eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Master of Science

thesisElectronic Health Record (EHR) adoption rates have been low in the United States. A key reason for this low adoption rate is poor EHR usability. Currently no standards exist for design, testing and monitoring the usability of EHRs. Therefore, we conducted a usability evaluation of a vendor's product in the Emergency Department at the University of Utah. In the first objective of this study, we evaluated a newly implemented computerized provider order entry application. Four usability experts used the Zhang et al 14 heuristics and 23 predefined tasks to perform the evaluation. The experts found 48 usability problems categorized into 51 heuristic violations. There were 4 cosmetic, 120 minor, 64 major, and 4 catastrophic problems identified. The interrater reliability was 0.81 using Fleis' Kappa, showing a high level of consistency in ratings across evaluators. For the second objective, we used an electronic version of Questionnaire of User Interaction Satisfaction (QUIS 7.0) to evaluate physician satisfaction with the CPOE application in the ED. The physician response rate was 50% (25/50). The total survey mean was 4.87, lower than the -a priori‖ definition for acceptable satisfaction score of 5.0 (of a possible 9). The lowest scale scores were for overall user reaction and learning iv and the highest were for screen, terminology and system capabilities. Further analyses were completed to determine any differences for satisfaction scores between physician trainees and attending. A multifactor ANOVA was performed to examine the combined effect of the different experience levels and sections of the QUIS. The results were significant at -1.43 (p < 0.05) for screen and terminology and system capabilities. In this setting, the ED CPOE application had a high level of usability issues and low mean satisfaction scores among physician end-users. The responsibility for improved usability lies with both vendors developing the product and facilities implementing the product and both should be educated on usability principles. The combination of a user-based and expert-based inspection method yielded congruent findings and was an accurate and efficient means of evaluation

Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort

(C) The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved.Financial disclosure: This project was supported by the National Institute on Aging (R01 AG030611), the National Center for Research Resources (5UL1RR025741), and the National Center for Advancing Translational Sciences (Grant 8UL1TR000150). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Smith is currently supported by a Cancer Research UK Fellowship

Engineering And Pilot Proxy Evaluation Of A Spoken Web Enabled Care Management Platform

Telephones are a ubiquitous and widely accepted technology worldwide. The low ownership cost, simple user interface, intuitive voice-based access and long history contribute to wide-spread use and success of telephones, and more recently, that of mobile phones. This study presents our preliminary efforts to leverage this technology to bridge disparities in the access to and delivery of personalized health and wellness care by developing and evaluating a Spoken Web enabled Care Management Platform (SW-CMP) for underserved and disadvantaged populations. A pilot evaluation study was conducted with eight proxy users representing both providers and patients. Surveys completed by the participants and data generated from the evaluation process were analyzed. Results were mixed; while the current state of the system does not yet fully support a beneficial user experience, promising opportunities are being pursued for improved health management for patients and providers alike

Development and Usability Evaluation of an mHealth Application for Symptom Self-Management in Underserved Persons Living with HIV

Effective symptom management is essential to decrease symptom severity and improve health-related quality of life for persons living with HIV (PLWH). A mobile health (mHealth) application (app) has the potential to be an effective delivery mode of an existing paper-based symptom management manual with self-management strategies for underserved PLWH. The quality of the mHealth app requires a thorough understanding of the needs of the intended end-users and ensuring the app’s usability. The purpose of this study was to translate paper-based health information into an mHealth app for symptom self-management in underserved PLWH, entitled mVIP (mobile Video Information Provider), and assess its usability. To achieve this goal, usability was evaluated rigorously throughout the development process of mVIP. Based on a stratified view of health information technology (IT) usability evaluation framework, usability evaluation was sequentially conducted with the following three levels: 1) user-task, 2) user-task-system, and 3) user-task-system-environment. At level 1 (user-task), we applied a user-centered design method to guide the information architecture of mVIP. Using a reverse in-person card sorting technique, symptoms and self-management strategies from a paper-based HIV/AIDS symptom management manual were ranked. The rank order of the 13 symptoms and 151 self-management strategies determined the order of appearance to end-users of the mVIP app, with higher-ranked symptoms and strategies appearing first. Based on the findings, we developed a prototype of mVIP as following: 1) once users log in, they are guided by an avatar through a series of 13 symptom questions ascertaining the nature and severity of their symptoms, and 2) the avatar recommends three self-management strategies for each symptom reported. At level 2 (user-task-system), we conducted a usability evaluation of the mVIP prototype in a laboratory setting through end-user usability testing and heuristic evaluation. In end-user usability testing, we used an eye-tracking and retrospective think-aloud method to examine task performance by 20 PLWH. For the heuristic evaluation, five usability experts in informatics assessed the user interface. In the two usability evaluations conducted in a laboratory setting, we found strong user acceptance of the mVIP prototype while identifying a number of usability issues with this prototype. Based on the recommendations from the end-users and heuristic evaluators, we iteratively refined the app’s content, functionality, and interface. We then inserted videos of the finalized symptom self-management strategies into the refined mVIP prototype. At level 3 (user-task-system-environment), the usability of the refined mVIP prototype was evaluated in a real-world setting. Through 10 in-depth interviews and four focus groups conducted at the conclusion of a three-month randomized controlled trial, we explored in-depth understandings of users’ experiences, perceptions, and satisfaction of mVIP use. Findings from the study showed that first, mVIP is useful for HIV-related symptom self-management and has the potential for being used as a communication tool with healthcare providers; and second, mVIP is easy to use to monitor symptom experience over time. At the same time, participants suggested mVIP be more sensitively tailored based on years from initial diagnosis of HIV, an individuals’ age, and conditions. The overall user satisfaction with the mVIP prototype was high, which reflects strong user acceptance of mVIP. Integral to the findings from the three-level usability evaluation, we assessed the quality of the mVIP prototype in use and found the prototype was highly accepted by PLWH with high user satisfaction. This study will add to the body of literature on translation of evidence-based health information into an mHealth app and its usability assessment, which highlights the importance of the use of mobile technology for PLWH, specifically racial and ethnic minorities and those from low-socioeconomic groups who have limited health literacy and low level of education

mHealth Technology: Towards a New Persuasive Mobile Application for Caregivers That Addresses Motivation and Usability

With the increasing use of mobile technologies and smartphones, new methods of promoting personal health have been developed. For example, there is now software for recording and tracking one\u27s exercise activity or blood pressure. Even though there are already many of these services, the mobile health field still presents many opportunities for new research. One apparent area of need would be software to support the efforts of caregivers for the elderly, especially those who suffer from multiple chronic conditions, such as cognitive impairment, chronic heart failure or diabetes. Very few mobile applications (apps) have been created that target caregivers of the elderly and most seem to be limited to a single condition or to creating generic to-do lists or tracking medications. None seem to address the complex tracking of multiple chronic conditions, nor one of the key difficulties found with written checklists for this population, namely that caregivers quit recording health information regularly as time passes. This dissertation will explore methods for improving the consistency of usage of health tracking software for the caregivers of the elderly with multiple chronic conditions by creating designs that explicitly address the context and motivations of caregivers. This work will assess a number of existing approaches and provide a design and a prototype for a new motivating application to help the caregivers of patients with multiple chronic conditions. It will assess how well the tool seems to address factors associated with intrinsic motivation (e.g. autonomy, competence, relatedness, and feedback). The overall usability of the software application will also be addressed, following guidelines from ISO standards and Nielsen’s theories

Development of an Internet-Based Chronic Disease Self-Management System

Patient self-management programs and information systems that support them can improve the quality of healthcare. Flaws in user experience reduce the willingness of patients to adopt such systems. To explore how emerging technology such as rich Internet applications can be used to address the usability issues of personal health information systems, we developed a health self-management application that is based on an open-source framework. In this work we present the architecture of the system, discuss the issues we faced and lessons we learned while developing it. This work can help researchers and practitioners in evaluating approaches towards developing new generation of personal health solutions. Furthermore, this work serves as a basis for implementing a feature-rich system that can improve chronic disease self-management

Tablet-based Self-management Intervention for Diabetes Mellitus Type II Patients: Usability and Efficacy of The ASSISTwell Tool

Background: The usefulness of technology and the powerful capabilities of technological applications have led to a significantly increased interest in finding novel approaches to support older adults’ self-management. Self-management technological applications have been used in various contexts, and usability is key in sustainability and adoption of such technologies. Objective: The purpose of this research is to assess the usability of the ASSISTwell application in an older adult population with Diabetes Type II (DMII) and explore whether the application can effectively enhance DMII patients’ self-management. Design: Qualitative interviews, Observation, and Quasi-experimental design. Methods: Semi-structured interviews, observation, documentation, and quantitative standardized measures were used in this study. A purposive sample of 24 elderly patients with DMII was recruited for the study. Descriptive and inferential analysis were used to analyze the quantitative data. Simple content analysis was used to organize the emerging usability themes. Results: User feedback from the four-week user intervention demonstrated good usability of the ASSISTwell application. After using the ASSISTwell for 30 days, there was significant improvement in the perceived diabetes self-management skills of the intervention group (difference in mean PDSMS (F (1, 20) =5.11, p=0.035). Furthermore, those who used ASSISTwell (mean= 30.22, SD= 6.34) had higher PDSMS scores than those who received usual care without ASSISTwell (mean= 23.95, SD= 7.12). There was no significant difference in mean blood glucose levels (F (1, 20) =0.37, p=0.54) between the two groups. Those who used ASSISTwell (M=178, SD=40) had lower blood glucose levels than those who received usual care without ASSISTwell (M=185, SD=49), but the difference is not statistically significant. Conclusions: The novel ASSISTwell application presented in this paper helped participants improve their diabetes self-management skills. A well-designed application with new features has the ability to provide more promising results regarding improving perceived diabetes self-management skills. Also, examining usability is an essential step in application development to ensure that the application\u27s features match users\u27 expectations and needs and minimize the likelihood of user errors and difficulties using the system

Recording of time-varying back-pain data: A wireless solution

Chronic back pain is a debilitating experience for a considerable proportion of the adult population, with a significant impact on countries’ economies and health systems. While there has been increasing anecdotal evidence to support the fact that for certain categories of patients (such as wheelchair users), the back pain experienced is dynamically varying with time, there is a relative scarcity of data to support and document this observation, with consequential impact upon such patients’ treatment and care. Part of the reason behind this state of affairs is the relative difficulty in gathering pain measurements at precisely defined moments in time. In this paper,we describe a wireless-enabled solution that collects both questionnaire and diagrammatic, visual-based data, via a pain drawing, which overcomes such limitations, enabling seamless data collection and its upload to a hospital server using existing wireless fidelity technology. Results show that it is generally perceived to be an easy-to-use and convenient solution to the challenges of anywhere/anytime data collection