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Groos SS, Linn AJ, Kuiper JI, van Schoor NM, van der Velde N, van Weert JCM. Combining user-centered design and behavioral theory to enhance health technologies: A personas-based approach for a primary-care based multifactorial falls risk assessment tool. Int J Med Inform 2024; 186:105420. [PMID: 38518678 DOI: 10.1016/j.ijmedinf.2024.105420] [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: 12/13/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Multifactorial falls risk assessment tools (FRATs) can be an effective falls prevention method for older adults, but are often underutilized by health care professionals (HCPs). This study aims to enhance the use and implementation of multifactorial FRATs by combining behavioral theory with the user-centered design (UCD) method of personas construction. Specifically, the study aimed to (1) construct personas that are based on external (i.e., needs, preferences) and intrinsic user characteristics (i.e., behavioral determinants); and (2) use these insights to inform requirements for optimizing an existing Dutch multifactorial FRAT (i.e., the 'Valanalyse'). METHODS Survey data from HCPs (n = 31) was used to construct personas of the 'Valanalyse.' To examine differences between clusters on 68 clustering variables, a multivariate cluster analysis technique with non-parametric analyses and computational methods was used. The aggregated external and intrinsic user characteristics of personas were used to inform key design and implementation requirements for the 'Valanalyse,' respectively, whereby intrinsic user characteristics were matched with appropriate behavior change techniques to guide implementation. RESULTS Significant differences between clusters were observed in 20 clustering variables (e.g., behavioral beliefs, situations for use). These variables were used to construct six personas representing users of each cluster. Together, the six personas helped operationalize four key design requirements (e.g., guide treatment-related decision making) and 14 implementation strategies (e.g., planning coping responses) for optimizing the 'Valanalyse' in Dutch geriatric, primary care settings. CONCLUSION The findings suggest that theory- and evidence-based personas that encompass both external and intrinsic user characteristics are a useful method for understanding how the use and implementation of multifactorial FRATs can be optimized with and for HCPs, providing important implications for developers and eHealth interventions with regards to encouraging technology adoption.
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Affiliation(s)
- Sara S Groos
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
| | | | - Natasja M van Schoor
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije University, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
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Carter EL, Hallen SAM, Welch GW, Gordon EN, Parker MG. Exploring attitudinal barriers to participation in inpatient fall risk assessment using the Theoretical Domains Framework: A survey of providers. Health Sci Rep 2024; 7:e2000. [PMID: 38605726 PMCID: PMC11006990 DOI: 10.1002/hsr2.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Background and Aims Lack of provider (physicians and advanced practice providers) participation in fall risk assessment was theorized to be contributing to rising rates of falls with injury at our institution. This project sought to identify if attitudinal barriers to inpatient provider participation in fall risk assessment were similar to those identified in other clinical settings. Methods Barriers to provider participation in fall risk assessment were identified in the literature. These were mapped to the Theoretical Domains Framework (TDF) domains to assist with interpretation of the data. A 10-item survey using a 5-point Likert scale (strongly agree to strongly disagree) with two open-ended questions was developed using these barriers. The survey was distributed via email to all providers on the Medical Staff in July 2021. Results The response rate was 9.1% (188/2062). 72.6% (95% confidence interval [CI]: 65.6, 78.5) of providers at our institution did agree that fall risk assessment was within their role and 72% (95% CI: 66.1, 78.5) agreed that assessment can prevent falls. Nearly half felt that they lacked formal training in fall risk assessment (48.1% [95% CI: 41.1, 55.1]) and 52.2% (95% CI: 44.6, 58.6) agreed that other aspects of patient care took priority over falls assessment. These barriers correlated best with the TDF domains of Beliefs about Capabilities and Beliefs about Consequences. Conclusions Survey results indicate that interventions focused on increasing provider motivation and capability regarding fall risk assessment and helping providers prioritize fall risk assessment are potential targets for future quality improvement projects.
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Affiliation(s)
- Emily L. Carter
- Division of Geriatric MedicineMaine Medical CenterPortlandMaineUSA
| | | | - Gavin W. Welch
- Department of Quality and Patient SafetyMaineHealthPortlandMaineUSA
| | - Erin N. Gordon
- Department of Family MedicineMaine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Department of Quality and Patient SafetyMaineHealthPortlandMaineUSA
- Division of Nephrology and TransplantationMaine Medical CenterPortlandMaineUSA
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Jutharee W, Paengkumhag C, Limpornchitwilai W, Mo WT, Chan JH, Jennawasin T, Kaewkamnerdpong B. Fall risk assessment dataset: older-adult participants undergoing the time up and go test. Data Brief 2023; 51:109653. [PMID: 37869625 PMCID: PMC10589772 DOI: 10.1016/j.dib.2023.109653] [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: 09/01/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023] Open
Abstract
This article presents a dataset comprising signal data collected from Inertial Measurement Unit (IMU) sensors during the administration of the Time Up and Go (TUG) test for assessing fall risk in older adults. The dataset is divided into two main sections. The first section contains personal, behavioral, and health-related data from 34 participants. The second section contains signal data from tri-axial acceleration and tri-axial gyroscope sensors embedded in an IMU sensor, which was affixed to the participants' waist area to capture signal data while they walked. The chosen assessment method for fall risk analysis is the TUG test, requiring participants to walk a 3-meter distance back and forth. To prepare the dataset for subsequent analysis, the raw signal data underwent processing to extract only the walking periods during the TUG test. Additionally, a low-pass filter technique was employed to reduce noise interference. This dataset holds the potential for the development of effective models for fall risk detection based on insights garnered from questionnaires administered to specialists who observed the experiments. The dataset also contains anonymized participant information that can be explored to investigate fall risk, along with other health-related conditions or behaviors that could influence the risk of falling. This information is invaluable for devising tailored treatment or rehabilitation plans for individual older adults. The complete dataset is accessible through the Mendeley repository."
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Affiliation(s)
- Wisanu Jutharee
- Institute of Field Robotics and Automation, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Chatchai Paengkumhag
- Biological Engineering Program, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Warissara Limpornchitwilai
- Biological Engineering Program, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Wen Tao Mo
- Innovative Cognitive Computing (IC2), School of Information Technology, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
- Engineering Science, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada
| | - Jonathan H. Chan
- Innovative Cognitive Computing (IC2), School of Information Technology, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Tanagorn Jennawasin
- Department of Control System and Instrumentation Engineering, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Boonserm Kaewkamnerdpong
- Biological Engineering Program, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
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4
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Bouzid W, Tavassoli N, Berbon C, Qassemi S, Vaysset S, Poly M, Bounes V, Shourick J, Nourhashémi F. Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience. Clin Interv Aging 2023; 18:1995-2008. [PMID: 38058551 PMCID: PMC10697010 DOI: 10.2147/cia.s421053] [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: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background An increasing number of falls among community-living older adults are reported in emergency calls. Data on evidence of appropriate fall prevention interventions are limited and challenges in recruiting this population in randomized trials are acknowledged. Purpose The main aim of this study was to provide demographic data, circumstance and fall-related outcomes of the population in the RISING-DOM study [Impact d'une évaluation des facteurs de RISque de chute et d'une prise en charge personnalisée, sur la mortalité et l'institutionnalisation, après INtervention du SAMU chez la personne âGée à DOMicile], a multicenter, randomized interventional trial involving community-dwelling older adults who have experienced a fall at home and were not hospitalized. Additionally, the challenges of remote recruitment in this population were discussed. Patients and Methods Participants were identified through the Occitania Emergency Observatory database. Participant recruitment and data collection were performed through telephone interviews (October 2019-March 2022). Additionally, a sample survey of Emergency Medical Services calls was carried out. Results Out of the 1151 individuals screened, a total of 951 participants were included in the trial follow-up, resulting in an acceptance rate of 82.62%. The screening delay was extended due to the COVID-19 pandemic. Recruiting difficulties were mainly related to identifying potential participants, unavailable contact information and unreachability. Participants' mean age was 84.1 years, 65.8% were women, and 44.3% lived alone. Pain was the most frequent outcome (53%). In the previous year, 73.5% of participants reported experiencing a fall, with 66.7% of those falls requiring assistance from Emergency Medical Services (EMS). Nearly, 40% did not take proactive steps to prevent future falls and walking aids (79.8%) were the most common preventive action. Conclusion Indicators of a high-risk group of falls have been identified underscoring the need for appropriate fall interventions in the target population. Challenges of large sampling for randomized fall prevention trials were provided. Trial Registration Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.
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Affiliation(s)
- Wafa Bouzid
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
- Regional Health Agency of Occitanie, Toulouse, 31000, France
| | - Neda Tavassoli
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Caroline Berbon
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Soraya Qassemi
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Sandrine Vaysset
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Magali Poly
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
| | - Vincent Bounes
- Emergency Medicine Unit, University of Toulouse Hospital Center, Toulouse, France
| | - Jason Shourick
- Research Methodology Support Unit (USMR), Clinical Epidemiology and Public Health Department, University of Toulouse Hospital Center, Toulouse, France
- CERPOP, UMR 1295, INSERM – University of Toulouse III, Toulouse, France
| | - Fati Nourhashémi
- Geriatric Medicine Unit (Gérontopole), University of Toulouse Hospital Center, Toulouse, France
- CERPOP, UMR 1295, INSERM – University of Toulouse III, Toulouse, France
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Theunissen LJHJ, Abdalrahim RBEM, Dekker LRC, Thijssen EJM, de Jong SFAMS, Polak PE, van de Voort PH, Smits G, Scheele K, Lucas A, van Veghel DPA, Cremers HP, van de Pol JAA, Kemps HMC. Regional implementation of atrial fibrillation screening: benefits and pitfalls. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:570-577. [PMID: 36710905 PMCID: PMC9779812 DOI: 10.1093/ehjdh/ztac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Aims Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare providers' perspectives. Methods and results A mixed-methods approach was used to gather data among practice nurses in primary care in the southern region of the Netherlands to evaluate the implementation of an ongoing single-lead electrocardiogram (ECG)-based AF screening programme. Potential facilitating and inhibiting factors were evaluated using online questionnaires (N = 74/75%) and 14 (of 24) semi-structured in-depth interviews (58.3%). All analyses were performed using SPSS 26.0. In total, 16 682 screenings were performed on an eligible population of 64 000, and 100 new AF cases were detected. Facilitating factors included 'receiving clear instructions' (mean ± SD; 4.12 ± 1.05), 'easy use of the ECG-based device' (4.58 ± 0.68), and 'patient satisfaction' (4.22 ± 0.65). Inhibiting factors were 'time availability' (3.20 ± 1.10), 'insufficient feedback to the practice nurse' (2.15 ± 0.89), 'absence of coordination' (54%), and the 'lack of fitting policy' (32%). Conclusion Large-scale regional implementation of an AF screening programme in primary care resulted in a low participation of all eligible patients. Based on the perceived barriers by healthcare providers, future AF screening programmes should create preconditions to fit the intervention into daily routines, appointing an overall project lead and a General Practitioner (GP) as a coordinator within every GP practice.
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Affiliation(s)
- Luc J H J Theunissen
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands
| | - Reyan B E M Abdalrahim
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands
| | - Lukas R C Dekker
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands,Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Eric J M Thijssen
- Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands
| | | | - Peter E Polak
- St. Anna hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | | | - Geert Smits
- GP Organization PoZoB, Bolwerk 10-14, 5509 MH, Veldhoven, The Netherlands
| | - Karin Scheele
- GP Organization PoZoB, Bolwerk 10-14, 5509 MH, Veldhoven, The Netherlands
| | - Annelies Lucas
- Diagnostics for You, Boschdijk 1119, 5626 AG, Eindhoven, The Netherlands
| | - Dennis P A van Veghel
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | | | - Hareld M C Kemps
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands,Department of Industrial Design, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
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6
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Sattar S, Haase KR, Milisen K, Campbell D, Kim SJ, Chalchal H, Kenis C. Oncology clinic nurses' attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study. Can Oncol Nurs J 2021; 31:367-375. [PMID: 34786454 PMCID: PMC8565430 DOI: 10.5737/23688076314367375] [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] [Indexed: 11/05/2022] Open
Abstract
Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses' willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.
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Affiliation(s)
| | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Koen Milisen
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium & Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Diane Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Haji Chalchal
- College of Medicine, University of Saskatchewan; Saskatchewan Cancer Agency, Regina, SK
| | - Cindy Kenis
- University Hospitals Leuven, Leuven, Belgium
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Sattar S, Haase KR, Milisen K, Campbell D, Kim SJ, Chalchal H, Kenis C. Évaluation systématique des chutes et du risque de chutes : Sondage sur l’attitude et les perceptions des infirmières cliniques en oncologie. Can Oncol Nurs J 2021; 31:376-385. [PMID: 34786455 PMCID: PMC8565442 DOI: 10.5737/23688076314376385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Chez les personnes âgées atteintes de cancer, les chutes sont un problème souvent sous-estimé et peu rapporté. La présente étude visait à explorer la volonté des infirmières cliniques en oncologie à évaluer et à dépister systématiquement les chutes dans leur pratique; l’étude examinait également les obstacles perçus à l’évaluation et au dépistage systématique. Les infirmières ont donc été invitées à remplir un sondage en ligne. Les données ont été analysées à l’aide de statistiques descriptives. La majorité des infirmières ayant répondu ont dit qu’elles accepteraient de poser systématiquement des questions sur les chutes (85,7 %) et de dépister les risques de chutes (73,5 %) chez les personnes âgées. Voici les principales raisons des réticences : conviction que les patients signalent les chutes d’euxmêmes, manque de temps, pénurie de personnel de soutien. Selon les résultats de l’étude, beaucoup d’infirmières en oncologie trouvent important d’évaluer et de dépister systématiquement les chutes, et sont d’accord pour l’intégrer à leur pratique bien que, d’habitude, les chutes ne fassent pas automatiquement l’objet de questions ou d’une évaluation. Étant donné les conséquences des chutes sur ces patients vulnérables, la recherche à venir devra explorer les stratégies permettant de surmonter les obstacles auxquels se butent les infirmières.
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Affiliation(s)
- Schroder Sattar
- Collège des sciences infirmières, Université de la Saskatchewan, Regina, SK
| | - Kristen R Haase
- École des sciences infirmières, Université de la Colombie-Britannique, Vancouver, BC
| | - Koen Milisen
- Département de gériatrie, Hôpital universitaire de Louvain, Louvain, Belgique, et Département de santé publique et de soins primaires, Centre universitaire de sciences infirmières et de pratique sagefemme, KU Leuven, Louvain, Belgique
| | - Diane Campbell
- Collège des sciences infirmières, Université de la Saskatchewan, Regina, SK
| | - Soo Jung Kim
- Service de gériatrie, Centre de cancérologie Memorial Sloan Kettering, New York, États-Unis
| | - Haji Chalchal
- Collège de médecine, Université de la Saskatchewan, Agence du cancer de la Saskatchewan, Regina, SK
| | - Cindy Kenis
- Hôpital universitaire de Louvain, Louvain, Belgique
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Older Adults' Perceived Barriers to Participation in a Falls Prevention Strategy. J Pers Med 2021; 11:jpm11060450. [PMID: 34070987 PMCID: PMC8224773 DOI: 10.3390/jpm11060450] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 01/09/2023] Open
Abstract
There is a need to increase older adults’ access and adherence to falls prevention strategies. This study aims to explore older adults’ perceived barriers to participation in a fall prevention strategy. A qualitative descriptive approach was used. Semi-structured interviews were conducted with 18 older adult users of a Day Care Unit from a Private Institution of Social Solidarity in the region of Lisbon and Tagus Valley in Portugal. The recruitment was made in September 2019. The interviews were recorded transcribed verbatim and analysed thematically using the method of constant comparisons. The barriers to participation in a fall prevention strategy are healthcare system gaps, social context, economic context, health status, psychological capability, and lack of knowledge to demystify myths and misconceptions about falls. There are different barriers to participate in a fall prevention strategy. It is urgent to eliminate or reduce the effect of these barriers to increase older adults’ participation in fall prevention strategies.
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