1
|
Schnoor K, Talboom-Kamp EPWA, Hajtić M, Chavannes NH, Versluis A. Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users. JMIR Hum Factors 2024; 11:e45115. [PMID: 38728071 PMCID: PMC11127139 DOI: 10.2196/45115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 01/02/2024] [Accepted: 03/20/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals' willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. OBJECTIVE This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. METHODS A qualitative method was used from a potential user's perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. RESULTS In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users' health and to maintain their health. CONCLUSIONS According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online.
Collapse
Affiliation(s)
- Kyma Schnoor
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Esther P W A Talboom-Kamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Zuyderland, Sittard-Geleen, Netherlands
| | - Muamer Hajtić
- Department of Medical informatics, University of Amsterdam, Amsterdam, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
2
|
Naranjo-Rojas A, Perula-de Torres LÁ, Cruz-Mosquera FE, Molina-Recio G. Usability of a mobile application for the clinical follow-up of patients with chronic obstructive pulmonary disease and home oxygen therapy. Int J Med Inform 2023; 175:105089. [PMID: 37172506 DOI: 10.1016/j.ijmedinf.2023.105089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Technological health tools (e-Health) may potentially facilitate the treatment of patients with chronic diseases through development of self-management and -care skills in patients and caregivers. However, these tools are usually marketed without prior analysis and without providing any context to final users, which frequently results in low adherence to their use. PURPOSE To determine the usability of and satisfaction toward a mobile app for the clinical monitoring of patients with chronic obstructive pulmonary disease (COPD) receiving oxygen therapy at home. METHODS This was a participative-qualitative study focused on final users-with direct intervention by patients and professionals-consisting of three phases as follows: (i) medium-fidelity mockups design, (ii) development of a usability test for each user profile, and (iii) assessment of the satisfaction level regarding the usability of the mobile app. A sample was established and selected through non-probability convenience sampling and was divided into two groups as follows: healthcare professionals (n = 13) and patients (n = 7). Each participant received a smartphone with mockup designs. The "think-aloud" method was applied in the usability test. Participants were audio recorded and the anonymous transcriptions were analyzed, highlighting fragments about mockups characteristics and the usability test. The difficulty level of the tasks was assessed with a scale from 1 (very easy) to 5 (too difficult), and task non-completion was considered a critical mistake. The satisfaction level related to test usability was assessed with a 4-score Likert scale ranging from 4 (totally agree) to 1 (totally disagree). RESULTS Regarding the difficulty level, >60% of professionals described most tasks as "very easy" and 70% of patients as "easy." No participant made critical mistakes and both groups reported a high satisfaction level regarding the usability variables. The patient and professionals group required 18 and 11 min to complete all tasks, respectively. CONCLUSIONS Participants described the app as intuitive and easy to use. The usability satisfaction results show a high level of satisfaction for both groups. This positive assessment and performance in user tests showed that the mobile application was able to be apprehended and used by participants in the circumstances of use in the usability tests. Usability evaluation through satisfaction surveys and qualitative data analysis allows for greater insight into the use of mobile applications in healthcare.
Collapse
Affiliation(s)
- Anisbed Naranjo-Rojas
- Universidad Santiago de Cali. Cali, Colombia, Faculty of Health, Health and Education Research Group (GINEYSA). Biomedicine doctoral program, University of cordoba, Spain.
| | - Luis Ángel Perula-de Torres
- Multiprofessional Teaching Unit for Family and Community Healthcare in the Districts of Cordoba and Guadalquivir. Maimonides Biomedical Research Institute of Córdoba. (IMIBIC), Hospital Universitario Reina Sofía, University of Córdoba, Spain
| | | | - Guillermo Molina-Recio
- Nursing, Pharmacology and Physiotherapy Department. University of Cordoba. Lifestyles, Innovation and Health (GA-16). Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
| |
Collapse
|
3
|
Niemann A, Hüer T, Neumann A, Wasem J, Schnell-Inderst P, Neusser S. Evaluation criteria for health apps supporting medication adherence in early-stage technology development - a scoping review. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2023; 21:Doc03. [PMID: 37260918 PMCID: PMC10227643 DOI: 10.3205/000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 06/02/2023]
Abstract
Introduction Health apps offer an approach to improve the patients' management of their medication. Although the Digital Healthcare Act (DVG) has created a claim in the statutory health insurance (SHI), the large number of health apps available and their varying quality make it difficult for service providers and especially for medical laypersons to select an adequate high-quality medication app. Manufacturers need guidance for the development of high-quality apps right from the start. Various general evaluation concepts for health apps have been available to date. However, the requirements that should be met by healthcare depend largely on the field of application and the type of apps. This article aims to provide an overview of the international evidence on specific criteria for the evaluation of medication apps. Methods Within the framework of a scoping review, a systematic search was conducted in PubMed and EMBASE on January 29, 2020. The search was limited to publications from 2007 onwards as well as to English and German articles. Additionally, a semi-systematic research of reference lists of the previously included articles as well as a structured search of websites of relevant stakeholders were conducted. Inclusion criteria were the following: the publication deals with health apps that can be used on smartphones and focus on supporting medication intake; the publication does not refer to evaluation criteria for a single app exclusively. The included publications were examined in a qualitative content analysis searching for evaluation criteria and categorizing them according to the framework criteria of the DVG and the Digital Health Applications Ordinance (DiGAV). Results 2,542 articles were identified in the systematic search (999 in PubMed, 1,543 in EMBASE, 560 duplicates). A total of 16 studies met the inclusion criteria. The semi-systematic research and the structured search identified one further study. A catalog of criteria was developed based on the included 17 studies. This catalog covers the general topics "patient orientation" (data protection and security, consumer protection, user friendliness) and "quality/core functions of medication apps" (reminder, self-monitoring, (drug) information, motivation to change behavior, drug/patient safety, robustness) as well as "interoperability/cooperation". Due to its specific importance for medication apps, the subcategory "motivation for behavioral change" stands out beneath the general topic "quality/core functions of medication apps". This category aims to evaluate the design of individual functions with regard to their potential to actually change the behavior of app users. Discussion The criteria for the evaluation of health apps mentioned in the DiGAV intersected with the criteria identified in the literature research. However, the area of positive health care effects was hardly covered by the included studies. In the development of the criteria catalog, it was not possible to weight the identified criteria. Therefore, the catalog should be understood as a supporting checklist for service providers, manufacturers, and/or users. Conclusions A large variety of possible evaluation criteria for medication apps could be shown. Future research should focus on the possibilities of weighting these diverse evaluation criteria, using not only clinical studies but also methods to identify preferences.
Collapse
Affiliation(s)
- Anja Niemann
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Theresa Hüer
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
| | - Silke Neusser
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
4
|
Gomes MLF, Da Silva Fernandes C, Sousa MGAD, Silva RLBD, Silva IDJMDC, Barros LM. Aplicaciones móviles dirigidas a personas mayores para la autogestión del cuidado: revisión del alcances. REVISTA CUIDARTE 2023. [DOI: 10.15649/cuidarte.2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Introducción: el uso de aplicaciones móviles puede facilitar la autogestión en salud y brindar oportunidades para la autonomía de las personas mayores en su autocuidado. Objetivo: mapear la producción científica en aplicaciones móviles para la autogestión del cuidado dirigido a las personas mayores. Materiales y Métodos: revisión de alcance realizada desde septiembre de 2020 a enero de 2021, con base en las siguientes bases de datos: MEDLINE, SciELO, Scopus, Web of Science y Science Direct, utilizando la estrategia de búsqueda: (“Self-management” OR “Self-care”) AND (Elderly OR “Old man”) AND (“Mobile Applications” OR Smartphone OR “Cell phone”), con la inclusión de artículos que tratan sobre el uso de aplicaciones móviles por parte de los ancianos para la autogestión de cuidado, sin limitaciones de tiempo e idioma. Resultados: la muestra final constó de 14 artículos, categorizados en tres aspectos del manejo, a saber: medicamentos, comorbilidades y prácticas saludables. En la mayoría de los estudios, las aplicaciones estuvieron dirigidas al autocontrol de los medicamentos, seguido de la atención de las condiciones crónicas y finalmente la autoevaluación del riesgo de caídas y los tratamientos no farmacológicos del dolor. Discusión: esta revisión contribuye a la práctica clínica y la investigación en enfermería, ya que sus resultados apuntan a lo publicado sobre el desarrollo y uso de aplicaciones móviles por parte de los ancianos para la autogestión del cuidado. Conclusiones: el uso de aplicaciones móviles facilita el autocuidado de la población anciana, especialmente en el manejo de la medicación para enfermedades crónicas.
Como citar este artículo: Gomes, Manoelise Linhares Ferreira; Fernandes, Cristina da Silva; Sousa, Maria Gabrieli Aguiar de; Silva, Raimunda Leandra Bráz da; Silva, Illeanne de Jesus Manhiça da Costa; Barros, Lívia Moreira. Aplicativos móveis direcionados aos idosos para autogerenciamento do cuidado: revisão de escopo. Revista Cuidarte. 2023;14(1):e2594. http://dx.doi.org/10.15649/cuidarte.2594
Collapse
|
5
|
Pratiwi H, Kristina SA, Widayanti AW, Prabandari YS, Kusuma IY. A Systematic Review of Compensation and Technology-Mediated Strategies to Maintain Older Adults' Medication Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:803. [PMID: 36613130 PMCID: PMC9819645 DOI: 10.3390/ijerph20010803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/16/2023]
Abstract
Elderly medication adherence is a challenge in health care. The elderly are often at higher risk for non-adherence, and more likely to be on multiple prescription medications for many comorbidities. This systematic review aimed to explore the current strategies for maintaining older adults' medication adherence with compensation and technology-mediated strategies. We conducted a systematic review to examine related articles published in the PubMed, Web of Science, and Scopus databases, as well as Google Scholar for additional reference sources by cross-reference review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this review. A total of 217 articles were screened, and 27 studies fulfilled the inclusion criteria. Older adults applied a variety of methods to maintain or enhance their medication adherence. Three studies indicated compensation strategies, 19 studies reported technological assistance, two studies used other strategies (community-offered help or caregivers help), and three studies used a combination of compensation with another strategy or technology. Studies identified various compensation- and technology-based strategies carried out by older adults to help remind them to take medication. This review identified potential benefits of technology and compensation strategy implementation in older adults to increase medication adherence. Although we are conscious of the heterogeneity of the included studies, it remains challenging to determine which elements underpin the most effective approaches.
Collapse
Affiliation(s)
- Hening Pratiwi
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pharmacy, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto 53122, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Yayi Suryo Prabandari
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Ikhwan Yuda Kusuma
- Pharmacy Study Program, Faculty of Health, Universitas Harapan Bangsa, Purwokerto 53182, Indonesia
| |
Collapse
|
6
|
Wang Q, Liu J, Zhou L, Tian J, Chen X, Zhang W, Wang H, Zhou W, Gao Y. Usability evaluation of mHealth apps for elderly individuals: a scoping review. BMC Med Inform Decis Mak 2022; 22:317. [PMID: 36461017 PMCID: PMC9717549 DOI: 10.1186/s12911-022-02064-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Usability is a key factor affecting the acceptance of mobile health applications (mHealth apps) for elderly individuals, but traditional usability evaluation methods may not be suitable for use in this population because of aging barriers. The objectives of this study were to identify, explore, and summarize the current state of the literature on the usability evaluation of mHealth apps for older adults and to incorporate these methods into the appropriate evaluation stage. METHODS Electronic searches were conducted in 10 databases. Inclusion criteria were articles focused on the usability evaluation of mHealth apps designed for older adults. The included studies were classified according to the mHealth app usability evaluation framework, and the suitability of evaluation methods for use among the elderly was analyzed. RESULTS Ninety-six articles met the inclusion criteria. Research activity increased steeply after 2013 (n = 92). Satisfaction (n = 74) and learnability (n = 60) were the most frequently evaluated critical measures, while memorability (n = 13) was the least evaluated. The ratios of satisfaction, learnability, operability, and understandability measures were significantly related to the different stages of evaluation (P < 0.05). The methods used for usability evaluation were questionnaire (n = 68), interview (n = 36), concurrent thinking aloud (n = 25), performance metrics (n = 25), behavioral observation log (n = 14), screen recording (n = 3), eye tracking (n = 1), retrospective thinking aloud (n = 1), and feedback log (n = 1). Thirty-two studies developed their own evaluation tool to assess unique design features for elderly individuals. CONCLUSION In the past five years, the number of studies in the field of usability evaluation of mHealth apps for the elderly has increased rapidly. The mHealth apps are often used as an auxiliary means of self-management to help the elderly manage their wellness and disease. According to the three stages of the mHealth app usability evaluation framework, the critical measures and evaluation methods are inconsistent. Future research should focus on selecting specific critical measures relevant to aging characteristics and adapting usability evaluation methods to elderly individuals by improving traditional tools, introducing automated evaluation tools and optimizing evaluation processes.
Collapse
Affiliation(s)
- Qiuyi Wang
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Jing Liu
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Lanshu Zhou
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Jing Tian
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Xuemei Chen
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Wei Zhang
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - He Wang
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Wanqiong Zhou
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Yitian Gao
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| |
Collapse
|
7
|
Tran-Nguyen K, Berger C, Bennett R, Wall M, Morin SN, Rajabiyazdi F. Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach. JMIR Aging 2022; 5:e37772. [PMID: 36251348 DOI: 10.2196/37772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. OBJECTIVE This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. METHODS This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. RESULTS We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. CONCLUSIONS We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future.
Collapse
Affiliation(s)
- Kevin Tran-Nguyen
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Caroline Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,University of Maryland, College of Information Studies, College Park, MD, United States
| | - Roxanne Bennett
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Michelle Wall
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Suzanne N Morin
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| |
Collapse
|
8
|
Effect of electronic reminders on patients' compliance during clear aligner treatment: an interrupted time series study. Sci Rep 2022; 12:16652. [PMID: 36198717 PMCID: PMC9534859 DOI: 10.1038/s41598-022-20820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50–74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients. Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.
Collapse
|
9
|
Suh A, Li M. How the use of mobile fitness technology influences older adults’ physical and psychological well-being. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
10
|
Dinari F, Bahaadinbeigy K, Moulaei K. Analysis of requirements for developing a mobile device‐based medicines management application for people who are blind and visually impaired. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fatemeh Dinari
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Khadijeh Moulaei
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| |
Collapse
|
11
|
Schretzlmaier P, Hecker A, Ammenwerth E. Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study. JMIR Hum Factors 2022; 9:e34918. [PMID: 35262493 PMCID: PMC8943545 DOI: 10.2196/34918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context.
Collapse
Affiliation(s)
- Patrik Schretzlmaier
- Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Achim Hecker
- Institute for Management and Economics in Healthcare, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,DBU Digital Business University of Applied Sciences, Berlin, Germany
| | - Elske Ammenwerth
- Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| |
Collapse
|
12
|
Chang PF, Bazarova NN, Wethington E. How Older Adults with Chronic Pain Manage Social Support Interactions with Mobile Media. HEALTH COMMUNICATION 2022; 37:384-396. [PMID: 33164561 PMCID: PMC8105424 DOI: 10.1080/10410236.2020.1846272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mobile media offer new ways for older adults to access and interact with their social support networks. While mobile media usage has been increasing among older adults, less is known about why older adults with chronic pain prefer to select members of their existing social network for quality social support interactions, what types of communication mechanisms they engage in when utilizing mobile media, and how they use their mobile media to manage their interactions and relationships. The analysis of 25 semi-structured interviews with older adults with chronic pain reveals that a sense of camaraderie and shared meaning of pain experiences underlie their preferences for communicating with similar others about chronic pain. On the other hand, having to take on a role reversal of comforting and receiving unsolicited advice are the main reasons for avoiding social support interactions with dissimilar others. Additionally, older adults strategically utilize specific features of mobile media such as SMS text messaging for short forms of validation and encouragement, staccato social support, and management of interaction coordination or avoidance. This study demonstrates how mobile technology can be adopted and appropriated to meet social, emotional, and interpersonal needs of older adults' lives. It also provides important insights into communicative dynamics of pain-related social support interactions and communication channel selection of older adults. The way mobile media are used to leverage social interactions and support networks can contribute to self-management, health-promoting behavior, and overall quality of life for older adults with chronic pain.
Collapse
Affiliation(s)
- Pamara F. Chang
- Department of Communication, University of Cincinnati
- Department of Communication, Cornell University
- Departments of Human Development and Sociology, Cornell University
| | - Natalya N. Bazarova
- Department of Communication, University of Cincinnati
- Department of Communication, Cornell University
- Departments of Human Development and Sociology, Cornell University
| | - Elaine Wethington
- Department of Communication, University of Cincinnati
- Department of Communication, Cornell University
- Departments of Human Development and Sociology, Cornell University
| |
Collapse
|
13
|
Van Emmenis M, Jamison J, Kassavou A, Hardeman W, Naughton F, A'Court C, Sutton S, Eborall H. Patient and practitioner views on a combined face-to-face and digital intervention to support medication adherence in hypertension: a qualitative study within primary care. BMJ Open 2022; 12:e053183. [PMID: 35228280 PMCID: PMC8886486 DOI: 10.1136/bmjopen-2021-053183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To explore patients' and healthcare practitioners' (HCPs) views about non-adherence to hypertension medication and potential content of a combined very brief face-to-face discussion (VBI) and digital intervention (DI). METHODS A qualitative study (N=31): interviews with patients with hypertension (n=6) and HCPs (n=11) and four focus groups with patients with hypertension (n=14). Participants were recruited through general practices in Eastern England and London. Topic guides explored reasons for medication non-adherence and attitudes towards a potential intervention to support adherence. Stimuli to facilitate discussion included example SMS messages and smartphone app features, including mobile sensing. Analysis was informed methodologically by the constant comparative approach and theoretically by perceptions and practicalities approach. RESULTS Participants' overarching explanations for non-adherence were non-intentional (forgetting) and intentional (concerns about side effects, reluctance to medicate). These underpinned their views on intervention components: messages that targeted forgetting medication or obtaining prescriptions were considered more useful than messages providing information on consequences of non-adherence. Tailoring the DI to the individuals' needs, regarding timing and number of messages, was considered important for user engagement. Patients wanted control over the DI and information about data use associated with any location sensing. While the DI was considered limited in its potential to address intentional non-adherence, HCPs saw the potential for a VBI in addressing this gap, if conducted in a non-judgemental manner. Incorporating a VBI into routine primary care was considered feasible, provided it complemented existing GP practice software and HCPs received sufficient training. CONCLUSIONS A combined VBI-DI can potentially address intentional and non-intentional reasons for non-adherence to hypertension medication. For optimal engagement, recommendations from this work include a VBI conducted in a non-judgmental manner and focusing on non-intentional factors, followed by a DI that is easy-to-use, highly tailored and with provision of data privacy details about any sensing technology used.
Collapse
Affiliation(s)
| | - James Jamison
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Charlotte A'Court
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Helen Eborall
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
14
|
Zaman SB, Khan RK, Evans RG, Thrift AG, Maddison R, Islam SMS. Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review. JMIR Aging 2022; 5:e25251. [PMID: 34994695 PMCID: PMC8783284 DOI: 10.2196/25251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/10/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions.
Collapse
Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Raihan Kabir Khan
- Department of Health Sciences, James Madison University, Harrisonburg, VA, United States
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Melbourne, Australia.,Department of Physiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
| |
Collapse
|
15
|
Chen E, Moracco KE, Kainz K, Muessig KE, Tate DF. Developing and validating a new scale to measure the acceptability of health apps among adolescents. Digit Health 2022; 8:20552076211067660. [PMID: 35154802 PMCID: PMC8832596 DOI: 10.1177/20552076211067660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background The acceptability of health interventions is centrally important to achieving
their desired health outcomes. The construct of acceptability of mobile
health interventions among adolescents is neither well-defined nor
consistently operationalized. Objectives Building on the theoretical framework of acceptability, these two studies
developed and assessed the reliability and validity of a new scale to
measure the acceptability of mobile health applications (“apps”) among
adolescents. Methods We followed a structured scale development process including exploratory
factor analyses (EFAs), confirmatory factor analyses (CFAs), and employed
structural equation modeling (SEM) to assess the relationship between the
scale and app usage. Adolescent participants used the
Fooducate healthy eating app and completed the
acceptability scale at baseline and one-week follow-up. Results EFA (n = 182) determined that the acceptability of health
apps was a multidimensional construct with six latent factors: affective
attitude, burden, ethicality, intervention coherence, perceived
effectiveness, and self-efficacy. CFA (n = 161) from the
second sample affirmed the six-factor structure and the unidimensional
structures for each of the six subscales. However, CFA did not confirm the
higher-order latent factor model suggesting that the six subscales reflect
unique aspects of acceptability. SEM indicated that two of the
subscales—ethicality and self-efficacy—were predictive of health app usage
at one-week follow-up. Conclusions These results highlight the importance of ethicality and self-efficacy for
health app acceptability. Future research testing and adapting this new
acceptability scale will enhance measurement tools in the fields of mobile
health and adolescent health.
Collapse
Affiliation(s)
- Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn E. Moracco
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirsten Kainz
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah F. Tate
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
16
|
Effects of Patient-Generated Health Data: Comparison of Two Versions of Long-Term Mobile Personal Health Record Usage Logs. Healthcare (Basel) 2021; 10:healthcare10010053. [PMID: 35052217 PMCID: PMC8775175 DOI: 10.3390/healthcare10010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Abstract
Patient-generated health data (PGHD) can be managed easily by a mobile personal health record (mPHR) and can increase patient engagement. This study investigated the effect of PGHD functions on mPHR usage. We collected usage log data from an mPHR app, My Chart in My Hand (MCMH), for seven years. We analyzed the number of accesses and trends for each menu by age and sex according to the version-up. Generalized estimating equation (GEE) analysis was used to determine the likelihood of continuous app usage according to the menus and version-up. The total number of users of each version were 15,357 and 51,553, respectively. Adult females under 50 years were the most prevalent user group (30.0%). The “My Chart” menu was the most accessed menu, and the total access count increased by ~10 times after the version-up. The “Health Management” menu designed for PGHD showed the largest degree of increase in its likelihood of continuous usage after the version-up (1.245; p < 0.0001) across menus (range: 0.925–1.050). Notably, improvement of PGHD management in adult females over 50 years is needed.
Collapse
|
17
|
Choemprayong S, Charoenlap C, Piromsopa K. Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study. JMIR Hum Factors 2021; 8:e31130. [PMID: 34931991 PMCID: PMC8726029 DOI: 10.2196/31130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective This study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated.
Collapse
Affiliation(s)
- Songphan Choemprayong
- Department of Library Science, Faculty of Arts, Chulalongkorn University, Bangkok, Thailand.,Behavioral Research and Informatics in Social Science Research Unit, Sasin School of Management, Chulalongkorn University, Bangkok, Thailand
| | - Chris Charoenlap
- Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krerk Piromsopa
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
18
|
Steele Gray C, Chau E, Tahsin F, Harvey S, Loganathan M, McKinstry B, Mercer SW, Nie JX, Palen TE, Ramsay T, Thavorn K, Upshur R, Wodchis WP. Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study. J Med Internet Res 2021; 23:e29071. [PMID: 34860675 PMCID: PMC8726765 DOI: 10.2196/29071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/19/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=−1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals’ lives and work acted as a key driver of adoption and tool appraisal. Conclusions This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954
Collapse
Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edward Chau
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Farah Tahsin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Harvey
- Logibec Inc (QoC Health Inc), Toronto, ON, Canada
| | - Mayura Loganathan
- Ray D Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian McKinstry
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Ted E Palen
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| |
Collapse
|
19
|
Pan J, Dong H, Bryan-Kinns N. Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation. JMIR Aging 2021; 4:e30420. [PMID: 34807836 PMCID: PMC8663706 DOI: 10.2196/30420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023] Open
Abstract
Background Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services. Conclusions The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults.
Collapse
Affiliation(s)
- Jing Pan
- College of Art and Design, Nanjing Tech University, Nanjing, China
| | - Hua Dong
- Brunel Design School, Brunel University London, London, United Kingdom
| | - Nick Bryan-Kinns
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
20
|
Diaz-Skeete YM, McQuaid D, Akinosun AS, Ekerete I, Carragher N, Carragher L. Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study. JMIR Mhealth Uhealth 2021; 9:e30674. [PMID: 34726613 PMCID: PMC8596242 DOI: 10.2196/30674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. Objective The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. Methods A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. Results Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. Conclusions The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.
Collapse
Affiliation(s)
| | | | | | | | - Natacha Carragher
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Alcohol, Drugs and Addictive Behaviours, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Lucia Carragher
- NetwellCASALA Advanced Research Centre, Dundalk Institute of Technology, Dundalk, Ireland
| |
Collapse
|
21
|
Abstract
Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics 'intervention', 'context of use' and 'user' were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.
Collapse
Affiliation(s)
| | - Peter Eh Schwarz
- Technische Universität Dresden, Germany; German Center for Diabetes Research (DZD), Germany
| | | |
Collapse
|
22
|
Pérez-Rodríguez R, Villalba-Mora E, Valdés-Aragonés M, Ferre X, Moral C, Mas-Romero M, Abizanda-Soler P, Rodríguez-Mañas L. Usability, User Experience, and Acceptance Evaluation of CAPACITY: A Technological Ecosystem for Remote Follow-Up of Frailty. SENSORS (BASEL, SWITZERLAND) 2021; 21:6458. [PMID: 34640777 PMCID: PMC8512153 DOI: 10.3390/s21196458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 12/03/2022]
Abstract
Frailty predisposes older persons to adverse events, and information and communication technologies can play a crucial role to prevent them. CAPACITY provides a means to remotely monitor variables with high predictive power for adverse events, enabling preventative personalized early interventions. This study aims at evaluating the usability, user experience, and acceptance of a novel mobile system to prevent disability. Usability was assessed using the system usability scale (SUS); user experience using the user experience questionnaire (UEQ); and acceptance with the technology acceptance model (TAM) and a customized quantitative questionnaire. Data were collected at baseline (recruitment), and after three and six months of use. Forty-six participants used CAPACITY for six months; nine dropped out, leaving a final sample of 37 subjects. SUS reached a maximum averaged value of 83.68 after six months of use; no statistically significant values have been found to demonstrate that usability improves with use, probably because of a ceiling effect. UEQ, obtained averages scores higher or very close to 2 in all categories. TAM reached a maximum of 51.54 points, showing an improvement trend. Results indicate the success of the participatory methodology, and support user centered design as a key methodology to design technologies for frail older persons. Involving potential end users and giving them voice during the design stage maximizes usability and acceptance.
Collapse
Affiliation(s)
- Rodrigo Pérez-Rodríguez
- Biomedical Research Foundation, Getafe University Hospital, 28905 Getafe, Spain
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain; (E.V.-M.); (M.V.-A.); (X.F.); (C.M.); (L.R.-M.)
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain;
| | - Elena Villalba-Mora
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain; (E.V.-M.); (M.V.-A.); (X.F.); (C.M.); (L.R.-M.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Myriam Valdés-Aragonés
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain; (E.V.-M.); (M.V.-A.); (X.F.); (C.M.); (L.R.-M.)
- Geriatrics Service, Getafe University Hospital, 28095 Getafe, Spain
| | - Xavier Ferre
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain; (E.V.-M.); (M.V.-A.); (X.F.); (C.M.); (L.R.-M.)
| | - Cristian Moral
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain; (E.V.-M.); (M.V.-A.); (X.F.); (C.M.); (L.R.-M.)
| | - Marta Mas-Romero
- Geriatrics Service, Albacete University Hospital, 02006 Albacete, Spain;
| | - Pedro Abizanda-Soler
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain;
- Geriatrics Service, Albacete University Hospital, 02006 Albacete, Spain;
- Faculty of Medicine, University of Castilla-La Mancha, 02008 Albacete, Spain
| | - Leocadio Rodríguez-Mañas
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain; (E.V.-M.); (M.V.-A.); (X.F.); (C.M.); (L.R.-M.)
- CIBER of Frailty and Healthy Aging (CIBERFES), 28001 Madrid, Spain;
- Geriatrics Service, Getafe University Hospital, 28095 Getafe, Spain
| |
Collapse
|
23
|
Li C, Neugroschl J, Zhu CW, Aloysi A, Schimming CA, Cai D, Grossman H, Martin J, Sewell M, Loizos M, Zeng X, Sano M. Design Considerations for Mobile Health Applications Targeting Older Adults. J Alzheimers Dis 2021; 79:1-8. [PMID: 33216024 DOI: 10.3233/jad-200485] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mobile technologies are becoming ubiquitous in the world, changing the way we communicate and provide patient care and services. Some of the most compelling benefits of mobile technologies are in the areas of disease prevention, health management, and care delivery. For all the advances that are occurring in mobile health, its full potential for older adults is only starting to emerge. Yet, existing mobile health applications have design flaws that may limit usability by older adults. The aim of this paper is to review barriers and identify knowledge gaps where more research is needed to improve the accessibility of mobile health use in aging populations. The same observations might apply to those who are not elderly, including individuals suffering from severe mental or medical illnesses.
Collapse
Affiliation(s)
- Clara Li
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Carolyn W Zhu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Amy Aloysi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corbett A Schimming
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Dongming Cai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Hillel Grossman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| | - Jane Martin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Maria Loizos
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaoyi Zeng
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, Bronx, NY, USA
| |
Collapse
|
24
|
Scheibe M, Lang C, Druschke D, Arnold K, Luntz E, Schmitt J, Holthoff-Detto V. Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study. JMIR Hum Factors 2021; 8:e27156. [PMID: 34255664 PMCID: PMC8314150 DOI: 10.2196/27156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022] Open
Abstract
Background The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. Objective We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? Methods We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. Results Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. Conclusions The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps.
Collapse
Affiliation(s)
- Madlen Scheibe
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Caroline Lang
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Diana Druschke
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Arnold
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Edwin Luntz
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St Hedwig Hospital Berlin, Berlin, Germany.,Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
25
|
Moon Z, Zuchowski M, Moss-Morris R, Hunter MS, Norton S, Hughes LD. Disparities in access to mobile devices and e-health literacy among breast cancer survivors. Support Care Cancer 2021; 30:117-126. [PMID: 34236506 PMCID: PMC8264175 DOI: 10.1007/s00520-021-06407-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
Background The number of e-health interventions developed for breast cancer survivors continues to increase. However, issues with engagement and retention are common. This study aimed to explore e-health literacy rates and access to smartphones and tablets in a large sample of breast cancer survivors. Methods In study 1, women were recruited from outpatient breast clinics across England and Wales. Eligible women were asked to complete a questionnaire pack to assess their access to devices and their e-health literacy. Multiple regression analyses were run to assess the relationship between technology access and e-health literacy with sociodemographic variables such as age, social deprivation, and education. Study 2 presents a smaller sample recruited through social media who answered a questionnaire relating to use of mobile devices and e-health, and apps. Results Two thousand nine women participated in the study. Seventy-one percent had access to a smartphone, 54% had access to a tablet, and 20% did not have access to either device. Multiple logistic regressions showed that women who were younger, had higher levels of education, and who were from less deprived areas were more likely to have access to either device. Poorer e-health literacy was associated with being older, having less education, and not having access to a mobile device. Conclusions Whilst the results show relatively widespread access to mobile devices, there is evidence of a digital divide across some groups. Online interventions should be developed with consideration of individuals who are less e-health-literate and less technologically adept in order to increase the likelihood of engagement. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06407-2.
Collapse
Affiliation(s)
- Zoe Moon
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Mira Zuchowski
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Myra S Hunter
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Lyndsay D Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 5th Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| |
Collapse
|
26
|
Yoo HJ, Suh EE. Development of a Mobile App-Based Self-care Health Diary for Heart Transplant Recipients: A Pilot Study. Comput Inform Nurs 2021; 39:804-812. [PMID: 34747896 DOI: 10.1097/cin.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Self-care is an essential concept in health maintenance for patients with heart problems. Mobile applications have received significant attention for their efficacy in facilitating lifestyle management. This study aimed to develop a practical mobile application for Android smartphones to aid in the self-care of heart transplant recipients. Development followed the five stages of the ADDIE model (analysis, design, development, implementation, and evaluation). The developed self-care health diary application provides users with a detailed guide to information and behaviors necessary for self-care through two main components: "Health information" and "Health diary." We conducted a 5-day pilot test with six subject experts and four heart transplant recipients. The participants were unanimously satisfied with the application's content, but experienced difficulty with its functionality, such as screen display and button operation. The feedback was used to revise and update the application, leading to the development of the final version. This study and application significantly contribute to the creation of a sustainable healthcare environment for the growing number of heart transplant recipients by enabling them to perform daily self-care. In future, education and promotion are required for encouraging heart transplant recipients to use the application regularly and proactively.
Collapse
Affiliation(s)
- Hye Jin Yoo
- Author Affiliations: College of Nursing, Dankook University (Dr Yoo) Cheonan, South Korea and College of Nursing, Research Institute of Nursing Science, Seoul National University (Dr Suh), South Korea
| | | |
Collapse
|
27
|
Shilbayeh SAR, Ismail SAER. Patient experience with an educational mobile health application: A pilot study on usability and feasibility in a Saudi population. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1843883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sireen Abdul Rahim Shilbayeh
- Computer Science Department, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University Riyadh, Saudi Arabia
| | - Sahar Abd El Rahman Ismail
- Department of Computer Science, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| |
Collapse
|
28
|
Schuuring MJ, Kauw D. How to initiate eHealth in congenital heart disease patients? EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2020; 1:83-86. [PMID: 36713962 PMCID: PMC9707933 DOI: 10.1093/ehjdh/ztaa012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Abstract
Patients with congenital heart disease (CHD) are a vulnerable subgroup of cardiac patients. These patients have a high morbidity and high mortality rate. As the number of patients with CHD keeps growing, while also getting older, new tools for the care and follow-up of these vulnerable patients are warranted. eHealth has an enormous potential to revolutionize health care, and particularly for CHD patients, by expanding care beyond hospital walls and even moving some of the provided care to the comfort of home. As new eHealth tools continue to grow in number, such as invasive eHealth tools, health care delivered through eHealth continues to evolve. This teaching series summarizes current insights and discusses challenges yet to be overcome. Importantly, none of them are insurmountable. This all lays ground for a promising future for eHealth in the care of patients with CHD.
Collapse
Affiliation(s)
- Mark J Schuuring
- Department of Cardiology, Amsterdam UMC location AMC, University of Amsterdam, the Netherlands,Corresponding author. Tel: +31 (0) 205669111,
| | - Dirkjan Kauw
- Department of Cardiology, Amsterdam UMC location AMC, University of Amsterdam, the Netherlands,Netherlands Heart Institute, Moreelsepark 1, 3351 EP Utrecht, the Netherlands
| |
Collapse
|
29
|
The Mobile Physical Activity and Cognitive Training App for Older Adults: A Pilot Study. Comput Inform Nurs 2020; 38:537-542. [PMID: 33170814 DOI: 10.1097/cin.0000000000000697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Böhm AK, Jensen ML, Sørensen MR, Stargardt T. Real-World Evidence of User Engagement With Mobile Health for Diabetes Management: Longitudinal Observational Study. JMIR Mhealth Uhealth 2020; 8:e22212. [PMID: 32975198 PMCID: PMC7679206 DOI: 10.2196/22212] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patient support apps have risen in popularity and provide novel opportunities for self-management of diabetes. Such apps offer patients to play an active role in monitoring their condition, thereby increasing their own treatment responsibility. Although many health apps require active user engagement to be effective, there is little evidence exploring engagement with mobile health (mHealth). Objective This study aims to analyze the extent to which users engage with mHealth for diabetes and identify patient characteristics that are associated with engagement. Methods The analysis is based on real-world data obtained by Novo Nordisk’s Cornerstones4Care Powered by Glooko diabetes support app. User engagement was assessed as the number of active days and using measures expressing the persistence, longevity, and regularity of interaction within the first 180 days of use. Beta regressions were estimated to assess the associations between user characteristics and engagement outcomes for each module of the app. Results A total of 9051 individuals initiated use after registration and could be observed for 180 days. Among these, 55.39% (5013/9051) used the app for one specific purpose. The average user activity ratio varied from 0.05 (medication and food) to 0.55 (continuous glucose monitoring), depending on the module of the app. Average user engagement was lower if modules required manual data entries, although the initial uptake was higher for these modules. Regression analyses further revealed that although more women used the app (2075/3649, 56.86%), they engaged significantly less with it. Older people and users who were recently diagnosed tended to use the app more actively. Conclusions Strategies to increase or sustain the use of apps and availability of health data may target the mode of data collection and content design and should take into account privacy concerns of the users at the same time. Users’ engagement was determined by various user characteristics, indicating that particular patient groups should be targeted or assisted when integrating apps into the self-management of their disease.
Collapse
Affiliation(s)
- Anna-Katharina Böhm
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | | | | | - Tom Stargardt
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| |
Collapse
|
31
|
Liu YC, Chen CH, Lin YS, Chen HY, Irianti D, Jen TN, Yeh JY, Chiu SYH. Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e20317. [PMID: 32985999 PMCID: PMC7551114 DOI: 10.2196/20317] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Advances in voice technology have raised new possibilities for apps related to daily health maintenance. However, the usability of such technologies for older users remains unclear and requires further investigation. OBJECTIVE We designed and evaluated two innovative mobile voice-added apps for food intake reporting, namely voice-only reporting (VOR) and voice-button reporting (VBR). Each app features a unique interactive procedure for reporting food intake. With VOR, users verbally report the main contents of each dish, while VBR provides both voice and existing touch screen inputs for food intake reporting. The relative usability of the two apps was assessed through the metrics of accuracy, efficiency, and user perception. METHODS The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. A group of 57 adults aged 60-90 years (12 male and 45 female participants) was recruited from a retirement community and randomized into two experimental groups, that is, VOR (n=30) and VBR (n=27) groups. Both groups were tested using the same set of 17 food items including dishes and beverages selected and allocated to present distinct breakfast, lunch, and dinner meals. All participants used a 7-inch tablet computer for the test. The resulting data were analyzed to evaluate reporting accuracy and time efficiency, and the system usability scale (SUS) was used to measure user perception. RESULTS For eight error types identified in the experiment, the VBR group participants were significantly (P<.001) more error prone owing to the required use of button-tapping actions. The highest error rates in the VOR group were related to incomprehensible reporting speech (28/420, 6.7%), while the highest error rates in the VBR group were related to failure to make required button taps (39/378, 10.3%). The VOR group required significantly (P<.001) less time to complete food reporting. The overall subjective reactions of the two groups based on the SUS surpassed the benchmark and were not significantly different (P=.20). CONCLUSIONS Experimental results showed that VOR outperformed VBR, suggesting that voice-only food input reporting is preferable for elderly users. Voice-added apps offer a potential mechanism for the self-management of dietary intake by elderly users. Our study contributes an evidence-based evaluation of prototype design and selection under a user-centered design model. The results provide a useful reference for selecting optimal user interaction design. TRIAL REGISTRATION International Standard Randomized Controlled Trial Registry ISRCTN17335889; http://www.isrctn.com/ISRCTN17335889.
Collapse
Affiliation(s)
- Ying-Chieh Liu
- Department of Industrial Design, College of Management, Chang Gung University, Taoyuan City, Taiwan.,Department of Internal Medicine, Health Promotion Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Chen
- Cybersecurity Technology Institute, Institute for Information Industry, Taipei, Taiwan
| | - Yu-Sheng Lin
- Department of Internal Medicine, Health Promotion Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Yun Chen
- Department of Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Denisa Irianti
- Department of Industrial Design, College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Ni Jen
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Jou-Yin Yeh
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, Taoyuan, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| |
Collapse
|
32
|
Alenazi HA, Jamal A, Batais MA. Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach. JMIR Mhealth Uhealth 2020; 8:e17083. [PMID: 32678798 PMCID: PMC7519429 DOI: 10.2196/17083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 04/25/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6% of the general population, and the prevalence of T2DM is predicted to rise to 45.36% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. OBJECTIVE The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. METHODS In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. RESULTS In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; P<.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user's goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; P<.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients' app use compliance during clinical visits (6.91), and flexibility and customization (7.91). CONCLUSIONS This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts' opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic.
Collapse
Affiliation(s)
| | - Amr Jamal
- Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Batais
- Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
33
|
Lindqvist AK, Rutberg S, Söderström E, Ek A, Alexandrou C, Maddison R, Löf M. User Perception of a Smartphone App to Promote Physical Activity Through Active Transportation: Inductive Qualitative Content Analysis Within the Smart City Active Mobile Phone Intervention (SCAMPI) Study. JMIR Mhealth Uhealth 2020; 8:e19380. [PMID: 32755889 PMCID: PMC7439138 DOI: 10.2196/19380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/21/2020] [Indexed: 01/15/2023] Open
Abstract
Background Physical inactivity is globally recognized as a major risk factor for morbidity, particularly the incidence of noncommunicable diseases. Increasing physical activity (PA) is therefore a public health priority. Engaging in active transportation (AT) is a viable approach for promoting daily PA levels. Mobile health interventions enable the promotion of AT to a larger population. The Smart City Active Mobile Phone Intervention (SCAMPI) study was a randomized controlled trial designed to evaluate the ability of a behavior change program delivered via a smartphone app to motivate participants to increase their PA by engaging in AT. Objective This qualitative study aims to examine the acceptance and user experience of the app promoting AT that was used in the SCAMPI trial (the TRavelVU Plus app). Methods A total of 17 residents of Stockholm County (13 women; age range 25-61 years) who completed the 3-month app-based behavioral change program (delivered through the TRavelVU Plus app) in the SCAMPI randomized controlled trial during 2018 agreed to participate in a semistructured telephone-based interview. These participants were well representative of the whole intervention group (n=127) in terms of baseline characteristics such as age, sex, and area of residence. The interviews were audiorecorded, transcribed verbatim, and analyzed using an inductive qualitative content analysis. Results The content analysis revealed 2 themes and 4 subcategories. The first theme, “main motivators: monitoring and messages,” highlighted that monitoring AT and being able to set weekly goals using the app were the primary motivators reported by study participants. The second theme, “acceptable but modifiable,” reflects that the app was well accepted and effectively encouraged many participants to use more AT. Nevertheless, there were functions in the app that require modification. For example, while the semiautomated travel tracking feature was appreciated, participants found it time-consuming and unreliable at times. Conclusions This study contributes novel insight into adults’ experiences of using a mobile app to promote the use of AT. The results showed that the app was well accepted and that self-monitoring and goal setting were the main motivators to engage in more AT. The semiautomated tracking of AT was appreciated; however, it was also reported to be energy- and time-consuming when it failed to work. Thus, this feature should be improved going forward. Trial Registration ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5658-4
Collapse
Affiliation(s)
- Anna-Karin Lindqvist
- Division of Health, Medicine and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Stina Rutberg
- Division of Health, Medicine and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Emmie Söderström
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Ek
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Christina Alexandrou
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Science Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Marie Löf
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
34
|
Ferreira da Silva PE, Junior GDSF, Ambrozio RB, Salles Tiburcio Costa MG, Machado GB, Guimarães de Carvalho SF, José de Oliveira E, Jorge DC, de Almeida Silva Teixeira L. LeishCare ®: A Software Designed for the Management of Individuals with Leishmaniases. Am J Trop Med Hyg 2020; 103:909-916. [PMID: 32602430 DOI: 10.4269/ajtmh.19-0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aims of this study were to describe a smartphone app aimed at healthcare professionals who work in areas endemic for visceral and tegumentary leishmaniases, and to report the user's perception of the app in these areas. The software, called LeishCare®, has the following features: data registration, image filter to record the evolution of skin lesions using photos, calculation of a score set to identify the risk of death from visceral leishmaniasis, and guides to the diseases. LeishCare® was made available to healthcare professionals in endemic municipalities in Brazil, and the perception of potential users was evaluated at baseline and after 6 and 12 months. In the first meeting, 96 (94.1%) of the 102 professionals who knew the app reported positive expectations for its use. The installation of LeishCare® on the individual device and the evaluation of user perception were completed at 6 months with 16 users and at 12 months with 20 users. More than 90% of the professionals evaluated in both assessments found the information of the app useful. The features related to the calculation of visceral leishmaniasis severity score, and the guides to leishmaniases were the most frequently accessed. Users reported competence gain attributed to the app for all items evaluated. In conclusion, LeishCare® was found to be a promising tool to help healthcare professionals in endemic areas with leishmaniasis management.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - David Calhau Jorge
- Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | |
Collapse
|
35
|
Caregivers' Experience of Caring for a Family Member with Alzheimer's Disease: A Content Analysis of Longitudinal Social Media Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124412. [PMID: 32575455 PMCID: PMC7345212 DOI: 10.3390/ijerph17124412] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
Background: The population aging together with an increased incidence of Alzheimer’s disease (AD) should also be accompanied by a growing interest in healthcare research. Therefore, this study examines the nature of the caregiver’s work, its mental and physical demands, experience and questions, and the relationship between the person with AD, the caregiver, and family members. Methods: As social media has become the place where people share family situations, a Facebook private discussion group of caregivers was chosen as the analytical data source. The study documented the daily-life situations of one-hundred dyads based on 2110 posts published during a six-month or longer period. A content analysis classified communication into 35 categories of basic, instrumental, and extended activities of daily livings (ADLs) and newly designed caregiver’s daily issues (CDIs). Results: The frequently discussed topics were related to exhaustion and feelings of “giving up” by caregivers and interpersonal communication and help from family members. The highest support was found for the topics of aging and dying and family events. Conclusion: The communications of caregivers were diverse and rather associated with co-occupational ADLs and CDIs than basic or instrumental ADLs. The support of the group was mainly provided in coping with fundamental life changes.
Collapse
|
36
|
Patel T, Ivo J, Faisal S, McDougall A, Carducci J, Pritchard S, Chang F. A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers. J Med Internet Res 2020; 22:e18073. [PMID: 32348292 PMCID: PMC7298635 DOI: 10.2196/18073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.
Collapse
Affiliation(s)
- Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,Centre for Family Medicine Family Health Team, Kitchener, ON, Canada.,Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel-University of Waterloo Research Institute of Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Aidan McDougall
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Jillian Carducci
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Sarah Pritchard
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| |
Collapse
|
37
|
Lin TTC, Bautista JR, Core R. Seniors and mobiles: A qualitative inquiry of mHealth adoption among Singapore seniors. Inform Health Soc Care 2020; 45:360-373. [PMID: 32484720 DOI: 10.1080/17538157.2020.1755974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study examines how seniors in Singapore use mobile devices for healthcare purposes. METHODS Semi-structured interviews with 35 mobile phone users aged between 58-82 years old. RESULTS Seniors regard mobile phones as important personal devices for socialization, security, and emergency purposes. Most of the seniors consider mobile telephony (voice calls and text messaging) as an accessible platform to access healthcare. Perceived usefulness, ease of use, compatibility, technology anxiety, financial cost, and self-efficacy were identified as factors affecting the use of mHealth among seniors. Although a few adopt mHealth applications and mobile Internet for health-information seeking, some younger seniors show enthusiastic attitudes toward its adoption. Additionally, some seniors also have technology anxiety and resistance toward using mHealth applications. CONCLUSION Seniors use mobile phones for healthcare purposes in their daily life, and its use involves several facilitators and barriers. Interpersonal training is likely to reduce their anxiety and increase mHealth literacy and adoption. Theoretical and practical implications are discussed.
Collapse
Affiliation(s)
- Trisha T C Lin
- Department of Radio & Television, National Chengchi University, Taipei, Taiwan
| | - John Robert Bautista
- School of Information, The University of Texas at Austin, Austin, Texas, USA.,Center for Health Communication, The University of Texas at Austin, Austin, Texas, USA
| | - Rachel Core
- College of Arts and Sciences, Stetson University, DeLand, Florida, USA
| |
Collapse
|
38
|
Chiu CJ, Yu YC, Du YF, Yang YC, Chen JY, Wong LP, Tanasugarn C. Comparing a Social and Communication App, Telephone Intervention, and Usual Care for Diabetes Self-Management: 3-Arm Quasiexperimental Evaluation Study. JMIR Mhealth Uhealth 2020; 8:e14024. [PMID: 32484448 PMCID: PMC7298636 DOI: 10.2196/14024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 01/30/2020] [Accepted: 03/29/2020] [Indexed: 01/15/2023] Open
Abstract
Background Many technology-assisted innovations have been used to manage disease. However, most of these innovations are not broadly used by older adults due to their cost. Additionally, disease management through technology-assisted innovations has not been compared with other interventions. Objective In this study, we tested the employment of a free and widely used social and communication app to help older adults with diabetes manage their distress and glycemic control. We also compared the effectiveness of the app with 2 other methods, namely telephone and conventional health education, and determined which subgroup experiences the most effects within each intervention. Methods Adults aged ≥50 years with type 2 diabetes were recruited from Southern Taiwan (N=231) and were allocated to different 3-month interventions. Informed consent was obtained at the Ministry of Science and Technology and approved by the National Cheng Kung University Hospital Institutional Review Board (No. A-ER-102-425). Results Participants in the mobile-based group had significant reductions in hemoglobin A1c compared with the telephone-based and usual care groups (mean changes of –0.4%, 0.1%, and 0.03%, respectively; P=.02). Diabetes-specific distress decreased to a greater extent in the mobile-based group compared to the other 2 groups (mean changes of –5.16, –3.49, and –2.44, respectively, P=.02). Subgroup analyses further revealed that the effects on reducing blood glucose levels in the social and communication app groups were especially evident in patients with lower distress scores, and diabetes-related distress was especially evident in participants who were younger than 60 years or had higher educational levels. Conclusions The findings of this study inform more flexible use of social and communication apps with in-person diabetes education and counselling.
Collapse
Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Chen Yu
- Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ye-Fong Du
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jou-Yin Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | |
Collapse
|
39
|
Igelström H, Hauffman A, Alfonsson S, Sjöström J, Cajander Å, Johansson B. User Experiences of an Internet-Based Stepped-Care Intervention for Individuals With Cancer and Concurrent Symptoms of Anxiety or Depression (the U-CARE AdultCan Trial): Qualitative Study. J Med Internet Res 2020; 22:e16604. [PMID: 32427108 PMCID: PMC7268002 DOI: 10.2196/16604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/04/2020] [Accepted: 03/21/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The internet-based stepped-care intervention iCAN-DO, used in the multicenter randomized controlled trial AdultCan, was developed for adult patients undergoing treatment for cancer and concurrently experiencing anxiety or depressive symptoms. iCAN-DO aimed to decrease symptoms of anxiety or depression. Step 1 comprises access to a library with psychoeducational material and a peer-support section, as well as the possibility to pose questions to a nurse. Step 2 of the intervention offers treatment consisting of internet-based cognitive behavioral therapy (iCBT) to participants still experiencing anxiety or depression at 1, 4, or 7 months after inclusion. OBJECTIVE The study aimed to explore user experiences of delivery, design, and structure of iCAN-DO from the perspective of people with cancer. METHODS We studied user experiences by interviewing 15 informants individually: 10 women with breast cancer (67%), 4 men with prostate cancer (27%), and 1 man with colorectal cancer (7%) with a mean age 58.9 years (SD 8.9). The interviews focused on informants' perceptions of ease of use and of system design and structure. Informants had been included in iCAN-DO for at least 7 months. They were purposefully selected based on activity in Step 1, participation in iCBT (ie, Step 2), gender, and diagnosis. RESULTS Of the 15 informants, 6 had been offered iCBT (40%). All informants used the internet on a daily basis, but 2 (13%) described themselves as very inexperienced computer users. The analysis revealed three subthemes, concerning how user experiences were affected by disease-specific factors and side effects (User experience in the context of cancer), technical problems (Technical struggles require patience and troubleshooting), and the structure and design of iCAN-DO (Appealing and usable, but rather simple). CONCLUSIONS The results indicate that user experiences were affected by informants' life situations, the technical aspects and the design of iCAN-DO, and informants' preferences. The results have generated some developments feasible to launch during the ongoing study, but if iCAN-DO is to be used beyond research interest, a greater level of tailoring of information, features, and design may be needed to improve user experiences. The use of recurrent questionnaires during the treatment period may highlight an individual's health, but also function as a motivator showing improvements over time.
Collapse
Affiliation(s)
- Helena Igelström
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Immmunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna Hauffman
- Department of Immmunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Sven Alfonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Sjöström
- Department of Informatics and Media, Uppsala University, Uppsala, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immmunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
40
|
Bhattarai P, Newton-John TRO, Phillips JL. Apps for pain self-management of older people's arthritic pain, one size doesn't fit all: A qualitative study. Arch Gerontol Geriatr 2020; 89:104062. [PMID: 32428787 DOI: 10.1016/j.archger.2020.104062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/26/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Introduction Arthritic pain is a major cause of illness and disability among older people. People living with arthritic pain carry out self-management activities to adequately manage their pain. As the trend of smartphone uptake continues to rise among older people, there are opportunities to explore the role of these devices in helping older people better manage their pain. Aim: To explore the attitudes and experiences of older people with chronic arthritic pain towards using an app for their pain selfmanagement. Methods A qualitative design using semi-structured interviews with community-dwelling older Australians living with arthritic pain (n = 16). Data was analyzed using thematic analysis. Results Four themes emerged from the data: (1) Apps are valuable self-management tool, but they do have the potential for harm; (2) A pain self-management app needs to strictly align with the user's needs; (3) Clinician's involvement is crucial when integrating an app into older people's pain selfmanagement regime; and (4) pain self-management app must be designed with enduser in mind. In addition, suggestions on how to make an app more useful and userfriendly were offered by the participants. Discussion While pain self-management apps have the potential to assist older people in their pain self-management process, this modality is not of interest to all older people. Adaptable apps that offer clinician input may be best placed to offer individual level relevance to older users. Future pain selfmanagement app development endeavors should adopt a co-design approach where older people are involved through all stages of design and development.
Collapse
Affiliation(s)
- Priyanka Bhattarai
- University of Notre Dame Australia, School of Nursing, Cnr Broadway and Abercrombie St, (PO Box 944), Broadway, Sydney, NSW 2007, Australia.
| | | | | |
Collapse
|
41
|
Sciascia S, Radin M, Cecchi I, Di Nunzio P, Buccarano N, Di Gregorio F, Valeria M, Osella S, Crosasso P, Favuzzi MD, Rubini E, Foddai SG, Baldovino S, Roccatello D, Rossi D. Tailoring Tofacitinib Oral Therapy in Rheumatoid Arthritis: The TuTORApp-A Usability Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103469. [PMID: 32429245 PMCID: PMC7277549 DOI: 10.3390/ijerph17103469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To create a mobile application able to help patients follow medical treatments properly. METHODS We designed and developed a custom Android/iOS App to remind patients of the pharmaceutical drugs to be taken, of the visits and exams to attend, and to detect their compliance with their personal therapeutic plan. In this paper we describe the App development, UX/UI design, Gamification. TuTOR is an Android and iOS application designed to remind patients of the drugs to be taken, giving them all the information related to their therapeutic plans in a simple and non-invasive way. Thanks to a dedicated back-office, specially designed to meet specific medical information needs, the App can also help physicians detect their patients' compliance with their treatments and modify prescriptions in real time. The App also ensures a state-of-the-art approach to data security and privacy protection. The main feature of TuTOR is the smart therapy assistant, which features dedicated alarms to remind users of taking their prescription drugs. Thanks to the automatic synchronization with a local database, the alert system works even without connection to the Internet. Particular attention was paid during the App's design process: we looked to create an intuitive interface to ensure absolute ease of use, with state-of-the-art visual design aimed at maximizing user experience. Other relevant features include the App's ability to givevisual evidence of the most important drugs to be taken and its note-taking feature, which gives patients the possibility to note down indications on why a specific drug was skipped. The App also keeps track of upcoming medical exams, laboratory tests, and visits on a devoted calendar. It also helps patients by listing therapy contacts, such as physicians' phone numbers, and indicates all medical references by showing, for example, locations of relevant clinics and pharmacies on a map. Thanks to specific visual progress indicators and an innovative gamification approach, the App encourages users to faithfully follow therapy guidelines. With TuTOR, assessing the therapy's state of completion is quick and easy.Thanksto the privacy-by-design approach used, all data managed by the system is compliant with the European Privacy Regulation and it is not available to third parties. EXPECTED RESULTS A mobile App for medication adherence might increase objectively and subjectively measured adherence.
Collapse
Affiliation(s)
- Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
- Correspondence: ; Tel.: +39-0112402056; Fax: +39-0112402052
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | - Irene Cecchi
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | | | | | | | - Milone Valeria
- Pharmacy Department, S. Giovanni Bosco Hospital, 10154 Turin, Italy; (M.V.); (S.O.); (P.C.)
| | - Sara Osella
- Pharmacy Department, S. Giovanni Bosco Hospital, 10154 Turin, Italy; (M.V.); (S.O.); (P.C.)
| | - Paola Crosasso
- Pharmacy Department, S. Giovanni Bosco Hospital, 10154 Turin, Italy; (M.V.); (S.O.); (P.C.)
| | - Marika Denise Favuzzi
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | - Elena Rubini
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | - Silvia Grazietta Foddai
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | - Simone Baldovino
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| | - Daniela Rossi
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis-ERKnet Member, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, 10154 Turin, Italy; (M.R.); (I.C.); (M.D.F.); (E.R.); (S.G.F.); (S.B.); (D.R.); (D.R.)
| |
Collapse
|
42
|
Glattacker M, Boeker M, Anger R, Reichenbach F, Tassoni A, Bredenkamp R, Giesler JM. Evaluation of a Mobile Phone App for Patients With Pollen-Related Allergic Rhinitis: Prospective Longitudinal Field Study. JMIR Mhealth Uhealth 2020; 8:e15514. [PMID: 32301735 PMCID: PMC7195669 DOI: 10.2196/15514] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/10/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background Mobile health apps have great potential to support the self-management of chronic conditions such as allergic diseases, which constitute significant challenges in health care. However, the health app market is confusing for users, as it is vast, dynamic, and lacks scientific evidence regarding the effectiveness of the apps on offer. To our knowledge, no health app for pollen-related allergic rhinitis has been evaluated. Objective The aim of our study was to evaluate the Husteblume mobile phone health app, developed in Germany to facilitate the self-management of pollen-related allergic rhinitis. Methods We evaluated usability and changes in quality of life, health literacy, and self-efficacy for managing one’s chronic disease. We conducted 2 online surveys of registered users of the app, 1 before and 1 after the 2017 pollen season, allowing for the analysis of both cross-sectional and longitudinal data in a field setting. Results The sample comprised 661 app users at the first measurement point and 143 users at follow-up. The subgroup of study participants at follow-up rated the usability of the app as good or very good. There were no significant changes in patient-reported outcomes such as quality of life, health literacy, and self-efficacy between the 2 measurement points (P>.05). However, those reached at follow-up perceived subjective improvements due to the app: 55.9% (80/143) reported being subjectively better informed about their allergy, 27.3% (39/143) noted improved quality of life, 33.6% (48/143) reported subjectively better coping with their allergy, and 28.0% (40/143) felt better prepared for the consultation with their physician. Finally, 90.9% (130/143) users did not identify any adverse effects of the app. Conclusions Despite some methodological caveats, the results of the evaluation of the Husteblume app are encouraging for the subgroup using the app in the long term. However, further studies evaluating the effectiveness of the app are needed. Trial Registration German Clinical Trials Register DRKS00011897; https://tinyurl.com/yxxrg9av
Collapse
Affiliation(s)
- Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Medical Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robin Anger
- Section of Health Care Research and Rehabilitation Research, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Reichenbach
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Adrian Tassoni
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Bredenkamp
- Clinical Trials Unit UMG, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Juergen M Giesler
- Section of Health Care Research and Rehabilitation Research, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
43
|
Zárate-Bravo E, García-Vázquez JP, Torres-Cervantes E, Ponce G, Andrade ÁG, Valenzuela-Beltrán M, Rodríguez MD. Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14680. [PMID: 32130164 PMCID: PMC7076413 DOI: 10.2196/14680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users' attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. OBJECTIVE This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. METHODS A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. RESULTS The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD's external cues not only improved older adults' medication adherence but also mediated family caregivers' involvement. CONCLUSIONS The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. TRIAL REGISTRATION ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97.
Collapse
Affiliation(s)
- Ernesto Zárate-Bravo
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | | | - Gisela Ponce
- Facultad de Enfermería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - Ángel G Andrade
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Marcela D Rodríguez
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| |
Collapse
|
44
|
Older adults’ views on eHealth services: a systematic review of scientific journal articles. Int J Med Inform 2020; 135:104031. [DOI: 10.1016/j.ijmedinf.2019.104031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 01/06/2023]
|
45
|
Duan H, Wang Z, Ji Y, Ma L, Liu F, Chi M, Deng N, An J. Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment. JMIR Mhealth Uhealth 2020; 8:e14466. [PMID: 32130161 PMCID: PMC7064970 DOI: 10.2196/14466] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management.
Collapse
Affiliation(s)
- Huilong Duan
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Zheyu Wang
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Yumeng Ji
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Li Ma
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fang Liu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Mingwei Chi
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Deng
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Jiye An
- College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, Hangzhou, China
| |
Collapse
|
46
|
Cao H, Zhang Z, Evans R, Dai W, Bi Q, Zhu Z, Shen L. Barriers and Enablers to the Implementation of Intelligent Guidance Systems for Patients in Chinese Tertiary Transfer Hospitals: Usability Evaluation (Preprint). JMIR Med Inform 2020. [DOI: 10.2196/18382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Fischer KI, De Faoite D, Rose M. Patient-reported outcomes feedback report for knee arthroplasty patients should present selective information in a simple design - findings of a qualitative study. J Patient Rep Outcomes 2020; 4:6. [PMID: 31965364 PMCID: PMC6973599 DOI: 10.1186/s41687-020-0173-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background Technical innovation to assess patient-reported outcomes (PROs) facilitates their implementation in clinical practice. In particular, mobile applications (apps) allow PROs to be assessed outside of the clinical setting. A patient’s health status can be remotely monitored and evaluated after discharge, and their recovery process tracked. This is of particular interest for patients after knee arthroplasty, as the recovery phase after surgery usually takes place in an outpatient setting and requires a high level of patient engagement. Providing results of PRO assessments to patients in the form of a feedback report could increase patient engagement and may improve communication between health care professionals and patients. The aim of the study is to develop a PRO feedback report for mobile devices that is comprehensible and provides valuable information for patients after knee arthroplasty. Results In an iterative development process, our expert group developed two preliminary feedback reports (a text-based version and a graphical display) based on previous research results and practical experience. In a second step, we discussed these reports with orthopedic patients (n = 8) in terms of comprehensibility and value using semi-structured interviews and cognitive debriefing methods. Participants assessed the reports as informative, but had some difficulties in fully comprehending all of the information provided. Based on the feedback from patients, we modified both versions and reduced complexity to increase comprehensibility. Conclusions A PRO feedback report for patients for mobile app use has to take account of the heterogeneous user group, particularly demographics such as age and experience with mobile devices. Information should be presented in a simple way to be comprehensible and of value to patients. Technological advancements allow a simple default report to be set, something which enables patients interested in additional information to make customizations.
Collapse
Affiliation(s)
- Kathrin I Fischer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin, Germany.
| | - Diarmuid De Faoite
- Smith & Nephew, Clinical Scientific and Medical Affairs, Global Clinical Strategy, Baar, Switzerland
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin, Germany.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
48
|
Singh G, MacGillivray M, Mills P, Adams J, Sawatzky B, Mortenson WB. Patients' Perspectives on the Usability of a Mobile App for Self-Management following Spinal Cord Injury. J Med Syst 2019; 44:26. [PMID: 31828440 DOI: 10.1007/s10916-019-1487-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
With decreasing inpatient lengths of stay following spinal cord injury (SCI), newly injured patients may be discharged into the community without the self-management skills needed to prevent secondary conditions. A mobile app was developed to facilitate self-management skills following SCI in the inpatient rehabilitation and early community settings. The objective of this study was to explore patients' perspectives on the usability of this self-management app. A mixed-methods study design was implemented. The app was trialed at a local rehabilitation centre with 20 inpatient participants who experienced a SCI. They received mobile app training sessions throughout their inpatient rehabilitation. A thematic analysis was performed on qualitative data from post-discharge exit questionnaires and researchers' field notes. Quantitative data (in the form of participants' tool usage data and self-reported system usability scale scores) were collected at discharge and 3 months post-discharge. Three main themes emerged from the qualitative analysis: (1) being accessible to users (i.e., being easy to adopt and compatible with assistive technologies), (2) being intuitive to navigate (i.e., incorporating a simple app layout and a system of alert notifications), and (3) offering users flexibility (i.e., providing users with control over their data). The mobile app received above average mean system usability scale scores, both at discharge (78.1/100) and 3 months post-discharge (71.6/100). Given that participants found the app acceptable for use in inpatient rehabilitation and following discharge into the community, further testing is warranted to explore its efficacy in preventing secondary complications.
Collapse
Affiliation(s)
- Gurkaran Singh
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.,Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Megan MacGillivray
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.,Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Patricia Mills
- G.F. Strong Rehabilitation Centre, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.,Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre-ICORD, 3rd Floor, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada. .,G.F. Strong Rehabilitation Centre, Vancouver, Canada. .,Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
49
|
Quintana Y, Fahy D, Abdelfattah AM, Henao J, Safran C. The design and methodology of a usability protocol for the management of medications by families for aging older adults. BMC Med Inform Decis Mak 2019; 19:181. [PMID: 31488134 PMCID: PMC6729072 DOI: 10.1186/s12911-019-0907-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Y Quintana
- Harvard Medical School, Boston, MA, USA. .,Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - D Fahy
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - J Henao
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C Safran
- Harvard Medical School, Boston, MA, USA.,Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
50
|
Shade M, Boron J, Manley N, Kupzyk K, Pullen C. Ease of Use and Usefulness of Medication Reminder Apps among Rural Aging Adults. J Community Health Nurs 2019; 36:105-114. [PMID: 31291770 DOI: 10.1080/07370016.2019.1630960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Older adults manage multiple medications for chronic disease and those living in rural areas are impacted by health care disparities due to health provider shortages and fewer pharmacies. The use of downloadable medication reminder apps on smartphones may serve as a strategy for medication self-management of chronic diseases. In this feasibility study, thirteen rural older adult participants downloaded Medisafe® and used the app to manage their daily medications. The community-dwelling aging adults in this pilot perceived the Medisafe® as not difficult to use, useful for medication tracking and providing reminders for the self-management of multiple medications.
Collapse
Affiliation(s)
- Marcia Shade
- a College of Nursing , University of Nebraska Medical Center College of Nursing-Omaha , Omaha , Nebraska , USA
| | - Julie Boron
- b Gerontology, Public Affairs and Community Service , University of Nebraska Omaha , Omaha , Nebraska , USA
| | - Natalie Manley
- c Internal Medicine , University of Nebraska Medical Center Internal Medicine Division of Geriatrics , Omaha , Nebraska , USA
| | - Kevin Kupzyk
- a College of Nursing , University of Nebraska Medical Center College of Nursing-Omaha , Omaha , Nebraska , USA
| | - Carol Pullen
- a College of Nursing , University of Nebraska Medical Center College of Nursing-Omaha , Omaha , Nebraska , USA
| |
Collapse
|