How to interact with medical terminologies? Formative usability evaluations comparing three approaches for supporting the use of MedDRA by pharmacovigilance specialists

Background: Medical terminologies are commonly used in medicine. For instance, to answer a pharmacovigilance question, pharmacovigilance specialists (PVS) search in a pharmacovigilance database for reports in relation to a given drug. To do that, they first need to identify all MedDRA terms that might have been used to code an adverse reaction in the database, but terms may be numerous and difficult to select as they may belong to different parts of the hierarchy. In previous studies, three tools have been developed to help PVS identify and group all relevant MedDRA terms using three different approaches: forms, structured query-builder, and icons. Yet, a poor usability of the tools may increase PVS' workload and reduce their performance. This study aims to evaluate, compare and improve the three tools during two rounds of formative usability evaluation. Methods: First, a cognitive walkthrough was performed. Based on the design recommendations obtained from this evaluation, designers made modifications to their tools to improve usability. Once this re-engineering phase completed, six PVS took part in a usability test: difficulties, errors and verbalizations during their interaction with the three tools were collected. Their satisfaction was measured through the System Usability Scale. The design recommendations issued from the tests were used to adapt the tools. Results: All tools had usability problems related to the lack of guidance in the graphical user interface (e.g., unintuitive labels). In two tools, the use of the SNOMED CT to find MedDRA terms hampered their use because French PVS were not used to it. For the most obvious and common terms, the icons-based interface would appear to be more useful. For the less frequently used MedDRA terms or those distributed in different parts of the hierarchy, the structured query-builder would be preferable thanks to its great power and flexibility. The form-based tool seems to be a compromise. Conclusion: These evaluations made it possible to identify the strengths of each tool but also their weaknesses to address them before further evaluation. Next step is to assess the acceptability of tools and the expressiveness of their results to help identify and group MedDRA terms

Usability and usefulness of a mobile health app for pregnancy-related work advice : mixed-methods approach

Acknowledgments The authors would like to thank all the pregnant participants who participated in the TA sessions and the employees of the obstetric care facilities. This pilot study received funding from ZonMw, the Netherlands Organization for Health Research and Development. This project is part of the Pregnancy and Birth Program.Peer reviewedPublisher PD

Visual Inspection of Sequential Data: A Research Instrument for Qualitative Data Analysis

Sequence analysis has been widely used to investigate the patterns of similarities and differences of sequential data in biology and sociology. However, the debate on the usage of sequence analysis in social sciences has not been settled yet. Among a long list, sequence analysis methods have been criticized for ignoring the qualitative information behind the sequences. This paper presents a new instrument for inspecting sequential data visually in qualitative studies. The method includes building a hierarchical tree of relations among the categories which is then used to recode the categories systematically. The recoding process is meant to give meaning to the differences among categories and, therefore, increases our ability to see the differences. The instrument is a fruit of a qualitative study carried out to explore student’s learning patterns. The focus in this paper will be on the algorithm of recoding the categories and how the emergent codes can be plotted to generate insights for further qualitative investigation

Proceedings of the Sixth Danish Human-Computer Interaction Research Symposium.

Proceedings of theSixth Danish Human-Computer Interaction Research Symposium.Aarhus, Denmark, November 15, 200

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

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

An Investigation of the Impact of Task-Types on the Reactivity of the Concurrent Think-Aloud in Usability Testing

The Concurrent think-aloud (CTA) is primarily used to understand users’ task based cognitive processes. However, is not without limitations. CTA procedures varies widely among practitioners. Also, it has been known to cause reactivity: an artificial change in task performance. This is problematic because it may alter the accuracy of task performance. Also, research on reactivity within usability testing have shown mixed findings. Thus, conclusions cannot be drawn to attest to whether reactivity occurs due to varying administration procedures and therefore we must now consider its relationship to other test-based factors. This research will be the first to systematically investigate the impact of task-type on reactivity of the CTA and the first to systematically investigates practitioners working habit in terms of their views on reactivity when using CTA in practice. Three studies were conducted, the first study investigates the Impact of task-types on the Reactivity of CTA and uses a mixed design. The results suggest that, thinking aloud during usability testing does not cause reactivity, and task type does not impact concurrent think-aloud. However, sensemaking tasks increase mental demand. The second study investigates the impact of task-type on two different think-aloud protocols and uses a mixed design. The result indicates that, the classic think-aloud method led to more successful task completion and no reactivity, while the explicit instruction produced fewer successful task completions and a higher mental workload. The explicit instruction produced less verbalisation, resulting in fewer relevant explanatory utterances, contradicting expectations. The third study uses an interview method to explores practitioners' experiences, views on reactivity and challenges when using the think-aloud method within usability testing. These studies demonstrates unequivocally that CTA should not be abandoned in usability studies as it provided valuable think-aloud data and helped identify usability issues. Additionally, practitioners should not replace the traditional think- aloud approach with explicit instruction, as explicit instruction had a greater influence on participants' behaviour. Ericsson and Simon's recommendations should be used for concurrent data collection, as it ensures data validity and generates the same type of data as explicit instruction while reducing reactivity

Formative Research on an Instructional Design Theory for Virtual Patients in Clinical Education: A Pressure Ulcer Prevention Clinical Reasoning Case

Despite advances in health care over the past decades, medical errors and omissions remain significant threats to patient safety and health. A large number of these mistakes are made by trainees, persons who are just beginning to build the case-based experiences that will transform them from novices to expert practitioners. Clinicians use both intuitive and deductive problem-solving skills in caring for patients and they acquire expertise in applying these skills through interaction with many and varied cases. The contemporary heath care environment, with decreased lengths of stay for patients and reduced duty hours for trainees, makes getting optimal patient exposure difficult. Virtual patients (VPs), online, interactive patient cases, may help close the case exposure gap. Evidence has shown that VPs improve clinical reasoning skills, but no formal instructional design theory of VPs has been advanced. The goal was to conduct formative research to develop an instructional design theory of VPs to help novice clinicians cultivate clinical reasoning and diagnostic skills. The instructional design theory, goal-based scenarios (GBS), grounded in the learning theory, Case-based Reasoning, provided methods that promised to be appropriate to the goal. An existing, two-module, multimedia VP, Matt Lane, A Pressure Ulcer Prevention Virtual Patient, was tested with 10 medical trainees to determine which methods of GBS it incorporated and which of its methods were not part of GBS. Leaners\u27 experience of what worked and didn\u27t work to promote learning in the VP was analyzed. The VP was found to incorporate all GBS methods and one significant method, the Life Model, that was not part of GBS. The Life Model Method involved replicating, with a high degree of fidelity, the experiences of a real patient in creating the VP scenario. Recommendations for customization of GBS for VPs included more explicit advertisement of learning goals and leverage of Internet search engines to provide just-in-time resources to support problem-solving. Incorporation of the Life Model was also recommended along with the Simplifying Conditions Method from Elaboration Theory to manage the complexity inherent in the Life Model. The resultant, enhanced GBS theory may be particularly relevant in teaching patient-centered care