Long-term Randomized Controlled Trial

Funding Information: The authors thank Sarah E Scott for her valuable contributions as the trial manager and in the user experience evaluation, and Susana Cunha for her contribution in conducting and reporting the focus groups. This project has received funding from the European Union?s Horizon 2020 research and innovation program under grant agreement number 643309. The material presented and views expressed here are the responsibility of the authors only. The European Union Commission does not take responsibility for any use made of the information set out.Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)—a DBCI that targets weight loss maintenance—over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content.publishersversionpublishe

Persuasive systems design:key issues, process model and system features 1

Abstract A growing number of information technology systems and services are being developed to change users’ attitudes or behavior or both. Despite the fact that attitudinal theories from social psychology have been quite extensively applied to the study of user intentions and behavior, these theories have been developed for predicting user acceptance of information technology rather than for providing systematic analysis and design methods for developing persuasive software solutions. This chapter is conceptual and theory-creating by its nature, suggesting a framework for Persuasive Systems Design (PSD). It discusses the process of designing and evaluating persuasive systems and describes what kind of content and software functionality may be found in the final product. It also highlights seven underlying postulates behind persuasive systems and ways to analyze the persuasion context (the intent, the event and the strategy). The chapter further lists 28 design principles for persuasive system content and functionality, describing example software requirements and implementations. Some of the design principles are novel. Moreover, a new categorization of these principles is proposed, consisting of the primary task, dialogue, system credibility and social support categories

Utilizing GQM+strategies for an organization-wide earned value analysis

In this paper, we offer an approach for performing an organization-wide earned value analysis by taking advantage of the hierarchical structure of the GQM+Strategies grid. The merger enables us to create an integrated hierarchy of business goals, value goals, and strategies for achieving those goals and to monitor and evaluate those goals at all levels. It provides a means to expand the definition of earned value metrics to cover both the costs and benefits of achieving those goals through those strategies and provides measurement support for all concepts

Healthcare professionals’ proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey:a qualitative interview study

Abstract Aims and objectives: This study examined the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty. The aim of this study is to understand healthcare professionals’ proposed eHealth needs in elective primary fast‐track hip and knee arthroplasty journey. Background: There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. Design: This was a qualitative interview study. Methods: Semi‐structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses, and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. Results: Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, post‐discharge care, patient counselling, communication, transparency of the journey, and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. Conclusions: From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast‐track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. Relevance to clinical practice: More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes, and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education

Healthcare professionals’ perceived problems in fast-track hip and knee arthroplasty:results of a qualitative interview study

Abstract Background: Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. Methods: Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. Results: Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. Conclusions: The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations

Patients’ satisfaction and experiences during elective primary fast‐track total hip and knee arthroplasty journey:a qualitative study

Abstract Aims and objectives: To explore how satisfied patients are with the process of treatment and care, and to identify the experiences that patients perceive during elective primary fast‐track total hip and knee arthroplasty journey. Background: Greater satisfaction with care has predicted better quality of recovery, and patient experience has been positively associated with patient safety and clinical effectiveness. However, little is still known about how patients experience their treatment and care. Design: A qualitative interview study. Methods: The study was conducted among 20 patients in a single joint replacement centre during 2018. Patient satisfaction was measured using a numerical rating scale. Patients’ experiences were identified through qualitative semi‐structured interviews which were analysed using an inductive content analysis method. The COREQ checklist was used (Supplementary File 1). Results: The mean numerical rating scale score for overall satisfaction was 9.0 (SD 1.1) on a scale from 0 to 10. The patients’ experiences were grouped under eight main categories that were derived from the qualitative data in the analysis: 1) patient selection, 2) meeting the Health Care Guarantee, 3) patient flow, 4) post‐discharge care, 5) patient counselling, 6) transparency of the journey, 7) communication and 8) feedback. Conclusions: The findings suggest that patients are highly satisfied after an elective primary fast‐track total hip and knee arthroplasty. However, closer analysis of the patients’ experiences reveals challenges and suggestions on how they could be solved, often involving digital technologies. Relevance to clinical practice: As the number of total joint arthroplasties grows, patients and their families need to take ever greater responsibility, for their own care from advance preparation to rehabilitation. The findings of the study can be used to organise work, improving patient‐clinical communication, fostering engagement, and improving patient centredness. In addition, the results pinpoint the issues on how the patient experience could be improved

Feasibility of digital footprint data for health analytics and services:an explorative case study

Abstract Background: As a result of digitalization, data is available about almost every aspect of our lives. Personal data collected by individuals themselves or stored by organizations interacting with people is known as a digital footprint. The purpose of this study was to identify prerequisites for collecting and using digital data that could be valuable for health data analytics and new health services. Methods: Researchers and their contacts involved in a nationwide research project focusing on digital health in Finland were asked to participate in a pilot study on collecting their own personal data from various organizations of their own choice, such as retail chains, banks, insurance companies, and healthcare providers. After the pilot, a qualitative inquiry was adopted to collect semi-structured interview data from twelve active participants in the pilot. Interviews comprised themes such as the experiences of collecting personal data, as well as the usefulness of the data in general and for the participants themselves. Interview data was then analyzed thematically. Results: Even if the participants had an academic background and were highly motivated to collect and use their data, they faced many challenges, such as quite long delays in the provision of the data, and the unresponsiveness of some organizations. Regarding the usefulness of the acquired personal data, our results show that participants had high expectations, but they were disappointed with the small amount of data and its irrelevant content. For the most part, the data was not in a format that would be useful for health data analytics and new health services. Participants also found that there were actual mistakes in their health data reports. Conclusions: The study revealed that collecting and using digital footprint data, even by knowledgeable individuals, is not an easy task. As the usefulness of the acquired personal health data mainly depended on its form and usability for services or solutions relevant to an individual, rather than on the data being valuable as such, more emphasis should be placed on providing the data in a reusable form

Aestimo: A Tangible Kit to Evaluate Older Adults’ User Experience

Part 1: Accessibility Design PrinciplesInternational audienceSurveys and questionnaires are commonly used to capture people’s experiences with technology. However, some older users experience issues when reading and filling out forms, and inexperienced computer users may not be comfortable with web-based versions. To improve the report of user experience, we designed and implemented Aestimo, a tangible interface based on a shortened version of the AttrakDiff questionnaire. The interface was evaluated during a study with 20 older adults (age avg. = 65.6). Although completing the Aestimo questionnaire took longer than a paper-and-pen version of AttrakDiff, 60% of participants preferred Aestimo over AttrakDiff. Aestimo was found to be innovative and inviting, and to stimulate the senses and the mind. Participants liked feeling guided by the interface, and also found their experience to be playful and fun. Overall, the evaluation of Aestimo was highly positive and suggests that some user groups may benefit from the availability of innovative evaluation experiences