Digital Health and Care Study on Elderly Monitoring

Sustainable technologies are being increasingly used in various areas of human life. While they have a multitude of benefits, they are especially useful in health monitoring, especially for certain groups of people, such as the elderly. However, there are still several issues that need to be addressed before its use becomes widespread. This work aims to clarify the aspects that are of great importance for increasing the acceptance of the use of this type of technology in the elderly. In addition, we aim to clarify whether the technologies that are already available are able to ensure acceptable accuracy and whether they could replace some of the manual approaches that are currently being used. A two-week study with people 65 years of age and over was conducted to address the questions posed here, and the results were evaluated. It was demonstrated that simplicity of use and automatic functioning play a crucial role. It was also concluded that technology cannot yet completely replace traditional methods such as questionnaires in some areas. Although the technologies that were tested were classified as being “easy to use”, the elderly population in the current study indicated that they were not sure that they would use these technologies regularly in the long term because the added value is not always clear, among other issues. Therefore, awareness-raising must take place in parallel with the development of technologies and services.

Relationship Between Efficiency, Effectiveness, and Learnability of Home Connected Medical Device in Ambulatory Surgery

Background: Currently, usability assessments of home connected medical devices do not systematically take into account learnability metrics. In case of the Smart Angel device-designed for monitoring ambulatory surgery patients-users are trained at the hospital and have to use the device at home to monitor their health remotely. Objective: The aim of this study was to better understand the relationships between two metrics of usability-efficiency and effectiveness-and learnability of the Smart Angel device. Materials and Methods: Twenty-eight participants were trained in a simulated hospital (SimUsanté), and then we filmed the participant using the device three times. Between each session, the participant had to complete questionnaires (sociodemographic and health literacy). Results: The results of a between-subject analysis [χ²(2) = 18.969, p < 0.001] and a within-subject analysis [F(2.28) = 13.34, p < 0.001, η² = 0.35] showed that efficiency (manipulation time) significantly improved with learnability (number of sessions). Conversely, effectiveness (number of manipulation errors) stagnated over the three sessions with a between-subject analysis [F(2.75) = 1.628, p = 0.203], while the within-subject analysis revealed that users seemed to significantly correct their errors with the number of sessions [F(2.28) = 6, p = 0.005, η² = 0.19]. By analyzing the errors, we observed that some errors could appear at any time (e.g., moving during the measurement) and others were systematic (e.g., the wrist blood pressure on the right arm). Conclusions: While the "first attempt" at using a home medical device is a major revealing step for the study of manipulation errors, learnability is an equally useful metric to include in usability studies, as well as in the very definition itself of usability.

Effects of User Characteristics on the Usability of a Home-Connected Medical Device (Smart Angel) for Ambulatory Monitoring: Usability Study

Background

The Smart Angel home medical device allows ambulatory surgery patients to monitor their own health by taking their blood pressure and oxygen levels and answering a health questionnaire from home. Currently, this device is a prototype in the design phase, and no usability evaluation has been performed. This preventive device must be usable by patients with different profiles; however, it is important to select patients carefully to ensure their safety when using the device. As such, it would be interesting to know how to select or exclude patients. However, the links between user characteristics and the usability of this home medical device remain unclear.

Objective

This study aims to better understand the links between certain characteristics of potential patients (ie, age, education, technophilia, and health literacy) and the usability (ie, effectiveness, efficiency, and satisfaction) of Smart Angel, as defined by the ISO 9241-11.

Methods

We conducted an experimental study involving 36 participants investigating the effects of 4 patient characteristics (ie, age, education, technophilia, and health literacy) on usability, measured in terms of effectiveness, efficiency, and satisfaction. A mixed methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). First, to help participants project themselves into the real use of the Smart Angel device, they watched a scenario in a video. Second, the participants completed a set of questionnaires to show the extent of their health literacy level (Newest Vital Sign [NVS] and the Health Literacy Survey [HLS]) and then operated Smart Angel devices. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (System Usability Scale [SUS]). The qualitative observational data were coded using inductive analysis by 2 independent researchers specialized in cognitive psychology and cognitive ergonomics.

Results

The results show a moderate and positive correlation between age and effectiveness (r=0.359; P=.03) and efficiency (r=0.357; P=.03). There is strong correlation between health literacy scored by the NVS and effectiveness (r=0.417; P=.01), efficiency (r=-0.38; P=.02), and satisfaction (r=0.45; P=.006). However, there is a weak correlation between technophilia and usability and no relationship between education level and usability.

Conclusions

Our results show that literacy level and age are 2 important factors to consider when selecting future users of the Smart Angel device to ensure patient safety. This study also serves as an example promoting mixed methodologies in assessments of medical device usability that cannot be performed under real-world conditions.

Impact of the format of user instructions on the handling of a wrist blood pressure monitor

Few studies have focused on procedural documents in the field of home medical devices, although incorrect use and usability problems can have important consequences for the patient's health. In this study, we focused on the procedural learning of a home medical device, a blood pressure monitor. Five formats (unimodal: text, audio, pictures; and multimodal: text/audio with pictures) were tested on 124 novice participants randomly assigned to 5 groups. We judged the quality of the formats on the basis of three metrics: efficiency (i.e., handling errors), effectiveness (i.e., consultation time of the procedure, execution time of the devices) and memorability (i.e., recall task). Results suggest that the audio format was more effective than the other groups but also the least efficient. We consider the audio format to be beneficial for patient safety because this format would oblige participants to use a strategy suited to the situation, namely an atomization of the action corresponding to a segmentation of information less likely to saturate working memory. Results in relation to the other formats did not show a more effective, efficient and memorable format. This lack of difference in user performance is nevertheless important, illustrating the need to adapt each instruction to the context of learning, i.e., according to the users, the environment, the resources and the complexity of the task to be executed.

Effect of Prior Health Knowledge on the Usability of Two Home Medical Devices: Usability Study

Background

Studies on the usability of health care devices are becoming more common, although usability standards are not necessarily specified and followed. Yet, there is little knowledge about the impact of the context of use on the usability outcome. It is specified in the usability standard (ISO 9241-11, 2018) of a device that it may be affected by its context of use and especially by the characteristics of its users. Among these, prior health knowledge (ie, knowledge about human body functioning) is crucial. However, no study has shown that prior health knowledge influences the usability of medical devices. 

Objective

Our study aimed to fill this gap by analyzing the relationship between the usability of two home medical devices (soon to be used in the context of ambulatory surgery) and prior health knowledge through an experimental approach.

Methods

For assessing the usability of two home medical devices (blood pressure monitor and pulse oximeter), user tests were conducted among 149 students. A mixed-methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). Participants completed a questionnaire to show the extent of their previous health knowledge and then operated both devices randomly. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (system usability scale [SUS]). The qualitative observational data were coded using inductive analysis by two independent researchers specialized in cognitive psychology and cognitive ergonomics. Correlational analyses and clusters were performed to test how usability relates to sociodemographic characteristics and prior health knowledge.

Results

The results indicated a lack of usability for both devices. Regarding the blood pressure monitor (137 participants), users made approximately 0.77 errors (SD 1.49), and the mean SUS score was 72.4 (SD 21.07), which is considered “satisfactory.” The pulse oximeter (147 participants) appeared easier to use, but participants made more errors (mean 0.99, SD 0.92), and the mean SUS score was 71.52 (SD 17.29), which is considered “satisfactory.” The results showed a low negative and significant correlation only between the effectiveness of the two devices and previous knowledge (blood pressure monitor: r=−0.191, P=.03; pulse oximeter: r=−0.263, P=.001). More subtly, we experimentally identified the existence of a threshold level (χ²_2,146=10.9, P=.004) for health knowledge to correctly use the pulse oximeter, but this was missing for the blood pressure monitor.

Conclusions

This study has the following two contributions: (1) a theoretical interest highlighting the importance of user characteristics including prior health knowledge on usability outcomes and (2) an applied interest to provide recommendations to designers and medical staff.