Designing comprehensible healthcare public reports: An investigation of the use of narratives and tests of quality metrics to support healthcare public report sensemaking

A key challenge for designers of healthcare public reports is the development of a presentation format that accurately communicates the variability in the quality of care among healthcare systems. This study conducted in the United States explored whether presenting public report information within narratives and with tests of healthcare quality metrics supported the public report sensemaking process. The study involved 200 participants and employed a 2 (public report information presented in the standard format, presented within a narrative) * 2 (no tests of quality metrics added to standard report, metrics tests added) between-subjects experimental design. The participants viewed the scenario of a patient looking for dialysis facility-related information. They were then asked which dialysis facility they would choose for their care and their level of confidence in their choice. Subsequently, a knowledge quiz evaluating how the participants interpreted the information presented to them, the NASA-TLX workload survey, and a usability questionnaire were administered. The results showed that the probability of choosing the better facility from the perspective of the quality measures included in the report changed from 0.69 to 0.89 when information was presented within a narrative rather than with the standard public report format. The results also found a significantly higher comprehension score (M = 54.58, SD = 18.51) when information was presented within the narrative than when presented in the standard public report format (M = 44.57, SD = 25.13). When information was presented to the participants within a narrative, the narrative may have enabled the participants to visualize themselves as the person depicted in the narrative and this may have increased the perceived relevance of the quality measures. Total workload, mental demand and perceived usability were higher when information was presented within the narrative than when presented in the standard format. The high workload and mental demand may be due to the stress placed on the information processing channels while reading a narrative and the effort expended to relate it to the quality measures. They may also be markers of more deliberative decision making facilitated by the narratives. No significant effect of tests of quality metrics was found on the dependent variables of choice of the better healthcare facility, comprehension, and usability. There was also no significant effect of quality metrics tests on overall workload. However, the effect of quality metrics tests on the mental demand subscale of NASA-TLX was significant. Mental demand was higher without quality metrics tests than with quality metrics tests. No significant interaction was found between the two independent variables on the dependent variables of choice of the better healthcare facility, comprehension, workload, and usability. It is recommended that narratives be used to present public report information to support informed healthcare decisions.

Prediction of the use of mobile device interfaces in the progressive aging process with the model of Fitts' law

PURPOSE

As the population ages, so do the potential users of technology, and older adults' behaviors when using mobile device interfaces are becoming increasingly important. A representative model for detecting older adults' behaviors and performance on the use of mobile device interfaces is needed to provide individualized designs. This research aimed to investigate the applicability of the broadly used model of Fitts' law to detect the progressive changes in the use of mobile device interfaces in older adults. The effect of experience with using technology on performance on a Fitts task was also examined.

METHOD

A sample of 135 older adults was recruited to test the application of Fitts' model to the use of technology by older adult users. Each participant was asked to finish tasks at 9 levels of difficulty, from easy to difficult, in a multidirectional tapping task. Analysis of variance was employed to examine the effect of age on performance on the Fitts task, movement time, and the standard deviation of movement time. Stepwise regression was used to investigate how well age and technology use could predict performance on the Fitts task.

RESULT

Performance on the Fitts task was sensitive to the gradual changes in abilities with aging. Rather than the amount of experience in using technology, age was the stronger predictor of older adults' performance on the Fitts task. Additionally, compared with the younger groups, the users above 80 years old demonstrated significantly higher behavioral variation during the use of mobile device interfaces.

CONCLUSION

This research confirmed that Fitts' law is applicable to the evaluation of the effects of aging on the use of mobile device interfaces. Adults above the age of 80 years should be a major focus for special individualized interface design. This finding can inform future designers and researchers in the development of individualized interface designs for older adult users to enhance their user experiences of mobile device technology.

RELEVANCE TO INDUSTRY

Future designers and researchers can apply the finding on Fitts' law in this research to develop user-friendly interface designs for mobile technology for older adults and thereby improve their user experiences to enhance their independence and quality of life through the use of technology.

The design and methodology of a usability protocol for the management of medications by families for aging older adults

Background

Health research apps often do not focus on usability as a design priority. This is problematic when the population of interest is disproportionately underrepresented as users of mobile apps, especially observed with aging older adults (> = 75). Challenges with the adoption of health information technology (HIT) among this group are exacerbated by poor design and user interface/experience (UI/UX) choices. This protocol describes the testing and evaluation process of one HIT app for the family-based collaboration platform InfoSAGE.

Methods

We aim to recruit twenty subjects from both informal family-caregivers and aging older adults to examine the usability of the InfoSAGE mobile medication manager. Participants will be audio and visually recorded, in addition to the use of screen capture recordings, while ‘thinking aloud’ as they complete eight common use-case scenarios. Multiple independent reviewers will code video and audio recordings for thematic analysis and use problems will be evaluated. Success and failure of each scenario will be determined by completion of sub-events. Time-to-complete analysis will be used to ascertain the learning curve associated with the app.

Discussion

Frequently observed problem areas will be used as the basis of further evolution of the app, and will further inform generalized recommendations for the design of HIT apps for research and public use. This study aims to improve the model of development for dual user populations with dissimilar technological literacy to improve retention and use. Results of this study will form the foundation of a design framework for mobile health apps.

Green wave for cyclists: Users' perception and preferences

Several innovative measures in traffic control applied in Europe have successfully improved the comfort and safety of cycling, among which is the green waves for cyclists. Consecutive traffic lights are synchronised to create a green wave, increasing comfort and decreasing waiting times and related deliberate red-light running. This study focused on exploring the user acceptance of green wave systems and the user evaluation of six distinct interface designs (i.e. numeric-based countdown, dot-based vertical countdown, dot-based clockwise countdown, LED line, LED road surface, on-bike speed indicator). Results indicate a preference for three systems: numeric-based countdown, LED line and LED road surface. Results also show a significant influence of nationality on the evaluation of the interfaces. Based on our findings, we argue that the numeric-based countdown represents the most promising option for future adaptive green wave implementations. The outcomes of the present study represent a useful evidence and guidance for researchers, designers and decision makers in the field of green waves, mobility and traffic safety.

Tablet form factors and swipe gesture designs affect thumb biomechanics and performance during two-handed use

Tablet computers' hardware and software designs may affect upper extremity muscle activity and postures. This study investigated the hypothesis that forearm muscle activity as well as wrist and thumb postures differ during simple gestures across different tablet form factors and touchscreen locations. Sixteen adult (8 female, 8 male) participants completed 320 tablet gestures across four swipe locations, with various tablet sizes (8″ and 10"), tablet orientations (portrait and landscape), swipe orientations (vertical and horizontal), and swipe directions (medial and radial). Three-dimensional motion analysis and surface electromyography measured wrist and thumb postures and forearm muscle activity, respectively. Postures and muscle activity varied significantly across the four swipe locations (p < .0001). Overall, swipe location closest to the palm allowed users to swipe with a more neutral thumb and wrist posture and required less forearm muscle activity. Greater thumb extension and abduction along with greater wrist extension and ulnar deviation was required to reach the target as the target moved farther from the palm. Extensor Carpi Radialis, Extensor Carpi Ulnaris, Flexor Carpi Ulnaris, Extensor Policis Brevis, and Abductor Pollicis Longus muscle activity also increased significantly with greater thumb reach (p < 001). Larger tablet size induced greater Extensor Carpi Radialis, Extensor Carpi Ulnaris, Flexor Carpi Ulnaris, Flexor Carpi Radialis, and Abductor Pollicis Longus muscle activity (p < .0001). The study results demonstrate the importance of swipe locations and suggest that the tablet interface design can be improved to induce more neutral thumb and wrist posture along with lower forearm muscle load.

Multi-method laboratory user evaluation of an actionable clinical performance information system: Implications for usability and patient safety

INTRODUCTION

Electronic audit and feedback (e-A&F) systems are used worldwide for care quality improvement. They measure health professionals' performance against clinical guidelines, and some systems suggest improvement actions. However, little is known about optimal interface designs for e-A&F, in particular how to present suggested actions for improvement. We developed a novel theory-informed system for primary care (the Performance Improvement plaN GeneratoR; PINGR) that covers the four principal interface components: clinical performance summaries; patient lists; detailed patient-level information; and suggested actions. As far as we are aware, this is the first report of an e-A&F system with all four interface components.

OBJECTIVES

(1) Use a combination of quantitative and qualitative methods to evaluate the usability of PINGR with target end-users; (2) refine existing design recommendations for e-A&F systems; (3) determine the implications of these recommendations for patient safety.

METHODS

We recruited seven primary care physicians to perform seven tasks with PINGR, during which we measured on-screen behaviour and eye movements. Participants subsequently completed usability questionnaires, and were interviewed in-depth. Data were integrated to: gain a more complete understanding of usability issues; enhance and explain each other's findings; and triangulate results to increase validity.

RESULTS

Participants committed a median of 10 errors (range 8-21) when using PINGR's interface, and completed a median of five out of seven tasks (range 4-7). Errors violated six usability heuristics: clear response options; perceptual grouping and data relationships; representational formats; unambiguous description; visually distinct screens for confusable items; and workflow integration. Eye movement analysis revealed the integration of components largely supported effective user workflow, although the modular design of clinical performance summaries unnecessarily increased cognitive load. Interviews and questionnaires revealed PINGR is user-friendly, and that improved information prioritisation could further promote useful user action.

CONCLUSIONS

Comparing our results with the wider usability literature we refine a previously published set of interface design recommendations for e-A&F. The implications for patient safety are significant regarding: user engagement; actionability; and information prioritisation. Our results also support adopting multi-method approaches in usability studies to maximise issue discovery and the credibility of findings.

Interface design recommendations for computerised clinical audit and feedback: Hybrid usability evidence from a research-led system

BACKGROUND

Audit and Feedback (A&F) is a widely used quality improvement technique that measures clinicians' clinical performance and reports it back to them. Computerised A&F (e-A&F) system interfaces may consist of four key components: (1) Summaries of clinical performance; (2) Patient lists; (3) Patient-level data; (4) Recommended actions. There is a lack of evidence regarding how to best design e-A&F interfaces; establishing such evidence is key to maximising usability, and in turn improving patient safety.

AIM

To evaluate the usability of a novel theoretically-informed and research-led e-A&F system for primary care (the Performance Improvement plaN GeneratoR: PINGR).

OBJECTIVES

(1) Describe PINGR's design, rationale and theoretical basis; (2) Identify usability issues with PINGR; (3) Understand how these issues may interfere with the cognitive goals of end-users; (4) Translate the issues into recommendations for the user-centred design of e-A&F systems.

METHODS

Eight experienced health system evaluators performed a usability inspection using an innovative hybrid approach consisting of five stages: (1) Development of representative user tasks, Goals, and Actions; (2) Combining Heuristic Evaluation and Cognitive Walkthrough methods into a single protocol to identify usability issues; (3) Consolidation of issues; (4) Severity rating of consolidated issues; (5) Analysis of issues according to usability heuristics, interface components, and Goal-Action structure.

RESULTS

A final list of 47 issues were categorised into 8 heuristic themes. The most error-prone heuristics were 'Consistency and standards' (13 usability issues; 28% of the total) and 'Match between system and real world' (n=10, 21%). The recommended actions component of the PINGR interface had the most usability issues (n=21, 45%), followed by patient-level data (n=5, 11%), patient lists (n=4, 9%), and summaries of clinical performance (n=4, 9%). The most error-prone Actions across all user Goals were: (1) Patient selection from a list; (2) Data identification from a figure (both population-level and patient-level); (3) Disagreement with a system recommendation.

CONCLUSIONS

By contextualising our findings within the wider literature on health information system usability, we provide recommendations for the design of e-A&F system interfaces relating to their four key components, in addition to how they may be integrated within a system.

A validation study regarding a generative approach in choosing appropriate colors for impaired users

In many circumstances, concepts, ideas and emotions are mainly conveyed by colors. Color vision disorders can heavily limit the user experience in accessing Information Society. Therefore, color vision impairments should be taken into account in order to make information and services accessible to a broader audience. The task is not easy for designers that generally are not affected by any color vision disorder. In any case, the design of accessible user interfaces should not lead to to boring color schemes. The selection of appealing and harmonic color combinations should be preserved. In past research we investigated a generative approach led by evolutionary computing in supporting interface designers to make colors accessible to impaired users. This approach has also been followed by other authors. The contribution of this paper is to provide an experimental validation to the claim that this approach is actually beneficial to designers and users.

Development of a Mobile User Interface for Image-based Dietary Assessment

In this paper, we present a mobile user interface for image-based dietary assessment. The mobile user interface provides a front end to a client-server image recognition and portion estimation software. In the client-server configuration, the user interactively records a series of food images using a built-in camera on the mobile device. Images are sent from the mobile device to the server, and the calorie content of the meal is estimated. In this paper, we describe and discuss the design and development of our mobile user interface features. We discuss the design concepts, through initial ideas and implementations. For each concept, we discuss qualitative user feedback from participants using the mobile client application. We then discuss future designs, including work on design considerations for the mobile application to allow the user to interactively correct errors in the automatic processing while reducing the user burden associated with classical pen-and-paper dietary records.