Evaluation of User Support: Factors That Affect User Satisfaction With Helpdesks and Helplines

In addition to technical documentation, face-to-face helpdesks and telephonic helplines are a powerful means for supporting users of technical products and services. This study investigates the factors that determine user satisfaction with helpdesks and helplines. A survey, based on the SERVQUAL framework and questionnaire, shows that the SERVQUAL dimensions of customer satisfaction are not applicable in these contexts. Three quality dimensions were found instead: solution quality, the experience of the consultation, and, in the case of a physical environment, the so-called tangibles. Helpdesk customers base their overall quality perceptions mainly on their experiences during a consultation, while helpline customers focus strongly on the quality of the solution offered.\ud The study also found a connection between the perceived helpline quality and the appreciation of the primary service

The appeal of the Functional Fitness MOT to older adults and health professionals in an outpatient setting: a mixed-method feasibility study

Purpose: To understand the views and perceptions regarding the Functional Fitness MOT (FFMOT), a battery of functional tests followed by a brief motivational interview, of both the older people undergoing it and the health professionals delivering it. Patients and methods: Physically inactive older adults (n=29) underwent the FFMOT and subsequently attended focus groups to share their perceptions of it and to discuss the barriers, motivators, health behavior change, and scope to improve physical activity (PA) levels. PA levels were recorded at baseline and again at 12 weeks together with a post-intervention questionnaire concerning behavior change. Participating physiotherapists and technical instructors were interviewed. Results: Most participants felt they had learned about their abilities and comparisons with their peers, had a change in perception about the importance of good balance and strength, and felt the FFMOT helped raise their awareness of local and self-directed physical activity opportunities. Most felt their awareness of the need for PA had not changed, but 25% of participants started a new organized PA opportunity. The health professionals perceived the FFMOT as being easy to administer, educating, and motivating for participants to increase their PA. Space, time, finances, and insecurity about having the necessary skills to conduct the FFMOTs were seen as barriers in implementing the FFMOT in daily practice. Conclusion: Over half of those offered the FFMOT accepted it, suggesting it is appealing. However, most participants felt they were already active enough and that their awareness of the need for PA had not changed. There were positive perceptions of the FFMOT from both professionals and older people, but both felt the FFMOT could be held in a community venue. The overall findings suggest that the FFMOT is feasible in the clinical setting, but its effectiveness has yet to be determined

Views and experiences of visually impaired older people and exercise instructors about the Falls Management Exercise programme: a qualitative study

Purpose: To gain insight into visually impaired older people’s views regarding acceptability of an adapted Falls Management Exercise programme, and to explore Postural Stability Instructors’s perspectives on provision of the programme. Materials and methods: Data from this qualitative study comprised interviews with nine visually impaired older people and two Postural Stability Instructors. Data were analysed using thematic analysis. Results: Themes identified from interviews with the participants related to self-perception, exercise-related factors and facilitators to participation. Participants positioned themselves as not old or at risk of falls, felt exercises were not challenging enough and recommended that home exercise materials be offered in individually tailored formats. Themes identified from interviews with the instructors related to programme adaptations for visual impairments, exercises and facilitators to participation. Instructors recommended stratifying groups into levels of ability. Social time after the exercise sessions was deemed key in programme adherence by both participants and instructors. Conclusions: Visually impaired older people have similar barriers and facilitators to group-based falls prevention sessions as older people without visual impairment, but seem to have more difficulties in motivation to exercise at home. Both participants and instructors felt the main facilitator to adherence to group exercise sessions was the social time

Participatory eHealth development to support nurses in antimicrobial stewardship

Background Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses’ can be supported in ASPs by means of an eHealth intervention that targets their information needs. Methods We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital. Results To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application’s functionality, content, and structure to nurse work practice and tasks. Conclusions By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses’) and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspective

A manual-based individual therapy to improve metacognition in schizophrenia:protocol of a multi-center RCT

BACKGROUND: Metacognitive dysfunction has been widely recognized as a feature of schizophrenia. As it is linked with deficits in several aspects of daily life functioning, improvement of metacognition may lead to improvement in functioning. Individual psychotherapy might be a useful form of treatment to improve metacognition in patients with schizophrenia; multiple case reports and a pilot study show promising results. The present study aims to measure the effectiveness of an individual, manual-based therapy (Metacognitive Reflection and Insight Therapy, MERIT) in improving metacognition in patients with schizophrenia. We also want to examine if improvement in metacognitive abilities is correlated with improvements in aspects of daily life functioning namely social functioning, experience of symptoms, quality of life, depression, work readiness, insight and experience of stigma. METHODS/DESIGN: MERIT is currently evaluated in a multicenter randomized controlled trial. Thirteen therapists in six mental health institutions in the Netherlands participate in this study. Patients are randomly assigned to either MERIT or the control condition: treatment as usual (TAU). DISCUSSION: If proven effective, MERIT can be a useful addition to the care for schizophrenia patients. The design brings along some methodological difficulties, these issues are addressed in the discussion of this paper. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN16659871

Reducing falls risk with Kinect based falls prevention EXERGAMES: a 12 week twocentre, cluster RCT of community-dwelling older adults living in sheltered housing

Introduction: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. Despite overwhelming evidence for strength/balance training, adherence to both group and home-exercise programmes is often poor1. A novel approach is the use of home-based, strength and balance video-games (EXERGAMES) but data from randomized controlled trials are limited2. The aim of this study was to test whether a 12 week EXERGAMES home-based intervention, co-developed with older adults and therapists, can improve the risk of falling [by Berg Balance Scale (BBS)] in older adults living in sheltered housing. Methods: We conducted a two-site (Manchester/Glasgow) cluster RCT. Twelve sheltered housing facilities were randomised (1:1) to either a 12wk standard care plus 3 times/ week EXERGAMES physiotherapist one-to-one intervention (n=56) or standard care (control group n=50). Standard care involved the provision of a home exercise booklet (standard approach for those unable/unwilling to attend group exercise programmes in the community). Results: A total of 106 older adults (83F, 23M) with a mean age of 77.8y (SD 10.2; range 55-101y), were recruited for the study. A total of 91 (86%) participants completed all study visits. Over 12 weeks the EXERGAMES intervention had a significant positive impact on BBS [p=0.003; mean (SD), 44.6 (10.7) (EXERGAMES) vs. 37.6 (14.9) (Control)]. The mean change of BBS from baseline was 2.9 (8.5) for the EXERGAMES and -2.8 (6.5) for the control group. The estimated increase in BBS score due to EXERGAMES was 6.2 (95% CI 2.4 to 9.9) which is greater than the minimal detectable change for the scale of 4.93. Conclusions: Balance, and thus risk of falling, can be improved through a 12wk physiotherapy led EXERGAMES programme. This type of home based intervention could be considered as an effective alternative to traditional falls prevention exercise regimes to support outcomes for patients

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years.

Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.A Task Force (TF) supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.The TF then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The TF formulated recommendations using the GRADE Evidence to Decision framework.Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future