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Atoyebi O, Beaudoin M, Routhier F, Auger C, Demers L, Wister A, Plante M, Mortenson WB. Potential assistive technology preferences of informal caregivers of people with disability. J Rehabil Assist Technol Eng 2023; 10:20556683231172671. [PMID: 37168036 PMCID: PMC10164850 DOI: 10.1177/20556683231172671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Background Preferences of informal caregivers of people with neurocognitive disorders for technological solutions are important in user- centered design approaches. It is crucial to take into consideration the needs and preferences of users when developing new technology to facilitate their uptake. Objectives The objective of this study was to determine caregiver preferences for potential technological solutions to help address their needs and compare technology preferences of caregivers who provide care to those with and without neurocognitive disorders (NCD). Methods This was a quantitative descriptive study. We surveyed informal caregivers of older adults with disability in Canada. Participants were asked to answer questions about their preferences for 10 potential technological solutions that could be developed to make caregiving easier. Results Data from 125 respondents (72 caregivers of people with NCD and 53 caregivers of people with non-NCD-related disabilities) were analyzed. Generally, caregivers preferred web-based solutions as these were among the first five choices for both groups combined. However, there were some differences in the order of preference of potential solutions in both groups. Conclusion Informal caregivers of people with NCD preferred web-based solutions to help address their needs.
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Affiliation(s)
- Oladele Atoyebi
- University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Program, Vancouver, Canada
| | - Maude Beaudoin
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de La Capitale-Nationale, Québec City, Canada
- Université Laval, Québec City, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de La Capitale-Nationale, Québec City, Canada
- Université Laval, Québec City, Canada
| | - Claudine Auger
- Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Louise Demers
- Université de Montréal, Montréal, Canada
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - Andrew Wister
- Gerontology Research Centre, Vancouver, Canada
- Simon Fraser University, Vancouver, Canada
| | - Michelle Plante
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - W Ben Mortenson
- University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Program, Vancouver, Canada
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Feldner HA, Gaebler-Spira D, Awasthi V, Bjornson K. Supportive mobility device use across the life span by individuals with cerebral palsy: A qualitative study. Dev Med Child Neurol 2022; 64:1392-1401. [PMID: 35426449 PMCID: PMC10883136 DOI: 10.1111/dmcn.15243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023]
Abstract
AIM To understand the mobility experiences, supportive mobility device (SMD) use, and desired participation outcomes of individuals with cerebral palsy (CP) across the life span, and describe how perspectives of rehabilitation care and professional resources may influence mobility decision-making processes and outcomes. METHOD In the second phase of an overarching study, focus groups were conducted with 164 participants (68 individuals with CP; 32 females, 36 males; mean age 17y 8mo, SD 11y 11mo, range 3-68y), 74 caregivers (50 females, 24 males), and 22 healthcare providers (14 females, eight males) across four US cities. Sessions were audio-recorded, transcribed, and analysed using constant comparison. RESULTS Six themes emerged. Five presented across all stakeholder groups: (1) the system is broken; (2) equipment is simultaneously liberating and restricting; (3) adaptation across the life span; (4) designed for transport, not for living; and (5) sharing our stories and sharing resources. One theme (theme 6) was specific to healthcare providers: caught in the middle. INTERPRETATION This qualitative study underscores the simultaneous value and frustration associated with SMDs as described by the community with CP, and recognition among all stakeholders of the need to improve connections and resource networks within the community with CP to improve SMD design and provision processes across device types and across the life span for individuals with CP. WHAT THIS PAPER ADDS Supportive mobility devices (SMDs) were most often equated with freedom, participation, and independence. Frustration with SMDs across the life span persisted with regard to design, function, cost, and maintenance. Stakeholders in the community with cerebral palsy are seeking greater networking and resource sharing to enhance SMD provision processes. Access to appropriate SMDs across the life span and the need for system improvement are critical.
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Affiliation(s)
- Heather A Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Varun Awasthi
- Seattle Children's Research Institute, Seattle, WA, USA
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Krukowski RA, Harvey J, Borden J, Stansbury ML, West DS. Expert opinions on reducing dietary self-monitoring burden and maintaining efficacy in weight loss programs: A Delphi study. Obes Sci Pract 2022; 8:401-410. [PMID: 35949285 PMCID: PMC9358747 DOI: 10.1002/osp4.586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Dietary self-monitoring is consistently related to both short- and long-term weight loss, but typically declines over time. Adopting an abbreviated approach to self-monitoring might reduce burden and potentially increase engagement while maintaining efficacy. Methods Using a Delphi-type study, experts were queried about abbreviated self-monitoring approaches that might best balance efficacy and burden and asked to identify when these approaches might best be implemented within a behavioral weight loss program. Experts were surveyed three times until consensus was reached. Results Experts identified three main categories of promising strategies for abbreviated self-monitoring regardless of whether individuals have been successful with weight loss or full dietary self-monitoring: (1) self-weighing only, (2) reducing the foods/beverages self-monitored to those that are often less routine and higher in caloric density, and (3) reducing the number of days per week to engage in full dietary self-monitoring. Experts recommended transitioning to abbreviated self-monitoring after 2 weeks of no self-monitoring among individuals who were struggling and after reaching 5%-10% weight loss among successful individuals. Conclusions These expert opinions offer a foundation to experimentally manipulate promising strategies for reducing burden and increasing long-term engagement in self-monitoring, with a goal of enhancing long-term weight control.
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Affiliation(s)
- Rebecca A. Krukowski
- Department of Public Health SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jean Harvey
- Nutrition and Food SciencesUniversity of VermontBurlingtonVirginiaUSA
| | - Janna Borden
- Arnold School of Public HealthCenter for Technology to Promote Healthy Lifestyles (TecHealth)University of South CarolinaColumbiaSouth CarolinaUSA
| | - Melissa L. Stansbury
- Arnold School of Public HealthCenter for Technology to Promote Healthy Lifestyles (TecHealth)University of South CarolinaColumbiaSouth CarolinaUSA
| | - Delia Smith West
- Arnold School of Public HealthCenter for Technology to Promote Healthy Lifestyles (TecHealth)University of South CarolinaColumbiaSouth CarolinaUSA
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Shojaee-Mend H, Ayatollahi H, Abdolahadi A. Ontology Engineering for Gastric Dystemperament in Persian Medicine. Methods Inf Med 2021; 60:162-170. [PMID: 34448178 DOI: 10.1055/s-0041-1735168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Developing an ontology can help collecting and sharing information in traditional medicine including Persian medicine in a well-defined format. The present study aimed to develop an ontology for gastric dystemperament in the Persian medicine. METHODS This was a mixed-methods study conducted in 2019. The first stage was related to providing an ontology requirements specification document. In the second stage, important terms, concepts, and their relationships were identified via literature review and expert panels. Then, the results derived from the second stage were refined and validated using the Delphi method in three rounds. Finally, in the fourth stage, the ontology was evaluated in terms of consistency and coherence. RESULTS In this study, 241 concepts related to different types of gastric dystemperament, diagnostic criteria, and treatments in the Persian medicine were identified through literature review and expert panels, and 12 new concepts were suggested during the Delphi study. In total, after performing three rounds of the Delphi study, 233 concepts were identified. Finally, an ontology was developed with 71 classes, and the results of the evaluation study revealed that the ontology was consistent and coherent. CONCLUSION In this study, an ontology was created for gastric dystemperament in the Persian medicine. This ontology can be used for designing future systems, such as case-based reasoning and expert systems. Moreover, the use of other evaluation methods is suggested to construct a more complete and precise ontology.
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Affiliation(s)
- Hassan Shojaee-Mend
- Department of Basic Sciences, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.,Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Abdolahadi
- Department of Complementary Medicine, Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
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Does GATS’ Influence on Private University Sector’s Growth Ensure ESD or Develop City ‘Sustainability Crisis’—Policy Framework to Respond COP21. SUSTAINABILITY 2021. [DOI: 10.3390/su13084520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The conventions and ratifications made by the United Nations (UN) have a long history. They were well respected for their ability to unite the world’s countries on some issues. The paradigm transformation of UN ratifications to combine both business models and social justice has received both positive and negative responses. While adherents argue that such a transformation is fundamental to boost economic development, opponents assert that the ‘so-called paradigm transformation’ has benefited the West by victimising the East, which has essentially complicated the global ‘sustainability crisis’. This also hinders executing the ESD (education for sustainable development) concept, especially in developing countries. The concept of ‘sustainable development’ is now the main agenda item of UN conventions. COP21 (United Nations Climate Change Conference in 2015, otherwise known as the 21st Conference of the Parties), is an example of the UN’s seriousness in addressing the ‘global sustainability crisis’. GATT and GATS are the international policies that are, respectively, the ‘causer’ and ‘developer’ of the private university sector in emerging market economies. Critics claim that this expanding sector generates an urban sustainability crisis. This study examined the effect of private universities’ expansion on urban sustainability, using a qualitative method for assessing primary and secondary data. The indices for night light intensity, heat and greenery served as the essential parameters to calculate the sustainability crisis. Results indicate that while the greenery index has fallen significantly, night light and heat indices have unexpectedly increased, which correlate with the development and expansion of the private university sector. To respond to COP21, a ‘carbon neutrality’ policy framework for the sector is suggested in an effort to control the sustainability crisis.
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Smoktunowicz E, Barak A, Andersson G, Banos RM, Berger T, Botella C, Dear BF, Donker T, Ebert DD, Hadjistavropoulos H, Hodgins DC, Kaldo V, Mohr DC, Nordgreen T, Powers MB, Riper H, Ritterband LM, Rozental A, Schueller SM, Titov N, Weise C, Carlbring P. Consensus statement on the problem of terminology in psychological interventions using the internet or digital components. Internet Interv 2020; 21:100331. [PMID: 32577404 PMCID: PMC7305336 DOI: 10.1016/j.invent.2020.100331] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022] Open
Abstract
Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.
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Affiliation(s)
- Ewelina Smoktunowicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19, 31 03-815 Warsaw, Poland,Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden
| | - Azy Barak
- Department of Counseling and Human Development, University of Haifa, Israel
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rosa M. Banos
- Universidad de Valencia, Valencia, Spain,CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Cristina Botella
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain,Uiversitat Jaume I, Valencia, Spain
| | - Blake F. Dear
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Tara Donker
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - David D. Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Institute of Child Health, UCL, London, UK
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps–University of Marburg, Marburg, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden,Corresponding author at: Department of Psychology, SE-106 91 Stockholm, Sweden.
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Jonsson J, Munck I, Volberg R, Carlbring P. GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior. J Gambl Stud 2017; 33:505-523. [PMID: 28265831 PMCID: PMC5445150 DOI: 10.1007/s10899-017-9676-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent increases in the number of online gambling sites have made gambling more available, which may contribute to an increase in gambling problems. At the same time, online gambling provides opportunities to introduce measures intended to prevent problem gambling. GamTest is an online test of gambling behavior that provides information that can be used to give players individualized feedback and recommendations for action. The aim of this study is to explore the dimensionality of GamTest and validate it against the Problem Gambling Severity Index (PGSI) and the gambler's own perceived problems. A recent psychometric approach, exploratory structural equation modeling (ESEM) is used. Well-defined constructs are identified in a two-step procedure fitting a traditional exploratory factor analysis model as well as a so-called bifactor model. Using data collected at four Nordic gambling sites in the autumn of 2009 (n = 10,402), the GamTest ESEM analyses indicate high correspondence with the players' own understanding of their problems and with the PGSI, a validated measure of problem gambling. We conclude that GamTest captures five dimensions of problematic gambling (i.e., overconsumption of money and time, and monetary, social and emotional negative consequences) with high reliability, and that the bifactor approach, composed of a general factor and specific residual factors, reproduces all these factors except one, the negative consequences emotional factor, which contributes to the dominant part of the general factor. The results underscore the importance of tailoring feedback and support to online gamblers with a particular focus on how to handle emotions in relation to their gambling behavior.
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Affiliation(s)
- Jakob Jonsson
- Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden.
| | - Ingrid Munck
- Department of Education and Special Education, University of Gothenburg, Östra Varvsgatan 16B, 211 75, Malmö, Sweden.,Professor Emerita, Östra Varvsgatan 16B, 211 75, Malmö, Sweden
| | - Rachel Volberg
- School of Public Health and Health Sciences, University Massachusetts Amherst, PO Box 1390, Northampton, MA, 01061, United States.,Gemini Research, Ltd., PO Box 1390, Northampton, MA, 01061, United States
| | - Per Carlbring
- Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden
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Danial-Saad A, Chiari L. A multidisciplinary approach for developing an assessment tool for touch screen devices. Disabil Rehabil Assist Technol 2017; 13:745-753. [PMID: 28903629 DOI: 10.1080/17483107.2017.1370500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study was to describe the processes of reaching consensus regarding the assessment of the user's skills required to operate various touch screen devices. A five-step procedure was used to collect and validate the required skills by a multidisciplinary team of 52 experts. Content validity was calculated to determine the agreement levels between the experts. A comparison was made between the discipline groups in order to test correlation between each group and their choice of specific clusters of tasks. METHODS The final consensus set by the experts' recommendations included 15 domains and 50 skills/measurements. The result of Cronbach's α test for the final assessment questionnaire (50 skills/measurements) was 0.94, which indicates a high degree of internal consistency. The results of Kruskal-Wallis's test showed the lack of any significant difference between agreements of the clinicians and the technicians groups, but significant differences were found between the educators and the clinicians groups. CONCLUSION The assessment questionnaire, in its current form, can be used by clinicians and it is expected to help in developing an objective assessment tool to quantify the performance and touch characteristics of individuals with varying abilities and disabilities, in order to enhance accessibility of touch screen technology. Implications for Rehabilitation Collecting and creating the required knowledge needed for assessing the user's skills for operating touch screen devices. The created knowledge helps clinicians to focus on the essential skills and measurements needed for a comprehensive assessment of the individual's abilities and disabilities while operating touch screen devices. The results of the assessment can be used as recommendations for enhancing accessibility of touch screen devices for various disabilities. This knowledge is expected to help in developing an application that provides an objective assessment tool. The study emphasizes the importance of close collaboration with multidisciplinary teams for creating a valid assessment tool.
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Affiliation(s)
- Alexandra Danial-Saad
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , The University of Haifa , Haifa , Israel.,b The Academic Arab College for Education in Israel , Haifa , Israel
| | - Lorenzo Chiari
- c Department of Electrical, Electronic, and Information Engineering - Guglielmo Marconi (DEI) and Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR) , University of Bologna , Bologna , Italy
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Danial-Saad A, Kuflik T, Weiss PLT, Schreuer N. Usability of clinical decision support system as a facilitator for learning the assistive technology adaptation process. Disabil Rehabil Assist Technol 2015. [PMID: 26203588 DOI: 10.3109/17483107.2015.1070439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the usability of Ontology Supported Computerized Assistive Technology Recommender (OSCAR), a Clinical Decision Support System (CDSS) for the assistive technology adaptation process, its impact on learning the matching process, and to determine the relationship between its usability and learnability. Two groups of expert and novice clinicians (total, n = 26) took part in this study. Each group filled out system usability scale (SUS) to evaluate OSCAR's usability. The novice group completed a learning questionnaire to assess OSCAR's effect on their ability to learn the matching process. Both groups rated OSCAR's usability as "very good", (M [SUS] = 80.7, SD = 11.6, median = 83.7) by the novices, and (M [SUS] = 81.2, SD = 6.8, median = 81.2) by the experts. The Mann-Whitney results indicated that no significant differences were found between the expert and novice groups in terms of OSCAR's usability. A significant positive correlation existed between the usability of OSCAR and the ability to learn the adaptation process (rs = 0.46, p = 0.04). Usability is an important factor in the acceptance of a system. The successful application of user-centered design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically in developing other systems. Implications for Rehabilitation Creating a CDSS with a focus on its usability is an important factor for its acceptance by its users. Successful usability outcomes can impact the learning process of the subject matter in general, and the AT prescription process in particular. The successful application of User-Centered Design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically. The study emphasizes the importance of close collaboration between the developers and the end users.
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Affiliation(s)
- Alexandra Danial-Saad
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , the University of Haifa , Haifa , Israel .,b The Academic Arab College for Education in Israel -- Haifa , Haifa , Israel , and
| | - Tsvi Kuflik
- c Department of Information Systems , the University of Haifa , Haifa , Israel
| | - Patrice L Tamar Weiss
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , the University of Haifa , Haifa , Israel
| | - Naomi Schreuer
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , the University of Haifa , Haifa , Israel
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