Understanding User Requirements for a Senior-Friendly Mobile Health Application

The advancement of mobile technologies has motivated countries around the world to aim for smarter health management to support senior citizens. However, the use of mobile health applications (mHealth apps) among senior citizens appears to be low. Thus, drawing upon user expectations, the present study examined user requirements for a senior-friendly mHealth application. A total of 74 senior citizens were interviewed to explore the difficulties they encounter when using existing mobile apps. This study followed Nielsen’s usability model to identify user requirements from five aspects, namely learnability, efficiency, memorability, error, and satisfaction. Based on the results, a guideline was proposed pertaining to usability and health management features. This guideline offers suggestions for mHealth app issues related to phrasing, menus, simplicity, error messages, icons and buttons, navigation, and layout, among others. The study also found that speech recognition technology can help seniors access information quickly. The proposed guideline and findings offer valuable input for software and app developers in building more engaging and senior-friendly mHealth apps.

Exploring Adoption and Satisfaction with Self-Service Health Technology in Older Age: Perspectives of Healthcare Professionals and Older People

(1) Background. A range of self-service technologies (SST) have been adapted to support the health of older people. Factors involved in older people’s and health professionals’ perceptions of SST in older age were investigated. (2) Methods. Customer Dominant Logic guided this prospective mixed-methods study, including surveys with people 70 years and over and health professionals and individual semi-structured interviews in a sample of survey respondents. Survey data were descriptively analysed, while interview themes were derived inductively. (3) Results. Surveyed (n = 12) people 70 years and over placed higher value, expressed more positive user experience, were more satisfied and had greater recognition of the benefits of SST, compared with (n = 10) health professionals (p = 0.001), who considered them to be inferior to traditional healthcare. All seven interviewees agreed that despite accessibility issues and complexity, they valued SST support of older people’s health, thereby confirming the relevance of Customer Dominant Logic in SST offerings. (4) Conclusions. Since older participants were positive and satisfied in using SSTs that are health-supporting, health professionals have a role in encouraging and assisting older people in their use. This requires targeted SST education for health professionals, and more accessible, user-friendly SST and technological support for older people.

Self-management processes, sedentary behavior, physical activity and dietary self-management behaviors: impact on muscle outcomes in continuing care retirement community residents

BACKGROUND

Despite the known benefits of non-sedentary behavior, physical activity, and protein and caloric intake to health and muscle mass, strength, and function, many older adults do not meet physical activity and dietary recommendations. A better understanding of the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes (muscle mass, strength, and function) is needed, particularly among continuing care retirement community residents. The objective of this study was to examine the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes among continuing care retirement community residents. It also aimed to determine whether sedentary behavior and physical activity and dietary self-management behaviors mediate the relationships between self-efficacy, goal congruence, aging expectations, social support, and muscle outcomes.

METHODS

A sample of 105 continuing care retirement community residents (age > 70 years) participated in this correlational, cross-sectional study. Questionnaires on pain, self-efficacy, goal congruence, aging expectation, social support, and daily protein and caloric intake were administered. Physical activity and sedentary behavior (ActiGraph wGT3X-BT), muscle mass (ImpediMed SFB7), muscle strength (Jamar Smart Digital Hand Dynamometer), and muscle function (Short Physical Performance Battery) were measured. Multiple regression, logistic regression, and mediation analyses were performed.

RESULTS

Low goal congruence predicted engagement in sedentary behavior and light physical activity. Higher levels of self-efficacy and social support were associated with increased likelihoods of achieving greater moderate physical activity and meeting daily recommendations for caloric intake, respectively. Self-efficacy and goal congruence predicted muscle function and strength. Moreover, sedentary behavior and achieving greater moderate physical activity were found to partially but significantly mediate the relationship between self-efficacy and muscle function.

CONCLUSION

Future research should evaluate whether attempts to reduce sedentary behavior and promote physical activity and dietary self-management behaviors and muscle outcomes are more successful when modifications to the self-management process factors are also targeted.

Understanding Health Self-Management Challenges and Needs for Older Adults with and without Mobility and Sensory Disabilities

Health self-management could be challenging for older adults with disabilities and technology has great potential to support them for managing health activities. Assessing users' needs is a significant technique to develop useful technologies. However, studies overwhelmingly collected and analyzed qualitative data in smaller samples or quantitative data in populations with single type of disability. This study aimed to analyze a national level dataset to assess the frequency of and challenges with managing health activities in older population with and without disabilities and identify potential support solutions to provide guidance for technology interventions. In this study, 4,541 older adults from the National Health and Aging Trends Study were grouped into five sub-groups (non-disability, mobility, vision, hearing, multiple disability). The findings indicated lower participation in wellness activities (e.g., exercise) than disease management activities (e.g., taking medicines, going to medical appointment). Around one tenth of older adults reported difficulty with tracking medicines and 23.4%-64.3% of respondents reported being accompanied during medical appointments. Managing health activities was more challenging for older adults with mobility and multiple disabilities. They were more likely to have difficulties and receive assistance with managing these activities, including accessing online health information. In conclusion, needs of older adults to manage health varied across activities and for people with different types of disabilities. We provide direction for person-centered and tailored interventions to respond to these needs.

A Framework for Design of Conversational Agents to Support Health Self-Care for Older Adults

OBJECTIVE

We examined the potential of conversational agents (CAs) to support older adults' self-care related to chronic illness in light of lessons learned from decades of pedagogical agent research, which investigates the impact and efficacy of CAs for a wide range of learners.

BACKGROUND

The role of CAs in education (i.e., pedagogical agents) has been long studied, but their potential for supporting self-care has received less attention, especially for older adults.

METHODS

We reviewed work on pedagogical agents and considered how it informs the design of CAs for older adults. We propose a framework for designing CAs to support older adult self-care, which organizes a review of work in this area and integration with the pedagogical agent literature.

RESULTS

Our review of the pedagogical agent literature revealed an evolution from teaching machines to interactive, social systems that influence student motivational as well as learning outcomes. To integrate this review with work on CAs and self-care, we developed a framework that specifies how self-care goals evolve with stages of an illness, communication goals that support self-care at each stage, patient needs, and requirements for CAs to support these needs. The review identified an agenda for future research on CA functions and features that help older adults accept need for self-care, establish self-care, and sustain self-care over time.

CONCLUSIONS

Integrating insights from the pedagogical agent literature with research on developing CAs for self-care defines an agenda for developing and evaluating CAs to help older adults manage illness.

Identifying Mobile Health Engagement Stages: Interviews and Observations for Developing Brief Message Content

BACKGROUND

Interest in mobile health (mHealth) has increased recently, and research suggests that mHealth devices can enhance end-user engagement, especially when used in conjunction with brief message content.

OBJECTIVE

This research aims to explore the stages of engagement framework for mHealth devices and develop a method to generate brief message content to promote sustained user engagement. This study uses the framework by O'Brien and Toms as a point of departure, where engagement is defined as the uptake or the use of an mHealth device. The framework is a linear repeatable process, including point of engagement, period of engagement, disengagement, and re-engagement. Each stage is characterized by attributes related to a person's technology experience. Although the literature has identified stages of engagement for health-related technology, few studies explore mHealth engagement. Furthermore, little research has determined a method for creating brief message content at each stage in this engagement journey.

METHODS

Interviews and observations from 19 participants who used mHealth technologies (apps, devices, or wellness websites) in a solo capacity were recruited for sample group 1. In sample group 2, interviews, and observations from 25 participants using mHealth technologies in a group capacity through the Global Corporate Challenge were used. These samples were investigated at 3 time points in both research contexts. The results underwent deductive-inductive thematic analysis for the engagement stages' framework and attributes.

RESULTS

In addition to the 4 stages identified by O'Brien and Toms, 2 additional stages, self-management and limited engagement, were identified. Self-management captures where users had disengaged from their technology but were still engaged with their health activity. Limited engagement captures where group mHealth users had minimal interaction with their mHealth technology but continued to engage in a group fitness activity. The results revealed that mHealth engagement stages were nonlinear and embedded in a wider engagement context and that each stage was characterized by a combination of 49 attributes that could be organized into 8 themes. Themes documented the total user experience and included technology usability, technology features, technology aesthetics, use motivations, health awareness, goal setting, social support, and interruptions. Different themes were found to have more relevance at different engagement stages. Knowing themes and attributes at all engagement stages allows technology developers and health care professionals to generate relevant brief message content informed by a person-centered approach.

CONCLUSIONS

This research extends an existing engagement stages framework and identifies attributes and themes relevant to mHealth technology users' total user experience and incorporates concepts derived from health, business studies, and information systems literature. In addition, we offer a practical 5-step process based on a person-centered approach to develop mHealth technology brief message content for sustained engagement.

Coaching Through Technology: A Systematic Review into Efficacy and Effectiveness for the Ageing Population

Background: Despite the evidence on the positive role of self-management, the adoption of health coaching strategies for older people is still limited. To address these gaps, recent efforts have been made in the ICT sector in order to develop systems for delivering coaching and overcoming barriers relating to scarcity of resources. The aim of this review is to examine the efficacy of personal health coaching systems for older adults using digital virtual agents. Methods: A systematic review of the literature was conducted in December 2019 analyzing manuscripts from four databases over the last 10 years. Nine papers were included. Results: Despite the low number of studies, there was evidence that technology-integrated interventions can deliver benefits for health over usual care. However, the review raises important questions about how to maintain benefits and permanence of behavior change produced by short-term interventions. Conclusion: These systems offer a potential tool to reduce costs, minimize therapist burden and training, and expand the range of clients who can benefit from them. It is desirable that in the future the number of studies will grow, considering other aspects such as the role of the virtual coaches’ characteristics, social-presence, empathy, usability, and health literacy.

Patient ergonomics: 10-year mapping review of patient-centered human factors

Patient ergonomics is the application of human factors or related disciplines to study and improve patients' and other non-professionals' performance of effortful work activities in pursuit of health goals. We performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. The review revealed a robust and growing body of literature on patient ergonomics, particularly in the areas of aging and chronic disease, tools and technologies, and evaluations of patient-centered interventions on outcomes such as usability, user acceptance, and performance. Findings highlighted gaps deserving future research, including research with understudied populations such as children, informal caregivers, networks and collectives (groups), and marginalized populations; on topics such as health promotion and transitions of care; and using longitudinal and experimental study designs. The growth of patient-centeredness in general and of patient ergonomics in particular compel other more focused reviews, new primary research, and developing a roadmap for future patient ergonomics research.

Promoting access to health information

Purpose

Describe the design of a health information and technology educational intervention that promotes health information sharing and technology use for older adult African Americans to support access to health information. The paper aims to discuss this issue.

Design/methodology/approach

The study team developed a novel method to design the intervention. It drew upon three approaches: intergenerational technology transfer, participatory design and community-based participatory research.

Findings

Older adult African Americans (55+) with diabetes and young adults (18–54) connected to them via familial or naturally occurring social networks designed the intervention, which was conducted in the two study sites in Michigan, USA. In total, 29 participants helped design the intervention. Four themes emerged concerning factors that promote intergenerational information exchange in the context of technology and health. First, focus on one technology skill. Second, working together in small groups is preferred. Third, patience is essential. Last, physical capabilities (i.e., eyesight, operating on relatively small screens) and literacy levels should be considered.

Originality/value

This novel method of having participants from the sample population select the health information materials and technology exercises serves as a guide for implementing health information and education interventions aimed at technology use to support self-management for vulnerable patient populations.

Mobile Health Apps: Improving Usability for Older Adult Users

With smartphone use among older populations on the rise, older adults have increased access to health-focused mobile apps. Despite their potential benefits for managing health, currently no guidelines exist for designing these apps specifically for older adult users. We evaluated the usability of one medication management app and two congestive heart failure management apps using cognitive walkthroughs, heuristic analysis, and user testing. We identified design issues that may affect usability for older users, including poor navigation, small button sizes, and inadequate data visualizations. We provide guidelines for developers of health apps to facilitate use by older adults.

Uncovering the invisible patient work system through a case study of breast cancer self-management

As patients transition from passive recipients to actors in their health management, there is an opportunity to enhance theoretical frameworks describing the patient work system. Previous macroergonomic frameworks depict how patients manage health outside the institutional healthcare system, though none formally integrate the concept of invisible work - self-management practices undervalued or unseen by healthcare providers. This article overlays invisible work onto the patient work system through a case study of breast cancer self-management. Thirty breast cancer survivors were interviewed about positive and negative experiences post-diagnosis. Invisible and visible components of participants' work systems were explicated through qualitative content analysis. The results demonstrate that all participants had invisible work system components, and based on these findings, this article theorises the existence of an 'invisible patient work system.' Future research and design to support self-management practices should explicitly address the invisible characteristics of the work systems in which patients are embedded.Practitioner Summary: This article seeks to enhance the healthcare human factors literature by integrating the concept of invisible work into preexisting patient work system models. Through a secondary analysis of an interview study with 30 breast cancer survivors, we found that all participants recalled invisible components of their respective work systems. Abbreviations CHIT Consumer Health Information Technology SEIPS Systems Engineering Initiative for Patient Safety IRB Institutional Review Board SES Socioeconomic Status mHealth Mobile Health PHR Patient Health Record ICAN Instrument for Patient Capacity Assessment HIPAA Health Insurance Portability and Accoutability Act.

Investigating the Enduring Impact of a Community-Based Health Education Program to Promote African American Elders' Use of Technology Designed to Support Chronic Disease Self-Management

Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies to address barriers, the study team recruited elder African Americans with diabetes and young adults connected to the elders through naturally occurring familial or social networks. Participants attended a community-based health education session focused on enhancing self-efficacy for recommended self-management and using consumer-oriented technology accessible on their smartphones for self-management support. To assess enduring impact, the study team conducted a pilot study to investigate perceptions and use one month following the health education session. Both elders and young adults offered perspectives on what was effective in teaching elders how to use technology. Both age groups stressed that having patience was crucial, as is providing encouragement for the elders to try tasks on their own. Both elders and young adults also showed a statistically significant increase in aspirations to work together for additional intergenerational health and technology knowledge exchange. Several elder participants continued using technology that they first used during the session. This novel, pilot study describes how to promote self-management and technology use for individuals plagued by persistent chronic disease and technology use disparities.

Technology for Remote Health Monitoring in an Older Population: A Role for Mobile Devices

The impact of an aging population on healthcare and the sustainability of our healthcare system are pressing issues in contemporary society. Technology has the potential to address these challenges, alleviating pressures on the healthcare system and empowering individuals to have greater control over monitoring their own health. Importantly, mobile devices such as smartphones and tablets can allow older adults to have “on the go” access to health-related information. This paper explores mobile health apps that enable older adults and those who care for them to track health-related factors such as body readings and medication adherence, and it serves as a review of the literature on the usability and acceptance of mobile health apps in an older population.

Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure

BACKGROUND

Personas are a canonical user-centered design method increasingly used in health informatics research. Personas-empirically-derived user archetypes-can be used by eHealth designers to gain a robust understanding of their target end users such as patients.

OBJECTIVE

To develop biopsychosocial personas of older patients with heart failure using quantitative analysis of survey data.

METHOD

Data were collected using standardized surveys and medical record abstraction from 32 older adults with heart failure recently hospitalized for acute heart failure exacerbation. Hierarchical cluster analysis was performed on a final dataset of n=30. Nonparametric analyses were used to identify differences between clusters on 30 clustering variables and seven outcome variables.

RESULTS

Six clusters were produced, ranging in size from two to eight patients per cluster. Clusters differed significantly on these biopsychosocial domains and subdomains: demographics (age, sex); medical status (comorbid diabetes); functional status (exhaustion, household work ability, hygiene care ability, physical ability); psychological status (depression, health literacy, numeracy); technology (Internet availability); healthcare system (visit by home healthcare, trust in providers); social context (informal caregiver support, cohabitation, marital status); and economic context (employment status). Tabular and narrative persona descriptions provide an easy reference guide for informatics designers.

DISCUSSION

Personas development using approaches such as clustering of structured survey data is an important tool for health informatics professionals. We describe insights from our study of patients with heart failure, then recommend a generic ten-step personas development process. Methods strengths and limitations of the study and of personas development generally are discussed.

Capturing the Medication Management Work System of Older Adults Using a Digital Diary Method

Human Factors and Ergonomics (HFE) has the potential to transform the lives of older adults by helping them better manage their health and disease. Older adults are often beset with multiple chronic illnesses and struggle to manage complex medication regimens. Non-adherence, errors, and poor outcomes are common. New research shows that patients’ health-related activities constitute an effortful, goal-driven type of work called patient work. HFE can play a major role in the study and improvement of patient work performance but current HFE methods are not fully suitable. This is in part because patient work is variable and takes place in home and community settings dissimilar to those commonly studied by healthcare HFE researchers. The objective of this study was to perform a work systems analysis of the medication management work of older adults with heart failure by adapting a method more suitable for the study of patient work. This qualitative longitudinal study used an innovative digital diary data collection method. Fifteen older adults with heart failure made medication-related multimedia recordings over a one-week period followed by an interview. These data were content analyzed according to the Patient Work System model. Results identified 6 organizational (70 instances), 7 task (45 instances), 7 tool (31 instances), 6 patient (31 instances), 4 social (21 instances), and 2 physical work system factors (10 instances). Patient medication performance suffered from a lack of care coordination and integration. Organizational tools such as mail order delivery facilitated access, but many patients devised tools and strategies to address other barriers. The study concluded that there is a need to design task-relevant tools to support and optimize the patients’ medication management work systems.

Medication Management Apps: Usable by Older Adults?

For older adults, managing medications can be a burden and could lead to medication non-adherence. To decrease risks associated with medication non-adherence, healthcare providers may recommend medication reminder apps as an assistive tool. However, these apps are often not designed with consideration of older adults' needs, capabilities, and limitations. To identify whether available apps are suitable for older adults, we conducted an in-depth cognitive walkthrough and a heuristic evaluation of the most commonly downloaded medication reminder app. Findings revealed three main issues: 1) difficulty in navigation, 2) poor visibility, and 3) a lack of transparency. We also selected the top five downloaded medication reminder apps and categorized user reviews to assess app functionality and usability problems. The results of our analysis provide guidance for app design for older adult users to provide effective tools for managing medications and supporting patient/user health.

Managing Heart Failure On the Go: Usability Issues with mHealth Apps for Older Adults

Mobile apps for self-managing chronic health conditions are widely available for download from online app stores. Mobile health (mHealth) apps provide a convenient way of managing health conditions (e.g., congestive heart failure); however, little is known about their design specifications with respect to older adult users. We conducted a 3-phase assessment of human factors issues for common mHealth apps designed for managing congestive heart failure. In Phase 1, we identified two apps often used by older adults. In Phase 2, we evaluated these apps according to standard human factors principles. In Phase 3, we conducted usability testing of the apps with six older adults. We report design issues identified in the apps that limit usability by older adults. We encourage mHealth app designers to improve usability by: 1) providing easier navigation, 2) streamlining data entry processes, 3) providing clear recovery from errors, and 4) simplifying visualizations of data patterns.

Supporting Optimal Aging through the Innovative Use of Virtual Reality Technology

Although virtual reality (VR) technology has been implemented as a tool to address the health issues of older adults, its applicability to social connectedness is underrepresented in the literature, and less is known about its efficacy in this area in contributing to overall wellness and well-being in later life. Expanding the VR possibilities beyond traditional entertainment purposes holds considerable potential for the older adult market. Technological tools have been employed in the elder health care field for many years, and cutting-edge developments such as virtual and augmented reality have begun to be used to facilitate optimal wellness in aging. Such technological advances have the potential to significantly impact one of the most important issues that older people face: social isolation and loneliness. This paper will serve as an introductory exploration of what is currently known about the use of virtual reality technology with an older cohort.

Understanding the Medication Adherence Strategies of Older Adults with Hypertension

Many older adults are living with at least one chronic disease and must adhere to prescribed medication to mitigate and control its impact. Hypertension is one chronic disease that affects a significant portion of the world’s population, especially older adults, and is responsible for a high number of annual deaths. It is asymptomatic, meaning that there are no perceptible symptoms and, as such, older adults may struggle with adhering to their prescribed antihypertensive medications. How one internalizes the disease may influence the degree of success in managing the condition. The current study analyzed archival data from a multifaceted prospective memory intervention for older adults with hypertension who were nonadherent to their medication. We coded their responses to self-management interview questions to identify the common themes regarding the knowledge and sense of control the older adults held relevant to managing their illness. Participants’ responses revealed how they internalized hypertension and their medication, as well as the strategies and goals they reportedly used to manage the illness. The association strategy was found to be the most commonly used within participants’ routines. In addition, many participants expressed a general lack of knowledge about the disease or their medication, and their goals regarding hypertension management were general and inexplicit (e.g., “to reduce their blood pressure). This information informs the design of more effective and longer-lasting interventions geared toward significantly improving the medication adherence of older adults diagnosed with hypertension.

Healthy Weight in Lesbian and Bisexual Women Aged 40 and Older: An Effective Intervention in 10 Cities Using Tailored Approaches

BACKGROUND

Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks.

METHODS

Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report.

ANALYTICAL PLAN

Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models.

RESULTS

Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n = 43) and mindfulness (n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18-2.36; p = .004; RR, 1.38; 95% CI, 1.01-1.89; p = .042, respectively) and those in the gym program (n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97-3.68, p = .06) compared with the comparison group (n = 67).

CONCLUSION

This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.

"Healthy to heaven" - Middle-agers looking ahead in the context of wellness consumption

Concentrating on personal health and well-being has become a central objective for people living in wealthy societies. In an age of consumerism, the current health enthusiasm can be observed particularly in the fast-growing wellness industry, the popularity of which has increased, in particular, among mature consumers, a trend also evident in people's individual strategies for aging well. As it is generally assumed that aging people consume wellness mainly to delay signs of aging, this study focuses on this understudied phenomenon with the aim of deepening the profile of mature wellness consumers. The data consist of eight group interviews of Finnish middle-agers (50-65years). Interviewees' (N=41) talk about the pursuit of wellness revealed several points of connection between their current life stage and wellness consumption. As people were experiencing many aging-related changes in their lives they tended to engage in different bodily practices with a view to an "active third age." In the context of the life stage of middle-agers, wellness as a present-day phenomenon can be interpreted as one of the social settings in which people both reflect on their personal aging experiences and seek to strengthen the "wellness skills" they feel are necessary for personal self-care and life-management especially in forthcoming years.

Macroergonomic factors in the patient work system: examining the context of patients with chronic illness

Human factors/ergonomics recognises work as embedded in and shaped by levels of social, physical and organisational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identified 17 factors across physical, social and organisational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative or varying effects on health and health behaviour. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients' health-related activities but also specific factors to consider in future research, design and policy efforts. Practitioner Summary: Health-related activities of patients are embedded in and shaped by levels of social, physical and organisational context. This paper combined findings from three studies to specify 17 contextual or macroergonomic factors in home- and community-based work systems of chronically ill patients. These factors have research, design and policy implications.

The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers

Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in "patient-engaged human factors," or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains-physical-spatial, social-cultural, and organizational-and multiple "spaces" such as "at home," "on the go," and "in the community." Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work.

Older Adults' Changes in Intent to Adopt Wellness Management Technologies

Individuals are becoming more involved in managing their own health. Health self-management technologies have the potential to help older adults remain well by promoting exercise and a good diet. However, older adults may or may not decide to adopt wellness management technologies. Adoption is a process and the intent to adopt may change over time. Sixteen older adults (8 females; M age=70.06, SD=3.09; range=65-75) used one of two wellness management technologies (the Fitbit One or myfitnesspal.com) over a 28-day period. Initially, all participants were open or neutral to adopting their technologies. After 28 days, 12 participants intended to adopt and 4 participants did not intend to adopt. The diary data revealed that over time, adopters made more positive comments than non-adopters. Both adopters and non-adopters mentioned perceived ease of use praises and complaints, whereas only adopters mentioned praises regarding usefulness. Results are interpreted within the frameworks of the unified theory of acceptance and use of technology (Venkatesh et al., 2003) and the diffusion of innovation (Rogers, 2003). Changes in intent to adopt suggest that experience is important in the adoption decision. Adoption of wellness management technologies by older adults may increase if designers attend to the perceived ease of use and perceived usefulness factors identified in this study.