adults in this study was 74.2 years (SD = 10.5), 66.7% were women. The most prominent home medication management tools used were pill boxes, containers and vials, and medication lists. Routines were often aligned with activities of daily living such as teeth brushing and eating. Their medication management work occurred in contexts of other household members and budget constraints. Routines and practices were sometimes idiosyncratic adaptations and supported goals of maintaining control and decreasing vulnerability. CONCLUSION In developing routines for home medication management, older adults developed systems and deliberate processes to make sense of their medication experiences in the context of their home environment and based on available resources.
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Affiliation(s)
- Olajide Fadare
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA
| | - Matthew Witry
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA
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Yazdani F, Simbar M, Hamzehgardeshi Z, Zare E, Nasiri M. Explaining sexual self-care status and its predictor factors in women referring to healthcare centers of Sari, Iran, 2021. BMC Womens Health 2023; 23:50. [PMID: 36755258 PMCID: PMC9907193 DOI: 10.1186/s12905-023-02196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION With the increase in the prevalence of non-communicable diseases and chronic health problems along with population growth, one of the definitions that is expanding is the ability to adapt and self-manage against diseases and self-care. Although there are several studies to examine self-care in medical conditions, there are not enough concepts and data related to sexual self-care. Therefore, the present study was conducted with the aim of explaining the status of sexual self-care and its predictor factors in women of reproductive age referring to healthcare centers. MATERIAL AND METHODS This research was a cross-sectional study that was conducted on 400 women of reproductive age that referring to healthcare centers affiliated to Mazandaran University of Medical Sciences, Sari in 2021. Data were collected using personal-obstetric characteristics and sexual self-care questionnaires in women of reproductive age. Pearson correlation coefficients, independent t-test, one-way analysis of variance and multiple linear regression model were used to analyze the data. RESULTS The average total score of sexual self-care in reproductive age women participating in the research was 70.66% ± 12.52%. In addition, the prevention of women's cancers and the prevention of unintended pregnancies obtained the lowest and highest scores, respectively. Factors such as age, education, education related to medical sciences, history of HIV testing, history of HPV vaccination, source of sexual information, method of contraception and infection-related action in a person can affect the level of sexual self-care in women. Based on the final regression model, education related to medical sciences (B = 5.46, P = 0.035), family income (B = 5.58, P = 0.025), prevention method (B = 10.127, P = 0.000) and action related to infection in the person (B = 12.27, P = 0.047) were the final predictors of sexual self-care score in reproductive age women. CONCLUSION Based on the findings of the study, development of self-care promotion programs for reproductive aged women are necessary in all areas of reproductive health, with a priority for women's cancer prevention, and focusing on promoting education and related economic assistance. The results of this study can be available to experts and policy makers to design programs to promote sexual self-care in women.
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Affiliation(s)
- Fereshteh Yazdani
- grid.411600.2Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zeinab Hamzehgardeshi
- grid.411623.30000 0001 2227 0923Sexual and Reproductive Health Research Center, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Zare
- grid.411600.2Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- grid.411600.2Department of Basic Sciences, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Kleman C, Magnus JM, Andrews M, Meyer K, Lutz BJ. The work of managing a chronic illness: A job description. J Eval Clin Pract 2023; 29:166-180. [PMID: 36031800 PMCID: PMC10087252 DOI: 10.1111/jep.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE Self-management of a chronic illness is a struggle for many patients. There is substantial evidence that patients are not as successful as they and their providers would like. Considering patient self-management through an innovative and diverse lens could help patients, providers and the health care system to consider novel changes to improve success. AIMS AND OBJECTIVES To provide a complete view of patient work by utilizing the human resources management practice of job analysis to develop an initial job description for patients suffering from chronic illness. METHODS Study design was descriptive qualitative with analysis aiming to identify those reoccurring ideas from the data. Thirty patients, with at least one chronic illness, in three focus groups were assembled for this study. Verbatim recordings and notes were used to categorize the data provided. Five coders analyzed the data independently, and jointly met to discuss the themes identified. Demographic data was collected via surveys. RESULTS Patients with chronic illness engage in five primary 'job' duties including self-care (actions taken to effectively manage physical and psychological symptoms), managing relationships (effective management of relationships with employers, family, friends and providers to ensure the best outcomes), managing resources (understanding and managing finances, health and prescription medication insurance), coordination (managing and scheduling visits to providers) and research/education (gathering information and conducting research relative to all aspects of managing one's illness). Relevant knowledge, skills, abilities (KSAs) and other resources were identified that are necessary for patients to effectively perform the five job duties. CONCLUSIONS Creating a job description for the 'job' of patient is a crucial step in understanding the work chronically ill patients undertake. Knowing the duties, their associated tasks and KSAs, and resources required to perform those tasks enables patients and their providers and advocates to better identify ways to assist, relieve and encourage these patients in order to maximize patient success.
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Affiliation(s)
- Carolyn Kleman
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Jessica Mesmer Magnus
- Department of Management Chair, Cameron School of Business, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Martha Andrews
- Cameron School of Business, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Kori Meyer
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Barbara J Lutz
- College of Health & Human Services School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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11
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Barton HJ, Pflaster E, Loganathar S, Werner A, Tarfa A, Wilkins D, Ehlenbach ML, Katz B, Coller RJ, Valdez R, Werner NE. What makes a home? Designing home personas to represent the homes of families caring for children with medical complexity. APPLIED ERGONOMICS 2023; 106:103900. [PMID: 36122551 PMCID: PMC10072316 DOI: 10.1016/j.apergo.2022.103900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
Personas are widely recognized as valuable design tools for communicating dimensions of individuals, yet they often lack critical contextual factors. For those people managing chronic health conditions, the home is a critical context of their patient work system (PWS). We propose the development of 'home personas' to convey essential aspects of the home context to those tasked with designing technologies and interventions to fit it. We used an iterative, multi-stakeholder design process to design 'home personas' for a model population, families caring for children with medical complexity. Each of the four resultant home personas-Multi-level, Customized, Ranch, and Rental-has a unique home layout, pain points, and are described on three dimensions that emerged from the data. This study builds on a foundation of work in the emerging field of Patient Ergonomics, describing a mechanism for distilling rich descriptions of the PWS into brief yet informative design tools.
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Affiliation(s)
- Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Ellen Pflaster
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Shanmugapriya Loganathar
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Allison Werner
- School of Human Ecology, University of Wisconsin-Madison, United States
| | - Adati Tarfa
- School of Pharmacy, University of Wisconsin-Madison, United States
| | - David Wilkins
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | | | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Rupa Valdez
- Department of Public Health Sciences and Department of Engineering Systems and Environment, University of Virginia, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, United States.
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12
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Xiao Y, Smith A, Abebe E, Hannum SM, Wessell AM, Gurses AP. Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals. J Patient Saf 2022; 18:e1174-e1180. [PMID: 35617608 PMCID: PMC9679039 DOI: 10.1097/pts.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Care transitions pose a high risk of adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach. METHODS Hospital-based professionals from 4 hospitals were interviewed about ADE risks after hospital discharge among older adults. Concerns were extracted from the interview transcript, and for each concern, hazard for medication-related harms was coded and grouped by its sources according to a human factors and systems engineering model that views postdischarge ADEs as the outcome of professional and patient home work systems. RESULTS Thirty-eight professionals participated (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers). Hazards were classified into 6 groups, ranked by frequencies of hazards coded: (1) medication tasks related at home, (2) patient and caregiver related, (3) hospital work system related, (4) home resource related, (5) hospital professional-patient collaborative work related, and (6) external environment related. Medications most frequently cited when describing concerns included anticoagulants, insulins, and diuretics. Top coded hazard types were complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information. CONCLUSIONS From the perspective of hospital-based frontline health care professionals, hazards for medication-related harms during care transitions were multifactorial and represented those introduced by the hospital work system as well as defects unrecognized and unaddressed in the home work system.
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Affiliation(s)
- Yan Xiao
- From the College of Nursing and Health Innovation, University of Texas at Arlington
| | - Aaliyah Smith
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Ephrem Abebe
- Department of Pharmacy Practice, Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea M Wessell
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland
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13
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Carleton-Eagleton K, Walker I, Gibson D, Freene N, Semple S. Testing the validation and reliability of the Caregiver-Patient Activation Measure (CG-PAM). PEC INNOVATION 2022; 1:100098. [PMID: 37213753 PMCID: PMC10194270 DOI: 10.1016/j.pecinn.2022.100098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 05/23/2023]
Abstract
Objective The objective of this study was to test the reliability and validity of the Caregiver-Patient Activation Measure (CG-PAM). Methods Based on the psychometric testing of the original Patient Activation Measure (PAM), three assessments of reliability and validity were completed on the CG-PAM. Test-retest reliability was assessed across two weeks (n = 23). Criterion validity was assessed by interviewing participants from the test-retest cohort (n = 10), with transcripts assessed by subject matter experts (n = 3) to classify activation levels of the interviewee. Construct validity was assessed through a survey (n = 179) consisting of demographic questions, the CG-PAM and concepts hypothesised to be related to caregiver activation. Results There was strong test-retest reliability (r = 0.893), but poor criterion validity. Assessment o;f construct validity demonstrated significant relationships found between caregiver activation and weekly hours of care provided (p < 0.001), relationship satisfaction (p < 0.001), and dyad typology (p < 0.001), but not with perceived levels of stress or social support. Conclusion The CG-PAM was found to have strong reliability, but there were inconsistent results across the validation tests conducted. Innovation Future research must consider the dynamic nature of caring and the importance of the relationship between the caregiver/recipient when defining activation levels within the CG-PAM.
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Affiliation(s)
- Katherine Carleton-Eagleton
- Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
- Corresponding author at: Faculty of Health, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Iain Walker
- School of Psychological Sciences, University of Melbourne, Level 7, Redmond Barry Building, The University of Melbourne, Victoria, 3010, Australia
| | - Diane Gibson
- Health Research Institute, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Stuart Semple
- Health Research Institute and Research Institute for Sport & Exercise, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
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14
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Weiler DT, Lingg AJ, Eagan BR, Shaffer DW, Werner NE. Quantifying the qualitative: exploring epistemic network analysis as a method to study work system interactions. ERGONOMICS 2022; 65:1434-1449. [PMID: 35258441 PMCID: PMC9489604 DOI: 10.1080/00140139.2022.2051609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/28/2022] [Indexed: 06/04/2023]
Abstract
Studying interactions faces methodological challenges and existing methods, such as configural diagramming, have limitations. This work demonstrates Epistemic Network Analysis (ENA) as an analytical method to construct configural diagrams. We demonstrated ENA as an analytical tool by applying this method to study dementia caregiver work systems. We conducted 20 semi-structured interviews with caregivers to collect caregiving experiences. Guided by the Patient Work System model, we conducted a directed content analysis to identify work system components and used ENA to study interactions between components. By using ENA to create configural diagrams, we identified five frequently occurring interactions, compared work system configurations of caregivers providing care at home and away from home. Although we were underpowered to determine statistically significant differences, we identified visual and qualitative differences. Our results demonstrate the capability of ENA as an analytical method for studying work system interactions through configural diagramming. Practitioner summary: A new methodology, Epistemic Network Analysis (ENA), was presented to better support the study of work system interactions through configural diagramming. ENA was applied to qualitative data to demonstrate the capabilities of this method to construct configural diagrams of the work system. This study successfully demonstrated that ENA can visually represent and describe work system configurations.
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Affiliation(s)
- Dustin T. Weiler
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | - Aloysius J. Lingg
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | - Brendan R. Eagan
- Department of Educational Psychology and Wisconsin Center for Education Research, University of Wisconsin-Madison, USA
| | - David W. Shaffer
- Department of Educational Psychology and Wisconsin Center for Education Research, University of Wisconsin-Madison, USA
| | - Nicole E. Werner
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
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15
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Werner NE, Rutkowski RA, Holden RJ, Ponnala S, Gilmore-Bykovskyi A. A human factors and ergonomics approach to conceptualizing care work among caregivers of people with dementia. APPLIED ERGONOMICS 2022; 104:103820. [PMID: 35689868 PMCID: PMC9392469 DOI: 10.1016/j.apergo.2022.103820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Society relies upon informal (family, friend) caregivers to provide much of the care to the estimated 43.8 million individuals living with Alzheimer's disease and related dementias globally. Caregivers rarely receive sufficient training, resources, or support to meet the demands associated with dementia care, which is often associated with increased risk of suboptimal outcomes. Human factors and ergonomics (HFE) can address the call for new approaches to better understand caregiving and support caregiver performance through systematic attention to and design of systems that support the work of caregivers- their care work. Thus, our objective was to perform a work system analysis of care work. We conducted a qualitative study using a Critical Incident Technique interviewing approach and Grounded Dimensional Analysis analytic procedures. Our findings introduce a new conceptual framework for understanding the care work system of dementia caregivers and suggest that care work is influenced by interactions among distinct caregiver goals, the task demands of the care needs of the person with dementia, daily life needs of the caregiver and family, and contextual factors that shape caregivers' perceptions surrounding care. The initial work system model produced by this study provides a foundation from which future work can further elucidate the care work system, determine how the care work system intersects and coordinates with other work systems such as the patient work system, and design systems that address caregivers' individual caregiving context.
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Affiliation(s)
- Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA.
| | - Rachel A Rutkowski
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA.
| | | | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA.
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16
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Uchmanowicz I, Wleklik M, Foster M, Olchowska-Kotala A, Vellone E, Kaluzna-Oleksy M, Szczepanowski R, Uchmanowicz B, Reczuch K, Jankowska EA. Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being? Front Psychol 2022; 13:940088. [PMID: 36275212 PMCID: PMC9580561 DOI: 10.3389/fpsyg.2022.940088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Ercole Vellone
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marta Kaluzna-Oleksy
- Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Bartosz Uchmanowicz
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Bartosz Uchmanowicz,
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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17
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Seale DE, LeRouge CM, Kolotylo-Kulkarni M. Professional Organizers’ Description of Personal Health Information Management Work with a Spotlight on the Practices of Older Adults: A Qualitative e-Delphi Study (Preprint). J Med Internet Res 2022; 25:e42330. [PMID: 37000478 PMCID: PMC10131782 DOI: 10.2196/42330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Personal health information (PHI) is created on behalf of and by health care consumers to support their care and wellness. Available tools designed to support PHI management (PHIM) remain insufficient. A comprehensive understanding of PHIM work is required, particularly for older adults, to offer more effective PHIM tools and support. OBJECTIVE The primary objective of this study was to use the Patient Work System model to provide a holistic description of PHIM work from the perspective of professional organizers with experience assisting health care consumers, including older adults, in managing their PHI. A secondary objective was to examine how factors associated with 4 Patient Work System components (person, tasks, tools and technologies, and context) interact to support or compromise PHIM work performance. METHODS A modified e-Delphi methodology was used to complete 3 web-based rounds of open-ended questions and obtain consensus among a panel of 16 experts in professional organizing. Data were collected between April and December 2017. The Patient Work System model was used as a coding schema and guided the interpretation of findings during the analysis. RESULTS The PHIM work of adults who sought assistance focused on the tasks of acquiring, organizing, and storing 3 classifications of PHI (medical, financial, and reference) and then processing, reconciling, and storing the medical and financial classifications to tend to their health, health care, and health finances. We also found that the complexities of PHI and PHIM-related work often exceeded the abilities and willingness of those who sought assistance. A total of 6 factors contributed to the complexity of PHIM work. The misalignment of these factors was found to increase the PHIM workload, particularly for older adults. The life changes that often accompanied aging, coupled with obscure and fragmented health care provider- and insurer-generated PHI, created the need for much PHIM work. Acquiring and integrating obscure and fragmented PHI, detecting and reconciling PHI discrepancies, and protecting PHI held by health care consumers were among the most burdensome tasks, especially for older adults. Consequently, personal stakeholders (paid and unpaid) were called upon or voluntarily stepped in to assist with PHIM work. CONCLUSIONS Streamlining and automating 2 of the most common and burdensome PHIM undertakings could drastically reduce health care consumers' PHIM workload: developing and maintaining accurate current and past health summaries and tracking medical bills and insurance claims to reconcile discrepancies. Other improvements that hold promise are the simplification and standardization of commonly used financial and medical PHI; standardization and automation of commonly used PHI acquisition interfaces; and provision of secure, Health Insurance Portability and Accountability Act (HIPAA)-certified PHI tools and technologies that control multiperson access for PHI stored by health care consumers in electronic and paper formats.
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Affiliation(s)
- Deborah E Seale
- Department of Public Health, College of Health Sciences, Des Moines University, Des Moines, IA, United States
| | - Cynthia M LeRouge
- Department of Information Systems & Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Malgorzata Kolotylo-Kulkarni
- Department of Information Management & Business Analytics, Zimpleman College of Business, Drake University, Des Moines, IA, United States
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18
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Pamuk D, Faezi SA, Başıbüyük GÖ. Ergonomics and aging: A bibliometric analysis. Work 2022; 72:853-864. [DOI: 10.3233/wor-210112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Despite the prevalence of publications focusing on the trends of the studies on ergonomics, the information of the aging focused studies within these publications is limited. OBJECTIVE: This study aims to provide general information regarding the trends of the studies on ergonomics and aging by using bibliometric analysis techniques and to provide a general view regarding to the development of this field. METHODS: The bibliometric data of the publications on ergonomics and aging were retrieved from the WOS Database and analysed by using the Bibliometrix extension of the R Packet Programme. For the visualisation of the bibliometric data, the Vosviewer programme was used. RESULTS: Analysis results of the 405 papers published between the years of 1979 and 2020 show that main themes were digital human modelling, design for all, workplace ergonomics, transport and vehicle design, kitchen design, human factors, care and vision in old age. CONCLUSIONS: The content of the studies on ergonomics and aging changed from basic elements of ergonomic design for older people to the investigations about computer-aided applications and the effect of the developing technology. Therefore, it can be said that the studies on ergonomics and aging are changing parallel to the development of the technology.
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Affiliation(s)
- Deniz Pamuk
- Department of Gerontology, Faculty of Health Sciences, Muş Alparslan University, Muş, Turkey
- Department of Gerontology, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Sanam Asadi Faezi
- Department of Gerontology, Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
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19
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Hernandez R, Roll SC, Jin H, Schneider S, Pyatak EA. Validation of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) adapted for the whole day repeated measures context. ERGONOMICS 2022; 65:960-975. [PMID: 34766872 PMCID: PMC9124236 DOI: 10.1080/00140139.2021.2006317] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analysed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of 'mental strain'. Practitioner Summary: Using within-person longitudinal data, we found evidence supporting the validity of a measure evaluating whole-day workload (i.e. workload derived from all sources, not only paid employment) derived from the NASA-TLX. This measure may be useful to assess how day-to-day variations in workload impact quality of life among adults.Abbreviations: NASA-TLX or TLX: National Aeronautics and Space Administration Task Load Index; TLX-6: six item version of the NASA-TLX; TLX-4: four item version of the NASA-TLX, TLX-4v2: four item NASA-TLX version two; NIOSH: National Institute for Occupational Safety and Health; CFA: confirmatory factor analysis; T1D: type 1 diabetes; EMA: ecological momentary assessment; BG: blood glucose; SD: standard deviation; CV: coefficient of variation; RMSEA: root mean square error of approximation; CFI: comparative fit index; TLI: Tucker-Lewis Index; SRMR: standardized root mean square residual; AIC: Akaike information criterion; BIC: Bayesian information criterion; χ2: Chi-square statistic.
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Affiliation(s)
- Raymond Hernandez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089 United States
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089 United States
| | - Haomiao Jin
- Dornsife Center for Self-Report Science and Center for Social & Economic Research, University of Southern California, Los Angeles, California, USA
| | - Stefan Schneider
- Dornsife Center for Self-Report Science and Center for Social & Economic Research, University of Southern California, Los Angeles, California, USA
| | - Elizabeth A. Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089 United States
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20
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Cohen DJ, Wyte-Lake T, Canfield SM, Hall JD, Steege L, Wareg NK, Koopman RJ. Impact of Home Blood Pressure Data Visualization on Hypertension Medical Decision Making in Primary Care. Ann Fam Med 2022; 20:305-311. [PMID: 35879086 PMCID: PMC9328720 DOI: 10.1370/afm.2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Evidence shows the value of home blood pressure (BP) monitoring in hypertension management. Questions exist about how to effectively incorporate these readings into BP follow-up visits. We developed and implemented a tool that combines clinical and home BP readings into an electronic health record (EHR)-integrated visualization tool. We examined how this tool was used during primary care visits and its effect on physician-patient communication and decision making about hypertension management, comparing it with home BP readings on paper. METHODS We video recorded the hypertension follow-up visits of 73 patients with 15 primary care physicians between July 2018 and April 2019. During visits, physicians reviewed home BP readings with patients, either directly from paper or as entered into the EHR visualization tool. We used conversation analysis to analyze the recordings. RESULTS Home BP readings were viewed on paper for 26 patients and in the visualization tool for 47 patients. Access to home BP readings during hypertension management visits, regardless of viewing mode, positioned the physician and patient to assess BP management and make decisions about treatment modification, if needed. Length of BP discussion with the visualization tool was similar to or shorter than that with paper. Advantages of the visualization tool included ease of use, and enhanced and faster sense making and decision making. Successful use of the tool required patients' ability to obtain their BP readings and enter them into the EHR via a portal, and an examination room configuration that allowed for screen sharing. CONCLUSIONS Reviewing home BP readings using a visualization tool is feasible and enhances sense making and patient engagement in decision making. Practices and their patients need appropriate infrastructure to realize these benefits.
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Affiliation(s)
- Deborah J Cohen
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Tamar Wyte-Lake
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Shannon M Canfield
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, Missouri
| | - Jennifer D Hall
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Linsey Steege
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nuha K Wareg
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, Missouri
| | - Richelle J Koopman
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, Missouri
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21
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Galliford N, Yin K, Blandford A, Jung J, Lau AYS. Patient Work Personas of Type 2 Diabetes—A Data-Driven Approach to Persona Development and Validation. Front Digit Health 2022; 4:838651. [PMID: 35814822 PMCID: PMC9260172 DOI: 10.3389/fdgth.2022.838651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Many have argued that a “one-size-fits-all” approach to designing digital health is not optimal and that personalisation is essential to achieve targeted outcomes. Yet, most digital health practitioners struggle to identify which design aspect require personalisation. Personas are commonly used to communicate patient needs in consumer-oriented digital health design, however there is often a lack of reproducible clarity on development process and few attempts to assess their accuracy against the targeted population. In this study, we present a transparent approach to designing and validating personas, as well as identifying aspects of “patient work,” defined as the combined total of work tasks required to manage one's health and the contextual factors influencing such tasks, that are sensitive to an individual's context and may require personalisation. Methods A data-driven approach was used to develop and validate personas for people with Type 2 diabetes mellitus (T2DM), focusing on patient work. Eight different personas of T2DM patient work were constructed based physical activity, dietary control and contextual influences of 26 elderly Australian participants (median age = 72 years) via wearable camera footage, interviews, and self-reported diaries. These personas were validated for accuracy and perceived usefulness for design, both by the original participants and a younger (median age bracket = 45–54 years) independent online cohort f 131 T2DM patients from the United Kingdom and the United States. Results Both the original participants and the independent online cohort reported the personas to be accurate representations of their patient work routines. For the independent online cohort, 74% (97/131) indicated personas stratified to their levels of exercise and diet control were similar to their patient work routines. Findings from both cohorts highlight aspects that may require personalisation include daily routine, use of time, and social context. Conclusion Personas made for a specific purpose can be very accurate if developed from real-life data. Our personas retained their accuracy even when tested against an independent cohort, demonstrating their generalisability. Our data-driven approach clarified the often non-transparent process of persona development and validation, suggesting it is possible to systematically identify whether persona components are accurate or. and which aspects require more personalisation and tailoring.
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Affiliation(s)
- Natasha Galliford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
- *Correspondence: Kathleen Yin
| | - Ann Blandford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Annie Y. S. Lau
- UCL Interaction Centre, University College London, London, United Kingdom
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
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22
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Wooldridge JS, Rossi FS, Anderson C, Yarish NM, Pukhraj A, Trivedi RB. Systematic Review of Dyadic Interventions for Ambulatory Care Sensitive Conditions: Current Evidence and Key Gaps. Clin Gerontol 2022:1-29. [PMID: 35713392 DOI: 10.1080/07317115.2022.2086089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Identify non-pharmacological interventions to support patient/caregiver dyads with ACSCs; review the effects of dyadic interventions on health services outcomes; and review the effectiveness of dyadic interventions on patient and caregiver biopsychosocial outcomes. METHODS A systematic review of randomized controlled trials (RCTs). RESULTS Twenty-six manuscripts representing 20 unique RCTs (Mean N = 154 patients, 140 caregivers) were eligible. Eleven RCTs examined caregiving in patients with HF, seven with T2DM, one with COPD, and one with mixed ACSCs. Dyadic interventions for ACSCs were diverse in terms of length and content, with most including an educational component. Only 4/26 included studies had a low risk of bias. Interventions were most successful at improving quality of life, clinical health outcomes, health behaviors, and health services outcomes, with fewer improvements in patient mental health outcomes, psychosocial outcomes, relationship outcomes, and caregiver outcomes in general. The largest effect sizes were reported from trials focused on T2DM. CONCLUSIONS High-quality research with consistent measuring instruments is needed to understand which interventions are associated with improved patient and caregiver outcomes. CLINICAL IMPLICATIONS There may be clinically relevant benefits to including caregivers in interventions for patients with ACSCs, and clinicians should consider this when devising treatment plans.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Health Care System
- Department of Psychiatry, University of California, San Diego, United States
| | - Fernanda S Rossi
- VA Palo Alto Healthcare System
- Department of Psychiatry Stanford University Stanford, California, United States
| | | | - Natalie M Yarish
- VA San Diego Health Care System
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, United States
| | - Ambri Pukhraj
- VA Palo Alto Healthcare System
- Department of Psychiatry Stanford University Stanford, California, United States
| | - Ranak B Trivedi
- VA Palo Alto Healthcare System
- Department of Psychiatry Stanford University Stanford, California, United States
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Weiler DT, Lingg AJ, Wilkins DM, Militello L, Werner NE. Exploring how caregivers for people living with dementia use strategies to overcome work system constraints. APPLIED ERGONOMICS 2022; 101:103689. [PMID: 35065428 PMCID: PMC8897249 DOI: 10.1016/j.apergo.2022.103689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 05/03/2023]
Abstract
Informal caregivers for persons living with dementia (PLWD) require interventions that incorporate caregiving context. We used the Patient Work System model to characterize caregiving context by identifying work system constraints experienced by caregivers during dementia care events (e.g., managing behavioral symptoms of dementia) and strategies used to overcome constraints. We conducted twenty semi-structured interviews with caregivers. We performed upward abstraction and strategy mapping and identified seven work system constraints and eight strategies used to overcome constraints across three care events. We found that strategies used by caregivers either directly modified a constraint or emphasized other positive work system components to overcome a constraint. For example a caregiver modified their bathroom to support the PLWD in bathing themselves properly and safely. These findings provide an understanding of how real-world context influences how caregivers deliver dementia care and the design and implementation of systems that support dementia caregivers.
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Affiliation(s)
- Dustin T Weiler
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | - Aloysius J Lingg
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | - David M Wilkins
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA
| | | | - Nicole E Werner
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, USA.
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Yin K, Coiera E, Jung J, Rohilla U, Lau AYS. OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:1244-1252. [PMID: 35477787 PMCID: PMC9129121 DOI: 10.1093/jamia/ocac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kathleen Yin
- Corresponding Author: Dr Kathleen Yin, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, North Ryde, New South Wales 2113, Australia;
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Urvashi Rohilla
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia
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25
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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Holden RJ, Abebe E, Russ-Jara AL, Chui MA. Human factors and ergonomics methods for pharmacy research and clinical practice. Res Social Adm Pharm 2021; 17:2019-2027. [PMID: 33985892 PMCID: PMC8603214 DOI: 10.1016/j.sapharm.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. OBJECTIVE To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy. METHODS We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice. RESULTS Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety. CONCLUSIONS Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michelle A Chui
- Social & Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Chang IS, Boger J, Mak S, Grace SL, Arcelus A, Chessex C, Mihailidis A. Load Distribution Analysis for Weight and Ballistocardiogram Measurements of Heart Failure Patients using a Bed Scale. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7369-7372. [PMID: 34892800 DOI: 10.1109/embc46164.2021.9629849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ballistocardiogram (BCG) is an emerging tool with the potential to monitor heart failure (HF) patients. A close association of the weight to the BCG as an intermediate signal source requires a careful design, where events such as saturation of the weight signal can result in the loss of the BCG. This work closely examined the factors around the weight while load cells placed under each support of a bed collected the BCG (e.g., body weight, distribution over the four supports of the bed). Following the calibration of weights based on the location of the polls, the study examined the ratios of loads in head-foot and lateral directions. The head-foot ratio was also correlated to the height. Twelve non-obese HF patients were recruited, and the weight and BCG were appropriately measured, where the average error of the weight measurements was 0.45 ± 0.30%. The mean ratio of the loads between head to foot sensors was 3.2 ± 0.7 with a maximum ratio of 4.5, showing that the head-ward sensors supported greater body weight. The ratio of the loads between the right to left sensors was 1.2 ± 0.1. The height and the head-to-foot ratio had an inverse correlation (r = 0.52). Based on the analysis, the head-ward sensors should have a higher capacity of up to three times that of the foot-ward sensors to prevent any signal saturation. Mobility issues were observed in some subjects, attributing to the lateral imbalance. These novel findings based on the end-users (i.e., HF population) may allow better allocation of conditioning resources to obtain the BCG (e.g., optimally adjusted sensitivity).
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28
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Cheng JM, Batten GP, Yao NA. A Qualitative Study of the Social and Lived Experiences of Homebound Older Adults. J Appl Gerontol 2021; 41:744-753. [PMID: 34459256 DOI: 10.1177/07334648211040383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The number of homebound older adults is increasing in the United States. We aimed to examine their social and lived experiences and to understand their perspectives on their situation, feelings, and coping mechanisms. METHODS We conducted a cross-sectional qualitative study using semi-structured interviews with 18 older homebound individuals in Central Virginia. RESULTS Homebound older adults experienced both physical and mental health challenges that restricted their ability to participate in activities of daily living, recreation, and social interactions. Participants often felt dependent, helpless, lonely, and socially isolated. Those who communicated regularly with friends, family, and health care providers reported positive benefits from these interactions. DISCUSSION Participants faced challenges to their physical, emotional, and mental well-being. Our findings might help clinicians, policymakers, and community organizations understand how to better support homebound older adults. We should provide educational opportunities, respect their autonomy, and implement initiatives to address their isolation and loneliness.
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Affiliation(s)
- Joyce M Cheng
- University of Virginia, Charlottesville, USA.,Johns Hopkins University, Baltimore, MD, USA
| | | | - Nengliang Aaron Yao
- University of Virginia, Charlottesville, USA.,Home Centered Care Institute, Schaumburg, IL, USA.,Shandong University, Jinan, China
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29
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Rogers CC, Moutinho TJ, Liu X, Valdez RS. Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work. JMIR Hum Factors 2021; 8:e27452. [PMID: 34383664 PMCID: PMC8386363 DOI: 10.2196/27452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/18/2021] [Accepted: 07/04/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. OBJECTIVE The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. METHODS We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. RESULTS Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. CONCLUSIONS This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time.
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Affiliation(s)
- Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States
| | - Thomas J Moutinho
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Xiaoyue Liu
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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30
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Austin RC, Schoonhoven L, Clancy M, Richardson A, Kalra PR, May CR. Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review. BMJ Open 2021; 11:e047060. [PMID: 34330858 PMCID: PMC8327846 DOI: 10.1136/bmjopen-2020-047060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Explore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients' experience of illness. DESIGN Review of qualitative research studies. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020. ELIGIBILITY CRITERIA Journal articles in English, reporting qualitative studies on lived experience of CHF. RESULTS 35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms' interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient's capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients' lives. CONCLUSIONS Symptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients' efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients' capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient's agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population. PROSPERO REGISTRATION NUMBER CRD42017077487.
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Affiliation(s)
- Rosalynn C Austin
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mike Clancy
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- Faculty of Health and Science, University of Portsmouth, Portsmouth, Hampshire, UK
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) North Thames, London, UK
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Karami Salaheddin Kola M, Jafari H, Charati JY, Shafipour V. Comparing the effects of teach-back method, multimedia and blended training on self-care and social support in patients with heart failure: A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:248. [PMID: 34485545 PMCID: PMC8395889 DOI: 10.4103/jehp.jehp_1481_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/10/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The knowledge level of caregivers and their support for patients can affect the self-care of patients with heart failure (HF). The present study was conducted to compare the effects of teach-back, multimedia, and blended training methods on self-care and social support in patients with HF and on knowledge in their caregivers. MATERIALS AND METHODS In a randomized clinical trial, a total of 150 HF patient-caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table (n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach-back, multimedia and blended training groups, patient-caregiver dyads participated in 20-30-min training sessions held face-to-face, using digital video disc (DVD) and combination of teach-back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self-Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers' level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients' discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). RESULTS All three educational methods improved self-care behaviors in patients. The comparison of self-care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences (P > 0.05), except 1 day before discharge (P = 0.04). There were no statistically-significant differences between the teach-back, multimedia and the blended training group in terms of perceived social support at any of the four-time points (P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups (P < 0.001). CONCLUSION According to the results of the present study, it seems that all three educational interventions can improve self-care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes.
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Affiliation(s)
| | - Hedayat Jafari
- Traditional and Complementary Medicine Research Center, Addiction Institute Mazandaran University of Medical Science, Sari, Iran
| | - Jamshid Yazdani Charati
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Vida Shafipour
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Werner NE, Ponnala S, Doutcheva N, Holden RJ. Human factors/ergonomics work system analysis of patient work: state of the science and future directions. Int J Qual Health Care 2021; 33:60-71. [PMID: 33432984 DOI: 10.1093/intqhc/mzaa099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To demonstrate the use and value of the Human Factors/Ergonomics-based Systems Engineering Initiative for Patient Safety (SEIPS) family of work system models for studying and improving patient work. DATA SOURCES We conducted a review of the published empirical literature applying the SEIPS family of work system models for patient work. STUDY SELECTION Included studies had to apply one of the SEIPS family of work system models to study patient work; be published in a peer-reviewed journal in English and include analysis of data. We identified 16 articles that met our inclusion criteria. DATA EXTRACTION For each study, we extracted settings and situations in which models were applied; research design; study methods; model(s) used; type and number of study participants; study objective(s); whether the study included an intervention; specific aspects of the model used; knowledge generated about patient work and benefits of using the models. RESULTS OF DATA SYNTHESIS Our analysis revealed that a majority of studies were conducted in the United States, used qualitative or mixed methods and employed a variety of data collection techniques to study adult patient populations with chronic illness and their informal caregivers and healthcare providers performing patient work in the home and clinical setting. The studies resulted in a variety of useful products, demonstrating several benefits of using the models. CONCLUSION Our review has demonstrated the value of using the SEIPS family of work systems models to study and improve patient and family contributions to health-related work.
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Affiliation(s)
| | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nadia Doutcheva
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
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Holden RJ, Carayon P. SEIPS 101 and seven simple SEIPS tools. BMJ Qual Saf 2021; 30:901-910. [PMID: 34039748 PMCID: PMC8543199 DOI: 10.1136/bmjqs-2020-012538] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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34
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Barton HJ, Coller RJ, Loganathar S, Singhe N, Ehlenbach ML, Katz B, Warner G, Kelly MM, Werner NE. Medical Device Workarounds in Providing Care for Children With Medical Complexity in the Home. Pediatrics 2021; 147:peds.2020-019513. [PMID: 33926988 PMCID: PMC8085995 DOI: 10.1542/peds.2020-019513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children with medical complexity (CMC) are commonly assisted by medical devices, which family caregivers are responsible for managing and troubleshooting in the home. Optimizing device use by maximizing the benefits and minimizing the complications is a critical goal for CMC but is relatively unexplored. In this study, we sought to identify and describe workarounds families have developed to optimize medical device use for their needs. METHODS We conducted 30 contextual inquiry interviews with families of CMC in homes. Interviews were recorded, transcribed, and analyzed for barriers and workarounds specific to medical device usage through a directed content analysis. We used observation notes and photographs to confirm and elaborate on interview findings. RESULTS We identified 4 barriers to using medical devices in the home: (1) the quantity and type of devices allotted do not meet family needs, (2) the device is not designed to be used in locations families require, (3) device use is physically or organizationally disruptive to the home, and (4) the device is not designed to fit the user. We also identified 11 categories of workarounds to the barriers. CONCLUSIONS Families face many barriers in using medical devices to care for CMC. Our findings offer rich narrative and photographic data revealing the ways in which caregivers work around these barriers. Future researchers should explore the downstream effects of these ubiquitous, necessary workarounds on CMC outcomes toward developing interventions that optimize device use for families.
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Affiliation(s)
| | - Ryan J. Coller
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Nawang Singhe
- Departments of Industrial and Systems Engineering and
| | - Mary L. Ehlenbach
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Gemma Warner
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | - Michelle M. Kelly
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
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Ozkaynak M, Valdez R, Hannah K, Woodhouse G, Klem P. Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study. J Med Internet Res 2021; 23:e17590. [PMID: 33629657 PMCID: PMC7952231 DOI: 10.2196/17590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. OBJECTIVE The aim of this study is to characterize gaps (from the patient's perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). METHODS Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. RESULTS The causes of gaps included clinician recommendations not fitting into patients' daily routines, recommendations not fitting into patients' living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. CONCLUSIONS Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado
- Anschutz Medical Campus, Aurora, CO, United States
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Katia Hannah
- College of Nursing, University of Colorado
- Anschutz Medical Campus, Aurora, CO, United States
| | - Gina Woodhouse
- University of Colorado Hospital, Aurora, CO, United States
| | - Patrick Klem
- University of Colorado Hospital, Aurora, CO, United States
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Papautsky EL, Patterson ES. Patients Are Knowledge Workers in the Clinical Information Space. Appl Clin Inform 2021; 12:133-140. [PMID: 33626585 DOI: 10.1055/s-0041-1723022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Limited research exists on patient knowledge/cognition or "getting inside patients' heads." Because patients possess unique and privileged knowledge, clinicians need this information to make patient-centered and coordinated treatment planning decisions. To achieve patient-centered care, we characterize patient knowledge and contributions to the clinical information space. METHODS AND OBJECTIVES In a theoretical overview, we explore the relevance of patient knowledge to care provision, apply historical perspectives of knowledge acquisition to patient knowledge, propose a representation of patient knowledge types across the continuum of care, and include illustrative vignettes about Mr. Jones. We highlight how the field of human factors (a core competency of health informatics) provides a perspective and methods for eliciting and characterizing patient knowledge. CONCLUSION Patients play a vital role in the clinical information space by possessing and sharing unique knowledge relevant to the clinical picture. Without a patient's contributions, the clinical picture of the patient is incomplete. A human factors perspective informs patient-centered care and health information technology solutions to support clinical information sharing.
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Affiliation(s)
- Elizabeth Lerner Papautsky
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Emily S Patterson
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States
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Amato C, Burridge G, Basic D, Huynh D, Gibbons E, Ní Chróinín D, Liu KPY. Assistance provided in daily tasks and difficulty experienced by caregivers for people living with dementia. Aust Occup Ther J 2021; 68:236-245. [PMID: 33533025 DOI: 10.1111/1440-1630.12720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION There is a growing body of research that addresses caregivers for people living with dementia. However, there is limited research looking at the perceptions of caregivers in specific daily tasks. To address this gap, this study investigated the assistance caregivers provided and the difficulty they faced when completing daily tasks for people with dementia and, additionally, how these experiences might relate to their perceived burden. METHODS Sixty-two caregivers for people living with dementia completed the study. Data were collected, through a survey, on the level of assistance caregivers provided, and the difficulties they experienced. The Zarit Burden Scale was used to measure the level of perceived burden. Descriptive statistics and Spearman's correlation coefficient were used to report the results and the relationship between the perceived burden, the level of assistance provided, and the difficulty experienced. RESULTS The activities of daily living that caregivers provided the most assistance for was dressing and showering. Most instrumental activities of daily living required maximal to total assistance. Overall, the caregivers did not experience a high level of difficulty with assisting with these daily tasks in comparison to the level of assistance provided. The caregiver burden was associated significantly with the difficulties experienced in dressing, toileting, and showering (rho = 0.30-0.75), most instrumental activities of daily living (rho = 0.29-0.47), but not with the level of assistance provided. CONCLUSION Caregivers are assisting in many daily tasks. Their level of difficulty is relatively low in comparison to the level of assistance they provide. Significant correlations were found between the difficulties experienced and the burden scale. There is a need for occupational therapists to address the specific daily tasks and the concerns experienced by caregivers and to provide them with adequate support to improve the quality of care for people with dementia.
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Affiliation(s)
- Carmen Amato
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Gemma Burridge
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - David Basic
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Danielle Huynh
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Emma Gibbons
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
| | | | - Karen P Y Liu
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
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Carleton-Eagleton K, Walker I, Freene N, Gibson D, Gibson D. Meeting support needs for informal caregivers of people with heart failure: a rapid review. Eur J Cardiovasc Nurs 2021; 20:493-500. [DOI: 10.1093/eurjcn/zvaa017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/01/2020] [Accepted: 10/29/2020] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
To explore whether a support-based intervention for informal caregivers of people with heart failure changes their psychosocial and emotional wellbeing. Background Successful self-management of heart failure includes addressing the psychosocial and emotional wellbeing needs of informal caregivers. However, there is limited evidence of how caregivers are supported in this way.
Methods and results
A rapid review was conducted searching four electronic databases with restrictions to dates January 1996 – September 2019. Specific inclusion and exclusion criteria were applied, and the first author reviewed articles based on title, abstract and then full text, before articles were assessed for conclusions and outcomes. Six studies met the criteria for review. The key caregiver outcomes were burden, depression/anxiety, and quality of life. Significant reductions in caregiver burden were demonstrated in the three studies that measured this outcome. There were mixed results for the outcome measures of depression/anxiety, as well as quality of life, with some interventions demonstrating either significant reductions in depression or anxiety scores, or increases in quality of life scores.
Conclusion
With only six studies included in this rapid review, it is not possible to make any definitive conclusions regarding the success, or otherwise, of interventions for caregivers of people with heart failure to improve their psychosocial and emotional wellbeing. Whilst some papers would tend to suggest that such interventions can reduce caregiver burden, there is a need to interrogate further interventions in this area to fill the current gap in the literature.
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Affiliation(s)
| | - Iain Walker
- Research School of Psychology, Australian National University, Canberra, ACT 2600, Australia
| | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Diane Gibson
- Health Research Institute, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Diane Gibson
- Health Research Institute and Research Institute for Sport & Exercise, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
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Schulman-Green D, Feder SL, Dionne-Odom JN, Batten J, En Long VJ, Harris Y, Wilpers A, Wong T, Whittemore R. Family Caregiver Support of Patient Self-Management During Chronic, Life-Limiting Illness: A Qualitative Metasynthesis. JOURNAL OF FAMILY NURSING 2021; 27:55-72. [PMID: 33334232 PMCID: PMC8114560 DOI: 10.1177/1074840720977180] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Family caregivers play an integral role in supporting patient self-management, yet how they perform this role is unclear. We conducted a qualitative metasynthesis of family caregivers' processes to support patient self-management of chronic, life-limiting illness and factors affecting their support. Methods included a systematic literature search, quality appraisal of articles, data abstraction, and data synthesis to produce novel themes. Thirty articles met inclusion criteria, representing 935 international family caregivers aged 18 to 89 years caring for patients with various health conditions. Three themes characterized family caregivers' processes to support patient self-management: "Focusing on the Patient's Illness Needs," "Activating Resources to Support Oneself as the Family Caregiver," and "Supporting a Patient Living with a Chronic, Life-Limiting Illness." Factors affecting family caregivers' support included Personal Characteristics, Health Status, Resources, Environmental Characteristics, and the Health Care System. The family caregiver role in supporting patient self-management is multidimensional, encompassing three processes of care and influenced by multiple factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Tiffany Wong
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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40
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Holden RJ, Abebe E. Medication transitions: Vulnerable periods of change in need of human factors and ergonomics. APPLIED ERGONOMICS 2021; 90:103279. [PMID: 33049545 PMCID: PMC7606579 DOI: 10.1016/j.apergo.2020.103279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 06/06/2023]
Abstract
We present a novel view of transitions from the lens of patient ergonomics (the "science of patient work"), which posits that patients and other non-professionals perform effortful work towards health-related goals. In patient work transitions, patients experience changes in, for example, health, task demands, work capacity, roles and responsibilities, knowledge and skills, routines, needs and technologies. Medication transitions are a particularly vulnerable type of patient work transitions. We describe two cases of medication transitions-new medications and medication deprescribing-in which the patient work lens reveals many accompanying changes, vulnerabilities, and opportunities for human factors and ergonomics.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
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Burgermaster M, Rudel R, Seres D. Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants. Am J Med 2020; 133:1391-1402. [PMID: 32682866 PMCID: PMC7704603 DOI: 10.1016/j.amjmed.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials, and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in 7 trials; none achieved 1500 mg/d (range 1938-4564 mg/d). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.
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Affiliation(s)
- Marissa Burgermaster
- Departments of Nutritional Sciences and Population Health, College of Natural Sciences and Dell Medical School, University of Texas at Austin.
| | | | - David Seres
- Department of Medicine, Columbia University Medical Center, New York, NY; Institute of Human Nutrition, Columbia University, New York, NY
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42
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Rutkowski RA, Ponnala S, Younan L, Weiler DT, Bykovskyi AG, Werner NE. A process-based approach to exploring the information behavior of informal caregivers of people living with dementia. Int J Med Inform 2020; 145:104341. [PMID: 33242761 DOI: 10.1016/j.ijmedinf.2020.104341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND PURPOSE Informal caregivers of persons living with dementia have significant unmet information needs that, if met, would better equip them to provide effective care. Despite the existence of health information technologies, websites, resources, and organizations dedicated to dementia caregiving, caregivers continue to report unmet information needs. Caregivers' continued unmet information needs suggest a misalignment between information products, and caregivers' information behavior-how caregivers generate, acquire, manage, use, communicate, and seek information. Researchers have developed conceptual models for understanding caregivers' information behavior, but these models are limited in that they are task-oriented, and they assume that caregivers' information needs will be met if they engage in information behavior. To address these limitations, the present study sought to explore caregivers' information behavior as a sociotechnical-systems-based process. METHODS We conduced semi-structured interviews with 30 self-identified caregivers to explore their daily experience of caregiving activities, including their information behavior. We applied a process-based conceptual framework that takes into account inputs, processes, outputs, and feedback mechanisms within a sociotechnical system to guide analysis. The process of interest was caregivers' information behavior as modeled by the information-seeking and communication model (ISCM). We conducted a deductive content analysis guided by the components of the ISCM. We then used team-based affinity diagramming to collapse and categorize the ISCM components into inputs, processes, outputs, and feedback. RESULTS We developed a conceptual model to depict caregivers' information behavior as a sociotechnical-systems-based process of inputs, processes, and outputs that feedback into the system. The conceptual model consisted of three inputs (i.e., information users, information providers, and information products), three information seeking and communication processes (i.e., information access, information interaction, and information assessment and processing), two outputs (i.e., utility and credibility), and feedback. DISCUSSION AND CONCLUSION Building on and addressing the gaps in previous information behavior models, our conceptual framework advances the previous task-level understandings of caregivers' information behavior into a comprehensive feedback-driven, process-level perspective consisting of context-based inputs, information seeking and communication processes, outputs, and feedback. A sociotechnical-systems-based understanding of caregivers' information behavior allows for misalignments between information providers and products, and caregivers' information behavior not only to be illuminated, but systematically addressed.
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Affiliation(s)
- Rachel A Rutkowski
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Laura Younan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Dustin T Weiler
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | | | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States.
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Chang IS, Mak S, Armanfard N, Boger J, Grace SL, Arcelus A, Chessex C, Mihailidis A. Quantification of Resting-State Ballistocardiogram Difference Between Clinical and Non-Clinical Populations for Ambient Monitoring of Heart Failure. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:2700811. [PMID: 33094034 PMCID: PMC7571868 DOI: 10.1109/jtehm.2020.3029690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 11/12/2022]
Abstract
A ballistocardiogram (BCG) is a versatile bio-signal that enables ambient remote monitoring of heart failure (HF) patients in a home setting, achieved through embedded sensors in the surrounding environment. Numerous methods of analysis are available for extracting physiological information using the BCG; however, most have been developed based on non-clinical subjects. While the difference between clinical and non-clinical populations are expected, quantification of the difference may serve as a useful tool. In this work, the differences in resting-state BCGs of the two cohorts in a sitting posture were quantified. An instrumented chair was used to collect the BCG from 29 healthy adults and 26 NYHA HF class I and II patients while seated without any stress test for five minutes. Five 20-second epochs per subject were used to calculate the waveform fluctuation metric at rest (WFMR). The WFMR was obtained in two steps. The ensemble average of the segmented BCG heartbeats within an epoch were calculated first. Mean square errors (MSE) between different ensemble average pairs were then retrieved. The MSEs were averaged to produce the WFMR. The comparison showed that the clinical cohort had higher fluctuation than the non-clinical population and had at least 82.2% separation, suggesting that greater errors may result when existing algorithms were used. The WFMR acts as a bridge that may enable important features, including the addition of error margins in parameter estimation and ways to devise a calibration strategy when resting-state BCG is unstable.
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Affiliation(s)
- Isaac Sungjae Chang
- Institute of Biomaterials and Biomedical Engineering, University of TorontoONM5S 3G9Canada
| | - Susanna Mak
- Division of CardiologyDepartment of MedicineMount Sinai HospitalTorontoONM5G 1X5Canada
| | - Narges Armanfard
- Department of Electrical and Computer EngineeringMcGill UniversityMontrealQCH3A 0G4Canada
| | - Jennifer Boger
- Department of Systems Design EngineeringUniversity of WaterlooWaterlooONN2L 3G1Canada.,Research Institute for AgingWaterlooONN2J 0E2Canada
| | - Sherry L Grace
- Faculty of HealthYork UniversityTorontoONM3J IP3Canada.,Toronto Rehabilitation Institute, University Health NetworkTorontoONM5T 2S8Canada
| | - Amaya Arcelus
- Toronto Rehabilitation Institute, University Health NetworkTorontoONM5T 2S8Canada
| | - Caroline Chessex
- Toronto Rehabilitation Institute, University Health NetworkTorontoONM5T 2S8Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute, University Health NetworkTorontoONM5T 2S8Canada
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44
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Novak LL, Baum HBA, Gray MH, Unertl KM, Tippey KG, Simpson CL, Uskavitch JR, Anders SH. Everyday objects and spaces: How they afford resilience in diabetes routines. APPLIED ERGONOMICS 2020; 88:103185. [PMID: 32678790 DOI: 10.1016/j.apergo.2020.103185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/11/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes. Our primary research goal was to explore how the work of self-care is embedded in the other routines of everyday living. We found that everyday objects and spaces were instrumental in the incorporation of diabetes work into daily routines. Objects anchored diabetes tasks by linking illness-specific artifacts to space and time (e.g. a morning routine), and by enabling the performance on diabetes tasks while on the move in either planned or unplanned ways.
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Affiliation(s)
- Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States.
| | - Howard B A Baum
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, United States
| | - Margaret H Gray
- Department of Medicine, University of Washington School of Medicine, United States
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States
| | - Kathryn G Tippey
- Lineberger Comprehensive Cancer Center - CHAI Core, University of North Carolina, Chapel Hill, United States
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States
| | | | - Shilo H Anders
- Department of Anesthesiology and Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, United States
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45
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Holden RJ. A Simplified System Usability Scale (SUS) for Cognitively Impaired and Older Adults. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/2327857920091021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the 10-item Simplified System Usability Scale (SUS) for Cognitively Impaired and Older Adults, which we have used in several studies since 2016. The Simplified SUS is a revised version of the SUS, a brief, psychometrically valid, and widely used global measure of usability. To improve the ease of administration, the Simplified SUS rewords 9 of 10 SUS items and replaces the original SUS question about inconsistency with a question about confusion. The Simplified SUS retains the SUS's 10-item design, five-item agreement-based Likert scale, and alternating valence of positively worded odd items and negatively worded even items. Because of this, the Simplified SUS can be interpreted the same way as the traditional SUS. The Simplified SUS is an example of an off-the-shelf human factors method adapted for work with vulnerable populations and usable by practitioners or researchers without human factors training.
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Cheng JM, Batten GP, Cornwell T, Yao N. A qualitative study of health-care experiences and challenges faced by ageing homebound adults. Health Expect 2020; 23:934-942. [PMID: 32476232 PMCID: PMC7495080 DOI: 10.1111/hex.13072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The ageing of the global population is associated with an increasing prevalence of chronic diseases and functional impairments, resulting in a greater proportion of homebound individuals. OBJECTIVE To examine the health-care experiences of older homebound adults who have not previously received home-based primary care (HBPC). To explore their impressions of this method of care. DESIGN Cross-sectional qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS 18 older homebound individuals in Central Virginia. RESULTS Our findings revealed that homebound individuals faced significant health challenges, including pain resulting from various comorbidities. They felt that their mobility was restricted by their physical conditions and transportation challenges. These were major barriers to social outings and health-care access. Participants left their homes infrequently and typically with assistance. Regarding office-based care, participants were concerned about long wait times and making timely appointments. Some thought that HBPC would be convenient and could result in better quality care; however, others believed that the structure of the health-care system and its focus on efficiency would not permit routine HBPC. DISCUSSION AND CONCLUSIONS Older homebound adults in this study faced high burdens of disease, a lack of mobility and difficulty accessing quality health care. Our observations may help researchers and clinicians better understand the health-care experiences and personal opinions of older homebound individuals, informing the development of effective and empathetic home-based care. Participant responses illuminated a need for education about HBPC. We must improve health-care delivery and develop comprehensive, patient-centered HBPC to meet the needs of homebound individuals.
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Affiliation(s)
- Joyce M. Cheng
- University of Virginia College of Arts and SciencesCharlottesvilleVAUnited States
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
| | - George P. Batten
- University of Virginia Cancer CenterCharlottesvilleVAUnited States
| | | | - Nengliang Yao
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
- Home Centered Care InstituteSchaumburgILUnited States
- University of Virginia School of MedicineCharlottesvilleVAUnited States
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Cornet VP, Toscos T, Bolchini D, Rohani Ghahari R, Ahmed R, Daley C, Mirro MJ, Holden RJ. Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure. JMIR Mhealth Uhealth 2020; 8:e17703. [PMID: 32706745 PMCID: PMC7404009 DOI: 10.2196/17703] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
Abstract
Background User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories.
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Affiliation(s)
- Victor Philip Cornet
- Department of Human-centered Computing, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States.,Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Davide Bolchini
- Department of Human-centered Computing, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States
| | - Romisa Rohani Ghahari
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Ryan Ahmed
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Carly Daley
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States.,Department of BioHealth Informatics, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States
| | - Michael J Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States.,Department of BioHealth Informatics, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States.,Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Richard J Holden
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States
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Yin K, Jung J, Coiera E, Laranjo L, Blandford A, Khoja A, Tai WT, Phillips DP, Lau AYS. Patient Work and Their Contexts: Scoping Review. J Med Internet Res 2020; 22:e16656. [PMID: 32484449 PMCID: PMC7298639 DOI: 10.2196/16656] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life. Objective This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors. Methods A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools). Results In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support. Conclusions This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.
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Affiliation(s)
- Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Joshua Jung
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ann Blandford
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Adeel Khoja
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Wan-Tien Tai
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Daniel Psillakis Phillips
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia.,UCL Interaction Centre, University College London, London, United Kingdom
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Jaime-Lara RB, Koons BC, Matura LA, Hodgson NA, Riegel B. A Qualitative Metasynthesis of the Experience of Fatigue Across Five Chronic Conditions. J Pain Symptom Manage 2020; 59:1320-1343. [PMID: 31866485 PMCID: PMC7239763 DOI: 10.1016/j.jpainsymman.2019.12.358] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/18/2023]
Abstract
CONTEXT Fatigue is a symptom reported by patients with a variety of chronic conditions. However, it is unclear whether fatigue is similar across conditions. Better understanding its nature could provide important clues regarding the mechanisms underlying fatigue and aid in developing more effective therapeutic interventions to decrease fatigue and improve quality of life. OBJECTIVES To better understand the nature of fatigue, we performed a qualitative metasynthesis exploring patients' experiences of fatigue across five chronic noninfectious conditions: heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease. METHODS We identified 34 qualitative studies written in the last 10 years describing fatigue in patients with one of the aforementioned conditions using three databases (Embase, PubMed, and CINAHL). Studies with patient quotes describing fatigue were synthesized, integrated, and interpreted. RESULTS Across conditions, patients consistently described fatigue as persistent overwhelming tiredness, severe lack of energy, and physical weakness that worsened over time. Four common themes emerged: running out of batteries, a bad life, associated symptoms (e.g., sleep disturbance, impaired cognition, and depression), and feeling misunderstood by others, with a fear of not being believed or being perceived negatively. CONCLUSION In adults with heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease, we found that fatigue was characterized by severe energy depletion, which had negative impacts on patients' lives and caused associated symptoms that exacerbated fatigue. Yet, fatigue is commonly misunderstood and inadequately acknowledged.
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Affiliation(s)
| | - Brittany C Koons
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lea Ann Matura
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ponnala S, Block L, Lingg AJ, Kind AJ, Werner NE. Conceptualizing caregiving activities for persons with dementia (PwD) through a patient work lens. APPLIED ERGONOMICS 2020; 85:103070. [PMID: 32174358 PMCID: PMC7098392 DOI: 10.1016/j.apergo.2020.103070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/03/2020] [Accepted: 01/29/2020] [Indexed: 05/18/2023]
Abstract
Informal caregivers are an integral part of care delivery for persons with dementia (PwD). Informal caregivers take part in a wide range of care activities both individually and collaboratively with other caregivers. Caregiving often involves high demands in the face of limited resources, which can lead to stress, burden, and burnout. To support caregivers, we need to conceptualize caregiving activities they perform, and the networks and roles through which they perform work. We performed a directed content analysis on interview data from twenty caregivers and applied a human factors approach to characterize informal caregiving work. Our results revealed 1) nuances in caregiving roles, 2) differences in caregiving networks, and 3) 13 categories of caregiving activities characterized by time commitments; physical, cognitive and socio-behavioral demands; and varying network dependencies. These findings can be applied in future studies to evaluate the needs of caregiving networks and how to better support them.
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Affiliation(s)
- Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, USA
| | - Laura Block
- School of Nursing, University of Wisconsin - Madison, USA
| | - Aloysius J Lingg
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, USA
| | - Amy J Kind
- School of Medicine, Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Health Services and Care Research Program, USA; School of Medicine and Public Health, University of Wisconsin - Madison, VA Geriatrics Research Education and Clinical Center, Madison VA Hospital, USA
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, USA.
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