JMIR Human Factors最新文献

Background: Refugees and asylum-seekers commonly experience numerous adverse and traumatic events and are therefore at increased risk of mental health problems. Despite the high need for mental health interventions, services tend to be underused by refugees and asylum-seekers, and various barriers compromise access. Digital, efficient screening, adapted for these groups, could facilitate initial assessment and increase accessibility to mental health services. We developed an internet-based tiered screening procedure (i-TAP) aiming to identify clinically relevant symptoms of major depressive disorder (MDD), anxiety disorder, posttraumatic stress disorder, and insomnia disorder among individuals with a refugee background. The i-TAP is an adaptive procedure with 3 tiers aiming to identify general mental distress in Tier 1, differentiate between symptoms in Tier 2, and assess the severity of symptoms in Tier 3. Each tier additionally functions as a gateway to further assessment, as a negative outcome terminates the procedure.

Objective: The purpose of this study was to evaluate the diagnostic test accuracy of the i-TAP, using structured clinical assessments as the reference standard.

Methods: In this prospective study, 70 adult participants with a refugee background, literate in Arabic, Dari, Farsi, or Swedish, and residing in Sweden, completed the i-TAP on tablets and participated in a subsequent structured diagnostic interview.

Results: It has been shown that the i-TAP could identify 91.7% (33/36) of individuals assessed with any psychiatric disorder, and correctly identified 82.1% of all positive cases of MDD, anxiety disorder, posttraumatic stress disorder, and insomnia disorder, with few false negative assessments. Overall test accuracy of the i-TAP ranged between 77.1% and 84.3%, depending on disorder. The tiered design could reduce item burden while maintaining accuracy. A vast majority of participants rated the user experience as positive. In this sample, 36/70 (51.4%) individuals were assessed with one or more psychiatric disorders and comorbidity was high.

Conclusions: The i-TAP may be a valid, efficient, and feasible screening tool for the identification of common psychiatric disorders among individuals with a refugee background in Sweden. The i-TAP could be implemented as a first screener in various settings, including online and in-person clinical practices. The digital, adaptive, multilingual format could facilitate early assessment and increase the availability of mental health services for refugees and asylum-seekers.

Background: Despite growing evidence demonstrating the connection between oral and systemic health, medical and dental care remain institutionally divided. A significant consequence of this division is the lack of information sharing, which is particularly problematic in dental care, where knowing patients' medical information is crucial for providing safe and effective treatments. This separation poses additional challenges in Swedish regions with limited resources, such as Dalarna, where dental care practices would benefit from improved access to relevant medical information in their electronic dental record (EDR) systems.

Objective: This study aimed to explore how current documentation workflows and EDR systems support the medical information needs within dental care practices in Dalarna and consider what influence direct access to medical information could have.

Methods: The study adopted an exploratory-descriptive qualitative approach. Semi-structured interviews were conducted with dental practitioners working in general dental practices. Data collection followed a sociotechnical framework, and thematic analysis was performed to identify key medical information needs, as well as current workflow and system limitations. Conceptual models were developed to reflect these findings.

Results: Eighteen dental practitioners were interviewed. The identified medical information needs included specific types of medical conditions, pharmacological information, treatment history, and laboratory values. Furthermore, dental practitioners highlighted substantial challenges in existing documentation workflows and the EDR system. Proposed conceptual models demonstrated how integrating EDR systems with the Swedish National Patient Overview ("Nationell Patientöversikt") via National Service Platform ("Nationell Tjänsteplattform") could streamline workflows and enhance information accessibility.

Conclusions: The findings show a clear need to improve medical information accessibility in dental care. A solution is to facilitate interoperability and align digital infrastructure with the identified needs. The proposed recommendations offer a feasible starting point for improving medical information access in Swedish dental care, particularly in resource-constrained regions like Dalarna.

Background: The 5-Star Quality Rating System for nursing homes plays a central role in evaluating quality of care, although it has both strengths and limitations. This system relies heavily on the Minimum Data Set and derives several quality measures (QMs) from it. In this study, we validated the effectiveness of the 5-Star Quality Rating System for nursing homes and its underlying QMs in estimating quality of care. We constructed a panel dataset of US nursing homes (n=15,416) active from May 2020 to June 2023, retrieving data from three major sources: (1) COVID-19 nursing home data, (2) Payroll-Based Journal data, and (3) nursing home QM snapshots. The outcome variables included (1) resident infection, (2) staff infection, or (3) resident and staff deaths. The predictor variables were the 5-Star Quality Rating System for nursing homes and its underlying QMs classified as structure, process, or outcome (SPO) QMs.

Objective: This study aims to evaluate the effectiveness of nursing home QMs by regressing nursing home COVID-19 outcomes on nursing home QMs, classified using the Donabedian SPO framework. We hypothesized that nursing homes with better structural quality (eg, greater staff availability, better skill mix, and so on), better process quality (eg, lower restraint use and higher vaccination rates), and better outcome quality (eg, lower number of residents with pressure ulcers and a lower number of resident falls) experienced better COVID-19 performance in terms of resident and staff infections and deaths.

Methods: To examine the association between the COVID-19 outcomes and SPO QMs, we imputed missing values in the dataset using random forest. Subsequently, we modeled the imputed dataset using hurdled zero-inflated negative binomial mixed effects models. The zero inflation model included factors influencing initial susceptibility to COVID-19 or factors influencing the possibility of death after COVID-19 had been contracted. The model estimates were conditioned on zero inflation and random effects.

Results: Staffing measures (P<.001 for all variables in all models), health deficiency scores (P<.001 for all variables in at least 1 model), COVID-19 hospitalization rates (P<.001 for all variables in at least 2 models), and vaccinations (P<.001 for all variables in at least 2 models) exhibited meaningful relationships with the COVID-19 outcomes, while the 5-star components, Medicaid dependency, and ownership showed no clear relationships.

Conclusions: Although widely used, the 5-Star Quality Rating System for nursing homes is an unreliable performance measure. Concerted efforts from lawmakers, policy makers, and lobbyists are needed to refine and enhance the measure, thereby ensuring its reliability and effectiveness.

Background: To better understand the effects of media use on children, it is essential to examine the various factors influencing the media use of digital native children. In the situational context, parental media usage, parents' attitudes toward media, and parenting styles have all been identified as significant factors influencing children's media use. This study focuses on the key factors and examines these relationships in greater depth, drawing on existing research to understand their impact on the media usage patterns of digital native children.

Objective: This study examines parental influences related to young children's media use in Korea over a 3-year period (2022-2024) using independent, nationally representative cohorts.

Methods: Using multigroup structural equation modeling, we analyzed data from 3 independent parent-reported cohorts (for 2022, n=1058; for 2023, n=1020; for 2024, n=1020) to investigate how parental media habits, attitudes, and distinct parenting styles predict children's daytime and nighttime media consumption.

Results: The online survey results revealed that parental media time, particularly for mothers, consistently correlated with higher levels of children's daytime media use (β=.002-.003). Positive parental attitudes toward media increased children's daytime media use (β=.028-.102), whereas negative attitudes had a limited effect (β=-.069-.140). Among the 7 parenting styles, positive parenting consistently reduced children's daytime media use in 2022 and 2023 (β=-.228 for 2022, β=-.215 for 2023), but harsh punishment emerged as the strongest factor in daytime media use in 2024 (β=-.078 for 2022, β=-.090 for 2023, and β=-.072 for 2024). Notably, parenting styles showed no significant effect on children's nighttime media use throughout the study, suggesting that parental influence may be more effective during daytime hours.

Conclusions: This analysis extends existing research by differentiating media use patterns across time periods and highlights the evolving influence of parenting styles. These findings have implications for the development of targeted parental guidelines for managing young children's media exposure, especially as digital media continues to become a pervasive part of daily life.

Background: In recent years, the global prevalence of myopia among children has continued to rise. The preschool years represent a critical period for visual development, and the widespread adoption of electronic screens among young children has brought increasing attention to pediatric visual health. However, the association between visual environmental exposures related to screen use-such as screen brightness and ambient illuminance-and the risk of myopia in preschool children has not been thoroughly investigated.

Objective: This monitoring study aimed to investigate the association between electronic screen brightness, ambient illuminance, and axial length in preschool children to provide evidence-based support for developing screen brightness usage recommendations for this population.

Methods: This cross-sectional monitoring study was conducted between March and July 2023 in Shanghai, China, involving 2 representative samples of kindergarten children aged 3 to 6 years. Each participant was provided with a tablet preinstalled with intelligent monitoring software, which continuously and objectively recorded real-time data on screen time and screen brightness over a consecutive 7-day period. In addition, comprehensive data collection encompassed standardized ophthalmic assessments, high-precision ambient illuminance measurements, simulated laboratory lighting evaluations, and parental questionnaires. Associations between ambient illuminance, screen brightness, and axial length were analyzed using multivariable linear regression and restricted cubic spline models.

Results: Of the 199 children included in the total sample, 124 (62.3%) were boys, and 75 (37.7%) were girls. After adjustment for demographic characteristics, parental myopia, and screen use behaviors, the median ambient illuminance during tablet use was significantly inversely associated with axial length (β=-0.13, 95% CI -0.22 to -0.04; P=.006). A nonlinear dose-response relationship was identified between median screen brightness and axial length (Pnonlinearity=.004), with axial elongation accelerating beyond approximately 27 cd/m² and peaking around 56 cd/m². Boys (P<.001) and greater height (P=.33) were also significantly associated with longer axial length.

Conclusions: Higher ambient illuminance during tablet use is associated with shorter axial length in preschoolers, whereas screen brightness exhibits a nonlinear effect on axial elongation. This study highlights the importance of optimizing both environmental lighting and device settings to protect visual health in young children, providing empirical support for guidelines on safe digital device use and ambient lighting conditions in early childhood.

Background: Emergency departments are often chaotic environments where delays can significantly impact patient care. Key items are stored in supply carts in or near patient rooms to promote efficiency and enable nurses to spend more time assisting patients. However, disorganization, lack of standardization, and lack of stocking can cause significant delays and negatively impact the quality of care.

Objective: This study utilized human-centered and participatory design to improve the workflow for supply acquisition in an emergency department.

Methods: Using a mixed methods, participatory design approach following the double diamond framework, the team worked with nursing staff and physicians in an urban emergency department to understand the root causes of frustrations with the current supply carts. Qualitative findings about bedside nursing workflows were integrated with quantitative observations of inventory and supply usage to drive a rapid-cycle prototyping process to optimize supply management in the bedside cart.

Results: A lack of clinical staffing exacerbates preexisting challenges with restocking the medical supplies in the bedside carts. This problem is compounded by the misallocation of supplies, with high-frequency items underrepresented and low-frequency items overrepresented in the bedside carts. This leads to wastage of the seldom-used supplies and a lack of access to the most used supplies. The reorganization of the cart through co-design with nursing staff sped up supply acquisition by approximately 20% overall, tripled the availability of the most important supplies, and reduced the need for restocking from once per shift to once per 3 shifts, thus producing tangible improvements even within institutional limitations.

Conclusions: A participatory design process, using human factors principles in tandem with extensive input from end users, enables improvements to stocking. Implications for practice include (1) lack of easy access to appropriate supplies negatively impacts patient care and contributes to nurse burnout and frustration, (2) human factors engineering can improve access to patient care supplies through redesigning the layout of hospital supply carts to better align with workflows, and (3) co-design with frequent collaboration from stakeholders and end users ensures that solutions address the issues that matter most in a sustainable way.

Background: Mobile health (mHealth) apps have become more commonly used in orthopedics. However, for these apps to be efficient, patients should be willing to use them, making it essential to understand patients' perspectives of mHealth interventions.

Objective: The aim of this single-center, intent-to-treat, preoperative single-cohort study of 100 patients was to evaluate the acceptability of mymobility (Zimmer-Biomet), an mHealth app designed for the postoperative care of total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: We measured acceptability using the theoretical framework for acceptability (TFA) preoperatively and at 3 months post operation. We also measured satisfaction with app use postoperatively using the Usefulness, Satisfaction, and Ease of Use questionnaire as well as patient-reported outcome measures preoperatively and postoperatively using the Oxford hip and knee scores and the visual analog scale for pain. Patients included were 18 years or older; underwent unilateral primary total hip, total knee, or partial knee arthroplasty; spoke and read French or English; and had a smartphone with internet access. Participants used mymobility in addition to standard government-funded physiotherapy.

Results: The preoperative overall TFA result was 4.2 out of 5, but results decreased significantly postoperatively. There was higher self-efficacy in preoperative TFAs with higher education, and lower acceptability in postoperative TFAs with TKA. The Usefulness, Satisfaction, and Ease of Use questionnaire revealed a good level of satisfaction with the use of the app. Patient-reported outcome measures showed earlier improvement in THA (31.2 d) than in TKA (89.4 d), whereas the visual analog scale showed a rapid decrease in pain with both procedures. Only 1 patient expressed privacy concerns with the use of the app.

Conclusions: There was a good level of acceptability with the use of mymobility for the postoperative management of THA and TKA, although acceptability decreased postoperatively. This decrease could signify high expectations toward the app preoperatively or higher than expected difficulty and pain in the early postoperative period. Acceptability tended to increase with higher education and decrease with TKA. These trends are consistent with prior literature and constitute a potential gap to address for app developers. The influence of the natural recovery process on acceptability remains unclear. Future studies could explore this gap by comparing results in cohorts using the app to cohorts with standard care.

Background: Delivering therapy through video consultations can increase the reach and impact of mental health care services. However, adoption varies, and there is a lack of professional consensus about the usefulness of video consultations in therapy settings.

Objective: This study aimed to explore mental health professionals' experiences with and attitudes toward video consultations across different clinical environments in the private and public health care sectors in Norway to inform the design of future digitalized services.

Methods: In this qualitative study, we recruited leaders and clinicians from public hospitals and private clinics. We conducted semistructured interviews that mapped individual experiences and attitudes concerning video consultations, as well as contextual aspects concerning the participants' professional environments. We used reflexive thematic analysis with an inductive, essentialist, and experiential orientation to analyze the data.

Results: A total of 24 mental health professionals (16 from public hospitals and 8 from private clinics) participated. Variations in their attitudes did not follow patterns reflecting the type of service or sector they worked in. Rather, attitudes seemed related to higher-level assumptions rooted in professional culture, societal values, and previous experiences. We generated six themes capturing and structuring the professional perspectives: (1) meta-perspectives on the digitalization of therapeutic rooms, (2) the "how" of service integration, (3) challenging therapist culture, (4) negotiating the limits of the digital therapy room, (5) creating clinical value from the digital format, and (6) adapting techniques and technology in digital therapy sessions.

Conclusions: To strengthen the adoption and impact of video consultations, we should direct attention toward higher-level societal and cultural aspects that shape attitudes and practices. We suggest incorporating digitalized therapy in education, facilitating personal experiences with video consultations, increasing the sharing of knowledge between clinical environments, and sparking innovation of both service models and technology.

Background: Mobile health (mHealth) is increasingly used in teledentistry for telediagnosis and other services; yet, the perceptions of frontline clinicians and end-line users regarding these technologies remain unexplored.

Objective: This study examined the acceptability, feasibility, and usability of an mHealth model for telediagnosis from the perspectives of frontline clinicians and end-line users.

Methods: A qualitative study using focus group interviews was conducted with 15 participants, including frontline clinicians and end-line users. Frontline clinicians captured dental images via a smartphone app, while end-line users assessed them through an mHealth platform. Interview transcriptions were thematically analyzed using consensus coding.

Results: Thematic analysis identified 9 key themes: feasibility and perceived ease of use, perceived usefulness, compatibility, self-image and social influences, self-efficacy, voluntariness and behavior intention, anxiety, facilitating conditions, and attitudes toward a behavior. Participants considered smartphone-based photography acceptable and feasible for remote dental assessment. Facilitators and barriers to implementing the mHealth model were highlighted, and recommendations for improvements were proposed.

Conclusions: Cyclical education and professional development are essential to enhancing user confidence and technology usability. Addressing patient and clinician resistance through targeted education, improved communication, and operational upgrades such as camera grids, system integration, and simplified login can support adoption. This study highlights mHealth's potential in emergency dental assessment and screening, particularly for underserved populations, and underscores opportunities for interprofessional collaboration. Future research should explore broader clinical applications across oral health conditions.

Background: Digital mental health tools, such as SMS text messaging and online resources, are increasingly used to support well-being. However, user satisfaction across these formats remains insufficiently explored.

Objective: The study assessed participants' engagement, perceived impact, and overall satisfaction with the Text4Support program and the e-mental health resources.

Methods: This randomized controlled study was conducted in Nova Scotia, Canada. Participants were assigned to either the Text4Support group, which received daily supportive text messages, or the control group, which received a single text message with a link to the Nova Scotia Mental Health and Addiction Program e-mental health resources. Responses to various aspects of the interventions were evaluated using a 5-point Likert scale, while overall satisfaction was measured on a scale from 0 to 10. The chi-square test and Fisher exact test were employed for data analysis.

Results: A total of 69 participants in the control group and 130 in the Text4Support group completed the satisfaction survey. The overall mean (SD) satisfaction score in the control group was 5.1 (2.3), and the overall mean (SD) satisfaction score for the Text4Support group was 7.1 (2.2). Compared to the control group, participants in the Text4Support group reported greater engagement and positive program impact. While 53.8% (70/130) of Text4Support recipients always read the messages, only 39.1% (27/69) of the control group rarely accessed the eHealth resources. When compared to the control group, participants allocated to the Text4Support group were reported to sometimes take positive action upon reading the messages (42.3% vs 33.3%). A significantly higher proportion of Text4Support users strongly agreed or agreed that the messages were supportive (81.4% vs 41.5%), positive (88.4% vs 49.2%), and helpful in coping with stress (44.2% vs 11.9%), loneliness (40.3% vs 13.4%), and improving mental well-being (51.2% vs 17.9%). In contrast, the majority of responses from the control group were largely neutral.

Conclusions: Results showed that Text4Support group participants were significantly more satisfied with the program than those receiving standard eHealth resources. This highlights that daily supportive SMS text messaging is an effective, low-cost adjunct to care delivery and mental health improvement. These findings suggest that aggregate, brief, and low-cost text-based interventions have great potential for increasing health access and engagement, particularly among traditionally disadvantaged populations with limited access to traditional services.