Integrated Home Monitoring and Compliance Optimization for Patients with Mechanical Circulatory Support Devices

Characteristics of Smart Health Ecosystems That Support Self-care Among People With Heart Failure: Scoping Review

BACKGROUND

The management of heart failure is complex. Innovative solutions are required to support health care providers and people with heart failure with decision-making and self-care behaviors. In recent years, more sophisticated technologies have enabled new health care models, such as smart health ecosystems. Smart health ecosystems use data collection, intelligent data processing, and communication to support the diagnosis, management, and primary and secondary prevention of chronic conditions. Currently, there is little information on the characteristics of smart health ecosystems for people with heart failure.

OBJECTIVE

We aimed to identify and describe the characteristics of smart health ecosystems that support heart failure self-care.

METHODS

We conducted a scoping review using the Joanna Briggs Institute methodology. The MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, and ACM Digital Library databases were searched from January 2008 to September 2021. The search strategy focused on identifying articles describing smart health ecosystems that support heart failure self-care. A total of 2 reviewers screened the articles and extracted relevant data from the included full texts.

RESULTS

After removing duplicates, 1543 articles were screened, and 34 articles representing 13 interventions were included in this review. To support self-care, the interventions used sensors and questionnaires to collect data and used tailoring methods to provide personalized support. The interventions used a total of 34 behavior change techniques, which were facilitated by a combination of 8 features for people with heart failure: automated feedback, monitoring (integrated and manual input), presentation of data, education, reminders, communication with a health care provider, and psychological support. Furthermore, features to support health care providers included data presentation, alarms, alerts, communication tools, remote care plan modification, and health record integration.

CONCLUSIONS

This scoping review identified that there are few reports of smart health ecosystems that support heart failure self-care, and those that have been reported do not provide comprehensive support across all domains of self-care. This review describes the technical and behavioral components of the identified interventions, providing information that can be used as a starting point for designing and testing future smart health ecosystems.

Social acceptance of serious games for physical and cognitive training in older adults residing in ambient assisted living environments

Aims

Although ambient assisted living (AAL) environments and serious games for healthcare have been proposed as solutions to meet the changing demographics, the two approaches are rarely combined. We present the development and empirical evaluation of two serious games for healthcare in AAL. The first uses a cooking scenario for training of cognitive functioning. The latter uses a gardening scenario and motion capture for training agility and endurance. As the frequent lack of social acceptance is a major challenge in consumer health technology, we integrated methods of technology acceptance research by means of the UTAUT2-model and intention to use into the evaluation.

Subject and methods

We developed both games utilizing user-centered and participatory design methods ranging from low-fidelity paper prototypes to usability and acceptance evaluations of functional prototypes. In the final evaluation, each game prototype was evaluated by 64 participants form different age groups.

Results

The results show that although performance decreases with age, the performance attained in the games is not decisive for social acceptance measured as intention to use. However, user diversity factors shape the evaluation of the games, and older people and people with low technical competence are in danger of being excluded from using serious games for healthcare.

Conclusion

Exercise games, if designed right, can mitigate the negative effects of demographic change. Nevertheless, user diversity needs must be considered to ensure that the games are usable and used by a broad audience. The article concludes with guidelines and open research questions for the design of serious games in AAL environments.

Unobtrusive Health Monitoring in Private Spaces: The Smart Home

With the advances in sensor technology, big data, and artificial intelligence, unobtrusive in-home health monitoring has been a research focus for decades. Following up our research on smart vehicles, within the framework of unobtrusive health monitoring in private spaces, this work attempts to provide a guide to current sensor technology for unobtrusive in-home monitoring by a literature review of the state of the art and to answer, in particular, the questions: (1) What types of sensors can be used for unobtrusive in-home health data acquisition? (2) Where should the sensors be placed? (3) What data can be monitored in a smart home? (4) How can the obtained data support the monitoring functions? We conducted a retrospective literature review and summarized the state-of-the-art research on leveraging sensor technology for unobtrusive in-home health monitoring. For structured analysis, we developed a four-category terminology (location, unobtrusive sensor, data, and monitoring functions). We acquired 912 unique articles from four relevant databases (ACM Digital Lib, IEEE Xplore, PubMed, and Scopus) and screened them for relevance, resulting in n=55 papers analyzed in a structured manner using the terminology. The results delivered 25 types of sensors (motion sensor, contact sensor, pressure sensor, electrical current sensor, etc.) that can be deployed within rooms, static facilities, or electric appliances in an ambient way. While behavioral data (e.g., presence (n=38), time spent on activities (n=18)) can be acquired effortlessly, physiological parameters (e.g., heart rate, respiratory rate) are measurable on a limited scale (n=5). Behavioral data contribute to functional monitoring. Emergency monitoring can be built up on behavioral and environmental data. Acquired physiological parameters allow reasonable monitoring of physiological functions to a limited extent. Environmental data and behavioral data also detect safety and security abnormalities. Social interaction monitoring relies mainly on direct monitoring of tools of communication (smartphone; computer). In summary, convincing proof of a clear effect of these monitoring functions on clinical outcome with a large sample size and long-term monitoring is still lacking.

Serious Motion-Based Exercise Games for Older Adults: Evaluation of Usability, Performance, and Pain Mitigation

Background

Many societies are facing demographic changes that challenge the viability of health and welfare systems. Serious games for health care and ambient assisted living (AAL) offer health benefits and support for older adults and may mitigate some of the negative effects of the demographic shift.

Objective

This study aimed to examine the acceptance of serious games to promote physical health in AAL environments. Since AAL environments are designed specifically to support independent living in older adults, we studied the relationship among age and user diversity, performance in the game, and overall usability and acceptance evaluation.

Methods

We developed a motion-based serious exercise game for prototypical AAL environments. In two evaluations, outside (n=71) and within (n=64) the AAL environment, we investigated the influence of age, gender, self-efficacy in interacting with technology, need for achievement on performance, effect of the game, usability evaluation of the game, and overall acceptance.

Results

Both games were evaluated as easy to use and fun to play. Both game interventions had a strong pain-mitigating effect in older adults (game 1: −55%, P=.002; game 2: −66%, P=.01).

Conclusions

Serious exercise games outside and inside AAL environments can contribute to individuals’ health and well-being and to the stability of health care systems.

Human Factors and User Experience Issues with Ventricular Assist Device Wearable Components: A Systematic Review

Ventricular Assist Devices (VADs) provide continuous mechanical circulatory support during in- and out-of-hospital care. However, limitations of the external wearable components influence patient quality of life. There is insufficient understanding of the issues with such components that combines a holistic viewpoint from both human factors and user (including patient and caregiver) experience perspectives. This paper comprehensively details the issues with VAD wearable systems and proposes a way for human-centered design to bridge the gap, addressing such issues synergistically. Through the review the authors investigated: the user issues caused by wearable components of VADs, and how human factors issues correlate to the VAD user experience. A Boolean search ("ventricular assist" AND "human factors" AND "experience") for peer-reviewed studies published between 2008 and 2018 returned 338 titles, with 35 relevant studies selected using a PRISMA process for inclusion in cross-study analysis and synthesis. This paper provides design recommendations for the issues found in the literature. Four key focus areas to inform the future design of VAD wearable components were identified-'Power Supply', 'Wearability and Travel Freedom', 'The Female Experience' and 'Intuitive Handling'. Using design to drive innovation could result in VAD wearable components which better meet or exceed users' quality of life goals.

Let's Talk about TEX-Understanding Consumer Preferences for Smart Interactive Textile Products Using a Conjoint Analysis Approach

Interactive textiles are reaching maturity. First technology augmented textiles in form of clothes and furnitures are becoming commercially available. In contrast to the close link between technological development and innovations, future users’ acceptance and usage of such interactive textiles has not been integrated sufficiently, yet. The current study investigates future users’ consumer behavior and acceptance of interactive textiles using a scenario-based conjoint analysis study, which was presented in an online questionnaire (n=324). Two prototypical interactive textiles were focused on: a smart jacket and a smart armchair. To assess the textile products, the participants had to choose the preferred product alternative consisting each of the acceptance-relevant factors “connectivity”, “input modality”, “feature range”, “usability”, and “ease of cleaning”and their respective levels. The results revealed that the “ease of cleaning” is the most important decision criterion for both textile devices (even more important for the smart jacket), followed by “feature range”, “connectivity”, and “usability”. In contrast, the “input modality” is perceived as least important. The study also identified user profiles based on the projected consumer behavior (“adopters”, “rejecters”, and “undecided”) for both products. Besides the differences in product evaluation and projected consumer behavior, the user groups are significantly influenced by the individual affinity to textiles (both products) and gender (smart jacket). The findings are used to derive design and communication guidelines referring to interactive textiles in order to incorporate users’ needs, wishes, and requirements into future products.

Telemedical versus conventional heart patient monitoring: a survey study with German physicians

OBJECTIVES

In this study, we explored crucial factors that explain a person's attitude toward and his or her assessment of telemedical systems. Special focus lies on the link between the perspective of physicians (telemedicine users) and technicians (telemedicine designers) to find potential barriers hindering the broad application of telemedical systems in hospitals and doctors' offices.

METHODS

A survey among medical professionals (n = 34), technical professionals (n = 39), and a control group (n = 44) was conducted. The collected data were assessed in terms of domain knowledge, attitudes toward telemedicine, and potential implementation barriers.

RESULTS

Participants favored the conventional method over telemedical monitoring in regards to privacy, security, and time efficiency. In contrast, telemedicine was preferred with reference to efficiency of data analysis, long-term care, and emergency adequacy. Significant differences between the professional groups were found regarding perceived cost effectiveness, patients' compliance, privacy protection, and false alarm sensitivity. Medical professionals exhibited the most reluctance toward using telemedical treatments.

CONCLUSIONS

The perceived drawbacks are attributed to a general uncertainty about the reliability of telemedical systems, in combination with concerns about personal data privacy, security, and loss of control. The reported fear of not being able to correctly use and handle the systems assumes a low usability of devices. To acquaint medical professionals with the benefits and limitations of telemedical systems, telemonitoring and tele-treatment should be included in the education of medical personnel at an early stage.

Privacy and data security in E-health: requirements from the user's perspective

In this study two currently relevant aspects of using medical assistive technologies were addressed-security and privacy. In a two-step empirical approach that used focus groups (n = 19) and a survey (n = 104), users' requirements for the use of medical technologies were collected and evaluated. Specifically, we focused on the perceived importance of data security and privacy issues. Outcomes showed that both security and privacy aspects play an important role in the successful adoption of medical assistive technologies in the home environment. In particular, analysis of data with respect to gender, health-status and age (young, middle-aged and old users) revealed that females and healthy adults require, and insist on, the highest security and privacy standards compared with males and the ailing elderly.