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Wang T, Zhu H, Qian S, Giunti G, Goossens R, Melles M. Designing digital patient experiences: The digital health design framework. APPLIED ERGONOMICS 2024; 119:104289. [PMID: 38688183 DOI: 10.1016/j.apergo.2024.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Digital health (DH) brings considerable benefits, but it comes with potential risks. Human Factors (HF) play a critical role in providing high-quality and acceptable DH solutions. Consultation with designers is crucial for reflecting on and improving current DH design practices. OBJECTIVES We investigated the general DH design processes, challenges, and corresponding strategies that can improve the digital patient experience (PEx). METHODS A semi-structured interview study with 24 design professionals. All audio recordings were transcribed, deidentified, grammatically corrected, and imported into ATLAS.ti for data analysis. Three coders participated in data coding following the thematic analysis approach. RESULTS We identified eight DH design stages and grouped them into four phases: preparation, problem-thinking, problem-solving, and implementation. The analysis presented twelve design challenges associated with contextual, practical, managerial, and commercial aspects that can hinder the design process. We identified eight common strategies used by respondents to tackle these challenges. CONCLUSIONS We propose a Digital Health Design (DHD) framework to improve the digital PEx. It provides an overview of design deliverables, activities, stakeholders, challenges, and corresponding strategies for each design stage.
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Affiliation(s)
- Tingting Wang
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands.
| | - Haiou Zhu
- Neuroscience, Ethics & Society, Department of Psychiatry, University of Oxford, Oxford, UK; School of Design and Creative Arts, Loughborough University, Loughborough, UK
| | - Shuxian Qian
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Guido Giunti
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard Goossens
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marijke Melles
- Human-Centered Design Department, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
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Braun M, Carlier S, De Backere F, Van De Velde M, De Turck F, Crombez G, De Paepe AL. Identifying app components that promote physical activity: a group concept mapping study. PeerJ 2024; 12:e17100. [PMID: 38563015 PMCID: PMC10984184 DOI: 10.7717/peerj.17100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Background Digital interventions are a promising avenue to promote physical activity in healthy adults. Current practices recommend to include end-users early on in the development process. This study focuses on the wishes and needs of users regarding an a mobile health (mHealth) application that promotes physical activity in healthy adults, and on the differences between participants who do or do not meet the World Health Organization's recommendation of an equivalent of 150 minutes of moderate intensity physical activity. Methods We used a mixed-method design called Group Concept Mapping. In a first phase, we collected statements completing the prompt "In an app that helps me move more, I would like to see/ do/ learn the following…" during four brainstorming sessions with physically inactive individuals (n = 19). The resulting 90 statements were then sorted and rated by a new group of participants (n = 46). Sorting data was aggregated, and (dis)similarity matrices were created using multidimensional scaling. Hierarchical clustering was applied using Ward's method. Analyses were carried out for the entire group, a subgroup of active participants and a subgroup of inactive participants. Explorative analyses further investigated ratings of the clusters as a function of activity level, gender, age and education. Results Six clusters of statements were identified, namely 'Ease-of-use and Self-monitoring', 'Technical Aspects and Advertisement', 'Personalised Information and Support', 'Motivational Aspects', 'Goal setting, goal review and rewards', and 'Social Features'. The cluster 'Ease-of-use and Self-monitoring' was rated highest in the overall group and the active subgroup, whereas the cluster 'Technical Aspects and Advertisement' was scored as most relevant in the inactive subgroup. For all groups, the cluster 'Social Features' was scored the lowest. Explorative analysis revealed minor between-group differences. Discussion The present study identified priorities of users for an mHealth application that promotes physical activity. First, the application should be user-friendly and accessible. Second, the application should provide personalized support and information. Third, users should be able to monitor their behaviour and compare their current activity to their past performance. Fourth, users should be provided autonomy within the app, such as over which and how many notifications they would like to receive, and whether or not they want to engage with social features. These priorities can serve as guiding principles for developing mHealth applications to promote physical activity in the general population.
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Affiliation(s)
- Maya Braun
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
| | - Stéphanie Carlier
- IDLab, Department of Information Technology - imec, Universiteit Gent, Ghent, Belgium
| | - Femke De Backere
- IDLab, Department of Information Technology - imec, Universiteit Gent, Ghent, Belgium
| | - Marie Van De Velde
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
| | - Filip De Turck
- IDLab, Department of Information Technology - imec, Universiteit Gent, Ghent, Belgium
| | - Geert Crombez
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
| | - Annick L. De Paepe
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
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Lamé G, Komashie A, Sinnott C, Bashford T. Design as a quality improvement strategy: The case for design expertise. Future Healthc J 2024; 11:100008. [PMID: 38646045 PMCID: PMC11025066 DOI: 10.1016/j.fhj.2024.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design can make it easier to use a service correctly, with impacts on both the safety and efficiency of healthcare delivery, as well as the experience of patients and staff. The participative dimension of design as an improvement strategy has recently gained traction in the healthcare quality improvement literature. However, the role of design expertise and professional design has been much less explored. Good design does not happen by accident: it takes expertise and the specific reasoning that expert designers develop through practical experience and training. Here, we define design, show why poor design can be disastrous and illustrate the benefits of good design. We argue for the recognition of distinctive design expertise and describe some of its characteristics. Finally, we discuss how design could be better promoted in healthcare improvement.
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Affiliation(s)
- Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Alexander Komashie
- Health Systems Design Group, Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Tom Bashford
- Health Systems Design Group, Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
- Department Anaesthetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, UK
- Technology and Systems Theme, Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, UK
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Siebelink NM, van Dam KN, Lukkien DRM, Boon B, Smits M, van der Poel A. Action Opportunities to Pursue Responsible Digital Care for People With Intellectual Disabilities: Qualitative Study. JMIR Ment Health 2024; 11:e48147. [PMID: 38416547 PMCID: PMC10938230 DOI: 10.2196/48147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/26/2023] [Accepted: 01/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Responsible digital care refers to any intentional systematic effort designed to increase the likelihood of a digital care technology developed through ethical decision-making, being socially responsible and aligned with the values and well-being of those impacted by it. OBJECTIVE We aimed to present examples of action opportunities for (1) designing "technology"; (2) shaping the "context" of use; and (3) adjusting the behavior of "users" to guide responsible digital care for people with intellectual disabilities. METHODS Three cases were considered: (1) design of a web application to support the preparation of meals for groups of people with intellectual disabilities, (2) implementation of an app to help people with intellectual disabilities regulate their stress independently, and (3) implementation of a social robot to stimulate interaction and physical activity among people with intellectual disabilities. Overall, 26 stakeholders participated in 3 multistakeholder workshops (case 1: 10/26, 38%; case 2: 10/26, 38%; case 3: 6/26, 23%) based on the "guidance ethics approach." We identified stakeholders' values based on bottom-up exploration of experienced and expected effects of using the technology, and we formulated action opportunities for these values in the specific context of use. Qualitative data were analyzed thematically. RESULTS Overall, 232 effects, 33 values, and 156 action opportunities were collected. General and case-specific themes were identified. Important stakeholder values included quality of care, autonomy, efficiency, health, enjoyment, reliability, and privacy. Both positive and negative effects could underlie stakeholders' values and influence the development of action opportunities. Action opportunities comprised the following: (1) technology: development of the technology (eg, user experience and customization), technology input (eg, recipes for meals, intervention options for reducing stress, and activities), and technology output (eg, storage and use of data); (2) context: guidelines, training and support, policy or agreements, and adjusting the physical environment in which the technology is used; and (3) users: integrating the technology into daily care practice, by diminishing (eg, "letting go" to increase the autonomy of people with intellectual disabilities), retaining (eg, face-to-face contact), and adding (eg, evaluation moments) certain behaviors of care professionals. CONCLUSIONS This is the first study to provide insight into responsible digital care for people with intellectual disabilities by means of bottom-up exploration of action opportunities to take account of stakeholders' values in designing technology, shaping the context of use, and adjusting the behavior of users. Although part of the findings may be generalized, case-specific insights and a complementary top-down approach (eg, predefined ethical frameworks) are essential. The findings represent a part of an ethical discourse that requires follow-up to meet the dynamism of stakeholders' values and further develop and implement action opportunities to achieve socially desirable, ethically acceptable, and sustainable digital care that improves the lives of people with intellectual disabilities.
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Affiliation(s)
| | - Kirstin N van Dam
- Academy Het Dorp, Arnhem, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Dirk R M Lukkien
- Vilans, Utrecht, Netherlands
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, Netherlands
| | - Brigitte Boon
- Academy Het Dorp, Arnhem, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Siza, Arnhem, Netherlands
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McAlpine RG, Sacchet MD, Simonsson O, Khan M, Krajnovic K, Morometescu L, Kamboj SK. Development of a digital intervention for psychedelic preparation (DIPP). Sci Rep 2024; 14:4072. [PMID: 38374177 PMCID: PMC10876638 DOI: 10.1038/s41598-024-54642-4] [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: 11/28/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
Psychedelic substances induce profound alterations in consciousness. Careful preparation is therefore essential to limit adverse reactions, enhance therapeutic benefits, and maintain user safety. This paper describes the development of a self-directed, digital intervention for psychedelic preparation. Drawing on elements from the UK Medical Research Council (MRC) framework for developing complex interventions, the design was informed by a four-factor model of psychedelic preparedness, using a person-centred approach. Our mixed-methods investigation consisted of two studies. The first involved interviews with 19 participants who had previously attended a 'high-dose' psilocybin retreat, systematically exploring their preparation behaviours and perspectives on the proposed intervention. The second study engaged 28 attendees of an ongoing psilocybin retreat in co-design workshops, refining the intervention protocol using insights from the initial interviews. The outcome is a co-produced 21-day digital course (Digital Intervention for Psychedelic Preparation (DIPP)), that is organised into four modules: Knowledge-Expectation, Psychophysical-Readiness, Safety-Planning, and Intention-Preparation. Fundamental components of the course include daily meditation practice, supplementary exercises tied to the weekly modules, and mood tracking. DIPP provides a comprehensive and scalable solution to enhance psychedelic preparedness, aligning with the broader shift towards digital mental health interventions.
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Affiliation(s)
- Rosalind G McAlpine
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Matthew D Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Maisha Khan
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katarina Krajnovic
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Larisa Morometescu
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
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Pannunzio V, Kleinsmann M, Snelders D, Raijmakers J. From digital health to learning health systems: four approaches to using data for digital health design. Health Syst (Basingstoke) 2024; 12:481-494. [PMID: 38235300 PMCID: PMC10791080 DOI: 10.1080/20476965.2023.2284712] [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: 12/16/2021] [Accepted: 11/14/2023] [Indexed: 01/19/2024] Open
Abstract
Digital health technologies, powered by digital data, provide an opportunity to improve the efficacy and efficiency of health systems at large. However, little is known about different approaches to the use of data for digital health design, or about their possible relations to system-level dynamics. In this contribution, we identify four existing approaches to the use of data for digital health design, namely the silent, the overt, the data-enabled, and the convergent. After characterising the approaches, we provide real-life examples of each. Furthermore, we compare the approaches in terms of selected desirable characteristics of the design process, highlighting relative advantages and disadvantages. Finally, we reflect on the system-level relevance of the differentiation between the approaches and point towards future research directions. Overall, the contribution provides researchers and practitioners with a broad conceptual framework to examine data-related challenges and opportunities in digital health design.
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Affiliation(s)
- Valeria Pannunzio
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Maaike Kleinsmann
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Dirk Snelders
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Jeroen Raijmakers
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
- Philips Experience Design, Philips, Eindhoven, the Netherlands
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Stanic T, Saygin Avsar T, Gomes M. Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review. J Med Internet Res 2023; 25:e45958. [PMID: 37921844 PMCID: PMC10656663 DOI: 10.2196/45958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions. OBJECTIVE This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities. METHODS We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation. RESULTS We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%). CONCLUSIONS This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes.
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Affiliation(s)
- Tijana Stanic
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Tuba Saygin Avsar
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, United Kingdom
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Lier EJ, Smits MLM, de Vries M, van Goor H. Self-Administered Virtual Reality for Postsurgical Pain Management: A Qualitative Study of Hospital Patients' Reported Experiences. J Clin Med 2023; 12:6805. [PMID: 37959270 PMCID: PMC10647437 DOI: 10.3390/jcm12216805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Virtual Reality (VR) has been shown to effectively reduce pain in patients with various pain conditions. However, questions arise on the use of VR in multimodal postsurgical pain management. Optimizing VR for pain management requires an understanding of intervention- and context-specific factors, based on patients' needs and expectations after major surgery. This substudy is part of a randomized controlled trial investigating the effects of three VR interventions as an add-on, self-administered treatment for postsurgical pain. Semi-structured interviews were conducted to evaluate VR effects, software, hardware, prescriptions, and factors affecting the implementation of VR. Experiences across interventions were compared to identify relevant factors for successful implementation. Patients benefitted from self-administered VR in postsurgical pain management in various aspects and without serious drawbacks. Participants preferred an intuitive, 3D, 360-degree VR device with a large choice of applications matching their interests. The preferred frequency and duration of VR use was 2-3 sessions a day for 10-15 min each. Adjusting the VR use to individuals' needs and contexts was reported to be key for successful implementation, with attention paid to improving the awareness of VR as a non-pharmacological means of promoting postsurgical recovery among patients and healthcare professionals.
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Affiliation(s)
- Elisabeth J. Lier
- Department of Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (E.J.L.); (M.L.M.S.); (M.d.V.)
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Merlijn L. M. Smits
- Department of Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (E.J.L.); (M.L.M.S.); (M.d.V.)
- Department of Industrial Design, Saxion University of Applied Sciences, 7500 KB Enschede, The Netherlands
| | - Marjan de Vries
- Department of Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (E.J.L.); (M.L.M.S.); (M.d.V.)
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (E.J.L.); (M.L.M.S.); (M.d.V.)
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Latuapon E, Hochstenbach L, Mahr D, Scheenstra B, Kietselaer B, Spreeuwenberg M. Cocreation to Facilitate Communication and Collaboration Between Multidisciplinary Stakeholders in eHealth Research and Development: Case Study of the CARRIER (Coronary Artery Disease: Risk Estimations and Interventions for Prevention and Early Detection) Consortium. JMIR Hum Factors 2023; 10:e45006. [PMID: 37874629 PMCID: PMC10630860 DOI: 10.2196/45006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not "speak the same language" and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. OBJECTIVE This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. METHODS The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. RESULTS First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. CONCLUSIONS This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration.
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Affiliation(s)
- Elizabeth Latuapon
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Laura Hochstenbach
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dominik Mahr
- Department of Marketing & Supply Chain Management, School of Business and Economics, Maastricht University, Maastricht, Netherlands
| | - Bart Scheenstra
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bas Kietselaer
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Marieke Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Martínez-Miranda J, Meza Magallanes MJ, Silva-Peña C, Mercado Rivas MX, Figueroa-Varela MDR, Sánchez Aranda ML. A Computational Platform to Support the Detection, Follow-up, and Epidemiological Surveillance of Mental Health and Substance Use Disorders: Protocol for a Development and Evaluation Study. JMIR Res Protoc 2023; 12:e44607. [PMID: 37097718 PMCID: PMC10170360 DOI: 10.2196/44607] [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: 11/25/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND According to the World Health Organization, approximately 15% of the global population is affected by mental health or substance use disorders. These conditions contribute significantly to the global disease burden, which has worsened because of the direct and indirect effects of COVID-19. In Mexico, a quarter of the population between the ages of 18 and 65 years who reside in urban areas present a mental health condition. The presence of a mental or substance abuse disorder is behind a significant percentage of suicidal behaviors in Mexico, where only 1 in 5 of those who have these disorders receive any treatment. OBJECTIVE This study aims to develop, deploy, and evaluate a computational platform to support the early detection and intervention of mental and substance use disorders in secondary and high schools as well as primary care units. The platform also aims to facilitate monitoring, treatment, and epidemiological surveillance ultimately helping specialized health units at the secondary level of care. METHODS The development and evaluation of the proposed computational platform will run during 3 stages. In stage 1, the identification of the functional and user requirements and the implementation of the modules to support the screening, follow-up, treatment, and epidemiological surveillance will be performed. In stage 2, the initial deployment of the screening module will be carried out in a set of secondary and high schools, as well as the deployment of the modules to support the follow-up, treatment, and epidemiological surveillance processes in primary and secondary care health units. In parallel, during stage 2, patient applications to support early interventions and continuous monitoring will also be developed. Finally, during stage 3, the deployment of the complete platform will be performed jointly with a quantitative and qualitative evaluation. RESULTS The screening process has started, and 6 schools have been currently enrolled. As of February 2023, a total of 1501 students have undergone screening, and the referral of those students presenting a risk in mental health or substance use to primary care units has also started. The development, deployment, and evaluation of all the modules of the proposed platform are expected to be completed by late 2024. CONCLUSIONS The expected results of this study are to impact a better integration between the different levels of health care, from early detection to follow-up and epidemiological surveillance of mental and substance use disorders contributing to reducing the gap in the attention to these problems in the community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44607.
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Affiliation(s)
- Juan Martínez-Miranda
- Unidad de Transferencia Tecnológica Tepic, Centro de Investigación Científica y de Educación Superior de Ensenada, Tepic, Mexico
| | | | - Cándido Silva-Peña
- Unidad Académica de Ciencias Sociales, Universidad Autónoma de Nayarit, Tepic, Mexico
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Tarp K, Holmberg TT, Moeller AM, Lichtenstein MB. Patient and therapist experiences of using a smartphone application monitoring anxiety symptoms. Int J Qual Stud Health Well-being 2022; 17:2044981. [PMID: 35212602 PMCID: PMC8925918 DOI: 10.1080/17482631.2022.2044981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Kristine Tarp
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Theresa Holmberg
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Anne Marie Moeller
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Health Promotion Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Fischer-Suárez N, Lozano-Paniagua D, García-Duarte S, Castro-Luna G, Parrón-Carreño T, Nievas-Soriano BJ. Using QR Codes as a Form of eHealth to Promote Health Among Women in a Pandemic: Cross-sectional Study. JMIR Hum Factors 2022; 9:e41143. [DOI: 10.2196/41143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Background
QR codes have played an integral role during the pandemic in many sectors, but their use has been limited in the health care sector, especially by patients. Although some authors have stated that developing specific content for women on how to cope with health problems could be an effective way to prevent problems, especially during pandemics, there is little research regarding the use of QR codes to promote health during a pandemic, and even fewer studies are focused on women. Moreover, although the importance of assessing these interventions from the users’ perspective has been stated, research carried out from this point of view is still scarce.
Objective
This study aimed to assess the usefulness of using QR codes with information to promote women’s health in the context of a pandemic. We also sought to design and validate a questionnaire to assess this.
Methods
A cross-sectional study was conducted among women in the gynecology waiting rooms of a reference hospital. Exploratory factorial analysis with the split-half method and Cronbach α values was performed for questionnaire validation. Univariant and bivariant analyses were performed to analyze the data obtained.
Results
In total, 186 women took part in the study. Exploratory factor analysis identified 2 domains: usability and applicability in medical practice. The Cronbach α value was .81. Overall, 83.7% of the answers to the first domain and 56.4% of those to the second were favorable. Women with university education or those who had used QR codes before scored better in the usability domain, while no differences were observed in the applicability scores.
Conclusions
Using QR codes in the gynecology clinics’ waiting rooms can help promote women’s health during a pandemic, regardless of their education level or whether they have used QR codes before. The questionnaire developed herein is a helpful tool to assess this. These findings are important for clinical practice. This research can be performed in other ambits, specialties, or countries.
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Smits M, Ludden GDS, Verbeek PP, van Goor H. How Digital Therapeutics Are Urging the Need for a Paradigm Shift: From Evidence-Based Health Care to Evidence-Based Well-being. Interact J Med Res 2022; 11:e39323. [PMID: 36264624 PMCID: PMC9634516 DOI: 10.2196/39323] [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: 05/06/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
A scientific paradigm consists of a set of shared rules, beliefs, values, methods, and instruments for addressing scientific problems. Currently, health care embraces the paradigm of evidence-based health care (EBH). This paradigm prompts health care institutions to base decisions on the best available evidence, which is commonly generated in large-scale randomized controlled trials. We illustrate the application of EBH via the evaluation of drugs. We show how EBH is challenged when it is applied to the evaluation of digital therapeutics, which refers to technology and data to prevent, manage, or treat a medical disorder or disease. We conclude that amid the growing application of digital therapeutics, the paradigm of EBH is challenged in four domains: population, intervention, comparison, outcome. In the second part of this viewpoint, we argue for a paradigm shift in health care so we can optimally evaluate and implement digital therapeutics, and we sketch out the contours of this novel paradigm. We address the need for considering design in health care and evaluation processes, studying user values so that health care can move from a focus on health to well-being, focusing on individual experiences rather than the average, addressing the need for evaluation in authentic use contexts, and stressing the need for continuous evaluation of the dynamic relations between users, context, and digital therapeutics. We conclude that the transition from EBH toward evidence-based well-being would improve the successful implementation of digital technologies in health care.
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Affiliation(s)
- Merlijn Smits
- Department of Surgery, Radboud university medical center, Nijmegen, Netherlands
| | - Geke D S Ludden
- Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Peter-Paul Verbeek
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud university medical center, Nijmegen, Netherlands
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Lamper C, Huijnen IPJ, Kroese MEAL, Köke AJ, Brouwer G, Ruwaard D, Verbunt JAMCF. Exploring the feasibility of a network of organizations for pain rehabilitation: What are the lessons learned? PLoS One 2022; 17:e0273030. [PMID: 36107861 PMCID: PMC9477302 DOI: 10.1371/journal.pone.0273030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIMS Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients' levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. METHODS This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. RESULTS According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. CONCLUSION Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. TRAIL REGISTRATION Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654.
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Affiliation(s)
- Cynthia Lamper
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ivan P. J. Huijnen
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Mariëlle E. A. L. Kroese
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Albère J. Köke
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Gijs Brouwer
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jeanine A. M. C. F. Verbunt
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
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Hughes S, Kassianos AP, Everitt HA, Stuart B, Band R. Planning and developing a web-based intervention for active surveillance in prostate cancer: an integrated self-care programme for managing psychological distress. Pilot Feasibility Stud 2022; 8:175. [PMID: 35945609 PMCID: PMC9361619 DOI: 10.1186/s40814-022-01124-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To outline the planning, development and optimisation of a psycho-educational behavioural intervention for patients on active surveillance for prostate cancer. The intervention aimed to support men manage active surveillance-related psychological distress. Methods The person-based approach (PBA) was used as the overarching guiding methodological framework for intervention development. Evidence-based methods were incorporated to improve robustness. The process commenced with data gathering activities comprising the following four components: • A systematic review and meta-analysis of depression and anxiety in prostate cancer • A cross-sectional survey on depression and anxiety in active surveillance • A review of existing interventions in the field • A qualitative study with the target audience The purpose of this paper is to bring these components together and describe how they facilitated the establishment of key guiding principles and a logic model, which underpinned the first draft of the intervention. Results The prototype intervention, named PROACTIVE, consists of six Internet-based sessions run concurrently with three group support sessions. The sessions cover the following topics: lifestyle (diet and exercise), relaxation and resilience techniques, talking to friends and family, thoughts and feelings, daily life (money and work) and information about prostate cancer and active surveillance. The resulting intervention has been trialled in a feasibility study, the results of which are published elsewhere. Conclusions The planning and development process is key to successful delivery of an appropriate, accessible and acceptable intervention. The PBA strengthened the intervention by drawing on target-user experiences to maximise acceptability and user engagement. This meticulous description in a clinical setting using this rigorous but flexible method is a useful demonstration for others developing similar interventions. Trial registration and Ethical Approval ISRCTN registered: ISRCTN38893965. NRES Committee South Central – Oxford A. REC reference: 11/SC/0355
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Affiliation(s)
- Stephanie Hughes
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Angelos P Kassianos
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.,Department of Applied Health Research, University College London, London, UK
| | - Hazel A Everitt
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Rebecca Band
- Health Sciences, University of Southampton, Southampton, UK
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Chapel B, Alexandre F, Heraud N, Ologeanu-Taddei R, Cases AS, Bughin F, Hayot M. Standardization of the assessment process within telerehabilitation in chronic diseases: a scoping meta-review. BMC Health Serv Res 2022; 22:984. [PMID: 35918690 PMCID: PMC9344755 DOI: 10.1186/s12913-022-08370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases. Aims and objectives The aim of this study was to identify domains of assessment in TR and to qualitatively and quantitatively analyze how and when they are examined to gain an overview of assessment in chronic disease. Methods A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", “evaluation", “chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis. Results Among the 7412 identified articles, 80 studies met the inclusion criteria and addressed at least one of the noncommunicable diseases (NCD) categories of cardiovascular disease (cardiovascular accidents), cancer, chronic respiratory disease, diabetes, and obesity. Regarding the domains of assessment, the most frequently occurring were “social aspect” (n = 63, 79%) (e.g., effects on behavioral changes) and “clinical efficacy” (n = 53, 66%), and the least frequently occurring was “safety aspects” (n = 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and post-implementation phases. Conclusions Through the HTA model, this scoping meta-review highlighted 10 assessment domains which have not been studied with the same degree of interest in the recent literature. We showed that each of these assessment domains could appear at different phases of TR development and proposed a new cross-disciplinary and comprehensive method for assessing TR interventions. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR, and it will be interesting to extend this assessment framework to other chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08370-y.
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Affiliation(s)
- Blandine Chapel
- University of Montpellier, Montpellier Research of Management, Montpellier, France.
| | - François Alexandre
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | - Nelly Heraud
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | | | - Anne-Sophie Cases
- University of Montpellier, Montpellier Research of Management, Montpellier, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
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van den Berg LN, Hallensleben C, Chavannes NH, Versluis A. Developing a Smartphone Application That Promotes Responsible Short-Acting Beta2-Agonist Use in People with Asthma: A Participatory Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148496. [PMID: 35886348 PMCID: PMC9318130 DOI: 10.3390/ijerph19148496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 01/27/2023]
Abstract
Around 339 million people worldwide have asthma, and 50% have uncontrolled asthma. One trait of uncontrolled asthma, often seen in primary care, is short-acting β2-agonist (SABA) overuse, defined as using SABA more than twice a week. SABA overuse can cause adverse health effects. An application could help patients gain more insight into their SABA use. Engaging stakeholders during the development is important to maximize the usability of and adherence to an application. This study describes the development process of an application that promotes responsible SABA use in people with asthma, using a participatory design. Different stakeholder groups were involved in two iterative development cycles. In the first cycle, four end-users evaluated the app’s prototype. During the second cycle, five end-users were interviewed about the usability of the new version. Resulting in an app that allows patients to register SABA use, asthma symptoms, and symptom triggers. A graph shows how these factors are related, and end-users can show the graph to their physician to facilitate communication. Medication use is compared to the medical guidelines or, when applicable, to the advice given by the users’ healthcare professionals. End-users found the app helpful. Research into the usability and effectiveness of the app in a bigger sample will follow.
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Affiliation(s)
- Liselot N. van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-526-57-61
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
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Surva L. Maintaining the Ideals of Co-production During Rapid Digitalisation: A Comparative Case Study of Digital Restorative Services in Estonia, Finland, Ireland and Portugal. VOLUNTAS : INTERNATIONAL JOURNAL OF VOLUNTARY AND NONPROFIT ORGANIZATIONS 2022; 34:1-15. [PMID: 35702570 PMCID: PMC9186484 DOI: 10.1007/s11266-022-00502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
With the exceptional COVID-19 circumstances in early 2020, public service co-production went through a push towards digitalisation. Using normalisation process theory as the basis for analysis, the article looks at the immediate effects of digitalisation on restorative practices, which is a co-produced approach to delivering justice. A comparative case study conducted in Estonia, Finland, Ireland and Portugal showed that digitalisation meant a more directive role for the mediators and more responsibility for the citizens in organising the service context. The process became more business-like, which put some integral aspects of restorative justice at risk, such as trust building and feeling connected. The launch of digital restorative services depended more on service providers' readiness to try digital solutions and less on service experience before digitalisation.
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Affiliation(s)
- Laidi Surva
- Ragnar Nurkse School of Innovation and Governance, Tallinn University of Technology, Akadeemia tee 3, 12618 Tallinn, Estonia
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19
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Gilstad H, Skogen M, Toussaint P, Larsen CB, Faxvaag A. Negotiating scientific knowledge in the development of an eHealth MOOC. EDUCATION AND INFORMATION TECHNOLOGIES 2022; 28:13-36. [PMID: 35645595 PMCID: PMC9126756 DOI: 10.1007/s10639-022-11107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
Interdisciplinary team communication in eHealth development is challenging because all disciplines have unique, intrinsic discursive practices, theories and artefacts. Due to these factors, members of interdisciplinary teams can experience problems in communication and collaboration. Through a centered focus, members can benefit individually, inspire one another, and ultimately reach a timely delivery of their common pedagogical goal(s). Using the lens of dialogism, this paper aims to identify the conceptual considerations that arose during the development of a Massive Open Online Course (MOOC) for higher education in eHealth. Methods included auto-ethnography and interdisciplinary dialogue supported by literacy artefacts, including visual material. Results yielded a visual tool for meta-assessment of team communication, and an organizing principle for topics in the MOOC. A major implication is that especially for eHealth, scientific communicative competence of experts-while establishing a common understanding-can lead to a unique and meaningful delivery of high pedagogical quality.
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Affiliation(s)
- Heidi Gilstad
- SEKOM, Department of Language and Literature, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department Rheumatology, St. Olavs University Hospital, Trondheim, Norway
| | - Martha Skogen
- Department of Neuromedicine and Movement Sciences, NTNU, Trondheim, Norway
| | - Pieter Toussaint
- Department of Informatics and Computer Science, NTNU, Trondheim, Norway
- Technology Management, SINTEF, Trondheim, Norway
| | - Cathrin B. Larsen
- SEKOM, Department of Language and Literature, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild Faxvaag
- Department Rheumatology, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU, Trondheim, Norway
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20
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Evans L, Evans J, Pagliari C, Källander K. Exploring the Equity Impact of Current Digital Health Design Practices: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e34013. [PMID: 35579918 PMCID: PMC9157315 DOI: 10.2196/34013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/27/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The field of digital health has grown rapidly in part due to digital health tools' potential to reduce health inequities. However, such potential has not always been realized. The design approaches used in digital health are one of the known aspects that have an impact on health equity. OBJECTIVE The aim of our scoping review will be to understand how design approaches in digital health have an impact on health equity. METHODS A scoping review of studies that describe how design practices for digital health have an impact on health equity will be carried out. The scoping review will follow the methodologies laid out by Arksey and O'Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The PubMed, Embase, Web of Science, and ACM Digital Library databases will be searched for peer-reviewed papers. The ProQuest Dissertations and Theses and Global Index Medicus databases will be searched for gray literature. The results will be screened against our inclusion and exclusion criteria. Subsequently, the data extracted from the included studies will be analyzed. RESULTS As of March 2022, a preliminary search of the peer-reviewed databases has yielded over 4900 studies, and more are anticipated when gray literature databases are searched. We expect that after duplicates are removed and screening is completed, a much smaller number of studies will meet all of our inclusion criteria. CONCLUSIONS Although there has been much discussion about the importance of design for lowering barriers to digital health participation, the evidence base demonstrating its impacts on health equity is less obvious. We hope that our findings will contribute to a better understanding of the impact that design in digital health has on health equity and that these findings will translate into action that leads to stronger, more equitable health care systems.
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Affiliation(s)
- Laura Evans
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jay Evans
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Claudia Pagliari
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Karin Källander
- UNICEF, New York, NY, United States
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Chaudhuri ER. The Syndemic of Inequity and COVID-19 in Virtual Care. J Med Internet Res 2022; 24:e37717. [PMID: 35512269 PMCID: PMC9162132 DOI: 10.2196/37717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
The critical intersections of structural inequities and vulnerabilities of marginalized populations, particularly those engaging the social gradient of minority ethnic communities, are revealed in the syndemic approach to COVID-19. Although proposals for cultural interventions to improve virtual care provide relevant measures, they may not address the root cause of the disparate impacts of a pandemic on population subgroups. The common misperception of equality as synonymous with equity further impedes the efficacy of digital health in quality-of-care initiatives, as it systemically fails to acknowledge the disparate realities of marginalized populations, while intending to benefit all. This commentary suggests that an alignment of the health care system with Canada’s pluralist principles would support a paradigm shift in transforming virtual care into an equitable standard as envisioned by Pham and colleagues in their paper, “The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic.”
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Brandl L, Cabrita M, Brodbeck J, Heylen D, van Velsen L. Consulting the Oracle: A Delphi study for determining parameters for a mental health user profile and personalization strategy for an online service to aid grieving older adults. Internet Interv 2022; 28:100534. [PMID: 35462943 PMCID: PMC9019256 DOI: 10.1016/j.invent.2022.100534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
While much effort has been devoted to the development of mental e-health interventions, the tailoring of these applications to user characteristics and needs is a comparatively novel field of research. The premise of personalizing mental e-health interventions is that personalization increases user motivation and (thereby) mitigates intervention dropout and enhances clinical effectiveness. In this study, we selected user profile parameters for personalizing a mental e-health intervention for older adults who lost their spouse. We conducted a three-round Delphi study involving an international and interdisciplinary expert panel (N = 16) with two objectives. The first aim was to elicit adaptation strategies that can be used to dynamically readjust the intervention to the user's needs. The second aim was to identify a set of meaningful indicators for monitoring the user from within the grief intervention to escalate from self-help to blended care, whenever advisable. This Delphi study used as starting point an evaluated, text-based grief intervention composed of ten modules, including psychoeducation about grief and cognitive-behavioral exercises to support the user in adjusting their lives after bereavement. Every user follows this grief intervention in a linear fashion from beginning to end. The resulting conceptual adaptation model encompasses dynamic adjustments, as well as one-time adjustments performed at the initialization of the service. On the level of the application structure, the adaptations affect when which topic module is presented to the user. The adaptations further provide strategies for adjusting the text-based content of individual intervention modules dependent on user characteristics and for selecting appropriate reactions to user input. Eighteen monitoring parameters were elicited and grouped into four categories: clinical, behavioral/emotional, interactive, and external. Parameters that were perceived as most urgent to attend to for escalation were Suicidality, Self-destructive behavior, Client-initiated escalation, Unresponsiveness and (Complicated) Grief symptoms.
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Affiliation(s)
- Lena Brandl
- Roessingh Research and Development, P.O. Box 1212, Enschede, the Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Human Media Interaction, P.O. Box 217, 7500AE Enschede, the Netherlands,Corresponding author at: University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Human Media Interaction, P.O. Box 217, 7500AE Enschede, the Netherlands.
| | - Miriam Cabrita
- Roessingh Research and Development, P.O. Box 1212, Enschede, the Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Biomedical Signals and Systems, P.O. Box 217, 7500AE Enschede, the Netherlands
| | - Jeannette Brodbeck
- Institute for Consulting, Coaching and Social Management, FHNW School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland,Universität Bern, Institut für Psychologie, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Dirk Heylen
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Human Media Interaction, P.O. Box 217, 7500AE Enschede, the Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, P.O. Box 1212, Enschede, the Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Biomedical Signals and Systems, P.O. Box 217, 7500AE Enschede, the Netherlands
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Nguyen KH, Cemballi AG, Fields JD, Brown W, Pantell MS, Lyles CR. Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings. JAMIA Open 2022; 5:ooac014. [PMID: 35571359 PMCID: PMC9097756 DOI: 10.1093/jamiaopen/ooac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Vulnerable populations face numerous barriers in managing chronic disease(s). As healthcare systems work toward integrating social risk factors into electronic health records and healthcare delivery, we need better understanding of the interrelated nature of social needs within patients' everyday lives to inform effective informatics interventions to advance health equity. Materials and Methods We conducted in-depth interviews, participant-led neighborhood tours, and clinic visit observations involving 10 patients with diabetes in underserved San Francisco neighborhoods and 10 community leaders serving those neighborhoods. We coded health barriers and facilitators using a socioecological framework. We also linked these qualitative data with early persona development, focusing on patients' experiences in these communities and within the healthcare system, as a starting place for our future informatics design. Results We identified social risk and protective factors across almost every socioecological domain and level-from physical disability to household context to neighborhood environment. We then detailed the complex interplay across domains and levels within two critical aspects of patients' lives: housing and food. Finally, from these data we generated 3 personas that capture the intersectional nature of these determinants. Conclusion Drawing from different disciplines, our study provides a socioecological approach to understanding health promotion for patients with chronic disease in a safety-net healthcare system, using multiple methodologies. Future digital health research should center the lived experiences of marginalized patients to effectively design and implement informatics solutions for this audience.
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Affiliation(s)
- Kim Hanh Nguyen
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
| | - Anupama G Cemballi
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
| | - Jessica D Fields
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
| | - William Brown
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
- Division of Prevention Science, Department of Medicine, Center for AIDS
Prevention Studies, University of California, San Francisco, California,
USA
- Bakar Computational Health Science Institute, University of
California, San Francisco, California, USA
| | - Matthew S Pantell
- Department of Pediatrics, University of California, San
Francisco, California, USA
- Department of Family and Community Medicine, Center for Health and Community,
University of California, San Francisco, California, USA
| | - Courtney Rees Lyles
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
- Bakar Computational Health Science Institute, University of
California, San Francisco, California, USA
- Corresponding Author: Courtney Rees Lyles, PhD, UCSF General
Internal Medicine ZSFG, Box 1364, 1001 Potrero Ave San Francisco CA 94110, USA;
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Kornfield R, Meyerhoff J, Studd H, Bhattacharjee A, Williams JJ, Reddy M, Mohr DC. Meeting Users Where They Are: User-centered Design of an Automated Text Messaging Tool to Support the Mental Health of Young Adults. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2022; 2022:329. [PMID: 35574512 PMCID: PMC9098159 DOI: 10.1145/3491102.3502046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Young adults have high rates of mental health conditions, but most do not want or cannot access formal treatment. We therefore recruited young adults with depression or anxiety symptoms to co-design a digital tool for self-managing their mental health concerns. Through study activities-consisting of an online discussion group and a series of design workshops-participants highlighted the importance of easy-to-use digital tools that allow them to exercise independence in their self-management. They described ways that an automated messaging tool might benefit them by: facilitating experimentation with diverse concepts and experiences; allowing variable depth of engagement based on preferences, availability, and mood; and collecting feedback to personalize the tool. While participants wanted to feel supported by an automated tool, they cautioned against incorporating an overtly human-like motivational tone. We discuss ways to apply these findings to improve the design and dissemination of digital mental health tools for young adults.
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Affiliation(s)
| | | | | | | | | | - Madhu Reddy
- University of California-Irvine, Irvine, CA, USA
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User-Centric Design Methodology for mHealth Apps. The PainApp Paradigm for Chronic Pain. TECHNOLOGIES 2022. [DOI: 10.3390/technologies10010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The paper presents a user-centric methodology in order to design successful mobile health (mHealth) applications. In addition to the theoretical background, such an example is presented with an application targeting chronic pain. The pain domain was decided due to its significance in many aspects: its complexity, dispersion in the population, the financial burden it causes, etc. The paper presents a step-by-step plan in order to build mobile health applications. Participatory design and interdisciplinarity are only some of the critical issues towards the desired result. In the given example (development of the PainApp), a participatory design was followed with a team of seventeen stakeholders that drove the design and development phases. Three physicians, one behavioral scientist, three IT and UX experts, and ten patients collaborated together to develop the final solution. The several features implemented in the PainApp solution are presented in details. The application is threefold: it supports the management, reporting, and treatment effectiveness monitoring. The paper is giving details on the methodological approach while presenting insights on the actual plan and the steps followed for having a patient-centric solution. Key success factors and barriers to mobile health applications that support the need for such an approach are also presented.
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Poduval S, Ross J, Pal K, Newhouse N, Hamilton F, Murray E. Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach. JMIR Hum Factors 2022; 9:e31567. [PMID: 35029531 PMCID: PMC8800092 DOI: 10.2196/31567] [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: 06/25/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Digital health research encompasses methods from human-computer interaction and health research. OBJECTIVE This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. METHODS The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. RESULTS The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. CONCLUSIONS The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs.
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Affiliation(s)
- Shoba Poduval
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Jamie Ross
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Kingshuk Pal
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fiona Hamilton
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
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Carraher-Wolverton C, Burleson J. Toward an Understanding of How Post- Deployment User- Developer Interactions Influence System Utilization. DATA BASE FOR ADVANCES IN INFORMATION SYSTEMS 2021. [DOI: 10.1145/3508484.3508488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although initial adoption of an information system has been shown to influence system success, further value can be obtained when end-users move beyond adoption, utilizing more features of the system and integrating it into their work routines. Organizations can increase the post-deployment utilization of their systems by emphasizing continued interaction between developers and end-users. In this study, we develop a research model investigating the influence of shared understanding, faithfulness of appropriation, and consensus on spirit on post-deployment system utilization. Using a sample from a healthcare organization, we show that increased end-user postdeployment interaction with developers supports a shared understanding between the two groups, which ultimately impacts both the routinization and infusion of a system. This study provides a contribution by demonstrating the impact of developer/user interaction in the post-implementation phase of systems development.
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Sun K, Goodfellow H, Konstantara E, Hill A, Lennard D, Lloyd-Dehler E, Mughal M, Pritchard-Jones K, Robson C, Murray E. The multidisciplinary, theory-based co-design of a new digital health intervention supporting the care of oesophageal cancer patients. Digit Health 2021; 7:20552076211038410. [PMID: 34873450 PMCID: PMC8642779 DOI: 10.1177/20552076211038410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Oesophageal cancer patients have complex care needs. Cancer clinical nurse
specialists play a key role in coordinating their care but often have heavy
workloads. Digital health interventions can improve patient care but there
are few examples for oesophageal cancer. This paper aims to describe the
multidisciplinary co-design process of a digital health intervention to
improve the experience of care and reduce unmet needs among patients with
oesophageal cancer. Methods A theory-based, multi-disciplinary, co-design approach was used to inform the
developmental process of the digital health intervention. Key user needs
were elicited using mixed methodology from systematic reviews, focus groups
and interviews and holistic need assessments. Overarching decisions were
discussed among a core team of patients, carers, health care professionals
including oncologists and cancer clinical nurse specialists, researchers and
digital health providers. A series of workshops incorporating a summary of
findings of key user needs resulted in the development of a minimum viable
product. This was further refined after a pilot study based on feedback from
end users. Results The final digital health intervention consists of a mobile app feature for
patients and carers connected to a dashboard with supporting additional
features for clinical nurse specialist. It contains a one-way messaging
function for clinical nurse specialists to communicate with patients,
functions for patients to record weight and holistic need assessment results
which could be viewed by their clinical nurse specialists as well as a
library of informative articles. Conclusions The multidisciplinary co-design of a digital health intervention providing
support for oesophageal cancer patients and health care professionals has
been described. Future studies to establish its impact on patient outcomes
are planned.
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Affiliation(s)
- Kristi Sun
- Research Department of Primary Care and Population Health, University College London, UK
| | - Henry Goodfellow
- Research Department of Primary Care and Population Health, University College London, UK
| | - Emmanouela Konstantara
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Debby Lennard
- Research Department of Primary Care and Population Health, University College London, UK
| | - Elizabeth Lloyd-Dehler
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Kathy Pritchard-Jones
- North Central and East London Cancer Alliance, University College London Hospitals NHS Foundation Trust, UK
| | - Chris Robson
- Research Department of Primary Care and Population Health, University College London, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, UK
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Pankhurst T, Evison F, Atia J, Gallier S, Coleman J, Ball S, McKee D, Ryan S, Black R. Introduction of Systematized Nomenclature of Medicine-Clinical Terms Coding Into an Electronic Health Record and Evaluation of its Impact: Qualitative and Quantitative Study. JMIR Med Inform 2021; 9:e29532. [PMID: 34817387 PMCID: PMC8663536 DOI: 10.2196/29532] [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: 04/11/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study describes the conversion within an existing electronic health record (EHR) from the International Classification of Diseases, Tenth Revision coding system to the SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) for the collection of patient histories and diagnoses. The setting is a large acute hospital that is designing and building its own EHR. Well-designed EHRs create opportunities for continuous data collection, which can be used in clinical decision support rules to drive patient safety. Collected data can be exchanged across health care systems to support patients in all health care settings. Data can be used for research to prevent diseases and protect future populations. OBJECTIVE The aim of this study was to migrate a current EHR, with all relevant patient data, to the SNOMED-CT coding system to optimize clinical use and clinical decision support, facilitate data sharing across organizational boundaries for national programs, and enable remodeling of medical pathways. METHODS The study used qualitative and quantitative data to understand the successes and gaps in the project, clinician attitudes toward the new tool, and the future use of the tool. RESULTS The new coding system (tool) was well received and immediately widely used in all specialties. This resulted in increased, accurate, and clinically relevant data collection. Clinicians appreciated the increased depth and detail of the new coding, welcomed the potential for both data sharing and research, and provided extensive feedback for further development. CONCLUSIONS Successful implementation of the new system aligned the University Hospitals Birmingham NHS Foundation Trust with national strategy and can be used as a blueprint for similar projects in other health care settings.
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Affiliation(s)
- Tanya Pankhurst
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Felicity Evison
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Jolene Atia
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Suzy Gallier
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Jamie Coleman
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Simon Ball
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom.,Health Data Research UK (HDR-UK), University of Birmingham, Birmingham, United Kingdom
| | - Deborah McKee
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Steven Ryan
- NHS Foundation Trust, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Ruth Black
- Institute for Global Health Innovation (IGHI), Imperial College London, London, United Kingdom
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Xu RH, Zhou LM, Wong ELY, Wang D. The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study. J Med Internet Res 2021; 23:e26721. [PMID: 34559062 PMCID: PMC8501410 DOI: 10.2196/26721] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/06/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Although previous studies have shown that a high level of health literacy can improve patients’ ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. Objective This study aims to assess the relationship between patients’ eHealth literacy and their socioeconomic determinants and to investigate the association between patients’ eHealth literacy and their SSDM and well-being. Methods The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients’ eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients’ background characteristics. Results A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM≥61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (β=.22; P<.001) and well-being (β=.26; P<.001) after adjusting for patients’ demographic, socioeconomic status, lifestyle, and health status variables. Conclusions This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients’ depressive status may alter the relationship between eHealth literacy and SSDM.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ling-Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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MacPherson M, Cranston K, Johnston C, Locke S, Jung ME. Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study. JMIR Form Res 2021; 5:e28163. [PMID: 34448713 PMCID: PMC8433931 DOI: 10.2196/28163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.
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Affiliation(s)
- Megan MacPherson
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Kaela Cranston
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Cara Johnston
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Sean Locke
- Department of Kinesiology, Brock University, St Catharines, ON, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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Gregório J, Reis L, Peyroteo M, Maia M, Mira da Silva M, Lapão LV. The role of Design Science Research Methodology in developing pharmacy eHealth services. Res Social Adm Pharm 2021; 17:2089-2096. [PMID: 34119446 DOI: 10.1016/j.sapharm.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
The increasing focus on efficiency of care has prompted health systems to look for innovative solutions that yield maximum value for care. Integration of care and eHealth are seen as the most promising solutions in the high technological environment of the coming decades. Pharmacy services have been developed to a point where the face of community pharmacy has changed dramatically. Thus, service design and implementation has become an area of increased attention by Pharmacy practice researchers, and the arrival of eHealth concepts to Pharmacy is driving the need to find alternative ways to design new services. Moreover, known barriers and challenges remain when securing integration of pharmacy services with the health systems. In this paper, Design Science Research Methodology (DSRM), a user-centered alternative methodology to the design, development and implementation of health services, especially eHealth services, is presented. This alternative, originally from the Information Sciences field, has been adopted as a service design methodology in diverse settings, including health care. Here, case studies are used to explain how a DSRM process should be conducted in a health care setting, illustrating what methods to choose in each step of the process. Finally, the advantages of DSRM compared to other user-centered methodologies for service design are presented, hopefully prompting the discussion on the use of DSRM for the study of the implementation and sustainability of pharmacy services.
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Affiliation(s)
- João Gregório
- CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisboa, Portugal.
| | - Lígia Reis
- CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisboa, Portugal.
| | - Mariana Peyroteo
- Comprehensive Health Research Centre, NOVA Medical School, Lisbon, Portugal.
| | - Melanie Maia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Jonathan GK, Dopke CA, Michaels T, Bank A, Martin CR, Adhikari K, Krakauer RL, Ryan C, McBride A, Babington P, Frauenhofer E, Silver J, Capra C, Simon M, Begale M, Mohr DC, Goulding EH. A Smartphone-Based Self-management Intervention for Bipolar Disorder (LiveWell): User-Centered Development Approach. JMIR Ment Health 2021; 8:e20424. [PMID: 33843607 PMCID: PMC8076988 DOI: 10.2196/20424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/13/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. OBJECTIVE This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. METHODS Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. RESULTS The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40%), followed by cognitive (25%), mood (15%), physical (10%), and motivational (7%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. CONCLUSIONS User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development.
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Affiliation(s)
- Geneva K Jonathan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tania Michaels
- Pediatrics, Loma Linda Children's Hospital, Loma Linda, CA, United States
| | - Andrew Bank
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Clair R Martin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Krina Adhikari
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Chloe Ryan
- Department of Social Work, UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States
| | - Alyssa McBride
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pamela Babington
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ella Frauenhofer
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Courtney Capra
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Melanie Simon
- Department of Psychology, School of Science and Engineering, Tulane University, New Orleans, LA, United States
| | | | - David C Mohr
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Loo Gee B, Batterham PJ, Gulliver A, Reynolds J, Griffiths KM. An Ecological Momentary Intervention for people with social anxiety: A descriptive case study. Inform Health Soc Care 2021; 46:370-398. [PMID: 33779480 DOI: 10.1080/17538157.2021.1896525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study describes the development and pilot evaluation of a smartphone- delivered Ecological Momentary Intervention (EMI) for people with social anxiety symptoms. Using a software engineering framework (agile modeling, model-driven development, bottom-up development), mental health experts and software developers collaborated to develop a 4-module EMI app designed to reduce social anxiety in real-time. Fifty-five participants with social anxiety were randomly allocated to the EMI or a wait-list control arm. App downloads, usage and user satisfaction data were collected and mental health outcomes assessed at baseline and post-intervention. Software development practices allowed mental health experts to distil core elements of a psychological intervention into discrete software components but there were challenges in engaging mental health experts in the process. Relative to control there was no significant reduction in social anxiety among the EMI participants in the pilot trial. However, post-test data were available for only 4 intervention and 10 control participants and only 2 (4.0%) of the EMI participants downloaded the app. The two participants who both accessed the app and completed the post-test reported being satisfied with the intervention. Future research should address managing resources and providing additional training to support ongoing engagement with key stakeholders.
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Affiliation(s)
- Brendan Loo Gee
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Julia Reynolds
- Research School of Psychology, The Australian National University, Canberra ACT, Australia
| | - Kathleen M Griffiths
- Research School of Psychology, The Australian National University, Canberra ACT, Australia
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Esdar M, Hübner U, Thye J, Babitsch B, Liebe JD. The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data. JMIR Med Inform 2021; 9:e23306. [PMID: 33720029 PMCID: PMC8077601 DOI: 10.2196/23306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/13/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. Objective The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. Methods We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. Results The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. Conclusions The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Johannes Thye
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Birgit Babitsch
- Institute of Health and Education, New Public Health, Osnabrück University, Osnabrueck, Germany
| | - Jan-David Liebe
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany.,Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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A Study of eHealth from the Perspective of Social Sciences. Healthcare (Basel) 2021; 9:healthcare9020108. [PMID: 33494182 PMCID: PMC7909835 DOI: 10.3390/healthcare9020108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
The field of social sciences has become increasingly important in eHealth. Patients currently engage more proactively with health services. This means that eHealth is linked to many different areas of Social Sciences. The main purpose of this research is to analyze the state-of-the-art research on eHealth from the perspective of social sciences. To this end, a bibliometric analysis was conducted using the Web of Science database. The main findings show the evolution of publications, the most influential countries, the most relevant journals and papers, and the importance of the different areas of knowledge. Although there are some studies on eHealth within social sciences, most of them focus on very specific aspects and do not develop a holistic analysis. Thus, this paper contributes to academia by analyzing the state-of-the-art of research, as well as identifying the most relevant trends and proposing future lines of research such as the potential of eHealth as a professional training instrument, development of predictive models in eHealth, analysis of the eHealth technology acceptance model (TAM), efficient integration of eHealth within public systems, efficient budget management, or improvement in the quality of service for patients.
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Arshad Ali S, Bin Arif T, Maab H, Baloch M, Manazir S, Jawed F, Ochani RK. Global Interest in Telehealth During COVID-19 Pandemic: An Analysis of Google Trends™. Cureus 2020; 12:e10487. [PMID: 33083187 PMCID: PMC7567313 DOI: 10.7759/cureus.10487] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Since the outbreak, healthcare systems across the globe are overcrowded with coronavirus disease (COVID-19) patients. To sustain the response towards the pandemic, many hospitals have adapted to virtual healthcare and telemedicine. Google™ has become the most widely used search engine over the years. Google Trends™ can be used to depict the public interest over a certain topic. The output of the Google Trends™ is displayed as relative search volume (RSV) which is the proportionate search volume regarding a specific topic comparative to the total search volume in a specific time and region. The primary aim of this study was to evaluate the relationship between the daily reported number of new COVID-19 cases and deaths and the corresponding changes in Google Trends™ RSV of telehealth over six months. Methods A retrospective study was conducted from January 21, 2020 to July 21, 2020. About 17 countries that reported the total number of cases greater than 200,000 in the situation report of July 21, 2020 were selected to be a part of this study. The daily reported new cases and deaths globally and of the selected countries were extracted from the World Health Organization (WHO) situation reports. The combination of keywords used for obtaining the RSV data through Google Trends™ was “telehealth”, “telemedicine”, “mHealth”, and “eHealth”. These words were used with the “+” feature of Google Trends™ with “1/21/2020 to 7/21/2020” as time range, “all categories” for the category, and “web search” for the type of search. The worldwide RSV as well as the RSVs of the selected countries were obtained from the Google Trends™ website. Spearman’s correlation coefficient (ρ) was used to determine the strength of the relationship between new cases or deaths and RSVs related to telehealth. Results A positive fair correlation was established between the global interest in telehealth and the new cases (ρ=0.307, p-value<0.001) and deaths (ρ=0.469, p-value<0.001) reported worldwide. The United States of America (USA), India, and Bangladesh were found to have a positive fair correlation between the public interest regarding telehealth and the emerging new COVID-19 cases and deaths. The United Kingdom (UK) and Italy demonstrated a positive poor correlation between the rising new cases or deaths and RSV. Similar statistics were noted for the daily new cases of Chile. For Turkey, a positive fair correlation between new deaths and RSV while a positive poor correlation between new cases and RSV was observed. No significant correlation was observed for the rest of the selected countries. Conclusion This study highlights the steadily rising public interest in telehealth during the COVID-19 pandemic. Telemedicine can provide the necessary remote consultation and healthcare for patients in the current situation. However, previous studies have shown that the majority of the countries are inadequately equipped for the digitization of the healthcare system. Therefore, it has become necessary to incorporate telemedicine into the healthcare system to combat any possible pandemic in the future.
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Affiliation(s)
| | - Taha Bin Arif
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hira Maab
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mariam Baloch
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sana Manazir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Fatima Jawed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Nguyen C, Dew MA, Irizarry T, McNulty M, Rennick J, Knäuper B, Descoteaux A, Grenier A, Jeannot L, Foster BJ, DeVito Dabbs AJ. Promoting medication adherence from the perspective of adolescent and young adult kidney transplant recipients, parents, and health care professionals: A TAKE-IT TOO study. Pediatr Transplant 2020; 24:e13709. [PMID: 32388916 PMCID: PMC7392786 DOI: 10.1111/petr.13709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 12/30/2022]
Abstract
Medication non-adherence is an important factor limiting allograft survival after kidney transplantation in AYA. Some interventions, including the TAKE-IT, showed some success in promoting adherence but the potential for scalability and use in routine clinical practice is limited. We applied user-centered design to gather the perspectives of recipients, parents, and health professionals concerning their needs, challenges, and potential intervention strategies to design an optimal, multi-component medication adherence intervention. The qualitative study was conducted at four Canadian and three American kidney transplant programs. Separate focus groups for recipients, parents, and health professionals were convened to explore these stakeholders' perspectives. Directed content analysis was employed to identify themes that were shared vs distinct across stakeholders. All stakeholder groups reported challenges related to taking medications on time in the midst of their busy schedules and the demands of transitioning toward independence during adolescence. The stakeholders also made suggestions for the multi-component behavioral intervention, including an expanded electronic pillbox and companion website, education materials, and customized digitized features to support shared responsibility and communication among recipients, parents, and health professionals. Several suggestions regarding the functionality and features of the potential intervention reported in this early stage will be explored in more depth as the iterative process unfolds. Our approach to actively involve all stakeholders in the process increases the likelihood of designing an adherence intervention that is truly user-informed and fit for the clinical setting.
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Affiliation(s)
- Christina Nguyen
- UH Rainbow Babies and Children’s Hospital Division of Pediatrics, Division of Pediatric Nephrology, Cleveland, OH, USA
| | - Mary Amanda Dew
- University of Pittsburgh School of Medicine, Psychiatry Pittsburgh, PA, USA
| | - Taya Irizarry
- University of Pittsburgh School of Nursing, Acute and Tertiary Care Pittsburgh, PA, USA
| | - Mary McNulty
- University of Pittsburgh School of Medicine, Psychiatry Pittsburgh, PA, USA
| | - Janet Rennick
- Research Institute of the McGill University Health Centre Montreal, QC, CAN
| | | | - Annie Descoteaux
- Centre Hospitalier Universitaire Ste. Justine, Montreal, QC, CAN
| | | | - Lovemine Jeannot
- Research Institute of the McGill University Health Centre Montreal, QC, CAN
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre Montreal, QC, CAN
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Cornet VP, Toscos T, Bolchini D, Rohani Ghahari R, Ahmed R, Daley C, Mirro MJ, Holden RJ. Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure. JMIR Mhealth Uhealth 2020; 8:e17703. [PMID: 32706745 PMCID: PMC7404009 DOI: 10.2196/17703] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
Abstract
Background User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories.
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Affiliation(s)
- Victor Philip Cornet
- Department of Human-centered Computing, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States.,Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Davide Bolchini
- Department of Human-centered Computing, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States
| | - Romisa Rohani Ghahari
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Ryan Ahmed
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States
| | - Carly Daley
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States.,Department of BioHealth Informatics, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States
| | - Michael J Mirro
- Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, United States.,Department of BioHealth Informatics, School of Informatics and Computing, IUPUI, Indianapolis, IN, United States.,Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Richard J Holden
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States
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Cruz-Martínez RR, Wentzel J, Asbjørnsen RA, Noort PD, van Niekerk JM, Sanderman R, van Gemert-Pijnen JE. Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development. J Med Internet Res 2020; 22:e16157. [PMID: 32436852 PMCID: PMC7273239 DOI: 10.2196/16157] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/19/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the use of different terms and concepts to explain the same phenomena and lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A review of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to achieve an understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods The metaethnography approach was used to review and synthesize researchers’ reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, Association for Computing Machinery Digital Library, and Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results Of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) applied by the projects were identified. Key ingredients (n=293) of the included articles were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) it targets behavior change; (7) it targets technology adoption; and (8) it targets health-related outcomes. Conclusions The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modeling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches. Trial Registration PROSPERO CRD42018104397; https://tinyurl.com/y8ajyajt International Registered Report Identifier (IRRID) RR2-10.2196/13334
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Saxion University of Applied Sciences, Deventer, Netherlands
| | - Rikke Aune Asbjørnsen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway
| | - Peter Daniel Noort
- Embedded Information Services, Library, ICT Services & Archive, University of Twente, Enschede, Netherlands
| | - Johan Magnus van Niekerk
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,GZW-Health Psychology-GZW-General, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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Prinjha S, Ricci-Cabello I, Newhouse N, Farmer A. British South Asian Patients' Perspectives on the Relevance and Acceptability of Mobile Health Text Messaging to Support Medication Adherence for Type 2 Diabetes: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e15789. [PMID: 32310150 PMCID: PMC7199132 DOI: 10.2196/15789] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/01/2019] [Accepted: 01/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2D) is greater in South Asian populations and health outcomes are poorer compared with other ethnic groups. British South Asians are up to six times more likely to have T2D than the general population, to develop the condition at a younger age, and to experience diabetes-related complications. Interventions to support people in managing their condition can potentially reduce debilitating complications. Evidence to support the use of digital devices in T2D management, including mobile phones, has shown positive impacts on glycemic control. There is increasing recognition that health interventions that are culturally adapted to the needs of specific groups are more likely to be relevant and acceptable, but evidence to support the effectiveness of adapted interventions is limited and inconclusive. OBJECTIVE This formative study aimed to explore the perceptions and views of British South Asian patients with T2D on mobile health SMS text messaging to support medication adherence, aimed at the general UK population. METHODS Eight exploratory focus groups were conducted in Leicester, the United Kingdom, between September 2017 and March 2018. A diverse sample of 67 adults took part. RESULTS British South Asian people with T2D who use digital devices, including mobile phones, felt that short messages to support medication adherence would be acceptable and relevant, but they also wanted messages that would support other aspects of self-management too. Participants were particularly interested in content that met their information needs, including information about South Asian foods, commonly used herbs and spices, natural and herbal approaches used in the United Kingdom and in South Asia, and religious fasting. Short messages delivered in English were perceived to be acceptable, often because family members could translate for those unable to read or understand the messages. Suggestions to support patients unable to understand short messages in English included having them available in different formats, and disseminated in face-to-face groups for those who did not use digital devices. CONCLUSIONS Exploring the views of British South Asian patients about SMS text messaging aimed at the general UK population is important in maximizing the potential of such an intervention. For such a digital system to meet the needs of UK South Asian populations, it may also have to include culturally relevant messages sent to those who opt to receive them. It is equally important to consider how to disseminate message content to patients who do not use digital devices to help reduce health inequalities.
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Affiliation(s)
- Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ignacio Ricci-Cabello
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma de Mallorca, Illes Balears, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Illes Balears, Spain
- Ciber de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Stephenson A, Garcia-Constantino M, McDonough SM, Murphy MH, Nugent CD, Mair JL. Iterative four-phase development of a theory-based digital behaviour change intervention to reduce occupational sedentary behaviour. Digit Health 2020; 6:2055207620913410. [PMID: 32257366 PMCID: PMC7099670 DOI: 10.1177/2055207620913410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction As high amounts of occupational sitting have been associated with negative
health consequences, designing workplace interventions to reduce sedentary
behaviour (SB) is of public health interest. Digital technology may serve as
a cost-effective and scalable platform to deliver such an intervention. This
study describes the iterative development of a theory-based, digital
behaviour change intervention to reduce occupational SB. Methods The behaviour change wheel and The Behaviour Change Technique Taxonomy were
used to guide the intervention design process and form a basis for selecting
the intervention components. The development process consisted of four
phases: phase 1 – preliminary research, phase 2 – consensus workshops, phase
3 – white boarding and phase 4 – usability testing. Results The process led to the development and refinement of a smartphone application
– Worktivity. The core component was self-monitoring and feedback of SB at
work, complemented by additional features focusing on goal setting, prompts
and reminders to break up prolonged periods of sitting, and educational
facts and tips. Key features of the app included simple data entry and
personalisation based on each individual’s self-reported sitting time.
Results from the ‘think-aloud’ interviews (n=5) suggest
Worktivity was well accepted and that users were positive about its
features. Conclusion This study led to the development of Worktivity, a theory-based and
user-informed mobile app intervention to reduce occupational SB. It is the
first app of its kind developed with the primary aim of reducing
occupational SB using digital self-monitoring. This paper provides a
template to guide others in the development and evaluation of
technology-supported behaviour change interventions.
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Affiliation(s)
- Aoife Stephenson
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Matias Garcia-Constantino
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
| | - Suzanne M McDonough
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,School of Physiotherapy, University of Otago, New Zealand
| | - Marie H Murphy
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Chris D Nugent
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
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Stephenson A, Pedlow K, McDonough S, Holmes D, Charles D, Barbabella F, Olivetti P, Chiatti C. Evaluation of the acceptability and usability of the MAGIC-GLASS virtual reality solution as part of the care pathway in people with acute, sub-acute and chronic stroke: a study protocol. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1757379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Aoife Stephenson
- Centre for Health and Rehabilitation Technologies, Ulster University, Newtownabbey, UK
| | - Katy Pedlow
- Centre for Health and Rehabilitation Technologies, Ulster University, Newtownabbey, UK
| | - Suzanne McDonough
- Centre for Health and Rehabilitation Technologies, Ulster University, Newtownabbey, UK
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
- School of Physiotherapy, RCSI, Dublin, Ireland
| | - Dominic Holmes
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Newtownabbey, UK
| | - Darryl Charles
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Newtownabbey, UK
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Grenha Teixeira J, Pinho NFD, Patrício L. Bringing service design to the development of health information systems: The case of the Portuguese national electronic health record. Int J Med Inform 2019; 132:103942. [DOI: 10.1016/j.ijmedinf.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
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Carbonnel F, Ninot G. Identifying Frameworks for Validation and Monitoring of Consensual Behavioral Intervention Technologies: Narrative Review. J Med Internet Res 2019; 21:e13606. [PMID: 31621638 PMCID: PMC6822061 DOI: 10.2196/13606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/08/2019] [Accepted: 08/02/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Changing health behaviors, such as smoking, unhealthy eating, inactivity, and alcohol abuse, may have a greater impact on population health than any curative strategy. One of the suggested strategies is the use of behavioral intervention technologies (BITs). They open up new opportunities in the area of prevention and therapy and have begun to show benefits in the durable change of health behaviors in patients or those at risk. A consensual and international paradigm was adopted by health authorities for drugs 50 years ago. It guides their development from research units to their authorization and surveillance. BITs' generalization brings into question their upstream evaluation before being placed on the market and their downstream monitoring once on the market; this is especially the case in view of the marketing information provided by manufacturers and the scarcity and methodological limits of scientific studies on these tools. OBJECTIVE This study aims to identify and categorize the frameworks for the validation and monitoring of BITs proposed in the literature. METHODS We conducted a narrative literature review using MEDLINE, PsycINFO, and Web of Science. The review items included the following: name, publication year, name of the creator (ie, first author), country, funding organization, health focus, target group, and design (ie, linear, iterative, evolutive, and/or concurrent). The frameworks were then categorized based on (1) translational research thanks to a continuum of steps and (2) the three paradigms that may have inspired the frameworks: biomedical, engineering, and/or behavioral. RESULTS We identified 46 frameworks besides the classic US Food and Drug Administration (FDA) five-phase drug development model. A total of 57% (26/46) of frameworks were created in the 2010s and 61% (28/46) involved the final user in an early and systematic way. A total of 4% (2/46) of frameworks had a linear-only sequence of their phases, 37% (17/46) had a linear and iterative structure, 33% (15/46) added an evolutive structure, and 24% (11/46) were associated with a parallel process. Only 12 out of 46 (26%) frameworks covered the continuum of steps and 12 (26%) relied on the three paradigms. CONCLUSIONS To date, 46 frameworks of BIT validation and surveillance coexist, besides the classic FDA five-phase drug development model, without the predominance of one of them or convergence in a consensual model. Their number has increased exponentially in the last three decades. Three dangerous scenarios are possible: (1) anarchic continuous development of BITs that depend on companies amalgamating health benefits and usability (ie, user experience, data security, and ergonomics) and limiting implementation to several countries; (2) the movement toward the type of framework for drug evaluation centered on establishing its effectiveness before marketing authorization to guarantee its safety for users, which is heavy and costly; and (3) the implementation of a framework reliant on big data analysis based on a posteriori research and an autoregulation of a market, but that does not address the safety risk for the health user, as the market will not regulate safety or efficacy issues. This paper recommends convergence toward an international validation and surveillance framework based on the specificities of BITs, not equivalent to medical devices, to guarantee their effectiveness and safety for users.
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Affiliation(s)
- François Carbonnel
- Research Unit EA4556 Epsylon, University of Montpellier, Montpellier, France.,Plateforme Universitaire Collaborative d'Evaluation des Programmes de Prévention et de Soins de Support, University of Montpellier, Montpellier, France.,University Department of General Practice, University of Montpellier, Montpellier, France.,University Multiprofessional Health Center Avicenne, Perpignan, France
| | - Gregory Ninot
- Research Unit EA4556 Epsylon, University of Montpellier, Montpellier, France.,Plateforme Universitaire Collaborative d'Evaluation des Programmes de Prévention et de Soins de Support, University of Montpellier, Montpellier, France.,Montpellier Cancer Institute, Montpellier, France
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Narasimha S, Dixon E, Bertrand JW, Chalil Madathil K. An empirical study to investigate the efficacy of collaborative immersive virtual reality systems for designing information architecture of software systems. APPLIED ERGONOMICS 2019; 80:175-186. [PMID: 31280803 DOI: 10.1016/j.apergo.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/06/2018] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
The ability of Immersive Virtual Reality (IVR) systems to mimic the real world has made it possible to use this technology to create environments for remote collaborative work. This study aimed to understand the feasibility of immersive virtual reality when conducting a collaborative Information Architecture (IA) design task-card sorting, with geographically dispersed participants. Using a between-subjects experimental design, thirty groups of two individuals each completed a card sorting activity using conventional in-person, video screen-sharing method or immersive virtual reality methods. The dependent measures included total time, percentage match with master card set, usability, presence and perceived workload. Overall usability was found to be significantly higher for the immersive virtual reality condition when compared to conventional in-person card sorting. In addition, the new immersive virtual reality technology performed as well as the other two conditions for other dependent variables. Qualitative data from the participants also indicated a positive reaction to the use of immersive virtual reality for this task. Overall, the participants felt they were productive and enjoyed the IVR condition, indicating the potential of IVR-based approaches as an alternative to conventional approaches for IA design.
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Affiliation(s)
- Shraddhaa Narasimha
- Department of Industrial Engineering, 110 Freeman Hall, Clemson, SC, 29634, USA
| | - Emma Dixon
- Department of Industrial Engineering, 110 Freeman Hall, Clemson, SC, 29634, USA
| | - Jeffrey W Bertrand
- Department of Industrial Engineering, 110 Freeman Hall, Clemson, SC, 29634, USA
| | - Kapil Chalil Madathil
- Departments of Industrial and Civil Engineering, Clemson University, 110 Freeman Hall, Clemson, SC, 29634, USA.
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Holeman I, Kane D. Human-centered design for global health equity. INFORMATION TECHNOLOGY FOR DEVELOPMENT 2019; 26:477-505. [PMID: 32982007 PMCID: PMC7484921 DOI: 10.1080/02681102.2019.1667289] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
As digital technologies play a growing role in healthcare, human-centered design is gaining traction in global health. Amid concern that this trend offers little more than buzzwords, our paper clarifies how human-centered design matters for global health equity. First, we contextualize how the design discipline differs from conventional approaches to research and innovation in global health, by emphasizing craft skills and iterative methods that reframe the relationship between design and implementation. Second, while there is no definitive agreement about what the 'human' part means, it often implies stakeholder participation, augmenting human skills, and attention to human values. Finally, we consider the practical relevance of human-centered design by reflecting on our experiences accompanying health workers through over seventy digital health initiatives. In light of this material, we describe human-centered design as a flexible yet disciplined approach to innovation that prioritizes people's needs and concrete experiences in the design of complex systems.
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Affiliation(s)
- Isaac Holeman
- Department of Global Health, The University of Washington, Seattle, WA, USA
- Medic Mobile, Seattle, WA, USA
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Esdar M, Hüsers J, Weiß JP, Rauch J, Hübner U. Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States. Int J Med Inform 2019; 131:103952. [PMID: 31557699 DOI: 10.1016/j.ijmedinf.2019.103952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/23/2019] [Accepted: 08/14/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches - particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR). OBJECTIVE To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US. MATERIALS AND METHODS All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007-2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation. RESULTS While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303). DISCUSSION These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders. CONCLUSION Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jens Hüsers
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jan-Patrick Weiß
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jens Rauch
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Ursula Hübner
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
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Semple CJ, McCaughan E. Developing and testing a theory-driven e-learning intervention to equip healthcare professionals to communicate with parents impacted by parental cancer. Eur J Oncol Nurs 2019; 41:126-134. [DOI: 10.1016/j.ejon.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 01/29/2023]
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LeRouge C, Durneva P, Sangameswaran S, Gloster AM. Design Guidelines for a Technology-Enabled Nutrition Education Program to Support Overweight and Obese Adolescents: Qualitative User-Centered Design Study. J Med Internet Res 2019; 21:e14430. [PMID: 31359871 PMCID: PMC6690165 DOI: 10.2196/14430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/07/2019] [Accepted: 06/09/2019] [Indexed: 01/16/2023] Open
Abstract
Background Childhood overweight and obesity are major health challenges in the United States. One of the recommendations to combat obesity is to maintain a healthy diet, which is often best supported by eating home-cooked meals to control cooking methods, ingredients, and portions. Diet control through home cooking is challenged because of the decline in culinary skills in the population and a paucity of effective culinary nutrition education (CNE) programs. Providing technology-enabled CNE (CNE-tech) to overweight and obese adolescents can equip them with life skills that can assist them in the future. Such skills can facilitate saving money, eating healthier, and creating social environments. In addition, CNE builds cooking confidence and food literacy that in turn can build adolescent self-efficacy, particularly toward managing their health behaviors. Objective This study aimed to inform functionalities, design requirements, and the context of use for CNE-tech that could enhance overweight and obese adolescents’ healthy food literacy, cooking confidence, and general self-efficacy with regard to self-management to ultimately promote healthy lifestyle management. Methods The design science study was completed in 2 distinct phases engaging overweight and obese adolescents, parents of overweight and obese adolescents, and the health care providers that treat adolescents with these conditions. Phase 2, our primary source of data, involved user-centered design methods including the following: (1) early stage prototype usability analysis, (2) semistructured interviews with 70 overweight or obese adolescents engaged in a healthy behavior program, and (3) semistructured interviews with 10 health care providers. Data were analyzed using constant comparison analysis to identify functionalities, design requirements, and inform the context of use of CNE-tech. Results Data revealed specific desired functionalities for the CNE-tech related to building cooking skills, populating a healthy recipe database, suggesting healthy alternatives, supporting the construction of a healthy plate, and the ability to share healthy recipes and cooking accomplishments. Moreover, the adolescents provided design requirements pertaining to the presentation (eg, vivid colors, semirealistic images, and cooking sounds), use of multimedia, and gaming. Data further revealed contextual factors, such as shared experiences with family members and enhanced continued use. Conclusions We demonstrate the potentiality of creating CNE-tech that could effectively lead to better self-care and induce sustainable behavioral change as it facilitates skill building, self-efficacy, and a pathway that enables overweight and obese adolescents to influence cooking habits in their family home and future dwellings. Our CNE-tech–proposed solution aligns with the goals of overweight and obese adolescents and also reflects existing theories about behavioral change.
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Affiliation(s)
- Cynthia LeRouge
- Health Informatics and Analytics Program, Department of Information Systems & Business Analytics, Florida International University, Miami, FL, United States
| | - Polina Durneva
- Health Informatics and Analytics Program, Department of Information Systems & Business Analytics, Florida International University, Miami, FL, United States
| | - Savitha Sangameswaran
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, United States
| | - Anne-Marie Gloster
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, United States
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