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Bosworth KT, Ghosh P, Flowers L, Proffitt R, Koopman RJ, Tosh AK, Wilson G, Braddock AS. The user-centered design and development of a childhood and adolescent obesity Electronic Health Record tool, a mixed-methods study. Front Digit Health 2024; 6:1396085. [PMID: 39411348 PMCID: PMC11476727 DOI: 10.3389/fdgth.2024.1396085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 08/30/2024] [Indexed: 10/19/2024] Open
Abstract
Background Childhood and adolescent obesity are persistent public health issues in the United States. Childhood obesity Electronic Health Record (EHR) tools strengthen provider-patient relationships and improve outcomes, but there are currently limited EHR tools that are linked to adolescent mHealth apps. This study is part of a larger study entitled, CommitFit, which features both an adolescent-targeted mobile health application (mHealth app) and an ambulatory EHR tool. The CommitFit mHealth app was designed to be paired with the CommitFit EHR tool for integration into clinical spaces for shared decision-making with patients and clinicians. Objectives The objective of this sub-study was to identify the functional and design needs and preferences of healthcare clinicians and professionals for the development of the CommitFit EHR tool, specifically as it relates to childhood and adolescent obesity management. Methods We utilized a user-centered design process with a mixed-method approach. Focus groups were used to assess current in-clinic practices, deficits, and general beliefs and preferences regarding the management of childhood and adolescent obesity. A pre- and post-focus group survey helped assess the perception of the design and functionality of the CommitFit EHR tool and other obesity clinic needs. Iterative design development of the CommitFit EHR tool occurred throughout the process. Results A total of 12 healthcare providers participated throughout the three focus group sessions. Two themes emerged regarding EHR design: (1) Functional Needs, including Enhancing Clinical Practices and Workflow, and (2) Visualization, including Colors and Graphs. Responses from the surveys (n = 52) further reflect the need for Functionality and User-Interface Design by clinicians. Clinicians want the CommitFit EHR tool to enhance in-clinic adolescent lifestyle counseling, be easy to use, and presentable to adolescent patients and their caregivers. Additionally, we found that clinicians preferred colors and graphs that improved readability and usability. During each step of feedback from focus group sessions and the survey, the design of the CommitFit EHR tool was updated and co-developed by clinicians in an iterative user-centered design process. Conclusion More research is needed to explore clinician actual user analytics for the CommitFit EHR tool to evaluate real-time workflow, design, and function needs. The effectiveness of the CommitFit mHealth and EHR tool as a weight management intervention needs to be evaluated in the future.
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Affiliation(s)
- K. Taylor Bosworth
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, United States
- School of Medicine, Tom and Anne Smith MD/PhD Program, University of Missouri, Columbia, MO, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, MO, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Aneesh K. Tosh
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Gwen Wilson
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Amy S. Braddock
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, United States
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Gannon H, Larsson L, Chimhuya S, Mangiza M, Wilson E, Kesler E, Chimhini G, Fitzgerald F, Zailani G, Crehan C, Khan N, Hull-Bailey T, Sassoon Y, Baradza M, Heys M, Chiume M. Development and Implementation of Digital Diagnostic Algorithms for Neonatal Units in Zimbabwe and Malawi: Development and Usability Study. JMIR Form Res 2024; 8:e54274. [PMID: 38277198 PMCID: PMC10858425 DOI: 10.2196/54274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms. OBJECTIVE This second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe. METHODS Overall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital's health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS). RESULTS Overall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively. CONCLUSIONS This study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings.
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Affiliation(s)
- Hannah Gannon
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Leyla Larsson
- Institute of Computational Biology, Computational Health Centre, Helmholtz, Munich, Germany
| | - Simbarashe Chimhuya
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | | | - Emma Wilson
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | - Erin Kesler
- Children's Hospital of Philadelphia, Philidephia, PA, United States
| | - Gwendoline Chimhini
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Felicity Fitzgerald
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Caroline Crehan
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | - Nushrat Khan
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | - Tim Hull-Bailey
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Michelle Heys
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
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Haghparast-Bidgoli H, Hull-Bailey T, Nkhoma D, Chiyaka T, Wilson E, Fitzgerald F, Chimhini G, Khan N, Gannon H, Batura R, Cortina-Borja M, Larsson L, Chiume M, Sassoon Y, Chimhuya S, Heys M. Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study. JMIR Mhealth Uhealth 2023; 11:e50467. [PMID: 38153802 PMCID: PMC10766148 DOI: 10.2196/50467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/21/2023] [Accepted: 11/07/2023] [Indexed: 12/30/2023] Open
Abstract
Background Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap. Objective We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe. Methods We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented. Results Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50). Conclusions Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.
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Affiliation(s)
| | - Tim Hull-Bailey
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | - Tarisai Chiyaka
- Centre for Sexual Health and HIV/AIDS Research, University of Zimbabwe, Harare, Zimbabwe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Emma Wilson
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Felicity Fitzgerald
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Gwendoline Chimhini
- Department of Child Adolescent and Women’s Health, University of Zimbabwe, Harare, Zimbabwe
| | - Nushrat Khan
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Hannah Gannon
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rekha Batura
- Institute for Global Health, University College London, London, United Kingdom
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Leyla Larsson
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Simbarashe Chimhuya
- Department of Child Adolescent and Women’s Health, University of Zimbabwe, Harare, Zimbabwe
- Neonatal Unit, Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - Michelle Heys
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Borda A, Molnar A, Heys M, Musyimi C, Kostkova P. Editorial: Digital interventions and serious mobile games for health in low- and middle-income countries (LMICs). Front Public Health 2023; 11:1153971. [PMID: 36875377 PMCID: PMC9975710 DOI: 10.3389/fpubh.2023.1153971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Ann Borda
- Faculty of Medicine, Dental and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Information Studies, University College London, London, United Kingdom
| | - Andreea Molnar
- Department of Computing Technologies, Swinburne University, Melbourne, VIC, Australia
| | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health (GOS ICH), University College London, London, United Kingdom
| | - Christine Musyimi
- Africa Mental Health Training and Research Foundation (AMHRTF), Nairobi, Kenya
| | - Patty Kostkova
- UCL Centre for Digital Public Heath in Emergencies (dPHE), University College London, London, United Kingdom
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