Icon Familiarity Affects the Performance of Complex Cognitive Tasks

Beyond Words: Enhancing Clinical Guideline Comprehension With Icons

Background

The Grading Recommendations, Assessment, Development, and Evaluations (GRADE) framework is widely applied in clinical guidelines to facilitate transparent evidence evaluation. While developing Infectious Diseases Society of America (IDSA) guidelines on the management of patients with coronavirus disease 2019 (COVID-19), panel members suggested developing and implementing a visual aid to enable quicker identification of key information by providers at bedside seeking guidance.

Methods

We conducted a mixed-methods study evaluating the usability of a newly designed infographic/icon using a survey and focus groups. The survey incorporated a simulated COVID-19 IDSA guideline with and without the icon, followed by comprehension questions. Focus group discussions provided qualitative feedback on the GRADE methodology and icon usability.

Results

The survey was returned by 289 health care providers. There was no statistical difference in the correct response rates between icon-aided and non-icon-aided guideline questions (McNemar's chi-square test, P > .1 for both questions). Interactions with the icon notably increased the time taken and number of clicks required to respond to the first question (Wilcoxon signed-rank test, P < .01). In contrast, response time did not differ between versions for the second question (P = .38). Most subjects (85%) indicated that the icon improved the readability of the guidelines. A focus group follow-up suggested alternative designs for the icon.

Conclusions

This study highlights the promise of iconography in clinical guidelines, although the specific icons tested did not measurably improve usability metrics. Future research should focus on icon design and testing within a formal usability framework, considering the impact of GRADE language on user experience.

The effects of icon design features on user perception and preference: A case study of icons for Covid-19

The objective of this study is to evaluate users' perceptions and preferences on the design features of the COVID-19 prevention promotion icon from the perspective of users' aesthetic and perceptual needs. In this study, 120 officially published icons from 24 countries and regions were collected from online platforms for ranking tests, and then the top-ranked icons were subjectively rated by the semantic differential method. By evaluating the quality of users' perceptions of multiple semantic dimensions of icons, we extracted the perceptual semantic words that users valued as the main icon design features. Spearmen correlations were applied to derive possible correlations between user rankings and semantic scales, and a Friedman test was also conducted to determine the true differences in user perceptions and preferences for different styles of icons. Factor analysis was conducted to extract six perceptual words that influence the design features of the COVID-19 prevention promotion icon. The methodology adopted in this study facilitated the screening of design features related to icon effectiveness, and the findings show that "Interesting," "Simple," "Familiar, "Recognizable," "Concrete," and "Close(semantic distance)" are the key features that influence users' perception and preference of COVID-19 icon design. The results of this study can be used as the basis for designing and improving publicity icons for preventive measures in COVID-19, and the methods adopted in this study can be applied to evaluate other types of icon design.

Implementation of major trauma app: usability and data completeness

BACKGROUND

The current UK standard for major trauma patients is to record notes in a paper trauma booklet. Through an innovative collaboration between a major trauma centre and a digital transformation industry partner, a TraumaApp was developed. Electronic notes have been shown to have fewer errors, granular data collection and enable time stamped contemporaneous record keeping. Implementation of digital clinical records presents a challenge within the context of trauma multidisciplinary trauma resuscitation. Data can be easily accessible and shared for quality improvement, audit and research purposes. This study compared paper and electronic notes for completeness and for acceptability data following the implementation of the TraumaApp.

METHODS

Trauma team members who performed scribe function attended training for the newly launched TraumaApp. Two staff members acted as scribe, using either the paper trauma booklet or TraumaApp, and attended major trauma calls. A framework for comparison of paper and electronic notes was created and used for a retrospective review of major trauma patients' notes. Statistical analysis was performed using a two-tailed t-test. Staff using the TraumaApp completed a System Usability Score questionnaire.

RESULTS

There was a total of 37 data points for collection per case. The mean numbers collected were paper notes 24.1 of 37 (65.1%) and electronic notes, 25.7 of 37 (69.5%). There was no statistical significance between the completeness of paper and electronic notes. The mean System Usability Score was 68.4.

DISCUSSION

Recording accurate patient information during a major trauma call can be challenging and the role of the scribe to accurately record events is critical for immediate and future care. There was no statistically significant difference in completeness of paper and electronic notes, however the mean System Usability Score was 68.4, which is greater than the internationally validated standard of acceptable usability.

CONCLUSION

It is feasible to introduce digital data collection tools enabling accurate record keeping during trauma resuscitation and improve information sharing between clinicians.

The effects of task novelty for age cohort and cognition level on memory for everyday virtual meal preparation tasks

Nonsensical information increases task novelty, which makes it difficult to rely on previous learning and provides insight into the learning of new tasks. This study investigated procedural-based action scripts in everyday memory for meal preparation tasks in virtual reality. The sample (N = 171) consisted of 3 groups determined by age and cognitive function: young adults (YA; n = 61), older adults with normal cognition (OA; n = 82), and older adults with impaired cognition (IC; n = 28). The three groups completed the Virtual Kitchen Protocol, a virtual reality-based measure of learning and memory for cooking both familiar and nonsensical meals. Results showed that YAs had a greater recall for both familiar and nonsensical meals than OAs or ICs. Additionally, novel stimuli (i.e., nonsensical meal tasks) appear to impact older adults more than young adults. Among older adults, impaired cognition was associated with lower performance on both the sensical and nonsensical meals compared to normal cognition. All three groups performed better on familiar tasks than nonsensical tasks. These results were consistent with the notion that familiarity may be of greater use than novelty in the context of procedural-based action scripts.

Elderly users' perceptions of signage systems from tertiary hospitals in Guangzhou

Wayfinding in hospitals today is a significant challenge for urban residents, especially for the elderly. This study investigated the perceptions and attitudes of the elderly toward existing hospital signage systems to identify the wayfinding needs in the healthcare environment. This study collected 762 elderly participants' perceptions and personal preferences regarding 12 features of the existing signage systems in three hospitals in the Yuexiu, Haizhu, and Liwan districts of Guangzhou using a questionnaire methodology. The study further explored the differences in perceptions and preferences for signage based on the gender, age, and educational level of the elderly participants. The findings indicate that most of the elderly participants experienced becoming lost in the hospital; they typically chose to ask others for directions first, followed by using the signage system. Most of the elderly participants had positive attitudes toward the current hospital signage system. Furthermore, they emphasized the importance of the signage system's graphics, texts, colors, and updates, which directly affects the readability and comprehensibility of signs. We found gender differences in perceptions and attitudes toward signage; male participants had more positive attitudes toward the hospital signage systems than female participants. Additionally, consistent with previous findings, the older the age of participants, the less comprehension they had regarding signage graphic symbols. We also found that the more educated elderly participants were, the more understanding of signage they had. At the same time, however, they were less satisfied, which is possibly because the more educated they were, the more aware they were of signage issues.

The gamification of nutrition labels to encourage healthier food selection in online grocery shopping: A randomized controlled trial

Food purchase choices, one of the main determinants of food consumption, is highly influenced by food environments. Given the surge in online grocery shopping because of the COVID-19 pandemic, interventions in digital environments present more than ever an opportunity to improve the nutritional quality of food purchase choices. One such opportunity can be found in gamification. Participants (n = 1228) shopped for 12 items from a shopping list on a simulated online grocery platform. We randomized them into four groups in a 2 × 2 factorial design: presence vs. absence of gamification, and high vs. low budget. Participants in the gamification groups saw foods with 1 (least nutritious) to 5 (most nutritious) crown icons and a scoreboard with a tally of the number of crowns the participant collected. We estimated ordinary least squares and Poisson regression models to test the impact of the gamification and budget on the nutritional quality of the shopping basket. In the absence of gamification and low budget, participants collected 30.78 (95% CI [30.27; 31.29]) crowns. In the gamification and low budget condition, participants increased the nutritional quality of their shopping basket by collecting more crowns (B = 4.15, 95% CI [3.55; 4.75], p < 0.001). The budget amount ($50 vs. $30) did not alter the final shopping basket (B = 0.45, 95% CI [-0.02; 1.18], p = 0.057), nor moderated the gamification effect. Gamification increased the nutritional quality of the final shopping baskets and nine of 12 shopping list items in this hypothetical experiment. Gamifying nutrition labels may be an effective strategy to improve the nutritional quality of food choices in online grocery stores, but further research is needed.

How Do Older Adults Process Icons in Visual Search Tasks? The Combined Effects of Icon Type and Cognitive Aging

Considering the differences in cognitive aging among older adults, this study examined how older adults process different types of graphic icons in visual search tasks. Fifty-four medical-related icons, including flat icons (FIs), FIs plus text (FIs + text), skeuomorphic icons (SIs), and SIs plus text (SIs + text), were created. The participants were divided into two groups—cognitively normal (CN) and mild cognitive impairment (MCI)—to complete a visual search task. According to the eye-tracking data of the participants, the search performance of the CN group was significantly better than that of the MCI group. In terms of icon types, all older adults performed better at searching for the combinations of icon and text, especially SI + text, which showed the smallest difference in the search performance between the MCI and CN groups. All older adults performed poorly when searching for FIs. The findings of this study considered the differences in cognitive aging among older adults and provided a useful reference for the icon and interface design of graphical user interfaces.

Usability of novel major TraumaApp for digital data collection

Background

Delivery of major trauma care is complex and often fast paced. Clear and comprehensive documentation is paramount to support effective communication during complex clinical care episodes, and to allow collection of data for audit, research and continuous improvement. Clinical events are typically recorded on paper-based records that are developed for individual centres or systems. As one of the priorities laid out by the Scottish Trauma Network project was to develop an electronic data collection system, the TraumaApp was created as a data collection tool for major trauma that could be adopted worldwide.

Methods

The study was performed as a service evaluation based at the Queen Elizabeth University Hospital Emergency Department. Fifty staff members were recruited in pairs and listened to five paired major trauma standby and handover recordings. Participants were randomised to input data to the TraumaApp and one into the existing paper proforma. The time taken to input data add into was measured, along with time for clarifications and any errors made. Those using the app completed a System Usability Score.

Results

No statistically significant difference was demonstrated between times taken for data entry for the digital and paper documentation, apart from the Case 5 Handover (p < 0.05). Case 1 showed a significantly higher time for clarifications and number of errors with digital data collection (p = 0.01 and p = 1.79E-05 respectively). There were no other differences between data for the app and the proforma. The mean System Usability score for this cohort was 75 out of 100, with a standard deviation of 17 (rounded to nearest integer).

Conclusion

Digital real-time recording of clinical events using a tool such as the TraumaApp is comparable to completion of paper proforma. The System Usability Score for the TraumaApp was above the internationally validated standard of acceptable usability. There was no evidence of improvement in use over time or familiarity, most likely due to the brevity of the assessments and the refined user interface. This would benefit from further research, exploring data completeness and a potential mixed methods approach to explore training requirements for use of the TraumaApp.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00578-9.