TURF for Teams: Considering Both the Team and I in the Work-Centered Design of Systems

Teams are an inherent part of many work domains, especially in the healthcare environment. Yet, most systems are often built with only the individual user in mind. How can we better incorporate the team, as a user, into the design of a system? By better understanding the team, through their user, task, representational, and functional needs, we can create more useful and helpful systems that match their work domain. For this research project, we utilize the TURF framework and expanded it further by also considering teams as a user, thus, creating the TURF for Teams framework. In addition, we chose to examine teams in the emergency department environment. We believe that designing a system with the team also fully incorporated and acknowledged in the work domain will be beneficial for supporting necessary team activities. Using TURF for Teams, we first conducted an observational field study in the emergency department to get a better understanding of the users, teams, tasks, workload, and interactions. We then identified the need for team communications to be better supported, especially in the management of interruptions, and further categorized the interruptions by their function in order to design a team tool that could help team members better manage their interruptions by focusing on the necessary, or domain, types of interruptions and more easily disregarding the unnecessary, or overhead, types of interruptions. We then administered some surveys and conducted a card sort and cognitive walkthrough with emergency clinician participants to help us better identify how to design interfaces for the team tool and simulation that would better match the needs of team communication behaviors observed and reported by emergency clinicians. After designing and developing the team tool and simulation, we conducted an evaluation of this system by having emergency medicine, medicine, and informatics graduate student teams go through the system and utilize the team tool and simulation as a team. Though we had a small sample size, we found that emergency medicine teams found the team tool and simulation to be very usable and they reacted favorably to its potential in helping them better understand and manage their team communications. In summary, we were able to utilize the TURF framework for incorporating teams into the design of systems, in this case a team communication tool and microworld simulation for the emergency department. Our findings suggest that TURF for Teams is a viable framework for designing useful and helpful team based systems for all work domains

Usability and acceptability of a cognitive training intervention (SMART) for people with multiple sclerosis (MS): A prefeasibility formative evaluation version 1; peer review: awaiting peer review

Background: Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system (CNS), increasing in incidence and prevalence across both developed and developing countries. Cognitive difficulties are common in MS sufferers with 70% experiencing difficulties in higher-level brain functioning such as planning, attention, problem solving, and memory. Computerised cognitive training programmes may hold promise as a treatment option for improving cognitive function in people with MS, subject to exploring and addressing potential barriers to usability and acceptability. Methods: This study aimed to test the usability and acceptability of a computerised cognitive training intervention—Strengthening Mental Abilities Through Relational Training (SMART) —for people with MS, through a mostly qualitative prefeasibility design (n= 12). There were two phases of testing: (1) initial usability testing via a think-aloud protocol (n= 6) and (2) alpha-testing to assess experienced acceptability over a four-week period of engagement (n= 6). Data from the two phases were subjected to Framework Analysis, wherein we deductively applied the Health IT Usability Evaluation Model and Theoretical Framework of Acceptability to assess usability and acceptability, respectively. Results: Results show SMART to have satisfactory usability with participants reacting positively to the formatting, visuality, and process of the interface. Minor suggestions were made on how best to adapt SMART for people with MS, but the programme and facilitative support were generally perceived to be acceptable, with participants expressing positive feelings about taking part in the intervention, despite associated burdens. Conclusions: This prefeasibility study provides preliminary evidence of the usability and acceptability of SMART as a computerised cognitive training programme for people with MS. We conclude that we can now move forward with a feasibility trial of SMART, with the intention of proceeding to a definitive trial with cost-effectiveness analysis. Keyword