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Menon RK, Elfadil S, Shqaidef A, Fanas SA. " Think Aloud" videos in clinical prosthodontics. J Dent Educ 2024. [PMID: 38693653 DOI: 10.1002/jdd.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/09/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Rohit Kunnath Menon
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Sittana Elfadil
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Abedalrahman Shqaidef
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Salem Abu Fanas
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
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Guo Y, Pannasch S, Helmert JR, Kaszowska A. Ambient and focal attention during complex problem-solving: preliminary evidence from real-world eye movement data. Front Psychol 2024; 15:1217106. [PMID: 38425554 PMCID: PMC10902451 DOI: 10.3389/fpsyg.2024.1217106] [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] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Time course analysis of eye movements during free exploration of real-world scenes often reveals an increase in fixation durations together with a decrease in saccade amplitudes, which has been explained within the two visual systems approach, i.e., a transition from ambient to focal. Short fixations and long saccades during early viewing periods are classified as ambient mode of vision, which is concerned with spatial orientation and is related to simple visual properties such as motion, contrast, and location. Longer fixations and shorter saccades during later viewing periods are classified as focal mode of vision, which is concentrated in the foveal projection and is capable of object identification and its semantic categorization. While these findings are mainly obtained in the context of image exploration, the present study endeavors to investigate whether the same pattern of interplay between ambient and focal visual attention is deployed when people work on complex real-world tasks-and if so, when? Based on a re-analysis of existing data that integrates concurrent think aloud and eye tracking protocols, the present study correlated participants' internal thinking models to the parameters of their eye movements when they planned solutions to an open-ended design problem in a real-world setting. We hypothesize that switching between ambient and focal attentional processing is useful when solvers encounter difficulty compelling them to shift their conceptual direction to adjust the solution path. Individuals may prefer different attentional strategies for information-seeking behavior, such as ambient-to-focal or focal-to-ambient. The observed increase in fixation durations and decrease in saccade amplitudes during the periods around shifts in conceptual direction lends support to the postulation of the ambient-to-focal processing; however, focal-to-ambient processing is not evident. Furthermore, our data demonstrate that the beginning of a shift in conceptual direction is observable in eye movement behavior with a significant prolongation of fixation. Our findings add to the conclusions drawn from laboratory settings by providing preliminary evidence for ambient and focal processing characteristics in real-world problem-solving.
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Affiliation(s)
- Yuxuan Guo
- Institute of Psychology III, Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Sebastian Pannasch
- Institute of Psychology III, Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Jens R. Helmert
- Institute of Psychology III, Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
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Lunde P, Skoglund G, Olsen CF, Hilde G, Bong WK, Nilsson BB. Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study. JMIR Hum Factors 2023; 10:e48950. [PMID: 37966894 PMCID: PMC10687681 DOI: 10.2196/48950] [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] [Received: 05/12/2023] [Revised: 08/23/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. OBJECTIVE The aim of this study was to assess the usability of an app among people at risk of DM2. METHODS A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. RESULTS In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. CONCLUSIONS Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial.
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Affiliation(s)
- Pernille Lunde
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Gyri Skoglund
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Cecilie Fromholt Olsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Gunvor Hilde
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Way Kiat Bong
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Birgitta Blakstad Nilsson
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Section for Physiotherapy Division of Medicine, Oslo University Hospital, Oslo, Norway
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Oladele DA, Iwelunmor J, Gbajabiamila T, Obiezu-Umeh C, Okwuzu JO, Nwaozuru U, Musa AZ, Tahlil K, Idigbe I, Ong J, Tang W, Tucker J, Ezechi O. An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility. JMIR Form Res 2023; 7:e44402. [PMID: 37747780 PMCID: PMC10562967 DOI: 10.2196/44402] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. OBJECTIVE The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. METHODS We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. RESULTS A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). CONCLUSIONS This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach.
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Affiliation(s)
- David Ayoola Oladele
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbajabiamila
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Jane Ogoamaka Okwuzu
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Adesola Zaidat Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Kadija Tahlil
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ifeoma Idigbe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Jason Ong
- Melbourne Sexual Health Centre (MSHC), University of Melbourne, Melbourne, Australia
| | - Weiming Tang
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph Tucker
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
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Walker S, Pham TN, Duong QH, Brock TP, Lyons KM. Cognitive and Metacognitive Processes Demonstrated by Pharmacy Students When Making Therapeutic Decisions. Am J Pharm Educ 2023; 87:ajpe8817. [PMID: 35272985 PMCID: PMC10159031 DOI: 10.5688/ajpe8817] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/07/2022] [Indexed: 05/03/2023]
Abstract
Objective. To characterize the types of cognitive and metacognitive processes demonstrated by third-year pharmacy students during a therapeutic reasoning activity.Methods. A qualitative, descriptive study following a think-aloud protocol was used to analyze the cognitive (analytical) and metacognitive processes observed by third-year pharmacy students as they completed a 25-minute therapeutic reasoning activity. Using a deductive codebook developed from literature about reasoning, two independent coders characterized processes from students' audio-recorded, transcribed think-aloud episodes while making therapeutic decisions about simulated clinical cases.Results. A total of 40 think-aloud episodes were transcribed among the cohort. Categorization of the think-aloud transcriptions revealed a series of cognitive analytical and metacognitive processes demonstrated by students during the therapeutic decision-making activity. A total of 1792 codes were categorized as analytical processes, falling into six major themes: 69% gathering information (1232/1792), 13% processing information (227/1792), 7% making assessments (133/1792), 1% synthesizing information (19/1792), 7% articulating evidence (117/1792), and 4% making a recommendation (64/1792). In comparison to gathering information, a much lower frequency of processing and assessment was observed for students, particularly for those that were unable to resolve the case. Students' movement between major analytical processes co-occurred commonly with metacognitive processes. Of the 918 codes categorized as metacognitive processes, two major themes arose: 28% monitoring for knowledge or emotions (257/918) and 72% controlling the planning of next steps or verification of correct information (661/918). Sequencing the codes and co-occurrences of processes allowed us to propose an integrated cognitive/metacognitive model of therapeutic reasoning for students.Conclusion. This study categorizes the cognitive (analytical) and metacognitive processes engaged during pharmacy students' therapeutic reasoning process. The findings can inform current instructional practices and further research into educational activities that can strengthen pharmacy students' therapeutic reasoning skills.
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Affiliation(s)
- Steven Walker
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, VIC, Australia
| | - To Nhu Pham
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Quang Hung Duong
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Tina P Brock
- Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Kayley M Lyons
- University of Melbourne, Centre for Digital Transformation of Health, Parkville, VIC, Australia
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Kushniruk A, Hedegaard L, Rask MT, Clemensen J, Frostholm L, Rosendal M. Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study. JMIR Hum Factors 2023; 10:e42572. [PMID: 36753312 PMCID: PMC9947758 DOI: 10.2196/42572] [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] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Patients with persistent physical symptoms presenting in primary care are often affected by multiple symptoms and reduced functioning. The medical and societal costs of these patients are high, and there is a need for new interventions tailored to both the patients and health care system. OBJECTIVE This study aimed to examine the usability of an unguided, self-help treatment program, "My Symptoms," developed to assist patients and general practitioners in symptom management. METHODS In all, 11 users (4 patients with persistent physical symptoms and 7 laypeople) participated in web-based thinking-aloud interviews involving the performance of predefined tasks in the program. Thematic analysis was used to categorize the severity of usability issues. General usability heuristics were cross-referenced with the usability issues. RESULTS The analysis identified important usability issues related to functionality, navigation, and content. The study shows how therapeutic knowledge in some cases was lost in the translation of face-to-face therapy to a digital format. The user testing helped uncover how the functionality of the digital elements and general navigation of the program played a huge part in locating and accessing the needed treatment. Examples of redesign to mediate the therapeutic value in the digital format involving health care professionals, web developers, and users are provided. The study also highlights the differences of involving patients and laypeople in the interviews. CONCLUSIONS Taking the experience of common symptoms as a point of departure, patients and laypeople contributed to finding usability issues on program functionality, navigation, and content to improve the program and make the treatment more accessible to users.
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Affiliation(s)
| | - Leonora Hedegaard
- Department of Culture and Learning, Aalborg University, Aalborg, Denmark
| | - Mette Trøllund Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Jane Clemensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marianne Rosendal
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark.,Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Jagannath AD, Dreicer JJ, Penner JC, Dhaliwal G. The cognitive apprenticeship: advancing reasoning education by thinking aloud. Diagnosis (Berl) 2023; 10:9-12. [PMID: 36450097 DOI: 10.1515/dx-2022-0043] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022]
Abstract
Teaching clinical reasoning has long challenged educators because it requires familiarity with reasoning concepts, experience with describing thinking, and comfort with exposing uncertainty and error. We propose that teachers adopt the cognitive apprenticeship model and a method of disclosing uncertainty known as intellectual streaking. These approaches reflect a shift in the educator's mindset from transmitting medical knowledge to broadcasting cognition. We provide several examples to guide the adoption of these strategies and make recommendations for teachers and training programs to improve the teaching of clinical reasoning.
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Affiliation(s)
- Anand D Jagannath
- Division of Hospital Medicine, VA Portland Healthcare System, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jessica J Dreicer
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - John C Penner
- Medical Service, VA San Francisco Healthcare System, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gurpreet Dhaliwal
- Medical Service, VA San Francisco Healthcare System, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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8
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Abdulmohdi N, Mcvicar A. Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study. J Adv Nurs 2023; 79:811-824. [PMID: 36412270 PMCID: PMC10099619 DOI: 10.1111/jan.15507] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario. DESIGN A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. METHODS Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher. RESULTS There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. CONCLUSION Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.
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Affiliation(s)
- Naim Abdulmohdi
- School of Nursing and Midwifery, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Andrew Mcvicar
- School of Nursing and Midwifery, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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Bösch VD, Warner LM, Nyman SR, Haftenberger J, Clarke K, Inauen J. What do older adults think about when formulating implementation intentions for physical activity? Evidence from a qualitative study. Br J Health Psychol 2023; 28:221-236. [PMID: 36000441 PMCID: PMC10087560 DOI: 10.1111/bjhp.12621] [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: 10/22/2021] [Accepted: 08/10/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Physical activity is an important health behaviour especially for older adults. Forming implementation intentions is an effective strategy to implement physical activity in daily life for young and middle-aged adults. However, evidence for older adults is inconclusive. This study explored the thoughts of older adults about implementation intentions and potential barriers and facilitators while formulating them. METHODS Three samples of older adults from the United Kingdom (n = 8), Germany (n = 9) and Switzerland (n = 17) were prompted to think aloud while formulating implementation intentions to be more physically active. After the task, semi-structured interviews were conducted. Data were analysed thematically. RESULTS Participants expressed pre-established thoughts about implementation intentions (e.g. they feel too restrictive). During the formulation of implementation intentions, several barriers to creating them were reported (e.g. problems with finding cues due to absence of recurring daily routines), but participants also mentioned that forming implementation intentions acted as a facilitator for physical activity (e.g. cues as useful reminders to be active, task itself triggering self-reflection about physical activity). After the task, participants reflected on circumstances that decrease the likelihood of enacting implementation intentions (e.g. spontaneous alternative activities, weather, health-related barriers, Covid-19-related barriers), which triggered spontaneous coping planning. CONCLUSIONS The results on barriers and facilitators of implementation intentions and physical activity from older adults' perspectives provide starting points for improving instructions for older adults on how to create implementation intentions for physical activity. Future studies are needed to investigate whether the findings extend to implementation intentions for other behaviours.
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Affiliation(s)
- Valérie Désirée Bösch
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Lisa Marie Warner
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Samuel R Nyman
- Bournemouth University Clinical Research Unit, Department of Medical Science & Public Health, Bournemouth University, Bournemouth, UK
| | | | - Kye Clarke
- Department of Psychology, Bournemouth University, Poole, UK
| | - Jennifer Inauen
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
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Morse B, Anstett T, Mistry N, Porter S, Pincus S, Lin CT, Novins-Montague S, Ho PM. User-Centered Design to Reduce Inappropriate Blood Transfusion Orders. Appl Clin Inform 2023; 14:28-36. [PMID: 36630999 PMCID: PMC9833954 DOI: 10.1055/s-0042-1759866] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To improve blood transfusion practices, we applied user-centered design (UCD) to evaluate potential changes to blood transfusion orders. OBJECTIVES The aim of the study is to build effective transfusion orders with different designs to improve guideline adherence. METHODS We developed three different versions of transfusion orders that varied how information was presented to clinicians ordering blood transfusions. We engaged 14 clinicians (residents, advanced practice providers [APPs], and attending physicians) from different specialties. We used the think aloud technique and rapid qualitative analysis to generate themes to incorporate into our modified orders. RESULTS Most end-users who participated in the semi-structured interviews preferred the interruptive alert design plus behavioral nudges (n = 8/14, 57%). The predominant rationale was that the in-line alert was not visually effective in capturing the end-user's attention, while the interruptive alert forced a brief stop in the workflow to consider the guidelines. All users supported the general improvements, though for different reasons, and as a result, the general improvements remained in the designs for the forthcoming trial. CONCLUSION The user experience uncovered through the think aloud approach produced a clear and rich understanding of potentially confounding factors in the initial design of different intervention versions. Input from end-users guided the creation of all three designs so each was addressing human factors with parity, which ensured that the results of our study reflected differences in interruptive properties of the alerts and not differences in design.
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Affiliation(s)
- Brad Morse
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States,Address for correspondence Brad Morse, PhD, MA Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine1890 N Revere Ct, Aurora, CO 80045United States
| | - Tyler Anstett
- Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Neelam Mistry
- Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Samuel Porter
- Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Sharon Pincus
- Adult & Child Center for Outcomes Research & Delivery Science/The NavLab, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Chen-Tan Lin
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Sylvie Novins-Montague
- Adult & Child Center for Outcomes Research & Delivery Science/The NavLab, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - P. Michael Ho
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
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Johansen SK, Kanstrup AM, Thomsen JL, Christensen MN, Rathleff MS. Exploring the barriers and facilitators for supporting adolescents with knee pains adherence to mobile health apps: A think-aloud study. Digit Health 2023; 9:20552076231205750. [PMID: 37868153 PMCID: PMC10588423 DOI: 10.1177/20552076231205750] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Mobile health (mHealth) applications have the potential to support adolescents' self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents. Objective This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles. Methods Think-aloud tests were conducted with 12 adolescents (aged 12.5 years median) with knee pain, using a low-fidelity prototype. The prototype was informed by the authors previous work, rapid prototyping sessions with seven health professionals, and synthesis via the Behavioral Intervention Technology Model. The think-aloud tests were video recorded and analyzed thematically to identify design principles. Results The analysis based on user testing with adolescents with knee pain identified three themes: "user experience and feedback," "contextual challenges," and "new features" and nine subthemes. Adolescents were able to use mHealth behavioral features such as self-tracking, goal setting, education, and data visualization to capture and reflect on their knee pain developments, which facilitated use. However, adolescents struggle with timing interventions, breaking down management behaviors, and biases towards interventions were identified as internal threats to adherence. Competing activities, parental meddling, and privacy concerns were external adherence barriers. Twelve design principles were identified for integrating these insights into mHealth designs. Conclusion Participants' motivations for adherence were influenced by internal and external factors. While adolescents were able to use mHealth behavioral features to capture and reflect on knee pain developments, understanding how to accommodate adolescents' cognitive abilities, competing activities, and need for independence is quintessential to enhance adherence in everyday contexts.
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Affiliation(s)
- Simon Kristoffer Johansen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
| | | | - Janus Laust Thomsen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
| | - Mads Norre Christensen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice (CAM-AAU), Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gistrup, Northern Jutland, Denmark
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12
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Reckers-Droog V, Karimi M, Lipman S, Verstraete J. Why Do Adults Value EQ-5D-Y-3L Health States Differently for Themselves Than for Children and Adolescents: A Think-Aloud Study. Value Health 2022; 25:1174-1184. [PMID: 35168891 DOI: 10.1016/j.jval.2021.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Following protocol, adults value EQ-5D-Y-3L health states from the perspective of a 10-year-old child. It remains unclear why adults value health states differently for themselves than for a 10-year-old child and whether the latter perspective is representative of adults' preferences for the 8 to 15 years age range of the EQ-5D-Y-3L. This study examines the reasons underlying (potential) differences in adults' health-state preferences for themselves, a 10-year-old child, and 15-year-old adolescent. METHODS We conducted semistructured interviews using a think-aloud protocol with 25 participants who performed valuation tasks in July 2020 to August 2020. Using the Framework Method, we developed 28 categories grouped under 5 themes that illustrated the differences emerging from the interviews. RESULTS Participants (A) deemed it more straining to perform valuation tasks for a 10-year-old child and 15-year-old adolescent than for themselves, (B) had a stable self-image, but varied in whom they imagined as 10-year-old child and 15-year-old adolescent, (C) focused on different dimensions and levels for a 15-year-old adolescent than for a 10-year-old child and themselves, (D) had various thoughts about nonhealth-related factors that influenced their preferences, and (E) gave up relatively few life-years for a 10-year-old child and 15-year-old adolescent, also to avoid others bearing a grudge against them. CONCLUSIONS Our results indicate that differences in adults' health-state preferences for themselves and a 10-year-old child largely result from differences in thoughts about nonhealth-related factors. They further indicate that health-state preferences for a 10-year-old child may not be representative of such preferences for the full EQ-5D-Y-3L age range.
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Affiliation(s)
- Vivian Reckers-Droog
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Milad Karimi
- OPEN Health Evidence & Access, Rotterdam, The Netherlands
| | - Stefan Lipman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Janine Verstraete
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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13
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Jabbour J, Dhillon HM, Shepherd HL, Sundaresan P, Milross C, Clark JR. A web-based comprehensive head and neck cancer patient education and support needs program: Usability testing. Health Informatics J 2022; 0:14604582221087128. [PMID: 35362344 DOI: 10.1177/14604582221087128] [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: 12/24/2022]
Abstract
Background: With increasing accessibility of the World Wide Web, patients are using it to obtain patient education materials (PEM). With this in mind, our group (surgeons, radiation oncologists, medical oncologists, nursing, allied health professionals and academic researchers) developed a comprehensive information resource for patients with head and neck cancer (HNC), the Head and Neck Cancer Australia, formerly Beyond Five website. The aim of this study was to determine patient usability of the Head and Neck Cancer Australia website. Methods: Usability testing (Cognitive walkthrough & Think-Aloud) in 18 patients treated for HNC was undertaken at a Cancer centre (anonymous for reviewers). Results: The tasks rated easiest by patients were finding information on psychological well-being (mean time spent: 66 s, range: 10-565), health and well-being effecting quality of life (mean time spent: 36 s, range 9-117) and carer information (mean time spent: 10 s, range 3-35). Patients indicated the website contained a lot of information, covers most topics, was a trusted source of information and a springboard to other information. Conclusions: The Head and Neck Cancer Australia website provides a wide range of information and support in multiple formats available to HNC patients. Further refinements in design, navigation and website instructions are needed to allow effective patient interaction.
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Affiliation(s)
- Joe Jabbour
- Central Clinical School, 4334University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, 4334The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-making, 4334The University of Sydney, Camperdown, NSW, Australia
| | - Heather L Shepherd
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, 4334The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-making, 4334The University of Sydney, Camperdown, NSW, Australia
| | - Puma Sundaresan
- Department of Radiation Oncology and Medical Services,10138Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,200123Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Chris Milross
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia.,Department of Radiation Oncology and Medical Services, 10138Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Central Clinical School, 4334University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, 10138Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,South West Clinical School, University of New South Wales, NSW, Australia
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14
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Lim L, Bannert M, van der Graaf J, Molenaar I, Fan Y, Kilgour J, Moore J, Gašević D. Temporal Assessment of Self-Regulated Learning by Mining Students' Think-Aloud Protocols. Front Psychol 2021; 12:749749. [PMID: 34803832 PMCID: PMC8601160 DOI: 10.3389/fpsyg.2021.749749] [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: 07/29/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
It has been widely theorized and empirically proven that self-regulated learning (SRL) is related to more desired learning outcomes, e.g., higher performance in transfer tests. Research has shifted to understanding the role of SRL during learning, such as the strategies and learning activities, learners employ and engage in the different SRL phases, which contribute to learning achievement. From a methodological perspective, measuring SRL using think-aloud data has been shown to be more insightful than self-report surveys as it helps better in determining the link between SRL activities and learning achievements. Educational process mining on the basis of think-aloud data enables a deeper understanding and more fine-grained analyses of SRL processes. Although students’ SRL is highly contextualized, there are consistent findings of the link between SRL activities and learning outcomes pointing to some consistency of the processes that support learning. However, past studies have utilized differing approaches which make generalization of findings between studies investigating the unfolding of SRL processes during learning a challenge. In the present study with 29 university students, we measured SRL via concurrent think-aloud protocols in a pre-post design using a similar approach from a previous study in an online learning environment during a 45-min learning session, where students learned about three topics and wrote an essay. Results revealed significant learning gain and replication of links between SRL activities and transfer performance, similar to past research. Additionally, temporal structures of successful and less successful students indicated meaningful differences associated with both theoretical assumptions and past research findings. In conclusion, extending prior research by exploring SRL patterns in an online learning setting provides insights to the replicability of previous findings from online learning settings and new findings show that it is important not only to focus on the repertoire of SRL strategies but also on how and when they are used.
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Affiliation(s)
- Lyn Lim
- TUM School of Education, Technical University of Munich, Munich, Germany
| | - Maria Bannert
- TUM School of Education, Technical University of Munich, Munich, Germany
| | - Joep van der Graaf
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Inge Molenaar
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Yizhou Fan
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathan Kilgour
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Johanna Moore
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Dragan Gašević
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Learning Analytics, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
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15
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Saldaris J, Weisenberg J, Pestana-Knight E, Marsh ED, Suter B, Rajaraman R, Heidary G, Olson HE, Devinsky O, Price D, Jacoby P, Leonard H, Benke TA, Demarest S, Downs J. Content Validation of Clinician-Reported Items for a Severity Measure for CDKL5 Deficiency Disorder. J Child Neurol 2021; 36:998-1006. [PMID: 34378447 PMCID: PMC8458223 DOI: 10.1177/08830738211019576] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CDKL5 deficiency disorder (CDD) results in early-onset seizures and severe developmental impairments. A CDD clinical severity assessment (CCSA) was previously developed with clinician and parent-report items to capture information on a range of domains. Consistent with US Food and Drug Administration (FDA) guidelines, content validation is the first step in evaluating the psychometric properties of an outcome measure. The aim of this study was to validate the content of the clinician-reported items in the CCSA (CCSA-Clinician). Eight neurologists leading the USA CDD Center of Excellence clinics were interviewed using the "think aloud" technique to critique 26 clinician-reported items. Common themes were aggregated, and a literature search of related assessments informed item modifications. The clinicians then participated in 2 consensus meetings to review themes and finalize the items. A consensus was achieved for the content of the CCSA-Clinician. Eight of the original items were omitted, 11 items were added, and the remaining 18 items were revised. The final 29 items were classified into 2 domains: functioning and neurologic impairments. This study enabled refinement of the CCSA-Clinician and provided evidence for its content validity. This preliminary validation is essential before field testing and further validation, in order to advance the instrument toward clinical trial readiness.
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Affiliation(s)
| | - Judith Weisenberg
- St. Louis Children’s Hospital and Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Eric D. Marsh
- Division of Neurology, Children’s Hospital of Philadelphia and School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bernhard Suter
- Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas, USA
| | | | - Gena Heidary
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Heather E. Olson
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Orrin Devinsky
- NYU Langone Health and Department of Neurology, New York University, New York, New York, USA
| | - Dana Price
- NYU Langone Health and Department of Neurology, New York University, New York, New York, USA
| | - Peter Jacoby
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, Perth, Western Australia, Australia,The University of Western Australia, Perth, Western Australia, Australia
| | - Tim A. Benke
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Scott Demarest
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jenny Downs
- Telethon Kids Institute, Perth, Western Australia, Australia,The School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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16
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Myhre EL, Garnweidner-Holme L, Dahl B, Reigstad MM, Lukasse M. Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study. JMIR Form Res 2021; 5:e28698. [PMID: 34569940 PMCID: PMC8506263 DOI: 10.2196/28698] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/21/2021] [Accepted: 08/01/2021] [Indexed: 01/30/2023] Open
Abstract
Background The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users’ experiences with the website to increase its user-friendliness. Methods We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website’s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants’ feedback on the website. Results Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants’ experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website’s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no.
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Affiliation(s)
- Enid Leren Myhre
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Marte Myhre Reigstad
- Norwegian Research Centre for Women's Health, Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
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17
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Derksen ME, Jaspers MW, van Strijp S, Fransen MP. Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study. JMIR Form Res 2021; 5:e24112. [PMID: 34346895 PMCID: PMC8374659 DOI: 10.2196/24112] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/26/2020] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Background Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing.
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Affiliation(s)
- Marloes E Derksen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Monique Wm Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Strijp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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18
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Dornonville de la Cour FL, Norup A, Schow T, Andersen TE. Evaluation of Response Processes to the Danish Version of the Dutch Multifactor Fatigue Scale in Stroke Using the Three-Step Test-Interview. Front Hum Neurosci 2021; 15:642680. [PMID: 34025374 PMCID: PMC8134536 DOI: 10.3389/fnhum.2021.642680] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Validated self-report measures of post-stroke fatigue are lacking. The Dutch Multifactor Fatigue Scale (DMFS) was translated into Danish, and response process evidence of validity was evaluated. DMFS consists of 38 Likert-rated items distributed on five subscales: Impact of fatigue (11 items), Signs and direct consequences of fatigue (9), Mental fatigue (7), Physical fatigue (6), and Coping with fatigue (5). Response processes to DMFS were investigated using a Three-Step Test-Interview (TSTI) protocol, and data were analyzed using Framework Analysis. Response processes were indexed on the following categories: (i) "congruent," response processes were related to the subscale construct; (ii) "incongruent," response processes were not related to the subscale construct; (iii) "ambiguous," response processes were both congruent and incongruent or insufficient to evaluate congruency; and (iv) "confused," participants did not understand the item. Nine adults were recruited consecutively 10-34 months post-stroke (median = 26.5) at an outpatient brain injury rehabilitation center in 2019 [five females, mean age = 55 years (SD = 6.3)]. Problematic items were defined as <50% of response processes being congruent with the intended construct. Of the 38 items, five problematic items were identified, including four items of Physical fatigue and one of Mental fatigue. In addition, seven items posed various response difficulties to some participants due to syntactic complexity, vague terms, a presupposition, and a double-barrelled statement. In conclusion, findings elucidate the interpretative processes involved in responding to DMFS post-stroke, strengthen the evidence base of validity, and guide revisions to mitigate potential problems in item performance.
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Affiliation(s)
- Frederik L Dornonville de la Cour
- BOMI Brain Injury Rehabilitation Center, Roskilde, Denmark.,Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anne Norup
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark
| | - Trine Schow
- BOMI Brain Injury Rehabilitation Center, Roskilde, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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19
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Szinay D, Perski O, Jones A, Chadborn T, Brown J, Naughton F. Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study. JMIR Mhealth Uhealth 2021; 9:e27173. [PMID: 33904827 PMCID: PMC8114158 DOI: 10.2196/27173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people's experiences of them. OBJECTIVE The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. METHODS A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. RESULTS Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants' capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual's needs. CONCLUSIONS The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations.
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Affiliation(s)
- Dorothy Szinay
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Andy Jones
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Tim Chadborn
- Behavioural Insights, Public Health England, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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20
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Ottolini MC, Chua I, Campbell J, Ottolini M, Goldman E. Pediatric Hospitalists' Performance and Perceptions of Script Concordance Testing for Self-Assessment. Acad Pediatr 2021; 21:252-258. [PMID: 33065290 DOI: 10.1016/j.acap.2020.10.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The cognitive expertise of Pediatric Hospitalists (PH) lies not in standard knowledge but in making decisions under conditions of uncertainty. To maintain expertise, PH should engage in deliberate practice via self-assessments that promote higher-level cognitive processes necessary to address problems with missing or ambiguous information. Higher levels of cognition are purported with Script Concordance Test (SCT) questions compared to Multiple Choice Questions (MCQ). To determine if PH use higher levels of cognition when answering SCT versus MCQ questions and to analyze participants' perceptions of the utility of using SCT self-assessment for deliberate practice in addressing clinical problems encountered in daily practice. METHODS This is a mixed methods study comparing the cognitive level expressed according to Bloom's Taxonomy by PH answering MCQ versus SCT questions using a "think aloud" (TA) exercise, followed by qualitative analysis of interviews conducted afterward. RESULTS A significantly greater percentage of comments were coded as higher cognitive processes (apply, analyze, evaluate, and create) for SCT versus MCQ (74% vs 19%) compared with lower order (remember, understand); chi-square P < .00001. Analysis of interviews revealed 6 themes. CONCLUSION SCT questions elicited higher level cognition essential to clinical reasoning compared to MCQ questions. PH-indicated MCQ questions measure standard knowledge, while SCT questions better measure decision-making under conditions of uncertainty. PH-perceived SCT could be useful for deliberate practice in Pediatric Hospital Medicine decision-making if they could compare their rationale in answering questions with that of experts.
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Affiliation(s)
- Mary C Ottolini
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center (MC Ottolini), Portland, Maine.
| | - Ian Chua
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences (I Chua and J Campbell), Washington, DC
| | - Joyce Campbell
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine and Health Sciences (I Chua and J Campbell), Washington, DC
| | - Martin Ottolini
- Department of Pediatrics, Uniformed Services University of the Health Sciences (M Ottolini), Bethesda, Md
| | - Ellen Goldman
- George Washington University Graduate School of Education and Human Development, George Washington University School of Medicine and Health Sciences (E Goldman), Washington, DC
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21
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Fink L, Strassner C, Ploeger A. Exploring External Factors Affecting the Intention-Behavior Gap When Trying to Adopt a Sustainable Diet: A Think Aloud Study. Front Nutr 2021; 8:511412. [PMID: 33681270 PMCID: PMC7933023 DOI: 10.3389/fnut.2021.511412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/11/2019] [Accepted: 01/06/2021] [Indexed: 01/01/2023] Open
Abstract
Not least from an ecological and health perspective, it can be posited that a broader part of consumers should practice sustainable diets. People who are already willing to do so are often confronted with the intention-behavior gap, caused by a range of internal and external factors. To eliminate these barriers requires a deeper and more comprehensive understanding of these factors and their interplay. Therefore, a think aloud study with 20 adult German participants was conducted to explore the four chosen external factors of availability, education, advertising and price. Furthermore, questionnaires for all four factors were handed out and a follow-up interview was conducted to gain additional qualitative data. Results show that these four external factors seem to have a major impact on the intention-behavior relation. According to the participants all factors interact in some way with other internal and external factors, making practicing sustainable diets a complex activity. In conclusion, the four external factors availability, education, advertising and price need to be addressed by various stakeholders within our food systems in order to move forward in the process of making sustainable diets practicable and sustainable food systems firmly established.
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Affiliation(s)
- Leonie Fink
- Department of Food Nutrition Facilities, Münster University of Applied Sciences, Münster, Germany
- Faculty of Organic Agricultural Sciences, Specialized Partnerships in Sustainable Food Systems and Food Sovereignty, University of Kassel, Kassel, Germany
| | - Carola Strassner
- Department of Food Nutrition Facilities, Münster University of Applied Sciences, Münster, Germany
| | - Angelika Ploeger
- Faculty of Organic Agricultural Sciences, Specialized Partnerships in Sustainable Food Systems and Food Sovereignty, University of Kassel, Kassel, Germany
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Taak K, Brown J, Perski O. Exploring views on alcohol consumption and digital support for alcohol reduction in UK-based Punjabi-Sikh men: A think aloud and interview study. Drug Alcohol Rev 2020; 40:231-238. [PMID: 32964571 PMCID: PMC8436744 DOI: 10.1111/dar.13172] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS We aimed to explore UK-based Punjabi-Sikh men's views on: (i) alcohol consumption within the community; (ii) available support for alcohol reduction; and (iii) an evidence-informed alcohol reduction app. DESIGN AND METHODS Semi-structured interviews and a think aloud method were employed. Participants (n = 15) were male, aged 18-27 years, identified as Punjabi-Sikh, were hazardous or harmful drinkers (i.e. had an Alcohol Use Disorders Identification Test-Consumption score of ≥5) and interested in using an app to reduce drinking. Interviews were audio-recorded, transcribed verbatim and analysed with inductive thematic analysis. RESULTS Six themes were developed: (i) fear of drinking to cope; (ii) clash between religious and cultural norms (i.e. an internal conflict between important values); (iii) stigmatisation of mental health issues and lack of knowledge as barriers to help seeking; (iv) perceived usefulness of goal setting, monitoring and feedback (i.e. beliefs about the utility of the app's components for reducing drinking); (v) concerns about accessibility of the app within the Punjabi-Sikh community; and (vi) desire for human support for continued app engagement. DISCUSSION AND CONCLUSIONS Among UK-based, Punjabi-Sikh men, clashing religious and cultural norms give rise to internal conflict about drinking. Stigmatisation of mental health issues and lack of knowledge of available support leads to reduced help seeking. Respondents believed an evidence-informed alcohol reduction app could be useful, but were concerned about accessibility within the wider community and wanted an element of human support. The potential for a combination of digital and face-to-face support should be explored.
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Affiliation(s)
- Karamjeet Taak
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Olga Perski
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Natkunam T, Tristani L, Peers D, Fraser-Thomas J, Latimer-Cheung AE, Bassett-Gunter R. Using a think-aloud methodology to understand online physical activity information search experiences and preferences of parents of children and youth with disabilities. J Appl Res Intellect Disabil 2020; 33:1478-1488. [PMID: 32602211 DOI: 10.1111/jar.12775] [Citation(s) in RCA: 2] [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] [Received: 11/08/2019] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Internet is a preferred source of physical activity (PA) information. However, limited research exists regarding the experiences of parents of children and youth with disabilities (CYWD) in searching for PA programme information online. This research examined the experiences and preferences of parents of CYWD in searching for PA programme information online. METHOD Parents of CYWD (n = 10) participated in a think-aloud exercise while searching for PA programme information online. Following the think-aloud exercise, semi-structured interviews were used to further understand parents' experiences and preferences in searching for PA programme information online. RESULTS Parents identified key features that contributed to a positive online search experience. Additionally, parents noted challenges and resulting negative affect that was experienced. CONCLUSIONS This research can inform the development and dissemination of online PA programme information that is accessible and relevant to the preferences of parents of CYWD and can facilitate positive search experiences.
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Affiliation(s)
- Tharsheka Natkunam
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
| | - Lauren Tristani
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
| | - Danielle Peers
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Fraser-Thomas
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
| | - Amy E Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Rebecca Bassett-Gunter
- School of Kinesiology and Health Science, Faculty of Health York University, Toronto, ON, Canada
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Asiedu GB, Finney Rutten LJ, Agunwamba A, Bielinski SJ, St. Sauver JL, Olson JE, Rohrer Vitek CR. An assessment of patient perspectives on pharmacogenomics educational materials. Pharmacogenomics 2020; 21:347-358. [PMID: 32292118 PMCID: PMC7197106 DOI: 10.2217/pgs-2019-0175] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
Aim: Pharmacogenomics (PGx) holds potential to improve patient treatment; yet, effective patient educational materials are limited. Materials & methods: Using a 'think aloud' technique, we sought to understand comprehension and perceptions of a multimedia PGx results packet including a cover letter with QR code to an educational video, brochure and prototype report in the context of PGx case vignettes. Results: The cover letter and video components were viewed less favorably due to excess detail, complex jargon and technology challenges. Recommendations were to enhance comprehension and utility and to customize materials to each patient's medications or disease conditions. Conclusion: Educational materials were revised to improve comprehension and usability, and diminish concerns to better prepare patients to understand the importance of discussing test results with their provider.
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Affiliation(s)
- Gladys B Asiedu
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Lila J Finney Rutten
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Amenah Agunwamba
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jennifer L St. Sauver
- Robert D. & Patricia E. Kern Center for The Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Mazaheri Habibi MR, Khajouei R, Eslami S, Jangi M, Ghalibaf AK, Zangouei S. Usability testing of bed information management system: A think-aloud method. J Adv Pharm Technol Res 2019; 9:153-157. [PMID: 30637234 PMCID: PMC6302686 DOI: 10.4103/japtr.japtr_320_18] [Citation(s) in RCA: 5] [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] [Indexed: 11/04/2022] Open
Abstract
Not considering the usability in designing clinical information systems causes problems in human–computer interaction and patient dissatisfaction. Therefore, in this study, the usability of the bed information management system (BIMS) was examined by think-aloud method. This cross-sectional study was conducted on the BIMS in 50 noneducational hospitals. Participants consisted of three groups including users, facilitators, and technical support. To carry out the study, a scenario consisting of four tasks was designed. Three researchers analyzed the recorded files to identify the usability problems and their severity. The mean time of the evaluation process was 20:33 ± 4:47 s. The total number of the problems identifies by users was 80 cases. Data entry and layout problems with 38 (48%) and 33 (41%) cases were the most frequently found problems, respectively. About 61% and 55% of the data entry and layout problems had a minor severity (Severity 2), respectively. Furthermore, 43 (54%) cases of the problems were resolved by the users and 32 (40%) cases by the facilitator assistance. This study showed that a large number of the problems were due to the system poor design. Furthermore, by increasing the users’ level of knowledge about the system, it is possible to enhance user-system interaction. It is recommended that before designing and implementing a system, the system should be evaluated for usability, and the users should be educated in clinical information systems.
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Affiliation(s)
- Mohammad Reza Mazaheri Habibi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Health Information Management and Technology, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Majid Jangi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Kamel Ghalibaf
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Zangouei
- Department of Computer, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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26
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Pasterfield M, Clarke SA, Thompson AR. The development of a self-help intervention to build social confidence in people living with visible skin conditions or scars: a think-aloud study. Scars Burn Heal 2019; 5:2059513118822954. [PMID: 30675396 PMCID: PMC6330721 DOI: 10.1177/2059513118822954] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION People with a visible difference, such as scarring or a skin condition, can experience anxiety and intrusive reactions from others when in social situations. The use of products to conceal marks on the skin is provided in a number of different hospital services and by charities. However, there are relatively few psychosocial interventions available for these individuals. OBJECTIVES To examine the views of skin camouflage users and practitioners on the acceptability, usability and need for a specifically developed cognitive behavioural therapy (CBT) self-help booklet. METHODS A think-aloud protocol and descriptive form of thematic analysis were used to ascertain participants' views of this novel psychosocial intervention. Nine participants took part in think-aloud interviews that were analysed using thematic analysis. Six skin camouflage users and three skin camouflage practitioners participated in the study. RESULTS Support for the relevance, acceptability and usability of the booklet was found from both participants who used camouflage and those who provided it. However, some participants reported that they would envisage that some people would need additional support so as to be able to use the techniques described within the booklet. CONCLUSIONS This study represents an important step towards developing a brief self-help intervention for people with living with visible skin conditions or scars and demonstrates the importance of seeking feedback from experts by experience on theoretically informed psychological interventions for this patient group.
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Affiliation(s)
- Madeline Pasterfield
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
- North Bristol NHS Trust, Bristol, UK
| | | | - Andrew R Thompson
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Taylor S, Allsop MJ, Bennett MI, Bewick BM. Usability testing of an electronic pain monitoring system for palliative cancer patients: A think-aloud study. Health Informatics J 2017; 25:1133-1147. [PMID: 29172951 DOI: 10.1177/1460458217741754] [Citation(s) in RCA: 6] [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: 11/17/2022]
Abstract
Pain experienced by advanced cancer patients is often poorly controlled due to inadequate assessment. We aimed to test an electronic pain monitoring system (PainCheck) with advanced cancer patients and health professionals. In all, 29 participants (13 patients and 16 health professionals (n = 16)) used PainCheck while thinking their thoughts aloud. After the think aloud, both groups were asked about their experiences. Think-aloud and semi-structured interview data were analysed using framework analysis. Both groups were generally positive about PainCheck and found it easy to understand but they had concerns about clinical integration. Their concerns related to impact on workload, how lack of response may affect patient care and ability to engage with and use the technology. PainCheck has the capacity to be useful in clinical practice. For integration to be successful, patients and health professionals need guidance on how to use PainCheck and the expectations of users need to be clarified.
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Abstract
Bronchiolitis is the leading cause of morbidity and hospitalization in infants under the age of one year. Supportive treatments and regular assessment remain the mainstay of care for infants admitted to hospital. Nurses play an important role in the assessment of infants with bronchiolitis; however, this is not well described in the literature and consequently little is known about what strategies nurses employ in assessing infants with bronchiolitis. The aim of this study was to explore bronchiolitis assessment in the context of nursing practice. A naturalistic inquiry study was undertaken using think aloud and retrospective probing data collection methods. The results revealed that the information gathered by nurses in their assessment of infants with bronchiolitis was varied and the process of acquiring and evaluating this information was multifaceted and holistic in nature. A close partnership between the nurse and mother was identified, and the mother's expert knowledge and ability to identify subtle changes in the infant's clinical condition over time was essential to the assessment process. The assessment partnership with families provides nurses with the most comprehensive and holistic view of the infant's clinical condition and vital assessment information could be lost if this partnership does not occur.
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Affiliation(s)
- Clare Davies
- 1 Sydney Nursing School, University of Sydney, 88, Mallett Street, Camperdown, New South Wales, Australia
| | - Donna Waters
- 1 Sydney Nursing School, University of Sydney, 88, Mallett Street, Camperdown, New South Wales, Australia
| | - Andrea Marshall
- 2 NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
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29
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Crane D, Garnett C, Brown J, West R, Michie S. Factors Influencing Usability of a Smartphone App to Reduce Excessive Alcohol Consumption: Think Aloud and Interview Studies. Front Public Health 2017; 5:39. [PMID: 28421175 PMCID: PMC5376568 DOI: 10.3389/fpubh.2017.00039] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/20/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions delivered by smartphone apps have the potential to help drinkers reduce their consumption of alcohol. To optimize engagement and reduce the high rates of attrition associated with the use of digital interventions, it is necessary to ensure that an app's design and functionality is appropriate for its intended purposes and target population. AIMS To understand the usability of an app to help people reduce their alcohol consumption. METHOD The app, Drink Less, contains a core module focusing on goal setting, supplemented by five additional modules: self-monitoring and feedback, identity change, cognitive bias re-training, action planning, and social comparison. Two studies were conducted, a "think aloud" study performed with people using the app for the first time and a semistructured interview study performed after users had had access to the app for at least 2 weeks. A thematic analysis of the "think aloud" and interview transcripts was conducted by one coder and verified by a second. RESULTS Twenty-four participants, half of whom were women and half from disadvantaged groups, took part in the two studies. Three main themes identified in the data were "Feeling lost and unsure of what to do next," "Make the app easy to use," and "Make the app beneficial and rewarding to use." These themes reflected participants' need for (i) guidance, particularly when first using the app or when entering data; (ii) the data entry process to be simple and the navigation intuitive; (iii) neither the amount of text nor range of options to be overwhelming; (iv) the app to reward them for effort and progress; and (v) it to be clear how the app could help alcohol reduction goals be reached. CONCLUSION First-time and experienced users want an alcohol reduction app to be easy, rewarding, and beneficial to use. An easy-to-use app would reduce user burden, offer ongoing help, and be esthetically pleasing. A rewarding and beneficial app would provide positive reinforcement, give feedback about progress, and demonstrate credibility. Users need help when first using the app, and they need a compelling reason to continue using it.
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Affiliation(s)
- David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Abstract
UNLABELLED Construct: Clinical reasoning assessment is a growing area of interest in the medical education literature. Script concordance testing (SCT) evaluates clinical reasoning in conditions of uncertainty and has emerged as an innovative tool in the domain of clinical reasoning assessment. SCT quantifies the degree of concordance between a learner and an experienced clinician and attempts to capture the breadth of responses of expert clinicians, acknowledging the significant yet acceptable variation in practice under situations of uncertainty. BACKGROUND SCT has been shown to be a valid and reliable clinical reasoning assessment tool. However, as SCT provides only quantitative information, it may not provide a complete assessment of clinical reasoning. APPROACH Think aloud (TA) is a qualitative research tool used in clinical reasoning assessment in which learners verbalize their thought process around an assigned task. This study explores the use of TA, in the form of written reflection, in SCT to assess resident clinical reasoning, hypothesizing that the information obtained from the written TA would enrich the quantitative data obtained through SCT. Ninety-one pediatric postgraduate trainees and 21 pediatricians from 4 Canadian training centers completed an online test consisting of 24 SCT cases immediately followed by retrospective written TA. Six of 24 cases were selected to gather TA data. These cases were chosen to allow all phases of clinical decision making (diagnosis, investigation, and treatment) to be represented in the TA data. Inductive thematic analysis was employed when systematically reviewing TA responses. RESULTS Three main benefits of adding written TA to SCT were identified: (a) uncovering instances of incorrect clinical reasoning despite a correct SCT response, (b) revealing sound clinical reasoning in the context of a suboptimal SCT response, and (c) detecting question misinterpretation. CONCLUSIONS Written TA can optimize SCT by demonstrating when correct examinee responses are based on guessing or uncertainty rather than robust clinical rationale. TA can also enhance SCT by allowing examinees to provide justification for responses that otherwise would have been considered incorrect and by identifying questions that are frequently misinterpreted to avoid including them in future examinations. TA also has significant value in differentiating between acceptable variations in expert clinician responses and deviance associated with faulty rationale or question misinterpretation; this could improve SCT reliability. A written TA protocol appears to be a valuable tool to assess trainees' clinical reasoning and can strengthen the quantitative assessment provided by SCT.
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Affiliation(s)
- Alyssa Power
- a Department of Pediatrics , Alberta Children's Hospital , Calgary , Alberta , Canada
| | - Jean-Francois Lemay
- a Department of Pediatrics , Alberta Children's Hospital , Calgary , Alberta , Canada
| | - Suzette Cooke
- a Department of Pediatrics , Alberta Children's Hospital , Calgary , Alberta , Canada
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Mertens VC, Moser A, Verbunt J, Smeets R, Goossens M. Content Validity of the Credibility and Expectancy Questionnaire in a Pain Rehabilitation Setting. Pain Pract 2016; 17:902-913. [PMID: 27911035 DOI: 10.1111/papr.12543] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/22/2016] [Accepted: 10/16/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Content validity, the proper reflection of the concept to be measured, is yet unknown for the Credibility and Expectancy Questionnaire (CEQ). It is frequently used in pain rehabilitation because treatment expectancy is influential on the outcome. OBJECTIVE To test and improve the content validity of the CEQ in a sample of patients with chronic pain in different phases of their treatment. METHODS A qualitative observational study design using the Three-Step Test-Interview method was used. Therein, data collection, analyses, and adaptations occur iteratively. RESULTS Seventeen patients with chronic pain in different stages of treatment participated through convenience sampling from the mother sample of a randomized controlled trial. The main study parameter is content validity, which is defined as (1) interpretations and responses of the participants and (2) the identification of response problems operationalized, and resulting in changes in the CEQ. For patients waiting for treatment, the written instruction of the CEQ allowed different interpretations. After changing the instructions, the CEQ became an easy-to-understand and content-valid questionnaire. For patients who had already undergone treatment, changes regarding time frame and recall period were necessary to overcome interpretation and response problems to the CEQ. DISCUSSION After small changes, the CEQ appeared to be a content-valid measurement instrument for patients waiting for treatment. However, for patients who had already undergone treatment, the content validity of the CEQ was less, and considerable changes were necessary.
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Affiliation(s)
- Vera-Christina Mertens
- Research Unit INSIDE, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Albine Moser
- Department of Family Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Faculty of Healthcare, Research Programme Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Libra Rehabilitation and Audiology, Eindhoven/Weert, Maastricht, The Netherlands
| | - Mariëlle Goossens
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Psychological Sciences, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Holmstrup M, Jensen B, Burkart R, Levis M. Using a novel assessment of procedural proficiency provides medical educators insight into blood pressure measurement. Int J Med Educ 2016; 7:375-381. [PMID: 27864919 PMCID: PMC5116368 DOI: 10.5116/ijme.580b.2e4f] [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] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This investigation was performed to determine how students in a health sciences program utilize and explain techniques within blood pressure measurement using a novel assessment, and changes associated with greater curricular exposure. METHODS An exploratory, qualitative and quantitative study was conducted using a 'Think Aloud' design with protocol analysis. Following familiarization, participants performed the task of measuring blood pressure on a reference subject while stating their thought processes. A trained practitioner recorded each participant's procedural proficiency using a standardized rubric. There were 112 participants in the study with varying levels of curricular exposure to blood pressure measurement. RESULTS Four trends are noted. Specifically, a trend was observed wherein a marked increase in procedural proficiency with a plateau occurred (e.g. released cuff pressure 2-4 mmHg, 10%, 60%, 83%, 82%). Secondly, a trend was observed with improvement across groups (e.g. cuff placed snugly/smoothly on upper arm, 20%, 60%, 81%, and 91%). Other trends included a marked improvement with subsequent decrease, and an improvement without achieving proficiency (e.g. palpation of the brachial pulse, 5%, 90%, 81%, 68%, appropriate size cuff, 17%, 40%, 33%, 41%, respectively). Qualitatively, transcript interpretation resulted in a need for clarification in the way blood pressure procedure is instructed in the curriculum. CONCLUSIONS The current investigation provides a snapshot of proficiency in blood pressure assessment across a curriculum and highlights considerations for best instructional practices, including the use of Think Aloud. Consequently, medical educators should use qualitative and quantitative assessments concurrently to determine achievement of blood pressure skill proficiency.
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Affiliation(s)
- Michael Holmstrup
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA
| | - Brock Jensen
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA
| | - Rebecca Burkart
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA
| | - Malorie Levis
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA
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Bolle S, Romijn G, Smets EMA, Loos EF, Kunneman M, van Weert JCM. Older Cancer Patients' User Experiences With Web-Based Health Information Tools: A Think-Aloud Study. J Med Internet Res 2016; 18:e208. [PMID: 27457709 PMCID: PMC4977420 DOI: 10.2196/jmir.5618] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 02/07/2016] [Revised: 06/13/2016] [Accepted: 06/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients.
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Affiliation(s)
- Sifra Bolle
- Amsterdam School of Communication Research/ ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands.
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Bailey C, Kinghorn P, Orlando R, Armour K, Perry R, Jones L, Coast J. 'The ICECAP-SCM tells you more about what I'm going through': A think-aloud study measuring quality of life among patients receiving supportive and palliative care. Palliat Med 2016; 30:642-52. [PMID: 26819326 PMCID: PMC4931711 DOI: 10.1177/0269216315624890] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The ICECAP-Supportive Care Measure is a self-complete questionnaire developed to aid economic evaluation of supportive care interventions. AIM To determine the feasibility of completing ICECAP-Supportive Care Measure alongside EQ-5D-5L and ICECAP-A (generic measures used in economic evaluation) among patients receiving hospice care, close persons and healthcare professionals. DESIGN Participants were asked to 'think aloud' while completing ICECAP-Supportive Care Measure and two other generic measures used in economic evaluation, EQ-5D-5L and ICECAP-A, and then participate in a semi-structured interview. From verbatim transcripts, five raters identified the frequency of errors in comprehension, retrieval, judgement and response. Qualitative data were analysed using constant comparison. SETTING/PARTICIPANTS Eligible patients were identified from one UK hospice by a research nurse. Close persons and healthcare professionals were identified by the patient. In all, 72 semi-structured interviews were conducted with patients (n = 33), close persons (n = 22) and healthcare professionals (n = 17). RESULTS Patients and close persons reported that the ICECAP-Supportive Care Measure was most appropriate for measuring their quality of life. It appeared more meaningful, easier to complete and had fewest errors (3.9% among patients, 4.5% among close persons) compared to EQ-5D-5L (9.7% among patients, 5.5% among close persons). Healthcare professionals acknowledged the value of the ICECAP-Supportive Care Measure but had fewer errors in completing the EQ-5D-5L (3.5% versus 6.7%). They found it easier to complete because it focuses on observable health states. CONCLUSIONS The ICECAP-Supportive Care Measure is feasible to use and perceived as appropriate for evaluating palliative care interventions. Healthcare professionals with limited knowledge of the patient who act as proxy completers may find the measure difficult to complete.
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Affiliation(s)
- Cara Bailey
- Nursing Institute of Clinical Sciences, University of Birmingham, Birmingham, UK Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rosanna Orlando
- NIHR CLAHRC Wessex Methodological Hub, University of Southampton, Southampton, UK
| | - Kathy Armour
- Marie Curie Hospice-West Midlands, West Midlands, UK
| | - Rachel Perry
- Marie Curie Hospice-West Midlands, West Midlands, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Bucknall TK, Forbes H, Phillips NM, Hewitt NA, Cooper S, Bogossian F. An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration. J Adv Nurs 2016; 72:2482-94. [PMID: 27265550 DOI: 10.1111/jan.13009] [Citation(s) in RCA: 26] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. BACKGROUND Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. DESIGN A descriptive exploratory design. METHODS Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. RESULTS Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. CONCLUSIONS Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication.
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Affiliation(s)
- Tracey K Bucknall
- Deakin University Centre for Quality and Patient Safety, School of Nursing and Midwifery, Geelong, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Helen Forbes
- Deakin University Centre for Quality and Patient Safety, School of Nursing and Midwifery, Geelong, Victoria, Australia
| | - Nicole M Phillips
- Deakin University Centre for Quality and Patient Safety, School of Nursing and Midwifery, Geelong, Victoria, Australia
| | | | - Simon Cooper
- School of Nursing, Midwifery and Paramedicine, Federation University Australia, Victoria, Australia
| | - Fiona Bogossian
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
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Davies EL. Feasibility of the Prototype Willingness Model as the basis for school-delivered alcohol misuse prevention: A qualitative think-aloud study to explore acceptability of 'The Alcohol Smart Quiz' with adolescents and teachers. J Health Psychol 2016; 23:1196-1210. [PMID: 27247092 DOI: 10.1177/1359105316648481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/16/2022] Open
Abstract
This study sought feedback from teachers and adolescents on a novel intervention to reduce alcohol misuse based on the Prototype Willingness Model. A qualitative, think-aloud interview study was conducted with 17 adolescents aged 11-14 years and nine teachers. Transcripts were analysed using thematic analysis. Adolescents found the content of the intervention appealing and credible. Teachers welcomed the content and format as a means of generating discussion. 'Moderate' drinking appeared to be an acceptable message, although difficult to define. Enacting 'if-then' plans in real social situations might be challenging and representations of drinking on social media should be considered.
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Holmstrup ME, Verba SD, Lynn JS. Developing best practices teaching procedures for skinfold assessment: observational examination using the Think Aloud method. Adv Physiol Educ 2015; 39:283-287. [PMID: 26628650 DOI: 10.1152/advan.00044.2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Skinfold assessment is valid and economical; however, it has a steep learning curve, and many programs only include one exposure to the technique. Increasing the number of exposures to skinfold assessment within an undergraduate curriculum would likely increase skill proficiency. The present study combined observational and Think Aloud methodologies to quantify procedural and cognitive characteristics of skinfold assessment. It was hypothesized that 1) increased curricular exposure to skinfold assessment would improve proficiency and 2) the combination of an observational and Think Aloud analysis would provide quantifiable areas of emphasis for instructing skinfold assessment. Seventy-five undergraduates with varied curricular exposure performed a seven-site skinfold assessment on a test subject while expressing their thoughts aloud. A trained practitioner recorded procedural observations, with transcripts generated from audio recordings to capture cognitive information. Skinfold measurements were compared with a criterion value, and bias scores were generated. Participants whose total bias fell within ±3.5% of the criterion value were proficient, with the remainder nonproficient. An independent-samples t-test was used to compare procedural and cognitive observations across experience and proficiency groups. Additional curricular exposure improved performance of skinfold assessment in areas such as the measurement of specific sites (e.g., chest, abdomen, and thigh) and procedural (e.g., landmark identification) and cognitive skills (e.g., complete site explanation). Furthermore, the Think Aloud method is a valuable tool for determining curricular strengths and weaknesses with skinfold assessment and as a pedagogical tool for individual instruction and feedback in the classroom.
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Affiliation(s)
- Michael E Holmstrup
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, Pennsylvania
| | - Steven D Verba
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, Pennsylvania
| | - Jeffrey S Lynn
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, Pennsylvania
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Davies EL, Martin J, Foxcroft DR. Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study. JMIR Hum Factors 2015; 2:e13. [PMID: 27025403 PMCID: PMC4797700 DOI: 10.2196/humanfactors.4452] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/31/2015] [Accepted: 06/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM. Objective This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version. Methods A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50%). Transcripts were analyzed using thematic analysis. Results The following 3 main themes relating the acceptability of the intervention were identified: “challenging expectations of alcohol education”; “motivations for drinking or not drinking,” and “the inevitability of drinking.” Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. Conclusions An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people.
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Affiliation(s)
- Emma Louise Davies
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, United Kingdom.
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Rushton PW, Smith E, Miller WC, Vaughan K. Measuring wheelchair confidence among power wheelchair users: an adaptation of the WheelCon-M using focus groups and a think aloud process. Disabil Rehabil Assist Technol 2015; 12:39-46. [PMID: 26123759 DOI: 10.3109/17483107.2015.1063018] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to adapt the WheelCon-M, an outcome measure used to assess confidence with manual wheelchair use, into a version that is applicable for power wheelchair users (WheelCon-P). METHODS Adaptation of the WheelCon-M into the WheelCon-P occurred in two phases: (1) item modification was conducted using focus groups and (2) item refinement was done using a think aloud process. RESULTS The healthcare professionals (n = 12) were mostly female, mostly occupational therapists and practiced an average of 14 years. The power wheelchair users (n = 8) were 50% men with an average of 8 years of power wheelchair experience and a range of diagnoses. In phase 1, of the 63 WheelCon-M items, 6 remained the same, 18 were removed, 38 modified and 15 new items added to develop the WheelCon-P. In phase 2, 15 WheelCon-P items were refined. CONCLUSIONS This study resulted in the modification of the WheelCon-M into the WheelCon-P, a 59-item, self-report outcome measure designed to assess confidence with power wheelchair use. The next step in the evolution of this promising new measure is the assessment of its measurement properties. Implications for Rehabilitation The WheelCon-P is a new outcome measure designed to assess confidence with power wheelchair use. This study suggests that the items in this measure will be interpreted as intended.
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Affiliation(s)
- Paula W Rushton
- a School of Rehabilitation, Université de Montréal , Montréal , QC , Canada.,b Centre de réadaptation Marie Enfant, CHU Sainte-Justine , Montréal , QC , Canada
| | - Emma Smith
- c Rehabilitation Sciences Graduate Program, University of British Columbia , Vancouver , BC , Canada , and.,d GF Strong Rehabilitation Research Program , Vancouver , BC , Canada
| | - William C Miller
- c Rehabilitation Sciences Graduate Program, University of British Columbia , Vancouver , BC , Canada , and.,d GF Strong Rehabilitation Research Program , Vancouver , BC , Canada
| | - Kristine Vaughan
- d GF Strong Rehabilitation Research Program , Vancouver , BC , Canada
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Papageorgiou K, Vermeulen KM, Leijten FRM, Buskens E, Ranchor AV, Schroevers MJ. Valuation of depression co-occurring with a somatic condition: feasibility of the time trade-off task. Health Expect 2014; 18:3147-59. [PMID: 25393599 DOI: 10.1111/hex.12303] [Citation(s) in RCA: 5] [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] [Accepted: 10/14/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Health state valuations obtained from the general population are used for cost-utility analyses of health-care interventions. Currently, most studies have focused on valuations of somatic conditions, to a much lesser extent of mental states, that is, depression and even less on valuations of depression co-occurring with somatic conditions. OBJECTIVE We tested the feasibility of the time trade-off (TTO) task to elicit valuations for depression solitary or co-occurring with a somatic condition. Moreover, we explored person- and state-related factors that may affect valuations. DESIGN During semi-structured interviews, 10 individuals (five women, mean age: 36 years) used a TTO task to value vignettes describing mild and severe depression; and mild depression co-occurring with moderate and severe states of cancer, diabetes or heart disease. During valuations, participants were thinking aloud. Feasibility criteria were successful completion and difficulty/concentration (1-10); logical consistency of values; and comprehension of the TTO, based on qualitative analysis of think aloud data. Factors influencing valuations were generated from think aloud data. RESULTS Participants reported satisfactory levels of difficulty (mean: 1.9) and concentration (mean: 8.3) and assigned consistent values. Qualitative analysis revealed difficulties with imagining: living with depression for lifetime (n = 4); reaching the age of 80 (n = 6); and living with a somatic condition and mentally healthy (n = 6). Person- and state-related factors, for example perceived susceptibility to depression (n = 4), appeared to affect valuations. CONCLUSION Quantitative findings supported feasibility of the valuation protocol, yet qualitative findings indicated that certain task aspects should be readdressed. Factors influencing valuations can be explored to better understand valuations.
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Affiliation(s)
- Katerina Papageorgiou
- Section Health Psychology, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fenna R M Leijten
- Section Health Psychology, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Section Health Psychology, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maya J Schroevers
- Section Health Psychology, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
Consumer health technologies can educate patients about diabetes and support their self-management, yet usability evidence is rarely published even though it determines patient engagement, optimal benefit of any intervention, and an understanding of generalizability. Therefore, we conducted a narrative review of peer-reviewed articles published from 2009 to 2013 that tested the usability of a web- or mobile-delivered system/application designed to educate and support patients with diabetes. Overall, the 23 papers included in our review used mixed (n = 11), descriptive quantitative (n = 9), and qualitative methods (n = 3) to assess usability, such as documenting which features performed as intended and how patients rated their experiences. More sophisticated usability evaluations combined several complementary approaches to elucidate more aspects of functionality. Future work pertaining to the design and evaluation of technology-delivered diabetes education/support interventions should aim to standardize the usability testing processes and publish usability findings to inform interpretation of why an intervention succeeded or failed and for whom.
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Affiliation(s)
- Courtney R Lyles
- UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA, USA,
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Smith SG, Vart G, Wolf MS, Obichere A, Baker HJ, Raine R, Wardle J, von Wagner C. How do people interpret information about colorectal cancer screening: observations from a think-aloud study. Health Expect 2013; 18:703-14. [PMID: 23910930 PMCID: PMC5060830 DOI: 10.1111/hex.12117] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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] [Accepted: 07/17/2013] [Indexed: 01/25/2023] Open
Abstract
Background The English NHS Bowel Cancer Screening Programme biennially invites individuals aged 60–74 to participate in screening. The booklet, ‘Bowel Cancer Screening: The Facts' accompanies this invitation. Its primary aim is to inform potential participants about the aims, advantages and disadvantages of colorectal cancer screening. Objective To provide detailed commentary on how individuals process the information contained within ‘The Facts’ booklet. Design, setting and participants This study comprised of 18 interviews with individuals aged 45–60 and used a ‘think‐aloud’ paradigm in which participants read aloud the booklet. Participant utterances (verbal statements made in response to researcher‐led prompts) were transcribed and analysed using a combination of content and thematic analysis. Results A total of 776 coded utterances were analysed (mean = 43.1 per person; range = 8–95). While overall comprehension was satisfactory, several problem areas were identified such as the use of complex unfamiliar terminology and the presentation of numerical information. Specific sections such as colonoscopy risk information evoked negative emotional responses. Participants made several suggestions for ways in which comprehension might be improved. Conclusion Public perceptions of the NHS Bowel Cancer Screening Programme information materials indicated that specific aspects of the booklet were difficult to process. These materials may be an appropriate target to improve public understanding of the aims, benefits and disadvantages of colorectal cancer screening. These findings will contribute to a broader NIHR‐funded project that aims to design a supplementary ‘gist‐based’ information leaflet suitable for low literacy populations.
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Affiliation(s)
- Samuel G Smith
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Gemma Vart
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Austin Obichere
- Colorectal Unit, Department of Surgery, University College London Hospitals, London, UK
| | - Helen J Baker
- Community Health and Learning Foundation, Leicester, UK
| | | | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
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