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van Velsen L, Schokking L, Siderakis E, Knospe GM, Brandl L, Mooser B, Madörin S, Jacinto S, Gouveia A, Brodbeck J. Development of an online service for coping with spousal loss by means of human-centered and stakeholder-inclusive design: the case of LEAVES. Death Stud 2024; 48:187-196. [PMID: 37102731 DOI: 10.1080/07481187.2023.2203680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
To support older mourners after the loss of their partner, LEAVES, an online self-help service that delivers the LIVIA spousal bereavement intervention, was developed. It integrates an embodied conversational agent and an initial risk assessment. Based on an iterative, human-centered, and stakeholder inclusive approach, interviews with older mourners and focus groups with stakeholders were conducted to understand their perspective on grief and on using LEAVES. Subsequently, the resulting technology and service model were evaluated by means of interviews, focus groups, and an online survey. While digital literacy remains a challenge, LEAVES shows promise of being supportive to the targeted end-users.
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Affiliation(s)
- Lex van Velsen
- eHealth group, Roessingh Research and Development, Enschede, Netherlands
| | - Lotte Schokking
- National Foundation for the Elderly, Amersfoort, Netherlands
| | - Eva Siderakis
- National Foundation for the Elderly, Amersfoort, Netherlands
| | | | - Lena Brandl
- eHealth group, Roessingh Research and Development, Enschede, Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, Netherlands
| | - Bettina Mooser
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sarah Madörin
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Sofia Jacinto
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | - Afonso Gouveia
- Psychiatric Department at The Health Unit of Baixo Alentejo, Beja, Portugal
| | - Jeannette Brodbeck
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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2
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Bartali V, van Velsen L. An experiment on data sharing options designs for eHealth interventions. Internet Interv 2023; 33:100642. [PMID: 37635947 PMCID: PMC10457541 DOI: 10.1016/j.invent.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/20/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background With eHealth technology interventions, users' personal health data can be easily shared among different stakeholders. Users should decide with whom they want to share their data. As support, most eHealth technology has data sharing options functionalities. However, there is little research on how to design these visually. In this paper, we took two possible data sharing options designs - data and party perspective - for an existing eHealth technology intervention, and we explored them. Objective The aim was to find which of the two designs is the best in terms of trust, privacy concerns, ease of use, and information control. Additionally, to investigate how these factors influence each other with also the goal of giving practical advice on designing for privacy. Method We conducted a between-subjects online design experiment (N = 123). After having visualised one of the two data sharing options designs, participants filled in an online questionnaire. To analyse the data, t-test analyses, correlation analyses, and backward regression analyses were conducted. Results Information control scored higher in the data perspective condition (t (97) = 2.25, p = .03). From the different regression analyses, we found that trust and ease of use play a role in all sharing-related factors. Conclusions We concluded that the design of data-sharing options in eHealth technology affects the experience of the user, mostly for trust and ease of use. In the end, we provided several actionable design advices on how to design for privacy.
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Affiliation(s)
- Valentina Bartali
- Roessingh Research and Development and University of Twente, Roessinghsbleekweg 33b, 7522 AH Enschede, the Netherlands
| | - Lex van Velsen
- Roessingh Research and Development and University of Twente, Roessinghsbleekweg 33b, 7522 AH Enschede, the Netherlands
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3
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Kramer LL, van Velsen L, Mulder BC, Ter Stal S, de Vet E. Optimizing appreciation and persuasion of embodied conversational agents for health behavior change: A design experiment and focus group study. Health Informatics J 2023; 29:14604582231183390. [PMID: 37625392 DOI: 10.1177/14604582231183390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Embodied Conversational Agents (ECAs) can increase user engagement and involvement and can strengthen the effect of an intervention on health outcomes that is provided via an ECA. However, evidence regarding the effectiveness of ECAs on health outcomes is still limited. In this article, we report on a study that has the goal to identify the effect of a match between a health topic and the ECAs' appearance on ratings of personality characteristics, persuasiveness and intention to use. We report on an online experiment with three different ECAs and three different health topics, conducted among 732 older adults. We triangulated the quantitative results with qualitative insights from a focus group. The results reveal that older adults prefer an ECA that has an appearance matching a certain health topic, resulting in higher ratings on persuasiveness and intention to use. Personality characteristics should be measured embedded within a health topic, but are not rated higher because of a match. We furthermore provide guidelines for designing the content of the ECA.
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Affiliation(s)
- Lean L Kramer
- Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, Enschede, Netherlands
| | - Bob C Mulder
- Wageningen University & Research, Wageningen, Netherlands
| | - Silke Ter Stal
- Roessingh Research and Development, Enschede, Netherlands
| | - Emely de Vet
- Wageningen University & Research, Wageningen, Netherlands
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4
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Hurmuz MZM, Jansen-Kosterink SM, van Velsen L. How to Prevent the Drop-Out: Understanding Why Adults Participate in Summative eHealth Evaluations. J Healthc Inform Res 2023; 7:125-140. [PMID: 36910916 PMCID: PMC9995638 DOI: 10.1007/s41666-023-00131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
The aim of this study was to investigate why adults participate in summative eHealth evaluations, and whether their reasons for participating affect their (non-)use of eHealth. A questionnaire was distributed among adults (aged ≥ 18 years) who participated in a summative eHealth evaluation. This questionnaire focused on participants' reason to enroll, their expectations, and on whether the study met their expectations. Answers to open-ended questions were coded by two researchers independently. With the generalized estimating equations method we tested whether there is a difference between the type of reasons in use of the eHealth service. One hundred and thirty-one adults participated (64.9% female; mean age 62.5 years (SD = 10.5)). Their reasons for participating were mainly health-related (e.g., being more active). Between two types of motivations there was a difference in the use of the eHealth service: Participants with an intellectual motivation were more likely to drop out, compared to participants with an altruistic motivation. The most prevalent expectations when joining a summative eHealth evaluation were health-related (like expecting to improve one's health). 38.6% of the participants said their expectation was fulfilled by the study. In conclusion, We encourage eHealth evaluators to learn about adults' motivation to participate in their summative evaluation, as this motivation is very likely to affect their results. Including altruistically motivated participants biases the results by their tendency to continue participating in a study.
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Affiliation(s)
- Marian Z M Hurmuz
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522 AH Enschede, The Netherlands.,Biomedical Signal and Systems Group, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Stephanie M Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522 AH Enschede, The Netherlands.,Biomedical Signal and Systems Group, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522 AH Enschede, The Netherlands.,Biomedical Signal and Systems Group, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
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5
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Brandl L, van Velsen L, Brodbeck J, Jacinto S, Hofs D, Heylen D. Developing an eMental health monitoring module for older mourners using fuzzy cognitive maps. Digit Health 2023; 9:20552076231183549. [PMID: 37361430 PMCID: PMC10286164 DOI: 10.1177/20552076231183549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Effective internet interventions often combine online self-help with regular professional guidance. In the absence of regularly scheduled contact with a professional, the internet intervention should refer users to professional human care if their condition deteriorates. The current article presents a monitoring module to recommend proactively seeking offline support in an eMental health service to aid older mourners. Method The module consists of two components: a user profile that collects relevant information about the user from the application, enabling the second component, a fuzzy cognitive map (FCM) decision-making algorithm that detects risk situations and to recommend the user to seek offline support, whenever advisable. In this article, we show how we configured the FCM with the help of eight clinical psychologists and we investigate the utility of the resulting decision tool using four fictitious scenarios. Results The current FCM algorithm succeeds in detecting unambiguous risk situations, as well as unambiguously safe situations, but it has more difficulty classifying borderline cases correctly. Based on recommendations from the participants and an analysis of the algorithm's erroneous classifications, we propose how the current FCM algorithm can be further improved. Conclusion The configuration of FCMs does not necessarily demand large amounts of privacy-sensitive data and their decisions are scrutable. Thus, they hold great potential for automatic decision-making algorithms in mental eHealth. Nevertheless, we conclude that there is a need for clear guidelines and best practices for developing FCMs, specifically for eMental health.
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Affiliation(s)
- Lena Brandl
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Jeannette Brodbeck
- FHNW School of Social Work, Institute for Consulting, Coaching and Social Management, Olten, Switzerland
- Institute for Psychology, University of Bern, Bern, Switzerland
| | - Sofia Jacinto
- FHNW School of Social Work, Institute for Consulting, Coaching and Social Management, Olten, Switzerland
- Institute for Psychology, University of Bern, Bern, Switzerland
| | - Dennis Hofs
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Dirk Heylen
- Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
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Brodbeck J, Jacinto S, Gouveia A, Mendonça N, Madörin S, Brandl L, Schokking L, Rodrigues AM, Gonçalves J, Mooser B, Marques MM, Isaac J, Nogueira V, Matos Pires A, van Velsen L. A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries. JMIR Res Protoc 2022; 11:e37827. [DOI: 10.2196/37827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background
The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content.
Objective
This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study.
Methods
The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20).
Results
The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023.
Conclusions
The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons.
Trial Registration
Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346
International Registered Report Identifier (IRRID)
PRR1-10.2196/37827
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van Velsen L, Ludden G, Grünloh C. The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them. J Med Internet Res 2022; 24:e37341. [PMID: 36197718 PMCID: PMC9582917 DOI: 10.2196/37341] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Human-centered design (HCD) is widely regarded as the best design approach for creating eHealth innovations that align with end users’ needs, wishes, and context and has the potential to impact health care. However, critical reflections on applying HCD within the context of eHealth are lacking. Applying a critical eye to the use of HCD approaches within eHealth, we present and discuss 9 limitations that the current practices of HCD in eHealth innovation often carry. The limitations identified range from limited reach and bias to narrow contextual and temporal focus. Design teams should carefully consider if, how, and when they should involve end users and other stakeholders in the design process and how they can combine their insights with existing knowledge and design skills. Finally, we discuss how a more critical perspective on using HCD in eHealth innovation can move the field forward and offer 3 directions of inspiration to improve our design practices: value-sensitive design, citizen science, and more-than-human design. Although value-sensitive design approaches offer a solution to some of the biased or limited views of traditional HCD approaches, combining a citizen science approach with design inspiration and imagining new futures could widen our view on eHealth innovation. Finally, a more-than-human design approach will allow eHealth solutions to care for both people and the environment. These directions can be seen as starting points that invite and support the field of eHealth innovation to do better and to try and develop more inclusive, fair, and valuable eHealth innovations that will have an impact on health and care.
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Affiliation(s)
- Lex van Velsen
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Department of Communication Science, University of Twente, Enschede, Netherlands
| | - Geke Ludden
- Department of Design, Production and Management, University of Twente, Enschede, Netherlands
| | - Christiane Grünloh
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals group, University of Twente, Enschede, Netherlands
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8
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Oberschmidt K, van Velsen L, Grünloh C, Fiorini L, Rovini E, Melero Muñoz FJ. International eHealth ecosystems and the quest for the winning value proposition: findings from a survey study. Open Res Eur 2022; 2:56. [PMID: 37645272 PMCID: PMC10445862 DOI: 10.12688/openreseurope.14655.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 08/31/2023]
Abstract
BACKGROUND eHealth ecosystems are becoming increasingly important for national and international healthcare. In such ecosystems, different actors are connected and work together to create mutual value. However, it is important to be aware of the goals that each actor pursues within the ecosystem. METHOD This study describes the outcomes of a workshop (30 participants) and two surveys (completed by 54 and 100 participants), which investigated how different types of industry stakeholders, namely social services, healthcare, technology developers and researchers, rated potential value propositions for an eHealth ecosystem. Both the feasibility and the importance of each proposition was taken into account. RESULTS Interoperability between services was highly valued across industry types but there were also vast differences concerning other propositions. CONCLUSION Jointly reflecting on the different perceived values of an ehealth ecosystem can help actors working together to form an ecosystem.
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Affiliation(s)
- Kira Oberschmidt
- Biomedical Signals and Systems Group, University of Twente, Enschede, 7500AE, The Netherlands
- eHealth department, Roessingh Research and Development, Enschede, 7500 AH, The Netherlands
| | - Lex van Velsen
- Biomedical Signals and Systems Group, University of Twente, Enschede, 7500AE, The Netherlands
- eHealth department, Roessingh Research and Development, Enschede, 7500 AH, The Netherlands
| | - Christiane Grünloh
- Biomedical Signals and Systems Group, University of Twente, Enschede, 7500AE, The Netherlands
- eHealth department, Roessingh Research and Development, Enschede, 7500 AH, The Netherlands
| | - Laura Fiorini
- Department of Industrial Engineering, University of Florence, Florence, 50139, Italy
| | - Erika Rovini
- Department of Industrial Engineering, University of Florence, Florence, 50139, Italy
| | - Francisco José Melero Muñoz
- Telecommunication Networks Engineering Group, Technical University of Cartagena, Cartagena, 30202, Spain
- Technical Research Centre of Furniture and Wood of the Region of Murcia (CETEM), Yecla, 30510, Spain
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Hurmuz MZ, Jansen-Kosterink SM, Hermens HJ, van Velsen L. Game not over: Explaining older adults' use and intention to continue using a gamified eHealth service. Health Informatics J 2022; 28:14604582221106008. [PMID: 35653268 DOI: 10.1177/14604582221106008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gamification within eHealth services can increase eHealth adoption. However, little is known about factors affecting adoption of gamified eHealth among older adults. In this study, we sought to explain the (continued) use of a gamified eHealth service among older adults (55+). METHODS Participants used a gamified eHealth service, focusing on falls prevention, for 4 weeks and completed a post-test questionnaire based on the Technology Acceptance Model. We used Partial Least Squares Structural Equation Modeling to analyse our data. RESULTS Seventy-two older adults participated with a mean age of 65.1 years (SD = 7.0). Our results show that first, perceived ease of use affected use of the service (use duration: β = 0.303, R2 = 0.130, and use frequency: β = 0.304, R2 = 0.107). Second, perceived usefulness affected the intention to continue using the service (β = 0.754, R2 = 0.640). Third, use of the service did not predict the intention to continue using it. Furthermore, enjoyment affected perceived usefulness (β = 0.783, R2 = 0.563) and aesthetics affected perceived ease of use (β = 0.634, R2 = 0.652). CONCLUSIONS This study refutes the expected relation between use and intention to continue use a gamified eHealth service. Additionally, we learned that using theoretical approaches focusing on technology acceptance, are not suitable for explaining (continued) use of gamified eHealth services.
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Affiliation(s)
- Marian Zm Hurmuz
- eHealth Department, Roessingh Research and Development, Enschede, The Netherlands
| | | | - Hermie J Hermens
- Biomedical Signal and Systems Group, 3230University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- Biomedical Signal and Systems Group, 3230University of Twente, Enschede, The Netherlands
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11
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Broekhuis M, van Velsen L, De Franco D, Pease A, Hermens H. Contextual Health Information Behavior in the Daily Lives of People with Type 2 Diabetes: A Diary Study in Scotland. Health Commun 2022; 37:272-284. [PMID: 33135473 DOI: 10.1080/10410236.2020.1837426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Changes in lifestyle can have positive effects on treating type 2 diabetes (T2D), like sporting or healthy eating. Therefore, a person diagnosed with T2D is often advised to make healthy choices throughout the day, in addition to other interventions such as medication. To do this, he or she needs health information to support decision-making. Literature describes ample categorizations of types of (health) information behavior and theoretical models that explain the factors that drive people to search for, encounter or avoid information. However, there are few longitudinal studies about triggers and factors in daily life that affect health information behavior (HIB). This study was set up to identify triggers, actions and outcomes for active, passive and avoidant HIB situations in daily life among Scots with Type 2 diabetes (T2D) to identify points of attention for communication strategies. Twelve participants took part in a four-week diary study. Every day, participants received an online diary form to describe active, passive or avoidant HIB situations. Data collection resulted in 53 active, 120 passive and 25 avoidant diary entries. Seven active HIB contexts (e.g., experiencing symptoms, cooking dinner, sports training) and five passive HIB contexts (e.g., home, work, medical facility) were identified. Four motivations for avoidance were found (e.g., time constraints, no health trigger). These results can be used to supplement the theoretical models of health information behavior. Furthermore, health professionals can use these results to support their clients with T2D in the self-management of their health, by guiding them to trustworthy sources of health information and lowering barriers for searching health information.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, eHealth Group
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente
| | - Lex van Velsen
- Roessingh Research and Development, eHealth Group
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente
| | - Dominic De Franco
- Centre for Argumentation Technology, School of Science and Engineering, University of Dundee
| | - Alison Pease
- Centre for Argumentation Technology, School of Science and Engineering, University of Dundee
| | - Hermie Hermens
- Roessingh Research and Development, eHealth Group
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente
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12
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Broekhuis M, van Velsen L. Improving usability benchmarking for the eHealth domain: The development of the eHealth UsaBility Benchmarking instrument (HUBBI). PLoS One 2022; 17:e0262036. [PMID: 35176033 PMCID: PMC8853524 DOI: 10.1371/journal.pone.0262036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Currently, most usability benchmarking tools used within the eHealth domain are based on re-classifications of old usability frameworks or generic usability surveys. This makes them outdated and not well suited for the eHealth domain. Recently, a new ontology of usability factors was developed for the eHealth domain. It consists of eight categories: Basic System Performance (BSP), Task-Technology Fit (TTF), Accessibility (ACC), Interface Design (ID), Navigation & Structure (NS), Information & Terminology (IT), Guidance & Support (GS) and Satisfaction (SAT).
Objective
The goal of this study is to develop a new usability benchmarking tool for eHealth, the eHealth UsaBility Benchmarking Instrument (HUBBI), that is based on a new ontology of usability factors for eHealth.
Methods
First, a large item pool was generated containing 66 items. Then, an online usability test was conducted, using the case study of a Dutch website for general health advice. Participants had to perform three tasks on the website, after which they completed the HUBBI. Using Partial Least Squares Structural Equation Modelling (PLS-SEM), we identified the items that assess each factor best and that, together, make up the HUBBI.
Results
A total of 148 persons participated. Our selection of items resulted in a shortened version of the HUBBI, containing 18 items. The category Accessibility is not included in the final version, due to the wide range of eHealth services and their heterogeneous populations. This creates a constantly different role of Accessibility, which is a problem for a uniform benchmarking tool.,
Conclusions
The HUBBI is a new and comprehensive usability benchmarking tool for the eHealth domain. It assesses usability on seven domains (BSP, TTF, ID, NS, IT, GS, SAT) in which a score per domain is generated. This can help eHealth developers to quickly determine which areas of the eHealth system’s usability need to be optimized.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, eHealth Group, Enschede, The Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, eHealth Group, Enschede, The Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- * E-mail:
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13
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Oberschmidt K, Grünloh C, Nijboer F, van Velsen L. Best Practices and Lessons Learned for Action Research in eHealth Design and Implementation: Literature Review. J Med Internet Res 2022; 24:e31795. [PMID: 35089158 PMCID: PMC8838546 DOI: 10.2196/31795] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development. OBJECTIVE This literature review aims to provide more knowledge on the best practices and lessons learned from eHealth AR studies. Additionally, an overview of the context in which AR eHealth studies take place is given. METHODS A semisystematic review of 44 papers reporting on 40 different AR projects was conducted to identify the best practices and lessons learned in the research studies while accounting for the particular contextual setting and used AR approach. RESULTS Recommendations include paying attention to the training of stakeholders' academic skills, as well as the various roles and tasks of action researchers. The studies also highlight the need for constant reflection and accessible dissemination suiting the target group. CONCLUSIONS This literature review identified room for improvements regarding communicating and specifying the particular AR definition and applied approach.
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Affiliation(s)
- Kira Oberschmidt
- eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Christiane Grünloh
- eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Femke Nijboer
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
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14
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Jansen-Kosterink S, Broekhuis M, van Velsen L. Time to act mature—Gearing eHealth evaluations towards technology readiness levels. Digit Health 2022; 8:20552076221113396. [PMID: 35847525 PMCID: PMC9280845 DOI: 10.1177/20552076221113396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
It is challenging to design a proper eHealth evaluation. In our opinion, the evaluation of eHealth should be a continuous process, wherein increasingly mature versions of the technology are put to the test. In this article, we present a model for continuous eHealth evaluation, geared towards technology maturity. Technology maturity can be determined best via Technology Readiness Levels, of which there are nine, divided into three phases: the research, development, and deployment phases. For each phase, we list and discuss applicable activities and outcomes on the end-user, clinical, and societal front. Instead of focusing on a single perspective, we recommend to blend the end-user, health and societal perspective. With this article we aim to contribute to the methodological debate on how to create the optimal eHealth evaluation design.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Marijke Broekhuis
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
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15
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Jansen-Kosterink S, Hurmuz M, den Ouden M, van Velsen L. Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens. JMIR Form Res 2021; 5:e28416. [PMID: 34818210 PMCID: PMC8691407 DOI: 10.2196/28416] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/04/2021] [Accepted: 11/16/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND eHealth apps have been recognized as a valuable tool to reduce COVID-19's effective reproduction number. The factors that determine the acceptance of COVID-19 apps remain unknown. The exception here is privacy. OBJECTIVE The aim of this article was to identify antecedents of acceptance of (1) a mobile app for COVID-19 symptom recognition and monitoring and (2) a mobile app for contact tracing, both by means of an online survey among Dutch citizens. METHODS Next to the demographics, the online survey contained questions focusing on perceived health, fear of COVID-19, and intention to use. We used snowball sampling via posts on social media and personal connections. To identify antecedents of the model for acceptance of the 2 mobile apps, we conducted multiple linear regression analyses. RESULTS In total, 238 Dutch adults completed the survey; 59.2% (n=141) of the responders were female and the average age was 45.6 years (SD 17.4 years). For the symptom app, the final model included the predictors age, attitude toward technology, and fear of COVID-19. The model had an r2 of 0.141. The final model for the tracing app included the same predictors and had an r2 of 0.156. The main reason to use both mobile apps was to control the spread of the COVID-19 virus. Concerns about privacy was mentioned as the main reason to not use the mobile apps. CONCLUSIONS Age, attitude toward technology, and fear of COVID-19 are important predictors of the acceptance of COVID-19 mobile apps for symptom recognition and monitoring and for contact tracing. These predictors should be taken into account during the development and implementation of these mobile apps to secure acceptance.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Marian Hurmuz
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Marjolein den Ouden
- Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Lex van Velsen
- eHealth Department, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
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16
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Kramer LL, van Velsen L, Clark JL, Mulder BC, de Vet E. Use and effect of embodied conversational agents for improving eating behavior and decreasing loneliness among community-dwelling older adults: A randomized controlled trial (Preprint). JMIR Form Res 2021; 6:e33974. [PMID: 35404255 PMCID: PMC9039822 DOI: 10.2196/33974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/05/2022] [Accepted: 02/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Embodied conversational agents (ECAs) have been proposed as a promising interaction modality for the delivery of programs focused on promoting lifestyle changes. However, it is not understood what factors influence the health effects of ECAs or their use. Objective We aimed to (1) identify whether ECAs could persuade community-dwelling older adults to change their dietary behavior and whether ECA use could decrease loneliness, (2) test the pathways to these effects, and (3) understand factors influencing the use of ECAs. Methods A randomized controlled trial was conducted. The intervention group received access to the PACO service for 8 weeks. The waitlist group started PACO use after waiting for 4 weeks. Two primary outcomes (eating behavior and loneliness) were assessed via online questionnaires at intake, upon joining the waitlist, after 4 weeks, and after 8 weeks. The third primary outcome (use) was assessed via data logs. Secondary outcomes were measured at the same time points, via questionnaires or an optional interview. Results In total, 32 participants completed the intervention. We found a significant correlation between use in minutes on the one hand, and perceived usefulness (r=0.39, P=.03) and enjoyment on the other (r=0.38, P=.03). However, these did not predict use in the full regression model (F2,29=1.98, P=.16, R2=0.12). Additionally, PACO use did not lead to improvement in eating behavior (χ22=0.34, P=.85) or a decrease in loneliness (χ22=0.02, P=.99). Conclusions Our study did not provide any concluding evidence about factors that are linked to the use or health effects of ECAs. Future service design could benefit from either creating a functional design catering to the predominant stage in the precaution adoption process model of the targeted population, or by personalizing the service based on an intake in which the end user’s stage is determined. Trial Registration ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883 International Registered Report Identifier (IRRID) RR2-10.2196/22186
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- eHealth cluster, Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Jenna L Clark
- Center for Advanced Hindsight, Duke University, Durham, NC, United States
| | - Bob C Mulder
- Strategic Communication Group, Wageningen University & Research, Wageningen, Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
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17
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Beinema T, op den Akker H, van Velsen L, Hermens H. Tailoring coaching strategies to users’ motivation in a multi-agent health coaching application. Computers in Human Behavior 2021. [DOI: 10.1016/j.chb.2021.106787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Broekhuis M, van Velsen L, Peute L, Halim M, Hermens H. Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications. JMIR Form Res 2021; 5:e18198. [PMID: 34313594 PMCID: PMC8367108 DOI: 10.2196/18198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/02/2020] [Accepted: 05/31/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions. However, most summative usability tests do not consider eHealth-specific factors that could potentially affect the usability of a system. One of the reasons for this is the lack of fine-grained frameworks or models of usability factors that are unique to the eHealth domain. OBJECTIVE In this study, we aim to develop an ontology of usability problems, specifically for eHealth applications, with patients as primary end users. METHODS We analyzed 8 data sets containing the results of 8 formative usability tests for eHealth applications. These data sets contained 400 usability problems that could be used for analysis. Both inductive and deductive coding were used to create an ontology from 6 data sets, and 2 data sets were used to validate the framework by assessing the intercoder agreement. RESULTS We identified 8 main categories of usability factors, including basic system performance, task-technology fit, accessibility, interface design, navigation and structure, information and terminology, guidance and support, and satisfaction. These 8 categories contained a total of 21 factors: 14 general usability factors and 7 eHealth-specific factors. Cohen κ was calculated for 2 data sets on both the category and factor levels, and all Cohen κ values were between 0.62 and 0.67, which is acceptable. Descriptive analysis revealed that approximately 69.5% (278/400) of the usability problems can be considered as general usability factors and 30.5% (122/400) as eHealth-specific usability factors. CONCLUSIONS Our ontology provides a detailed overview of the usability factors for eHealth applications. Current usability benchmarking instruments include only a subset of the factors that emerged from our study and are therefore not fully suited for summative evaluations of eHealth applications. Our findings support the development of new usability benchmarking tools for the eHealth domain.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
| | - Linda Peute
- Center for Human Factor Engineering of Health Information technology, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Meilani Halim
- Communication Sciences, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, Netherlands
| | - Hermie Hermens
- Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, Netherlands
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19
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Broekhuis M, Weering MDV, Schuit C, Schürz S, van Velsen L. Designing a stakeholder-inclusive service model for an eHealth service to support older adults in an active and social life. BMC Health Serv Res 2021; 21:654. [PMID: 34225745 PMCID: PMC8256482 DOI: 10.1186/s12913-021-06597-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Service model design is slowly being recognized among eHealth developers as a valuable method for creating durable implementation strategies. Nonetheless, practical guidelines and case-studies that inform the community on how to design a service model for an eHealth innovation are lacking. This study describes the development of a service model for an eHealth service, titled 'SALSA', which intends to support older adults with a physically active and socially inclusive lifestyle. METHODS The service model for the SALSA service was developed in eight consecutive rounds, using a mixed-methods approach. First, a stakeholder salience analysis was conducted to identify the most relevant stakeholders. In rounds 2-4, in-depth insights about implementation barriers, facilitators and workflow processes of these stakeholders were gathered. Rounds 5 and 6 were set up to optimize the service model and receive feedback from stakeholders. In rounds 7 and 8, we focused on future implementation and integrating the service model with the technical components of the eHealth service. RESULTS While the initial goal was to create one digital platform for the eHealth service, the results of the service modelling showed how the needs of two important stakeholders, physiotherapists and sports trainers, were too different for integrating them in one platform. Therefore, the decision was made to create two platforms, one for preventive (senior sports activities) and one for curative (physical rehabilitation) purposes. CONCLUSIONS A service model shows the interplay between service model design, technical development and business modelling. The process of service modelling helps to align the interests of the different stakeholders to create support for future implementation of an eHealth service. This study provides clear documentation on how to conduct service model design processes which can enable future learning and kickstart new research. Our results show the potential that service model design has for service development and innovation in health care.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, eHealth group, Roessinghsbleekweg 33b, 7522AH, Enschede, The Netherlands. .,Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands.
| | | | - Cheyenne Schuit
- National Foundation for the Elderly, Smallepad 30e, 3811 MG, Amersfoort, The Netherlands
| | | | - Lex van Velsen
- Roessingh Research and Development, eHealth group, Roessinghsbleekweg 33b, 7522AH, Enschede, The Netherlands.,Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
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20
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van Velsen L, Flierman I, Tabak M. The formation of patient trust and its transference to online health services: the case of a Dutch online patient portal for rehabilitation care. BMC Med Inform Decis Mak 2021; 21:188. [PMID: 34118919 PMCID: PMC8199797 DOI: 10.1186/s12911-021-01552-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Trust is widely recognized as a crucial factor in successful physician–patient communication and patient engagement in treatment. However, with the rise of eHealth technologies, such as online patient portals, the role of trust and the factors that influence it need to be reconsidered. In this study, we aim to identify the factors that contribute to trust in an eHealth service and we aim to identify the consequences of trust in an eHealth service in terms of use. Methods The Patient Trust Assessment Tool was provided to new outpatients of a rehabilitation center in the Netherlands, that were expected to use the center’s online patient portal. Via this tool, we assessed five trust-related factors. This data was supplemented by questions about demographics (age, gender, rehabilitation treatment) and data about use (number of sessions, total time spent in sessions), derived from data logs. Data was analyzed via Partial Least Squares Structural Equation Modelling. Results In total, 93 patients participated in the study. Out of these participants, 61 used the portal at least once. The measurement model was considered good. Trust in the organization was found to affect trust in the care team (β = .63), trust in the care team affected trust in the treatment (β = .60). Both, trust in the care team and trust in the treatment influenced trust in the technology (β = .42 and .30, respectively). Trust in the technology affected the holistic concept trust in the service (β = .78). This holistic trust in the service finally, did not affect use. Conclusions This study shows that the formation of this trust is not unidimensional, but consists of different, separate factors (trust in the care organization, trust in the care team and trust in the treatment). Trust transfer does take place from offline to online health services. However, trust in the service does not directly affect the use of the eHealth technology. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01552-4.
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Affiliation(s)
- Lex van Velsen
- eHealth Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, the Netherlands. .,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands.
| | - Ina Flierman
- Roessingh Center for Rehabilitation, Enschede, the Netherlands
| | - Monique Tabak
- eHealth Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, the Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
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21
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Jansen-Kosterink S, van Velsen L, Cabrita M. Clinician acceptance of complex clinical decision support systems for treatment allocation of patients with chronic low back pain. BMC Med Inform Decis Mak 2021; 21:137. [PMID: 33906665 PMCID: PMC8077885 DOI: 10.1186/s12911-021-01502-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS this study aims to identify the factors that hinder, or alleviate the acceptance of, clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain. Methods We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, in turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling. The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with a video animation of the complex CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use and not use, a complex CDSS. Results Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD ± 12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence. Conclusions To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the development of complex CDSSs that fit more into the daily clinical practice of clinicians.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AL, Enschede, The Netherlands. .,Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine Group, University of Twente, Enschede, the Netherlands.
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AL, Enschede, The Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine Group, University of Twente, Enschede, the Netherlands
| | - Miriam Cabrita
- eHealth Group, Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AL, Enschede, The Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine Group, University of Twente, Enschede, the Netherlands
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22
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Kramer LL, Blok M, van Velsen L, Mulder BC, de Vet E. Supporting eating behaviour of community-dwelling older adults: co-design of an embodied conversational agent. ACTA ACUST UNITED AC 2021; 5:120-139. [PMID: 34381936 PMCID: PMC8300522 DOI: 10.1080/24735132.2021.1885592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In order to support community-dwelling older adults with healthy eating behaviours, Embodied Conversational Agents (ECAs) may be an effective and engaging medium. However, ECAs have not yet been found to be capable of engendering behaviour change, which is partly attributed to the absence of a match with users’ practices, needs and preferences. Hence, we describe a co-design process with older adults that informs both the content and the appearance of an ECA. Data was gathered through three consecutive iterations of co-design sessions with two groups of community-dwelling older adults in the Netherlands. Prior to the first session, participants completed a seven-day lifestyle diary. This study adds knowledge on the meaning of healthy eating, as well as on specific barriers to, and opportunities for, giving advice using an ECA in this target group. Furthermore, we translate this knowledge into general advice for designing an ECA in the context of health behaviour change, while reflecting on a co-design process with older adults.
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles group, Wageningen University & Research, Wageningen, The Netherlands
| | - Marije Blok
- Department of Sociology, VU Amsterdam, Amsterdam, The Netherlands.,National Foundation for the Elderly, Amersfoort, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, eHealth cluster, Enschede, The Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Bob C Mulder
- Strategic Communication group, Wageningen University & Research, Wageningen, The Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles group, Wageningen University & Research, Wageningen, The Netherlands
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23
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Kramer LL, Mulder BC, van Velsen L, de Vet E. Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e22186. [PMID: 33404513 PMCID: PMC7817356 DOI: 10.2196/22186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/20/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner. OBJECTIVE We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA. METHODS The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome-use-will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview. RESULTS As of July 2020, we have begun recruiting participants. CONCLUSIONS By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context. TRIAL REGISTRATION ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/22186.
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Bob C Mulder
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
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Jurkeviciute M, van Velsen L, Eriksson H, Lifvergren S, Trimarchi PD, Andin U, Svensson J. Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models. J Med Internet Res 2020; 22:e17720. [PMID: 33064089 PMCID: PMC7600009 DOI: 10.2196/17720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/17/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Value is one of the central concepts in health care, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of the value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways, ranging from measuring outcomes such as clinical efficacy or behavior change of patients or professionals to measuring the perceptions of various stakeholders or in economic terms. OBJECTIVE The objective of our study is to identify contextual factors that determine similarities and differences in the value of an eHealth intervention between two contexts. We also aim to reflect on and contribute to the discussion about the specification, assessment, and relativity of the "value" concept in the evaluation of eHealth interventions. METHODS The study concerned a 6-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating the value of eHealth interventions was designed as monetary and nonmonetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using the Mini-Mental State Examination (MMSE), the clock drawing test, and the 5-level EQ-5D (EQ-5D-5L). Semistructured interviews were conducted with patients and health care professionals. Monetary data was collected from the health care and technology providers. RESULTS The value of an eHealth intervention applied to similar types of populations but differed in different contexts. In Sweden, patients improved cognitive performance (MMSE mean 0.85, SD 1.62, P<.001), reduced anxiety (EQ-5D-5L mean 0.16, SD 0.54, P=.046), perceived their health better (EQ-5D-5L VAS scale mean 2.6, SD 9.7, P=.035), and both patients and health care professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for health care professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, and the health care professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, clinical efficacy and quality of life improvements have not been observed. We identified 6 factors that influence the value of eHealth intervention in a particular context: (1) service delivery design of the intervention (process of delivery), (2) organizational setup of the intervention (ie, organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (eg, how physically active they were in their daily life and if they were living alone or with family), and (6) local preferences on the quality of patient care. CONCLUSIONS Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behavior changes. To obtain a holistic view of the value created, it needs to be operationalized into monetary and nonmonetary outcomes, categorizing these into benefits and sacrifices.
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Affiliation(s)
- Monika Jurkeviciute
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands
| | - Henrik Eriksson
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Svante Lifvergren
- Centre for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
- Skaraborg Hospital Group, Lidköping, Sweden
| | | | - Ulla Andin
- Skaraborg Hospital Group, Lidköping, Sweden
| | - Johan Svensson
- Skaraborg Hospital Group, Lidköping, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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van Velsen L, Cabrita M, Op den Akker H, Brandl L, Isaac J, Suárez M, Gouveia A, Dinis de Sousa R, Rodrigues AM, Canhão H, Evans N, Blok M, Alcobia C, Brodbeck J. LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy): Proposal for an Online Service Development and Evaluation. JMIR Res Protoc 2020; 9:e19344. [PMID: 32897238 PMCID: PMC7509633 DOI: 10.2196/19344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Loss of a spouse is a frequent occurrence in later life. While most older adults successfully process this loss and will return to a normal life, about 10% of the individuals are unable to cope, and progress to prolonged grief (PG). PG, in turn, can result in mental and physical problems including poor sleep, cardiovascular problems, depression, and suicidal tendencies. Objective LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) is an online bereavement program that will support the prevention and treatment of PG, so that elderly mourners can continue to lead an active, meaningful, and dignified life. LEAVES will cater to secondary end users (eg, family, informal caregivers) by reducing stress. Methods LEAVES will help older adults to process the loss of a spouse in an online environment, which consists of (1) an existing online grief self-help program LIVIA, (2) the Before You Leave program that allows for storing personal memories, (3) a virtual agent platform, and (4) an accessible front-end design. LEAVES can detect persons at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The service relies on online support whenever possible but is blended with telephone or face-to-face counseling when necessary. Results The project will take place between February 2020 and January 2023 and includes a real-life evaluation in which 315 end users will use the service across 3 countries (the Netherlands, Portugal, and Switzerland). The evaluation of LEAVES will focus on clinical effect, its business case, and technology acceptance. The results will pave the way for smooth integration into existing care paths and reimbursement schemes. Conclusions The LEAVES service aims to soften the mourning process, prevents depression or social isolation, strengthens widow(er)s resilience and well-being, and quickens one’s return to societal participation. International Registered Report Identifier (IRRID) DERR1-10.2196/19344
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Affiliation(s)
- Lex van Velsen
- eHealth group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Miriam Cabrita
- eHealth group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Harm Op den Akker
- eHealth group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Lena Brandl
- eHealth group, Roessingh Research and Development, Enschede, Netherlands
| | - Joana Isaac
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal.,Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - María Suárez
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | - Afonso Gouveia
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | - Rute Dinis de Sousa
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | | | | | - Marije Blok
- National Foundation for the Elderly, Amersfoort, Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Jeannette Brodbeck
- School of Social Work, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.,Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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26
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Ter Stal S, Broekhuis M, van Velsen L, Hermens H, Tabak M. Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study. JMIR Hum Factors 2020; 7:e19987. [PMID: 32886068 PMCID: PMC7501582 DOI: 10.2196/19987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. OBJECTIVE This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users' likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. METHODS The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent's advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. RESULTS A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. CONCLUSIONS Agent age and gender little influence users' impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps.
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Affiliation(s)
- Silke Ter Stal
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Marijke Broekhuis
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Hermie Hermens
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Monique Tabak
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
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Allouch SB, van Velsen L. Social Robots for Elderly Care: An Inventory of Promising Use Cases and Business Models. Stud Health Technol Inform 2020; 270:1046-1050. [PMID: 32570541 DOI: 10.3233/shti200321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper discusses a study that aimed to elicit promising application areas and potential business models for social robotics in healthcare. For this goal, we conducted focus groups with care professionals and the management of elderly care organizations in the Netherlands and Germany. Three use cases were mentioned as the most promising: the robot as a ubiquitous aid, the robot as a helper in the room, and the robot as a guide. Finally, we discuss the implications of the medical device and privacy legislation for these three use cases.
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Affiliation(s)
| | - Lex van Velsen
- Roessingh Research and Development, Enschede, The Netherlands
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28
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Boerema S, van Velsen L, Hermens H. An intervention study to assess potential effect and user experience of an mHealth intervention to reduce sedentary behaviour among older office workers. BMJ Health Care Inform 2020; 26:bmjhci-2019-100014. [PMID: 31744844 PMCID: PMC7253002 DOI: 10.1136/bmjhci-2019-100014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Office workers spend a high percentage of their time sitting, often in long periods of time. Research suggests that it is healthier to break these long bouts into shorter periods by being physically active. OBJECTIVE We evaluated the effect of a context-aware activity coach, called the PEARL app, an mHealth intervention that provides activity suggestions, based on a physical activity prediction model, consisting of past and current physical activity and digital agendas. METHOD Fifteen office workers, aged 50+, participated in an intervention study in which they used the intervention for 1 week, preceded by a 1-week baseline period. Measurements were taken before and after the intervention period. RESULTS 107 days of data from 14 participants were analysed. Total sedentary time was not reduced as a result of using the intervention (baseline vs intervention: 47.8±3.6 vs 46.8±3.0, n.s.). When using the intervention, participants reduced their total time spent in long sitting bouts (≥45 min) from 19.3 to 14.4 min per hour of wear time (p<0.05). Participants indicated that the main value of the intervention lies in creating awareness about their personal sedentary behaviour pattern. CONCLUSION An mHealth service has the potential to improve the sedentary behaviour of older office workers, especially for breaking up long sedentary periods. Focusing on total sedentary time as an outcome of an intervention, aimed at reducing sedentary behaviour, is too simplistic. One should take into account both the duration and the number of bouts when determining the effect.
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Affiliation(s)
- Simone Boerema
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands .,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Hermie Hermens
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
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29
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Boerema ST, van Velsen L, Vollenbroek MM, Hermens HJ. Pattern measures of sedentary behaviour in adults: A literature review. Digit Health 2020; 6:2055207620905418. [PMID: 32095261 PMCID: PMC7013117 DOI: 10.1177/2055207620905418] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/14/2020] [Indexed: 12/13/2022] Open
Abstract
Objective With sensors, we are increasingly able to assess sitting behaviour during the day. However, there is no consensus among researchers on the best outcome measures for representing the accumulation of sedentary time during the day. Methods We analysed the pattern measures of sedentary behaviour. Articles reporting patterns measures in adults, in which behaviour data was collected with a sensor were included. We discuss the strengths and weaknesses of the pattern measures of sedentary behaviour and provide recommendations for choosing objective measures of sedentary behaviour. Results Most studies report the number of sitting bouts during the day. Others focus on the number of breaks and/or periods of physical activity. Simple measures of sedentary behaviour were most popular. More complex pattern measures, such as the Gini index or the half-life bout duration, that capture the distribution of lengths of sitting periods in a single number, were reported sparsely. The sedentary patterns that were reported in the various studies were difficult to compare, due to the differences among measurement devices, data analysis protocols and a lack of basic outcome parameters such as total wear-time and total sedentary time. Conclusions Objective sedentary measures can be grouped into simple and complex measures of sedentary time accumulation during the day. These measures serve different goals. The answer to the question as to which measures are most suitable to report, is strongly dependent on the research question. We have shown that the reported measures were dependent on (a) the sensing method, (b) the classification method, (c) the experimental and data cleaning protocol and (d) the applied definitions of bouts and breaks. We recommend that studies should always report total wear-time, total sedentary time, number of bouts and at least one measure describing the diversity of bout lengths in the sedentary behaviour such as the half-life bout duration. Additionally, we recommend reporting the measurement conditions and data processing steps.
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Affiliation(s)
- Simone T Boerema
- Biomedical Signals and Systems Group, University of Twente, The Netherlands.,eHealth Group, Roessingh Research and Development, The Netherlands
| | - Lex van Velsen
- Biomedical Signals and Systems Group, University of Twente, The Netherlands.,eHealth Group, Roessingh Research and Development, The Netherlands
| | | | - Hermie J Hermens
- Biomedical Signals and Systems Group, University of Twente, The Netherlands.,eHealth Group, Roessingh Research and Development, The Netherlands
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30
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Kramer LL, Ter Stal S, Mulder BC, de Vet E, van Velsen L. Developing Embodied Conversational Agents for Coaching People in a Healthy Lifestyle: Scoping Review. J Med Internet Res 2020; 22:e14058. [PMID: 32022693 PMCID: PMC7055763 DOI: 10.2196/14058] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/12/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Embodied conversational agents (ECAs) are animated computer characters that simulate face-to-face counseling. Owing to their capacity to establish and maintain an empathic relationship, they are deemed to be a promising tool for starting and maintaining a healthy lifestyle. OBJECTIVE This review aimed to identify the current practices in designing and evaluating ECAs for coaching people in a healthy lifestyle and provide an overview of their efficacy (on behavioral, knowledge, and motivational parameters) and use (on usability, usage, and user satisfaction parameters). METHODS We used the Arksey and O'Malley framework to conduct a scoping review. PsycINFO, Medical Literature Analysis and Retrieval System Online, and Scopus were searched with a combination of terms related to ECA and lifestyle. Initially, 1789 unique studies were identified; 20 studies were included. RESULTS Most often, ECAs targeted physical activity (n=16) and had the appearance of a middle-aged African American woman (n=13). Multiple behavior change techniques (median=3) and theories or principles (median=3) were applied, but their interpretation and application were usually not reported. ECAs seemed to be designed for the end user rather than with the end user. Stakeholders were usually not involved. A total of 7 out of 15 studies reported better efficacy outcomes for the intervention group, and 5 out of 8 studies reported better use-related outcomes, as compared with the control group. CONCLUSIONS ECAs are a promising tool for persuasive communication in the health domain. This review provided valuable insights into the current developmental processes, and it recommends the use of human-centered, stakeholder-inclusive design approaches, along with reporting on the design activities in a systematic and comprehensive manner. The gaps in knowledge were identified on the working mechanisms of intervention components and the right timing and frequency of coaching.
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Silke Ter Stal
- eHealth cluster, Roessingh Research and Development, Enschede, Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Bob C Mulder
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- eHealth cluster, Roessingh Research and Development, Enschede, Netherlands
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van Velsen L, Broekhuis M, Jansen-Kosterink S, Op den Akker H. Tailoring Persuasive Electronic Health Strategies for Older Adults on the Basis of Personal Motivation: Web-Based Survey Study. J Med Internet Res 2019; 21:11759. [PMID: 31493323 PMCID: PMC6788334 DOI: 10.2196/11759] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/31/2019] [Accepted: 05/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Persuasive design, in which the aim is to change attitudes and behaviors by means of technology, is an important aspect of electronic health (eHealth) design. However, selecting the right persuasive feature for an individual is a delicate task and is likely to depend on individual characteristics. Personalization of the persuasive strategy in an eHealth intervention therefore seems to be a promising approach. Objective This study aimed to develop a method that allows us to model motivation in older adults with respect to leading a healthy life and a strategy for personalizing the persuasive strategy of an eHealth intervention, based on this user model. Methods We deployed a Web-based survey among older adults (aged >60 years) in the Netherlands. In the first part, we administered an adapted version of the revised Sports Motivation Scale (SMS-II) as input for the user models. Then, we provided each participant with a selection of 5 randomly chosen mock-ups (out of a total of 11), each depicting a different persuasive strategy. After showing each strategy, we asked participants how much they appreciated it. The survey was concluded by addressing demographics. Results A total of 212 older adults completed the Web-based survey, with a mean age of 68.35 years (SD 5.27 years). Of 212 adults, 45.3% were males (96/212) and 54.7% were female (116/212). Factor analysis did not allow us to replicate the 5-factor structure for motivation, as targeted by the SMS-II. Instead, a 3-factor structure emerged with a total explained variance of 62.79%. These 3 factors are intrinsic motivation, acting to derive satisfaction from the behavior itself (5 items; Cronbach alpha=.90); external regulation, acting because of externally controlled rewards or punishments (4 items; Cronbach alpha=.83); and a-motivation, a situation where there is a lack of intention to act (2 items; r=0.50; P<.001). Persuasive strategies were appreciated differently, depending on the type of personal motivation. In some cases, demographics played a role. Conclusions The personal type of motivation of older adults (intrinsic, externally regulated, and/or a-motivation), combined with their educational level or living situation, affects an individual’s like or dislike for a persuasive eHealth feature. We provide a practical approach for profiling older adults as well as an overview of which persuasive features should or should not be provided to each profile. Future research should take into account the coexistence of multiple types of motivation within an individual and the presence of a-motivation.
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Affiliation(s)
- Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Marijke Broekhuis
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Harm Op den Akker
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
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32
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Gwyther H, van Velsen L, Shaw RL, D'Avanzo B, Bujnowska-Fedak M, Kurpas D, Szwamel K, Van't Klooster JW, Holland C. The use of technology in the context of frailty screening and management interventions: a study of stakeholders' perspectives. BMC Med Inform Decis Mak 2019; 19:110. [PMID: 31186018 PMCID: PMC6560850 DOI: 10.1186/s12911-019-0828-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background Health and social care interventions show promise as a way of managing the progression of frailty in older adults. Information technology could improve the availability of interventions and services for older adults. The views of stakeholders on the acceptability of technological solutions for frailty screening and management have not been explored. Methods Focus groups were used to gather data from healthy and frail/pre-frail older adults, health and social care providers, and caregivers in three European countries – Italy, Poland and UK. Data were analysed using framework analysis in terms of facilitators or determinants of older adults’ adoption of technology. Results Our findings clustered around the perceived value; usability, affordability and accessibility; and emotional benefits of frailty screening and management technology to stakeholders. We also noted issues relating to social support, previous experience of technology and confidence of stakeholders. Conclusions Professionals and caregivers understand the benefits of technology to facilitate frailty care pathways but these views are tempered by concerns around social isolation. Frail older adults raised legitimate concerns about the accessibility and usability of technology, specifically around the potential for their personal information to be compromised. Solutions must be developed within a framework that addresses social contexts and avoids stigma around frailty and ageing.
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Affiliation(s)
- Holly Gwyther
- The Centre for Ageing Research, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522, Enschede, AH, Netherlands
| | - Rachel L Shaw
- Research Centre for Healthy Ageing, School of Life and Health Sciences, Aston University, B4 7ET, Birmingham, UK
| | - Barbara D'Avanzo
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Bujnowska-Fedak
- Family Medicine Department, Wroclaw Medical University, Syrokomli 1, 51-141, Wroclaw, Poland
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Syrokomli 1, 51-141, Wroclaw, Poland.,Opole Medical School, ul. Katowicka 68, 45-060, Opole, Poland
| | - Katarzyna Szwamel
- Family Medicine Department, Wroclaw Medical University, Syrokomli 1, 51-141, Wroclaw, Poland.,Opole Medical School, ul. Katowicka 68, 45-060, Opole, Poland
| | - Jan-Willem Van't Klooster
- BMS Lab, Faculty of behavioural, management and social sciences, University of Twente, Drienerlolaan 5, 7522, Enschede, NB, Netherlands
| | - Carol Holland
- The Centre for Ageing Research, Lancaster University, Lancaster, LA1 4YG, UK
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Broekhuis M, van Velsen L, Hermens H. Assessing usability of eHealth technology: A comparison of usability benchmarking instruments. Int J Med Inform 2019; 128:24-31. [PMID: 31160008 DOI: 10.1016/j.ijmedinf.2019.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/04/2019] [Accepted: 05/04/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is generally assumed that usability benchmarking instruments are technology agnostic. The same methods for usability evaluations are used for digital commercial, educational, governmental and healthcare systems. However, eHealth technologies have unique characteristics. They need to support patients' health, provide treatment or monitor progress. Little research is done on the effectiveness of different benchmarks (qualitative and quantitative) within the eHealth context. OBJECTIVES In this study, we compared three usability benchmarking instruments (logging task performance, think aloud and the SUS, the System Usability Scale) to assess which metric is most indicative of usability in an eHealth technology. Also, we analyzed how these outcome variables (task completion, system usability score, serious and critical usability issues) interacted with the acceptance factors Perceived benefits, Usefulness and Intention to use. METHODS A usability evaluation protocol was set up that incorporated all three benchmarking methods. This protocol was deployed among 36 Dutch participants and across three different eHealth technologies: a gamified application for older adults (N = 19), an online tele-rehabilitation portal for healthcare professionals (N = 9), and a mobile health app for adolescents (N = 8). RESULTS The main finding was that task completion, compared to the SUS, had stronger correlations with usability benchmarks. Also, serious and critical issues were stronger correlated to task metrics than the SUS. With regard to acceptance factors, there were no significant differences between the three usability benchmarking instruments. CONCLUSIONS With this study, we took a first step in examining how to improve usability evaluations for eHealth. The results show that listing usability issues from think aloud protocols remains one of the most effective tools to explain the usability for eHealth. Using the SUS as a stand-alone usability metric for eHealth is not recommended. Preferably, the SUS should be combined with task metrics, especially task completion. We recommend to develop a usability benchmarking instrument specifically for eHealth.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH, Enschede, the Netherlands; Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, the Netherlands.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH, Enschede, the Netherlands; Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, the Netherlands
| | - Hermie Hermens
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH, Enschede, the Netherlands; Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, the Netherlands
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Jansen-Kosterink S, van Velsen L, Frazer S, Dekker-van Weering M, O'Caoimh R, Vollenbroek-Hutten M. Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands. BMC Public Health 2019; 19:504. [PMID: 31053090 PMCID: PMC6500037 DOI: 10.1186/s12889-019-6876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands. .,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Sanne Frazer
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Marit Dekker-van Weering
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | - Miriam Vollenbroek-Hutten
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.,ZiekenhuisGroep Twente (ZGT), scientific office ZGT academie, Almelo, the Netherlands
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Olde Keizer RACM, van Velsen L, Moncharmont M, Riche B, Ammour N, Del Signore S, Zia G, Hermens H, N’Dja A. Using socially assistive robots for monitoring and preventing frailty among older adults: a study on usability and user experience challenges. Health Technol 2019. [DOI: 10.1007/s12553-019-00320-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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van Velsen L, Evers M, Bara CD, Op den Akker H, Boerema S, Hermens H. Understanding the Acceptance of an eHealth Technology in the Early Stages of Development: An End-User Walkthrough Approach and Two Case Studies. JMIR Form Res 2018; 2:e10474. [PMID: 30684434 PMCID: PMC6334698 DOI: 10.2196/10474] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background Studies that focus on the acceptance of an electronic health (eHealth) technology generally make use of surveys. However, results of such studies hold little value for a redesign, as they focus only on quantifying end-user appreciation of general factors (eg, perceived usefulness). Objective We present a method for understanding end-user acceptance of an eHealth technology, early in the development process: The eHealth End-User Walkthrough. Methods During a walkthrough, a participant is guided by using the technology via a scenario, a persona, and a low-fidelity protoype. A participant is questioned about factors that may affect acceptance during and after the demonstration. We show the value of the method via two case studies. Results During the case studies, participants commented on whether they intend to use a technology and why they would (not) use its main features. They also provided redesign advice or input for additional functions. Finally, the sessions provide guidance for the generation of business models and implementation plans. Conclusions The eHealth End-User Walkthrough can aid design teams in understanding the acceptance of their eHealth application in a very early stage of the design process. Consequently, it can prevent a mismatch between technology and end-users’ needs, wishes and context.
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Affiliation(s)
- Lex van Velsen
- Telemedicine Cluster, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Mirka Evers
- Telemedicine Cluster, Roessingh Research and Development, Enschede, Netherlands
| | - Cristian-Dan Bara
- Telemedicine Cluster, Roessingh Research and Development, Enschede, Netherlands
| | - Harm Op den Akker
- Telemedicine Cluster, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Simone Boerema
- Telemedicine Cluster, Roessingh Research and Development, Enschede, Netherlands
| | - Hermie Hermens
- Telemedicine Cluster, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
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Swinkels ICS, Huygens MWJ, Schoenmakers TM, Oude Nijeweme-D'Hollosy W, van Velsen L, Vermeulen J, Schoone-Harmsen M, Jansen YJ, van Schayck OC, Friele R, de Witte L. Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care. J Med Internet Res 2018; 20:e83. [PMID: 29599108 PMCID: PMC5897624 DOI: 10.2196/jmir.9110] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 01/21/2023] Open
Abstract
Background Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. Conclusions For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.
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Affiliation(s)
- Ilse Catharina Sophia Swinkels
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Care Technology Research, Maastricht, Netherlands
| | - Martine Wilhelmina Johanna Huygens
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Tim M Schoenmakers
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Care Technology Research, Maastricht, Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Wendy Oude Nijeweme-D'Hollosy
- Centre for Care Technology Research, Maastricht, Netherlands.,Telemedicine, Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- Centre for Care Technology Research, Maastricht, Netherlands.,Telemedicine, Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Roessingh Research & Development, Enschede, Netherlands
| | - Joan Vermeulen
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Lunet Zorg, Eindhoven, Netherlands
| | - Marian Schoone-Harmsen
- Centre for Care Technology Research, Maastricht, Netherlands.,Work Health Technology Expertise Group, Netherlands Organisation for Applied Scientific Research TNO, Leiden, Netherlands
| | - Yvonne Jfm Jansen
- Centre for Care Technology Research, Maastricht, Netherlands.,Work Health Technology Expertise Group, Netherlands Organisation for Applied Scientific Research TNO, Leiden, Netherlands.,Robuust, Eindhoven, Netherlands
| | - Onno Cp van Schayck
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Family Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Roland Friele
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Care Technology Research, Maastricht, Netherlands.,Tranzo, Tilburg School of Social and Behavorial Sciences, Tilburg University, Tilburg, Netherlands
| | - Luc de Witte
- Centre for Care Technology Research, Maastricht, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.,Research Center Technology and Care, Zuyd University of Applied Sciences, Heerlen, Netherlands
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Oude Nijeweme-d’Hollosy W, van Velsen L, Poel M, Groothuis-Oudshoorn CG, Soer R, Hermens H. Evaluation of three machine learning models for self-referral decision support on low back pain in primary care. Int J Med Inform 2018; 110:31-41. [DOI: 10.1016/j.ijmedinf.2017.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 12/21/2022]
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van Velsen L, Frazer S, N'dja A, Ammour N, Del Signore S, Zia G, Hermens H. The Reliability of Using Tablet Technology for Screening the Health of Older Adults. Stud Health Technol Inform 2018; 247:651-655. [PMID: 29678041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this study, we assessed the reliability of using a tablet application for collecting health data among older adults, in comparison to using paper surveys for this goal. Test-retest reliability between the two modalities, usability, user experience factors, and older adults' preference were determined. The results show perfect agreement between tablet and paper for the SARC-F and high agreement for the SF-36 physical scale and EQ-5D. Usability and user experience factors were perceived the same for both modalities. The majority of the participants preferred the tablet for health screening purposes, mainly because of its ease of use. This study shows that using tablets for health screenings among older adults does not affect test reliability, and that older adults prefer the tablet to paper for completing these tests.
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Affiliation(s)
- Lex van Velsen
- Roessingh Research and Development, Telemedicine cluster, The Netherlands
| | - Sanne Frazer
- Roessingh Research and Development, Telemedicine cluster, The Netherlands
| | | | | | | | | | - Hermie Hermens
- Roessingh Research and Development, Telemedicine cluster, The Netherlands
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Allouch SB, van Velsen L. Fit by Bits: An Explorative Study of Sports Physiotherapists' Perception of Quantified Self Technologies. Stud Health Technol Inform 2018; 247:296-300. [PMID: 29677970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Our aim was to determine sport physiotherapists' attitudes towards Quantified Self technology usage and adoption and to analyze factors that may influence this attitude. A survey was used to study a sample in the Netherlands. Assessment was made of attitudes of towards Quantified Self technology usage by clients of therapists, by therapists themselves and intention to adopt Quantified Self technology. Results show that the uptake of Quantified Self technology by sports physiotherapists is rather low but that the intention to adopt Quantified Self technology by sports physiotherapists is quite high. These results can provide a foundation to provide an infrastructure for sports physiotherapists to fulfill their wishes with regard to Quantified Self technology.
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Buimer HP, Tabak M, van Velsen L, van der Geest T, Hermens H. Exploring Determinants of Patient Adherence to a Portal-Supported Oncology Rehabilitation Program: Interview and Data Log Analyses. JMIR Rehabil Assist Technol 2017; 4:e12. [PMID: 29242173 PMCID: PMC5746616 DOI: 10.2196/rehab.6294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/14/2017] [Accepted: 09/07/2017] [Indexed: 11/21/2022] Open
Abstract
Background Telemedicine applications often do not live up to their expectations and often fail once they have reached the operational phase. Objective The objective of this study was to explore the determinants of patient adherence to a blended care rehabilitation program, which includes a Web portal, from a patient’s perspective. Methods Patients were enrolled in a 12-week oncology rehabilitation treatment supported by a Web portal that was developed in cooperation with patients and care professionals. Semistructured interviews were used to analyze thought processes and behavior concerning patient adherence and portal use. Interviews were conducted with patients close to the start and the end of the treatment. Besides, usage data from the portal were analyzed to gain insights into actual usage of the portal. Results A total of 12 patients participated in the first interview, whereas 10 participated in the second round of interviews. Furthermore, portal usage of 31 patients was monitored. On average, 11 persons used the portal each week, with a maximum of 20 in the seventh week and a drop toward just one person in the weeks in the follow-up period of the treatment. From the interviews, it was derived that patients’ behavior in the treatment and use of the portal was primarily determined by extrinsic motivation cues (eg, stimulation by care professionals and patient group), perceived severity of the disease (eg, physical and mental condition), perceived ease of use (eg, accessibility of the portal and the ease with which information is found), and perceived usefulness (eg, fit with the treatment). Conclusions The results emphasized the impact that care professionals and fellow patients have on patient adherence and portal usage. For this reason, the success of blended care telemedicine interventions seems highly dependent on the willingness of care professionals to include the technology in their treatment and stimulate usage among patients.
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Affiliation(s)
- Hendrik P Buimer
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,Department of Biophysics, Faculty of Science, Radboud University, Nijmegen, Netherlands
| | - Monique Tabak
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,Telemedicine Group, Roessingh Research & Development, Enschede, Netherlands
| | - Lex van Velsen
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,Telemedicine Group, Roessingh Research & Development, Enschede, Netherlands
| | - Thea van der Geest
- Research Center IT + Media, HAN University of Applied Sciences, Arnhem, Netherlands
| | - Hermie Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.,Telemedicine Group, Roessingh Research & Development, Enschede, Netherlands
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Beukema S, van Velsen L, Jansen-Kosterink S, Karreman J. “There Is Something We Need to Tell You…”: Communicating Health-Screening Results to Older Adults via the Internet. Telemed J E Health 2017; 23:741-746. [DOI: 10.1089/tmj.2016.0210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sander Beukema
- Department of Communication Science, University of Twente, Enschede, Netherlands
| | - Lex van Velsen
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
- Roessingh Research and Development, Telemedicine Cluster, Enschede, Netherlands
| | | | - Joyce Karreman
- Department of Communication Science, University of Twente, Enschede, Netherlands
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Velsen LV, Tabak M, Hermens H. Measuring patient trust in telemedicine services: Development of a survey instrument and its validation for an anticoagulation web-service. Int J Med Inform 2016; 97:52-58. [PMID: 27919395 DOI: 10.1016/j.ijmedinf.2016.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND For many eServices, end-user trust is a crucial prerequisite for use. For the telemedicine context however, knowledge about the coming about and measurement of end-user trust is scarce. OBJECTIVE To develop and validate the PAtient Trust Assessment Tool (PATAT): a survey instrument to quantitatively assess patient trust in a telemedicine service. METHODS Informed by focus groups, we developed a survey that includes measurement scales for the following factors: trust in the care organization, care professional, treatment, and technology, as well as a scale that assesses a holistic view on trust in the telemedicine service. The survey was completed by 795 patients that use a telemedicine application to manage their anticoagulation treatment. Data were analyzed by means of Partial Least Squares Structural Equation Modeling (PLS-SEM). RESULTS The measurement model yielded good to excellent quality measures, after the removal of one item. The causal model resulted in high explained variance (R2=0.68). Trust in healthcare professionals and the treatment had a small effect on overall trust, while trust in the technology displayed a large effect. Trust in the care organization did not result in a significant effect on overall trust. CONCLUSION The PATAT is a valid means to assess patient trust in a telemedicine service and can be used to benchmark such a service or to elicit redesign input.
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Affiliation(s)
- Lex van Velsen
- Roessingh Research and Development, Telemedicine cluster, P.O. box 310, 7500 AH, Enschede, The Netherlands; University of Twente, Biomedical Signals and Systems Group, P.O. box 217, 7500 AE, Enschede, The Netherlands.
| | - Monique Tabak
- Roessingh Research and Development, Telemedicine cluster, P.O. box 310, 7500 AH, Enschede, The Netherlands; University of Twente, Biomedical Signals and Systems Group, P.O. box 217, 7500 AE, Enschede, The Netherlands.
| | - Hermie Hermens
- Roessingh Research and Development, Telemedicine cluster, P.O. box 310, 7500 AH, Enschede, The Netherlands; University of Twente, Biomedical Signals and Systems Group, P.O. box 217, 7500 AE, Enschede, The Netherlands.
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Boerema ST, van Velsen L, Vollenbroek-Hutten MMR, Hermens HJ. Value-based design for the elderly: An application in the field of mobility aids. Assist Technol 2016; 29:76-84. [PMID: 27532436 DOI: 10.1080/10400435.2016.1208303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance. We elicited values, facilitators, and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews. The interviews resulted in a myriad of key values, such as "independence from family" and "doing their own groceries." Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.
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Affiliation(s)
- Simone T Boerema
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
| | - Lex van Velsen
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
| | - Miriam M R Vollenbroek-Hutten
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
| | - Hermie J Hermens
- a Telemedicine Group , Roessingh Research and Development, Roessingsbleekweg , Enschede , The Netherlands.,b Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science , University of Twente, Drienerlolaan , Enschede , The Netherlands
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Boerema ST, Essink GB, Tönis TM, van Velsen L, Hermens HJ. Sedentary Behaviour Profiling of Office Workers: A Sensitivity Analysis of Sedentary Cut-Points. Sensors (Basel) 2015; 16:s16010022. [PMID: 26712758 PMCID: PMC4732055 DOI: 10.3390/s16010022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 01/22/2023]
Abstract
Measuring sedentary behaviour and physical activity with wearable sensors provides detailed information on activity patterns and can serve health interventions. At the basis of activity analysis stands the ability to distinguish sedentary from active time. As there is no consensus regarding the optimal cut-point for classifying sedentary behaviour, we studied the consequences of using different cut-points for this type of analysis. We conducted a battery of sitting and walking activities with 14 office workers, wearing the Promove 3D activity sensor to determine the optimal cut-point (in counts per minute (m·s(-2))) for classifying sedentary behaviour. Then, 27 office workers wore the sensor for five days. We evaluated the sensitivity of five sedentary pattern measures for various sedentary cut-points and found an optimal cut-point for sedentary behaviour of 1660 × 10(-3) m·s(-2). Total sedentary time was not sensitive to cut-point changes within ±10% of this optimal cut-point; other sedentary pattern measures were not sensitive to changes within the ±20% interval. The results from studies analyzing sedentary patterns, using different cut-points, can be compared within these boundaries. Furthermore, commercial, hip-worn activity trackers can implement feedback and interventions on sedentary behaviour patterns, using these cut-points.
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Affiliation(s)
- Simone T Boerema
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Gerard B Essink
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Thijs M Tönis
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Lex van Velsen
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Hermie J Hermens
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
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van Velsen L, van der Geest T, van de Wijngaert L, van den Berg S, Steehouder M. Personalization has a Price, Controllability is the Currency: Predictors for the Intention to use Personalized eGovernment Websites. Journal of Organizational Computing and Electronic Commerce 2015. [DOI: 10.1080/10919392.2015.990782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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van Velsen L, Solana J, Oude-Nijeweme D'Hollosy W, Garate-Barreiro F, Vollenbroek-Hutten M. Advancing Telemedicine Services for the Aging Population: The challenge of Interoperability. Stud Health Technol Inform 2015; 217:897-900. [PMID: 26294581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We reflect on our experiences in two projects in which we developed interoperable telemedicine applications for the aging population. While technically data exchange could be implemented technically, uptake was impeded by a lack of working procedures. We argue that development of interoperable health technology for the aging population should go accompanied by a thorough study into working protocols by consulting all end-users and stakeholders.
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Affiliation(s)
- Lex van Velsen
- Roessingh Research and Development, Telemedicine cluster, Enschede, The Netherlands
| | - Javier Solana
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Universidad Politécnica de Madrid, Spain
| | | | - Francisco Garate-Barreiro
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Universidad Politécnica de Madrid, Spain
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Wentzel J, van Velsen L, van Limburg M, de Jong N, Karreman J, Hendrix R, van Gemert-Pijnen JEWC. Participatory eHealth development to support nurses in antimicrobial stewardship. BMC Med Inform Decis Mak 2014; 14:45. [PMID: 24898694 PMCID: PMC4074392 DOI: 10.1186/1472-6947-14-45] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 05/23/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses' can be supported in ASPs by means of an eHealth intervention that targets their information needs. METHODS We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital. RESULTS To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application's functionality, content, and structure to nurse work practice and tasks. CONCLUSIONS By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses') and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspectives.
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Affiliation(s)
- Jobke Wentzel
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Lex van Velsen
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Maarten van Limburg
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Nienke de Jong
- Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands
| | - Joyce Karreman
- Department of Technical and Professional Communication, University of Twente, Enschede, the Netherlands
| | - Ron Hendrix
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Boerema ST, van Velsen L, Schaake L, Tönis TM, Hermens HJ. Optimal sensor placement for measuring physical activity with a 3D accelerometer. Sensors (Basel) 2014; 14:3188-206. [PMID: 24553085 PMCID: PMC3958275 DOI: 10.3390/s140203188] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/24/2014] [Accepted: 02/07/2014] [Indexed: 01/23/2023]
Abstract
Accelerometer-based activity monitors are popular for monitoring physical activity. In this study, we investigated optimal sensor placement for increasing the quality of studies that utilize accelerometer data to assess physical activity. We performed a two-staged study, focused on sensor location and type of mounting. Ten subjects walked at various walking speeds on a treadmill, performed a deskwork protocol, and walked on level ground, while simultaneously wearing five ProMove2 sensors with a snug fit on an elastic waist belt. We found that sensor location, type of activity, and their interaction-effect affected sensor output. The most lateral positions on the waist belt were the least sensitive for interference. The effect of mounting was explored, by making two subjects repeat the experimental protocol with sensors more loosely fitted to the elastic belt. The loose fit resulted in lower sensor output, except for the deskwork protocol, where output was higher. In order to increase the reliability and to reduce the variability of sensor output, researchers should place activity sensors on the most lateral position of a participant's waist belt. If the sensor hampers free movement, it may be positioned slightly more forward on the belt. Finally, sensors should be fitted tightly to the body.
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Affiliation(s)
- Simone T Boerema
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
| | - Lex van Velsen
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
| | - Leendert Schaake
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
| | - Thijs M Tönis
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
| | - Hermie J Hermens
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands.
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van Velsen L, Beaujean DJ, van Gemert-Pijnen JE, van Steenbergen JE, Timen A. Public knowledge and preventive behavior during a large-scale Salmonella outbreak: results from an online survey in the Netherlands. BMC Public Health 2014; 14:100. [PMID: 24479614 PMCID: PMC3913330 DOI: 10.1186/1471-2458-14-100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 01/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food-borne Salmonella infections are a worldwide concern. During a large-scale outbreak, it is important that the public follows preventive advice. To increase compliance, insight in how the public gathers its knowledge and which factors determine whether or not an individual complies with preventive advice is crucial. METHODS In 2012, contaminated salmon caused a large Salmonella Thompson outbreak in the Netherlands. During the outbreak, we conducted an online survey (n = 1,057) to assess the general public's perceptions, knowledge, preventive behavior and sources of information. RESULTS Respondents perceived Salmonella infections and the 2012 outbreak as severe (m = 4.21; five-point scale with 5 as severe). Their knowledge regarding common food sources, the incubation period and regular treatment of Salmonella (gastro-enteritis) was relatively low (e.g., only 28.7% knew that Salmonella is not normally treated with antibiotics). Preventive behavior differed widely, and the majority (64.7%) did not check for contaminated salmon at home. Most information about the outbreak was gathered through traditional media and news and newspaper websites. This was mostly determined by time spent on the medium. Social media played a marginal role. Wikipedia seemed a potentially important source of information. CONCLUSIONS To persuade the public to take preventive actions, public health organizations should deliver their message primarily through mass media. Wikipedia seems a promising instrument for educating the public about food-borne Salmonella.
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Affiliation(s)
- Lex van Velsen
- National Institute of Public Health and the Environment, Centre for Infectious Disease Control, P,O, box 1, 3720 BA Bilthoven, The Netherlands.
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