Evaluation of the Perceived Persuasiveness Questionnaire:User-Centered Card-Sort Study

Background: eHealth technologies aim to change users’ health-related behavior. Persuasive design and system features can make an eHealth technology more motivating, engaging, or supportive to its users. The Persuasive Systems Design (PSD) model incorporates software features that have the possibility to increase the persuasiveness of technologies. However, the effects of specific PSD software features on the effectiveness of an intervention are still largely unknown. The Perceived Persuasiveness Questionnaire (PPQ) was developed to gain insight into the working mechanisms of persuasive technologies. Although the PPQ seems to be a suitable method for measuring subjective persuasiveness, it needs to be further evaluated to determine how suitable it is for measuring perceived persuasiveness among the public. Objective: This study aims to evaluate the face and construct validity of the PPQ, identify points of improvement, and provide suggestions for further development of the PPQ. Methods: A web-based closed-ended card-sort study was performed wherein participants grouped existing PPQ items under existing PPQ constructs. Participants were invited via a Massive Open Online Course on eHealth. A total of 398 people (average age 44.15 years, SD 15.17; 251/398, 63.1% women) completed the card sort. Face validity was evaluated by determining the item-level agreement of the original PPQ constructs. Construct validity was evaluated by determining the construct in which each item was placed most often, regardless of the original placement and how often 2 items were (regardless of the constructs) paired together and what interitem correlations were according to a cluster analysis. Results: Four PPQ constructs obtained relatively high face validity scores: perceived social support, use continuance, perceived credibility, and perceived effort. Item-level agreement on the other constructs was relatively low. Item-level agreement for almost all constructs, except perceived effort and perceived effectiveness, would increase if items would be grouped differently. Finally, a cluster analysis of the PPQ indicated that the strengths of the newly identified 9 clusters varied strongly. Unchanged strong clusters were only found for perceived credibility support, perceived social support, and use continuance. The placement of the other items was much more spread out over the other constructs, suggesting an overlap between them. Conclusions: The findings of this study provide a solid starting point toward a redesigned PPQ that is a true asset to the field of persuasiveness research. To achieve this, we advocate that the redesigned PPQ should adhere more closely to what persuasiveness is according to the PSD model and to the mental models of potential end users of technology. The revised PPQ should, for example, enquire if the user thinks anything is done to provide task support but not how this is done exactly

Navigating travel in Europe during the pandemic:from mobile apps, certificates and quarantine to traffic-light system

Background Ever since 2020, travelling has become complex, and increasingly so as the COVID-19 pandemic continues. To reopen Europe safely, a consensus of travel measures has been agreed between countries to enable movement between countries with as few restrictions as possible. However, communication of these travel measures and requirements for entry are not always clear and easily available. The aim of this study was to assess the availability, accessibility and harmonization of current travel information available in Europe. Methods We performed a systematic documental analysis of online publicly available information and synthesized travel entry requirements for all countries in the European Union and Schengen Area (N = 31). For each country we assessed entry requirements, actions after entry, how risk was assessed, and how accessible the information was. Results We found varying measures implemented across Europe for entry and a range of exemptions and restrictions, some of which were consistent between countries. Information was not always easy to find taking on average 10 clicks to locate. Twenty-one countries required pre-travel forms to be completed. Forty apps were in use, 11 serving as digital certification checkers. All countries required some form of COVID-19 certification for entry with some exemptions (e.g. children). Nineteen percent (n = 6) of countries used the ECDC risk assessment system; 80% (n = 25) defined their own. Forty-eight percent (n = 15) of countries used a traffic-light system with 2-5 risk classifications. Conclusion A comprehensive set of measures has been developed to enable continued safe travel in Europe. However further refinements and coordination is needed to align travel measures throughout the EU to minimize confusion and maximize adherence to requested measures. We recommend that, along with developing travel measures based on a common set of rules, a standard approach is taken to communicate what these measures are

RadaR (Rapid analysis of diagnostic and antimicrobial patterns in R) - an interactive open source software tool

Background: Analysing outcome and quality of care indicators for infectious patients in an entire hospital requires processing large datasets, accounting for numerous patient parameters and treatment guidelines. Rapid, reproducible and adaptable analyses usually require substantial technical expertise. We describe a dashboard tool (RadaR) allowing user-friendly, intuitive and interactive analysis of large datasets without prior in-depth knowledge. This tool was developed for studying the effect of taking blood cultures on length of stay (LOS) and antibiotic consumption in patients receiving intravenous (IV) antibiotics at an academic tertiary referral hospital. RadaR handled a modelling dataset of more than 80,000 patients (eight years, 59 sub-specialties, 35 different antibiotic agents). Materials/methods: RadaR was built in R (version 3.4.2), an open source programming language using Shiny package (version 1.0.5), a web application framework for R. Analytical graphs are generated with ggplot2 and survminer packages. The source code and additional required R packages for RadaR can be found at github.com/ceefluz/radar with a running example at ceefluz.shinyapps.io/radar. Results: RadaR visualizes analytical graphs in an interactive manner within seconds. Users can control different input variables: time of blood culture taken, study year, patient age, specialty, admission route and antibiotic agents. For a predefined grouping variable (e.g. blood cultures taken vs. not taken) in the selected patient population RadaR automatically calculates the following: LOS distribution, animated LOS distribution over time, Kaplan-Meier estimates for hospital discharge, frequencies and ratios in antibiotic prescriptions, antibiotic consumption (in DDD) and mortality. Stratification can be done for (sub-)specialties, admission route, age, gender, admissions per quarter and antibiotic agent. Moreover, multiple logistic and Cox regression analysis in RadaR allows to investigate the grouping variable further. Finally, datasets of identified groups can easily be downloaded for further analysis. Conclusions: This tool enables intuitive, rapid and reproducible quality of care pattern analysis of infectious patients without prior software experience. Hence, it facilitates understanding and communication of important trends, performances and patient outcome. We have started using RadaR to investigate blood culture use at our institution. However, due to its open source nature this tool can be easily adapted to different objectives and settings

Technology to support integrated Antimicrobial Stewardship Programs:A user centered and stakeholder driven development approach

The rise of antimicrobial resistance (AMR) is a severe global health problem. Tackling this problem requires the prudent prescribing of antimicrobials. This is promoted through Antimicrobial Stewardship Programs (ASPs). In this position paper we describe i) how a socio-technical multidisciplinary approach (based on the CeHRes Roadmap) can be applied in the development and implementation of Antimicrobial Stewardship technologies and ii) how this approach can be of value to support Antimicrobial Stewardship in practice. The CeHRes Roadmap entails five different phases to explore and test how an eHealth technology can be tailored to the target group and successfully implemented in practice: i) contextual inquiry, ii) value specification, iii) design, iv) operationalization, v) evaluation. In this position paper we describe the lessons learned from research and practice to guide future developments of technology based ASP interventions. Since AMR is a huge wicked problem on a global level, it requires innovative methods and models to empower general public and professionals to be proactive rather than reactive in a digitalized world. We highlight how to combat the dangerous rise of antimicrobial resistance in the future