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van Velsen L, Ludden G, Grünloh C. The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them. J Med Internet Res 2022; 24:e37341. [PMID: 36197718 PMCID: PMC9582917 DOI: 10.2196/37341] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Human-centered design (HCD) is widely regarded as the best design approach for creating eHealth innovations that align with end users’ needs, wishes, and context and has the potential to impact health care. However, critical reflections on applying HCD within the context of eHealth are lacking. Applying a critical eye to the use of HCD approaches within eHealth, we present and discuss 9 limitations that the current practices of HCD in eHealth innovation often carry. The limitations identified range from limited reach and bias to narrow contextual and temporal focus. Design teams should carefully consider if, how, and when they should involve end users and other stakeholders in the design process and how they can combine their insights with existing knowledge and design skills. Finally, we discuss how a more critical perspective on using HCD in eHealth innovation can move the field forward and offer 3 directions of inspiration to improve our design practices: value-sensitive design, citizen science, and more-than-human design. Although value-sensitive design approaches offer a solution to some of the biased or limited views of traditional HCD approaches, combining a citizen science approach with design inspiration and imagining new futures could widen our view on eHealth innovation. Finally, a more-than-human design approach will allow eHealth solutions to care for both people and the environment. These directions can be seen as starting points that invite and support the field of eHealth innovation to do better and to try and develop more inclusive, fair, and valuable eHealth innovations that will have an impact on health and care.
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Affiliation(s)
- Lex van Velsen
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Department of Communication Science, University of Twente, Enschede, Netherlands
| | - Geke Ludden
- Department of Design, Production and Management, University of Twente, Enschede, Netherlands
| | - Christiane Grünloh
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals group, University of Twente, Enschede, Netherlands
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2
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Kip H, Keizer J, da Silva MC, Beerlage-de Jong N, Köhle N, Kelders SM. Methods for Human-Centered eHealth Development: Narrative Scoping Review. J Med Internet Res 2022; 24:e31858. [PMID: 35084359 PMCID: PMC8832261 DOI: 10.2196/31858] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Julia Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Marcia C da Silva
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Nienke Beerlage-de Jong
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Nadine Köhle
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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3
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Marx GE, Hinckley AF, Mead PS. Post-treatment Lyme borreliosis in context: Advancing the science and patient care. THE LANCET REGIONAL HEALTH. EUROPE 2021; 6:100153. [PMID: 34557835 PMCID: PMC8454648 DOI: 10.1016/j.lanepe.2021.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Grace E. Marx
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Alison F. Hinckley
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Paul S. Mead
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Kramer LL, Ter Stal S, Mulder BC, de Vet E, van Velsen L. Developing Embodied Conversational Agents for Coaching People in a Healthy Lifestyle: Scoping Review. J Med Internet Res 2020; 22:e14058. [PMID: 32022693 PMCID: PMC7055763 DOI: 10.2196/14058] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/12/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Embodied conversational agents (ECAs) are animated computer characters that simulate face-to-face counseling. Owing to their capacity to establish and maintain an empathic relationship, they are deemed to be a promising tool for starting and maintaining a healthy lifestyle. OBJECTIVE This review aimed to identify the current practices in designing and evaluating ECAs for coaching people in a healthy lifestyle and provide an overview of their efficacy (on behavioral, knowledge, and motivational parameters) and use (on usability, usage, and user satisfaction parameters). METHODS We used the Arksey and O'Malley framework to conduct a scoping review. PsycINFO, Medical Literature Analysis and Retrieval System Online, and Scopus were searched with a combination of terms related to ECA and lifestyle. Initially, 1789 unique studies were identified; 20 studies were included. RESULTS Most often, ECAs targeted physical activity (n=16) and had the appearance of a middle-aged African American woman (n=13). Multiple behavior change techniques (median=3) and theories or principles (median=3) were applied, but their interpretation and application were usually not reported. ECAs seemed to be designed for the end user rather than with the end user. Stakeholders were usually not involved. A total of 7 out of 15 studies reported better efficacy outcomes for the intervention group, and 5 out of 8 studies reported better use-related outcomes, as compared with the control group. CONCLUSIONS ECAs are a promising tool for persuasive communication in the health domain. This review provided valuable insights into the current developmental processes, and it recommends the use of human-centered, stakeholder-inclusive design approaches, along with reporting on the design activities in a systematic and comprehensive manner. The gaps in knowledge were identified on the working mechanisms of intervention components and the right timing and frequency of coaching.
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Silke Ter Stal
- eHealth cluster, Roessingh Research and Development, Enschede, Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Bob C Mulder
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- eHealth cluster, Roessingh Research and Development, Enschede, Netherlands
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5
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Fernandez MP, Bron GM, Kache PA, Larson SR, Maus A, Gustafson D, Tsao JI, Bartholomay LC, Paskewitz SM, Diuk-Wasser MA. Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e14769. [PMID: 31651409 PMCID: PMC6913724 DOI: 10.2196/14769] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/29/2023] Open
Abstract
Background Mobile health (mHealth) technology takes advantage of smartphone features to turn them into research tools, with the potential to reach a larger section of the population in a cost-effective manner, compared with traditional epidemiological methods. Although mHealth apps have been widely implemented in chronic diseases and psychology, their potential use in the research of vector-borne diseases has not yet been fully exploited. Objective This study aimed to assess the usability and feasibility of The Tick App, the first tick research–focused app in the United States. Methods The Tick App was designed as a survey tool to collect data on human behaviors and movements associated with tick exposure while engaging users in tick identification and reporting. It consists of an enrollment survey to identify general risk factors, daily surveys to collect data on human activities and tick encounters (Tick Diaries), a survey to enter the details of tick encounters coupled with tick identification services provided by the research team (Report a Tick), and educational material. Using quantitative and qualitative methods, we evaluated the enrollment strategy (passive vs active), the user profile, location, longitudinal use of its features, and users’ feedback. Results Between May and September 2018, 1468 adult users enrolled in the app. The Tick App users were equally represented across genders and evenly distributed across age groups. Most users owned a pet (65.94%, 962/1459; P<.001), did frequent outdoor activities (recreational or peridomestic; 75.24%, 1094/1454; P<.001 and 64.58%, 941/1457; P<.001, respectively), and lived in the Midwest (56.55%, 824/1457) and Northeast (33.0%, 481/1457) regions in the United States, more specifically in Wisconsin, southern New York, and New Jersey. Users lived more frequently in high-incidence counties for Lyme disease (incidence rate ratio [IRR] 3.5, 95% CI 1.8-7.2; P<.001) and in counties with cases recently increasing (IRR 1.8, 95% CI 1.1-3.2; P=.03). Recurring users (49.25%, 723/1468) had a similar demographic profile to all users but participated in outdoor activities more frequently (80.5%, 575/714; P<.01). The number of Tick Diaries submitted per user (median 2, interquartile range [IQR] 1-11) was higher for older age groups (aged >55 years; IRR 3.4, 95% CI 1.5-7.6; P<.001) and lower in the Northeast (IRR[NE] 0.4, 95% CI 0.3-0.7; P<.001), whereas the number of tick reports (median 1, IQR 1-2) increased with the frequency of outdoor activities (IRR 1.5, 95% CI 1.3-1.8; P<.001). Conclusions This assessment allowed us to identify what fraction of the population used The Tick App and how it was used during a pilot phase. This information will be used to improve future iterations of The Tick App and tailor potential tick prevention interventions to the users’ characteristics.
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Affiliation(s)
- Maria P Fernandez
- Earth Institute, Columbia University, New York City, NY, United States.,Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, United States
| | - Gebbiena M Bron
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, United States
| | - Pallavi A Kache
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, United States
| | - Scott R Larson
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam Maus
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - David Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jean I Tsao
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, United States
| | - Lyric C Bartholomay
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Susan M Paskewitz
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, United States
| | - Maria A Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, United States
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Edwards EA, Caton H, Lumsden J, Rivas C, Steed L, Pirunsarn Y, Jumbe S, Newby C, Shenvi A, Mazumdar S, Smith JQ, Greenhill D, Griffiths CJ, Walton RT. Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game. JMIR Serious Games 2018; 6:e10252. [PMID: 30497994 PMCID: PMC6293248 DOI: 10.2196/10252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/25/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. Objective This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. Methods A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. Results Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. Conclusions A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings.
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Affiliation(s)
- Elizabeth A Edwards
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Hope Caton
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Jim Lumsden
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Carol Rivas
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Social Science Research Unit, University College London, London, United Kingdom
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yutthana Pirunsarn
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Sandra Jumbe
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chris Newby
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Aditi Shenvi
- Centre for Complexity Science, University of Warwick, Coventry, United Kingdom
| | - Samaresh Mazumdar
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jim Q Smith
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Darrel Greenhill
- Faculty of Science, Engineering Computing, Kingston University, London, United Kingdom
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Robert T Walton
- Centre for Primary Care and Public Health, Blizard Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Asthma UK Centre for Applied Research, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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7
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Kuosmanen T, Fleming TM, Barry MM. Using Computerized Mental Health Programs in Alternative Education: Understanding the Requirements of Students and Staff. HEALTH COMMUNICATION 2018; 33:753-761. [PMID: 28426253 DOI: 10.1080/10410236.2017.1309620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Computerized cognitive behavioral therapy (cCBT) programs have been shown to be both acceptable and effective with youth. However, their use with more vulnerable youth, such as early school leavers, remains relatively unstudied. This study explored student and staff attitudes toward the use of cCBT in an alternative education setting. METHODS Student and staff needs were assessed using the Requirements development approach (Van Velsen, Wentzel, & Van Gemert-Pijnen, 2013). An online staff survey (n = 16) was conducted to provide information on the context of delivery, and stakeholder requirements were further explored in four student workshops (n = 32) and staff group discussions (n = 12). RESULTS Students' requirements in relation to program look and feel were reflective of issues with literacy and concentration. Activity- rather than text-based programs were considered easier to learn from, whereas attractive design with features such as connecting with others were thought necessary to keep young people engaged. Students wanted to learn practical skills on improving their mental health and well-being, using content that is positive, encouraging, and credible and that can be tailored to individual needs. Anonymity and voluntary participation were considered essential when delivering cCBT in the context of alternative education, as well as additional access from home to ensure timeliness of support. Staff required both flexibility and careful planning and timetabling in order to deliver cCBT in the alternative education setting and to support student engagement. CONCLUSION The findings provide novel insight into the needs and preferences of vulnerable youth, with important implications for the implementation of computerized mental health programs in alternative education settings. A better understanding of user needs and preferences is critical for improving the uptake and impact of e-mental health resources.
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Affiliation(s)
- Tuuli Kuosmanen
- a Health Promotion Research Centre , National University of Ireland, Galway
| | - Theresa M Fleming
- b Department of Paediatrics: Child and Youth Health & Department of Psychological Medicine, Adolescent Health Research Group & Youth e-Therapy , University of Auckland
| | - Margaret M Barry
- a Health Promotion Research Centre , National University of Ireland, Galway
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Paglialonga A, Lugo A, Santoro E. An overview on the emerging area of identification, characterization, and assessment of health apps. J Biomed Inform 2018; 83:97-102. [PMID: 29852318 DOI: 10.1016/j.jbi.2018.05.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/22/2018] [Accepted: 05/27/2018] [Indexed: 11/18/2022]
Abstract
The need to characterize and assess health apps has inspired a significant amount of research in the past years, in search for methods able to provide potential app users with relevant, meaningful knowledge. This article presents an overview of the recent literature in this field and categorizes - by discussing some specific examples - the various methodologies introduced so far for the identification, characterization, and assessment of health apps. Specifically, this article outlines the most significant web-based resources for app identification, relevant frameworks for descriptive characterization of apps' features, and a number of methods for the assessment of quality along its various components (e.g., evidence base, trustworthiness, privacy, or user engagement). The development of methods to characterize the apps' features and to assess their quality is important to define benchmarks and minimum requirements. Similarly, such methods are important to categorize potential risks and challenges in the field so that risks can be minimized, whenever possible, by design. Understanding methods to assess apps is key to raise the standards of quality of health apps on the market, towards the final goal of delivering apps that are built on the pillars of evidence-base, reliability, long-term effectiveness, and user-oriented quality.
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Affiliation(s)
- Alessia Paglialonga
- CNR - Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni (IEIIT), Piazza Leonardo da Vinci, 32, I-20133 Milan, Italy.
| | - Alessandra Lugo
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Dipartimento di Ambiente e Salute, Laboratorio di Epidemiologia degli Stili di Vita, Via La Masa, 19, I-20156 Milan, Italy
| | - Eugenio Santoro
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Dipartimento di Salute Pubblica, Laboratorio di Informatica Medica, Via La Masa, 19, I-20156 Milan, Italy
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9
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Antonise-Kamp L, Beaujean DJMA, Crutzen R, van Steenbergen JE, Ruwaard D. Prevention of tick bites: an evaluation of a smartphone app. BMC Infect Dis 2017; 17:744. [PMID: 29202704 PMCID: PMC5716000 DOI: 10.1186/s12879-017-2836-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/16/2017] [Indexed: 02/07/2023] Open
Abstract
Background Lyme borreliosis (LB) is the most common reported tick-borne infection in Europe, and involves transmission of Borrelia by ticks. As long as a vaccine is not available and effective measures for controlling tick populations are insufficient, LB control is focused on preventive measures to avoid tick bites. To inform citizens about the risk of ticks, motivate them to check for tick bites, and encourage them to remove any attached tick as quickly as possible, a mobile app called ‘Tekenbeet’ (Dutch for ‘tick bite’) was developed and released. The aim of this study was to evaluate the usage and user satisfaction of the ‘Tekenbeet’ app and to investigate whether it affects users’ knowledge, perceived severity, perceived susceptibility, self-efficacy, response efficacy, current behavior and intention to comply with preventive measures. Methods Usage of the app was evaluated with data obtained from Google Analytics. A survey among the Dutch general adult population with two data collection periods evaluated the usage, user satisfaction and its influence on abovementioned outcomes. Results Data obtained from Google Analytics showed the app was downloaded almost 40,000 in the 20 months following the launch. The ‘tick radar’ and ‘tick diary’ screens were viewed most often. In addition, a total of 554 respondents completed an online survey. The mean user satisfaction score was 7.44 (on a scale of 1–10) and 90.9% of respondents would recommend the app to others. On average, survey respondents who downloaded the app (n = 243) recorded significantly more often higher knowledge scores (OR 3.37; 95% CI 2.02–5.09) and had a higher intention to comply with preventive measures (OR 2.47; 95% CI 1.22–5.85) compared to respondents who did not download the app (n = 311). Conclusions The ‘Tekenbeet’ app is a frequently used and well-appreciated educational tool to increase public knowledge of ticks and tick bites. It also helps to improve the user’s intention to apply preventive measures. The use of smartphones and apps is now commonplace in the Netherlands; the ‘Tekenbeet’ app feeds into this trend and thereby offers a modern day alternative to established formats such as an information leaflet and information provision on the Internet. Electronic supplementary material The online version of this article (10.1186/s12879-017-2836-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Antonise-Kamp
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands.
| | - D J M A Beaujean
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - R Crutzen
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - J E van Steenbergen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands.,Centre for Infectious Diseases, Leiden University Medical Centre, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
| | - D Ruwaard
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
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10
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Health Behavior Change Support Systems as a research discipline; A viewpoint. Int J Med Inform 2016; 96:3-10. [DOI: 10.1016/j.ijmedinf.2016.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 11/20/2022]
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11
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Boerema ST, van Velsen L, Vollenbroek-Hutten MMR, Hermens HJ. Value-based design for the elderly: An application in the field of mobility aids. Assist Technol 2016; 29:76-84. [PMID: 27532436 DOI: 10.1080/10400435.2016.1208303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance. We elicited values, facilitators, and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews. The interviews resulted in a myriad of key values, such as "independence from family" and "doing their own groceries." Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.
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Affiliation(s)
- Simone T Boerema
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
| | - Lex van Velsen
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
| | - Miriam M R Vollenbroek-Hutten
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
| | - Hermie J Hermens
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
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Skjøth MM, Hansen HP, Draborg E, Pedersen CD, Lamont RF, Jørgensen JS. Informed Choice for Participation in Down Syndrome Screening: Development and Content of a Web-Based Decision Aid. JMIR Res Protoc 2015; 4:e113. [PMID: 26392319 PMCID: PMC4704943 DOI: 10.2196/resprot.4291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/06/2015] [Accepted: 07/03/2015] [Indexed: 12/26/2022] Open
Abstract
Background In Denmark, all pregnant women are offered screening in early pregnancy to estimate the risk of having a fetus with Down syndrome. Pregnant women participating in the screening program should be provided with information and support to allow them to make an informed choice. There is increasing interest in the use of Web-based technology to provide information and digital solutions for the delivery of health care. Objective The aim of this study was to develop an eHealth tool that contained accurate and relevant information to allow pregnant women to make an informed choice about whether to accept or reject participation in screening for Down syndrome. Methods The development of the eHealth tool involved the cooperation of researchers, technology experts, clinicians, and users. The underlying theoretical framework was based on participatory design, the International Patient Decision Aid Standards (IPDAS) Collaboration guide to develop a patient decision aid, and the roadmap for developing eHealth technologies from the Center for eHealth Research and Disease Management (CeHRes). The methods employed were a systematic literature search, focus group interviews with 3 care providers and 14 pregnant women, and 2 weeks of field observations. A qualitative descriptive approach was used in this study. Results Relevant themes from pregnant women and care providers with respect to information about Down syndrome screening were identified. Based on formalized processes for developing patient decision aids and eHealth technologies, an interactive website containing information about Down syndrome, methods of screening, and consequences of the test was developed. The intervention was based on user requests and needs, and reflected the current hospital practice and national guidelines. Conclusions This paper describes the development and content of an interactive website to support pregnant women in making informed choices about Down syndrome screening. To develop the website, we used a well-structured process based on scientific evidence and involved pregnant women, care providers, and technology experts as stakeholders. To our knowledge, there has been no research on the combination of IPDAS standards and the CeHRes roadmap to develop an eHealth tool to target information about screening for Down syndrome.
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Affiliation(s)
- Mette Maria Skjøth
- Research Unit of Gynecology and Obstetrics, Department of Gynecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
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Beaujean D, van Velsen L, van Gemert-Pijnen JE, Maat A, van Steenbergen JE, Crutzen R. Using risk group profiles as a lightweight qualitative approach for intervention development: an example of prevention of tick bites and lyme disease. JMIR Res Protoc 2013; 2:e45. [PMID: 24172875 PMCID: PMC3841373 DOI: 10.2196/resprot.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many public health campaigns use a one-size-fits-all strategy to achieve their desired effect. Public health campaigns for tick bites and Lyme disease (LD) in many countries convey all relevant preventive measures to all members of the public. Although preventing tick bites (eg, by wearing protective clothing or using repellants) and checking for tick bites after visiting a risk area are effective and cost-efficient methods to prevent an individual from contracting a tick-borne disease, public compliance to these methods is low. OBJECTIVE We aimed to identify the group of individuals within the general Dutch population that are at high risk of being bitten by a tick or developing LD and to describe their characteristics, knowledge, and perceptions. The incidence of patients visiting their general practitioner for tick bites and erythema migrans (the first sign of LD) has increased tremendously in the last decades in the Netherlands and other European countries; therefore, our efforts can be used to counter this troubling trend. METHODS We conducted in-depth semi-structured interviews to identify individuals belonging to the average risk group. Participants were recruited in two ways. Patients who visited two municipal health services travel health clinics (one in a high-endemic area and one in a low-endemic area) were asked to participate. This resulted in 18 interviews. Further, parents were recruited using the convenience sampling method, which resulted in 7 interviews. We discontinued interviewing when the point of data saturation was reached. We analyzed the results immediately after each interview to identify the point of data saturation. Data saturation is when the new interviews provided no new information compared to the previous interviews. The interviews were transcribed and analyzed using inductive thematic analysis. RESULTS We identified four groups at risk of being bitten by ticks and developing LD among the general Dutch population. The groups were as follows: (1) outdoor people that check for tick bites, (2) outdoor people that do not check for tick bites, (3) parents that check their children for tick bites, and (4) parents that do not check their children for tick bites. Previous experience with ticks or LD was the main denominator between the groups. Checking for tick bites is a more easily adopted measure than preventing tick bites. Therefore, for all groups, public health efforts in the future should primarily emphasize on the importance of checking for tick bites. CONCLUSIONS The lightweight qualitative approach presented in this paper is highly relevant in tailoring public health efforts toward specific groups. The profiles of members in each risk group and the motivations underlying the behaviors of the members in each risk group can be used to determine the features and content of a targeted communication strategy about ticks and LD.
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Affiliation(s)
- Desiree Beaujean
- National Institute for Public Health and the Environment, National Coordination Centre for Outbreak Management (LCI), Bilthoven, Netherlands.
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van Velsen L, Beaujean DJMA, van Gemert-Pijnen JEWC. Why mobile health app overload drives us crazy, and how to restore the sanity. BMC Med Inform Decis Mak 2013; 13:23. [PMID: 23399513 PMCID: PMC3621678 DOI: 10.1186/1472-6947-13-23] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 01/29/2013] [Indexed: 11/25/2022] Open
Abstract
Background Smartphones and tablet computers have become an integral part of our lives. One of their key features is the possibility of installing third-party apps. These apps can be very helpful for improving health and healthcare. However, medical professionals and citizens are currently being overloaded with health apps. Consequently, they will have difficulty with finding the right app, and information and features are fragmented over too many apps, thereby limiting their usefulness. Discussion In order to combat health app overload, suppliers of apps need to do three things. One, join the open source movement, so that a few apps can work as gateway to medical information by incorporating information from different sources. Two, standardize content, so that the information provided via apps is readable. And third, in order to prevent information overload from occurring within an app, content should be personalized towards an individual’s characteristics and context. Summary Suppliers of medical information and features need to join the open source movement and must make use of standardized medical information formats, in order to allow third parties to create valuable, mobile gateway apps. This can prevent the occurrence of health app overload. By going along in these trends, we can make health apps achieve the impact on healthcare quality and citizens’ health many of us envision.
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Affiliation(s)
- Lex van Velsen
- National Institute for Public Health and the Environment, P,O, box 1, Bilthoven 3720 BA, The Netherlands.
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