A usability evaluation of the perceived user friendliness, accessibility, and inclusiveness of a personalized digital care pathway tool

OBJECTIVE

This study aimed to acquire insight into the perceived user friendliness, accessibility and inclusiveness of a personalized digital care pathway.

MATERIALS & METHODS

Usability of the tool was tested in an experimental setting. Mixed methods data collection consisted of scenario-based eye tracking tests in a web- or mobile-based prototype of the tool, followed by a questionnaire assessing user friendliness (System Usability Scale; SUS) and a structured interview. Inclusiveness was assessed by subgroup comparisons based on language proficiency, age and education level. Via purposive sampling a heterogeneous population of users (N = 24) was recruited. Eye tracking was used to measure gaze behavior.

RESULTS

Overall, participants were satisfied with the tool (scale 0-10, 7.5; SD = 1.29). User friendliness of the mobile version (68.3; SD = 21.6) was higher than the web version (50.9; SD = 17.3) measured by SUS score (0-100). With regard to accessibility, eye tracking scenarios showed that the menu bar was hard to find (17% mobile, 55% web). In all scenario's, information was found faster in the mobile version than the web version. Attention was easily drawn to images. Regarding inclusiveness of the tool, we found significantly longer completing time of the scenario tasks for low language proficiency (p-value = 0.029) and higher age subgroups (p-value = 0.049). Lower language proficiency scored a significant lower SUS score (p-value = 0.012).

CONCLUSIONS

Overall, user friendliness and accessibility were positively evaluated. Assessment of inclusiveness emphasized the need for tailoring digital tools to those with low language proficiency and/or an older age. Co-creation of digital care tools with users is therefore important to match users' needs, make tools easily understandable and accessible to all users, and ultimately result in better uptake and impact.

Internet-delivered cognitive behavioural therapy for insomnia disorder in depressed patients treated at an outpatient clinic for mood disorders: protocol of a randomised controlled trial

BACKGROUND

Major depression is a highly prevalent disorder causing severe personal distress, and high societal costs. Patients with depression often have comorbid insomnia disorder (ID) leading to even worse personal distress and worse treatment outcomes. Recent results from a non-randomised pilot study with internet-delivered Cognitive Behavioural Therapy (CBTi) for Insomnia (I-Sleep) added to regular depression care were promising regarding feasibility and initial effects on insomnia complaints and depression. However, no randomised controlled trial (RCT) has been performed yet to access the (cost-) effectiveness of I-Sleep for depression. Therefore, this protocol article presents the design of an RCT aimed to assess the (cost-) effectiveness of I-Sleep in addition to usual care for depression compared to usual care alone in depressed patients with a comorbid Insomnia Disorder (ID) treated at outpatient clinics for mood disorders.  METHODS /DESIGN: This is a multi-centre RCT with measurements at baseline and at 3, 6, 9, and 12 months of follow-up. Patients with depression and an ID are randomised to either I-Sleep treatment followed by regular depression care or to regular depression care alone. Our aim is to recruit one hundred and seventy-five patients from multiple outpatient clinics for mood disorders. The primary outcome is the change in depressive symptoms over 12 months of follow-up measured with the Patient Health Questionnaire (PHQ-9). Secondary outcomes are recovery from depression (PHQ-9), insomnia severity (Insomnia Severity Index, ISI), daily functioning (Work and Social Adjustment Scale, WSAS), general quality of life (EuroQol 5-level version, EQ-5D-5L), and societal costs (Adapted versions of the iMTA Productivity Cost Questionnaire, iPCQ and iMTA Medical Cost Questionnaire, iMCQ).

DISCUSSION

We hypothesize that the addition of I-Sleep to usual care will result in a significant improvement in depression treatment outcomes and quality of life as well as a decrease in healthcare and societal costs compared to usual care alone. This study is the first pragmatic RCT evaluating the effectiveness and cost-effectiveness of adding CBTi to usual care for depression.

TRIAL REGISTRATION

Netherlands Trial Register (NL8955). Registered on October 6^th2020. https://trialsearch.who.int/Trial2.aspx?TrialID=NL8955.

The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation

BACKGROUND

EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes.

METHODS

This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club.

DISCUSSION

The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs.

TRIAL REGISTRATION

ISRCTN81935608 . Registered on 16 June 2015.

Body mass index, waist circumference and skin-fold thickness in 12- to 14-year-old Dutch adolescents: differences between 2003 and 2011

OBJECTIVES

The aim of this study was to compare anthropometrics of 12- to 14-year-old Dutch adolescents attending lower levels of education in 2011 with adolescents measured in 2003.

METHODS

We used baseline data from two trials evaluating a school-based obesity prevention programme in 2003 (randomized controlled trial with 18 schools) and in 2011 (cluster controlled trial with 29 schools). We measured adolescents' body height and weight, skin-fold thickness, and waist circumference in 2003 (n = 1000; response rate 76%) and 2011 (n = 1898; response rate 86%). We used multivariable multilevel linear or logistic regression analyses stratifying for gender, ethnicity and prevocational education track (vocational or theoretical) where appropriate.

RESULTS

In boys, prevalence of overweight, waist circumference, triceps, biceps and subscapular skin-folds were significantly higher in 2011. This was also true for vocational girls, except for the subscapular skin-fold. Girls, attending the theoretical track, had a significantly larger waist circumference, but thinner subscapular and suprailiac skin-fold thickness in 2011.

CONCLUSIONS

The increased prevalence of overweight and obesity in Dutch adolescents attending prevocational education is worrisome.

TRIAL REGISTRATION NUMBER

Current Controlled Trials ISRCTN87127361 and Current Controlled Trials ISRCTN92755979.

Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: a pooled analysis of six European studies

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4-7 years); (ii) identify energy balance-related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long-term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers.

Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies

The current review aimed to systematically identify dietary, physical activity and sedentary behaviours in preschool children (4-6 years of age) that are prospectively related to overweight or obesity later in childhood. Prospective studies published between January 1990 and June 2010 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library. Studies examining the prospective association between at least one relevant behaviour measured during preschool period (children aged 4-6 years at baseline) in relation to at least one anthropometric measurement at follow-up (age <18 years) were included. Harvest plots were used to summarize the results and draw conclusions from the evidence. Of the 8,718 retrieved papers, 23 papers reporting on 15 different study samples were included in this review. Strong evidence was found for an inverse association between total physical activity and overweight. Moderate evidence was observed for a positive association between television viewing and overweight. Because of the heterogeneity in the assessed dietary behaviours, insufficient evidence was found for an association between dietary intake or specific dietary behaviours and overweight. These results suggest that interventions aiming to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group. However, despite the lack of evidence for dietary behaviours from the present review, future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight.