Development and usability testing of a web-based and therapist-assisted coping skills program for managing psychosocial problems in individuals with hand and upper limb injuries: Mixed methods study

© 2020 Folarin Omoniyi Babatunde, Joy MacDermid, Ruby Grewal, Luciana Macedo, Mike Szekeres. Background: Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. Objective: This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. Methods: The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. Results: In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: Task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. Conclusions: We describe the development and usability testing of HOCOS; a new web-based psychosocial intervention for individuals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants

Emerging Insights of Health Informatics Research: A Literature Analysis for Outlining New Themes

This paper presents a contemporary literature review to provide insights into the current health informatics literature. The objective of this study is to identify emerging directions of current health informatics research from the latest and existing studies in the health informatics domain. We analyse existing health informatics studies using a thematic analysis, so that justified sets of research agenda can be outlined on the basis of these findings. We selected articles that are published in the Science Direct online database. The selected 73 sample articles (published from 2014 to 2018 in premier health informatics journals) are considered as representative samples of health informatics studies. The analysis revealed ten topic areas and themes that would be of paramount importance for researchers and practitioners to follow. The findings provide an important foundational understanding for new health informatics studies

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

The Development of a Point of Care Clinical Guidelines Mobile Application Following a User-Centred Design Approach

This paper describes the development of a point of care clinical guidelines mobile application. A user-centred design approach was utilised to inform the design of a smartphone application, this included: Observations; a survey; focus groups and an analysis of popular apps utilised by clinicians in a UK NHS Trust. Usability testing was conducted to inform iterations of the application, which presents clinicians with a variety of integrated tools to aid in decision making and information retrieval. The study found that clinicians use a mixture of technology to retrieve information, which is often inefficient or has poor usability. It also shows that smartphone application development for use in UK hospitals needs to consider the variety of users and their clinical knowledge and work pattern. This study highlights the need for applying user-centred design methods in the design of information presented to clinicians and the need for clinical information delivery that is efficient and easy to use at the bedside

Examining the Design and Usability of Telemedicine Communications: A Mixed-methods Study

This dissertation describes a mixed-methods study that examines the usability of telemedicine provider interfaces. This study consisted of content analysis, survey, and think aloud methodologies, which afford a multifaceted corpus of data for which to draw inferences and identify design features and functions that negatively impact usability. Usability is a critical component of the user experience with a telemedicine provider interface and can suede or impede the acceptance and adoption of telemedicine. Telemedicine has the potential to increase quality healthcare access and positive health outcomes for individuals who use it, and usability is a key component of technology acceptance and effective use. Empirical testing of health information technology (HIT) and telemedicine is advocated for as it is the most valuable method of research to understand humans\u27 cognitive processing of information as they interact with technology. In addition, using activity theory and mobile interface theory as a lens in which to understand human activities and interaction with telemedicine provider interfaces, including the telemedicine provider websites and their mobile-responsive websites in this study, is an effective tool for drawing reasonable inferences regarding the usability of telemedicine communications. Considering the rate at which an unprecedented amount of health information becomes available online and HIT facilitates the delivery of healthcare, usability testing and user-centered, iterative design practices become increasingly essential in order to design effective—and safe—health information and technology that enhance the patient-experience, the affordability and accessibility of healthcare, health literacy and patient empowerment, and positive health outcomes. Usability testing plays an increasingly important role in characterizing obstacles to achieving these initiatives of the modern patient-centered health paradigm and telemedicine. The mixed-methods usability testing performed in this study offers a principled approach to usability testing and is ecologically valid because it involves real human subjects. This study fulfills a void in research on the usability of telemedicine communications and reveals usability problems that may not be anticipated by designers of HIT and health information providers. Drawing from the insight gained from this mixed-method study, design features and functions that enhance the usability of health communications are offered. This study draws insight from the human factors, technical communication, and health and medical fields to develop systematic, practical usability testing methods that can be replicated and applied in many fields. The design recommendations resulting from this study will be valuable to programmers; systems analysts; clinicians and nurses; technical communicators; information architects; visual designers; and others in similar roles

The Impact of Mobile Technology in the Battle against COVID-19

Mobile technology has undergone rapid development in the last decade and immediately found fertile ground for use in digital healthcare applications. The advantages both for citizens and the health domain are many and interconnected. During the pandemic, mobile technology was also useful for minimizing social distancing, epidemiological monitoring through contact tracing, psychological support, and maintaining social relationships. There is a particular need for scholars to focus both on the innovations in this field during the pandemic and on the problems hampering the use of mobile technology to facilitate the correct and effective introduction of this technology into routine clinical programs in stable health care models. All professionals working in this sector were encouraged to contribute with their experiences. This reprint contains contributions from various experts and different fields. Aspects relating to the success and failures of employment, the medical experience, and acceptance are addressed. Particular space was also given to the role of social media, the use of apps (also presenting critical issues), and innovative apps for contact tracing. The digital divide and the infodemic were also investigated along with their impacts on citizens during the pandemic, for example, in following government directives relating to prevention and vaccination. We dedicate the book to all those involved with different roles in digital health

Design Strategy for Integrated Personal Health Records: Improving the User Experience of Digital Healthcare and Wellbeing

This dissertation addresses the timely problem of designing Integrated Personal Health Records (PHR). The goal is to provide citizens with digital user experiences, sustainable and flexible enough, for gaining control over their personal health information in a seamless way. Most importantly, so that people are able to reflect and act upon their selfknowledge, towards the accomplishment of their good health and wellbeing. Towards this end, the Integrated PHR as an emerging model in the field of Health IT, was the framework that set this research forward on exploring how communication and collaboration between patients and providers can be improved, which naturally impacts the field of HCI. Acknowledging that today patients are the ones who own all that is recorded about their health data, this new model was object of a design strategy that shaped the results presented in this dissertation. These have showed how patients can have more control of their health over time, through a patient-centered, organic system, which has the ability of combining multiple sources of data both from patient and provider side. As this new type of PHR fosters the creation of integrated networks, this milestone was achieved in this research by interacting with cross-channel user experiences that took part of nationwide healthcare ecosystems. The work presented herein, has demonstrated through the analysis and development of two use cases in cooperation with organizations connected to the Portuguese Ministry of Health, how an Integrated PHR can be a powerful personal tool, to be used by the citizen with undeniable value to the demands of an aging society. The use cases structured the thesis into two parts. The first part in collaboration with the Portuguese National Patient Portal, combines an Integrated PHR and incorporates the Portuguese Data Sharing Platform (PDS), which can be used by any Portuguese citizen. This use case study led to a proposal of the portal by also creating a foundational model for designing Integrated PHRs. The second part in collaboration with the Portuguese National Senior Telehealth Program (Saúde 24 Sénior), led to another proposal for an Integrated PHR, applying the outcomes from Part 1 and the requirements that derived from the findings explored in this second use case study. The proposed solution, has the potential to be used by the Portuguese senior community in the scope of home assistive care. Both proposals applied a user experience design methodology and included the development of two prototypes. The engagement of the stakeholders during the two case studies was accomplished with participatory design methods and followed a multidisciplinary approach to create solutions that would meet the human, politics and behavior interdependencies that were inherent to the process of working with large healthcare organizations. The provided contributions from this thesis intent to be part of a transition process that is changing the behavior of the healthcare sector, which is increasingly moving towards the improvement of the patient-provider relationship, patient engagement, collaborative care and positive computing, where digital technologies play a key role

P5 eHealth: An Agenda for the Health Technologies of the Future

This open access volume focuses on the development of a P5 eHealth, or better, a methodological resource for developing the health technologies of the future, based on patients’ personal characteristics and needs as the fundamental guidelines for design. It provides practical guidelines and evidence based examples on how to design, implement, use and elevate new technologies for healthcare to support the management of incurable, chronic conditions. The volume further discusses the criticalities of eHealth, why it is difficult to employ eHealth from an organizational point of view or why patients do not always accept the technology, and how eHealth interventions can be improved in the future. By dealing with the state-of-the-art in eHealth technologies, this volume is of great interest to researchers in the field of physical and mental healthcare, psychologists, stakeholders and policymakers as well as technology developers working in the healthcare sector

The Development of a Point of Care Clinical Guidelines Mobile Application Following a User-Centred Design Approach

This paper describes the development of a point of care clinical guidelines mobile application. A user-centred design approach was utilised to inform the design of a smartphone application, this included: Observations; a survey; focus groups and an analysis of popular apps utilised by clinicians in a UK NHS Trust. Usability testing was conducted to inform iterations of the application, which presents clinicians with a variety of integrated tools to aid in decision making and information retrieval.The study found that clinicians use a mixture of technology to retrieve information, which is often inefficient or has poor usability. It also shows that smartphone application development for use in UK hospitals needs to consider the variety of users and their clinical knowledge and work pattern. This study highlights the need for applying user-centred design methods in the design of information presented to clinicians and the need for clinical information delivery that is efficient and easy to use at the bedside