The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study

Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.

Technology-Enabled Senior Living: A Preliminary Report on Stakeholder Perspectives

BACKGROUND

The integration of stakeholders is crucial in developing smart living technologies to support the autonomy of elderly populations. Despite the clear benefits of these technologies, there remains a significant gap in comprehensive research.

METHODS

This study presents the viewpoints of 19 stakeholders from Europe and Japan, focusing on the sustainability of smart living solutions for Active and Healthy Ageing (AHA). Data were gathered through qualitative semi-structured interviews and analysed using a Framework Analysis approach.

RESULTS

Analysis of the interviews revealed six key sustainability categories: addressing the unmet needs of older adults, functionalities of the smart living coach, integration within organizations, identified barriers, financial considerations, and the social role of the smart living coach.

CONCLUSIONS

This research underscores the importance of evaluating user needs through the involvement of various stakeholders, including the elderly, their caregivers, professionals, technicians, service providers, and government bodies. Collaborative efforts are essential to generate new evidence demonstrating the value of smart living solutions in facilitating Active and Healthy Ageing.

Internet-delivered emotional self-management program for the general population during the COVID-19 pandemic: Usability testing

Introduction

Internet-based self-help interventions have the potential to help people address their emotional needs at relatively low costs. However, if the system does not offer optimal functions, it could reduce end-user adherence and satisfaction with treatment and compromise the effectiveness of the program. This study evaluated the usability of an Internet-based self-help intervention for emotional self-management among the general population of Italy during the COVID-19 pandemic.

Methods

A balanced sex-age sample of 10 individuals who met the inclusion criteria were consecutively recruited online. The think-aloud testing method, the system usability scale and an ad hoc semi-structured interview were used to determine the overall system usability.Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis.

Results

The participants were mostly satisfied with the usability of the program. However, older users (<45 years) encountered some problems, which took longer, made more mistakes, and needed more help in performing the tasks than their younger counterparts. The analysis of the interviews revealed three central themes: general thoughts about the platform, weaknesses of the platform and difficulties encountered while navigating and completing tasks, and strengths of the platform.

Discussion

Based on the results of this study, important improvements will be made before the RinasciMENTE program is tested under real-world conditions. Conducting usability testing is a crucial step at an early stage of the development process of an Internet-based self-help intervention to identify potential usability problems with the system.

Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study

BACKGROUND

As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers.

OBJECTIVE

This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity.

METHODS

The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers.

RESULTS

Among the participants, "disability welfare information and related institutional linkage" was the highest priority. Three of the 14 user interface sketches the participants created were related to "providing educational content." The 11 heuristic evaluation experts identified "focusing on a single task" as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased.

CONCLUSIONS

In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity.

Effectiveness of Human-Supported and Self-Help eHealth Lifestyle Interventions for Patients With Cardiometabolic Risk Factors: A Meta-Analysis

OBJECTIVE

eHealth is a useful tool to deliver lifestyle interventions for patients with cardiometabolic diseases. However, there are inconsistent findings about whether these eHealth interventions should be supported by a human professional, or whether self-help interventions are equally effective.

METHODS

Databases were searched between January 1995 and October 2021 for randomized controlled trials on cardiometabolic diseases (cardiovascular disease, chronic kidney disease, type 1 and 2 diabetes mellitus) and eHealth lifestyle interventions. A multilevel meta-analysis was used to pool clinical and behavioral health outcomes. Moderator analyses assessed the effect of intervention type (self-help versus human-supported), dose of human support (minor versus major part of intervention), and delivery mode of human support (remote versus blended). One hundred seven articles fulfilled eligibility criteria and 102 unique ( N = 20,781) studies were included.

RESULTS

The analysis showed a positive effect of eHealth lifestyle interventions on clinical and behavioral health outcomes ( p < .001). However, these effects were not moderated by intervention type ( p = .169), dose ( p = .698), or delivery mode of human support ( p = .557).

CONCLUSIONS

This shows that self-help eHealth interventions are equally effective as human-supported ones in improving health outcomes among patients with cardiometabolic disease. Future studies could investigate whether higher-quality eHealth interventions compensate for a lack of human support.Meta-analysis registration: PROSPERO CRD42021269263 .

Predicting and Empowering Health for Generation Z by Comparing Health Information Seeking and Digital Health Literacy: Cross-Sectional Questionnaire Study

BACKGROUND

Generation Z (born 1995-2010) members are digital residents who use technology and the internet more frequently than any previous generation to learn about their health. They are increasingly moving away from conventional methods of seeking health information as technology advances quickly and becomes more widely available, resulting in a more digitalized health care system. Similar to all groups, Generation Z has specific health care requirements and preferences, and their use of technology influences how they look for health information. However, they have often been overlooked in scholarly research.

OBJECTIVE

First, we aimed to identify the information-seeking preferences of older individuals and Generation Z (those between the ages of 18 and 26 years); second, we aimed to predict the effects of digital health literacy and health empowerment in both groups. We also aimed to identify factors that impact how both groups engage in digital health and remain in control of their own health.

METHODS

The Health Information National Trends Survey was adopted for further use in 2022. We analyzed 1862 valid data points by conducting a survey among Chinese respondents to address the research gap. A descriptive analysis, 2-tailed t test, and multiple linear regression were applied to the results.

RESULTS

When compared with previous generations, Generation Z respondents (995/1862, 53.44%) were more likely to use the internet to find out about health-related topics, whereas earlier generations relied more on traditional media and interpersonal contact. Web-based information-seeking behavior is predicted by digital health literacy (Generation Z: β=.192, P<.001; older population: β=.337, P<.001). While this was happening, only seeking health information from physicians positively predicted health empowerment (Generation Z: β=.070, P=.002; older population: β=.089, P<.001). Despite more frequent use of the internet to learn about their health, Generation Z showed lower levels of health empowerment and less desire to look for health information, overall.

CONCLUSIONS

This study examined and compared the health information-seeking behaviors of Generation Z and older individuals to improve their digital health literacy and health empowerment. The 2 groups demonstrated distinct preferences regarding their choice of information sources. Health empowerment and digital health literacy were both significantly related to information-seeking behaviors.

Digital literacy as a new determinant of health: A scoping review

INTRODUCTION

Harnessing new digital technologies can improve access to health care but can also widen the health divide for those with poor digital literacy. This scoping review aims to assess the current situation of low digital health literacy in terms of its definition, reach, impact on health and interventions for its mitigation.

METHODS

A comprehensive literature search strategy was composed by a qualified medical librarian. Literature databases [Medline (Ovid), Embase (Ovid), Scopus, and Google Scholar] were queried using appropriate natural language and controlled vocabulary terms along with hand-searching and citation chaining. We focused on recent and highly cited references published in English. Reviews were excluded. This scoping review was conducted following the methodological framework of Arksey and O'Malley.

RESULTS

A total of 268 articles were identified (263 from the initial search and 5 more added from the references of the original papers), 53 of which were finally selected for full text analysis. Digital health literacy is the most frequently used descriptor to refer to the ability to find and use health information with the goal of addressing or solving a health problem using technology. The most utilized tool to assess digital health literacy is the eHealth literacy scale (eHEALS), a self-reported measurement tool that evaluates six core dimensions and is available in various languages. Individuals with higher digital health literacy scores have better self-management and participation in their own medical decisions, mental and psychological state and quality of life. Effective interventions addressing poor digital health literacy included education/training and social support.

CONCLUSIONS

Although there is interest in the study and impact of poor digital health literacy, there is still a long way to go to improve measurement tools and find effective interventions to reduce the digital health divide.

Health literacy in individuals with knee pain-a mixed methods study

BACKGROUND

Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain.

METHODS

A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis.

RESULTS

The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation.

CONCLUSION

Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain.

The effects of a mobile-based multi-domain intervention on cognitive function among older adults

Behavioral and social research has stressed the importance of multi-domain lifestyle interventions to prevent, delay, or remedy age-related cognitive decline among older adults at high risk for dementia. In light of the benefits of multi-domain interventions, some studies demonstrate the effectiveness of a mobile-based program for dementia prevention. Unfortunately, there is limited evidence of whether or not a mobile application of a multi-domain program is effective in improving cognitive functioning among older adults who are a high risk for dementia. Thus, the purpose of this study was to determine whether there was a pre-post change of cognition and there were age-group differences in pre-post change after the 12 weeks multi-domain program, Silvia program (N = 59). The Silvia program consisted of five domains, including (a)daily smart routine, (b)cognitive training, (c)lifestyle monitoring, (d)home-based exercise, and (e)voice-based AI cognitive assessment. Using a paired t-test and analysis of variance, this study found that there was a significant mean difference in cognitive function scores between pre and post-intervention (95 % CI = 1.10-1.87, P <.05). The difference score in cognitive function was higher in the old-old group than in the young-old group (95 % CI = -2.29-0.10, p <.05). The findings of this study demonstrated that Silvia program was effective in promoting cognitive function among older Korean adults, especially for the old-old group.

Perceptions of a Digital Mental Health Platform Among Participants With Depressive Disorder, Anxiety Disorder, and Other Clinically Diagnosed Mental Disorders in Singapore: Usability and Acceptability Study

BACKGROUND

The website mindline.sg is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, mindline.sg may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders.

OBJECTIVE

This study aims to determine the perceived usability, acceptability, and usefulness of mindline.sg among individuals with diagnosed mental disorders in a clinical setting.

METHODS

A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist's office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of mindline.sg. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of mindline.sg. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users' responses on acceptability and perceived usefulness of mindline.sg. For this study, P<.05 is considered significant.

RESULTS

We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (β=.49; P=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (β=.18; P=.03). The platform mindline.sg is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of mindline.sg.

CONCLUSIONS

Our results show that mindline.sg is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of mindline.sg as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies.

Usability Evaluation of Connected Health Devices in Home Monitoring: Toward Devices Adapted to the Characteristics of Informal Caregivers

While an increasing number of Informal CareGivers (ICGs) are assisting their dependent loved ones with the daily living tasks and medical care, they are rarely considered in the medical devices design process. The objective of this study is to identify the characteristics of ICGs impacting the use of the iHealth® Sense BP7 medical device, namely a connected wrist blood pressure monitor. For this purpose, user tests were conducted with 29 potential or actual ICGs. First, the participants filled out a socio-demographic questionnaire and then handled the blood pressure monitor. Finally, they completed the System Usability Scale questionnaire. The results revealed an impact of technophilia and age on usability dimensions. To conclude, the consideration of the ICG population in the design process of connected medical devices is discussed, particularly the age and level of technophilia.

Managing Older Adults' Chronic Pain: Lower-Risk Interventions

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Evaluation of Usability and User Experience of Oncodoc 's M-Health Application for Early Detection of Cancer

OBJECTIVE

Cancer is a non-communicable disease that accounts for 71% of deaths globally. The prevalence of people living with cancer in Indonesia increased from 1.4/1000 population (2013) to 1.8/1,000 population (2018). This study aims to evaluate usability, user experience, and user feedback on the use of the Oncodoc m-health application.

METHODS

 The research method uses mixed methods with a cross-sectional approach and online survey sampling techniques (677 respondents), in December 2021-January 2022 in Indonesia. The instruments used are the System Usability Scale and User Experience Questionnaire. The variables measured include the characteristics of respondents, usability, user experience, and responses to using applications qualitatively. Quantitative data were analysed descriptively and the User Experience Questionnaire's analysis tool. Qualitative data were analysed thematically.

RESULTS

Evaluation of the usability of Oncodoc's m-health application is in the "acceptable" category (70.88), and the adjective rating is in the "Good" category. Evaluations of the relative quality of user experience are in the "good" and "very good" types. The average user experience scale is (mean; SD): attractiveness (1.80; 0.99), perspicuity (1.82; 1.05), efficiency (1.78; 1.09), dependability (1.56; 1.01), stimulation (1.81; 1.06), and novelty (1.32; 1.10). The findings of this study are 1) the ability to accommodate user needs, 2) usage barriers, and 3) user expectations for the Oncodoc application.

CONCLUSION

Overall, the Oncodoc m-health application is acceptable to users. We recommend developing a cancer early detection application with an approach that refers to user needs for further research.

How smart senior care can achieve value co-creation: Evidence from China

With the rapid rise of artificial intelligence, smart senior care has become a new trend for future development. The collection of "Typical Cases of Chinese Elderly Service Industry Development" is selected by the script materials. The main purpose of this article is to investigate how smart senior care can achieve value co-creation by grounded theory. This study explores the phenomenon of value co-creation in the participation of multiple actors in smart senior care services. Findings show that institutional guarantee, technical intake, market empowerment, emotional support, service interaction, and reciprocity norm are identified as the driving factors for value co-creation. In addition, the behavioral processes of value co-creation include multi-actor value consensus, co-creation environment establishment, practical value co-creation, public value sharing, and diffusion of service added value in smart senior care. Finally, this study constructs a practical logic model of achieving value co-creation. It extends and enriches the scope of the value co-creation theory. This study confirms that value co-creation can be effectively achieved in smart senior care by the above-mentioned ways, revealing its driving factors and behavioral processes. The article expands on the application of value co-creation in the field of public healthcare. The results have important theoretical and practical significance for narrowing the public service equalization gap.

Digital Health Literacy: Bibliometric Analysis

Background

Digital health is growing at a rapid pace, and digital health literacy has attracted increasing attention from the academic community.

Objective

The purposes of this study are to conduct a systematic bibliometric analysis on the field of digital health literacy and to understand the research context and trends in this field.

Methods

Methods: A total of 1955 scientific publications were collected from the Web of Science core collection. Institutional co-operation, journal co-citation, theme bursting, keyword co-occurrence, author co-operation, author co-citation, literature co-citation, and references in the field of digital health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools.

Results

The results demonstrate that the United States has the highest number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in the number of publications, citations, and co-citations. Research areas of highly cited articles in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy.

Conclusions

We summarized research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. We found that digital health literacy has a significant potential to improve health outcomes, bridge the digital divide, and reduce health inequalities. Our work can serve as a fundamental reference and directional guide for future research in this field.

Behavioral Patterns of Supply and Demand Sides of Health Services for the Elderly in Sustainable Digital Transformation: A Mixed Methods Study

The aging transformation of digital health services faces issues of how to distinguish influencing factors, redesign services, and effectively promote measures and policies. In this study, in-depth interviews were conducted, and grounded theory applied to open coding, main axis coding, and selective coding to form concepts and categories. Trajectory equifinality modeling clarified the evolution logic of digital transformation. Based on the theory of service ecology, a digital health service aging model was constructed from the “macro–medium–micro” stages and includes governance, service, and technology transformation paths. The macro stage relies on organizational elements to promote the institutionalization of management and guide the transformation of governance for value realization, including the construction of three categories: mechanism, indemnification, and decision-making. The meso stage relies on service elements to promote service design and realize service transformation that is suitable for aging design, including the construction of three categories: organization, resources, and processes. The micro stage relies on technical elements to practice experiencing humanization, including the construction of three categories: target, methods, and evaluation. These results deepen the understanding of the main behaviors and roles of macro-organizational, meso-service, and micro-technical elements in digital transformation practice and have positive significance for health administrative agencies to implement action strategies.

Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study

BACKGROUND

The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models.

METHODS

A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test-retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis.

RESULTS

The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy.

CONCLUSION

The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study

Background

Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity.

Objective

The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory.

Methods

We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score.

Results

Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss.

Conclusions

This study found that a digital app that provides personalized nutrition recommendations and change in one’s food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity.