JMIR Human Factors最新文献

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.

Background: Telemedicine has rapidly expanded worldwide due to its convenience and accessibility. In China, an increasing number of hospitals have begun offering telemedicine services; however, patient utilization remains relatively low. Limited research has examined patients' behaviors during the process of adopting telemedicine services.

Objective: This study aimed to identify barriers to and enablers for patients using telemedicine services and to formulate implementation strategies.

Methods: We conducted semistructured qualitative interviews based on the Theoretical Domains Framework (TDF) to identify barriers and enablers to telemedicine utilization. Twenty-one patients who had used Peking University Third Hospital's telemedicine services were included in the interviews. Data were analyzed using NVivo 12.0 with deductive thematic analysis guided by the TDF. Moreover, a group of experts was assembled to devise potential intervention strategies.

Results: A total of 28 themes were identified, including 14 barriers and 14 enablers across 5 of the 14 TDF domains. The most frequently reported barriers were operational challenges, prolonged waiting periods from asynchronous communication, and doubts about therapeutic efficacy, whereas the most frequently mentioned enablers were the convenience of telemedicine, time conservation, and support from hospitals. On the basis of these factors, we devised 6 intervention strategies.

Conclusions: This study demonstrated that patients' utilization of telemedicine services was affected by several barriers and enablers, including system architecture and design, patient interactions using telemedicine, and external assistance. To enhance the utilization, these factors must be meticulously considered. This study also suggests strategies to enhance the utilization of telemedicine.

Unlabelled: Symptom checkers are apps and websites that assist medical laypeople in diagnosing their symptoms and determining which course of action to take. When evaluating these tools, previous studies primarily used an approach introduced a decade ago that lacked any type of quality control. Numerous studies have criticized this approach, and several empirical studies have sought to improve specific aspects of evaluations. However, even after a decade, a high-quality methodological framework for standardizing the evaluation of symptom checkers is still lacking. This paper synthesizes empirical studies to outline the Symptom Checker Accuracy Reporting Framework (SCARF) and a corresponding checklist for standardizing evaluations based on representative case selection, an externally and internally valid evaluation design, and metrics that increase cross-study comparability. This approach is supported by several open access resources to facilitate implementation. Ultimately, it should enhance the quality and comparability of future evaluations of online and artificial intelligence (AI)-based symptom checkers, diagnostic decision support systems, and large language models to enable meta-analyses and help stakeholders make more informed decisions.

Background: The German electronic health record (EHR) aims to enhance patient care and reduce costs, but users often worry about data privacy and security. To mitigate disease-related privacy concerns, for instance, surrounding stigmatized diseases, we test the effect of privacy fact sheets (PFSs)-a concise but comprehensive transparency feature designed to increase users' perceived control over their data-on increasing EHR use in a simulated online study.

Objective: The study aimed to investigate whether displaying a PFS shortly before upload decisions must be made mitigates disease-related privacy concerns and makes uploads more likely.

Methods: In an online survey study, 393 German participants from the recruitment platform Prolific were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and time course (TC; acute vs chronic). They were then asked to decide whether to upload the report to an EHR click dummy, while we systematically varied the presentation of privacy information (PFS vs no PFS). Participants were randomly (single-blinded) assigned to one of the 2×2×2 conditions (stigma, TC, privacy information).

Results: All 393 participants were randomly assigned to one of the following groups: low, acute, no PFS (n=52, 13.2%); low, chronic, no PFS (n=45, 11.5%); high, acute, no PFS (n=46, 11.7%); high, chronic, no PFS (n=55, 14%); low, acute, PFS (n=44, 11.2%); low, chronic, PFS (n=41, 10.4%); high, acute, PFS (n=56, 14.2%); and high, chronic, PFS (n=54, 13.7%). The results show that, in general, upload behavior is negatively influenced by disease-related stigma (odds ratio [OR] 0.130; P<.001) and positively influenced when a PFS is given (OR 4.527; P<.001). This increase was particularly pronounced for stigmatized diseases (OR 5.952; P=.006), but independent of the TC of the diseases.

Conclusions: Our results demonstrate that PFSs may help to increase EHR uploads in people interacting with a realistic EHR click dummy, by mitigating privacy concerns in scenarios involving stigmatized diseases. Results further indicate that a PFS is mainly relevant and effective for people with increased privacy risk perceptions, whereas they neither benefit nor hurt others. Thus, implementing PFSs may increase the likelihood that users who perceive high privacy risks when confronted with sensitive or stigmatized health information decide to upload their data to the EHR, ultimately increasing digital health equity.