JMIR Human Factors最新文献

Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure.

Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework.

Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed.

Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app's adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app's impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills.

Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app's effectiveness in real-world settings and refine it continuously based on user input.

Background: Image-driven specialisms such as radiology and pathology are at the forefront of medical artificial intelligence (AI) innovation. Many believe that AI will lead to significant shifts in professional roles, so it is vital to investigate how professionals view the pending changes that AI innovation will initiate and incorporate their views in ongoing AI developments.

Objective: Our study aimed to gain insights into the perspectives and wishes of radiologists and pathologists regarding the promise of AI.

Methods: We have conducted the first qualitative interview study investigating the perspectives of both radiologists and pathologists regarding the integration of AI in their fields. The study design is in accordance with the consolidated criteria for reporting qualitative research (COREQ).

Results: In total, 21 participants were interviewed for this study (7 pathologists, 10 radiologists, and 4 computer scientists). The interviews revealed a diverse range of perspectives on the impact of AI. Respondents discussed various task-specific benefits of AI; yet, both pathologists and radiologists agreed that AI had yet to live up to its hype. Overall, our study shows that AI could facilitate welcome changes in the workflows of image-driven professionals and eventually lead to better quality of care. At the same time, these professionals also admitted that many hopes and expectations for AI were unlikely to become a reality in the next decade.

Conclusions: This study points to the importance of maintaining a "healthy skepticism" on the promise of AI in imaging specialisms and argues for more structural and inclusive discussions about whether AI is the right technology to solve current problems encountered in daily clinical practice.

Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the "Telehealth Usability Questionnaire" (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility.

Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients-"Telehealth Usability and Perceived Usefulness Short Questionnaire for patients" (TUUSQ).

Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted.

Results: The analysis revealed that a parsimonious factor structure with 2 factors ("perceived usefulness in health care" and "usability") is sufficient to describe the patient's perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness.

Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors "perceived usefulness in health care" and "usability" in patients.

Trial registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546.

Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action.

Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands?

Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization.

Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the "unorganized stage" of patients' searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients' decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient's next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data.

Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients' anxiety, was too risk-averse, or made patients more insistent on their own opinions.

Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings.

Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist.

Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began.

Results: There was a decrease (59%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size (τ-U=-0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants.

Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step.

Background: Future Health Today (FHT) is a technology program that integrates with general practice clinical software to provide point of care (PoC) clinical decision support and a quality improvement dashboard. This qualitative study looks at the use of FHT in the context of cardiovascular disease risk in chronic kidney disease (CKD).

Objective: This study aims to explore factors influencing clinical implementation of the FHT module focusing on cardiovascular risk in CKD, from the perspectives of participating general practitioner staff.

Methods: Practices in Victoria were recruited to participate in a pragmatic cluster randomized controlled trial using FHT, of which 19 practices were randomly assigned to use FHT's cardiovascular risk in CKD program. A total of 13 semistructured interviews were undertaken with a nominated general practitioner (n=7) or practice nurse (n=6) from 10 participating practices. Interview questions focused on the clinical usefulness of the tool and its place in clinical workflows. Qualitative data were coded by 2 researchers and analyzed using framework analysis and Clinical Performance Feedback Intervention Theory.

Results: All 13 interviewees had used the FHT PoC tool, and feedback was largely positive. Overall, clinicians described engaging with the tool as a "prompt" or "reminder" system. Themes reflected that the tool's goals and clinical content were aligned with clinician's existing priorities and knowledge, and the tool's design facilitated easy integration into existing workflows. The main barrier to implementation identified by 2 clinicians was notification fatigue. A total of 7 interviewees had used the FHT dashboard tool. The main barriers to use were its limited integration into clinical workflows, such that some participants did not know of its existence; clinicians' competing clinical priorities; and limited time to learn and use the tool.

Conclusions: This study identified many facilitators for the successful use of the FHT PoC program, in the context of cardiovascular risk in CKD, and barriers to the use of the dashboard program. This work will be used to inform the wider implementation of FHT, as well as the development of future modules of FHT for other risk or disease states.