A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Qualitative Evaluation of Diverse Public and Patient Perceptions Using Focus Groups

Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network

BACKGROUND

Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research.

METHODS

In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations.

RESULTS

Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic.

CONCLUSIONS

Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.

Bariatric Patient Engagement in a Pre-surgery Virtual Patient Navigation Platform (VPNP)

BACKGROUND

This study analyzed patient engagement with a virtual patient navigation platform (VPNP) designed to help guide bariatric surgery candidates through the complex pre-operative workup for surgery.

METHODS

Data on baseline sociodemographic and medical history was collected on patients enrolled in the bariatric program at a single academic institution between March and May 2021. The System Usability Scale (SUS) survey was administered to assess VPNP usability. Two groups emerged: "engaged" (ENG; n = 30) who activated their accounts and completed the SUS, and "not-engaged" (NEG; n = 35) who did not activate their accounts (n = 13) or did not use the app (n = 22) and were therefore ineligible for the SUS survey.

RESULTS

Analyses demonstrated that only insurance status differed between groups (private insurance: 60% versus 34.3% for ENG versus NEG, respectively; p = 0.038). SUS survey analysis demonstrated high perceived usability (median score = 86.3), corresponding to the 97th percentile of usability. The top three reasons for disengagement included being too busy (22.9%), not being interested (20%), and being unsure about the purpose of the app (20%).

CONCLUSIONS

The VPNP scored in the 97th percentile of usability. However, given a majority of patients did not engage with the app, and engagement was associated with completing pre-surgery requirements faster (unpublished), future work will focus on mitigating identified reasons for patients not engaging.

Patients' experiences of using a mobile application-based rehabilitation programme after total hip or knee arthroplasty: a qualitative descriptive study

BACKGROUND

An increasing number of patients are discharged from a total hip or knee arthroplasty with a short length of hospital stay. Technologies, such as mobile applications, are used to provide remote support to patients' postoperative rehabilitation. Patients' experiences of receiving mobile application-based rehabilitation after total hip or knee arthroplasty have not been investigated extensively.

METHODS

This was a qualitative descriptive study. Twenty-five participants who had completed a mobile application-based rehabilitation programme for total hip or knee arthroplasty were recruited. Semi-structured interviews were conducted via telephone between July 2021 and January 2022 regarding the participants' experiences using the programme. All interviews were audio-recorded and verbatim transcribed. Data were analysed using inductive content analysis. The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

Data analysis revealed five categories: (a) improved access to health care, (b) encouraged postoperative recovery, (c) established supportive relationships, (d) facilitated learning, and (e) future directions.

CONCLUSION

The theory-underpinned mobile application-based rehabilitation programme demonstrated potential value in supporting patients' rehabilitation after arthroplasty. Nurses can consider using mobile technologies to expand their role in arthroplasty rehabilitation and improve the quality of rehabilitation care.

How the smartphone apps can improve your sexual wellbeing

The use of smartphones and other technological devices has rapidly increased in the last few years, along with the availability of various applications that can be downloaded on iOS or Android devices. In this narrative review, we included most of the literature found on the specific topic of smartphone apps related to sexual health. Using the two databases PubMed and PsycInfo, we conducted research by the following terms: "apps" and "sexual wellbeing"; "apps" and "sexual health"; "mhealth" and "sex"; "mhealth", "apps" and "sex". We selected all articles written in English within the last 6 years to ensure the accessibility and consider the rapid changes in this field. The article highlights that many populations are interested in gaining information on a wide range of topics relating to sexual practices, potential risks, coercion, sexual violence and the prevention and recognition of potentially dangerous situations. Some findings suggest that sex education for sexual minority adolescents should focus on online sexual safety. Despite their value, many concerns and limitations must be solved, and future research studies are needed to explore how to fix them.

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation

BACKGROUND

The World Health Organization's Global Patient Safety Action Plan 2021-2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients' involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients' completion. Studies on such checklists are small scale, but they are linked to reduction in length of hospital stay and readmissions. We have previously developed and validated a two-part surgical patient safety checklist (PASC). This study aims to investigate the feasibility of the PASC usage and implementation prior to its use in a large-scale clinical trial.

METHODS

This is a prospective cross-sectional feasibility study, set up as part of the design of a larger stepped-wedge cluster randomised controlled trial (SW-CRCT). Descriptive statistics were used to investigate patient demographics, reasons for not completing the PASC and percentage of PASC item usage. Qualitative patient interviews were used to identify barriers and drivers for implementation. Interview was analysed through content analysis.

RESULTS

Out of 428 recruited patients, 50.2% (215/428) used both parts of PASC. A total of 24.1% (103/428) of the patients did not use it at all due to surgical or COVID-19-related cancellations. A total of 19.9% (85/428) did not consent to participate, 5.1% (22/428) lost the checklist and 0.7% (3/428) of the patients died during the study. A total of 86.5% (186/215) patients used ≥ 80% of the checklist items. Barriers and drivers for PASC implementation were grouped into the following categories: Time frame for completing the checklist, patient safety checklist design, impetus to communicate with healthcare professionals and support throughout the surgical pathway.

CONCLUSIONS

Elective surgical patients were willing and able to use PASC. The study further revealed a set of barriers and drivers to the implementation. A large-scale definitive clinical-implementation hybrid trial is being launched to ascertain the clinical effectiveness and scalability of PASC in improving surgical patient safety.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT03105713. Registered 10.04.2017.

A review of the factors influencing adoption of digital health applications for people living with dementia

Objective

Researchers have used various theories and models to understand technology adoption, however, with the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing the adoption of digital health applications for people living with dementia and add to the current literature on this topic.

Methods

Searches were conducted in CINHAL, Web of Science, Psych Info, ProQuest Health and Medical, IEEE Xplore and Scopus. Citation searching and handsearching were used in the identification of other studies.

Results

Following an assessment of relevancy, nine studies remained and are included within this review. Methodological quality was assessed using The Mixed Methods Appraisal Tool (MMAT). A thematic analysis was used for the data synthesis of included studies. Each study reported on different types of apps.

Conclusion

From the synthesis of included studies, four analytic themes were identified; Theme 1: Personal and contextual factors; Theme 2: Perceived value and benefit; Theme 3: Design and content of app; and Theme 4: Digital Literacy and Confidence. People are diverse and so are their reasons for the adoption of apps. These findings provide an insight into the range of factors that impact the adoption of apps for people living with dementia. Understanding the factors that impact the adoption of mobile applications is critical to their success. These findings can be beneficial for app developers and for people living with dementia and their carers.

Checklists and cognitive aids: underutilized and under-researched tools to promote patient safety and optimize clinician performance

PURPOSE OF REVIEW

Checklists and other cognitive aids serve multiple purposes in the peri-operative setting and have become nearly ubiquitous in healthcare. This review lays out the evidence for their use, shortcomings and pitfalls to be aware of, and how technology and innovation may improve checklist and cognitive aid relevance and usability.

RECENT FINDINGS

It has been difficult to show a direct link between the use of checklists alone and patient outcomes, but simulation studies have repeatedly demonstrated an association between checklist or cognitive aid use and improved performance. When implemented as part of a bundle of interventions, checklists likely have a positive impact, but the benefit of checklists and other cognitive aids may be both context- and user dependent. Advances in technology and automation demonstrate promise, but usability, design, and implementation research in this area are necessary to maximize effectiveness.

SUMMARY

Cognitive aids like checklists are powerful tools in the perioperative and critical care setting. Further research and innovation may elevate what is possible by improving the usability and relevance of these tools, possibly translating into improved patient outcomes.

Development and validation of patients' surgical safety checklist

Background

Poor uptake and understanding of critical perioperative information represent a major safety risk for surgical patients. Implementing a patient-driven surgical safety checklist might enhance the way critical information is given and increase patient involvement in their own safety throughout the surgical pathway. The aim of this study was to develop and validate a Surgical Patient Safety Checklist (PASC) for use by surgical patients.

Method

This was a prospective study, involving patient representatives, multidisciplinary healthcare professionals and elective surgical patients to develop and validate PASC using consensus-building techniques in two Norwegian hospitals. A set of items intended for PASC were rated by patients and then submitted to Content Validation Index (CVI) analyses. Items of low CVI went through a Healthcare Failure Mode and Effect Analysis (HFMEA) Hazard Scoring process, as well as a consensus process before they were either kept or discarded. Reliability of patients’ PASC ratings was assessed using Intraclass Correlation Coefficient analysis. Lastly, the face validity of PASC was investigated through focus group interviews with postoperative patients.

Results

Initial development of PASC resulted in a checklist consisting of two parts, one before (32 items) and one after surgery (26 items). After achieving consensus on the PASC content, 215 surgical patients from six surgical wards rated the items for the CVI analysis on a 1-4 scale and mostly agreed on the content. Five items were removed from the checklist, and six items were redesigned to improve PASCs’ user-friendliness. The total Scale-level index/Average (S-CVI/Ave) before revision was 0.83 and 0.86 for pre- and post-operative PASC items, respectively. Following revision, these increased to 0.86 and 0.93, respectively. The PASC items reliability score was 0.97 (95% confidence interval 0.96 to 0.98). The qualitative assessment identified that patients who used PASC felt more in control of their situation; this was achieved when PASC was given to them at what they felt was the right time and healthcare professionals took part in its usage.

Conclusion

Multidisciplinary perioperative care staff and surgical patients agreed upon PASC content, the checklist ratings were reliable, and qualitative assessment suggested good face validity. PASC appears to be a usable and valid checklist for elective surgical patients across specialties.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07470-z.

Patient-completed safety checklists as an empowerment tool for patient involvement in patient safety: concepts, considerations and recommendations

The application of safety checklists to healthcare settings to help systematise routines and improve communication between healthcare professionals has proven to be effective in reducing errors, complications, mortality and hospitalisation time. There is a new call to extend the checklist concept to develop safety checklists that can be used by patients to help empower their involvement in safety practices. Only a handful of studies around patient-completed checklists exist, but those that do indicate a positive impact on patient empowerment and involvement in safety-related behaviours. In this article, we present the concept of patient-completed checklists and provide a review of the existing evidence, highlighting important design and implementation considerations, and making recommendations for future research and development.

My hip journey: A qualitative study of patients' experiences of an eHealth program for patient preparation and recovery from hip replacement surgery

AIM AND OBJECTIVE

To explore patient experiences, perceived benefits and suggestions of an eHealth program for pre- and post-operative education for total hip arthroplasty.

BACKGROUND

eHealth programs for surgical patients can facilitate the delivery of information, provide individualised rehabilitation plans and enable communication with health professionals to promote overall patient recovery.

DESIGN

A qualitative descriptive study was conducted following the COREQ guidelines. A convenience sample of nine patients who had total hip arthroplasty and used the My Hip Journey eHealth program were recruited and participated in individual semi-structured telephone interviews. Interviews were audio recorded, transcribed verbatim and analysed using inductive thematic analysis.

RESULTS

The participant group were aged between 53 and 70 years. The results are described in three overarching themes and sub-themes: (1) Supported surgical journey-how the My Hip Journey eHealth program supported them in their preparation and recovery from their surgery, and how the program provided information and encouraged engagement; (2) Motivated recovery-how patients found the program motivational, facilitated their self-management and enabled communication with the healthcare team if they had any concern; and (3) Functionality-how the program related to ease of use, its interactivity with the patient and suggestions for future use.

CONCLUSIONS

The patients reported that using the eHealth program for pre- and post-operative education was helpful to their overall surgical experience and recovery. It was found to engage patients in their care, enabled self-management, encouraged communication with health professionals and motivated them with their recovery. These findings identify the potential for eHealth programs to support patients in the preparation and post-operative stages, and in their post-discharge self-care for other surgical and orthopaedic journeys.

RELEVANCE TO CLINICAL PRACTICE

Patient experiences of eHealth education can inform nurses of the benefits of eHealth and the development of future eHealth education programs.