JMIR Human Factors最新文献

Background: Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs.

Objective: The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital.

Methods: Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study.

Results: According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement.

Conclusions: This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.

Background: When older adults (OAs) can no longer live independently at home, they have the option to choose from various types of geriatric care institutions, such as residential facilities or nursing homes. For several years now, thanks to the development of interactive television (iTV), social link functions have been accessible directly on televisions, tools that are already integrated into residents' rooms. The acceptance of technologies specifically targeting older users, as well as iTV, has been widely documented in the literature, incorporating factors from the innovation resistance model.

Objective: This research aims to enrich the acceptance of existing models of innovation by OAs living in different settings.

Methods: User tests were carried out to evaluate OAs' experiences with iTV and identify the factors involved in its acceptance. A total of 32 OAs living at home, in nursing homes, or in residential facilities in France were interviewed between November 2022 and June 2023. iTV acceptance was examined using an interview grid based on the technology acceptance model and included the following factors: intention to use, perceived usefulness, perceived ease of use, user resistance, anxiety, facilitating conditions, and user characteristics.

Results: The deductive qualitative analysis based on the technology acceptance model helped to identify 33 concepts.

Conclusions: This study has contributed to the literature on the acceptance of iTV by OAs living at home and in geriatric institutions, particularly by enriching existing models and proposing new avenues for reflection.

Background: Chronic pain is one of the most common diseases in the world and requires a multidisciplinary treatment approach. Spinal cord stimulation is a possible treatment option, but these patients require close follow-up, which is not always feasible. Introduction: eHealth apps also offer the possibility of closer patient follow-up, although adherence tends to decrease over time, dropping to around 60%. To improve adherence to remote follow-up, we developed a remote follow-up system consisting of a mobile phone app for patients, a website for professionals and a remote support center.

Objective: To evaluate adherence to remote follow-up using a system with mobile phone app and a remote support center.

Methods: After review of the literature and approval by a multidisciplinary committee, a team of experts designed a follow-up system based on a mobile phone app, a website for professionals, and a remote support center. The system was developed with the collaboration of healthcare professionals and uses validated scales to capture patients' clinical data at each stage of treatment (pre-treatment phase, trial phase and implantation phase). Data was collected prospectively from January 2020 to August 2023, including total surveys sent and surveys answered, in addition to notifications sent.

Results: A total of 64 patients were included (40 female, 62.5%). At the end of the study, 19 patients were in the pre-treatment phase (29'7%), 8 had reached the trial phase (12.5%) and 37 reached the implantation phase (57.8%). The follow-up period was 15.30 ± 9.43 months (mean ± SD). A total of 1574 surveys were sent out, along with 488 SMS reminders and 53 reminder calls. The adherence rate decreased from 94.53% in the pre-treatment phase to 65.68% in the implantation phase, with an overall adherence rate for the app of 87.37%. ANOVA analysis showed that adherence was higher in the earlier phases of treatment (p < 0.001).

Conclusions: Our remote follow-up system, supported by a remote support center, improves adherence to follow-up, although adherence tends to decrease over time. Further studies are needed to investigate the correlation between adherence to the app and pain management.

Clinicaltrial:

Background: Morning emotions can significantly affect daily wellness. While many studies have analyzed daily survey responses to identify factors influencing morning emotions, these methods require additional time and effort from individuals for emotional monitoring.

Objective: This study aims to identify daily alarm usage patterns related to morning emotions.

Methods: We recruited 373 users of the Alarmy app (DelightRoom) in the United States and South Korea and surveyed their demographics and usual behaviors related to morning emotions. Participants described their morning emotions over a 2-week period, during which we collected daily alarm app logs. We used a generalized estimating equation (GEE) method to identify factors affecting morning emotions.

Results: The findings indicate that varied alarm usage is related to morning emotions. Alarm set time was positively associated with feelings of peacefulness and refreshment in the morning, while task-based alarms were related to nervousness. The time taken to deactivate the alarm after it rang was negatively correlated with happiness. In addition, usual behaviors and demographic factors were found to be related to morning emotions, consistent with previous studies.

Conclusions: The study reveals that daily alarm usage is related to morning emotions, suggesting that daily alarm logs can supplement survey methods to facilitate daily emotion monitoring.

Background: Wearable devices (WDs) have evolved beyond simple fitness trackers to sophisticated health monitors capable of measuring vital signs, such as heart rate and blood oxygen levels. Their application in health care, particularly medication management, is an emerging field poised to significantly enhance patient adherence to treatment regimens. Despite their widespread use and increasing incorporation into clinical trials, a comprehensive review of WDs in terms of medication adherence has not been conducted.

Objective: This study aimed to conduct a comprehensive scoping review to evaluate the impact of WDs on medication adherence across a variety of diseases, summarizing key research findings, outcomes, and challenges encountered.

Methods: Adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, a structured search was conducted across MEDLINE, Web of Science, and Embase databases, covering the literature from January 1, 2010, to September 30, 2022. The search strategy was based on terms related to WDs and medication adherence, specifically focusing on empirical studies to ensure the inclusion of original research findings. Studies were selected based on their relevance to medication adherence, usage of WDs in detecting medication-taking actions, and their role in integrated medication management systems.

Results: We screened 657 articles and identified 18 articles. The identified studies demonstrated the diverse applications of WDs in enhancing medication adherence across diseases such as Parkinson disease, diabetes, and cardiovascular conditions. The geographical distribution and publication years of these studies indicate a growing interest in this research area. The studies were divided into three types: (1) studies reporting a correlation between data from WDs or their usage and medication adherence or drug usage as outcomes, (2) studies using WDs to detect the act of medication-taking itself, and (3) studies proposing an integrated medication management system that uses WDs in managing medication.

Conclusions: WDs are increasingly being recognized for their potential to enhance medication management and adherence. This review underscores the need for further empirical research to validate the effectiveness of WDs in real-life settings and explore their use in predicting adherence based on activity rhythms and activities. Despite technological advancements, challenges remain regarding the integration of WDs into routine clinical practice. Future research should focus on leveraging the comprehensive data provided by WDs to develop personalized medication management strategies that can improve patient outcomes.

Background: First Nations children and youth may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and the low rates of treatment for the conditions they experience. Evidence suggests a colonial history has resulted in poor experiences with the healthcare system, lack of trust with health providers and miscommunication between clinicians and patients. Contemporary ways using both Indigenous and Western knowledge is needed to bridge the gap in communicating pain.

Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youth and clinicians working with youth.

Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youth and clinicians perspectives on quality, intensity and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device.

Results: Three rounds of low-fidelity testing (n=19), two rounds of high-fidelity testing (n=20) and two rounds of clinical feasibility testing (n=10) were conducted with First Nations youth (10-19 years) to determine the relevance, validity and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youth had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youth and clinicians related to a visual in their preference for way to convey pain. Youth's preference was maintained in the app.

Conclusions: All youth in all rounds of testing indicated they would use the Kids Hurt App if it was available to them in a health care setting with most clinicians noting the app would be useful in practice.

Clinicaltrial:

Background: A 2017 survey of patient perspectives showed overall willingness and comfort to use telemedicine, but low actual use. Given recent growth and widespread exposure of patients to telemedicine, patient preferences are likely to have changed.

Objective: This study aimed to (1) identify demographic trends in patient preferences and experiences; (2) measure ease of use and satisfaction of telemedicine; and (3) measure changes in telemedicine use, willingness, and comfort since 2017.

Methods: We replicated a 2017 study with a nationwide survey of US adults. The survey, an extended version of the previous study, measured patient health care access as well as knowledge, experiences, and preferences regarding telemedicine encounters. We recruited participants using SurveyMonkey Audience in July 2022. We used descriptive statistics and generalized estimating equations to measure change and identify trends.

Results: We accrued 4577 complete responses. Patient experience with telemedicine was substantially higher in 2022 than in 2017, with 61.1% (vs 5.3%) of participants aware that their primary care provider offered telemedicine and 34.5% (vs 3.5%) reporting use of telemedicine with their primary care provider. This study also reported ease of use and satisfaction rates to be similar to in-person visits, while overall willingness and comfort in using telemedicine increased from 2017. Individuals at the poverty line were significantly less likely to report satisfaction with telemedicine visits. We found increased interpersonal distance in a patient and health care professional relationship significantly reduced patient ease of use, willingness, and comfort in using telemedicine.

Conclusions: This study identified an association between income and patient satisfaction, conveying the importance of understanding telemedicine in relation to health care access and equity. Telemedicine ease of use and satisfaction were comparable to in-person visits. Individuals reported greater use and higher positive perceptions of telemedicine willingness and comfort since 2017.

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.