JMIR Human Factors最新文献

Background: Clinical trials of psychological therapies such as cognitive behavioral therapy typically show sustained posttreatment effects. However, less is known about individuals' outcomes following treatment in routine practice, and additionally, patient representatives have highlighted a need for better postdischarge support.

Objective: The "Paddle" app aims to address these issues. Paddle allows patients to store their therapy materials, reflect on sessions, and monitor their well-being during and after treatment, completing outcome questionnaires and monthly reviews.

Methods: Study 1 evaluated patients' use of Paddle during treatment in routine practice. Patient and therapist surveys explored feasibility, acceptability, and helpfulness. Study 2 examined the feasibility of using the app post discharge, inviting users to submit monthly questionnaires for 6 months, and seeking feedback via survey.

Results: Our findings indicate that Paddle was feasible to implement with few technical problems. Although not all patients wanted to use an app in Study 1, uptake was 66% (111/168) and users found it acceptable and helpful for organizing and remembering therapy information. Most reported using the app on a weekly or fortnightly basis. In Study 2, a total of 321 patients downloaded and used the app at least once, of whom 49% (156/321) submitted follow-up data. Of those who reliably improved during treatment, 73% (86/118) remained so throughout the 6-month follow-up period. Among all users, 20% (31/156) showed further reliable improvement at least once compared to their end-of-treatment score. We introduce the concept of "reliable relapse," which occurred for 36% (32/89) of users who had reliably recovered during treatment, highlighting that some experience fluctuations or deterioration. Feedback highlighted Paddle's value in helping people self-monitor and prioritize their well-being after treatment, with 81% (50/62) suggesting a postdischarge follow-up period longer than 6 months would be helpful.

Conclusions: These preliminary findings suggest that Paddle shows promise in supporting patients to collate therapy resources and monitor their well-being during and after treatment. It may help to improve rates of follow-up data collection, which warrants further investigation.

Background: Digital health tools are increasingly prevalent in postoperative care management, yet limited research exists on digital health literacy and tool adoption among safety-net hospital populations. Understanding these factors is crucial for developing effective digital health solutions for historically underserved communities.

Objective: This study aimed to evaluate digital health literacy, assess technology adoption readiness, and examine the relationship between patient-reported capabilities and demographic factors in a postoperative care context at a safety-net hospital.

Methods: We conducted a mixed methods study with 71 postoperative patients and 29 health care providers at a safety-net hospital. Participants completed a modified eHealth Literacy Scale (eHEALS) assessment and a demographic questionnaire, followed by usability testing of PocketDoc, a digital health prototype. The modified 7-item eHEALS demonstrated adequate internal consistency (Cronbach α=0.77). Qualitative data from think-aloud protocols during usability testing were collected for future analysis. This study focused on quantitative assessments of digital health literacy (using the modified eHEALS on a 5-point Likert scale) and technology adoption readiness (via usability metrics on a 10-point Likert scale) analyzed using nonparametric statistical tests. Correlations between demographic factors and digital health literacy were examined using Spearman rank-order correlation.

Results: Despite common assumptions about technology barriers in safety-net populations, 69% (49/71) of patients reported high confidence (score of ≥3 on a 5-point scale) in finding health resources online, and 61% (43/71) expressed confidence in using the internet for health-related questions. However, only 49% (35/71) felt confident in using digital resources for health decision-making. Digital health literacy scores did not correlate with age or educational level, although 79% (56/71) of patients reported ≥10 years of digital device experience. Both patients and health care providers rated PocketDoc highly for ease of use (median 10, IQR 8-10) and task intuitiveness (median 10, IQR 8-10). Patients' confidence in finding and using health resources online positively correlated with interface satisfaction (ρ=0.262-0.304 and ρ=0.010-0.027, respectively).

Conclusions: Our exploratory findings from 100 participants suggest that digital health tools may be more feasible in safety-net settings than previously considered, although the sample size and single-site design limit generalizability. However, the gap between patients' ability to find health resources (49/71, 69% confident) and their confidence in using these resources for health decision-making (35/71, 49% confident) highlights the need for targeted support in translating digital capabilities to health management skills.

Background: Heart failure (HF) is a prevalent condition among older adults in Canada, often leading to reduced quality of life and frequent hospitalizations. HF disease management interventions, particularly those delivered through telehealth, aim to improve care by fostering self-care and reducing readmissions. However, disparities in access to and use of HF telehealth services persist among vulnerable populations.

Objective: This study aimed to present the findings of a scoping review and a rapid realist synthesis of HF telehealth interventions for vulnerable groups of patients with HF. This review is underpinned by the metatheory of critical realism and intersectionality theory.

Methods: A rapid realist synthesis of the retrieved literature was undertaken to explore the underlying mechanisms and contexts that make HF telehealth interventions work or not work for marginalized groups of patients with HF.

Results: The realist review findings indicated that vulnerable patients require simple interventions. The findings also suggested that for effective use of telehealth and remote monitoring services, these patients require simplified training that could increase their confidence. The review findings further demonstrated that involving patients' family members in the delivery of telehealth interventions ensures success.

Conclusions: Future research with vulnerable populations should be underpinned by the critical realism and intersectionality theory and should apply the principles of intersectionality at all stages of the research process, including evaluation and analysis. This review also urges HF practitioners to apply the principles of intersectionality and health equity in clinical practice, such that interventions are simple and personalized, involve family members, include an in-person component, provide training for patients and health professionals, and integrate telemonitoring data.